PSYCHOTHERAPY SEVEN DEADLY SINS! (1)
We know enough about what makes psychotherapists tick. But what about what makes them suck?
Disclaimer: Okay, it's not really seven. More like twelve, but the number seven has an eternal mystic about it, steeped in religious myths and, thus, having more metaphysical flavour. So, consider the title a mere literary device.
NB: I'd be using the following terms interchangeably to refer to the same concept: psychological awareness, psychological mindedness, psychological astuteness, and psychological attunement (the last is my favorite).
Source: 7bozeman.com
I was recently triggered into again reflecting about the very often dangerous cost of being psychologically naive (in other words, of being a child - which should not be confused with being childlike) when and where one is expected to be aware (in other words, of being an adult). That wouldn't be the first time I would be indulging in such reflection as I've indeed found myself many times in the past reflecting on this same function of the mind. Over the years, I've become so attuned to noticing this deficit of the psychological mind in others, although I can't confidently make the same claim with respect to myself - it's easier to detect in others than in oneself.
Psychological naivety is a very intriguing and infinitely explorable phenomenon which manifests itself in so many facets of intrapersonal, interpersonal, and group encounters. However, my most recent reflection on this phenomenon was the first time I would explicitly be contemplating it strictly in relation to psychotherapy, specifically with respect to a colleague who I've come to know, professionally, very well in a short time. I admire and respect this colleague for a number of reasons, not to mention that we share some basic cognitive styles in common; that is, an analytical thinking style and the preference for listening over talking. But I have also been very struck by how this colleague can often be interpersonally unaware. I was the more puzzled because this was not a weakness I would naturally predict in someone who is high in analytical and attentional traits (but then again, she's more cavalier in attitude, lower in the trait conscientiousness, and, on the balance, a better and livelier talker). And in the short time that I have known this colleague, the price she has paid for this shortcoming in the professional space has indeed been costly and continues to throw up needless conundrums for her. I have witnessed occasions when she encountered overt resistance and pushbacks from previously compliant clients, with some going as far as verbalizing their discontent and resentment. In all the instances I have witnessed, I was not surprised by the actions of the specific clients involved (as I was familiar with the buildup that eventually culminated in each outburst); but this colleague is often at a loss as to the manifestation, the meaning, and the origin of these breakdowns in therapeutic relationship. Unfortunately, my personal relationship with her as well as her psychological posture towards me is not yet conducive enough for a direct feedback of my observations without the risk of introducing some elements of spite and tension into our budding personal relationship. But luckily for her, she has many other professional and personal virtues in sufficient amount as to minimize the frequency as well as attenuate the severity of the invalidating impact of these occasional therapeutic implosions on her sense of efficacy and esteem. They more than make up for this one lacking virtue.
In my admittedly very limited years of practice, I have experienced many unpleasant incidences such as clients wordlessly dropping out, stubbornly locking up, and permanently ghosting me; but I have never had a client lash out, directly accuse me of incompetence or of insensitivity or explicitly request to be transferred to someone else (even though these charges are sometimes probably implied in their stated reactions above). And I know any of these verbalized rupturing of therapeutic relationship may still happen in the future, but such things are far more likely to happen at the beginning of one's practice than in later stages.
One of the experiences I consider personally most exasperating as a psychotherapist is to have a client drop out or cease contact without notice or explanation. It utterly frustrates my professional curiosity and the irrepressible yearning to understand. However, more than half of the time, I'm able to retroactively justify or at least retrospectively make sense of this action on the client's part. But there are still few instances that completely catch me unprepared and leave me totally puzzled. And this is a state of affair I find extremely difficult to bear - to not know, and to have no clue as to any apparent reason a client decided to discontinue and cease communication. I know there are times when this decision by the client has nothing to do with me or the quality of the therapy experience (but that's besides the point). I always imagine that even if there's a zero percent chance that I contributed to or trigger the decision by something originating from me, I still consider it absolutely essential to know. This is because I believe very strongly that, for such a relational profession as psychotherapy, client-based feedback (rather than textbook and superior colleagues’ advice) is the best route to the most authentic and personally-relevant professional growth. Hence, I have come to price negative feedback more than the positive variety, because it is more revealing, more truthful, and more corrective. Yes, it is more inconvenient and emotionally triggering, but unlike positive feedback, it is less subject to the confounding desire to flatter or to suck up to the therapist. In other words, people rarely employs negative feedback as a means of deceiving the therapist even though they may use it to camouflage something about themselves. But I find that even after I learned to preface my sessions with a direct and explicit instruction to my clients to never shy away from speaking their mind to me, no matter how critical, most of them still never do so voluntarily except I directly probe them for it. (And this is not even as simple as it seems: to probe for something, one must first be aware that it is there.) On the other hand, they often have no difficulty voicing words of commendation. But I personally don't need clients to verbalize their thoughts before I deduce they have positive feelings about the session. I could say the same for negative feelings but because negative feedbacks demand a corrective rather a maintaining response, one needs to get at specifics rather than generalities, and this cannot be achieved through wordless inference. This feedback principle applies to all forms of human-to-human relationship and not just the psychotherapy type, and anyone who understands this adaptive lopsidedness in the expressibility of negative versus positive feedback would apply more energy in extracting the former.
Apropos psychological naivety, I began to think of this accursed deficit and others in terms of "seven deadly sin". With deeper reflection, I find myself regarding psychological naivety as the most consequential and most deadly of all the faults a psychotherapist may possess (this is of course subject to debate). And of all the contexts (of the positive kind) in which the salience of psychological awareness is amplified, psychotherapy is perhaps the most consequential simply because it is a quality that psychologists in general, and psychotherapists in particular, are expected to possess in large quantity. In fact, this covert expectation is the basis of the popular assumption that psychologist can and should be able to read minds. And of the context (of the negative type) of which the salience of psychological awareness is amplified, the world of politics, crime, and business may be the most consequential. To be psychologically unaware in any of these contexts can be irredeemably costly, often with very fine margins. In any of these domains of interaction, exquisite psychological attunement can thus mark the subtle marginal difference between 'the maverick' and 'the expert', between 'the revered' and 'the respected', and between “the beloved" and “the admired" professional.
At the most refined level, psychological attunement is being able to construct a theory of the metaframework of the intra and interpersonal assumptions that stipulate the relational stance of the person one is engaged with. It is constantly computing theories about the internal and the metacognitive universe of the other; their motives, their fears, their desires, their insecurities, their weaknesses, their strengths, their values, their vices, their tendencies, their attractions, etc. At the simplest level, it is just about a robust theory of mind (but even this is difficult enough for most people). But at the most advanced level, it is a theory of the theory of mind. It has to incorporate not just what is revealed overtly, but what isn't revealed at all or only revealed indirectly or even what is actively disguised. It is the most sophisticated level at which a human mind can operate in the interpersonal/social realm, and it entails the deployment of both logical, intuitive, and empirical information processing skills in their finest forms.
Psychological mindedness or sophistication or attunement (which is the opposite of psychological naivety) also entails being aware of your own instances of naivety (which, for many, is only achieved after the event). It involves the awareness to closely monitor your own psychological blindspots and duly accounting for it in your estimate of projected outcomes in any ongoing relational dynamics. It is in this introjected sense that it can be regarded as the psychological underpinning of the Socratic definition of the highest wisdom: "knowing that you don't know". The supremely psychologically aware person is able to pause in a middle of an interpersonal exchange, observe the manifestation of a relational or intrapsychic phenomenon (both in oneself and/or in the other person), and then recognize that one does not understand its meaning yet even though one has rightly perceived it. This is a rightly superhuman ability: it takes the capacity for keenness of awareness, the willingness to suspend judgement, the skill to separate sensation, intuition, and raw perception (in their broad presentation) from their specific meanings, and the patience, however long, to wait for those meanings to emerge in time and space. It also entails the radical acceptance of the possibility of never knowing the meaning of something and restraining one's mind from imposing a contrived one.
Psychological awareness is the mother of all the other virtues that I would iterate in the second installment of this piece, and a relational cheat code that confers a godlike power and aura on those who possess it to the highest degree. It has been known and empirically demonstrated that the female person or the feminine persona confers a capacity for empathy that's about 9 times well-attuned than that of a male or the masculine persona. But while empathic resonance is a necessary component of psychological attunement, it is a grossly insufficient one. In fact, empathy often appears to correlate strongly with naivety. The most empathic sex also tends to be the most naive in pragmatic situations. But it is still a necessary apparatus in persons gifted and skilled in psychological attunement. If you're incapable of sensing what the psychological realities of the other person feels like, then you are severely limited in your meta-metacognitive capacity. Hence, in addition to empathy, the psychologically astute mind must possess the capacity for detachment, immersion, imagination, ego-substitution (putting one's self in the person's situation), ego-abandonment (which loosen the egocentric point of view), and self-awareness (which keeps track of one's internal processes). The last element, self-awareness, is arguably more important than empathy, because the person who understands themselves in the most intricate details would most certainly understand others (either in absolute or relative terms) to the same or even more degree. If any of the components of psychological mindedness is necessary and sufficient, it is self-awareness, because it also incorporates almost all the elements of psychological astuteness in interpersonal context.
These virtues are often woven deeply into personality styles so much that it'd be too simplistic to construe them as products of bad or insufficient professional training. As a result of this fact, and unsurprisingly, there are lay persons outside the field of psychotherapy who possess all of these virtues in striking abundance, and there are many professionally trained psychotherapists who lack many of these virtues in tragic quantity. It has always been debated whether exceptional competence in psychotherapy is due more to experience and training or more to certain innate abilities and sensibilities. Also, therapeutic alliance has been identified as a sine qua non of effective psychotherapy; and its achievement has been ascribed primarily to the presence of what has been conceptualized as nonspecific therapeutic factors. In other words, the human factors which are often radically independent of training, certification, and years of experience. I believe that the virtues I'm going to outline here are the psychological infrastructure that fundamentally underlie the therapist-related nonspecific factors and set the upper limit to which each professional can be expected to evolve, cultivate, and skillfully apply themselves in practice.
I would go as far as proposing that individuals with the best aptitude and intuition for delivering psychotherapy can be identified a priori on the basis of these virtues. I would also expect that the relative magnitude of these virtues that any individual possesses should bear significantly moderate correlation with the psychological constructs of emotional intelligence and general IQ. To be clear, these virtues, at least in the professional context of psychotherapy, are necessarily difficult (if not impossible) to operationalize largely because they are expressed more as gestalt tendencies than as discrete behaviours, and are experienced by others more as general effects than as overtly deployed skills.
Look out for part 2!