I'm Working On It in Therapy

How to Get the Most Out of Psychotherapy

Gary Trosclair

• Publisher: Skyhorse
• Year: 2015
• Print ISBN: 9781632204486
• eBook ISBN: 9781632207487
• Topic: Psychology
• Subtopic: Movements in Psychology
• Index: Psychology

Learn to get the most out of therapy to unlock your best self. Learn to get the most out of therapy to unlock your best self. Millions of Americans will go to therapy this year, but veteran psychotherapist Gary Trosclair believes the vast majority of them will start the process with little to no sense of how to best use their sessions to achieve their goals. Recent research has identified effective client participation as one of the most crucial factors in successful therapy. What can one do to get the most out of their sessions to create lasting positive changes in their lives? What does it look like to "work on it" in therapy?Trosclair covers these points and more, combining cutting-edge scientific research with years of fascinating anecdotal evidence to create a guide that is as compelling as it is indispensable. It teaches readers how to take off their masks and be real with their therapists, how to deal with emotions that arise in session, how to continue their psychological work outside of sessions, how to know when it's time to say goodbye to their therapists, and much more.Whether you're already in therapy and looking to make more out of each appointment, or you're thinking of starting the process and want to go in with a game plan, I'm Working on It in Therapy will show you how you can make every session count towards becoming your best possible self.

Chapter One:

Get Real: Take Off the Mask and Show Your Many Faces

“That’s Eleanor. She’s a fact checker.”

“Do you talk to your therapist about this?”

“Of course not, that’s much too private.”

—Kissing Jessica Stein

After his fourth combat tour, to Afghanistan in 2011, Sgt. First Class Michael B. Lube, a proud member of the Army Special Forces, came home alienated and angry. Once a rock-solid sergeant and devoted husband, he became sullen, took to drinking, got in trouble with his commanders, and started beating his wife.

“He would put this mask on, but behind it was a shattered version of the man I knew,” said his wife, Susan Ullman.

She begged him to get help, but he refused, telling her: “I’ll lose my security clearance. I’ll get thrown out.” When she quietly reached out to his superior officers for guidance, she said, she was told: “Keep it in the family. Deal with it.”

And so he did. Last summer, just days after his 36th birthday, Sergeant Lube put on his Green Beret uniform and scribbled a note, saying, “I’m so goddamn tired of holding it together.” Then he placed a gun to his head and pulled the trigger.

—The New York Times, June 6, 2014

BEWARE THE DANGERS OF THE “GOOD CLIENT” MASK

Let’s start with the paradox right at the heart of psychotherapy: working too hard to be a “good” client will limit what you get out of it. If working hard means being compliant and taking in what your therapist says without question, you’re in for a long, dry, and not very productive process. Working hard could mean different things to different people. But whatever it is that you think you’re supposed to be doing in therapy, if you restrict yourself to it, your progress will certainly be limited. In fact, to make progress you may need to work harder at being a “bad” client.

Trying hard in therapy by doing only what you think you’re supposed to be doing would be like wearing a mask in your session, a mask that shows only one face, one facet, of your personality. We all need to use masks in certain areas of our lives. Consciously choosing to present just one part of our personality, a particular mask, helps us to get along with others and to feel safe in the world.

While the most common mask is a polite one, we may also present ourselves as intimidating, cheery, rebellious, self-effacing, invulnerable, needy, detached, or superior, to name just a few of the ways that we prefer to appear at times. Masks aren’t necessarily fake; ideally they are just limited expressions of who we are. How effective they are depends on whether they are appropriate to the situation. If the mask covers too much, or if we never take it off, our self-expression is quite narrow, which can lead to the problems that bring us into therapy. An appropriate mask has an important place in our lives—but that place isn’t in therapy.

BRING ALL OF THE DIFFERENT PARTS OF YOUR PERSONALITY INTO YOUR SESSIONS

This paradox of working hard in therapy need not paralyze you: you need only to redefine what it means to work hard. Working hard in therapy includes taking off the mask and bringing in as many different parts of your personality as possible, not just the one facet of your personality that the mask shows. Some parts want to work hard and others want to just pout and complain. Others would like to play and others would like to cry. Don’t worry, you’re in good company: as Walt Whitman wrote, “I am large, I contain multitudes.”

Let’s not call these multitudes good or bad, let’s see them all as part of who we are. Taking off the mask and bringing all of these aspects of ourselves into the room is part of what leads to healing and growth. Getting to know the different parts of our psychology, many of them that we’ve hidden from others and from ourselves, is part of what it means to work on ourselves in therapy. And, according to some research,1 is what many clients find to be one of the most helpful aspects of the process.

Acknowledging these hidden parts of our personalities, sometimes undeveloped parts, and letting them show in session, may feel like a wound to our idealized sense of whom we want to be, but it’s also how we move toward growth and wholeness. The masks we wear cut us off not just from others, but also from the possibilities of our own personalities, possibilities that can make life richer and more fulfilling.

PAY ATTENTION TO WHO IT IS THAT YOU WANT TO LEAVE OUT

Trying too hard to be a good client, or trying too hard to please the therapist, could be a repetition of what you’ve been doing for years, and it may hide the parts of you that you need to bring into your process. When you notice what you want to hold back from your therapist (your angry, childish, vulnerable, or strong parts, for instance), you get clues as to what you have excluded from your personality.

Whatever you think it means to be a good client will make for an interesting discussion with your therapist. Exploring with your therapist what you think you are supposed to do in therapy will tell you a lot about the issues that have kept you from living as you’d like to live. It might also be interesting to talk about what you’d love to do in therapy but think you shouldn’t.

Sigmund Freud, the founder of psychoanalysis, encapsulated his belief in what work the patient needs to do in the Fundamental Rule: say whatever comes into mind, even if you think it unimportant or irrelevant or nonsensical or embarrassing or distressing. I don’t recommend this technique, known as free association, for everyday interactions, but it is a helpful direction for work with your therapist.

In similar fashion, when your therapist asks you a question, don’t censor or think about it too much. Say the first thing that pops into mind. You can always qualify it later. This approach opens the possibility for the many different aspects of your personality to come to the surface. The more you can do this in the here and now, describing your experience in the session itself, the more you will be able to work at deeper levels of your issues.

Rather than presenting only your mask—your social self—in session, you’ll need to present the full range of your facial expressions, metaphorically speaking. Bring your mask in, show what it looks like, but then take it off and study it to see how it works and what it’s covering up. This part that we want to cover up, deny, or get rid of, is known as the shadow, that part that we don’t want to expose to the light. As we’ll find out, the shadow causes problems only to the degree that it’s hidden or unconscious; once we begin to integrate it more consciously, it actually enriches our personality.2

Cindy

Cindy was in her late twenties and was determined to study law and become an environmental attorney. She had come from a working-class family and had worked hard since her early teens not only to get good grades and develop a good resumé, but also to help bring some money into the family. She came to therapy at the suggestion of her boyfriend, who felt that while she didn’t get demonstrably angry, she was too hard on herself, on him, and on everyone around them. Even though she tried to hide her anger, people could feel it.

In our first session she made it a point to let me know that her problems were not serious and that she was actually in pretty good shape. And she was clearly a strong person; since completing undergraduate school she was working two jobs to save money, ran marathons, and served on the rather contentious board of the local food co-op.

But Cindy was emotionally exhausted on a profound level and kept trying to hold back tears in our initial session. This wasn’t her plan for therapy; she had intended to use her considerable willpower to blast through her problems with strength and determination.

At first she was baffled by what was happening, but she eventually allowed herself to acknowledge that she had been trying to ignore her emotional depletion and now wanted to hide it from me. She began to take her mask off. She imagined that I would think she was a weakling like everyone else who went to therapy. She liked to think of herself as having no limits, and any sign of limitations proved to her that she was weak and vulnerable. Tears, fatigue, and limitations didn’t fit in with her mask.

While she was disturbed by her tears and exhaustion, she also had some sense that this more vulnerable side was an important aspect of herself that she needed to come to terms with—in one way or another. The heroic identity her mask portrayed had truth to it—she did have some of the warrior in her personality and she was determined to make changes in the world. But to think of herself and to present herself in this exclusively heroic way denied other essential aspects of her personality—parts that needed downtime and play.

Cindy gained some awareness of these other parts in that first session, but it took time for her to become more comfortable with them and to actually accept them. In one session she adamantly expressed her disdain for weakness, hers and everyone else’s. Then, somewhat surprised by her vehemence, she sat back in curiosity and wondered how she had become so judgmental.

She recalled that, accurately or not, she had felt loved by her father for her strength, and disregarded whenever she felt tired, sad, or discouraged. As we explored her relationship to him, it became clear that she had adopted the values she had thought he embraced, thinking it would win her his approval.

She went back and forth for some time about whether her “limitations” made her a weak person. It took courage for her to take off her mask, let her tears flow, and allow me to see what she was really going through. She told me about the times that she felt exhausted, and about the times when she really didn’t feel like training for another marathon or going to another meeting. She admitted to me that at times she didn’t feel like coming to her sessions because she felt that she was betraying her values.

Eventually Cindy came to accept that the oppressive way she treated herself was actually counterproductive. It led to her irritability, impatience, and exhaustion. She also came to understand that efforts to make herself “a better person” will backfire if they merely exclude unwanted parts of her personality, rather than get to know, understand, and integrate those parts consciously.

AIM FOR WHOLENESS AND A TRUE SELF, NOT PERFECTION

The healthy human psyche seeks not perfection, but wholeness. Whatever chance we have for real, sustainable integrity comes about through unity and inclusion, integrating and balancing as many different parts of our psychology as we can, rather than excluding some of them because they don’t fit into our idealized standard of perfection. The experience of wholeness is represented by the mandala, a venerated shape found in cultures across the globe that combines the opposite qualities of squareness and roundness, relating all the different and complementary parts to a center.

Here are two mandalas, one a classical religious representation, the other a very personal expression by mandala artist April Castoldi (on the right):

When we aspire to wholeness rather than to perfection we bring in all the different parts of ourselves into sessions: the part that is afraid this isn’t going to work, the part that would rather skip the session today, and the part that thinks that no decent therapist could possibly hang such an ugly painting on her wall.

The idea of wholeness is similar to what is expressed by the phrase “the true self,” our complete and authentic personality. Emotional health is achieved partly by finding a realistic way to live out the true self. Betraying the true self can lead to anxiety, depression, compulsion, suspiciousness, addiction, and relationship problems. In therapy we can observe how we betray our true selves in both conscious and unconscious ways.

I will address these more in Chapter Two when we discuss emotions, but as a brief example of how you might consciously betray your true self, you may notice yourself thinking, “Maybe I don’t have to tell my therapist about that episode that happened yesterday that I’m not so proud of.” Yes, it’s true, you don’t have to tell him or her anything, but why don’t you want to, and what part of you are you hiding if you don’t talk about it? Ask yourself: Who wants to hide it, who is it that is being hidden, and who wants to tell about it?

The famous British psychoanalyst D. W. Winnicott once worked with a patient who had previously been in psychoanalysis with another analyst for years. The patient told Winnicott that his therapeutic work had really started only when Winnicott recognized that he had existed only falsely, and that all of the work he had previously done in analysis had been done on a false self that the previous analyst mistook for the true self.3 Watch to see whether you bring your true self or your false self into session; distinguishing between the two can be enormously helpful.

Our experiences in life often force us to split ourselves into two halves, one supposedly good, the other supposedly bad. Here’s a story about reuniting the different parts that have been at odds.

The Cloven Viscount Is Reunited

In The Cloven Viscount, a novella by Italo Calvino,4 a man goes to war and is torn in half by a cannonball. His two halves are saved and rehabilitated, but separately; the right side is helped by military physicians, the left side by spiritual hermits. These two halves then live very separate lives for years.

The right half returns to his castle in Italy and terrorizes everyone by cutting objects and people into half. “The Bad ’Un,” as this half is later called, believes that being cut in half and suffering enlightened him, and he believes that everyone else should be torn in half too, because “beauty and knowledge and justice exists only in what has been torn to shreds.”

The left half, known as “The Good ’Un,” has compassion for everyone, and tries to do good, but is rather naïve and righteous in his crusades. His efforts at good sometimes don’t end so well. He becomes moralistic and forbids the celebrations that had helped many to survive. While he isn’t as ostensibly destructive as the “The Bad ’Un,” he’s also cold-hearted in his own way.

It seems that the separation has caused each of them to go to extremes.

Eventually they both end up back in the village they came from, and...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Dedication
• Preface
• Introduction and a Few Things to Know Before Reading This Book
• Chapter One: Get Real: Take Off the Mask and Show Your Many Faces
• Chapter Two: Channel the Flow of Emotion: Have Your Feelings without Your Feelings Having You
• Chapter Three: Enough about Them: Look Deeply Within for the Sources of Change
• Chapter Four: Don’t Hold Back: Forge an Authentic Connection with Your Therapist
• Chapter Five: Be Curious, Not Judgmental: Observe Yourself Honestly without Attacking Yourself
• Chapter Six: Carry Your Fair Share, and Only Your Fair Share: Differentiate When to Take Responsibility and When Not To
• Chapter Seven: What’s Your Story? Identify the Recurring Themes and Fundamental Beliefs That Guide You
• Chapter Eight: It Ain’t Necessarily So: Build a Better Narrative and Choose Your Beliefs Consciously
• Chapter Nine: Do Something! Continue Your Psychological Work outside of Sessions
• Chapter Ten: Into the Fire: Use Challenges as Opportunities for Growth
• Afterword
• Appendix A: In the Beginning: Starting Therapy
• Appendix B: Are We There Yet? Stopping Therapy
• Appendix C: Does This Thing Work? Research Evidence Supporting the Efficacy of Psychodynamic Psychotherapy
• Acknowledgments
• About the Author
• Endnotes
• Index