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[James Sacks]

>
>Dear Adam & Anath,
>Your making this maddening problem from  patients explicit, suggests
>a possible technique. With each patient you start with an attempt to
>build this missing capacity to look at themselves to prepare them to
>listen and show some evidence that they understand and give honest
>consideration to what you have to say. It's a sort of Rogerianism
>made more mutual. I would not agree with Rogers that full
>understanding combined with unconditional positive regard will render
>the patients so happy that they will cure themselves. Mostly the
>patients will talk to you about themselves and their life and you
>will try to understand and you will let them know in some way what
>you understand. I would also let them know that, during an initial
>period, a pre-therapy training, you will from time to time, tell them
>something about them that they have not told you and they are to try
>to satisfy you that they understood what you have said it and will
>give it consideration. You must emphasize that this in no way
>includes their agreement with what you said and that you might very
>well be wrong.
>
>It should possible for many people to learn this ability this if what
>is told them is carefully titrated with just the right dosage at just
>the right time. Then, as this this capacity takes root, you could
>introduce the therapy proper using as much tact as necessary. For the
>rare patients that already have this ability, you could skip this
>pre-therapy phase entirely. With others, learning to hear what is
>said about them may be important therapy in itself. Finally there are
>patients who are so defended against understanding therapeutic
>interventions that they cannot be taught to do so. With them, purely
>supportive therapy might necessary untli they are able to do the
>pre-therapy.
>
>No patient will learn this skill and retain it forever. More likely
>they will learn it and forget it after a few sessions. Conscious
>effort can prevail over unconscious forces for short periods but the
>unconscious is more persistent so it is up to the therapist to
>reinforce this skill when it is forgotten. When the patient begins
>treatment there is usually some critical moment in their lives it is
>no time to learn to listen well. so maybe the pre-therapy should
>start as a second phase during a more emotionally neutral time. I
>imagine that the countertransference will be a vital source of
>material for  practicing listening. For  example:  "I found myself
>having a bored feeing again  when you were telling about your girl
>friend. As you were telling me the story it seemed to me as if as if
>you were reading it and that you didn't care whether I knew how you
>felt or not. Maybe it's related to why your students so often don't
>get engaged in their work with you". Is there a way that you can let
>me know how you understood what I just said . If not, I can repeat
>it."
>
>Although I used to try to draw my patients attention the obvious -
>That I was a psychotherapist and they were my patient and that I was
>to help them fix something imperfect in their personality. What could
>I not do was to change somebody else. I could even try to help them
>deal more effectively with a difficult person but it would still have
>to involve making a change in themselves. You can see that I had a
>lot of patients who were very blame-avoident and wanted nothing more
>than to get me to agree that their problems were caused by somebody
>else as if that would help.
>
>Sincerely,
>Jim
>
>>Hi Anath,
>>       okay, so it seems to me we have a spectrum.
>>
>>On one side, we have people who want relief of symptoms but have
>>little psychological mindedness, and indeed, are pretty resistant to
>>any hint that their deepest motivations and many of their attitudes
>>might be not only mistaken but misleading. They have a strong shame
>>barrier.
>>
>>On the other extreme we have seekers for truth, and they are willing
>>to suffer a fair amount of humility, confrontation, recognition of
>  >their follies, as a price they must pay to make headway. They expect
>>it, even. >From these folks, resistance is more likely to be because
>>perhaps the therapist is mistaken.
>>
>>So what is the distribution...
>>        Your point about private practice is good, because folks who
>>pay for themselves tend to be more group two.
>>
>>     An interesting question: I wonder if anyone has ever researched
>>it. Warmly, Adam
>  >
>>----- Original Message -----
>>From: <mailto:anathga at hotmail.com>thana ag
>>To: <mailto:adam at blatner.com>adam blatner ;
>><mailto:sewell.2 at osu.edu>regina sewall
>>Cc: <mailto:list at grouptalkweb.org>list at grouptalkweb.org
>>Sent: Sunday, August 09, 2009 9:12 PM
>>Subject: RE: Moving past fear/guilt
>>
>>Dear Adm,
>>I am obviously lucky,having been in private practice for decades.In
>>my exoperience the people I see ,may come originally b/c of an
>>unpleasant precipitating situation/predicament,but al lchose to
>>evolve rather that get  relief,or present themselves in the role of
>>a sick person.
>  >anath