The Ordinariness of Good Psychotherapy

In the frenzy to establish and distinguish ourselves as psychotherapists, whether it be  acquiring a specialty in working with a newly-minted psychological condition, or becoming more fastidious practitioners of our chosen therapeutic paradigm, we overlook the ordinariness of what constitutes good psychotherapy.

Often it is out of a sense of real responsibility to the client, or to the interaction with the client, that our own need to be clever is overridden and we return to time-honored human virtues such as forbearance, sensitivity, tact, even-mindedness, honesty, and courage in our approach. There is the nagging suspicion that perhaps our own need to be clever arises from the client’s repetitiousness, and its unbearable effects, as if change could and should happen faster, catalyzed by a more sophisticated interpretation or skillful application of technique. Taking clients at their word, truly entering and residing in the manifest content of their narratives, the warp and woof of their everyday lives, what they feel actually matters, requires that we give ourselves over to the ordinary.   Sometimes our need to be clever is rooted in our own disfavor with giving ourselves over to the ordinary, and our interpretations and interventions become disguised ways of coaxing the client to talk about what should actually matter, to justify the potency of our education and training, or simply to stave off boredom. Which is not to say that clients do not need, yet resist, deeper meaningful linkages.

Often much of the salutary relational unlearning and re-learning that occurs in therapy remains implicit, embedded in moment-to-moment client-therapist interactions, in the form of mutually coordinated eye contact, speech prosody, voice cadence, and other rudimentary forms of human interaction. A smile, a sincere frown, or merely countenancing the calm demeanor of the therapist at the right moment, when the client expected disapproval, can have liberating effects, no matter how imperceptive. Contrary to the Freudian dictum, not all experiences have to be made conscious in order for them to have transformative effects.  Robust fees can rightfully be charged for having the presence of mind to be mindfully present, rather than being a masterful decoder of meaning.

So what are we offering to clients when we offer psychotherapy? And, if good psychotherapy is a more concentrated and specialized form of actual human relating, rather than something categorically different, ought we to even use words like treatment, intervention, and technique?

Yet, when we draw from our own humanity to help clients, desiring to act naturally, valuing transparency over mystification, common speech over clinical jargon,  tact over tactics,  and an awareness of mutual influence, many thorny ethical and professional issues arise. What separates psychotherapy from a form of therapeutic companionship? For that matter, under these conditions how are we to define professionalism? Appropriate training and education?  The role of clinical theory and technique? Arguably, somehow the line between implementing a technique and being a real person in the room has to be a permeable one, and acting authentically professional, as well as professionally authentic, an achievable way of being.

Likewise, a life of depth and dimensionality surely improves the relational goodness-of-fit that a therapist might have with an array of clients, across a variety of problems in living. It is probably more true than untrue that our clients covertly scan our faces for physiognomic signs of similarity between the life we have lived and live, and the life they desire to live. And yet, graduate schools are rightly not in the business of prescribing lifestyles, and it would be unthinkable of a supervisor to advise a beginning therapist to go out and get his or her heart broken, or to break someone else’s heart.

Lastly, rather than mimic the field of medicine and hotly pursue cutting-edge techniques and technology for his or her professional advancement, arguably the diligent therapist needs to assume greater stewardship for his or her own self-care out of the office in ways that allow for finessing his or her humanness in the office with clients.