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When psychotherapists talk shop

What do psychotherapists talk about when they get together? On the one hand, they talk about the same kinds of things anybody does, especially if they know one another. One of my friends is an avid Wagner addict and periodically travels to view opera in various cities. I confess I would not know a Wagnerian opera from a cat's tail caught in the door.

Beyond the normal stuff of relationships, however, psychotherapists also talk shop. For instance, the other day I was talking with some colleagues and someone made a comment about therapeutic process. He said, “It's interesting to notice what is not said.”

That stuck in my brain, like when you walk in the woods and your clothes get snagged on the brush. I could not get past it until I untangled myself from it.

“How can you notice something that isn't there?” I asked. Would this not simply be the therapist imagining something about the client, which may or may not be valid? What if someone walked into the room and said absolutely nothing? I did this once when I was a neuropsychiatric technician in the Navy. Our head psychiatrist was an analyst from Harvard, and people thought the thing to do was to schedule an appointment with him just for the experience. So, I did, but I didn't really feel the need to be analysed, and I had nothing much to talk about. So, I said nothing. He said nothing. We sat in silence with one another while he smoked his pipe. In that case, what was not said, and who did not say it?

If the therapist makes up a story about the client, either that is an interpretation or it's a countertransference. An interpretation is when a person makes a meaning out of what is perceived, either through what is vocalised or what is non-verbal in nature. A countertransference is when something the client says or does reminds the therapist of something else in the therapist's life, and suddenly the therapist must deal with his or her own unfinished business. When there is an absence, something not said, does the therapist notice that because it's an interpretation or because it's a countertransference? This is the kind of thing that we were discussing.

I find this level of discussion with colleagues in the field of psychotherapy to keep me sharp. Clinicians living and practising several hundred miles out into the middle of the Atlantic Ocean, on a small island with limited resources, need to be able to interact in order to keep sharp. Attending occasional continuing education events is the bare necessity, but what really helps is interacting on a regular basis with people who can “talk shop”, question, review clinical process, and help keep one another up to speed.

When I asked how a person could notice something that isn't there, my colleagues came back saying that usually what is not said is rather obvious — that we become quite aware of it. For instance, a person describes devotion to someone who cheats on them, disrespects them, and lies to them, and what is not said is how disappointing and annoying that is. What is missing is the anger. What is missing is the determination not to be treated like that by that person in the future. In another example what is missing is how an addict will set him or herself up to use again; they will put themselves into a situation almost guaranteed to lead to relapse and then wonder how on earth the relapse happened. In another example, it's the parents never mentioned when someone has attachment issues. It's the sexual abuse one experienced as a child. It's the family history of mood disorders when someone seems to have bipolar. It's the sense that a narcissistic person has that people might be able to think of them as less than perfect without annihilating their worth altogether. It's the missing end of a polarity when someone has completely identified with the other end (i.e. you are totally bad, the world is absolutely a dangerous place, and homosexual people are just sinners).

In fact homosexual people are not just sinners; they are whole human beings capable of affection, loyalty, kindness, graciousness, and faith in God. As far as that goes, Christians are not just forgiven; they are also capable of deceit, unfaithfulness, cruelty, pharisaical rigidness, and superficial credalism. What is not said? What is not said when we split other people into good or bad, believer or non-believer, sinner or saint? What is not said is the fact that life is grey; it is not black or white. There are the extremes, of course, but most of our lives are lived between those extremes. We only reduce that complexity because it is more simple, easy, and convenient to think like a computer — zero or one — yes or no — go or don't go. But human beings are not computers, and sometimes it's worth hanging out in a situation awhile and asking yourself what is not being said, what is not being perceived, what is not being understood.

When Jesus met with people on a mountain in Galilee and taught them about the kingdom of God, He challenged them to contemplate what was not being said. He used the formula, “You have read that it was written … but I say to you …” In other words, “You have heard it said … but what is missing is …” You have heard that the ancients were told not to commit murder … but I say to you that everyone who is angry with his brother and says, “You good for nothing,” or “You fool” is deserving of hell. You have heard that it was said you shall not commit adultery, but I say everyone who looks upon a woman with lust has already committed adultery with her in his heart. You have heard that it was written, an eye for an eye and a tooth for a tooth, but I say to you, do not resist an evil person, but whoever slaps you on your right cheek, turn the other to him also.

What is missing? What is not said in our dealings with one another? We will likely do better if we are slow to split people out into categories such as “us” and “them.” We will do better if we try to appreciate the grey that resides at the zero point between this and that, between good and evil, between straight and gay, between one political party or another, between this gang and that, between the extremes of our differences. That is where grace resides.

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Published September 10, 2013 at 9:00 am (Updated September 09, 2013 at 8:35 pm)

When psychotherapists talk shop

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