Part 2: The Most Important Qualities You Need To Be An Effective Therapist. By Dr Linda Berman

  • Having A Non-Judgemental Approach.

imageA Sleeping Judge.Thomas Couture. 1859. Wikimedia Commons.

“True empathy is always free of any evaluative or diagnostic quality. This comes across to the recipient with some surprise. “If I am not being judged, perhaps I am not so evil or abnormal as I have thought.”

Carl Rogers

A non-judgmental stance in everyday life is one which is accepting, patient, caring and empathic. It is unbiased and free of prejudices.

Such an attitude creates an aura of understanding and safety for the person you are with. In this way, relationships tend to be deeper and closer, more trusting.

In therapy, being free of judgement is a liberating experience for the patient, one that they may never have had before.

Often in life, people have felt criticised for being different in some way from those around them. Accepting and valuing a patient’s difference is a crucially important aspect of being a therapist.

imageStreet Art in Paris. Yamen. Wikimedia Commons.

“We are all different. Don’t judge, understand instead.”

 Roy T. Bennett

It is absolutely necessary for the therapist to accept, with genuinely felt tolerance and lack of bias, a patient’s political or religious views, appearance, ethnicity or gender identity.

If there are any areas of doubt, bigotry, or discomfort around diversity on the part of the therapist, then it is that therapist’s duty to discuss any such ‘blocks’ with a colleague, therapist or a supervisor.

By not judging, we allow ourselves to be genuinely interested in the person, so that all aspects of their personal material in therapy can be explored in an atmosphere of safety and containment.

All this is crucially important in therapy; it is vital to be non-judgemental. This applies to non-verbal messages also; the image below is an excellent example of how not to be as a therapist! 

The rigidity and oppositional style of the woman’s posture, her fixed, impenetrable, rather accusing gaze, her cold, haughty, unsmiling expression and upright, raised head, her folded arms (closed, defensive, aggressive), all suggest judgement, authority, one-upmanship and non-availability.

Even her buttoned-up, black and white, crisp, brisk choice of dress could be interpreted as judge-like.

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“The establishment of an authentic relationship with patients, by its very nature, demands that we forego the power of the triumvirate of magic, mystery, and authority.”

 Irvin D. Yalom

If we are judgmental in any way, we will damage the therapeutic alliance, sometimes irrevocably, and we will possibly be sending the patient back for years to the internal prison of their self-doubts and fears.

imageThe Accused – Odilon Redon. Wikioo.

“I have no right, by anything I do or say, to demean a human being in his own eyes. What matters is not what I think of him; it is what he thinks of himself. To undermine a man’s self-respect is a sin.”

 Antoine de Saint-Exupery

The patient will feel threatened and highly uncomfortable, accused and condemned, will usually withdraw emotionally and most likely fail to return.

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Many people coming for therapy will anticipate being judged or criticised anyway, and fears about this may need to be explored.

From the beginning of therapy, the therapist needs to demonstrate an attitude of acceptance, care and empathic affirmation of the patient’s identity, in all its many aspects.

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Then the patient will hopefully feel safe enough to trust the therapist to gently explore the roots of their fears.

The meaning of such feelings in the transference to the therapist will be highly significant. It will give us strong clues as to the core of the patient’s issues and the way they relate to others outside of the therapy room.

“Acceptance is simply love in practice. When you love, you accept, when you lack love, you judge.”

Abhijit Naskar

If the therapist can offer an appropriately warm and loving reception, the patient will hopefully feel safe enough to trust the therapist to gently explore together the roots and development of their most difficult life issues.

  • Having An Understanding Of The Human Condition.

imageThe Human Condition – Rene Magritte. Wikioo.

“There is no human deed or thought that lies fully outside the experience of other people.”

Irvin D. Yalom

It is crucial for all therapists to have an understanding of the human condition.

What does this mean?

The Human Condition is a term that encompasses the common needs, experiences and essentials of existence of every one of us.

It refers to a state that universally affects all human beings on the planet.

We may be diverse in many ways, and our differences are highly important in society. At the same time, we are all deeply connected. We see ourselves in others, even strangers, everywhere.

50336627772_f6602f613d_oShinya Sato – Snooze [2014]Gandalf’s Gallery. Flickr.

We are all born, we all will die. Every one of us needs to relate, to work and learn, have intimacy, rest, sleep, eat, drink, secrete, breathe….

24639026014_27aedbe404_oFrank Oriti – C.K. [2014]Gandalf’s Galley. Flickr.

“Every man [and woman!] bears the whole stamp of the human condition.”

Michel de Montaigne

We are, all of us, beset by uncertainties in life.

imageWorlds Unknown – George Graham. Wikioo.

“Most of us, no matter what we say, are walking in the dark, whistling in the dark. Nobody knows what is going to happen to him from one moment to the next, or how one will bear it. This is irreducible. And it’s true of everybody.”

James Baldwin

The emotions of humanity are indeed universal. For example, we all feel love, hate, anger, envy, fear, joy, pain and suffering.

“The bounds of a personality are not reproducible by a sharp black line, but…each of us flows imperceptibly into adjacent people and things.”

Edith Wharton

It is important for us all to understand and read about this, especially therapists.

imageFlowers and Books – Paul Gauguin. Wikioo.

“You think your pain and your heartbreak are unprecedented in the history of the world, but then you read. It was books that taught me that the things that tormented me most were the very things that connected me with all the people who were alive, who had ever been alive.”

James Baldwin

If a therapist does not understand the human condition and grasp the fact that therapists are as much bound by it as patients, then it could be difficult to empathise with others’ worries.

In this case, we may not understand a person’s fear of death, their searching for meaning in life, or concerns about impermanence and change.

The existential psychotherapy described by Irvin Yalom, which focusses on these and other related issues, certainly takes into account the fact that, in this regard, therapist and patient are ‘in the same boat.’

imageBoaters Rowing on the Yerres – Gustave Caillebotte. 1879. Wikioo.

This means that we have to learn to accept unchangeable aspects of our lives within ourselves, so that we can help the patient to do the same.

In addition, we all know what it is like to feel the full gamut of emotions, and we all have a dark side.

To effectively help the patient recognise and accept their dark side, the therapist needs to have understood and worked on their own ‘shadow’ side.

imageAlexej von Jawlensky – Sizilianerin mit grünem Schal (1912)

“One thing I can be sure of, every person is capable of great kindness. And the dark opposite is also true. This is the human condition.”

Charles F Glassman

  • Understanding Of Paradox, Ambiguity And Contradictions.

imageAmbigram Ambiguity (animated).gif

“Learning to live with ambiguity is learning to live with how life really is, full of complexities and strange surprises..”

James Hollis

Why have I included this topic of understanding ambiguity in my list of therapist qualities? How does it make a difference in terms of therapists’ knowledge, attitudes and outlook?

“Take the road to contradiction, it’ll lead you, I promise, to the palace of wisdom.”

Frank Lentricchia

Understanding the power of paradoxes help us to develop flexible ways of thinking. As a therapist, it is crucial to be able to have the ability to keep both sides of a contradiction in mind:

“What if you rested in between contradicting energies? What if you practiced holding contradictory views at the same time with no fantasy of them ever being resolved?”

Nate Green

This is a key quotation. Being able to keep two different views in our heads simultaneously, without feeling that we have to come down on one side or another, gives us the ability to reflect, to weigh and balance opposites, to discover contradictory truths that may both have value.

Put together, the apparently opposing views might make a whole picture.

This may be especially pertinent in relation to couples therapy, where two people may have very differing views about the same issue.

These ways of thinking mean that we are taking time to consider, to ponder and reflect, which are in themselves creative acts.

This is so much better than having a thoughtlessly rigid and superficial mindset, one which immediately takes sides without weighing the real evidence, and which cannot accommodate two opposing truths at the same time.

“It’s not at all hard to understand a person; it’s only hard to listen without bias.”

Criss Jami

By adopting open ways of thinking, therapists can keep their minds, and their opinions, adaptable and flexible, and understand that nothing is as a clear-cut as it may seem.

Maintaining an open attitude to the contradictions of life contrasts with a closed and rigid outlook and with black and white thinking.

“I would rather be a man of paradoxes than a man of prejudices.”

Jean-Jacques Rousseau

What is important in terms of the contradictions and paradoxes within ourselves and the world, is to accept them, to stay with them, rather than running off into some kind of false certainty.

If we are able to do this, to hold onto the two sides of a truth, our lives and our work as therapists will inevitably be richer and more full of colour and depth.

We are all complex creatures, and the universe is multi-faceted, full of diversity and difference, ambiguous, quirky, nuanced and intricate in its complexity.

Whitman knew this well, and was accepting and proud of all the contradictory aspects of himself:

“Do I contradict myself? Very well, then I contradict myself, I am large, I contain multitudes.”

Walt Whitman

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“Let go of certainty. The opposite isn’t uncertainty. It’s openness, curiosity and a willingness to embrace paradox, rather than choose up sides. The ultimate challenge is to accept ourselves exactly as we are, but never stop trying to learn and grow.”

Tony Schwartz

  •  The Ability To Set And Maintain Boundaries.

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“Boundaries define us. They define what is me and what is not me. A boundary shows me where I end and someone else begins, leading me to a sense of ownership. Knowing what I am to own and take responsibility for gives me freedom.”

Henry Cloud

Boundaries in psychotherapy delineate the ‘rules’ that therapists set and maintain, to protect and care for themselves and, most importantly, for the client.

In addition, the patient will have their own boundaries, which must at all times be respected and honoured.

It is crucial for all therapists to have clear professional boundaries, in order to work ethically and responsibly.

Different schools of psychotherapy have differing thoughts about boundaries. For example, most psychoanalytical psychotherapists would consider that hugging a client is unprofessional, whereas some others might not.

Boundaries in therapy include issues such as fees, setting, appointment times, the therapeutic relationship and confidentiality.

In therapy, the setting of boundaries is commonly discussed over the initial sessions. These boundaries need also to be elastic and permeable.

Awareness of a patient’s own boundaries, as mentioned above, is also of paramount importance;  therapists need to be very aware of respecting these, so that they do not intrude on the patient’s inner world, which could replicate past bad experiences.

  • The Ability To Wait And To Tolerate Not Knowing.

imageWaiting – David Ross Warrillow. 2004. Wikioo.

The ability to wait quietly with the patient is an important and necessary therapist skill. This will allow room for not knowing, for taking time to stay with thoughts and feelings, rather than rushing into action.

The psychoanalyst D.W. Winnicott asserted that 

 ‘…acceptance of not-knowing produces tremendous relief.’

Why should not knowing, on the part of both therapist and patient, bring such comfort?

Think about the world outside the peace of the therapy room. Think of the pressure to perform, to achieve, to go places, to be socially adept, to hurry up, to provide instant answers.

Often, if we do not know the answer, some of us may pretend to know, or spout something clichéd, just to appear knowledgeable.

In therapy there is an opportunity to escape such societal demands to perform. There is a chance to slow the pace, to stay with feelings….. and to pause.

In pausing, we can more easily notice what is happening within us and outside of us, and get in touch with feelings and bodily sensations, without the need to rush into superficial activity or easy formulaic responses.

Although there are time limits to the session, there are generally further sessions; there should be no pressure to hurry through the process of therapy.

Not knowing also allows the therapist to be fully there for the patient, a quiet, strong and reflective presence, listening and attending to the patient’s needs, rather than to her own theoretical formulations.

With this in mind, both therapist and patient can wait, for something to emerge from the unconscious that is more than a superficial statement or response.

How often does one experience such calm, authentic support?

In psychotherapy, many times, people are afraid of silence and not-knowing. They feel uncomfortable. The therapist can help the patient here by demonstrating a relaxed tolerance of the silent space.

The therapist is trained to wait without frustration for something to emerge, rather than rushing to fill the valuable reflective time with superficialities.

This is a way of being there for another person, and is very much about experiencing the present moment.

imageMorning Landscape, Giverny. Claude Monet. Wikioo.

“Nothing is more precious than being in the present moment, fully alive, fully aware.”

Thich Nhat Hanh.

Living in the present is not easy. It is difficult to stay with the now, without allowing the mind to wander or to worry and be distracted into the past or into an imagined future.

However, silent spaces can be so creative and productive, in our lives and in therapy.

Such quiet intervals in psychotherapy allow the patient some space to feel free of therapist intrusion and over-activity.

If the therapist rushes into interpretation and quick ‘understandings,’ without waiting with the patient to see what might transpire, something valuable may be lost and the therapeutic process compromised.

Timing and pace are crucial in every psychotherapy session. Waiting with someone in an atmosphere of acceptance and compassion is crucial in this regard.

It involves therapist having the ability to engage in creative listening, feeling with that person, and thinking in a way that is based on the intuitive, rather than the purely cognitive.

  • The Ability To Think Symbolically.

49903545118_cda7c818d6_oFilip Warzecha – The Dream [2018]Gandalf’s Gallery. Flickr.

Here is another golden key to being a therapist. Across all the different therapeutic approaches, there needs to be an openness to symbolic communication in therapy.

If we see the world- and our patients- only in concrete, literal terms, we will miss the amazing abstract and symbolic qualities in people’s manner of communicating with us.

25061830464_21c0d832b8_oFlora Borsi – Subjective Freedom I. Gandalf’s Gallery. Flickr.

This is important in terms of understanding the nuances, conscious and unconscious, of verbal language, for example, the use of metaphors and images.

Sometimes it may be hard for a patient in therapy to express directly how they feel and think. This is where it is important to listen and look for symbolic communications.

imageI am not much like myself anymore.’ Christopher Michel. Wikimedia Commons.

A therapist needs to be adept at noticing the symbolic importance of body language, and talking with the patient, if the time is right, about the meaning of their actions.

These may involve the patient bringing objects into therapy, like photographs, paintings, drawings, poems and gifts.

Awareness on the part of the therapist of the important symbology of jewellery, tattoos, or  logos on T-Shirts can also be highly relevant to the therapeutic process.

These often ‘speak’ volumes, symbolically, about some of the patient’s key issues.

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All these are communications. For example, when a couple comes for therapy, it is often interesting to note, that, as they progress and become closer to each other and less adversarial, they will often, usually unconsciously, choose the same, or similar, colour clothes to wear for therapy.

When patients bring dreams into therapy, thinking symbolically is paramount, so that we can help the patient to decipher the message of the dream and its relation to their current life.

“Dreams are impartial, spontaneous products of the unconscious psyche, outside the control of the will. They are pure nature; they show us the unvarnished, natural truth, and are therefore fitted, as nothing else is, to give us back an attitude that accords with our basic human nature when our consciousness has strayed too far from its foundations and run into an impasse.”

Carl Jung

imageHead with Flowers – Odilon Redon. Wikioo.

“As a plant produces its flower, so the psyche creates its symbols.”

Carl Jung

© Linda Berman.

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