[archipelago]

I just got back from an interesting session with the cover shrink for mine who is on a long vacation. He was addressing me half as a patient and half as a future therapist so it was sort of like colleagues in a way so he was talking about things that came up for therapists since I had started specifically with wondering about challenges.

He said that therapists don't really learn who they are as therapists until they have a patient rock their boat. He described some so-called difficult patients and where lines were drawn for him and where he was ready to but let it go because he recognized the patient's needs as greater than his own.

So I thought of people here who often seem to really worry about how they have acted or what they have said in therapy. Or fears of such things. Or worries about being dropped.

To hear a seasoned therapist talk about the benefits he gets from being challenged and also describing some behavior that really is a bit beyond what I had realized some people do was interesting. And I thought it may be reassuring to some.

[tealBumblebee]

That sounds like a pretty awesome discussion you two had. Thanks for sharing!

[lilypup]

I agree...it has to be interesting when you have a challenge.

[sailorboy]

Thanks for sharing. That sounds like a cool conversation to have. I'd love to hear about my T's challenging cases.

So are you going to share the behaviors that is really beyond what you knew people did? I don't get how this post is reassuring since you didn't share where some Ts draw a line... Where they let it go and what is a truly "difficult" patient?

[stopdog]

I think rocking the therapist's world a bit is a good thing for every client to do. I think therapists can get a bit complacent.

[archipelago]

Originally Posted by Readytostop

So are you going to share the behaviors that is really beyond what you knew people did? I don't get how this post is reassuring since you didn't share where some Ts draw a line... Where they let it go and what is a truly "difficult" patient?

Sorry. I meant to suggest that nothing I have seen here would be considered even difficult really let alone beyond a line. If people worry about maybe crossing some boundaries or out of session contact, maybe they think they are being taken as difficult. This therapist wouldn't have said that and he was also referring to other colleagues and reading too.

What was over the line for him was threatening behavior. What was nearly over the line but he allowed the patient to continue because he recognize her need to was a very aggressive angry attack trying to rip him apart and get inside his head to do so. He said he was considered saying "enough is enough" but then saw that the person really needed to be in the place at that moment and that he could tolerate and not have to react. It challenged him for sure, but didn't push him over. So even extreme behavior isn't necessarily taken badly.

I really was trying to be reassuring. Sorry you didn't feel that way.

[healed84]

Yes, that is pretty much what my T said to me, one day when I was worried about ruining our relationship. He said are you go to threaten me or my family? I said nope.. and he said, then don't worry about it. Sometimes it is reassuring, other times, I still worry about emailing him too much and then him terminating me.

[Partless]

Archipelago, but not every therapist is like that. I think it's a matter of getting to know the therapist as the person continues in the relationship. Some therapists are quick to send the patient to someone else. Their boundaries are tighter.

[archipelago]

I just stuck to describing this one therapist (and later included that he mentioned colleagues and peers). And I just said this might be "reassuring to some." I didn't overgeneralize or claim it would be to all or that this is the way all therapists are.

The point of view was different enough: to see something that some would call difficulty as a challenge that causes growth. It also seems like a healthy perspective. This guy has seen everything and works voluntarily to help at a 100 bed locked unit, and yet here he is saying he is still learning and growing and open to challenges. I find that reassuring.

[JaneTennison1]

I find it very reassuring and interesting. I don't think I am a typical client and I beat myself up for not being as "normal" as other people. I like the thought that a therapist would learn something from difficult people and that I may not be as difficult as I think.

Originally Posted by Partless

Archipelago, but not every therapist is like that. I think it's a matter of getting to know the therapist as the person continues in the relationship. Some therapists are quick to send the patient to someone else. Their boundaries are tighter.

I want to accentuate what Partless said here. You didnt say if this T is s psychoanalyst like your regular T, but am making the association since you mentioned his colleagues.

Psychoanalysts are a different breed, with usually longer and more intensive training and preparation. Especially with transference, relational/attachment issues, and the most complex cases. They are known for their ability to tolerate the most difficult emotions and behaviors in the patient population.

I know you're not generalizing, and it is s nice thought, but i think this distinguishment is important to make at a place with a good amount of diversityvin terms of treatment providers.

Sounds like an interesting session.

[archipelago]

Point well made and taken. Yes, he is deeply psychoanalytic, though not technically an analyst; he is also a psychiatrist, who does both intensive and long term therapy as well as treating people who are on the severe side and need medication as well as those who are barely functioning at the locked unit. Still I thought his take that was upbeat and still full of interest about such tough cases was really inspiring and interesting.

You are probably right that psychoanalytic therapists who are into this type of work do end up with more training and do deal with more complexity. And definitely they are trained and just do tolerate very difficult things that would try most people's patience or make them reactive in some way or other.

I apologize for not being clearer about his specific qualifications and experience, which do change the picture more than I guess I had realized. I am so used to psychoanalytic types and read so much of it, that I probably take things for granted that are not so.

I'm curious though. You cite Partless who makes a point about tighter boundaries. Do you think that this therapist had loose boundaries because he tolerated an angry outburst even when it started to make him wonder? Or do you think he had good boundaries because he was able to control his personal response and realize it was not him being attacked, but the patient's needs to be angry? One is about controlling the behavior in the environment. The other is more about controlling the effects of internal/interpersonal relating and especially countertransference.

Originally Posted by archipelago

à
I'm curious though. You cite Partless who makes a point about tighter boundaries. Do you think that this therapist had loose boundaries because he tolerated an angry outburst even when it started to make him wonder? Or do you think he had good boundaries because he was able to control his personal response and realize it was not him being attacked, but the patient's needs to be angry? One is about controlling the behavior in the environment. The other is more about controlling the effects of internal/interpersonal relating and especially countertransference.

From my perspective, I think that he has good and seasoned [psychological] boundaries.

Overall, I get the impression that you found a way to connect with this therapist right at the onset, and that your experience of connectiveness is subtly expressed in this thread.

[Lauliza]

Originally Posted by archipelago

I'm curious though. You cite Partless who makes a point about tighter boundaries. Do you think that this therapist had loose boundaries because he tolerated an angry outburst even when it started to make him wonder? Or do you think he had good boundaries because he was able to control his personal response and realize it was not him being attacked, but the patient's needs to be angry? One is about controlling the behavior in the environment. The other is more about controlling the effects of internal/interpersonal relating and especially countertransference.

I think the therapist you're describing here has very appropriate boundaries. It could be due a little to his analytic philosophy, but I think it has more to do with his clinical inpatient experience. Doctors and t's who work in hospitals and locked units see and experience everything, so they can handle the most difficult patients. Private practice Ts who dont have such experience generally have a less demanding clientele and might have a lower stress threshold. Thanks for sharing this is. It's very interesting and definitely reassuring.

[Partless]

Originally Posted by archipelago

I'm curious though. You cite Partless who makes a point about tighter boundaries. Do you think that this therapist had loose boundaries because he tolerated an angry outburst even when it started to make him wonder? Or do you think he had good boundaries because he was able to control his personal response and realize it was not him being attacked, but the patient's needs to be angry? One is about controlling the behavior in the environment. The other is more about controlling the effects of internal/interpersonal relating and especially countertransference.

I agree with Skies and Lauliza, and just wanted to clarify what I said because I think perhaps you misunderstand what I meant by "tighter boundaries." I did not mean that in positive way, implying the opposite being loose and somehow bad. I meant tight in the sense of protecting therapist and his/her interests more and allowing less room for flexibility and patience (which perhaps comes from training or experience or personality) needed in dealing with more difficult patients or unpredictable behavior. In other words, I think you are lucky to have such a therapist, but that in my experience that is not the norm (though I don't think you were suggesting it is).

[archipelago]

Perhaps I did not understand the boundaries issue, but it was raised and has been raised in other ways very often in discussions here, enough to be taken up as a general concern that people seem to overlappingly share, though people may differ on what the terms really are and what is appropriate.

I didn't mean to suggest that this therapist is normative at all. In fact, sorta the opposite. That I found it curious and interesting that such an experienced therapist would say something like what he said, that it takes sometimes a push against you (and your boundaries) to really understand who you are as a therapist. That just seemed cool. And it also seemed to suggest that at least some people don't just automatically judge behavior or speech as bad or out of the limits or whatever, and instead take it in to consider how it can help them challenge themselves. That is where I saw insight, promise, and even relief. For so many who struggle with self-doubts and worries about their connections to their therapists, it just seemed to suggest that there are people who think about this even late into their careers and remain open to challenge. It just seemed to be a hopeful perspective to share.

[archipelago]

By the way, this is not my own therapist, and he is temperamentally and even theoretically distinct from my own therapist. But they are very close personally and in the same long standing reading group. I have known him for decades because my former therapist used him as a cover too. They are all psychoanalytic but vary in their affiliations, styles, and credentials.

I am lucky I guess to know all of them and have a chance to work with them to one extent or another. I'm also lucky in the sense that a lot of the deeper work has already been done so I'm able to use therapy slightly differently (not always though) to explore which I feel psychoanalysis really is good for allowing.

Since I have chosen it as a field of interest, some of these healing people in my life have shifted slightly toward mentoring though not in a way that is problematic. I do learn a lot from how they work and what they say about how they work. And occasionally something will come along that seems to be something someone has really developed over time and experience that is worth considering.