How I give psychotherapy

All my assumptions, attitudes, experiences, and skills in the open

First, I prepare by telling myself to be as passive and flexible as possible. I want to be like the classical, perfect midwife. She puts one hand on her back and holds it with the other, thinking of everything that could go wrong while smiling and speaking reassuringly. I have all the following intros ready, but I might skip saying or share them later. I play it by ear.

To comply with the law, I ensure they know I’m not a psychologist or psychiatrist. I have 45 years of therapy experience and 70 years of life experience under my belt. I worked on many of my own problems and with ex-psychiatric patients to tell a bit what to do and not do to help.

Psychotherapy won’t work when the client is drunk, stoned, or drugged. I may ask if the client is drugged. And, if they have any questions about me or conditions for me to feel safer. I may ask if they had therapy before. If so, I could explain that, unlike many therapists, I don’t see myself as the specialist. I just want to walk up with them like a good friend who might volunteer an outsider view or join forces against what they are battling.

Then I could explain that I have the greatest regard and respect for the human brain. It always brings up exactly what needs to be worked on next. I’m not here to correct it. I may add something because I could have more experience with something, but the client decides if it’s helpful. I could show that I understand. I could say something like: They lied to you, no? Or I may point out the obvious that no one says. ‘Yes, you feel desperate if anyone will ever love you, but look into his eyes now: he loves you with all his being. And he will always love you.’ I try not to say what everyone says already. Apparently, that didn’t help. I may try to share the insight no one can make us feel bad. We generate what we feel. That doesn’t mean no one could hurt us. But we have all our buttons. We were/are never entirely powerless victims. But if something I said goes nowhere or makes it unsafe, I can apologize and return to what I do best anyway: listening.

I assume my clients need to determine what happens because they have all the information and are the real specialists. I try to walk up with my clients. I’ll try to hold back saying many things because, with a little more patience, the client might say it better and more helpful than I could. My ideas to intervene are not for me to act on eagerly. They come up to entertain me, make sure I don’t get bored, and my brain stays in gear.

I like to work with people for three hours in a row. Why cut it off, just when a client is getting somewhere? Having clients return for another short session day after day, week after week, may be good for my steady income but does the client a disservice. With couples, I prefer to start with the person who seems the brainiest. When s/he opens up emotionally, it becomes also safer for the other to do so too. I reassure the one I don’t work with that when we switch, I’ll have all attention for them, and, most likely, I won’t tell them what I told the first. I might suggest to him to stop talking for a moment and feel, while I may ask her what she’s thinking.

I never prey or dig into a client’s brain. Patience and respect go a long way. When the client is ready, they’ll bring up more. Why make someone face something they’re not ready for? So that I can feel superior or in control?

I never ever blame the client. They do the best they can. The only one who can make it still better is me. I don’t think: ‘If only he was not so scared, he could better work on his fears.’ That’s what he’s here for. I try to make it safe for the client to bring up anything. That’s not the same as making the client comfortable. By quickly reassuring the client, you could come across as someone who doesn’t want to hear how bad it’s been. But I want to hear it all. I remember this client who meekly shared what an awful thing she did as a three-year-old to a two-year-old. I didn’t say: ‘But you were still so young and innocent.’ Instead, I playacted indignance and said: ‘What a monster you were!’ She sobbed. A lifetime of exaggerated guilt feelings got healed. If the client says: I’m nervous, I don’t say they don’t need to. I friendly ask: About what? That makes it safer. When the client is angry, I know anger is most of the time a fake feeling that covers up loss, sadness, disappointment, or/and fears. But anger often is displayed to feel safer. So, I encourage anger (and guard against violence): Good for you.

When a client is shut down, talks but it’s just chatting, or the session isn’t going anywhere, I can ask: How’s the safety? You can’t work without it.

Feeling bad is not a dysfunction of the brain. Again: Feeling bad is not a dysfunction of the brain. Suffering typically is from the past. The brain may figure that now is the best time to heal the old hurts. Feeling good comes from healing those old hurts. Recurring nightmares? Talk about it in increasing detail until it is enough. It doesn’t get more complicated.

When a client shares a certain feeling, I may ask what they could have said to themselves (possibly very softly) that could have generated this. When they have an idea, I could ask if that’s the story of their life, and listen.

‘Crazy’ does not exist. It means: I don’t have the time, respect, or patience to listen long enough to understand everything you say and do. The sticker ‘crazy’ says more about the one attaching it than about the one labeled. ‘Normalcy’ as a goal means to hide one’s uniqueness and authenticity.

I will not ask my clients to do certain things which ‘are good for everyone.’

Most people like me to look as if you get it. But I distinctly remember this arrogant control freak. She could cry with me because I played dumb. Most people like me to look happy, optimistic, and confident. But I do remember this courageous woman who could cry with me because I stopped smiling, allowing her a break from keeping up hope to everyone.

The general rule is: There is no general rule. Everyone is different. When I stopped seeing them as an individual and view them as a typical …, I’ve stopped paying attention to them. I must reconnect my brain to who sits in front of me. Whatever I think, read, past sessions, and other clients may all inspire me, but they don’t dictate and define this new situation.

After listening a lot, for one, two hours, I might add missing information. You don’t hear voices; when you were tiny, your brain recorded these words from careless people around you or the TV. Your brain brings them up now because it figured that you’re ready to heal the confusion you had then. Or: Bad feelings may stem from the past. They don’t certainly mean something is wrong now. There was something wrong back then. Shall we see if that would be true for you right now? What is your first thought when I ask you: ‘What’s your earliest memory connected to this feeling?’

Silence and a smile go a long way for many. Whatever the client says first is the thing to tackle. I don’t wait until I hear something that ‘interests’ me. It’s not about me. The client says: I don’t know where to start. That’s the issue already. Wait, and more will come. The client says: I can’t talk about it. I don’t try to help them talk. I’ll be there with them in their inability. As Ram Dass said: Be an environment in which healing can take place. The client says: I see a hole. I don’t ask them to look through the hole. That would be my nosiness. They may continue: It reminds me of Swiss cheese. Ah, I was once in Switzerland … I don’t assume their parents did …—they may have grown up in an orphanage. I don’t assume. I walk with them.

During the session, I try not to reassure, but it’s easy to forget. I try to help the client feel terrible; enough social pressure says we should just ‘forget’ or ‘get over it already.’ ‘Sounds terrible’ respects where the client is going.

When they talk, cry, shiver, blush, perspire, yawn, or stretch, generally, those are signs of deep healing taking place. I might have to say: This may feel awful, but you are healing right now and will feel much better soon. One of my teachers used to say: ‘Don’t feel bad for them when they cry. This is what they always wanted.’ When they cry deeper in reaction to what I say, it was helpful. While they cry, they improve so I can’t just stay where I was before. When they become more aware, I better do too. So, I must continue to be a client so they’ll have a better counselor next time.

Sometimes, the best I can do is sit back, listen, and nod. But often, experienced clients who know me well need me to team up with them and go with them where no one went before, helping them cry deeper.

Sexuality is hardly an issue. But even when it is, it isn’t. Why? The problem is mostly with what got associated with sex for them. Like eating itself is seldom troublesome. The trouble is what it stands for. Therapy can loosen these links because they stem from hurts in the past. Therapy about it is like listening to any other subject except that therapists who have not worked long hours on cleaning up their own sexual hang-ups will have a hard time focusing on what their client is saying and needs to hear. For them, it’s easier to listen well to early-in-life stories related to sex now.

Another funny subject is death. Helping someone mourn is easy. Preparing for impending death is too. But what troubles most people is desperation and a ‘fear of death,’ which isn’t. Fear of death is just heavy fear that stops one from living without doom. This melts away with ridicule.

Often, we get hurt not just in random incidents but as part of an often-worldwide pattern of systematic mistreatment and institutionalized oppression of certain groups. I may try to evoke that to enhance the client’s sense of safety, innocence, and hope. ‘Say to all fellow working-class people around the world: We can and we will.’ ‘Say to all women who ever lived: We won’t settle any longer.’ Say to all queer people: We’re all innocent, good, and holy.’ ‘Say to all Jews: Soon we all could be safe.’ Not to lecture the downtrodden, after that, I need to listen deeply.

Clients may be stuck on a subject I happened to have done a lot of work about. Lucky them. I will still start by simply listening. As Marshall Rosenberg always said: Empathy before education. I could help extra about: how to fight burnout, quit addictions, feel good, make friends, diet well, fall asleep easily, deal with shoulds, regain pride, become an activist, and work against adultism, able-bodyism, classism, antisemitism, racism, sexism, homophobia, transphobia, nationalism, and any other bigotry.

When they ask for advice, I could just ask what they think. Or, since I try to add my thinking to theirs, if I see several ways to progress, I may say so. ‘I see three ways for you to tackle this: …. Does any of them speak to you? What do you think?’ I may inspire them but not lead them. They lead.

Something really fantastic I sometimes can do for a client or a couple is to figure out the main problem spoiling their lives and the one thing they need to do to tackle most of their serious troubles, to do different, to build a life with all their dreams coming true.

It is not up to me how many sessions to take. Often, I’ve thought: ten more sessions, it’s going well, but the client says: That’s enough for me. Or the reverse: I think we’re done, and the client says: Ten more sessions, please. So, I try to focus on everything brought up since it might be the last time.

Especially when working with a client longer, I may challenge them to step out of their comfort zone: the shy to speak up, the haughty to be meek, etc., but not to try to make them ‘normal.’ Rather, when we have grown crooked, there is a story there and hurt to heal. This can help to bring up and clean up whatever happened that bent them and kept them like that.

With clients who told their life story and worked on problems for years, I won’t sit back and let them do all the work on their own. I chip in by saying things that are hard for them to say. When they’re doing well (laughing, crying), I add oil to the fire or cheer them on. This isn’t my time to be lazy. Yet, I guard myself against ‘taking over’ the control of the session. And if I actually exaggerated and was too active for this client this time, my ‘punishment’ is to go listen a lot and so give back the power to the client.

I try to formulate homework. Why should all the effective emotional work only happen in my presence? Don’t try to ‘forget’ what upset you. It won’t work. It’ll come back ten times stronger. Rather, every time you think of the Devil, realize they frightened you for nothing, and you can get rid of this terror by making fun of it. Say to it: ‘YOU are more powerful than G^D? Whoahaha.’ Don’t get intimidated anymore. Or at least, bring the Satan idea to a virtual museum and look at it while being lightly amused.