FIRST QUESTIONS: WHAT MAKES COUNSELING WORK?
When a female psychotherapy client begins the search for a therapist she must confront the issue of how guidance and good counsel happen.
How does she know she’s going to the right therapist?
There are a few considerations:
1. Finding someone who can understand her.
2. Finding someone who can care about her.
3. Finding someone who can help her.
Please Don’t Let Me Be Misunderstood
For most people seeking counseling the first order of business is being understood. In general we wont seek the counsel of those that we feel do not have a basic understanding of our condition. And too, being understood can sometimes be the only element desired by a person under duress. Being understood can lead to positive outcomes all by itself. Ever talk about a personal problem with a friend? Just by unpacking the problem, allowing that friend to see your troubles and reflect back to you what you have experienced, can transform your thoughts and feelings about the situation.
Jeanette came to see Dr. Mary and began to talk about her lifelong difficulties with her mother. Dr. Mary listened intently and reflected back to Jeanette what Jeanette was thinking and feeling and experiencing. Jeanette felt she was being heard and understood. But whenever Jeanette asked for what to do about it, Dr. Mary reflected back that Jeanette was confused. And she would simply ask Jeanette what she wanted to do about it. Jeanette said, “I want a better relationship with my mom, I want to figure out HOW to do that!”
Dr. Mary just responded with “you really want to know how to make that relationship better.”
Dr. Mary was using a classic but not necessarily most effective or efficient method of psychotherapy. She wasn’t necessarily caring about Jeanettes dilemma. She certainly understood the problem but she wasn’t able to give practical suggestions and or express deep empathy because the philosophy and practice of her method did not allow it.
Jeanette did get some solace out of her weekly meetings with Dr. Mary but she was left wondering why she wasn’t making any progress in her relationship with her mother and was still not at peace with the dysfunctional communication between her mother and herself.
Sadly, she concluded that therapy wouldn’t work for her.
Understanding vs Empathy
Understanding someone else’s problems can involve caring about them but not necessarily so. A doctor can understand that a condition is causing you pain but still be relatively dispassionate about it. With a mental/emotional condition or behavioral problem, a therapist may understand the problem but have little empathy for the effects it is having upon their patient.
The experience of understanding without concern is a little like drowning in the water while someone describes your situation accurately. Now you both know that you are drowning, but how does that help you?
Understanding + Caring does not always = Helping
Even when you do find a therapist who understands your problem AND cares about how it is affecting you, they may still have difficulty HELPING you.
Gina saw her therapist, Simone, weekly for 6 months. Gina was suffering from an anxiety disorder. She would panic whenever she had to drive any significant distance outside her own neighborhood. She also became very anxious at shopping malls. She had become more and more socially isolated due to her fear that she would have a panic attack and collapse in public.
Simone was a thoughtful, sensitive, kind soul. She became a therapist because she had such incredible empathy for other people that she even ‘felt their feelings’ with them.
Gina, felt that Simone not only understood her emotionally, but actually cared about Gina in a way few people had in her life. Simone not only listened, she showed Gina in her tone and behavior that she wanted Gina to be happy. Sometimes Simone would even become tearful, hearing the sad stories that Gina revealed.
And Gina did feel SOME relief. She felt cared for and this did help take some of the sting out of her hurt feelings in regards to her mother. But again, it didn’t change anything about her ongoing stress with her mother, except when she was in her therapist’s office.
This situation is a bit like a person witnessing you choking on food, being very concerned, WANTING to help you, but not knowing the technique of the Heimlich Maneuver. They understand, they care but they simply can’t help you. They simply don’t have the necessary skill.
Do you want a Heart Surgeon who Cares or a Heart Surgeon who is Skillful?
When Gina came to my office, I did what both Dr. Mary and Simone did. I worked hard to understand Gina’s situation, I genuinely felt empathy for the difficulty of her situation with her mother and conveyed my emotional support to her. But I did one more thing that all helpful therapists do.
I gave Gina real-life techniques, skills to practice both in session and outside session. I helped Gina identify her actual Values, (how she wanted to behave/what life principles she believed in). We then used those Values as a compass for Gina’s direction in her personal relationships, including the relationship with her mother. We then worked on ‘operationalizing’ those values, identifying ways she could actually LIVE those Values in her day-to-day life and in her communications with her mother. We identified Goals (again based on Values), and methods to turn those Goals into bite size behaviors—actions and activities she could actually DO, outside of session, whether her mother was being cooperative or not.
For example, Gina identified one of her life goals as Connection—a desire to connect and feel connected to others and the world around her. Her Connection Value led to a Goal for her relationship with her mother. In this case, it meant finding a way to feel closer to her mother.
Her mother didn’t make Gina’s goal easy. She was in fact, often hyper-critical, gave little emotional support or praise. Up until now, Gina’s reaction to this was to become infuriated, yell and curse at her mother, hang up on her mother, avoid talking to her for months at a time.
Another Objective in order to achieve the goal of a closer relationship with her mother (living out the Value of Connection) was to assist Gina in 2 different ways.
Practical Problems vs Emotional Problems
I worked with Gina to separate out 2 different problems she was having with her Mother’s admittedly highly unpleasant, irritating behavior. These 2 problems are the kind we all share. They are:
1. Practical Problems
2. Emotional Reactions to Practical Problems.
Gina had a practical problem of poor communication between her mother and herself. Anyone witnessing the two talking could see this objectively.
But her second problem, and the one that makes solving the first problem much more difficult, is her Emotional Reactivity to the problem at hand.
We all talk to ourselves. We tell ourselves stories about our reality. We give ourselves commands. We also give commands (in our heads) to other people and the world around us.
Does your Therapist have the 3 Elements of Good Therapy?
So ideally you want a therapist who strives to understand, who cares and who knows how to help you. These are the 3 best elements, when combined, to help you make big changes in your life.
These things are difficult to know up front before you’ve spent time with a therapist. You may be able to get some information from the way they communicate their treatment philosophy on their marketing materials, website. You may also gather other information by the way they speak to you in your first phone calls to inquire or set up an appointment.
Are they demonstrating some Understanding: giving assurance that they have treated similar problems or know how to treat your problem?
Does the therapist convey Caring: does their voice tone or body language, the content of their speech reflect concern and warmth?
Finally, does the therapist convey Skillfulness? Can they explain a bit about the nature of their work, their technique or treatment philosophy that conveys ability to handle the problem being addressed.
But should a Woman choose a Male or a Female Therapist?
One of the initial decisions she must make is choosing the gender of her therapist.
Should she see a female or a male therapist?
There are potential advantages and disadvantages to either choice. It’s important to remember that each psychotherapist and patient are different. There is no gender difference assignment written in stone. This list, by its very nature, is overly general and speaks to potential, not necessarily actual advantages or disadvantages.
Men can be emotional and nurturing and women can be very rational and directive.
Potential Advantages of a Female Psychotherapist for a Female Patient:
1. Just having the social and biological experience of growing up female allows a female therapist to have a very quick shorthand to understanding some of the basic identity issues of female patients.
2. Understanding the social experience of growing up and living as a female.
3. Understanding the effects of hormonal changes on moods and behaviors.
4. Understanding the social rules and prohibitions that each woman must contend with and make personal decisions as to their stance.
5. Understanding the female perspective on male behavior.
6. Potentially offering a positive female role model so that a female client can have a ‘corrective emotional experience’ (in common language—a second chance or re-do of earlier negative relationships with women).
7. Potentially less pathologizing of moods and emotions, more accepting of a wide range of emotional reactions.
Potential Disadvantages of a Female Psychotherapist for a Female Patient:
1. May have blindspots as to Male behavior or perspective.
2. May have blindspots as to female behavior
3. May have countertransference in relation to her own feelings towards females
4. Client may erroneously compare herself to the female therapist and create negative self-evaluations.
5. Therapist may assume she understands female patient and thus may ask fewer questions or refrain from questions as to motivations and thoughts, assuming she understands client because she is female.
6. Female therapist may err on the side of passive, listening stance and nurturing efforts and rely less on active assignments and homework.
7. Patient may feel competitive and alienated from other women, making self revelation more difficult.
8. Patient may feel more criticized and judged by women.
9. Patient may not trust other women.
Potential Advantages of a Male Psychotherapist for a Female Patient:
1. Because the male therapist is biologically male they may have an advantage in discussing male perspective in male/female relationships and attitudes. Therapist can correct some female patient assumptions about male motivation and behavior
2. Because the male therapist is not biologically female they are likely to ask more questions about female patient motivations, thoughts, behaviors—since none are assumed to be the natural state of things.
3. The male therapist may provide the first experience of male acceptance, safety, willingness to listen to the female patient without a personal sexualized agenda.
4. Potentially offering a positive male role model so that a female client can have a ‘corrective emotional experience’ (in common language—a second chance or re-do of earlier negative relationships with men).
5. IF a female patient has grown up without a primary male caretaker in her life, she may wish to experience the care and concern she has been missing in her formative years which may provide additional emotional reparative effect.
6. Potentially a pro-active, solution focused therapeutic stance that is based on problem solving and logic.
7. Historically, men have spent more time at work than at home and may have less active communication with daughters. A male therapist can be an emotional surrogate that provides nurturing and problem solving in a way that the biological father may not have been able to provide.
Potential Disadvantages of a Male Psychotherapist for a Female Patient:
1. May erroneously assume that hormonal changes are causative factor in moods and behaviors.
2. May have blindspots as to the effects of male behavior on female psychology
1. May have countertransference in relation to his own feelings towards females
2. May have a more mechanistic, logic based ‘let’s fix it’ approach vs an acceptance of moods and emotions as legitimate within themselves ie. A female patient may simply need a place to be heard, rather than fixed, and this is the solution that she seeks.
3. Therapist may spend more time asking questions about patient’s female perspective, whereas a female therapist may already have an internal shorthand for that perspective.
4. Patient may feel more abused by men and transfer those feelings onto a male therapist.
5. Patient may not trust men.
Straight Therapist/LGBTQ Client
Another positive aspect to a non-biased, inclusive male therapist is the reparative effect he may have on both straight and gay/lesbian female clients. In particular, due to the historical devaluation of this population by straight (often white) males, there is particularly strong reparative effect in experiencing the acceptance, care and concern of a male therapist.
I hope this article assist you in making an informed decision when considering the gender and sexual orientation of your potential psychotherapist!
©2019 Ross Grossman, MA, LMFT
Affinity Therapy Services