When I disagree with someone, sometimes, they believe I’m just not listening.
While both can be true at the same time, more often than that, my interlocutor means that he believes I must not be listening because if I were, I would’ve certainly agreed with him. In its more extreme form, he’ll believe that I don’t care him or what he has to say, conceiving of the disagreement as an attack or invalidation of his entire being. As a therapist, it’s easy to become too accommodating, but depending on the client’s treatment goals, the work to be done lies within the framework of his interpretations and the black and white thinking of, “You’re either with me or against me.”
Diagnosing, especially due to its accompanying stigma, is one of these areas where personalization and defensiveness abound. And many refuse its labels. It’s been argued that personality disorders should give way to more affect-related diagnoses, with the focus being more on one’s emotions instead of their decisions. But, if the constructs of personality aren’t used to bludgeon patients with shame (as patients sometimes think they are), we can’t pretend that personality (or long-term patterns of decision-making) don’t affect people’s relationships, moods, and potential to care for themselves. And, yet, attempting to address these realities, along with the anger of being misunderstood, is frequently met with resistance. Fundamentally, most of us want nothing more than to possess the ability to fully control the narrative. However, relinquishing some degree of control in the process of full emotional exposure, allowing oneself to be judged, is a prerequisite to healing.
The therapeutic relationship is always an alliance, which means that the clinician is always asking herself, “What’s best for my client?” And this is where we enter into the arena of truth-telling, asking, “Should I be kind or honest?” Younger therapists normally take the former route, fearing re-traumatizing their clients. But my question to those who believe that is, why not present them with a choice? If I were going to attempt to be both, I’d afford my client my assessment of their symptoms, how I believe they came about, and what I believe the best plan of action is for them. Additionally, I would note the difficulty of treatment, informing them of their freedom to modify or discontinue it at any point. Honesty is expressed in my clinical formulation, and kindness is granted in the message of suspended judgement (i.e. I don’t solely blame them for their patterns and wouldn’t criticize them for ending treatment).
My hope is that my client begins to accept that I am on her side and, of course, she’s open to disagree with any of my formulations. Therapeutic alliances may begin with a general sense of antagonism, as clients tend to test us. But either direction, kindness or honesty, only leads us to oblivion. If you’re merely honest, you fail to understand the role shame played in the client’s upbringing. Many of our patients were pathologized when they didn’t even know the meaning of term. Their parents blamed them for their own troubles and made them feel inadequate. So, their chronic shame becomes triggered by another label. And, if you’re merely kind, you’re infantilizing your patient, effectively telling them that they aren’t ready to understand how their mistakes have influenced their predicaments. To me, re-traumatizing means re-experiencing the trauma. Thus, speaking of a trauma or having a respectful conversation that engenders shame isn’t quite the same.
Additionally, therapists can become overly-preoccupied with formalities. Psychoanalyst Nancy McWilliams notes, “If I find myself preoccupied with issues of diagnosis in an ongoing way, I suspect myself of defending against being fully present with the patient’s pain. Diagnosis can, like anything else, be used as a defense against anxiety about the unknown.” Therefore, at times, we need to roll with the resistance. Obviously, your clinical formulation may simply be wrong and need revision. But, at others, you’ll need to meet the person where they are, moving past the diagnosis, just sitting with their pain. For us, listening can feel as though we’re wasting time. But, ultimately, we’re creating the foundation for future acts of courage. Once safety and a perceived sense of importance is established, denied realities can be explored.
At bottom, resistance is often met with either of the above-mentioned extremes. And, for the most part, if we’re being honest with ourselves, either choice is self-serving. Honesty is used as a way to shore up one’s authority and wall off one’s fear of empathy, as noted by McWilliams. And kindness on its own is little more than co-dependency, a symbiotic relationship wherein two selfish people avoid authenticity while deluding themselves into believing that real work is being done. Therapy, like many of our other relationships, requires a delicate balance of opposing forces. And mastering kindness and truth is the key to cultivating trust.
There’s a difference between being polite and kind. Politeness is about self-protection and managing your anxiety by making others feel comfortable. Kindness is about pushing through your own discomfort to provide them with necessary insight. Many are polite; few are kind. And genuine kindness, or compassion, involves a high degree of honesty.
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