Bring Your Context Into Therapy
April 27, 2010 · Posted in Communication, Mental Health, Parenting, Therapy · Permalink

chp_cell_phoneThe recent essay  In Therapy Cell Phones Ring True by psychiatrist Barbara Schildkrout talks of the snippets of context she gets as her clients take short cell phone calls in her office.

“A mother receives a call from her teenage daughter. One theme of our sessions has been how to deal with the daughter’s “demanding behavior.” The volume is up; I hear both sides. The daughter is insistent about something trivial; mother is endlessly patient, even solicitous. Now I see that this child hasn’t been getting consistent feedback that her behavior is problematic. Guilt has driven my patient to conceal her anger. She is surprised to learn from me how successful she has become at this deception and how counterproductive it is…When another patient’s husband calls to learn the results of her medical tests, I sense his tenderness; this counterbalances my knowledge of their sexual difficulties…A calliope blares from the coat pocket of another patient, a young man. “I bet a hundred dollars it’s my sister!” he says. Clearly she calls him a lot, and he kind of loves it. Oddly, he rarely mentions her in therapy. Now I learn why. He had been afraid to disrupt the sweetness of his sibling relationship by uncovering its competitive core…In trying to grasp the infinite complexity of an individual’s mind, it helps to narrow the focus by closing out the world and creating a place of privacy. But, for understanding the context — the life a patient inhabits outside the office — it helps to let in some of the sights and sounds.”

Schildkrout is on to something – the importance of understanding a person’s outside world to really help them make progress. So why are we protecting the sanctity of the one-on-one therapist client relationship when it obscures so much crucial information? Loyalty to theory? Narrow mindedness on the part of the therapist? Fear on the part of the client? While there is certainly a place and time for individual work, we feel that bringing in the spouse, children, sister, mother of the client -in an ongoing way or even just for sessions here and there- provides critical insight that speeds the therapeutic process and makes therapy much more honest and useful. Though the essay is funny and sweet I wonder why Dr. Schildkrout would just wait for the cell phone snippets– expedite the process and invite those people into the room. You will be much more helpful to your clients!

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