This week I was again reminded of two core issue in psychotherapy and how easy it is to get them wrong: 1) timing 2) interpretations.
Timing, of course, is everything in therapy. You can have the best strategy in the world, but if you get your timing wrong, it will be of no help to the patient. One of the most common mistakes I see when I supervise mental health professionals, is that they get ahead of the patient. It’s understandable: we’re here to help and we want to give the patient something useful as soon as possible. But sometimes it’s better that we don’t. The key question is: how do we get our timing right? The answer is simple: we pay attention to the patient. They will tell us. Maybe not in words but with what they don’t say, their choice of words, tone, rhythm, eye contact, their shifting in the chair, moving forward or back as well as facial expressions (In particular watch out for instances when the verbally expressed affect doesn’t match the facial expressions). Some of this you will register on a conscious level but much of it will be processed on an unconscious level. However, two things are clear: you have to stay closely attuned to your patient and you have to become proficient at reading your own intuition because that’s where the unconscious reading of the patient’s cues will let themselves be known to you.
I agree with Glen Gabbard’s observation that interpretations in psychotherapy are “high risk and high gain”. When we get it right, the patient and you suddenly have a shared understanding and there is often a quiet celebration between therapist and patient because things now make sense. But when we get it wrong, we need to swing straight into repairing the rupture in the therapeutic relationship. Basically, if the patient is not agreeing with your interpretation – stop. It doesn’t matter if you’re right or wrong because if you keep pushing it, the relationship with the patient will suffer. If you’re right in your interpretation, chances are that you’ll get another chance to share it with the patient. After all, treatment often circles around the same few core issues for each patient. If the patient is not ready to hear what you have to say, you need to stop talking (remember the importance of timing?)
Interpretations are best presented with words along the lines of: “I wonder if..” Because an interpretation is a hypothesis – an educated guess – and we don’t always get it right. Like all good scientist, we should try to disprove our hypothesis and to acknowledge that although we’re experts on mental health and psychological interventions but we’re not infallible. Getting it wrong is generally not a big disaster if we’re willing to admit to it, abandon that line of inquiry (at least for the time being) and make immediate repairs to the therapeutic relationship