Therapeutic Conversation

by alkjash4 min read24th Jan 20184 comments

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TherapyConversation (topic)
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In a mad world, all interaction is psychiatry.

Here is an idea which I believe originates from Carl Rogers: conversations should be therapeutic for both parties. Thus, one should approach a serious conversation between friends as both therapist and patient. This post is about taking Rogers seriously.

Many have written on how to be a therapist. What is missing from the discourse – and what I aim to correct – is how to be a good patient.

BE THE PATIENT

I fear that when people hear Rogers’ dictum, they imagine two people taking turns trying to therapy each other. I fear that an aspiring conversationalist who reads this kind of advice decides to spend his time exclusively pursuing the art and craft of psychotherapy.

Becoming a good therapist is hard, but it seems to me that becoming a good patient is easy, and that’s where people should marginal (am I using that word right?). Nobody thinks about their skill level as a patient. As a starting point to taking Rogers seriously, spend at least half your energy trying to increase your patient skill level.

What characterizes a great psychiatric patient? The best therapists recognize that a basic willingness to change is the minimum precondition for therapy. In the past, I have entered defensive or inattentive into conversations with master conversationalists, conversations I fully expected to change me for good, only to find the first hour or two entirely wasted on gradually kneading away my automatic defenses and aversions. A great psychiatric patient is someone who skips the superficial tug-of-war that frames the conversation and goes directly to the life-changing catharsis part.

I’m not saying one must immediately prostrate oneself as a mentally broken psych patient in every casual conversation one strikes up. However, in the course of many long nights of meandering conversations one develops a certain instinct for where things are going. It sounds like: right now, it’s only midnight and we are only allowed to skim the surface of things, but by the time 3am rolls around we’ll be inconsolably weeping about our anxieties and self-sabotaging tendencies. When such a foreshadowing strikes, don’t beat a tedious retreat against it. Surrender immediately.

The rest of this post is a meditation on the intrinsic value of human beings. It serves, I hope, to induce the requisite respect for another person that one needs to become a good patient in a therapeutic conversation.

INTRINSIC VALUE

I was recently asked if I believe that human beings have intrinsic value. I was sufficiently unsettled by the question to start defining words. Here is a partial answer.

What kind of qualities would inspire me to treat someone with genuine respect? Sentience and the capacity for suffering are the standard answers, but knowing the other person is capable of pain hardly raises them in my eyes to the status of therapist.

The standards for intrinsic value must be the highest possible ones: the metrics against which I measure myself. Here are my four metrics, very much informed by the Christian mythos.

  1. Divine Spark: the capacity to create something out of nothing. Around heroes there is a sort of reality-distortion field within which the laws of physics cease to exist – well, not to exist, precisely, but to be relevant. Such a person will stare into the distance as if to pierce the veil and return from it with a single sentence that throws you, mentally, like a ragdoll, off the trail of an argument you’ve practiced a thousand times.
  2. Pluripotence: the possibility of fulfilling the dreams of an entire civilization. I used to think that children are filled with possibility, but adults must choose one specialization and be content with their lot. Then, I met people simultaneously awesome in so many dimensions they seem to have drank a Greater Life Potion. Lowering yourself in the presence of such a person is easy. I recently spoke to a past mentor who is simultaneously a leading mathematician, one of my favorite lecturers, the life of the conversation, a programmer and startup founder. When his daughter wanted to learn a foreign language, he personally found her a pen-pal during his travels in that country.
  3. Resurrection: the ability to be continually reborn and rejuvenated. There is a reason Fawkes’ tears are healing and Daenerys Targaryen went willing into the pyre when Drogo died and the last vestiges of her old identity along with him. One cannot be reborn better and stronger without first dying. A common romantic story goes like this: the man offers the woman a knife, points it at his own heart, and says, “Marry me or kill me.” This is deeply cruel to both parties, but somehow right. When the man is rejected, the woman judges some part of him to be insufficient, and participation in this ritual allows that insufficient part of him to die.
  4. Heroic Responsibility: personal responsibility to save the world. In an interview about his new self-help book “12 Rules for Life,” Jordan Peterson was asked if he ever fails his own standards. He responded (paraphrased), “The fact that we are not currently in the Kingdom of Heaven is proof I’m failing all the time.”

Having defined the term, I cannot say for certain that I believe everyone has intrinsic value. I can, however, report that when I began to treat people as if they have intrinsic value in all the senses above, only good has come of it.

It seems to me that to treat people with genuine respect, one must entertain delusions of grandeur on their behalf. What does it mean, after all, for a friend to believe in you? It means that they hold onto your dreams for you even when you lose track of them yourself.

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I'm not sure that the advice you give will make the medium person on LW a better patient.

If you use your system II to silence the system I defenses that come up the therapist will have it a lot harder to actually work with those system I defenses.

Eugene Gendlin did research on what makes a good patient and came up with Focusing as a way to teach the central skills he identified.

Having defined the term, I cannot say for certain that I believe everyone has intrinsic value. I can, however, report that when I began to treat people as if they have intrinsic value in all the senses above, only good has come of it.

What changes when you treat people as if they have intrinsic value in the senses above, and why are those changes tied to the above criteria?

I think very, very few people have the qualities you've described (I personally don't think I do), and I'm sad at the thought of how incredibly high this standard is for getting something as simple as genuine respect. It writes off nearly all of humanity, and I think they're worth treating with genuine respect anyway.

I think I see it in nearly anyone, or at least intimations of it. Perhaps it requires a kind of leap of faith. This was the only sufficient to engender genuine respect in myself.

Given that Carl Rogers was a psychologist and not a psychiatrist it feels odd to It's odd to speak to speak here about "how do be a great psychiatric patient".

Being a psychiatric patient is easy. You take the drugs that the psychiatrist gives you.