change · health · healthcare · integrative psychotherapy · mental health · poetry · psychology · psychotherapy · somatic psychotherapy · trauma healing

Last week

Last week…
Over and over session after session;
Patients truth-telling.
Aliveness transforms.

Habit narratives are so damn limited.
Drop them.

I watch the beauty of learning to turn toward experience
And dive in fearlessly.

Inspired, I encourage.
“Fear not. You will not be swallowed up and chewed into bits.”
Experience opens its arms; welcomes them in.
Scoops them up and lifts them high.

Dance  sway  rest  feel
Open in wonderment!

This is real.
The alive one you have always been.

health · healthcare · mental health · psychological inquiry · psychology · psychotherapy · wellness

Psychotherapist as provocateur

Provocateur: a person who provokes dissension; agitator.

Effective therapeutic change must include pivotal moments of therapeutic provocation. Yet we all know patients most love psychotherapists that make them feel good. But honestly unconditional positive regard only goes so far and therapy that focuses on producing good feelings is ultimately unhelpful and frankly dishonest. Why? Because real change rests on the hard work of facilitating mental clarity, humility, uprightness, and fierce compassion—not just in the patient but also in the mental health professional. To accomplish that task, a psychotherapist must be willing to call patients on their blind spots, their hubris, avoidance, and plain old bullshit.

Yes, that can be uncomfortable and possibly confrontative. Therefore, a therapeutic professional has to look deeply at their own blind spots, avoidances, hubris and bullshit with courage and compassionate regard for basic human suffering. We are fallible humans too.

Some of that blind spot work involves honest assessment of whether one is clinging to pleasurable feelings that arise from being a patient’s good gal or savior. Ouch! Even writing that sentence elicits feelings of disgust when I consider how much harm is done to a patient when a psychotherapist is lost in their own ego fixation. That is the worst form of therapeutic unconsciousness.

I remember many years ago reading Irvin Yalom’s, The Gift of Therapy. This manual on how to skillfully accomplish self-disclosure blew my mind and showed me the value of continually assessing the best interests of a patient and acting solely on that. Sometimes I don’t know or I can’t decide what is in their best interest. That is when I ask them directly.

Often asking involves provocation in one form or another. Provoking by questioning a blind spot or naming an oft-discussed avoidance. Even directly pointing at hubris, assumptiveness, or outright disownment of responsibility. This kind of provocation for the purpose of clear-seeing can frustrate or even anger a patient. Anger shows they trust you. So rather than backing away in fearfulness, lean in to skillful inquiry.

It’s like surfing a wave of habit reactivity on a surfboard of mutual curiosity about the patient’s feelings. All while inviting them to join you on the surfboard of openness to accomplish shifting reactivity to responsivity. Not rejecting; not accepting—this is the way to model equanimous provocative inquiry that leads to wisdom and transformation.  

And best of all, this process allows a psychotherapist to model fearlessness and facilitate movement away from defensive eruptions and into intentional, deliberate engagement with confused or distressful thoughts and feelings. For me, that movement produces the most change. Change born from a patient skillfully facing their own internal provocations and realizations with or without the psychotherapist.