6 自我认知

CHAPTER 6 Know Yourself To fully relate to another, one must first relate to oneself. —­Irvin Yalom W hy did you become a therapist? Let’s look at what some therapists participating in the online FAP community have to say. I knew what it was to suffer. I wanted others not to be alone in that suffering. To be there when others want to run, when even you want to run. I fell in love with the science of psychology at a time in my life when I felt a strong need to learn more about myself. Then, after witnessing the great potential psychotherapy had for bettering the lives of people, I decided that practicing it was what I wanted to do with mine. I wanted to pull one other person out of the hole I had been in. At the beginning, to help people suffering. Right now, it is a selfish reason; I am a psychotherapist because it makes me a better person. One of the reasons was to learn how to heal, and to bring that back to my family. Because helping others helps me, and I wanted to turn what happened to me into something good. When I was a teenager I experienced some losses and some pain, and in facing them I recognized the importance of having loving, meaningful, and deep connection with others as a way to heal the wounds I have in my heart. Unquenchable curiosity about the formation and the falling away of knowledge about ourselves and the world around us. Seeing the opportunity to be of service to another person by simply being myself. First I wanted to save the world. Then I realized I can barely save myself. Now I am content if my clients can just sit with themselves. I wanted to make sense of repeated existential crises I experienced as a child, which I continue to experience to this day. I wanted to understand and support my own sense of lostness and other vulnerability and extend my support to others around me—­ultimately to feel less alone. I had a wonderful psychotherapist that made an actual difference in my life. I wanted to do the same for other people. I wanted to understand people, and life. I was deeply curious about the whys behind life trajectories, the whys behind (my own) suffering—­and the big question about the meaning of life—­all the ponderings of a soul-­searching teenager… Only later on it turned into a wish to help others. To understand more deeply why I do the things I do, and why others do the things they do, and with that understanding decrease our mutual suffering. To understand why people (some people) are so miserable. I wanted to help myself and others feel they had real choices in their lives. To have the life they really yearned for. And to know what that was. I was taught from a young age that feelings don’t matter. I got therapy for major depressive disorder as a young adult and had to reorient my approach to emotions. After what I’ve been through, I feel so much empathy for people who are suffering emotionally. I wanted to do something to help others feel better. Curiosity about how people work, how misery works, how triumph works. How families fall apart. A love of story. It is very reinforcing to perceive that I truly “see” someone. I feel reinforced when someone “sees” me—­the good, bad, and ugly. I spent a long time dangerous and destructive. In doing therapy, I could see a way to be useful. That has meant a lot to me. Because I genuinely enjoy seeing people “waking up, becoming alive, and starting to live” this life and taking care of themselves. I wouldn’t put this into words then, like now, but I have the same look in the eyes when I am witnessing “waking up” as then. I woke up and started to take care of myself at the age of twenty-­five, and I am still learning how to live this life. I wanted to help people and better understand my family. And luckily I found the healing through connection, and now I want to show the same path to my clients. Self-­knowledge has always been a fascinating field for me. Being influenced as an adolescent by Socrates and Scott Peck, I took the decision to dive into the exploration of self-­awareness and to encourage others to do this leap as well. I loved ideas and stories of suffering and redemption but believed I was too awkward and deficient to ever help people. At a certain point, because some key people believed in me, I decided to take on the challenge of becoming what I thought I could not be, and of helping others enter their fear and shame as well. In a moment of cynicism an armchair critic might say, “Therapists are in it for themselves—­ they’re all just working out their own issues.” This is meant to disparage therapists, but the cynic misunderstands our purpose and goals. Our personal commitment to our work—­why we do it—­is one of our greatest sources of strength, insight, and empathy. As in any profession that demands intellectual and emotional labor, creativity, persistence through ups and downs, independent thought, and dedicated study, the most compel- ling whys are always deeply personal. If we are to be effective in our chosen field, it is crucial that we are grounded in a living sense of purpose that makes the struggle meaningful. Besides purpose, you are present in the therapy you offer in other ways. Most concretely, in any given moment of any given session, you are not outside the process looking in. You are as central to the process as the client; your reactions are the medium of therapy. We’re not just talking about your techniques and grasp of theory, but also your emotions, your avoidances, your willingness to feel, and your personal experiences and how they shape what you bring to the therapeutic relation- ship. Your worldview. Your convictions. This is the landscape of working as a therapist (Alves de Oliveira & Vandenberghe, 2009; Vandenberghe & Silvestre, 2014). FAP asks you to ground your practice by relating well, to yourself and others, deliberately and effectively across a whole range of social relationships, roles, and situations. FAP shares this focus on personal practice with numerous other therapy approaches: • Psychoanalytic training involves completing your own analysis. • Dialectical behavior therapy asks therapists to develop a personal mindfulness and skills practice. • Acceptance and commitment therapy asks therapists to practice psychological flexibil- ity using the processes in the hexaflex. • Compassion-­focused therapy asks therapists to develop a compassion practice. Across all of the approaches listed above, therapist self-­development is as much about ensuring that therapist issues remain distinct from client issues as it is about inviting the therapist to partici- pate in a more self-­disclosing, self-­involving way. For example, when a client becomes angry at you and you “feel disrespected,” will you remain flexible and therapeutic? Or will you react impul- sively? Will you listen beyond your own reaction to hear what the issue is for your client, distinct from what it is for you? Your ability to notice and modulate your own reactions contributes to what you will tend to evoke (or avoid evoking) and reinforce (or fail to reinforce) in your clients. For example, if you feel angry or ashamed when a client gives you the feedback that she didn’t understand what you just explained, you may subtly punish or extinguish such feedback—­even if that’s the last thing you would want to do. If you are averse to “conflict” or avoid making others “feel bad,” you may not address the negative impact a client has on other people—­and which you experience firsthand in the therapy relationship—­thereby missing a crucial dimension of the client’s presenting issues. Nuanced self-­awareness allows you to step back from such patterns. By seeing them clearly and appraising their costs—­to you and to your clients—­you can instead find opportunities to engage your clients with a flexible balance of courage and compassion. Therapist self-­development is an ongoing reflective process, a self-­discovery process, as well as a skill-­development process. It is well supported by functional thinking. The therapist self-­development process (or struggle) is not just reflected in clinically relevant moments in the therapeutic relationship. Again and again in our consultation with clinicians, we see how the extended process of therapy itself—­especially the trial and error and persistence demanded by challenging cases—­brings therapists face-­to-­face with their own vulnerabilities around persis- tence, faith, trust, control, and so on. One consultee, for example, described feeling a sense of incompetence and uncertainty when her client did not respond to her initial interventions. In response she felt a great deal of pressure—­ grounded in a genuine empathy—­to help or solve her client’s issues. In other words, the function of her empathy was to increase her distress and ineffectiveness! With consultation, she came to realize that her pressure and anxiety led to more of exactly what the client didn’t need: an expecta- tion of changing, an urgent need to solve “the problem,” and a sense that the problem was intoler- able. And this intention came across to the client even with innocuous questions like “What are you feeling right now?” This urgency to resolve uncertainty and pain had a deep history for the therapist. By practicing acceptance of her own discomfort with uncertainty (and with awareness of how her past had shaped it), she gradually built a more flexible stance from which to empathize with the client’s pain, while remaining grounded in her own perspective, as a therapist, of trust and compassion. In turn she was able to more effectively invite her client to let go of “control” and instead find and embrace the choices he did have. When you master your own fears and vulnerabilities, you don’t just solve those particular issues—­your struggle with uncertainty, or criticism, or whatever; you learn, in a visceral way, what only genuine, boundary-­expanding self-­development can teach you. You learn what it means to face what seems impossible or overwhelming and to grow through the process. So often this is what we ask our clients to do, so knowing the territory personally is invaluable. In this chapter, we will walk you through a series of exercises designed to guide you in your personal practice of self-­development: • The life history exercise asks you to look at your most formative learning experiences—­ both negative and positive—­so you can see clearly where your current vulnerabilities and strengths lie and how your experiences shaped them. • The client history audit, paralleling the life history, asks you to look at how your experi- ences with clients—­throughout your career—­have shaped who you are and where you are vulnerable as a therapist. • The feedback interview is about stepping beyond self-­reflection and looking at your strengths and weaknesses from the perspective of someone you trust. • Risk-­taking is the practice of looking at the important things in your life or therapeutic work that you are avoiding, out of some aversion to discomfort or uncertainty, and deliberately challenging yourself to step forward. • Finally, the therapeutic purpose statement invites you to define who you are as a thera- pist, who you want to be for your clients, and what type of therapeutic relationships you wish to provide.

LIFE HISTORY We are creatures defined by our history. We think of who we are based on what we’ve done. Our expectations of how others will treat us are largely shaped by our history. We learn what will be painful and what will be safe. Because of this learning we are susceptible to missing the present moment and instead staying within the confines of what is safe. The life history exercise is about finding insight from your life story: how your history has shaped you, and in what ways it has created vulnerabilities and strengths. The goal of this exercise is to help you be effectively present in the therapeutic relationship. Telling your story is effective for this goal because it allows you to see the meaning of this moment by recognizing the specific episodes that preceded it. Telling your story is not about the details, rather it’s about the narrative—­how does the history make this moment meaningful? Just as you wouldn’t understand Return of the Jedi if you haven’t seen Star Wars and The Empire Strikes Back, you can’t understand the context of this episode of your life without knowing the past. Consider the following: •Why do angry clients make you especially anxious? Did you learn that anger is dangerous in your history? •How has your history left you unprepared to empathize with those who struggle at school? Did you always find effort relatively effortless? •How does the fear of making a mistake lead you to avoid certain types of vulnerability? Did you learn that making mistakes means you are incompetent or unlovable? Seeing clearly your story creates the possibility of understanding other perspectives. For instance, it may allow you to see that anger is not as dangerous as it feels, or that mistakes are a road to learning. Knowing our story well, even the most shameful chapters—­and living closely with it and sharing it with those who matter to us—­also tends to connect us with a broader sense of common humanity. In his memoir Telling Secrets (1991), Frederick Buechner makes this point and several others well: I have come to believe that by and large the human family all has the same secrets, which are both very telling and very important to tell. They are telling in the sense that they tell what is perhaps the central paradox of our condition—­that what we hunger for perhaps more than anything else is to be known in our full humanness, and yet that is often just what we also fear more than anything else. It is important to tell at least from time to time the secret of who we truly and fully are—­even if we tell it only to ourselves—­because otherwise we run the risk of losing track of who we truly and fully are and little by little come to accept instead the highly edited version which we put forth in hope that the world will find it more acceptable than the real thing. It is important to tell our secrets too because it makes it easier that way to see where we have been in our lives and where we are going. It also makes it easier for other people to tell us a secret or two of their own, and exchanges like that have a lot to do with what being a family is all about and what being human is all about (p. 2–3). Step 1 The first step is to make some kind of representation of your story, either visual or narrative. Option 1: Creating a Visual Timeline On a piece of paper, draw a vertical line down the middle of the page. Label the top of the line “now” and the bottom “birth.” To the right of the line, record positive life events, using the horizontal distance from the line to represent the degree of positivity; in other words, events farther away from the center line are more positive. To the left of the line, record negative life events in the same way. You need not write a detailed description of each event; a brief label is sufficient. Of course, some events may have both negative and positive aspects. In such cases, feel free to record the event on both sides of the line. Option 2: Writing a Narrative Write your history in narrative form. This format allows for more in-­depth description of the cir- cumstances and impacts of various events, but it can also be overwhelming. We encourage you to write freely in a way that works for you. Take as much or as little time as feels right. Do this exercise in a way that is a 2 for you. Step 2 Now step back and reflect on your story and how it has shaped you. You can do this immediately after completing step 1, but in our experience this second reflective step is often more productive after a pause of at least twenty-­four hours. When you’re ready to reflect, read through the following questions and pick a handful that seem relevant to you. If you can’t choose, work through all the questions in order. Awareness •Which key events most shaped who you are today? •What lessons did you learn about yourself from these events? •What lessons did you learn about others from these events? •What lessons did you learn about the world? •What effects have these lessons had in your life? How do they shape how you see specific people in your life? •How do you relate to these lessons? For example, do you accept them or resist them? Do you mostly keep them out of awareness, or do they often make up part of your mental landscape? Courage •As you reflect on your life history, where do you feel discomfort, which may be reflected by emotions such as fear, anxiety, or shame? •Which parts are the most painful to linger with? •Where do you feel urges to speed up and move on? If you slowed down, what would you notice? •What did you learn about taking risks by showing your emotions or vulnerability with others? Love •Where do you feel the most love or compassion in your story? •Can you bring more love or compassion to aspects of your story, perhaps those that are the most difficult to see compassionately? Step 3 Pick one theme from the preceding reflections on your life history that seems particularly relevant to your life at the moment. Then answer the following questions in the context of that theme. •What do you do that is counterproductive? What are your 1s? •In situations in which your 1s happen, what matters most to you? •Relative to your 1s, what sorts of behaviors might represent improvements? What are your 2s? •Look ahead to the coming week, or whatever time frame seems relevant, and identify a few sit- uations in which these 1s and 2s might happen. What would your 2s look like in these situations? Therapist Avoidance Questions Avoidance often occurs in the most difficult or stuck part of our relationships; avoidance of vulnerability limits our closeness with others and impacts our therapeutic relationships. As a supplement to thinking about your 1s and 2s in general, then, think specifically about the function of avoidance in your life. The questions below explore parallels that may exist between what you avoid in your daily life and what you avoid as a therapist. Write brief responses to each of the following question: 106 •What do you tend to avoid addressing with your clients? With the clients you have seen or will see this week, what are you avoiding? •How does this avoidance impact the work you do with these clients? •What do you tend to avoid dealing with in your life? Be specific, and consider tasks, people, memories, needs, and emotions (including longing, grief, anger, sadness, and fear). What are you avoiding this week? This month? This year? • How does your avoidance in daily life impact the work you do with your clients? Once you’ve identified particular areas of avoidance, you can begin to explore what your 2s would be in those situations. It can be useful to revisit these questions over time because avoidance evolves. Optional Exercise: Share the Life History with a Partner One final option for working with the life history exercise is to share your story with others. Sharing your story provides a natural opportunity for vulnerable disclosure and responsiveness from your lis- tener. In FAP trainings, we confine the verbal story to five minutes, not only for the sake of giving every- one time to share but also because brevity compels us to get to the essence of the vulnerability in the story sooner, rather than spending a lot of time on the details of storytelling. Share in a way that feels vulnerable, by which we mean taking a workable step beyond your normal comfort zone into a place of vulnerability. This can be either a small step or a large step; the choice is yours. Whichever life history method you use, take time to respond vulnerably and compassionately after each person shares his or her story. CLIENT HISTORY AUDIT Your history as a therapist also shapes who you are in therapy. On the one hand, many of us remember the client who got away, the client who pushed past all our limits, and the clients with whom we felt powerless. On the other hand, we may also remember the clients who most inspired us or taught us the most about something. In this exercise, you will make a detailed audit of your clinical history. The aim is to put all your clients on the table and, with clear eyes, reflect on how they’ve influenced you. Step 1 Make a list, by year, of all the clients you’ve seen. Consult old session notes, records, and so forth. If you’ve been in practice for more than a handful of years, this task may be quite difficult. Do it anyway, perhaps limiting your audit to the clients you can remember; however, if you have the records, by all means make an exhaustive list. You may add supervisors or consultants to this list as well. Step 2 Survey the list and pick out one client, or a handful, who shaped you the most, then answer the following: •What did you learn from these clients? •What did you discover about yourself? •What did you come to fear? • What do you tend to avoid now because of your experience with this client? Repeat this step with as many clients from your audit list as you wish. Notice any themes that develop in the lessons you learned from clients. Optional Step 3 The final step is an exercise in perspective taking. From the perspective of the clients you most strug- gled to understand or work effectively with, try to answer the following questions: •What did I experience and learn as a child? •How did I learn to cope? •What is my biggest fear? FEEDBACK INTERVIEWS We don’t always see ourselves clearly. And sometimes, in important ways, other people see us more clearly than we see ourselves. In this exercise, you will take advantage of this possibility. The feedback interview is intense because you invite others who know you and care about you to offer insights about your behavior—­both strengths and weaknesses. You elicit this feedback via a structured interview, during which you suspend your reactions (to the extent possible) and instead focus on drawing out and understanding the perspective of the other person. You may come to see yourself more clearly while expanding your grasp of your 1s and 2s. Step 1 Pick someone who knows you and has your best interests in mind. You can conduct the interview solely for yourself. Or, if appropriate and both parties agree, you can take turns conducting the interview. Pick someone you trust to give caring feedback; or, if you’re up for the challenge, you can certainly choose someone who might be bold or confrontational. Either way, be sure to explicitly invite the other person to be honest and compassionate. Step 2 Mentally prepare yourself: 108 •What are you afraid of? •What might you hear? •How would you react at your best? Step 3 Do the interview. We highly recommend using a script to structure the conversation. This can facilitate greater courage, whereas ambiguity or lack of structure can lead to avoidance. Here are some ques- tions you might consider using. Feel free to adapt them as you see fit. •What do you most appreciate about me? •What do you wish I would appreciate more about myself? •What do you see me actively working on in my life? •What do you see me doing that’s self-­defeating? •What do I do that brings others close to me? •What do I do that can put up barriers between me and others? •When I’m at my best, what do I do? •When I’m not at my best, what do I do? Just listen, and clarify. Thank the person for his or her insight. Step 4 Now it’s time to debrief: •Did the feedback fulfill your expectations? •Did the feedback match up with your existing self-­assessment? •How is the feedback-­giver biased? •How is the feedback giver more accurate than you (perhaps more than you’d like to admit)? RISK-­TAKING Risk-­taking is a central personal practice among members of the FAP community. Tim Ferriss, author of The Four-­Hour Workweek and winner of Wired magazine’s self-­promotion prize in 2008, writes that “A person’s success in life can usually be measured by the number of uncomfortable conversations he or she is willing to have” (2007, p. 47). The FAP version of this idea looks something like this: a FAP therapist’s success can often be measured by the number of uncomfortable conversations he or she is willing to have. In essence, the practice of taking meaningful personal risks builds skills that translate to the therapy room. Risk-­taking is about courage—­a willingness to move forward toward what matters while carrying your vulnerability or pain or uncertainty or the reality of failure or whatever comes. Below we offer some examples of practices you might follow to cultivate your risk-­taking in ways that will serve your development as a FAP therapist. Start with option 1 below and then consider options 2 and 3. Option 1 Step back and take a ten-­thousand-­foot view of what you are avoiding in life. Consider your profes- sional life, personal relationships, health, finances, home maintenance, family, spirituality, community, creativity—­anything and everything that is meaningful to you. For many people, there are a few linger- ing elephants that have not been squarely looked at for some time. You know what (or who) they are. Take a deep breath and name them. Write them down on a piece of paper or right here: Now consider these questions and write down your answers: What is most important for you to begin moving on now? And over the coming year? What is the internal or external obstacle you must face to begin moving? oasis-ebl|Rsalles|1490374138 Are you willing to move through that obstacle—­or figure out how to get around it—­in order to move forward? What do you need to do to get started?

Option 2 Every day, take a risk. Remember, “risk” is not the same as “reckless.” It is strategic. A meaningful daily risk may seem quite pedestrian. For example, be more assertive about how you want your meal prepared when ordering at a restaurant. Commit to send out invoices every week. Slow down, turn off your phone, and spend time with your kids (yes, that can be a risk for some). In contrast, a risk can be life changing. Reach out to your estranged brother and apologize. Send a thank-­ you note to your high school teacher. Sign up for a triathlon. Track your daily risks in a diary or some other kind of document. Rate the risk in intensity if you wish. Option 3 Find a colleague or friend or family member who wants to practice deliberate risk-­taking and share your risk logs with each other periodically. Meet over coffee or beer or online and give each other feedback about the risks you’ve taken. Give and let yourself receive appreciation. Gareth, one of the authors, exchanged risk logs with his close friend Chris Hall for a year. Chris was transitioning from unhappily employed to self-­employed to happily employed—­a major set of profes- sional risks—­and Gareth was moving through some of his own early career developments. Those talks were deeply motivating and satisfying highlights every month for both of them. THERAPEUTIC PURPOSE STATEMENT We’ll wrap up this chapter with an exercise in getting clear on who you are and what matters to you in your relationships with your clients and in your work as a therapist in general. While here we focus on your values as a therapist, we highly recommend that you commit to ongoing values work and goal setting more broadly. The acceptance and commitment therapy literature is full of great resources for these types of work (in particular, check out Dahl, Plumb-­Vilardaga, Stewart, & Lundgren, 2009). A note before we get started: While “purpose statement” connotes a finished, polished document, please do not approach this exercise with that goal in mind. Crafting a purpose statement is a practice that you will start imperfectly and then continue steadily—or sometimes in fits and starts—like shaping and reshaping a sculpture from a block of clay. Step 1 Reflect on the moments or messages or ideas or people that have been most inspiring to you in the course of your career; for example, the feedback of a specific client or supervisor, a therapeutic rela- tionship you thought was strong, or a type of therapy you found effective. Don’t worry yet about making anything coherent. Just assemble all the things that made you light you up in some way. Put them in a list or otherwise lay them out on paper or a screen. Step 2 What themes or patterns or unifying ideas do you see in the things that are meaningful to you? What tensions do you see that don’t need to be resolved because, in fact, you are committed to both sides of the tension? Is there anything you put down because “you should,” but in fact you don’t really care for that thing? What seems most important to you? Step 3 Given your reflections above, draft a single statement (or two or three) that captures who you want to be as a clinician today and where you want to focus your intention and energy today and in the coming ninety days. Let go of the need to make something that will last forever and be perfectly right. What feels right today? Step 4 This step is critical. Put your purpose statement aside for at least forty-­eight hours. Then revisit it and ask yourself if it’s still right. What would you change to make it more right for today? Rinse and repeat, continuing weekly or monthly or quarterly or annually forever.

A NOTE ON BOLD PERSONAL MISSIONS: DO NOT LET THE FIELD SILENCE YOU We are professionals. Our first steps into the field begin a process of professionalization, through which we learn to follow the path of what works. We mean this in the sense of what maintains the working of the profession, what obeys the rules and respects the risks that we have not personally experienced—­but that our profession has learned to respect. As students and professionals we benefit immensely from that learning. We agree to follow the laws and principles of professional ethics. We agree to serve our client’s needs and to act on the basis of what is effective rather than what we idiosyncratically believe. And yet beyond professionalism, our work is also intensely personal—­and difficult, and some- times lonely—­because, in part, of the professional structures (confidentiality, individual therapy) in which we work. There can also be a conservatism in professional contexts that insidiously dis- tances us from our more personal experience and values. For example, academic settings and pro- fessional organizations often communicate to clinicians that they should not be open about their own struggles with psychological suffering (and the sense of purpose that can arise from that suf- fering). Thankfully that trend is changing. If you hold a personal mission in this field, do not let the absence of that personal thing in the articulation of the professional rules and the professional context alienate you from it. Cling to your mission. It is not wrong. It may not be spoken by those around you. But it is vital and life giving. Hold on to what is vital. SUMMARY • Develop self-­awareness and practice courage and purpose in order to effectively navi- gate therapeutic relationships. • Maintain an ongoing practice of self-­reflection and courageous risk-­taking to move yourself toward what you care about. • Assess and shape your own 1s and 2s across diverse contexts.