Dear Dr. Brilliant Cliché;
I wanted to write to you about my friend Betsy. This is something that maybe you should know.
Betsy has been going to therapy for about 2 years now. She originally went when she was going through a divorce. She stayed because she hasn’t seen much improvement, but it gives her a sense of security.
Betsy’s biggest problem is that she just isn’t very good at understanding verbal concepts so she doesn’t get most of what her therapist says. But she doesn’t want to tell him that because she’s afraid she will look stupid as well as neurotic and needy. So she nods and smiles and acts like she knows what’s going on. She goes home and handles everything the way she always did. Then she feels totally messed up until she sees her therapist. She says listening to his voice calms her down.
I don’t know how many people approach therapy this way, but you guys should realize that we didn’t have six or more years of university and don’t have the understanding of vocabulary and concepts that you do. Can you try to keep the talks in plain English? I’d like to see people like Betsy get more out of their visits than they can from listening to a new age tranquility tape of the ocean.
Wanda Watts
Dear Wanda,
I agree that this is a huge problem. Many clients are in trouble because they think more about others than themselves. Because they have a desire to please others, they just smile and nod and act as if the therapist is brilliant when really they have no idea what’s going on. They can’t stop anticipating what the therapist is thinking of them. Psychological tests can become skewed for this very reason- people answer questions thinking what is expected of them to answer rather than what they really think. Such people are difficult because they don’t know how to help others to help them.
Honestly the therapist could be saying the A B C’s and it would be the same. Many people would smile and nod and feel that they just don’t understand the metaphor.
The other thing that causes a smile and nod reflex is politeness. Clients can feel it is impolite to disagree. Many times I’ve had people smile and act as if I have changed their lives with my brilliance- then immediately after the session they would switch to a different doctor. They were really offended by something I said but couldn’t say so to my face.
Therapy needs to be a two way conversation; that means you should ask questions if you do not understand. Stick up for yourself if you disagree with something that is said and clarify by saying, “so what I hear you saying is…? “
We live in a passive TV culture where people watch blankly or are spoon-fed information. People aren’t accustomed to asking questions or being asked their opinion. Communication skills aren’t really emphasized in our culture.
It is something all therapists must keep in mind and check in often to see if they are on the same page as their clients. But the smile and nod thing is tough. Communication isn’t easy and if people were skilled at it in the first place many wouldn’t have the need for therapy. Often communication is the first issue that has to be dealt with before anything else can follow.
Dr. Brilliant Cliché
Granny says:
It seems to me that it would be easy enough for a therapist to figure out if someone was just sitting in a coma or if they really got what you were saying. As an artist and workshop program director, I often have to explain things to people that must be clearly understood. If one of my assistants is just playing lip service and doesn’t get it, they’ll be useless to me once the action starts. In order to make sure that my words are clearly communicated, I ask people to say them back to me, exactly as they understood them. If they weren’t listening, or didn’t get it, it’s instantly obvious.
You can’t do that with a test, but you can do it when you talk to a human being. I thought that’s what therapy was about. Oh, excuse me, I forgot that these days psychiatric medicine is about multiple choice charts, symptom clusters and the DSM-5.
And Dr. Brilliant- I know you think outside the box, so don’t consider that a jab thrown at you. It’s my guess that if patients walk out it’s because you hand them the truth instead of a prescription for some mind numbing drug. But I’m just guessing.
Dr. Brilliant Cliche 
Comments:
@ The Granny Doctor:
Yes, but communication in therapy isn’t as easy as it seems or should be for people lie. Whether it is because they believe the lie, because they don’t know they are lying or because they have an investment in their symptomology and don’t want to give it up, many people who come for help lie. Sometimes it is obvious but often it is not and you can’t point out the lie as people do not want to hear it.
So it isn’t as simple as giving instructions.
Dr. Brilliant Cliché
Granny says: Nobody is saying that communication is easy or that assimilating advice is the same as hearing it. But whether someone is lying to themselves or not, you can tell if they interpreted your advice accurately or not. What they do with that information is another story, but making sure they at least heard your words accurately is easy.
Moo Kitty commented: When tutoring kids it’s about the questions you ask. If you explain something then say, “Does that make sense?” They almost always say “yes”.If you ask them to explain it back to you, give their own example or apply the explanation to a problem they often can’t. I’m thinking that a therapist and therapy recipient probably need an agreement that it’s a two way deal. A therapist is teaching and a patient needs to be an “active listener”. That said, it takes years to learn the layers of what the therapist is explaining.
Dr. Brilliant Cliche commented: All true and good points… and yes, it often takes a base of experience to build on before NEW ideas can be entertained and embraced.
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Dear Betsy,
A new therapist may hide behind formal education language to buy for time because they’re petrified to say one thing: “I don’t know what to say.” I’m not saying the therapist should admit that but it would be better to say nothing than to say things just to fill the silent air. Formal education doesn’t make the therapist. Trust your instincts Betsy. If you don’t think the therapist heard what you said, ask the therapist to rephrase what you said. After all, you were told during the intake the therapist was an intern. When was the last time you got your haircut at a hairdressing school? Don’t you always go to someone who is licensed?
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Just another thought. Betsy may not be confident enough to act on her instincts. She may briefly question the therapists responses to herself, but lack the practice to question the therapist’s conclusions. Its hard to be in the position of need and at the same time to really trust someone else. The test of real trust is the awareness they are doing something substantial for you.
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