Edward S. Hume, M.D., J.D.
Rules Of Thumb For
The
Practice Of Psychotherapy
Feel free to print out and post this stuff.
Watch Your Countertransference
1. Not with patients! The "No
Intercourse"
rule --- no sexual, financial or social intercourse with patients: no
relationship that starts from a therapist-patient encounter.
2. Never work harder than your patient does
(the
patient will watch you do the work…).
3. Don't push your own agenda onto your
patients.
In other words, watch your countertransference.
Watching your countertransference is good for another reason: the
set
of feelings a patient provokes in you gives you a valuable insight into
that
patient (e.g. --- if you find yourself losing hope, your patient may be depressed).
Watch Your Boundaries
The easiest was to end up violating Countertransference rule #1 (not with patients) is to get sloppy with your boundaries. In fact, studies of therapist-client/psychiatrist-patient violations indicate that the trouble starts with those violations. In fact, your most troubled patients would rather not know much about you, no matter how much they ask. Freud was absolutely right here.
Patients are reassured when you have the continence not to spill yourself all over their therapy hour. They want to talk about them, not hear about you (see Countertransference rule #3).
For more about boundaries, see Back off
when
working for trauma survivors, OMHNews 1/95, p. 16 [NY State Office
of
Mental Health publication], by Maxine Harris, PhD.
Respect Defenses
Never try to take a defense away from a patient --- unless the
patient
already has another defense to use against what the defense is
defending
the patient from (but then, if the patient is ready to use a healthy
coping
skill, you won't have take the old defense away, will you?). [Did I
hear
some old Austrian guy muttering something about symptom substitution?]
See Countertransference rule #3.
O'Neill's
Law (on the families of patients):
Keep in mind that for every "one" in here (the
hospital,
the clinic, etc.) there is at least "one" out there.
Listen, but don't throw away your brain
Listen to your patients --- they will tell you what is wrong with them.
But remember: patients lie (Newton's law) --- or at least, give you
information
from their perspective, which may not seem "factual" from your
perspective.
So don't forget to talk to other people, too.
Do your job
Even if the patient is a "crock", and you are sure there is nothing
wrong
--- just imaginary problems --- do a thorough examination and
appropriate
workup: you are a professional, and you are paid to do examinations; do
what
you are paid to do (Chasanow's Challenge). Also: this time the patient
just
may have a real problem. After all, hypochondriacs have a somewhat
longer
lifespan than the rest of the population, perhaps because they get
earlier
attention to their real problems.