Can We Talk?

Life is what happens to you while you’re busy making other plans.

According to Wikipedia, this quote, most commonly attributed to John Lennon, goes back to a (then) famous cartoonist in 1957.

Psychotherapy 1006As time has passed, I’ve been conscious of the fact that since starting this blog I’ve gained a few followers, several of whom have made kind comments as well as following the blog.  I follow a couple myself, and some of them which post frequently seem to have a lot of filler material, like “ten ways to be happy” and “seven ways you sabotage yourself.”  I’m all in favor of happiness, except as inappropriate affect in psychosis, and I don’t believe in self sabotage. Those who have followed this blog long enough may remember the post on that:


But I try not to post unless it’s something closer to my own heart. I’ve got a lot of little emails that I’ve sent to myself with the title “blog food” and I’m sure I’ll get around to developing them eventually.  Lately I’ve been pretty busy with real life clients, some of whom have been significantly struggling, and some of whom have blessedly been doing a lot better. Or in a couple of cases, both. Thus the quote.

But I’ve been thinking of the classic picture of the therapist as a “well paid friend,” as radical psychology once posited. I’ve had some extremely friendly relationships with clients, and some that were quite prickly– but therapeutically successful. One framework about paying for therapy is the idea that you pay for the time, but what happens in that block of time is something that money may not be able to buy.

I’m thinking of two relative extremes in how sessions have gone with people. The cases I’m thinking about are not unique, one-off happenings, but actually represent styles, if you will, in how people use a therapy hour. The first is represented by the client coming in and having what seems like a rather upbeat, rather superficial conversation. In any number of cases I’ve interrupted the flow of such a session to observe this to the client– hey, we seem to be having a friendly chat. Do you have other people in your life with whom you can have conversations like this? In a lot of cases, the answer is no. That’s part of the client’s problem. She or he needs to develop interpersonal skills in connecting with people. In other cases, it’s about the client having come to therapy originally to deal with depression but not seeming at all depressed in the session. For the one, we’ve actually identified a life issue– how to create the kinds of friendships that allow for more conversations with the right kind of people. For the other, the therapy hour might represent an island of calm and sanity in an otherwise chaotic and bleak world. Either way, the seemingly superficial conversation doesn’t turn out to be exactly that. Making sure it’s not is part of my job.

The other kind of session is exemplified by the client who comes in, says a few words about how terrible everything is, then bursts into tears and sobs deeply for forty-five minutes. then, with a few minutes left– and me wondering if the person is going to be OK to leave– they pull themselves together, stop crying, thank me for the chance to be completely vulnerable for an hour in a life where they have to keep up a stoic, unwavering front, and then walk out the door, completely self-possessed. I’ve had some amazing, therapy-wise clients who can really unpack a lot in a session– and then pack it back up again until next time. Talk about some awesome boundaries!

Over the course of therapy, some people have done all of the above. Some none. My point(s) is(are)  that there’s a lot you can pack into a completely focused, uninterrupted hour, and you can use the time in completely different ways that are very helpful.

Then there are folks who can’t manage to stay away from their cell phones, even in a therapy session… but that’s for another time.

Therapy image by : Athanasia Nomikou from


About jamesmatter

Marriage and Family Therapist (MFT) in private practice in San Francisco. I work with adults, adolescents, and couples, with focus on substance use and abuse and co-occurring disorders (having both a mental illness and an addiction).
This entry was posted in behavioral health, Depression, Emotions, Feelings, Therapy processes and tagged . Bookmark the permalink.

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