I appreciate this, as someone who comes to this profession via disability and infant care work. These roles require a different disposition and frame. I think it is important to be discerning about helping and being in or of service to others in a particular manner. “Helping” in matters of the mind and meaning making, to me, requires us to see patients as incompetent or unskillful, rather than whole beings who have agency/autonomy. I care about my patients. I can’t imagine not caring about patients, since I am generally fond of people, but it is a relationship like any other that requires time to naturally develop a deeper sense of care and connection. I have found a degree of frustration in some training/professional development environments in which it is insinuated that I lack care or warmth, because I’m not an overtly kind of saccharine person, which I worry stems in part from this idea of needing to be stereotypically “nice” or “caring” to be “helpful.” I often perceive that, a veneer of nice and helpful, is preferred to authenticity, and perhaps a less obvious but nevertheless genuinely compassionate stance. I have found thus far in this role that patients respond well to challenges to this idea that I should be helpful to them. A part of them might want me to fix their problem or absolve them of something. A part of me may also wish I could as well. I typically light heartedly remind them, and perhaps myself, that I am neither god nor a priest, and I haven’t met many people who truly enjoy being told what to do. I find that folks are receptive to being supported in creatively exploring and developing their own agency when provided a rationale for my reluctance to “help.”
Yes, and…I strongly believe that without an attuned relationship the change can’t happen. The trouble is that we see care typically as warmth and nurture only. Sometimes attunement is playful aggression. Sometimes it is tolerating the feelings of uselessness. Sometimes it is in challenging a patient to consider their position or resistance. I would like to think of all of those positions as care. But I am a big Object Relations and Modern Analysis geek. I know we get criticized as the “touchy feely” therapists. But I think there is solid evidence to support the often intense and brave experience of meeting unmet relational needs.
When I think of care, I think of healthcare... And think genuine care for the patient is an essential ingredient that is lost in algorithms and monkey medicine. For me, it's a crucial part of the therapeutic alliance - I want to know that my clinician is a real human being who genuinely cares about me. Empowering me to manage my life independently is the epitome of care.
I'm more used to seeing nursing described as the caring or helping profession, and think that it acknowledges that sick people are often dependent on others and that genuine human relating in the form of care is profoundly important. Ideally, the goal of nursing - and medicine/psychiatry, and therapy - is to facilitate healing so the patient doesn't need us anymore. I think of care of the soul - holding the patient's vulnerabilities and supporting growth - a spiritual work that is beyond most contemporary therapists.
So I don't see psychotherapy as the caring profession, more typically a transactional one, and do think that's psychotherapy's loss. I think feeling that another human being genuinely cares about one can be profoundly healing. But it involves acknowledging the power a therapist can have as a fellow human being, and maybe that's disconcerting to those invested in the role of the therapist as a disinterested facilitator?
Unscrupulous practitioners use ‘care’ and similar words to lure in new paying clients. This sets unhelpful expectations about the work and self-selects people looking for affirmation rather than change.
So true. Caring and “helping” can quickly have a codependent context. A one upping. Instead coming from a place of even exchange is so important I as the client give you a livelihood, income .. without clients there is no practice.. and in turn I’m getting a safe space to self reflect and grow
I agree with this piece and it highlights something important. However, I would add that caring and helping are crucial aspects of setting the frame for the challenges that effective psychotherapy must present for the client. We all need a secure base from which to explore the jungle, otherwise we may never set out. So, more accurately I would say caring and helping sits right alongside challenge and change - and without the former you cannot have the latter.
This is an important clarification. Psychotherapy is a change process, not a caretaking role. When therapy is framed primarily as “helping” or “caring,” it obscures patient agency and misrepresents the work as support rather than disciplined psychological intervention aimed at lasting change.
Again, while I don’t disagree with what you’re saying, ultimately, this reads a little like click bait…I think only fairly unsophisticated therapists would take issue with what you’re pointing to. Love and care and help are of course involved more or less, in various ways, in the practice of deeper forms of therapy, which I take you to be representing. Maybe longer pieces are in order where the profundity of the thinking of a Winnicott, for example, is acknowledged, rather than seemingly taken issue with.
I have the impression you’d describe anything as “clickbait” that communicates a straightforward idea and is accessible for general readers. If you prefer to read academic journal articles, I’ve written plenty and they’re available online too.
I can understand why you’d have that impression from this comment, which was a touch irritable. But in fact what you describe yourself doing is something I admire, and think it’s often harder to do well than publishing something in an academic journal, by the way. I like your sensibility—why I subscribe and read—but stand by the observation that this very interesting subject—where love and care fit in psychotherapy—deserves more attention, lest the general reader be misled into thinking these aren’t part of the deeper forms of therapy, as I think they are (once we parse what love and care amount to in that context!).
Absolutely right (I started in 1978), we defined therapy as a limited period of time, and the separation phase was usually the most important part. Nowadays, it's about infinite support = infinite payment by a person who never matures.
I can't help but feel there is a huge amount of Social Class lurking in those opening paragraphs. Helping and caring framed as everyday activities with passive recipients and psychotherapy framed as working with people with agency and who can engage in the much trickier business of psychological change all curated by the highly skilled specialist.
I've done all three over many a year, never met anyone receiving help or care who was passive, and whilst the setting for the first two was every day, the professional skills entailed certainly were not (how utterly presumptious).
Good read. This is true but particularly difficult in a profession that prioritizes emotional empathy as a core indicator of morality.
I find that if I employ cognitive empathy, sympathy, any realm of theory of mind, I can stay in line with what you’re saying here. Emotional empathy clouds all of that.
I can see that in its location far off track. It’s certainly plausible and even likely.
But I’ve seen many who just can’t see past their blinding empathy and make terrible decisions, like refusing to introduce change as the defining mechanism you speak of in this piece.
I guess what I’m saying is there appears to be levels of malevolence contributing to this that seem to be intentional at times, and just uninformed during other times.
I appreciate this, as someone who comes to this profession via disability and infant care work. These roles require a different disposition and frame. I think it is important to be discerning about helping and being in or of service to others in a particular manner. “Helping” in matters of the mind and meaning making, to me, requires us to see patients as incompetent or unskillful, rather than whole beings who have agency/autonomy. I care about my patients. I can’t imagine not caring about patients, since I am generally fond of people, but it is a relationship like any other that requires time to naturally develop a deeper sense of care and connection. I have found a degree of frustration in some training/professional development environments in which it is insinuated that I lack care or warmth, because I’m not an overtly kind of saccharine person, which I worry stems in part from this idea of needing to be stereotypically “nice” or “caring” to be “helpful.” I often perceive that, a veneer of nice and helpful, is preferred to authenticity, and perhaps a less obvious but nevertheless genuinely compassionate stance. I have found thus far in this role that patients respond well to challenges to this idea that I should be helpful to them. A part of them might want me to fix their problem or absolve them of something. A part of me may also wish I could as well. I typically light heartedly remind them, and perhaps myself, that I am neither god nor a priest, and I haven’t met many people who truly enjoy being told what to do. I find that folks are receptive to being supported in creatively exploring and developing their own agency when provided a rationale for my reluctance to “help.”
Yes, and…I strongly believe that without an attuned relationship the change can’t happen. The trouble is that we see care typically as warmth and nurture only. Sometimes attunement is playful aggression. Sometimes it is tolerating the feelings of uselessness. Sometimes it is in challenging a patient to consider their position or resistance. I would like to think of all of those positions as care. But I am a big Object Relations and Modern Analysis geek. I know we get criticized as the “touchy feely” therapists. But I think there is solid evidence to support the often intense and brave experience of meeting unmet relational needs.
When I think of care, I think of healthcare... And think genuine care for the patient is an essential ingredient that is lost in algorithms and monkey medicine. For me, it's a crucial part of the therapeutic alliance - I want to know that my clinician is a real human being who genuinely cares about me. Empowering me to manage my life independently is the epitome of care.
I'm more used to seeing nursing described as the caring or helping profession, and think that it acknowledges that sick people are often dependent on others and that genuine human relating in the form of care is profoundly important. Ideally, the goal of nursing - and medicine/psychiatry, and therapy - is to facilitate healing so the patient doesn't need us anymore. I think of care of the soul - holding the patient's vulnerabilities and supporting growth - a spiritual work that is beyond most contemporary therapists.
So I don't see psychotherapy as the caring profession, more typically a transactional one, and do think that's psychotherapy's loss. I think feeling that another human being genuinely cares about one can be profoundly healing. But it involves acknowledging the power a therapist can have as a fellow human being, and maybe that's disconcerting to those invested in the role of the therapist as a disinterested facilitator?
Unscrupulous practitioners use ‘care’ and similar words to lure in new paying clients. This sets unhelpful expectations about the work and self-selects people looking for affirmation rather than change.
It is unethical in ‘marketing’ and practice.
So true. Caring and “helping” can quickly have a codependent context. A one upping. Instead coming from a place of even exchange is so important I as the client give you a livelihood, income .. without clients there is no practice.. and in turn I’m getting a safe space to self reflect and grow
I agree with this piece and it highlights something important. However, I would add that caring and helping are crucial aspects of setting the frame for the challenges that effective psychotherapy must present for the client. We all need a secure base from which to explore the jungle, otherwise we may never set out. So, more accurately I would say caring and helping sits right alongside challenge and change - and without the former you cannot have the latter.
This is an important clarification. Psychotherapy is a change process, not a caretaking role. When therapy is framed primarily as “helping” or “caring,” it obscures patient agency and misrepresents the work as support rather than disciplined psychological intervention aimed at lasting change.
Again, while I don’t disagree with what you’re saying, ultimately, this reads a little like click bait…I think only fairly unsophisticated therapists would take issue with what you’re pointing to. Love and care and help are of course involved more or less, in various ways, in the practice of deeper forms of therapy, which I take you to be representing. Maybe longer pieces are in order where the profundity of the thinking of a Winnicott, for example, is acknowledged, rather than seemingly taken issue with.
I have the impression you’d describe anything as “clickbait” that communicates a straightforward idea and is accessible for general readers. If you prefer to read academic journal articles, I’ve written plenty and they’re available online too.
I can understand why you’d have that impression from this comment, which was a touch irritable. But in fact what you describe yourself doing is something I admire, and think it’s often harder to do well than publishing something in an academic journal, by the way. I like your sensibility—why I subscribe and read—but stand by the observation that this very interesting subject—where love and care fit in psychotherapy—deserves more attention, lest the general reader be misled into thinking these aren’t part of the deeper forms of therapy, as I think they are (once we parse what love and care amount to in that context!).
Absolutely right (I started in 1978), we defined therapy as a limited period of time, and the separation phase was usually the most important part. Nowadays, it's about infinite support = infinite payment by a person who never matures.
I can't help but feel there is a huge amount of Social Class lurking in those opening paragraphs. Helping and caring framed as everyday activities with passive recipients and psychotherapy framed as working with people with agency and who can engage in the much trickier business of psychological change all curated by the highly skilled specialist.
I've done all three over many a year, never met anyone receiving help or care who was passive, and whilst the setting for the first two was every day, the professional skills entailed certainly were not (how utterly presumptious).
“Helping and caring framed as everyday activities with passive recipients” can you elaborate why this is a class-based assumption?
Good read. This is true but particularly difficult in a profession that prioritizes emotional empathy as a core indicator of morality.
I find that if I employ cognitive empathy, sympathy, any realm of theory of mind, I can stay in line with what you’re saying here. Emotional empathy clouds all of that.
I actually don’t think it’s about empathy at all. I think it’s about virtue signaling and moral masochism.
I can see that in its location far off track. It’s certainly plausible and even likely.
But I’ve seen many who just can’t see past their blinding empathy and make terrible decisions, like refusing to introduce change as the defining mechanism you speak of in this piece.
I guess what I’m saying is there appears to be levels of malevolence contributing to this that seem to be intentional at times, and just uninformed during other times.