This was a bad week. About half of the couples I am seeing, are going through a severe crisis.
And that has an effect on my clinical self-esteem: I feel incompetent.
Here is a sample of my self-talk after a session with certain couples in crisis this week:
“I should have read that book”
“I should have interrupted the session”
“I shouldn’t have made that mistake”
“What was I thinking when I decided to work exclusively with couples”.
And one of my personal favorites: “If I were a better therapist, this would not be happening”.
When I went through couples therapy training, I didn’t even think that part of my job would be to manage my own clinical self-esteem.
Feeling incompetent is an uncomfortable feeling and I want to get rid of it as fast as I can. It doesn’t match with my own self-image as an experienced and competent clinician and trainer. Feeling incompetent makes me feel embarrassed.
So, what do I generally do? For a while, I try to deny it, forget that I feel it, and pretend it’s not there. But, like most feelings, it doesn’t go away and eventually, I have to figure out what to do about it.
I don’t always feel this way. In fact, much of the time I feel competent, sure of my clinical skills, and satisfied with the work I do.
Therapists who work with couples experience swings in their clinical self-esteem quite often.
One reason why therapists who work with couples experience swings in their clinical self-esteem is the difficult nature of the work. Another reason is that couples project on to their therapists their own embarrassment and hopelessness, among other feelings.
Of course, the swings in clinical self-esteem also depend on the individual therapist’s personal and relational history, just like everyone else’s self-esteem.
All relationships are hard. The relationship between a therapist and his/her couples is no different.
Managing the ups and downs of my clinical self-esteem is not an easy task at any stage of the treatment with a couple. One way that I use to address my own embarrassment when I feel incompetent, is the feedback request. Once I am ready to face my own shame about feeling incompetent, I can request feedback from the couples I am working with. I teach couples to understand the impact of their behavior on their partners. Requesting their feedback is, then, also good modeling.
When we request feedback to find out the impact of our actions on people, we can shift how we behave and the relationship generally improves. In fact, it’s one of the main differences between relationship that work and those that do not: Listening to the feedback of another person and doing something about it.
I need to know that what I am doing is working for the couples I am treating:
What is working/not working in our therapy?
What is helpful for you about my approach?
What do you wish I did that I am not doing?
Is there anything I am not paying enough attention to that needs attention?
Sometimes I add: “It will not hurt my feelings if you tell me what’s really going on”. When couples can have an honest conversation with me about my approach, I can sift through what belongs to me and what belongs to them; I can isolate the impact of my behavior on the couple and make the necessary shifts; I can confront them better and in a clearer way.
The feedback conversation can sometimes repair a rift in the therapeutic alliance, align my clients’ goals with my goals for them, increase the motivation of one of the partners.
Feedback often gives me new ideas, and helps me to think about creative ways to help couples. One time, a client told me: “I need more guidance”, and we were able to come up with something new we hadn’t thought about before about how I could provide more guidance, while keeping the client more accountable.
I don’t have a feedback conversation only when I feel incompetent; I actually recommend it on an ongoing basis.
But when I do feel incompetent, it’s a signal that I need face my clients and ask them: “How I am doing”?
It looks like I know how I will start my next session with the couples in crisis.