I used to ask groups of graduate students a couple of questions about their own therapies, the answers to which left me so disheartened that lately I’ve just skipped the exercise. They went like this: Can you think of something your therapist did that annoyed you? (Everyone answers yes.) Did you tell your therapist about it? Only one student ever answered yes to the second question. So I almost never got to ask how the therapist managed the information.
Two people cannot be in the same room for more than a few minutes without experiencing some conflict (incompatible goals). (Freud would say the same of one person.) They certainly cannot spend much time together in a power differential like therapy without encountering the problem of whether the patient is going to be marginalized or disqualified for having an agenda different from the therapist’s party line. In therapy, the duty of the person in power with respect to the marginalized voice is paramount. This is because so many therapy patients are in therapy because they were marginalized by others and now marginalize themselves; one way or another, therapy patients are constantly telling some part of themselves to shut up and go to its room (or worse). The cure for this way of treating the self is a welcoming attitude toward all that is human in us. The cure is accomplished by developing a therapeutic relationship in which all aspects of the self (if represented verbally and emotionally) are welcome. This leads the patient to developing a welcoming attitude toward herself when she is on her own, because she learns in exposing these marginalized identity elements that they are not so aversive after all. (The attitude of acceptance will transfer only if the therapist is ambiguous enough; otherwise, the patient concludes that the therapist is especially accepting and not that the patient is acceptable.)
This is the second major frame element in psychotherapy, a welcoming attitude. It’s what Frieda Fromm-Reichmann meant when she said, apocryphally, “Wear old clothes,” after a trainee asked her what to do when the patient wants to smear feces on you. As noted, the kind of therapy I am writing about is one that requires patients to stay in their chair and use words and minor frame deviations to express themselves. So “wear old clothes” stands as a metaphor to describe an attitude, not literal advice.
Good therapists communicate that the patient’s complaints are important—not by asking for complaints, which usually garners assurances that everything is fine or attempts at obedience by reporting very minor annoyances. Good therapists inhabit a welcoming posture, and they detect complaints even without being told, through empathy. They use the content of complaints to explore the meaning for the patient, partly to reflect on the patient’s problematic patterns and partly to understand exactly and specifically how the patient experienced the annoyance, so that any ensuing remedies are specific to what needs remedying. Then, the therapist changes the things that ought to be changed (in the direction of fostering a therapeutic frame), helps the patient reconcile herself to the things that constitute a therapeutic frame, or helps the patient reconcile herself to the deviations in the frame that cannot be remedied.
So if you want to know if you are in a real therapy, complain about something annoying and see what happens. The same goes for democracy, by the way, which is why the right to complain is in the First Amendment, along with freedoms of speech and religion and assembly. You never know if you are in a democracy until you complain and discover whether you will be listened to or silenced.
Michael Karson, Ph.D. 
“…Which is why the right to complain is in the First Amendment…Complain and discover whether you will be listened to or silenced.” That sounds like a great idea until you realize that in the real world sometimes people in positions of authority who lack actual skills will try to silence you instead of looking at their own shortcomings. Often those who speak out are just shot down because the person in the position of authority doesn’t have the integrity or mental acuity to engage in honest introspection. It sounds like you probably spend a lot of time in the classroom and not much out in the real world. I don’t mean to criticize. As they say, “Those who can, do; those who can’t…”
In my view, a putative democracy is not a real democracy to the extent that its representatives violate its laws and values. If petty officials shut you up and violate your rights, it doesn’t matter whether it happens in America or in Somalia, it’s a sign that something’s wrong. There are many institutions that congratulates themselves on their democratic values while shutting up complaints, and only by making (or observing) complaints can we tell which are which. Otherwise, your note is not worth replying to.
I found this post very helpful. But I am curious about this phrase: “The attitude of acceptance will transfer only if the therapist is ambiguous enough; otherwise, the patient concludes that the therapist is especially accepting and not that the patient is acceptable.”
Ambiguous how, I wonder? I seem to fall into this trap with clients — where they conclude I am especially accepting, instead of concluding that they themselves are acceptable.
Much of the therapeutic frame (implicit rules) is organized around achieving this kind of ambiguity, under the rubrics of anonymity and neutrality. There is, of course, no such thing as an anonymous or neutral therapist, therapists being people and all. So the question becomes one of optimizing ambiguity, and I will blog on each topic in future descriptions of the frame. For now, let me say that many self-disclosures are unnecessary, many directives constrict response alternatives, and many professional and social behaviors fill up the space with professional and social expectations.