There are different ways of doing therapy – psychotherapy, that is. Different ways of approaching it.
There’s the medical model. Based on this model, you go to therapy because there’s something wrong with you. You have an illness, a chemical imbalance, or you’re broken. You need to be “fixed.”
Insurance companies typically work from a medical model. They want to know what your treatment plan is, what your goals are, and whether or not you’re making progress.
That makes sense. In a way.
The medical model is based on the idea that the therapist knows what you need, or at least has some knowledge or information that you’re lacking. That the therapist can guide, direct, or teach you how to get “better.”
The medical model believes you need to receive this guidance, knowledge, or information and make use of it to get “better.” Getting better is objective and measurable in terms of symptom reduction.
Sometimes, therapy works like that. Let’s say you come to see me because you’re depressed, lethargic, and sleeping all day. You rate your depression at an 8, on a scale of 0-10.
So we can work up a pleasurable activities schedule for you and, if you follow it, you will be sleeping less, be less lethargic, and your depression rating will probably go down. It might drop to a 6. Or a 4. Easy as pie.
It’s prescriptive therapy. You say, “here’s the problem,” i say “here’s how to fix it.” If i’m a good therapist, i couch that in collaborative terms, i work with you, i don’t dictate.
But the idea is the same. i’m the expert, you’re not. You’re the one who needs help.
Sometimes, it’s not the person that’s broken, it’s their life. Sometimes, it’s circumstances ~ a death in the family, job loss, and so on. But with a medical model, the principle is the same. Problem = symptoms = need for help.
It seems to me that when you introduce kink to a medical model approach, with a therapist who is not well aware of the BDSM culture, the temptation to see the kink as the underlying problem would be almost overwhelming. Even if it’s just to tweak it a little ~ to make the submissive a little more assertive, the Dominant a little less controlling ~ it could seem so obvious. And some of the time, it might even be helpful.
But the medical model isn’t the only way to do therapy.
My view of therapy ~ and i’ve been blessed to have therapists myself who helped teach me this ~ is that the client is the only one who knows what needs to happen in his or her life. That whatever is going on with them makes perfect sense given their circumstances.
They’re not broken or in need of fixing, even though they may feel like they are. How they are is generally how they’ve learned to be in order to survive and to get their needs met. Since they’re in therapy, what they’re doing is probably not completely working for them anymore. They may want to look at some ways to do things differently, or some new ways to think about things , if they want to feel differently, but i don’t necessarily have “the answers.”
i listen. i try to understand what their experience is, how they see themselves, the world, their past and their future. We look at their life together and see what they think can change.
i do have some knowledge and expertise, and i share that with them, but i don’t have their answers.
It seems to me when you involve kink in the therapeutic mix that the therapist needs to be able to take an observer’s stance. To help the client clarify their thoughts and feelings, explore, consider, ponder, even experiment.
i still bring my values to the therapeutic table. And sometimes they make me not a great fit for someone. When that happens, i’m fairly transparent about it. Then the client can decide if he or she wants to continue with me.
But i think therapy’s a journey ~ it’s the client’s journey, and i’m there as a support.
Therapists talk about “resistance” sometimes. That’s what we call it when the client doesn’t do what we think they need to do. This bothers some therapists. Shoot, sometimes it bothers me.
But i believe in honoring the “resistance. ” i won’t do a tug of war with you over your life choices. You know yourself and your life better than i do. i will want to understand more about it, and will be relying on you to really work to figure out what will be helpful.
i will work to let go of whatever i think the answer is and let the ball rest in your court.
i can be a guide, a witness, or a mirror. i can challenge, cheerlead, shine a light, or point out the path i know. But it’s always the client’s journey.
And i’m not there to fix anyone.
Tags: BDSM
aisha 