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Humans of MHT: An Interview with Dr. Vanessa Spooner

Humans of MHT: An Interview with Dr. Vanessa Spooner

In this installment of our series "Humans of MHT," Laura talks with Vanessa about holding contradictions within ourselves, growing up in Maine, and the power of group psychotherapy. 

Laura: Hello, my name is Laura MacRae-Serpa and I am a Marriage and Family Therapist Intern at Michelle Harwell Therapy. I am here with Dr. Vanessa Spooner, who is a Clinician and Clinical Supervisor at MHT, and we are going to have the pleasure of doing the fourth interview in the Humans of MHT series. So, I also wanted to mention that Dr. Spooner is the President of GPALA, which is the Group Psychotherapy Association of Los Angeles - Hello Vanessa!

Vanessa: Hi Laura - How are you?

L: I'm good, thank you. Are you ready to talk about feelings and thoughts about humanness?

V: Let's get started.

L: Okay, I'm interested in knowing what humanness means to you?

V: So, I was thinking about this this morning, as I was getting ready to head into work and for me, I think being human is being a contradiction - that we are so many polarities and opposites and we are constantly experiencing the tension between different thoughts or different feelings. And I think that as humans sometimes we get into trouble when we try to condense ourselves into just one thing - just one way of being - just one way of thinking - just one way of relating to people.

I think sometimes people think that they shouldn't have conflicting feelings or they shouldn't have different ways of relating to people but I really think that the richness that comes from being human is really found in that - in that contradiction. And I think the more we are open to that and the more that we embrace it - the more alive we feel and the happier we are. I think it's a part of our experience. I think some people really enjoy it and other people might feel stressed or trapped by that feeling - that nothing is simple - our thoughts and feelings can change about things -but we also enjoy it and seek it out.

For example, if a movie didn't have some tension in it and you didn't know what was going to happen then you wouldn't feel really riveted by it or if you're reading a book and a character seems pretty one-dimensional then you're not that interested. And people usually enjoy things when there's some ambiguity and there's many different meanings that could come from it - like a painting or poem - things that are so rich because they can have a lot of contradictions in them or they have a lot of different narratives in them. I think for me thinking about humanness that essence really speaks to me - the contradiction - the dialectics of it in that way - that you can have two opposing things happening at the same time and they don't cancel each other out and they can co-exist - like they don't completely contradict each other in that way.

L: Nicely said. True. During our photo shoot, you held up a cutting board of Maine, and I'm curious to know what that object means to you when you're thinking about your humanness?

V: So, I chose the cutting board because it's probably the easiest way to represent that I'm from Maine, otherwise I would have had to show a a state map or something. I chose Maine to represent my humanness because it kind of embodies exactly what I'm talking about- this dialectical opposition that we all embody. For me, a lot of times I have people who are surprised that I'm from Maine living out in California. It’s like - how opposite can you be? - you're coming from the other side of the country. I'm also from a very small town in Maine and there's a part of me that loves being from Maine and there’s part of me that hates being from Maine.

I think I chose that to represent my humanness because we all have mixed feelings about our homes. Mixed feelings about where we come from. We can have a sense of pride of where we're from. We can have a sense of shame, depending on our backgrounds. If I could have it my way then I would live in Maine and work in California. There are so many parts of Maine that feel more like me. It's slower and quieter. You're in nature more, the pace of life is slower and it just seems simple but not in a bad way. like People aren't rushing around trying to do different things. They're a little bit more interested in being. But LA also has a lot of things too. LA has a very vibrant community. LA has way more diversity than you find in Maine - diversity of thought, diversity of ethnicity, socioeconomic backgrounds, diversity of food and restaurants and things like that.

I find that I find myself kind of wondering where I might be in ten years and I honestly don't know. I don't know if I’ll be back in Maine or not but it reminds me of drawing than I did when I was a little kid. I think I was about six or seven and I drew this house that was in the woods on top of like a hill or mountain and I vividly remember making this drawing. I don’t know if I said anything to any of my family members but I know the story I told myself about the drawing was that I want to live in the country in this house in the middle of the woods and then I want to drive to the city and go to work. So, that was the ideal picture that I had in my head when I was a kid and I think I think I'm starting to ramble a little bit but that that's why I chose Maine to represent my humanness. I think there's a there's a tension in me from wanting to be kind of a rural country type girl from a small town and also wanting to be in LA - wanting to be in the intellectual community in Los Angeles as a therapist - so there's definitely the duality there. I think that represents my humanness well.

L: I will be interested to see where you are at in ten years as well after sharing that. See if you're here - maybe living out further and commuting or if you are actually back in Maine.

V: Well, we will see what happens.

L: How does your humanness come into the room with you as a therapist?

V: So, talking about duality - kind of oppositional forces - it almost sounds like I'm campaigning for a DBT therapy - dialectical behavioral therapy. I will say I'm not a DBT therapist but I think one of the reasons why DBT has helped so many people is because of exactly what I've been talking about- that we can have these conflicting ideas or different thoughts at the same time. They can coexist and we can start to understand from a outside perspective - our thoughts - how we feel about two contradictory things. I really like that viewpoint from DBT and I feel like that shows up a lot in my work with my clients - that it's okay to have opposing feelings. It's okay if feelings change. It's okay if your logic and your emotions don't agree with each other but how are you going to have a different dialogue with yourself? How are you going to come to terms with these contradictions and slowly over time make decisions that intuitively start to feel right? And to know that that's part of the process.

I think being human is being a contradiction - that we are so many polarities and opposites and we are constantly experiencing the tension between different thoughts or different feelings. And I think that as humans sometimes we get into trouble when we try to condense ourselves into just one thing - just one way of being - just one way of thinking - just one way of relating to people.

I think people feel like they're doing something wrong or they're stuck or something else isn't right if they're experiencing this tension. And like I was saying before about a movie, if you don't have tension, then the plot doesn't move along. So, if you don't have tension inside of you, then you don't have something to push against. I want clients to kind of embrace that tension and to know that it's not something they're going to overcome and then it's done. Like, if I go to therapy then I'll never have mixed feelings again. I'll always know what I want and it's done. It's not that you're overcoming once - each day you're overcoming this resistance to whatever it is that you might want to be doing. It's the conversation that you're having with yourself to kind of get yourself through to what you want.

It reminds me of this book called The War on Art. The author Steven Pressfield talks about resistance against creativity and he gives it a capital R and I like that because he's naming it. He's talking about how when you're trying to be a creative person, you need to have discipline and understand that resistance is always going to be there. You're not going to create just because you feel like creating-that happens sometimes but not most of the time. So, with my clients in therapy, I want them to kind of have the same feeling - that this resistance, this tension isn't going anywhere but if they are making peace with it inside of themselves then things don't have to be so stressful. There is going to be tension, there is still going to be friction but they're having an experience of themselves. They're not too critical of themselves. They're not shutting down differing points of view or different feelings inside of themselves. They're not limiting themselves to just relating to either other people, or the world, or themselves and just one standard or constricted way. So, I guess that's in a nutshell that’s how I see humanness in the room.

L: What are your thoughts on humanness in the group process or in group therapy? Do you see some similar tension - dynamics?

V: I think group therapy is humanness times a thousand. What I mean by that is that group therapy is inherently full of contradictions and opposition. Every time somebody talks in group, somebody else can't talk and there's always this tension…How much space do I take up in the group? What things are okay and not okay to say? What different types of relationships am I having in the group? I might be relating to someone as a sibling. I might be regulating someone else as a parent. I might want to relate to someone else in the group like a lover but I might be scared of showing that side of myself.

So, group, I think, is wonderful because you get all of these different points of view and there's no one truth to put in quotes- there isn't.  I could say something in a therapy group whether I'm a client in the group or the therapist and everybody in the group could have a different reaction, and all of those reactions are valid in their own way, and all of those reactions could also be reflected upon and shifted in a certain way. So, I love group for that reason. I think being a group therapist you show your humanness a little bit more because just like a parent, you're not going to relate to everyone in the group in the same way. Whereas, if you're in individual therapy, your individual clients don't know - they don't know how you were in the room with the person before them or the person after them. They just know the dyad - the relationship that the two of you have.  But when you're in a therapy group, you're kind of in the hot seat in a good way because everything that you say you have an audience. You have six or seven or eight people who are watching you and then they're also watching you interact with the other group members so, you're going to be you're going to be full of contradictions in that way.

It’s okay if feelings change. It’s okay if your logic and your emotions don’t agree with each other but how are you going to have a different dialogue with yourself? How are you going to come to terms with these contradictions and slowly over time make decisions that intuitively start to feel right?

I think the more I receive training in group therapy, the more I realize how comfortable I have to be with my humaneness in that way. I'm not going to be the same every week. The group is not going to be the same every week and that doesn't mean that anyone's doing anything wrong. It just means that it's a tension that we need to be aware of. I think another tension that comes up a lot in group, that doesn't quite come up in the same way individual therapy is the tension between wanting to be separate and the tension between wanting to be a part of. If you have a group, some group members are going to be very eager in the beginning to be like yes, we're a group and this is how we relate to each other. I understand you. Your story is similar to mine and we're forming into something that's a collective. Throughout the group, there will be periods of time when people don't want that and they want to separate. They're experiencing the tension of what if I don't want to be a part of this group? What if I lose a part of myself if I'm in this group? So maybe I don't talk, maybe I get mad at someone, maybe I don't show up one week… and I think that tension is very much present in our everyday lives and our communities and our relationships. How much we want to be connected? How much we want to be separate? You can definitely go there in individual therapy but I think it just comes up in a richer way in group therapy. You're really seeing it happened in the room whereas in individual therapy, it's the dyad and the client might be worried about getting too close to you. But I think it's a slightly different interpersonal experience when you're talking about the collective - when you're talking about a group instead of the dyad.

L: Thank you for your thoughts and sharing your humaneness and your experience. It's been wonderful listening to you and chatting with you.

V: Great, thank you so much for coming on today.

L: Bye Vanessa.

V: Bye.

Vanessa Spooner, PsyD, is a licensed clinical psychologist who specializes in helping adults work through anxiety, depression, grief, and eating disorders. Dr. Spooner also has extensive training and experience in group therapy and is currently president of the Group Psychotherapy Association of Los Angeles (GPALA)

Laura MacRae-Serpa, MFTI, CCLS has special interests in supporting children and families navigating adoption and the challenges of chronic illness.

Authentic Encounters: An Interview with Dr. Gil Spielberg

Authentic Encounters: An Interview with Dr. Gil Spielberg

Vanessa Spooner: Alright, good morning Gil Spielberg!

Gil Spielberg: Good morning Vanessa.

VS: So, my name is Vanessa Spooner and I am interviewing Gil for this month’s Michelle Harwell Therapy Newsletter. So to warm us up a little bit Gil can you just give us a quick two-minute background on yourself, your practice, your approach to your work as a therapist?

GS: That’s in two minutes?

VS: Maybe three minutes?

GS: How about two hours? In two hours I could do that.

VS: [laughs]

GS: Let's see. I have a doctorate in Clinical Psychology, then I have my analytic training from the Institute for the Study of Subjectivity in New York. That was my individual analytic training. My group analytic training was from the Center for Group Studies, also in New York. And I have taught group therapy in a variety of places over the past 30 years. Currently my practice is group-oriented, but not exclusively, I see individuals, some individuals both in group and individually, some patients just in psychoanalysis, either once a week or more often, and couples. And then I also do supervision at a place called Beit T’Shuvah, which is a Jewish rehab center and in terms of authenticity that is a wonderful example of a place to be.

VS: And so Gil, you touched on what we are going to be talking about today, which is authenticity. What comes to mind for you when you are thinking about Beit T’Shuvah and authenticity?

GS: Well, the thing about Beit T’Shuvah that I really like is that it is the goal of the staff and for those patients who are really willing to engage is to live more authentic lives. Because for addicts in particular, there was a lot of hiding – from themselves and from others – a great deal of deception. So for those people who come in and are allowing themselves to fully engage in the program, they are learning to figure out how to present themselves honestly to themselves and to the world. But the part of this that is particularly meaningful to me is that the staff mirrors that. So the staff also tries to communicate authentically with one another and with the patients. You don’t have much of a sense of hierarchy; you have more of a sense of people trying to find ways of creatively and constructively relating to one another. Which means it becomes a more complicated institution at times, but much more fulfilling for all who sort of enjoy that kind of environment and can tolerate it.

VS: And is that where you come in, when things get more complicated, when you are providing supervision?

GS: I provide supervision in a couple of ways. In sort of the basic aspect of teaching people the craft of psychotherapy, helping them locate where they want to be in terms of their theory and who they are. And then for the organization itself, as well as the individuals, I help them sort of navigate trying to find themselves therapeutically and cooperating in a very complex emotional environment.

VS: And does that guidance you provide them kind of mirror how you are as a leader in your therapy groups?

GS: Not entirely. Partly. It does to the extent that I am always trying to use myself and my experience to help me understand what’s going on. And to figure out what other people want and need from the situation. But in my therapy groups I am much more aware of how to make use of something like transference than I am in a consulting situation, where that is not sort of a guiding task. I have a different task, so I use myself differently.

VS: I could imagine that with transference it can feel a little tricky, because on the one hand it is a very authentic experience between you and someone else, but at the same time there are pieces of it that are repetitive from someone’s past, and so it might be a little less authentic in the present. What do you think about that?

GS: Well, some of this goes back to Freud who would say that within transference the relationship is never fully authentic, because the patient is not really seeing you fully, they are seeing someone else. They may be presenting themselves as honestly as they can, but the relationship is not fully authentic, because they are not totally in the present. And for me, since I’m not fully presenting all of my thoughts and feelings and trying to be transparent as possible, I’m not fully authentic. I’m using my authentic experience, but I may not be presenting it.

VS: So the way that you present it is more filtered, depending on the person.

Gil Spielberg 1

GS: More…filtered is probably correct, but it is more…um…what is a better word?

VS: Like selective?

GS: Yeah, maybe selective is a better word, if I can think of a better word I’ll tell you better. But we can go with that for now.

VS: So what’s the big deal with authenticity? Why is it so important?

GS: That’s a great question. It actually didn’t start out being important. You know, originally when the field was much more medicalized, which was in the beginning of psychotherapy and psychoanalysis, authenticity was nowhere on the map. What was on the map were symptoms and neuroses. I don’t think it was until the Humanists like Carl Rogers came on the scene where they began to change the point of view of psychotherapy to not just relieve symptoms, but to live a different kind of life. And at that point, what was emphasized was the patient becoming more of themselves, sort of getting rid of the shackles of what they were supposed to be. And the therapists presenting more of him or herself. Carl Rogers I think one of his first papers was The Necessary Sufficient Conditions for Psychotherapy (or for Change), I can’t get the exact title of it. One of the things that he talked about was that the therapist needs to present, be genuine, have positive regard and be respectful. But that was new to the field to begin to understand what the therapist had to do as well. So that way the therapist was modeling for the patient to live and talk and relate authentically. And I think within psychoanalysis Heinz Kohut took that over when he talked about having relationships that work true to the self. When he put the sense of self, a vigorous and vital self, in the center of what needs to happen in psychoanalysis. When he did that and moved that into the center, what he did was also to say to privilege living authentically with one’s self and with one’s important relationships. And that had been picked up by the Relationalists and some of the other Intersubjectivists within Self Psychology, who now stress relating more authentically with the patient and with the patient relating more authentically with them. Now in order to relate authentically, a person has to be congruent with their speech, body and mind. And then from there, as a platform, he or she can engage in an authentic relationship.

VS: Can you say a little more about what being congruent looks like?

GS: It’s not just what it looks like, it’s what is feels like.

VS: What it feels like.

GS: The person is…what they are feeling and thinking inside is available fully to them and eventually they can present that transparently to another and that is sort of their contribution to an authentic relationship.  So their feelings can be sensed by themselves or another, their thoughts reflect their feelings, and their body reflects their thoughts and feelings. They’re all sort of working together, they’re in congruence with one another. I think that they are people you may have noticed who, who may have a feeling, even a strong feeling, but you can’t tell what they are feeling, they can hardly tell what they’re feeling. And their body may be in some kind state of tension, but it doesn’t come through easily in what they’re saying. So they are confusing to talk to, and it is not clear what really they are experiencing. So that would be a state of incongruence.

VS: I have definitely experienced that where someone is either confusing, or they wind up, at least to me, like feeling very flat. And I am not sure where the flatness is coming from and what is underneath the flatness.

GS: How do you tend to handle it?

VS: If it’s someone that I’ve been working with for a while, I will definitely try to pay attention to their body and see if there are any signs there that kind of help. If it’s someone that I haven’t been working with for a while, I might try to change the subject or notice when there are any little periods where I notice like a little bit of spark, a little bit of feeling that comes through and I might try to center in on that a little more. But definitely in the beginning it is more of a mystery and I’m noticing it and I’m trying to figure out what to make of it.

GS: Well I tell you, to the extent you can treat it as a mystery and have sort of interest and curiosity, that’s terrific. I think some people get involved in breaking through that defense and it’s too overwhelming for the patient and you lose the experience of being just curious about who that person is and how they got to be that way. And curiosity is such a main part of what we do, maybe one of the most important traits. You can probably get away with a lot of mistakes if you are truly curious and the patient senses it. But that’s another topic.

VS: Well I do feel like that relates back to authenticity in terms of we’re kind of curious about others and if we don’t feel a sense of authenticity from them, then we don’t feel like we can actually get to know them.

GS: Well you get to know the part of them that is defending against it, defending against some other parts of them. You’re still getting to know them, you’re just getting to know more about how they have protect themselves than what they could experience if they weren’t as emotionally protected. But if they can sense your authentic curiosity, that goes a long way.

VS: Does that go a long way in terms of why you think we need authenticity or why we crave it?

GS: I think authenticity has the potential to be extraordinarily nourishing in relationships. It is a way of the self being nourished by the interactions with another. Even if your circumstances don’t change, the fact that you’re having an interaction with someone who you are feeling nourished and they are feeling nourished by you, that is going to change your present experience and your mood and some aspect of the self over time. So it is REALLY important. The sense of curiosity is sort of the foundational attitude that one really needs to have to do this work well. And if you really embody that, people will sense it from you and it is really beckoning for them to be more open with you and themselves. I’m not even sure I’m answering these questions correctly.

VS: You’re not sure if you’re authentically answering them? [laughs]

GS: No, no, I’m sure I’m authentically answering them, I just have no idea if this is really what you are asking for.

VS: You’re doing great. How do you notice the difference between how this authenticity feeds the self in individual versus your groups?

GS: Well in group my goal is to set a culture where people can have as many authentic relationships as they can tolerate and even take risks to do something a little bit uncomfortable. Now sometimes I’ll model an authentic relationship with someone in that I will be fully transparent. Sometimes my interventions are more towards the culture of the group to help the group to step into more authentic and transparent relationships with themselves and others. Sometimes I will point out what is getting in the way. So, it all depends on how I use myself. But basically it is to set the culture of the group, that will help people find themselves and find more authentic relationships with others in the group. Because that is where the growth is, or what is termed in psychoanalysis these days as the leading edge of risk and growth.

I think authenticity has the potential to be extraordinarily nourishing in relationships. It is a way of the self being nourished by the interactions with another.

VS: And maybe in group there is more opportunity for risk and growth since there are more people involved versus individual.

GS: I can’t say there is more opportunity; it sort of depends on what people need. Some people really need the individual experience for various reasons and that is where at different points in their life they will find the maximum benefit. Although my other sense is that most everybody at some point can make great use of a good group experience. The other thing about group though that is most interesting is that you have a lot of personalities and characters in group who are not primarily there to listen well to you and respond to what you as a patient developmentally need. They are there to over time find themselves and so that is very different. As a patient in group you are going to rub up against people that are very similar that you fit with really well and those you don’t fit with really well. And you can learn from both. And that is the magic of group. No one is there primarily there to meet your needs. So right away that is a harsh reality. One that becomes ultimately very very growth-full. Most people pick their therapist because they feel in some way akin or comfortable and the therapist will go out of his or her way to make sure the patient feel comfortable, which is fine, but that means the kind of relationships that they can have is somewhat limited because they have this basic comfort between them. And aspects of each other that might be very problematic let’s say in the patient’s life might not be triggered. It is very hard to have a sibling kind of transference with the therapist. And sibling experiences are very, very important to people’s lives. They’re more important than we tend to give them credit for. And those are much more easily accessible in group.

VS: Can you say a little bit more about why sibling relationships or transferences are so important?

GS: They are underemphasized. We emphasize in the literature the relationship to the parents. And that’s fine. And especially in the early years that’s important. But if you ask people about their lives, invariably what comes up are people’s relationships to their siblings. And if they got along, if they were good mentors and friends to each other, where they fit in the family. Siblings are important and they determine a lot about how we relate to our peers. So the group is a much more natural place to have those kinds of relationships. And in addition, you will find aspects of a parent that you really liked or disliked that may not have been available to you in the individual relationship. And people have all kinds of experiences that come not only from their family, but being in school with friends that are very impactful in their lives and they are likely to find that in group much more easily than individual. Individual they can remember them and in group of course they get to re-experience them.

VS: And it sounds like that re-experiencing can be filled with a lot of growth, but it can also be filled with a lot of discomfort at times.

GS: It is filled with a lot of discomfort, so a good deal of what you do in individual therapy, and especially group, is find ways to help the group tolerate the discomfort. That is very, very important. Because when groups or patients cannot tolerate much discomfort, there’s not going to be a great deal of growth. And one of the larger sources of discomfort is how they feels towards one another when they are in the midst of aspects of their prior experiences that have been difficult. It’s one thing to talk about one’s relationships to a sibling or parent and sort of talk about it in absentia and it’s quite another thing to talk about that as it’s being played out here and now in the room and understanding what you as the patient bring to that experience, how you help to train someone else to be a part of your early drama.

VS: Your job as the leader then is to find a balance between making it tolerable enough for the group to hold those feelings, while at the same time trying to increase the authenticity in the room so that these things can be talked about and felt more.

GS: I think that’s a very good way of putting it. I’m going to help the group figure out how to make that tolerable. I don’t make it tolerable for them, I help the group engage in the process where we can over time find a way to make it tolerable or not.

VS: What happens if it is not tolerable?

GS: Well if it’s not tolerable and it’s not being talked about, people will either begin to shut down and you will have a group that has come to a halt, sometimes called a status quo resistance, or you will find that people will begin to act out a lot of aggression behaviorally: lateness, absences, people wanting to leave the group. Sometimes the leader picks this up because they are uncomfortable in the group – they begin to dislike coming to the group, they are not enjoying themselves, they are finding desires to get rid of the group or get rid of people in the group. And that is one pathway, that through the leader’s willingness to be authentically attached to themselves, they begin to realize that there’s something happening in the group that really needs to be attended to.

VS: And in those types of situations…

GS: By the way, I’m glad you’re following me because I’m just sort of free associating. So I’m glad you’re following.

VS: Oh yeah, I am right here with you. So in those instances in group where you might be feeling some of those feelings, is that something that you are sharing with the group or is that something that you are just using as a way to make a “group as a whole” interpretation?

GS: It sort of depends on the group, where they are at developmentally, what I think their relationships are like, what they can tolerate. Let's see if I can think of a good example that would be great. Let’s see if I have an example [pauses]. I don’t have one at the moment, but maybe I will think of one.

VS: That’s fine. But yeah it sounds like depending on what the group can tolerate developmentally you may be sharing more of your authenticity in terms of how you’re feeling or you might limit it a little bit more so that they can tolerate it and process it.

GS: Something like that. So I had a group where there were a number of people who were quite disruptive in the group, so I remember one time coming in and saying: “I found myself coming in to this group with a lot of tension today. Who’s tension am I picking up?” So I remember using it once that way. I can remember some other time thinking about how much competition there was in the room so I sort of primed myself based upon my own sort of fantasies that were coming to me, I was thinking a lot about being a kid and playing baseball and how competitive that was. I came into the room and someone in the group who I thought was most triggered by the degree of competition and I asked him if they thought there was any competition in the group that we weren’t talking about. So sometimes that will happen.

VS: So it sounds like you use your feelings as a way to try to hone in on someone in the group or to have the group kind of wonder about where these feelings might lie in the group, whether it is in the group-as-a-whole, or particularly resonating with one of the members.

GS: Exactly. Beautifully said. I think I will interview you. Good job!

VS: We can swap roles next time. [laughs]. One final question: How has your definition of authenticity changed over the years? Whether it is through various trainings or just through your own view of the world, how have you noticed it changing?

GS: Well, I will put it in two ways, in terms of my sense of authenticity and what I am looking for with patients. In terms of my sense, my original training was more classically analytic so there was absolutely no emphasis on the therapist/analyst being authentic to the patient at all. That radically shifted, I actually trained at times with Carl Rogers and in Gestalt therapy. So that really changed things around for me and I began to appreciate how important the therapist’s authenticity was. Then by the time I got back into analytic training the field had changed and it was now being valued to a very different degree. So that has allowed me to have a lot more presence and enjoyment in my work. It really wasn’t enjoyable keeping so much of me apart, it was sort of deadening for me. At the same time, I find it more enlivening and not scary in the way that it would have been 20 or 25 years ago to have those authentic moments and spontaneous moments with people. Both in group and individually. But those moments in group are sort of a life blood of what happens in group. It’s inherently a less predictable place. And it needs to be. Once it gets predictable, it’s sort of game over.

VS: Is that what you were mentioning before when you were talking about the status quo?

GS: Yeah. That’s one of the things. Yes. When the group becomes predictable and routinized, it is a level of communication, you have a system that no longer has any perturbations in it. It is never shaken up and therefore everyone is not shaking themselves up and not shaking others up. So it is a shark dying, not moving in the water. The authentic encounters in group are what keeps it going and the ability of the therapist to tolerate all the intense feeling that occur within the authentic encounter is what is more anxiety provoking in people, but what is ultimately the most fun and the most enlivening. Over time I have been able to tolerate more of that, so my groups have more of that. And that part is terrific.

VS: And it sounds like then the patients are able to experience, if they are able to, a wider range of authenticity if you are able to tolerate a wider range.

GS: Exactly. So there’s often as much laughter as there are tears in my group. Because that’s the range of human experience.

VS: I think that is a wonderful note to end on, people in group being able to share as many laughs as good cries. I think sometimes people think that therapy is always supposed to be this painful daunting emotionally wrenching thing and that’s not as authentic.

GS: No, it’s not.

VS: There’s a wider range of experiences and you really encourage your group members to delve into that if they are ready.

GS: Absolutely.

VS: Wonderful. Well thank you Gil for being available this morning for the interview. We’re very excited to kind of mull over these thoughts that you have provided us about authenticity, especially as we are thinking about the new year and how we all at Michelle Harwell Therapy want to help our clients to become more authentic as they are beginning a new year and maybe a new chapter for themselves.

GS: Well you know, it gave me the opportunity to do more thinking more about it. I myself am in a consultation group with people around the country. So I ran this past my group, and that was a great experience and we all had an interesting time talking about it. So actually I have enjoyed the process.

VS: Wonderful. That’s wonderful to hear. 

Gil Spielberg, PhD, ABPP, is a clinical psychologist and psychoanalyst who maintains a private practice in Los Angeles, California. His specialty is group therapy, a form of therapy in which a small number of people meet together under the guidance of a therapist to help themselves and one another by developing, exploring, and examining interpersonal relationships within the group.

Vanessa Spooner, PsyD, is a licensed clinical psychologist who specializes in helping adults work through anxiety, depression, grief, and eating disorders. Dr. Spooner also has extensive training and experience in group therapy and is currently president of the Group Psychotherapy Association of Los Angeles (GPALA)

Clinical Candor: An Interview with Dr. Karen Maroda

Clinical Candor: An Interview with Dr. Karen Maroda

M: I'm at the tail end of my analytic training and I’ve become fascinated by how my mind has shifted in the process of training. How in love I am with this process, this way of thinking but how inaccessible it feels to the masses. I don't think it has to be. My idea with my newsletter and blogs, similar to analysis, is how can we think more complexly about simple ideas and think more simply about complex ideas. Karen, I think you excel at this. You have a great ability to speak about ideas in a really clear and approachable way. Before we jump into the idea of candor, can you give us an idea of how you got interested in psychoanalysis.

K: My mother, who we did not have a college education, was naturally psychologically minded. She would observe our emotions and if it wasn't clear to her what I was feeling or why, she would inquire. She would say, “Well, Karen you seem a little down or you're not as lively coming home after school. Did something happen?” She always knew of course. She was very intuitive. She was just asking, “did I want to talk about it?” So, in a sense, my mother was psychoanalyzing me from the time I was young and inducting me into the whole notion that you don't just accept what someone says at face value, that you should trust your feelings. I think that my mother introduced me to the whole notion of trusting my emotional intuition and that asking someone about what they were feeling was an expression of love.

K: It’s been life pursuit, a way of being. I was speaking in Indianapolis a few months ago and I was pleased to hear a candidate talk about psychoanalysis not simply as a profession, it’s a calling. It’s a life.

Dr. Karen Maroda

Dr. Karen Maroda

M: Yes! I had this experience when I was developing as a young clinician where I would get around analysts and I couldn't always keep up with the terminology used but their minds were so alive to me. They had this spontaneous quality. It reminds me how you shared the origins of the word candor is candid which evokes a sense of freedom and spontaneity. There was a flexibility and freedom to explore, play and reflect that was more than the sum of its parts. And I could just feel the difference between their mind and my own. It's a way of thinking and being that that evolves overtime...

In your paper on counter-transference, you talk about how clinicians, by our nature we are often empaths. We feel, we care, we listen but we are not very good at being direct or honest both clinically and in our lives.  How do prepare your client for the role of honesty in therapy?

K: Well, most people don't really understand what an analytically-oriented treatment looks like. I tell them the three basic rules are: they have to show up, they have to be as open as they reasonably can be given that no one is completely open, and they have to pay. (laughs)

M: (laughs) Good basics.

K: Then I usually explain about transference. That any of their feelings toward me are not out of bounds. Anything that comes up and particularly anything that's repetitive that they're feeling either positively or negatively toward me is important for them to express.

M: This idea of having candor, of being direct, the fear is, in speaking up, you might shut the client down. How do you negotiate this: keeping lines of communication open given that generally the analyst is in a position of some kind of power?

K: The idea is there’s candor and then there’s candor.  You know what I mean?  You don't just blurt out anything that you may be thinking which is like, “Boy, was that a stupid thing to do.”

M: Right, right.

K: So I take a moment to gather my thoughts and think about how it fits in the context of the person. I seek to complete the analytic task to gain perspective on their behavior historically and currently. But you know if somebody did something really stupid then I am more likely to say, “Well, it seems to me that this behavior had a pretty bad outcome for you. You know, probably not one of your finest moments.” (laughs)

M: (laughs)

K:  I use humor a lot. It cuts the tension. I'm agreeing that they screwed up without saying you're screwed.

M: I'm thinking about this on two levels: what are you trying to create within your client through the use of candor; what are you hoping that they bring into their lives through this process? The other part I'd love to hear more about is, the fact that our patients don't just want empathy, or I should say, sympathy, they also crave sincerity. There's relief when we can speak directly to all parts of the self, even negative ones.

Being authentic without being insulting or cruel. Finding a way to constructively give feedback, whether positive or negative. So the positive isn’t too over-stimulating or generate too much expectation of a repeat performance. The whole notion of not waiting until your own feelings are so intense that you have trouble managing them and being in control of them when you’re talking. It’s easier to be honest when you’re in control of how you feel. Most people white knuckle it.

K: Absolutely. I think people want feedback. Particularly, as I wrote in “The Power of Countertransference” if they are seeking it, then I don’t understand why you would not be responsive to a direct request for feedback. I think where we get into the delicate issue is when you're not sure, or when the patient is provoking possible feedback but not asking for it directly. Then you have to explore it and make a decision which may or may not include asking them if they want feedback. I think it's a no brainer when the patient is literally saying I want to know what you are really thinking or feeling about me?

M: Yeah, yeah.

K: For example: most of my clients become much more successful as a result of their treatment and they want to know am I going to resent them? Especially if their parents were very competitive with them. If they are too successful will I try to destroy them, take it away?

M: So what do you think benefits your clients in being able to ask you those questions in terms of their growth and development?

K: I think it gives them a tremendous confidence in their own intuition because I think one of the greatest contributions of neuroscience and the whole notion of unconscious to unconscious communication, is that clients already know what we are feeling. We already know what they’re feeling. I think the art is to determine, ultimately, what's most beneficial to actually discuss to get to the bottom of what’s going on. What's important to the work and what isn't. Will some of our ideas, notions shut down the patient experience, I think inevitably yes! That's the nature of relationships, whether it's analyst and patient or mother and child or spouse. There are ways you just cannot relate to someone else or you can't promote it.

M: A client having to contend with the real you rather than just feeling it.

K:  You know, I successfully treated someone with severe borderline personality disorder. That was where I first experimented with expressing rage. She thought everything was somebody else's fault. She would talk about her husband and blame the poor guy for everything. He was responsible for every feeling she ever had. She wanted me to endorse that. That he wasn’t sufficiently empathic but he was!  He martyred himself for her, whatever it took. She really needed somebody to stand up to her.

M: You made a comment about our culture not leaving room for negative emotions. I see this an an epidemic in parenting. We've got the hover parent generation where parents can't give feedback to their children or they have to sandwich it with so much goodness. To me, it's about emotional clarity, right? Sometimes it's not about positive or negative. It's about being clear with emotions and our intentions.

K: Yes. Being authentic without being insulting or cruel. Finding a way to constructively give feedback, whether positive or negative. So the positive isn’t too over-stimulating or generate too much expectation of a repeat performance. The whole notion of not waiting until your own feelings are so intense that you have trouble managing them and being in control of them when you're talking. It’s easier to be honest when you’re in control of how you feel. Most people white knuckle it. Neuroscience shows us that negative emotions are rarely outside of our conscious awareness. (They are felt and known even if not explicitly acknowledged). So we need to talk about it….

M:. You alluded to something earlier that I’ve been processing for a while, personally. I have a tendency at to be effusive with my language, you spoke to how we can say something positively in a way that is not too overstimulating.  Candor is about being clear in feedback. I have an awareness  of my tendency to slant towards hope and it has impact. Not always negative but I have to watch it. The truth is I have these little awareness all the time in session and I think ‘bookmark’ I need to go back to that. But how often do we, have the internal candor to take a deeper look?

K: Bookmark is a great word. That’s the beauty of the whole analytic approach. You bookmark it and you're curious about it. You don’t just blurt it out to the patient. You bookmark it and think about it. You wait to see, is this more about me or more about the patient. Because transference is repetitive, it will always come up again, and you don't have to figure it out in the moment.

M: So, what I hear is with candor, there's a certain amount of measure. Working towards an internal space that is curious. Curiosity to pay attention to the tiniest movements inside, an internal honesty that translates to a clinical (relational) honesty. 

So with enactments, there can be a dishonesty there. I mean, of course, we fall into things but I think you're putting more onus on the clinician to pay attention. 

K: Absolutely, and I think that if you look at the literature most of the enactments are not positive, they’re negative. But if you have transcript of sessions you would see there are just as many positive enactments as negative going on, but we don't yet care about those. Because those generally are not disturbing the universe of the relationship. (laughs)  I will notice with a patient that I really like or admire we do this little mutual admiration thing, you know? It is a sense a form of acting out. A little flirtation, something.

M: This is where the awareness comes in. How much of that is unconscious to the analyst?. There's a part of you that's just feeling good and maybe another part has the passing thought..I wonder if this is something?

Be thoughtful, of course, but be courageous. If you have any anxiety when you’re practicing, that’s good...Take risks. If you’re never afraid and you’re just offering soothing, comforting things you’re probably not giving the person everything that person really needs.

K: Right, it depends. If it’s happening too often (repeating) then it's like OK, well, wait a minute.  The enactments that we talk about in literature are mostly negative ones. I have yet to talk to a therapist where they were not aware of some negative feelings before the enactment. An enactment comes typically after an impasse that’s lasted a minimum of days if not a weeks or months. The impasse is broken by an enactment or treatment is destroyed by the enactment. I think that since I started using self disclosure regularly I have almost no enactments. I currently have one patient I have regular enactments with on a regular basis because she cannot accept negative emotions mine or hers. She simply won't allow for an emotionally honest exchange. You cannot eliminate enactments with everyone.

I think if you are sitting harboring negative feelings and thinking about them, no treatment is taking place. That’s why my new line I'm going to be using a lot in my next book is, “what is the analyst’s fiduciary responsibility to the patient? (laughs) What is clinically beneficial and to what extent are we stealing their money? When we sit white knuckled and think ‘this guy is a pain in the ass.”

M: Well, it’s another aspect of coasting in the counter-transference right?

K: Yes, like what you were saying about parents being overly effusive or overly positive. Therapists do this too. They try to be super positive or uplifting and affirming. Of course we want to do that to a point but that's not really what most people come to treatment for. Most people who have a lot of positive attributes and good relation skills get reinforcement in the world. They come to us to help them work through the obstacles and the negative behaviors that they can't work out anywhere else and the pain.

K: Right. I was thinking about submitting a presentation to Division 39, “Did Winnicott kill psychoanalysis?”

M: (laughs) Oh no!

K: Of course I’m tongue and cheek but we are so enamored with good enough mother which is about always being positive,  always being the cheerleader. I think most therapists are so masochistic and they allow patients in small and large ways to be abusive towards them...

M: Yeah I thought that that is what is revolutionary about your paper. In the first paragraph you talk about why as therapists we're drawn to this profession to help but simultaneously you are calling out our own masochism.  The way we feed off our ability to hold pain in the service of someone, to contain, soften…

K: To be saint like.  We're so overly invested in ourselves being the perfect mother to all of our patients. As if  the perfect mother is somebody who would just lie down, puts up with everything. It’s not.

M: Well, thank you for jumping in with me to explore the concept of candor and your clinical practice. Your mind is so alive. It’s been a pleasure.

K: You know, I end my most of my lectures with this:  Be thoughtful, of course, but be courageous. If you have any anxiety when you're practicing, that’s good.

M: Ah! I love that.

K: Take risks. If you're never afraid and you're just offering soothing, comforting things you're probably not giving the person everything that person really needs.


Karen Maroda, PhD is a clinical psychologist in private practice in Milwaukee, Wisconsin and a board certified in psychoanalyst by the American Board of Professional Psychology. In 2012, she was elected Fellow status by the American Psychological Association for her contributions to psychology on a national level. She is also a Fellow of the American Academy of Psychoanalysis. She has been in private practice for over 30 years and lectures nationally and internationally. She is the author of three books, several book chapters, and numerous journal articles and book reviews. She is passionate about the change process and has made it her life’s work to innovate psychodynamic techniques, making the process more interactive and collaborative. 

Michelle Harwell, MS, LMFT is an expert trainer, respected speaker, and licensed therapist in trauma and attachment. She is noted for her specialization in areas of development, attachment, trauma, and neuroscience, and her ability to communicate complex topics with clarity and humor. Michelle is currently completing her PhD in Psychoanalysis from The Institute of Contemporary Psychoanalysis. She received her BA in English Literature from University of Oklahoma, MA in Theology from Fuller Theological Seminary, and MS in Marriage and Family Therapy from the Fuller Graduate School of Psychology.