Therapy Learnings: A Memorable Practice

There are many lessons I’ve learned that I’ve forgotten. Some times, my memory is like an old bookshelf, stock-piled with endless stories, references, and guidebooks, but shelved in such randomness that there is no quick-way to find a particular book.

If I can’t recall an important lesson, what good is it that I’ve have experienced it, but not able to recall it?

Memory is the mother of all wisdom.- Aeschylus

About two years ago, this geriatric problem confronted me. I was in my group private practice in Western Australia (SPOT), and I was seeing a young adult male, Jonah, who was depressed over the past two months. After the first two initial sessions, even though I felt that we had a good working rapport – along with his scores on the Session Rating Scale (SRS) indicated good engagement levels, I was daunted by the fact I still didn’t seem to get a sense of who he was. It was this paradox of communicating with him, but not knowing him. At that moment, I didn’t know what more to ask in order for me to get a sense of who he is, and how he was experiencing himself. It was an odd feeling, because I didn’t often run into such a situation relating with a person, what more after a few sessions. Aside from reflecting my disconnect with him, I didn’t know what else to do at that point.

My drive home left me thinking about Jonah. I ruminated, closed to bashing myself (with soft pillows) for not being able to get deeper with this pleasant and friendly client in my therapy office. Then my mind wandered. I felt like listening to the Beatles (Perhaps I wanted some Help!). Sgt Pepper was near at hand. I hit that last track.

It was “A Day in The Life”… That’s it! I’ve learned this before. Several years back, during my post-graduate training, I read Irvin Yalom’s wonderful book, The Gift of Therapy. One of the golden nugget that struck me then was about Asking for a blow-by-blow account of a person’s daily activities. How could I have forgotten this?

At the start of the next session, , that was what I did. I requested for him to share with me the details of what he did the day before, almost an hour-by-hour account. In between his part-time work at the supermarket and swimming training, he was ferried about by his mother. Why was this important? He felt he was not in control of his life, and he also felt bad if he was to tell him mum to back off a little, especially since she has been divorced and alone. Further discussions revealed that he also longed for connection with his mates, but has been plagued with a sense of inferiority (e.g., working in a low paying job, no car).

This session with Jonah struck home on two fronts. The first was that we were able to progress further on improving his life situation. He ended up sitting his mother down and having a talk about needing to move along in his life. The second was for me. I was confronted with the fact that my retrieval memory was like my old bookshelf, messy and disorganised. I needed to get organised.

Since then, on friday afternoons before I pack my bag and head home, I gather my thoughts and spend 3-5 mins, typing out my TherapyLearnings for the week.

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Here’s How:

At the end of every typical work week, look at your work calendar to recall all of the clients that you’ve met. Pick one of the cases that strike you the most in that week. Write down one thing that you want to remember about your experience. This could be a lesson that you’ve learned from interacting with that client, a feedback that was given to you, even a mistake that you felt you’ve made? (Did you know that more effective therapists are more likely to elicit negative feedback than less effective counterparts? More on that).

Benefits:

1. You develop your own learnings, bespoke from your own clinical experiences.
2. In a month, you will have 4 learnings. In a year, you will have 48 such gems in your pocket! (well, probably less that 48. I highly encourage holidays).
3. The act of writing it out helps with the consolidation process of the memory, as well as aiding future retrieval. Be forewarned of this pitfall: “Since it’s so important, I will be able to recall it.” For a busy professional, things easily slip us by, and we miss making a pit-stop at the memory bank.

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Suggested Format:

You can choose to do this on a notebook that you dedicate to your own TherapyLearnings, or you can choose to do this on apps for portable devices (e.g., tablets, smartphones). Free note taking apps like Evernote and Simplenote are available, and it syncs on multiple devices. Although I use Evernote premium for my web-clippings and other more advanced note-taking, I use Simplenote for my TherapyLearnings. As the name alludes, it is no-frills. Just create a tag therapylearnings for each of your weekly notes. A bonus feature about this is that you can share and collaborate each note with your colleagues in your TherapyLearning Group (more on this below).

Date: ________

Title: A succinct and catchy title helps e.g., A Day in a Life

Learnings: A one-sentence summary of this therapy learnings

Example: Provide a brief snippet of the case that led to this learning, in order to make it more alive and personalised for your future recall.

Keep each TherapyLearning to a maximum of 140 words. Constrains are helpful. For busy professionals, time is a luxury. By self-imposing a word limit (the 140 word limit was borrowed from Twitter), it helps to get the mind to pack a punch, keeps it focused, and makes it doable on a regular basis.

TherapyLearnings Group: I recommend doing this on any individual basis. Complementarily, a TherapyLearnings group can be formed to sharpen this weekly nuggets. A small group size of 4-5 is beneficial. It would typically take 45-60mins for each to share. One tidbit for someone can also be an impactful vicarious learning for the other. Resist the temptation of going into the group without first noting your therapylearnings down. This helps to keep the phenomena of group-think at bay. Walter Lippmann’s quipped, “where all think alike, no one thinks very much.”

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Stick-It:

Recall -> Pick one -> Write

Psychotherapy is one of the few professions that practice actually means the real thing. Our task is to predispose ourselves to learn from our ongoing clinical practice. In order to learn, we must develop the ability to have a retrievable memory. This is the hallmark of a memorial life. This is worth remembering.