I have used the “I Ching” intermittently in the course of my psychiatric practice — often when I am challenged one way or another and feel “stuck” or otherwise unsure of how to proceed in the work with a particular patient. The approach of the “I Ching” is itself challenging in its application to this specific circumstance.
The “I Ching” counsels patience. It encourages holding and containing the discomfort and tension that presses for action for relief.
Particularly with a patient who uses avoidance as a coping mechanism, the challenge for the therapist is the matter of how to bring forward issues that need to be dealt with. I have learned not to confuse patience and pacivity. Time after time, I find that NOT taking the action of actively confronting issues head-on, NOT “pointing out”, but proceeding by asking about the details of a patient’s life, is the action that is fruitful.
My mentor, Dr. Elvin Semrad, used to say that the most important function in therapy is to “ask, ask, ask.” He would encourage a therapist to ask about the facts and feelings of a patient’s life, “looking for details omitted from consideration at the time.”
This is the most useful activity of a therapist.
It is often the case that a patient complains, chronically and repeatedly and at length, about symptoms of depression or anxiety, but is not accustomed to taking an interest in the details of the facts and feelings of his/her own life. I find that I have to teach a patient to take an active interest in him/herself. The work of modeling an interactive experience of “ask, ask, ask” and respectful and patient and intelligent listening is something that too many people have, painfully, not had enough of in their lives.
This enquiry and attention very often releases very strong and painful feelings. Dr. Semrad also said, “Two people bearing painful feelings can handle them more easily than one.” A long lifetime of practicing psychotherapy has taught me the truth of this observation.