There's this older woman.
She suffers significantly, she's willing to talk to a psychologist, she's cooperative, she's moderate intelligent, she doesn't have problems that impact her thinking/reasoning/expressing. Yet it's almost impossible for her to reflect on herself. She has simply never done it ever in her life. She finds a therapist, but the therapist refuses to treat her as she lacks reflective skills.
My question is: does anyone know if there's a psychotherapeutical school or specific techniques for this lady?
I'm writing cautiously, as I see you are a first-time poster, and a part of me is wondering if you are the client who received this message, rather than a would-be clinical psychologist. I've written some thoughts based on what is written here, but the major caveat I would have is that I am conscious the client may have received a different message from what the clinician meant to communicate, as we often do when under stress, or in states of distress. However, my comments are based on the information given here.
I'm really uncomfortable with this message being given to a client, if it is what was intended to be communicated, and I don't think it is a fair or good rationale for not offering therapy. As Ruthie says, sometimes clients may not wish to do the work, but that's a different thing, and I'm really uncomfortable with a client being left feeling that they did not merit care because of a lack of reflective functioning. The 'not psychologically-minded' trope went out 40+ years ago. I would argue that many-most clients who come to therapy 'lack the ability to reflect on themselves' or have 'simply never done it'. That's normal-we can understand reflective functioning (the capacity to reflect on oneself) as having been developed from childhood through a secure attachment relationship-being 'held in the mind' of another. Dan Siegal calls it 'mind-sight'. Most of our clients will not have had this experience, and I would argue that the role of the therapist (whatever model they use) is to act as that secure reflective person, who offers enough safety and containment to begin to allow the client to develop these skills. Susie Orbach talks about 'pause and reflect', Tara Brach says 'attend and befriend'. That's pretty much therapy in a nut shell really, whatever the presenting difficulty. Figure out what's going on for you, learn how to regulate it, and offer yourself some compassion in the face of your distress. Have choices in the way you respond instead of just reacting. Make choices and set boundaries for the relationships you are in, instead of just re-enacting a past dynamic. Some types of therapy (such as EMDR) don't even require talking!
The only way I can see a therapist saying that from a solid place is if we are speaking about a client who has severe affect regulation difficulties, and copes by very risky behaviours. That's not to say that therapy couldn't still be helpful for someone with these difficulties (large part of the work of most CMHTs, and actually the evidence base for intervention with this group is very strong) but just that the person might benefit from stabilisation work first, perhaps a group intervention such as STEPPS or DBT. It's definitely true that for some people, the risk of individual therapy is that it will bring up more pain than is actually helpful or manageable within the time available. There are some really interesting critiques of therapy written from the client's perspective (Falling for Therapy by Anna Sands, Folie a Deux by Rosie Alexander, When Boundaries Betray Us by Carter Hayward) and the message to therapists is clear-sometimes it is more harmful than helpful to intervene, and this process can cause life-changing pain and harm without any gain.
I'm also uncomfortable with this woman being described as 'moderate intelligent'. This seems so loaded with layers of ableism and meaning, and is actually irrelevant, as well as possibly inaccurate if a WAIS has not been done. If you are a would-be psychologist I would be cautious about this kind of language. I've done complex therapy work with clients who have had learning disabilities, early stage dementia, acquired brain injury-I believe good therapy work can still happen in these contexts.
In summary, based on what has been written here I don't think this is a good piece of work, even as a one session assessment. The client should have been left with a clearer understanding of her difficulties, a sense that she had been understood and heard, and potentially helpful ways forward, not a message that she is inadequate in some way-that could really compound previous traumatic relational experiences. However, it may be that the clinician tried to feedback something helpful, but that this could not be heard because of the level of distress occasioned by the perceived rejection. That said, you don't say what kind of therapist, and there are some really dodgy people practicing out there under that title-it's not regulated. It might be that she saw someone really inadequate and poor at their job, without proper training, who re-enacted something or blames clients for their own inadequacies. If she is willing to take the risk of looking again I'd advise her to see a clinical psychologist where possible-it may be more expensive but it's properly regulated, and we can draw on more than one model to understand the client's difficulties and adapt our approach accordingly. She can meet with a few practitioners until she finds one that feels like a good fit-it's perfectly ok to go along for an initial session to see whether you like the therapist without committing yourself. With my current therapist I insisted on 3 sessions before I decided whether I wanted to keep working with him or not, and he was fine with that-any good therapist would be. Might be worth looking for someone who specialises in treating older adults.
Without knowing or assessing the client it would be dodgy for any of us to recommend a therapy, but if she enjoys reading then a compassion-focussed therapy self-help book may be helpful (Paul Gilbert, Deborah Lee). You say that she is suffering, and compassionate practice looks at being kind to ourselves during our suffering-it might give her something to hold on to until she finds someone good.
I hope she's ok.
Kintsukuroi: 'to repair with gold'. the art of repairing pottery with gold or silver lacquer and understanding that the piece is more beautiful for having been broken.