Therapy-bashing has been all the rage lately — and I don’t use the word “rage” lightly. The backlash against psychotherapy is typified by a bitter anger. Not only has conventional psychotherapy actually harmed some of the people who turned to it for help, say its critics, it has encouraged in many others a degree of self-absorption that harms the social commons and depletes the very soul of the world.

Unfortunately, most of the critics are long on rancor and short on constructive suggestions for fixing or replacing therapy. There is a coldness in their implicit message that people in inner pain should just quit their bitching and get on with life; there’s also some common sense in that message. Still, it’s clear that many people could use caring, competent advice on how to get on with their lives, how to rouse themselves from pain and self-pity and connect their personal growth to the well-being of the world.

One therapy critic, Tom Rusk, goes beyond fault-finding to propose a positive, concrete, comprehensive alternative to psychotherapy in Instead Of Therapy: Help Yourself Change And Change The Help You’re Getting (Hay House, 1991).

When a literary agent asked me to meet Dr. Rusk, an associate clinical professor of psychiatry at the University of California-San Diego, to discuss collaborating on Instead Of Therapy, I was not thrilled. Having little respect for shrinks in general, I didn’t think I’d care to help some cucumber-cool professor foist his pet theories on all the self-help book-buyers out there.

But Tom was not what I expected. He was hot when I expected coolness, passionate when I expected detachment, and apologetic when I expected superiority. He no longer considered himself a psychiatrist, he hastened to explain. In fact, he had resigned as an elected Fellow of the American Psychiatric Association, and had abandoned the medical model of psychotherapy for an educational model of counseling that he calls “guided self-change.”

While ordinary therapy often encourages people to spend too much time mulling over their problems, guided self-change provokes clients actually to begin changing their habitual, unproductive ways of thinking, feeling, and relating. To do that, Tom insists, people must stop depending on their therapists to be ersatz parents — a dependence psychologists refer to as “the transference.” Tom admits that part of his motivation in abandoning the transference was practical: “Hell, I’m just hanging on by my fingertips most of the time. I’m not going to try running somebody else’s life.”

Guided self-change departs from conventional therapy in at least five ways. First is the aforementioned, fundamental shift from medical to educational assumptions about the nature of the counseling relationship. This introduces an equality between client and therapist, discouraging the transference and placing the responsibility for healing squarely on the client.

Second, guided self-change requires the client’s explicit, contractual endorsement of four particular values — respect, understanding, caring, and fairness — as guidelines for healthy relationships, including the counseling relationship.

Third, the mutual respect established between client and therapist calls for greater self-disclosure on the part of the counselor than normally occurs in therapy. That is, the therapist freely uses experiences from his or her own life to illustrate ideas for the client, and constantly to reaffirm their equality as human beings.

Fourth, guided self-change encourages the client’s experimentation with new beliefs and behaviors as the primary source of healing and growth. Thus, emphasis is shifted from the “psychodrama” of the counseling session to the client’s real-life attempts at self-change.

Such “homework” is supplemented by the fifth major departure from therapy: the tape-recording of counseling sessions for the client’s exclusive review and possession. This encourages the development in the client of the compassionate self-observation necessary to pursue self-change.

Some of these ideas will be familiar to progressive therapists. Tom’s philosophy and practice are not stunningly original point by point; were that the case, guided self-change might not be so accessible. Instead, his model represents an intelligent, pragmatic synthesis of the leading edge aspects of humane, progressive psychological counseling.

As Rusk’s co-author, I must acknowledge the obvious conflict of interest here. Yet our friendship and my familiarity with his work enabled me to pose questions that might not have occurred to other interviewers. This was also made possible by Tom’s openness to challenge, something one doesn’t always find in more conventional therapists.

— D. Patrick Miller

 

Miller: Traditionally, psychotherapy is supposed to proceed on a values-free basis. In other words, the therapist doesn’t impose any values on the client. The values you ask your clients to endorse by contract — respect, understanding, caring, and fairness — seem so basic. What’s the point of making them explicit?

Rusk: When a person agrees to accept this value system — which means pursuing respect, understanding, caring, and fairness within oneself, while also requiring them from others — I can use that agreement to great effect.

In a couple I’m seeing now, the husband resists spending ordinary time with his wife — waking up together, running errands, doing day-to-day chores. He’s more comfortable with special dates with her. When she accuses him of not really wanting to be with her, he says, “You’re wrong. I do want to be with you, but I’m a military man and a loner and I’d rather just spend special time together. Why do you always have to attack me about this? You’re destroying our relationship.”

She reacts by saying, “You’re not telling me what you really feel” — which infuriates him. He’s saying what he feels, but she doesn’t believe it. So I role-play his side of the argument, in front of both of them, but I put it this way: “Honey, I understand that it’s upsetting for you that I don’t want to do everyday things with you. I can see how that must hurt you, but I’m trying to explain how things are for me. I have this military background, and I’m used to being by myself. Something about going to the laundromat together is just too awkward for me. Do you believe me?”

Now the wife says to me, “When you say it, I do believe you. If my husband would say it that way, I’d understand him.”

Her husband makes an exasperated sound, shaking his head. I ask him what’s the problem, and he sputters, “She doesn’t really believe it!”

I say, “Hold it! Do you hear what you’re doing? You’ve been angry with your wife because you think she’s not respecting you or caring about your feelings. But she’s saying right now that if you spoke differently — respectfully, honoring her experience as well as your own — she could believe you.”

The problem with these two is not so much how they spend time together, but that they’ve been invalidating each other’s feelings whenever they talk. So I can use the agreement we made to demonstrate to them how they’re not being respectful, understanding, caring, or fair.

I believe that if people try to behave toward themselves and others this way, then their quality of life improves — regardless of what diagnostic labels psychologists might stick on their problems. You have to take certain risks to experiment with the values; you have to face your fears and courageously learn and practice new behaviors.

I don’t always challenge people in this manner. Challenge sometimes takes the form of a plea for compassion: “My God, just look at what you’re doing to yourself, and to each other! Would you do the same things to a child you love very much?” I plead with people this way sometimes, hoping that I’m not whining.

Miller: But are you not imposing these values — your values — on clients?

Rusk: Values are defined in so many ways these days. Dan Quayle talks about moral community standards — moral codes that are not universal, that simply cannot apply equally to Mormons, Muslims, the poor, the rich, and so on. I think I can make a better claim to universality for internal guides of conduct — the four values I’ve been talking about. These values concern process, not content. Having children out of wedlock is a content issue. Whether you as a single mother raise your children respectfully, fairly, with care, and with understanding — those are the values of process, which I think we can all honor and talk about without condescension or imposition.

Miller: But when you say, “My God, don’t you see what you’re doing to yourself,” aren’t you imposing your idea of what’s respectful? A more cautious counselor might say, “Do you really think you’re being respectful to yourself and others?”

Rusk: I do say it that way sometimes. My style depends on the situation. Either way, I’m reminding clients of the values they’ve agreed to honor and explore as a healthier way of getting on with their lives. That’s a radically different process than just listening to people’s problems, diagnosing them, and proceeding with a supposed cure, whether it’s pharmaceutical or a “talking cure.”

One reason that I send clients home with tapes of our sessions, encouraging them to take notes about what happened, is so they can catch me when I’m imposing my ideas, or missing the boat, or suggesting something that doesn’t fit that person. But I remind clients to sort out that which is uncomfortable from that which feels wrong. Most people can tell the difference right away through some internal sense of guidance. I’m encouraging people to place their faith in that internal sense, not in what I say. That’s my safeguard against imposing my personal interpretation of the values.

Miller: Has anyone ever refused to sign the contract endorsing the values?

Rusk: You mean someone who says, “I’m not really in favor of respect,” or “Caring sounds good, but it’s a dog-eat-dog world out there”? Some people let me know that they can’t handle the values. The upshot is that I don’t see them for very long. One couple, whose suicidal daughter I had counseled, came in with their own marital difficulties. Right away they started going at each other in a very negative way. I stopped them and said, “I can’t imagine you’ve gone through all these years talking to each other with such insulting disrespect. It’s unbelievable that you can tolerate this.” They both started to laugh — like I’d blown their cover. I asked, “What’s so amusing?” They replied that if they changed their combative way of talking, they wouldn’t know what to say to each other. “We’re just teasing,” they said. I told them, “I don’t believe you’ll ever have a better marriage unless you’re willing to reconsider your way of talking to each other.”

This was not a dramatic confrontation; everyone was very good-humored. They kept laughing right out the door, and they never came back. They understood that I would ask them to learn to speak to each other respectfully — which would change everything about them. They got the message, and they didn’t like it.

Miller: They weren’t willing to pay the price of changing — although it sounds like their daughter had been paying the price of their not changing.

Rusk: Absolutely. Their daughter was in college and was being beaten up repeatedly by her boyfriend — and putting up with it. Of course. That’s all she saw growing up: abuse in one form or another.

I had a client who was an attorney. He defended drug dealers and was a heavy user of cocaine himself. He came to see me after his wife caught him having sex with their maid, a woman he admitted wasn’t even attractive to him. I worked with him and his wife on the four values, but things got bogged down when we started looking at how he was earning a living. Though he was making phenomenal amounts of money, he had absolutely no respect for himself. At that point he dropped out of counseling because he got too uncomfortable. I wasn’t just talking about the values, I represented them. It was too much for him.

I think a lot of therapists would hesitate to require an endorsement of the values because they realize they would lose some clients right away. Some people balk at the idea of living responsibly — of maintaining a sense of loving responsibility for their mind, body, and spirit. But that’s how you learn to hear the inner voice that steers you in the direction that’s right for you.

Miller: You’re implying that conventional therapy allows some people to continue living irresponsibly while still being taken care of by the therapist.

Miller: You’re implying that conventional therapy allows some people to continue living irresponsibly while still being taken care of by the therapist. Does it follow that people who are not capable of maintaining that sense of loving responsibility for themselves belong in therapy, and not guided self-change? Do some people need to experience the transference because they’re not ready for your “coaching” them in a different way of life?

Rusk: In traditional therapy, clients spend time with someone who shows them a modicum of understanding and caring while they stay in their private hell. That’s humane care, in a sense, but it’s also “enabling the dysfunction,” as they say. To me it’s fundamentally disrespectful of clients to allow them to continue to abuse themselves. These therapists may think they are providing the best possible care, but they’re effectively sending their clients the message that they’re not capable of learning to be responsible: “I can’t put any pressure on you to change because you can’t handle it.”

What if there were no therapy available besides guided self-change? Then the message to everyone seeking counseling would be that developing a better relationship with yourself and others is a learning enterprise. Everyone is capable of living more ethically, regardless of anyone’s particular problems or varying talents. Everyone can change, no matter how hard it is. This message would increase everyone’s burden of responsibility, but it would also vastly increase their sense of hope.

When I counseled schizophrenics in a Veterans Administration hospital, I put a certain burden of responsibility on them: mutual respect in communication. I said, “If you want to talk to me, you can’t talk to your voices at the same time. I’m not trying to talk on the phone while I talk to you. So please, if we’re going to talk, tune out your voices.” I never met a schizophrenic who couldn’t meet that direct request, even if I had to remind him from time to time. In general, I think therapists infantilize their clients with a patronizing if well-intentioned disrespect, therefore enabling their clients’ disrespect to themselves and others.

Rusk: In general, I think therapists infantilize their clients with a patronizing if well-intentioned disrespect, therefore enabling their clients’ disrespect to themselves and others.

Miller: So you would agree with the psychologist and writer James Hillman that conventional therapy is infantilizing.

Rusk: Yes. In traditional psychoanalysis, people are actually encouraged not to make changes in their lives until therapy is over, because the only purpose of therapy is to gain healing insights. So what people get is fantastic insights into their continuing chaotic behavior.

Miller: Do you also agree with Hillman that therapy encourages self-absorption and disengages people from the social and political needs of the world around them? Is the world getting worse because therapy keeps people disconnected?

Rusk: Therapy encourages self-absorption, but there are some problems with Hillman’s political diagnosis. Look at our political leaders who are doing very little to improve the lot of humanity or the environment. Are they in therapy? Is that their problem?

One of my best friends is a therapist who’s very active in the environmental movement. When he was in therapy himself, he thought activism was important, but felt incapable of doing anything worthwhile. Only as a result of his courageous inner work did he develop the level of self-acceptance necessary to become responsibly involved.

California Governor Pete Wilson told the Los Angeles Times that he tried introspection once and didn’t like it! Now, he’s very political, but certainly not a great environmental leader or social progressive. On the other hand, we may have a good number of effective politicians who are or have been in therapy, and to good effect. They just can’t talk about it publicly.

Miller: Therapy has always been stigmatized, particularly for political candidates. If we replaced therapy with the idea of self-change education, we could allow our political candidates to say that they’re in counseling for personal growth. Being in counseling wouldn’t signal that a candidate was unstable.

Rusk: Highly competent athletes have excellent coaches, and at world-class levels they may have several: a nutritional coach, a skills coach, a psychological coach. No stigma there. Buddhist politicians in Southeast Asia are required to go on retreats to meditate and do personal growth work. Why couldn’t we learn to be proud of receiving self-change coaching? Why couldn’t this be a badge of pride and responsibility?

The mental-health profession is partly responsible for this dilemma by labeling everything that’s “deviant” from normality — as if there were such a thing as a normal human being. Who we are at any given moment is a result of our genes, history, current circumstances, and the way we choose to live. Any of us can change if we are willing to dedicate ourselves to growth.

Miller: The idea of normality is connected to medical assumptions about mental or emotional “illness.”

Rusk: Yes. People used to be disturbed; now they’re dysfunctional. Part of the problem is the assumption that all pain is symptomatic of disease, dysfunction, or deviation from the “norm.” But some emotional pain is necessary. Some people are in discomfort because that’s exactly where they need to be in order to grow.

A man tells me he’s feeling guilty because he and his wife made three moves to accommodate his career, and now she wants them to move for her career and he doesn’t want to do it. He says, “In all fairness, I should do this, but I just don’t want to. I don’t like the weather there, my job would suffer. But I also can’t stand the guilt.”

So I ask him, “If you didn’t feel guilty about this, what kind of a person would you be? What if you didn’t care how she felt, and just regarded it as her problem?” He replies, “I’d be a psychopath.” And I say, “You got it. In this situation, guilt is the price you pay not to be a total jerk. What does that say about you?” “Well, I guess it means I care about my wife,” he says. “Seems that way to me,” I answer. “You feel guilt because you care and because you know you’re being unfair.” It can’t be a therapist’s job to take away all bad feelings.

Miller: Without values, you might not have a way to distinguish when you should be having bad feelings.

Rusk: That’s right. It’s not that the values allow me to determine that for my clients; they enable the client to determine it. By contrast, the traditional therapist labels the client’s bad feelings as one or another kind of disorder and comes to a prognosis, usually kept private, about the client’s chances of improvement. Whereas I will tell this client that his chances of getting over his guilt depend on how enthusiastic he’s willing to be about re-entering the discussion with his wife on a fair and respectful basis. He can do something about it tomorrow if he wants to, not months or years from now when his repetition compulsion from childhood has been resolved through analysis.

I have no quarrel with understanding the past, as long as you don’t dwell on it. If you spend too much time away from the here and now, you run a serious risk of increasing suffering and decreasing quality of life in the long run. To do the right thing now will straighten out your life, regardless of what happened in the past.

Doing right when you’re not used to it is extremely awkward and uncomfortable, and you’ve got to be willing to suffer the discomfort of change. If a therapist is only trying to be a loving, compassionate person who witnesses and analyzes your pain, then he’s unlikely to be able to help you do the painful work of change. By contrast, following the values allows you to move forward in the right direction, no matter how much pain you have.

Now the interesting thing about moving forward is that a lot bubbles up from the past as soon as you start treating yourself and others rightly and fairly. All of a sudden, it becomes shocking to see what you’ve put up with in yourself and from others. Shocking what your mother and father put up with, shocking what you all did to each other in your family. You’re appalled to see how you’ve been living once you make even a little improvement in your standards.

Miller: If somebody in pain comes to you and you start talking about the necessary discomfort and awkwardness of change, how do you distinguish between the two kinds of pain? And how do you “sell” the healthier discomfort?

Rusk: I have to introduce a language that has what psychologists call “face validity” for the client’s subjective experience; that is, it has to make sense. For example, can the client feel the difference between unhappiness and awkwardness? A woman is in real emotional pain in her marriage and I ask her, “Do you mean that you feel awkward?” She says, “No, I’m very unhappy.” I reply, “If you were to talk more respectfully to your husband and explain that you must be talked to respectfully, would that be awkward?” She says, “That would be terribly awkward and frightening.” Now we’re getting somewhere; we’re distinguishing between the old pain and what would be a new discomfort.

I say, “Let’s assume everything goes well. Your husband shapes up, and you both start treating each other more considerately. What are the odds that your original pain and discomfort will have decreased?” She laughs and says that of course she’d feel better.

That may sound terribly obvious, but the fact is that people often lose their way in therapy over such simple issues. They aren’t given guidelines for distinguishing the pointless discomfort of staying in habitual pain from the purposeful discomfort of changing for the better. So they keep acting the same way because they don’t want to stir up any more trouble than they already have. And the therapist sits and listens to the same old complaints for a long time. In guided self-change, values provide the necessary guidelines for proceeding through fear and awkwardness in order to decrease pain and suffering.

Miller: The idea of normality is connected to medical assumptions about mental or emotional “illness.”

Miller: How do you relate this process to drug therapy? I know that you seldom prescribe conventional psychiatric medications.

Rusk: I saw a woman the other day who’s been doing an exceptionally good job of honoring the values in her self-change work, but she’s still having trouble concentrating at work, not sleeping well, having trouble getting out of bed, having sexual problems. She clearly required antidepressant medication. This woman was exhausted and burned out from the stress of change and of her life in general.

Miller: So your orientation toward medication has to do with what helps people get through the stress of change, rather than what drug goes with a particular psychiatric diagnosis.

Rusk: Sometimes I see people who just can’t attempt a different kind of life; they can’t grasp it from inside the fog of their pain. Then I may prescribe a medication to help them find the energy and the concentration to start thinking about change. To use a physical analogy, consider a person who’s bedridden with an infection because she hasn’t been taking good care of herself. Certainly she needs more exercise in her life, but you can’t tell her to jump up and go outside. You need to give her something for the infection first, help her get to where she can sit up in bed before you can even talk about an exercise program.

Despite my anti-drug reputation, I try to avoid absolute attitudes about drugs or such interventions as electroconvulsive therapy (ECT). I have a client who has made three serious suicide attempts and has tried every kind of healing you can imagine, from traditional psychotherapy to inner-child work to yoga, plus every kind of antidepressant medication. The only thing that has ever helped his suicidal phase is ECT; I’m certainly not going to deny it to him. This man lives a life of absolute hell on earth, and I’d even recommend psychosurgery if I was reasonably certain it would help.

Rusk: People used to be disturbed; now they’re dysfunctional. Part of the problem is the assumption that all pain is symptomatic of disease, dysfunction, or deviation from the “norm.” But some emotional pain is necessary. Some people are in discomfort because that’s exactly where they need to be in order to grow.

Miller: Can people in such exceptional pain do much work with values?

Rusk: I’ve tried to get this individual to consider a life of service. He’s a health professional, a traditional role that pays well, but the situation is toxic to him. I’ve suggested that he become a frontline Greenpeace activist, something requiring physical courage and self-denial. Like most people in extreme emotional pain, he’s extraordinarily self-centered. He should try losing himself in good works before psychosurgery, that’s for sure.

People like this don’t fit into society in the usual ways. They have to search for a way of life that resonates with them, no matter how strange it seems to the rest of us.

From childhood, the brightest of us tend to get co-opted for our talents rather than comforted for our sensitivities — which is how we produce tortured geniuses. Self-acceptance is rare among adults because few of us receive the respect, understanding, caring, and fairness we need as children, and thus we do not learn to live ethical lives. You can’t develop self-acceptance without leading an ethical life; it’s absolutely impossible. And without self-acceptance, we become convinced that we’ve got to depend on parents, doctors, drugs, and intimate partners for the answers. We ask, “Who am I to take charge of my own life, when I’m so inadequate?”

Learning to give, receive, and require respect, understanding, caring, and fairness is the only way I know to create the compassion for oneself and others that’s missing in most of our childhoods — instead of endlessly mourning its absence. The hardest thing for any of us to learn is how to have compassion for our own pain. You have to do more than dig out all the past hurts; you have to change the way you live now, and that requires experimentation and awkwardness.

Miller: Why is self-disclosure on the part of the self-change guide so important?

Rusk: We know that modeling is one of the most powerful ways to teach. The tennis coach demonstrates as best she can the perfect strokes and footwork. Self-disclosure allows the counselor to illustrate different kinds of learning, tell inspiring success stories, and model introspection. For example, self-disclosure allows me to make clear the distinctions between having compassion for my own pain and just feeling sorry for myself, which is difficult for most people to understand. Self-disclosure allows me to illustrate the connection between strength and vulnerability, which most people tend to see as opposites — when in fact, the more vulnerable you are the stronger you must be.

Self-disclosure also decreases co-dependency. Some clients avoid responsibility by putting their therapist on a pedestal, thus postponing any courageous acts until they are as wise and unafraid as the therapist is.

Miller: Or appears to be. Part of what makes the therapist look so impressive is the attitude, “I’m only here for you. I’m not here to talk about myself.”

Rusk: Which is ludicrous from the coaching point of view. You have a problem with your backhand and you ask your tennis coach, “Can you show me how to do this? How do you hit a backhand?” What if she said, “I’m not here to talk about my backhand. I’m only here for you.” Ridiculous!

If I’m talking about myself just because I have a problem today, and I’m unloading it on you so I can feel better, that’s obviously not ethical. But often I will bring up some difficulty from my personal experience, and a client will say, “That’s exactly like what I’m going through.” If I bring up experiences that are like those of my clients — especially if I’ve resolved those situations to some degree — it’s a lot harder for them to see themselves as alone in the world, defective, or cornered with no way out.

Miller: I can imagine a client describing an abusive relationship to a therapist, and the therapist going so far as to say, “Maybe you should try to stand up for yourself more often.” But if the client said, “Can you show that to me? How would you do that?” — that might be where the conventional therapist hesitates.

Rusk: More so if the client asks, “Have you ever allowed yourself to be treated disrespectfully? How did you handle it?” The therapist smiles and says, “Well, we’re not here to talk about me.”

What I’m going to say is, “That’s an interesting question. As a matter of fact, I lived that way for years with my own family and it was awful. I used to blame my family for it, but gradually I learned that it was my problem, not theirs.”

For instance, years ago I used to think that my wife Judy was sarcastic and uncaring about my feelings, until I realized that she was really just trying to provoke me. She’d already gotten tired of asking me what was wrong when I was visibly upset, only to have me clam up and say, “Nothing. Just leave me alone.” When I finally realized that Judy’s seemingly uncaring attitude was really my problem to start with, I devised an experiment to force myself to open up more. One day, I told Judy that if I ever clammed up again when she asked how I was feeling, she should send me to stay in a motel until I was ready to come back home and talk. Her response was, “Why didn’t I think of that?” But she never got to do it. It would have been so humiliating to me that I quickly learned how to admit when I was feeling bad, even if I didn’t know what was wrong.

Miller: What if a client seems to be violating the values with you in a counseling session? Do you disclose your real reaction?

Rusk: Once a woman went into a tirade and said to me, “Listen, honey, you men are all the same. No matter what you say, you really think women are inferior. That’s why we have to play dumb to get what we want.” I stopped her and said, “Hold it a minute. In the first place, I’m not your honey. In the second place, I’m not one of ‘you men,’ I’m Tom Rusk. I won’t tolerate being treated as a stereotype.”

I’ve never quite thought of it this way before, but the transference is really just another means of stereotyping.

Miller: The response of most psychiatrists would probably be raising an eyebrow and jotting down a note about the client’s belligerence. Or maybe going so far as to say, “Why do you think you feel anger toward me at this moment?” Perhaps therapists can’t model authentic communication because they’ve learned to listen and analyze, but not to communicate respectfully.

Rusk: They’re likely to dodge and say, “I could show you how to ask for more respect in your relationship, but perhaps it will be more useful if you find out on your own.”

Miller: Part of what makes the therapist look so impressive is the attitude, “I’m only here for you. I’m not here to talk about myself.”

Miller: As if they shouldn’t give away the prize.

Rusk: Another myth of therapy is that it’s much more effective for a person to discover an insight on his own than to be given the insight. There’s not a shred of evidence to support that idea. What does imprint the insight is trying it out on your own — making it yours through practice and further exploration, no matter how you get it.

There’s also the question of readiness: if you’re not ready for an insight, I can repeat it to you a thousand times and you won’t get it. Or it can be staring you in the face from your own experience. Sometimes you’re not ready until somebody brings it up in a context different than your own, and then you get it. In that case, the typically passive, withholding therapist can really be depriving people of the chance to accelerate their learning dramatically.

Self-disclosure discourages the parental transference and affirms the human equality of counselor and client. Not to self-disclose is to have an inauthentic relationship. What a weird model for people who are supposed to be learning how to have healthier relationships! My assumption in guided self-change is not that I’m better psychologically than my clients, but that I can be effective as a coach for a limited period of time. I can coach on following the values in the same way that a tennis coach can teach a good swing, without necessarily having the best swing in the world.

I can’t tell you the number of people I’ve coached who have acted with more courage and self-respect than I ever have. I sit in awe of them, the way they’ve followed their life’s journey and faced tremendous terrors. But I could still coach these people through their toughest moments; I’m coaching by principle and my own authenticity, not superiority or specialized therapeutic knowledge. I always remember the saying, “Pity the poor teacher who is not surpassed by his students.” I certainly deserve no pity in that regard.

One of the questions I always ask clients after they’ve turned a corner in their lives is whether they can think of anything I could have said or done earlier that would have speeded up their process. They’re in a good position to assess me on this, because they have the tapes of the sessions.

Rusk: Which is ludicrous from the coaching point of view. You have a problem with your backhand and you ask your tennis coach, “Can you show me how to do this? How do you hit a backhand?” What if she said, “I’m not here to talk about my backhand. I’m only here for you.” Ridiculous!

Miller: That aspect of your counseling goes beyond even the most progressive therapists, some of whom may be comfortable with self-disclosure. By making tapes of your sessions and handing them over to your clients, you’re venturing an unusual degree of vulnerability for a counselor. You’re giving away the complete record of the relationship.

Rusk: The tapes bring the client’s self-observer into the process in a way that nothing else will. I always apologize to clients that in our sessions I’m not really talking to them so much as I’m talking to their self-observer, who will listen to the tapes later. It’s the self-observer who’s really my partner in the guided self-change process.

Miller: You’re facilitating the same inner relationship that many Eastern religions address through meditation.

Rusk: Even writings on traditional Western analysis speak at length about encouraging the development of the “observing ego” in the client. But as a rule, analysts don’t tell their clients they’re looking for that to happen. They wait for the observing ego to emerge, they make notes about how it’s doing, and they discuss the matter with their colleagues, but not with their clients.

I’d much rather explain to my clients the importance of developing a compassionate self-observer who stands back and looks at the way they’ve been thinking, feeling, and behaving, and who can consider new ways of being. It’s their inner relationship to develop and learn from, not the therapist’s.

Miller: What goes on when people listen to their tapes? What do they report back to you?

Rusk: In the first place, it’s amazing how many people won’t listen at first. They aren’t comfortable hearing themselves without me there. It’s a clear indication of how people in significant trouble lack compassion for their own pain. It requires courage to be compassionate, to hear yourself in pain, and to observe your pain with respect, understanding, caring, and fairness. Until you can have a heart for your own failings and suffering, you won’t do very well having a heart for other people.

Miller: So when the person is alone with the tape, she has to become the compassionate listener that you are during the session itself.

Rusk: Right. The model is there on the tape, as best I can provide it, but the client still has to do it at home.

Miller: Do you think therapists can adapt guided self-change to their practice without your instruction or modeling? How much of this approach has to do with your personality?

Rusk: Look, I’m not a patient man. I come on strong, I’m intimidating, I ask for too much too soon. These are not great qualities for a coach or a therapist. Yet I’m amazed at the degree of effectiveness I do manage to have. I’m certain there are many counselors who could adopt the major features of guided self-change on their own and become far more effective than I am in one-on-one counseling. More patient, quieter, kinder, and gentler people should do wonderfully with this counseling approach.

Miller: If a client wanted his therapist to try out these ideas, should he begin by asking for tape recordings of his therapy sessions?

Rusk: Well, it’s certainly the most concrete change you can make right away. You’d have to explain fully why you want to do it: “I want to tape my sessions and review them at home because I think I have to do more study and self-observation on my own. I don’t want to rely on our sessions as the only time that I’m working on my personal growth.” Now you’re not just asking for tapes. You’re announcing your willingness to take more responsibility for your own growth and health — which should make all but the most insecure and traditional psychoanalysts happy.