The Go-Between: A psychologist’s play for the new year

Prologue: Life is not about finding oneself. It’s about creating oneself. So it says on our refrigerator magnet, but I’ve never been entirely comfortable with that idea.
Creating oneself is a nice idea, but there are limits. It would have been fun to create myself to be an NBA All-Star, but I never had the skill despite my love for the game of basketball.

Never had the ambition for politics, the stomach for space flight, the nerves for surgery, the exposure or the ear for music, and I am in the wrong place and time to become a knight in King Arthur’s court.

What I do have either from the beginning or as hard-won acquisitions along the way is a handful of qualities that make me a good go-between, and I’d like to think that good go-betweens make good psychologists.

Looking back on my long career, I am struck by all the ways psychologists practice a kind of shuttle diplomacy as we work to reconcile opposing mental contents, social units, and institutions. If this was a play, it might go something like this.

Cast: The Psychologist/Go-Between, The Advocate, frequently on stage never far from the Go-Between, The Creator, a loving God, an intelligent universe, or pure chance. It’s up to you, however you think you got here with all the skills you bring to the work of psychology; The Client/Patient; Id, Ego and Superego; The Teacher; The Parents; The Couple; The Treatment Team: Psychiatrist, Nurse, Social Worker; The Judge; The Qualities: Trustworthiness, Empathy, Listening Skills, Clarity, Knowledge, Understanding, Problem-Solving Ability, Impartiality, Diplomacy, Tact, Persuasiveness, Humility, Patience, Reliability, Flexibility.

Act 1: The Internal Struggle and the Therapeutic Alliance. Now enter the ego, id and superego, the holy trinity of Freudian psychology, that has endured waves of new ways of understanding the human person and techniques of therapy. If ever there was a need for a go-between, it is here that the psychologist is called upon to create harmony between these different aspects of mental functioning so easily set in opposition to one another.

We strive for balance, recognizing the primacy of the ego to enable our patients to function in the real world. At the same time, we support the role of a well-regulated superego and id to aid in the development of conscience and a healthy connection with emotions and impulses.

The focus in Act 1 is on the psychologist and the patient with strong lines for id, ego, and superego and a chorus of all the qualities that make for an effective therapeutic alliance.
Knowledge is on stage in all three acts. She sits stage right, listening and observing everything and writing notes that she slips to the other actors when they are called upon to make an important contribution to the discussion.

When she is not acting or rehearsing, knowledge can be found taking continuing education courses or reading in the library.

Act 2: The Bond of Connection, the Psychologist as Bridge This act presents the psychologist as the go-between working to understand his patient/client and communicate that understanding to significant figures in the patient’s life. One scene might feature the psychologist meeting with a child patient and later, with the patient’s permission, communicating something the child might want his teacher or his parents to understand about him that he hasn’t been able to express directly.

The psychologist might also convey information to his patient that will help him to understand the expectations of school and home. These sessions can be done individually or in groups where all or subgroups of stakeholders can share their concerns. Flexibility as always is a key actor.

Another scene in Act 2 might show the psychologist working as a go-between with a couple on any of the issues that interfere with mutual satisfaction in a relationship. Listening skills, empathy, clarity, impartiality, diplomacy, and tact will have a strong stage presence here as in all the situations where the psychologist acts as a bridge between his client/patient and other significant figures.

Include here a scene showing a psychologist working as part of an inpatient treatment team acting in the role of go-between mediating between the patient and the team. Questions around passes, level of supervision, treatment plans, behavioral expectations, and discharge arrangements would all make for a lively dialogue at this point in Act 2.

Act 3: Extending the Bridge: Building Links to the Community. As go-between and sometimes advocate, the psychologist strives to understand the complexity of individuals, their relationships with others, and their connection to the larger institutions that affect their mental health.

Halfway houses, outpatient clinics, sheltered workshops, and the court system all represent opportunities and challenges for patients preparing for discharge from psychiatric hospitals. In the situation of people confined to the hospital because of serious crimes they had committed under the influence of mental illness, the most important community link is often the bridge to the criminal justice system. The success of this bridge will determine the fate of patients whose mental illnesses are stabilized by medication and psychotherapy but whose freedom remains limited by their continuing court commitments.

Now enter the judge, the patient, the psychologist go-between, and advocate and all the qualities that serve us in our work at every level of human functioning. Qualities supporting the therapeutic alliance will have an important role in assuring the patient that he is represented by a psychologist who understands him well and can communicate clearly to the court.

This chorus of trustworthiness, reliability, and clarity, together with the knowledge of an expert witness and a healthy dose of persuasiveness will also elevate the psychologist’s credibility in the eyes of the court.

And let’s not forget the roles that psychologists play when we bridge the scientific community with the public or advocate for causes germane to mental health in the corridors of power to create important policy changes, all the work of go-betweens.

Epilogue: So now at the beginning of the New Year, I rest my case. Let us make whatever resolutions we wish to break bad habits, build new and better ones, see the world, learn new skills, or realize cherished dreams. Just let’s not forget to celebrate and sharpen the qualities that made us go-betweens. That’s how we became the psychologists we are today. And what could be better than that?