If you’re going to learn how to be a psychotherapist, you should study psychology and acquaint yourself with all the theories of human behavior. I believe it also helps to read Russian novels and ponder philosophy. You can do worse than have a solid grounding in statistics and research design if only to wade through the malarkey that tries to pass itself off as science. If you’re going to do your psychotherapy in a large organization, you should be able to practice politics. But if you really care about being a good therapist, you need to study magic. Continue reading
In 1900, for eleven weeks, Sigmund Freud met with a teenage girl stricken by hysterical mutism. We know this woman by the name Freud gave her, Dora. It wasn’t her real name. Precipitating the symptoms, she had accused an older family friend of making sexual advances to her. The family friend denied it and her father didn’t believe her. Continue reading
Some people think psychotherapy is like getting their teeth cleaned. For others, it’s like getting their teeth pulled.
There are some who value a comfortable, long term relationship with a therapist: someone who doesn’t judge, someone who lets them be who they are and go at their own pace. They go periodically to get things off their chest. Their therapist doesn’t have much to say, but they don’t go to hear her talk; they go so they can. There may be some uncomfortable moments; but, going makes them feel better. Therapy is supposed to clean out all those toxic thoughts before they eat away. It relieves the pressure building so they don’t explode. It’s maintenance, not renovation. Successful therapy, for them, means they always have someone they can talk to about anything. Rogerian Person-Centered Therapy is this way. So is Psychoanalysis.
There are others who don’t look at therapy that way. They would never consider seeing a therapist unless they absolutely needed to. They come in with a problem and expect it solved. They want some advice on how they can handle that toxic boss, the nagging spouse, the episode of depression, the heavy drinking, or those pesky panic attacks. Successful therapy, for them, means they don’t have to come anymore. They might as well be saying, if a tooth is diseased, don’t clean it, pull it before it corrupts the whole body. Those people are asking for Solution Focused Brief Therapy.
Solution focused brief therapy may be a description of any therapy that is solution focused and brief, but it’s also a specific brand name approach that they teach in therapist school and write books about. The hypnotist, Milton Erickson started it all. Insoo Kim Berg and Steve de Shazer later elaborated. You don’t get hypnotized when you go to Solution Focused Brief Therapy, at least not in the usual sense of the word. Instead, your therapist will ask you what we call the miracle question:
If you woke up one morning and a miracle had occurred so that your problem was gone, how would you know it?
You might say something like, “When I come home, I won’t dread seeing my wife.” The next question will ask you to rate this dread on a ten-point scale. This will help you see progress better.
Then you’ll get some other questions like: When is your dread less severe? “When I haven’t been drinking.” How have you coped with dread so far? “If I screw up, I just tell her.” What are the parts of your life that is free of dread? “I don’t feel it at work. I give them my best at work.” The answers to these questions can suggest particular tasks for you to do towards helping you feel less dread. You’ll have homework that your therapist will ask about if you return.
In Solution Focused Brief Therapy you’ll get a therapist who asks a lot of pointed questions designed to get to the heart of the matter. She won’t just wait for you to get there. She’ll bring you there and hold you accountable for doing something to help yourself. There will be no exploration of how the dread started. Your therapist won’t ask you about your childhood. The whole technique is about harnessing your existing strengths towards a solution to the problem. It’s not like getting a tooth pulled in terms of pain; only in terms of the aggressiveness of the therapist’s intervention.
Should you be asking for Solution Focused Brief Therapy? It depends on what you need. If you’re totally miserable, in crisis, ready to cash in your chips or go for broke, then you probably don’t need to dick around, exploring your childhood. You need a therapist who’s willing to be directive. You don’t have time to waste. You need a solution, fast; so, you should be in a therapy that focuses on solutions. It doesn’t really have to be brief, per se; but it has to be fast acting. If it works, great. If it doesn’t, you need to know soon so you can try something else.
You should also as for it if you don’t think you’ll be going for long. If going to a therapist is hard for you, or if you can barely afford it, then you’ll want to make the most of the little time you have. You don’t necessarily need brand-named Solution Focused Brief Therapy. There are lots of therapeutic techniques that are solution focused and expected to be brief. Cognitive Behavioral Therapy and Motivational Enhancement are two that come to mind. But you do need a therapist who is willing to pull teeth if he has to. Not all are.
If you are not that bad off; or, if you had been suffering, but now you’re doing better and want to maintain your gains, then the kind of therapy you need, if you need any, is more like getting your teeth cleaned. It’s often a good idea to keep a therapist on retainer, so to speak, and check in from time to time. It’s a good idea for everyone to have someone to talk to. It may not have to be a therapist. If you have one, mental health hygiene can be performed by a good friend, a non-reactive spouse, a calm parent, or a trusted self-help group. If you don’t have one, or if they ones you have aren’t up to the task, then you may need a therapist, but not the kind that’ll pull out every tooth.
Don’t let your insurance company decide what you need if you can help it. Your insurance company would like you to only engage in brief, solution focused therapy because they think it saves them money. They are like those people who skimp on maintenance: people who don’t change their oil, don’t paint their house, and don’t clean their teeth. Insurance companies are always penny wise and pound foolish because they’re hoping that by the time all the neglect of your physical and mental health has run its course, you’ll be off their rolls and on Medicare.
There are often therapists who specialize in one method or the other. The therapist who thinks of therapy as a cleaning is going to be relatively quiet, unobtrusive, and reflective. You’re going to be doing most of the talking, not him. It doesn’t really matter what he thinks or what he says, what matters is that you talk freely, without fear and without anyone controlling you. The therapist who thinks of himself as a kind of mental health hygienist is very willing to do that.
The other kind of therapist, the brief, solution focused therapy kind, is not going to be happy listening to you talk about how dysfunctional you are, week after week, without trying to do something about it. It’s not that he’s impatient with you, it’s more like he feels it’s his responsibility to take action. He doesn’t want to be accused of fostering dependency. Just listening doesn’t seem like he’s working hard enough. Moreover, he has lots of ideas. Because the duration of therapy is brief, solution focused therapists see lots of people and ask those people to try lots of things, so they know what works and what doesn’t.
The best kind of therapist, I believe, is the kind who can both pull teeth and clean them, depending on what’s needed. A reflective eclectic, in other words. Someone with a lot of tools at his disposal and knows how and when to use them.
Basically, it’s true; but, like many adages, there’s more to it than that. Continue reading
You know the type: the type of person I call a fire hose. This is the person who, as soon as he thinks he has your ear, lets loose a flood of words without regard to the give and take that is found in normal conversation.
If you’re a political activist, you might have a lot to say. You might be uncommonly well-informed; but, if you’re a fire hose, you will not change the mind of anyone. Instead, if people do not flee at the sight of you, they will shut down and tune out; they’ll miss the finer points of what you’re trying to say and replace your sound, reasoned argument with, “Blah.. blah…blah…blah…blah….”
If you’re a political activist and let people know you’re interested in public affairs, you’ll attract a lot of fire hoses, if you’re not one, yourself. They’ll point their nozzles at you and gush. You know what it’s like to drink from a fire hose. You can’t do it.
Why do people become fire hoses? Why do they talk well beyond anyone’s capacity to listen? I think there are three reasons: a belief in venting; a desire to hold the floor; and a need to overcome oppression.
I get a lot of fire hoses in my counseling practice because people often mistake venting for healing. They think it’s what they’re supposed to do when they see a shrink. Psychotherapy may be the only profession where the professional is hired for his or her expertise in human affairs and is then often expected to not share it. Sometimes when I see a couple for marriage counseling, one or both of the partners is a fire hose because they heard it was important to get things off their chest. They’re afraid they’re going to blow up if they hold a thought too long.
Freud gets quoted a lot by people who believe in venting. They say that he said people repress a lot of anger, which causes all kinds of bad things to happen. It’s better to release that pressure by venting, they say, than to let it back up and cause anxiety, resentments, paralysis, and depression.
With all the upsetting things we hear in the news these days, there’s a whole lot of venting going on as people get all worked up by the latest thing Trump, or the Democrats, or the Russians, or the Republicans are doing or failed to do. Even if venting actually worked and the internal pressure was released, what you get is something like this: A Trump resister blows off steam, but a Trump supporter hears her. He blows off steam and she hears him; so, now she needs to vent again. The net result is no one gets anywhere. There’s no end to all this venting; and plenty of work for us shrinks.
It should be remembered that Freud saw a lot of corseted and muted Victorian women. They really needed a chance to vent and benefited a lot by doing so. This is seldom the case today. When I see someone in my office who has a hard time speaking up, I want them to vent, too. But there aren’t many like that. Basically, I have a rule of thumb: If you can’t vent, then I want you to; if you like venting, then I’m shutting it down.
You see, once you pass a certain point, venting does not promote change. Once you’ve get the basic information across, it may actually inhibit adjustment if the thing that is keeping you locked up in a dysfunctional pattern is the way you look at things. Venting doesn’t permit anyone else to show you another way out.
Holding the floor
If you’re around a lot of fire hoses, you might have found that the only way to protect yourself from the verbal onslaught is to be a fire hose, yourself. You mount a filibuster and drench them so they can’t turn the hose on you.
First, you tell them what you’re going to tell them, then you tell them, then you tell them what you just told them. You pile on subordinate clauses that no one can disentangle; extend a sentence ad infinitum. You’ve learned to take a breath in mid-sentence so no one can break in when you finally do reach a period. You’ve learned not to look at people when you talk, so they can’t signal you that they’re ready to reply.
By employing these means, you, too, can become a fire hose; but there’s only one problem. Whatever you were trying to say, you may say it, but you might just as well stayed silent for all the impact it has on others.
Many fire hoses belong to an oppressed minority of one kind or another, misrepresented and misunderstood. The fire hose attempts to tell his story his way for once, as soon as they find someone who said they would listen. That’s fine until the listener stops listening, like when she has a question or is unable to clarify a missed point because the speaker is not paying attention when the listener has that lost look on her face. Eventually, it all catches up and the fact that the listener has not been following gets revealed. Then the chronically-oppressed-minority fire hose goes on feeling misrepresented and misunderstood.
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What can you do if your therapist turns out to be abusive? Who can you tell? You can tell TELL, the Therapy Exploitation Link Line. Here’s the link to the link line, so you can tell TELL.
TELL is a resource, referral, and networking organization that seeks to help victims and survivors of exploitation by psychotherapists and other healthcare providers find the support and resources they will need to understand what has happened to them, take action, and heal.
I wouldn’t have known to tell you about TELL had I not been asked to review a book by one woman who turned to that organization for help in recovering from a psychotherapist gone bad. The book is Mending the Shattered Mirror: A Journey of Recovery from Abuse in Therapy by Analie Shepherd. Continue reading
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Once upon a time, a client came into the community mental health clinic where I worked, checked in with the receptionist, and, instead of sitting in the waiting room till I came to get her, went straight to the lady’s room and slit her wrist. She had slit her wrists many, many times before and had dozens of hospitalizations for suicide attempts. She was the toughest, most frustrating, most hopeless case known to all the therapists in the clinic, given up on by all, and recently transferred to me. When I heard what she had done, I began to believe she was beyond help, too. Continue reading