Several weekends ago Daphne Merkin wrote a moving piece in the Sunday New York Times Magazine about psychoanalysis and the therapists that go with it. Aside from an eloquent account of her forty years in therapy, I found the questions she raised about its ultimate value intriguing. First, it caused me to reflect on my own experience with psychologists. I've had two. Both of whom kicked me out. Well, not exactly. It wasn't quite as cold and callous as that, but they did tell me in so many words that it was time for me to get my act together.
As I get older and witness the prevalence of this endless therapy syndrome and read articles like "My Shrunk Life," by Ms. Merkin, I realize what a selfless, professional and giving act it was for my doctors to send me out into the world where the expectation was clear that I apply and practice what I'd learned. I was always free to go back with other "issues," but they were not interested in keeping me on the couch, stuck, mired in something that I could not undo or change. It makes me think of how birds learn to fly. There is a reason why they get pushed out of the nest whether they want to go or not. And guess what? It works. They learn. They fly. They may flutter and flop, but after a few attempts, they're on their way.
I wondered why similar conversations never seemed to be a reality for Ms. Merkin. Of all those shrinks, had it not occurred to one of them that not being dependent on therapy might possibly help her? I also wondered what it must be like to keep digging at the same old wounds for 40 years. Would it not make them worse and less likely to heal, like scratching at a scab? I felt sorrow for her and others who have devoted valuable time focused on the past in lieu of living for the future. And, I struggled with my own desire to hold the doctors accountable for not calling it a day and evaluating themselves as to whether their efforts were working -- or not.
See, I think of shrinks -- the good ones, that is -- as teachers. We're there to learn how to look at ourselves and live life in a healthy way ... supposedly. And like anything else where we pay for "lessons," there should be levels, with criteria to measure whether one is making progress or not. But to swim around in the vapors of the past for no real gain or to not have a marker that deems the time (and money) well spent, is crazy at best and irresponsible at worst. Eventually, someone needs to ask -- and answer -- the question, "What's the point?"
I know people who religiously sit in their appointments week after week, month after month, year after year and all they are able to do at the end of the day (or week or month or year) is keep talking about what they talk about. At some point, someone must question if the effect of all that talk is paralyzing. At some point, someone needs to assess whether there has been any change and if not, make one. Change something. Try something else.
Personally, I benefited immensely from what both of my shrinks taught me because they did just that. They taught. As a result, looking back, this is what I learned about what makes a therapeutic relationship successful, effective and worth the time, effort and money.
No B.S. You need someone who is willing to tell you that you are full of shit. Otherwise, the game keeps going around and around and the patient goes in circles, only to end up right back from where he or she started. In many cases, the net outcome is that you create situations where current behaviors are justified with explanations from the past, and the cycle never ends.
Move on. Seeing the past is important, but not at the expense of stifling the future. A good shrink will balance what needs to be brought into the conscious mind with creating a new consciousness that will help his or her patient move forward. Bottom line, if you don't let go of the bogeymen, you will not be free to advance in the right direction.
Start doing, stop thinking. I got homework from my shrinks because of the value in turning cognitive thought to behavioral action. Again, we could have sat on our butts and talked about it all day, but if I was unable to put the learning into motion, the entire therapeutic effort would have been moot.
A chance to grow up. Good shrinks also understand the importance of a normal, healthy maturation process. They are able to sensitize patients to the feelings and needs of others rather than allowing the individual to exclusively perpetuate the self-absorbed environment that so often accompanies self-analysis. At the end of the day, analyzing one's childhood should not equate with being stuck in one's childhood for that prevents us from becoming adults.
The silent treatment is not so golden. Despite conventional wisdom, there is nothing wrong with psychologists speaking up and offering their knowledge and observations. What I appreciated most was that my shrinks didn't make me sit there in the dark groping around for information inside memories that may or may not be relevant to developing a healthy state of mind today. Instead, they talked to me like a fellow human being.
In the final analysis, the aim of good psychotherapy should be that of a therapist who creates the space necessary for patients to bring themselves into the room in an honest way and manage the destructive aspects of ego out.
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I'll build upon your list if you don't mind my "butting in." ;)
#6. Insight beyond text books: Inner Wisdom
A great counselor/therapist/coach/mentor/teacher or whatever you'd like to call it, necessarily has a profound understanding of the human condition; and I don't mean "psych-anese" vocabulary understandings like dissasociation or cognitive dissonance, but perhaps more like Victor Frankel or an existential philosopher might understand humans: as conscious beings seeking meaning in their lives and suffering.
This way the depressed person is NOT just seen as having a chemical imbalance, but also seen as a person, who is depressed about the direction (or lack of direction) in their lives. Humans may look back to the past for Information, but we look forward to the future for Inspiration. Not feeling inspired or excited about life? Perhaps you aren't looking forward to a great future because you have nothing to "look forward" to. As I often (lovingly and supportively) ask/challenge my clients, "are you clinically depressed, or is your life depressing?" Do you have a disease or are you suffering from dis-ease?" "Is life really that boring, or are you boring?" (again this is done after rapport is established)
I can't tell you how many times I've seen clinical depression dissapear with the "pill" of inspiring plans for a better tomorrow; that and genuine support towards making it happen.
#6? : A fundamental understanding of human beings. ;)
Also, links to resources are not a bad thing. It's easy to see most shrinks are useless, harder to figure out where and what to look for... Be great if there was a yelp-for-the-brain set of reviews by patients. Any pointers?
And no, I'm not saying coaching should replace therapy. They are just as vulnerable to falling into the same traps and so too are their models. Accreditation isn't the issue so much as it is the quality of the practitioner.
On the other hand, life coaching has certification boards out there but (currently) they are nowhere near as professional as the APA (American Psychological Association). Many agree, that the true "certification" of a coach is whether or not they can walk what they talk. ( ie- If they coach people into how to make 100k yearly as an entrepreneur, then they better have that accomplished in their own life, etc.) "Once you achieve it, then you can teach it." This is the litmus test of life coaching.
Professionally, it seems that we could learn a lot from each other. This is why I pursued both; Add a little mindfulness training, and you have a complete system. :)
Thank you for posting this! I'm high five-ing you in my head for calling out the importance of leadership in this line of work. Bravo! ;)
Therapeutically, it seems we went from "the doctor knows best" (days of Freud) to "the patient knows best" (humanistic model), and so few of us seems to have caught on to "the middle way"between the two.
What would this middle way look like? Well for starters, we need to not only start teaching again, but MENTORING as well. We need to expand the typical "uh huh" style of passive listening into the realm of "empathetic and energetic understanding" (where the client feels you REALLY get them on a human level). Here's the kicker, this middle-way model requires US to be LIVING models of what we teach others. I love this idea!
This is about a call to greater integrity in our craft. i.e - Why would I pay to work with a fitness trainer who is not fit themselves? So too, why would I want relationship advice from a clinician who cannot make a relationship work? This is the gap between HAVING a teaching, and BEING the teaching. In my experience, when we show up as powerful and wise mentors for our clients, it empowers them to think big, allows them to trust that things can change, and awakens possibility for a greater life.
Leading by example, and listening with an open heart. To me, this is the "middle way."
Just my opinion...Last I checked, that opinion and two bucks gets me a small coffee at Starbucks...
Exactly my point! I think that any long-term relationship where trust is essential should be vetted in the same way...same type of point-of-view and outlook are a must.
Well, there is a little bit of a difference in that speed dating is about "finding" a date - (I think!) They don't actually have the date. Speed-shrinking, if I understand it correctly, is about seeing the shrink for advice in a sound-bite of a session. I suspect that each probably has its place. Like Ann Landers doled out advice for so many years, speed shrinking could answer a question in the same fashion. But if it is not a fairly straightforward question and someone is interested of either changing patterns or working on his or her internal growth, then I don't think it is sufficient. Some things fall under work that needs to be done within our internal worlds and other efforts need to be applied to what is happening externally. Speed-shrinking is probably an appropriate response to life and what it hands us in our external worlds. You raise an interesting point though... what if people did search for a "match" in their psychologists they way they look to pair up in dating? Wow. What a concept. You may be onto something!
1. The therapist does not care. And the patient knows. (Emerging Postmodern Process Model)
2, The therapist cares. And the patient knows. (Late Modern Facilitation Model)
Perhaps, one of the differences in approach is that those of us in integrative and holistic health practices, work with the whole being, introduce methods & practices for supporting, maintaining, strengthening, balancing the physical, mental, emotional and spiritual systems.
I like to feel that I practice what I teach or introduce. For example, I introduce holistic self-care planning with goals, that incorporates and applys methods for improving our whole being. Meditation and body work are incorporated into my therapies to support wellness, achieve high levels of consciousness, and become the best we can be or meant to be.
Thank you for your inspiring and timely article. I especially appreciate the diversity, interests and skills that we all bring to the empowering and helping professions.
Cognitive and behavioral schools are future-oriented being targeted towards remodeling of behavior with the cognitive moving forward from the past while the behavioral may simply ignore it.
Some Postmodern approaches which are emerging from management and organisational methodologies (and which are rightly looked upon with concern by practitioner of established methods) focus upon the present and the processing which is taking place in the present. The world of a neurotic does not fall apart if they are told unequivocally that they are manipulative and self-centred. Engagement and for some re-engagement with reality is unavoidably painful. Therapy should only shield the potentially suicidal from reality.
I wonder how your article could have gone had you not felt the need to be judgmental? We don't KNOW that the patient talks about the past, do we ?
I am a substance abuse T and I am aware that some of my colleagues are working with patients on day to day struggles and obstructions. Not every problem starts in childhood, contrary to how you are perceiving all therapy.
I've always felt that some articles and conversations can become a negative instead of a positive because someone who needs therapy may end up thinking that it would be a waste.
Don't throw the baby out with the bath water, please.