Before You See That Psychiatrist: Why Psychotherapy May Be Bad For Your Health
It’s not bad enough that if you go see a psychiatrist that they may give you medications of questionable efficacy that may be complicated by making it hard for you to get off your couch and other side effects. But as I was discussing at lunch the other day with Charles Whitfield MD, friend and fellow Atlanta MD author and author of The Truth About Mental Illness and other books in the trauma field, psychotherapy can be helpful but can also be a double edged sword. That made me think about my long term psychotherapy supervision as a Yale psychiatry resident. The supervisors were great, I followed a patient for several years and they met with me (two of them) for an hour a week, they were both with the New England Psychoanalytical Institute, which was affiliated with Yale, and both had offices on Trumbull Street in New Haven, CT, which was “therapy row”.
Therapy Row, Trumbull St, in New Haven CT
Their names were Charles Gardner MD and Ira Levine MD. After I graduated I subletted Charlie Gardner’s office for my own small private practice for a while. Then I moved my practice to my house. My five year old daughter liked to talk to the borderline-strippers with total body tatoos in the waiting room. Oddly they seemed to be at a similar level of psychological development.
When I moved from Yale to Emory in 2000, the Director of Clinical Services, Steven Levy MD, who was (is) a psychoanalyst, kind of eyed me funny, as I was a researcher who was primarily focused on brain imaging studies in PTSD. He is now the acting chair of psychiatry at Emory. How ironic. He probably doesn’t know that I was born at the Meninger Clinic in Topeka KS, where my father was a psychiatry resident and whose mentor was the famous American psychoanalyst Karl Menninger MD. One of his jobs was entertaining visitors to the Meninger Clinic, who included Aldous Huxley, the author of the book Brave New World, who had dinner at our house.
We don't need soma, since we have Seroquel
Dr. B. outside Berggasse 19, Vienna
Anyhoo Charlie Gardner gave me a paper by a psychiatrist and analyst named Robert Langs, MD. He wrote several books including Rating Your Psychotherapist which I went back and repurchased. The gist of these books is that there are certain principles that characterize good therapists, including the fact that they start and end on time. Langs discussed the “frame” of therapy as something almost religious, which at the time I thought sounded nuts, but with time I came to appreciate as being very important. He makes these points about what is required for a good therapy:
- A single set fee
- A single, set location
- A set time for and length of sessions
- A soundproof office
- The rule of free association
- The therapist limited to neutral interventions (i.e. not from personal needs of therapist)
- The relative anonymity of the therapist (no self revelation or opinions, work limited to the material from the patient)
- total privacy
- total confidentiality
I don’t think this list is unreasonable. And I don’t think it is unreasonable to request that someone you are paying money to should abide by these rules if that is what you want. And yes dreams are important, in spite of what the Shrink Rap bloggers think, and I recommend this book by Robert Langs called Decoding Your Dreams. He recommends free association from the elements of the dream, identifying the day’s event that triggered the dream, and not writing it down or talking about it with others (to let the dream continue to grow in meaning).
Unfortunately the current generation of psychiatrists was trained by the pharma-bio consortium, and doesn’t always take dreams and therapy seriously, but the ”New Psychiatry” is on the way (stay tuned).
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By Stephany, April 1, 2009 @ 10:24 pm
Thanks for the laugh re: the body tatoos LOL
I see my psychiatrist and pretty much have navigated the time into talking, we talk about pharma reps (of course we know I ask anything and everything)and my life, and other stuff. He’s supportive of my “ideas” and going off meds, etc but is always making sure I don’t “need any Lexapro?”. We have a good laugh about stuff, and, he knows my daughter. So I can just talk about whatever and he gets it.
Sorry this is probably a ramble for my own blog, but thanks for posting this, and I like the pic in Vienna.
By Doug Bremner, April 1, 2009 @ 10:31 pm
We like your blog Stephany!
By Marian, April 2, 2009 @ 12:08 am
“Total confidentiality” seems somewhat misleading to me, when it comes to therapists. Indeed, there’s only one profession in the whole wide world, whose members do have total confidentiality: Catholic priests. Therapists’ – and anyone else’s – confidentiality is relative.
It actually got on my nerves to listen to my therapist repeatedly trying to convince me of her, non-existent, total confidentiality: ‘Ugh, she’s paranoid, so let’s ram this home!’ Unfortunately, I knew better. And the repeated lying about it almost ruined my trust in her. I’d preferred to be told the truth: “My confidentiality ends the moment I assess you to be a danger to yourself and/or others.” See, that would have been honest.
(Hope, your comment field takes html tags.)
By Alex (WWU), April 2, 2009 @ 12:23 am
Loved the history lesson, loved Brave New World.
Jungian and/or Freudian dream interpretation bothers me… I’ve never been sold on the proposition that our dreams particularly meaningful.
“dreams are related to the residue of an event that occurred the day before that triggered something mentally that is too emotionally charged to be brought to the conscious mind.”
Has this been empirically tested/is it empirically testable?
I mean… the last dream I remember involved of hundreds of children reminiscent of the children from “The Midwich Cuckoos” coming off a giant boat… I’ve still wracking my brain to find meaning in that one…
By Gianna, April 2, 2009 @ 12:34 am
all I do now is dream work and it’s the most rewarding therapy I’ve ever had…it’s really amazing…
of course I did it years ago with a sadistic Freudian analyst and now I’m doing it with a loving Jungian analyst…
I don’t actually think their orientations made them respectively sadistic and loving, I think that is only incidental to their personalities…but boy does my current therapist rock my world!
I had given up on therapy. I certainly don’t think it’s right for everyone…AND Marian’s comment is extremely valid. If you have a trigger happy therapist you can have your life ruined in an instant if you utter the word suicide. And in general suicidal ideation can be worked with and so that kind of loss of confidentiality can be devastating and well, frankly, terminal.
By Gina Pera, April 2, 2009 @ 5:50 am
I dunno, Dr. B. Given the right therapist and the right patient, I know that this modality can be very powerful. The problem comes when the therapist can’t discern what is addressable with therapy and what is not. Sometimes the therapist is more interested in entertainment, I feel — interesting stories from the patient.
A friend of mine, in psychoanalysis for years, finally figured out he had ADHD and demanded a trial of stimulant medication from his psychiatrist. The psychiatrist agreed, but only on the priviso that the patient keep coming and have interesting things to talk about, like the latest book read or film viewed — because the psychiatrist wanted an interesting hour.
Sorry, but when it comes to the ADHD population, I’ve heard 1,000 times as many stories about years wasted in therapy (or lives even made worse by it) than I have stories where therapy helped a person to be more functional.
Approach with caution.
By Gina Pera, April 2, 2009 @ 5:50 am
Interesting story about your dad.
By Gina Pera, April 2, 2009 @ 5:52 am
I have very vivid dreams if I eat yogurt within a few hours of bedtime. I don’t think that’s significant of anything.
But, while writing my book, for years I had the recurring dream that I was leaving for an important trip, running late, and having a hard time packing everything into the suitcase. I rely on my husband for morning interpretation. For years he could say, “It’s about the book.”
By Doug Bremner, April 2, 2009 @ 7:56 am
I think it is about death. Oh btw I want to add that your therapist should disclose if they have been through therapy themselves. When I was a med student at Duke is was a requirement for the psychiatry residents and I think we should get back to that.
By Gina Pera, April 2, 2009 @ 11:46 am
Hmmm, you think EVERYTHING is about death?
By Gina Pera, April 2, 2009 @ 11:49 am
Hmmm, you think EVERYTHING is about death?
Hey, Dr. B., I’m in London now, where folks are talking about this new Wunder Pill — it combines all the medications we’ve been disparaging (statins, aspirin to prevent cardio issues, etc.). They’re talking about it being mandatory for people over age 50.
This in a country where I’ve had to scramble to find a few vegetables for each meal — and where there’s still plenty of smoking and drinking. Perhaps you should investigate and report — even if it is across the pond.
By Kathy, April 2, 2009 @ 12:49 pm
Interesting post Doug. Did you see the recently published list in the New York Times/ Psych Central of the 12 Most Annoying Bad Habits of Therapists. I concur with the list Robert Lange suggests as reasonable expectations of therapy. I would add one more… turning up at least 30 minutes before your first client of the day! In my many years of managing a private practice I continue to be disappointed by the tardiness of therapists with regard to this ! Glad to have discovered your blog (through twitter)
By Doug Bremner, April 2, 2009 @ 2:05 pm
Thanks for the reference, Kathy. That comment string was interesting.
http://psychcentral.com/blog/archives/2009/03/08/12-most-annoying-bad-habits-of-therapists/
To summarize the content of the other post, to give specific examples of the comment “be free from the needs of the therapist”, don’t grab, vomit on, confide in or expose yourself to your patient. Don’t bring your dogs or ask to meet your patients dogs. Don’t: 1) work on your laptop; 2) fall asleep; 3) yawn excessively; 4) talk about your own childhood; 5) talk about your other patients; 6) fart excessively; 7) eat your lunch;
show too much cleavage; 9) flirt; 10) not show up; 11) meet for two hours instead of one; 12) add on “extra time” to another session cuz you cut off time on the last one; 13) bill for sessions you never had; 14) ask your patient to give you a loan to pay for your house; 15) terminate your patient by email or by leaving a message on their machine.
And that is only a partial list. I guess I didn’t think I needed to be so specific.
By Kathy, April 2, 2009 @ 3:15 pm
Great precis
By Dan, April 2, 2009 @ 8:22 pm
Psychoanalysis takes at times years. Cognitive behavioral therapy may be the way to go. It avoids the cognitive copulation one of the opposite gender may have with their psychoanalyst. And the patient maintains reality perhaps more. You tell me, doc.
By Gianna, April 2, 2009 @ 8:31 pm
CBT is not appropriate for everyone…I’ve given it several shots and have not encountered its use in such a way that I don’t experience as completely insulting to my intelligence.
ACT seems to overcome these problems…it is deeply respectful of people’s experience and is essentially a marriage of CBT and mindfulness practice borrowed from Buddhism…CBT, on it’s own, in my experience is not respectful of people. And I’ve talked to many many people who experience it that way.
Granted, I’ve also met many who swear it saved their lives.
Me..I need that deep look into the depths of my soul. And no, that is not for everyone either…
It’s never a one size fits all when it comes to psychotherapy. I also don’t believe for a second that psychotherapy is even necessary for even severe mental health issues and have met some incredible human beings who have found methods of healing their damaged psyches that did not involve psychotherapists or psychiatrists at all.
By Doug Bremner, April 2, 2009 @ 8:32 pm
Ha ha. At this point I would not recommend ‘traditional’ psychoanalysis since that is a fairly theory embedded profession and since many of the practitioners are so old that they may have early AD and be falling asleep like many of the commenters on the post I gave the link to above. That said, I do think that although cognitive behavioral therapy is shown to be effective in clinical trials, that most of the people who actually do CBT would rather have “psychoanalytically informed psychotherapy” cuz they want to expand on their feelings and have more time etc. And I do think that type of therapy is useful for those who are open to examining their emotions and thinking psychologically.
By Gianna, April 2, 2009 @ 8:36 pm
we cross-posted Doug,
you said:
most of the people who actually do CBT would rather have “psychoanalytically informed psychotherapy” cuz they want to expand on their feelings and have more time etc. And I do think that type of therapy is useful for those who are open to examining their emotions and thinking psychologically.
a lot of people want to examine their feelings…but a lot DO NOT. I would guess most people actually don’t want to…it’s a very painful process that people avoid like the plague in general and may be why some people really like CBT.
though I think the deepest, most lasting change comes with a willingness to look inside deep into the painful hidden parts of our being.
By Doug Bremner, April 2, 2009 @ 8:38 pm
CBT for PTSD. The dirty little secret is that over half of the patients drop out, so that the ’survivors’ of course look good. They would never let them get away with that in a drug trial. They would do an intent to treat analysis, meaning lets look at everyone even if they dropped out. An intent to treat analysis of CBT for PTSD would show that it is ineffective. I.e. shoving traumatic memories down someones throat and expecting them to swim doesnt work. It is just the behavioral psychologists trying to swim with the druggy psychiatrists.
By Doug Bremner, April 2, 2009 @ 8:44 pm
Yes I would agree that most people do not *really* want to examine their feelings in depth. Which is why they choose CBT or medication therapy. I see them all the time in our screening clinic at the VA for returning Iraq vets.
By Psychotherapist, April 2, 2009 @ 9:31 pm
Hi Doug–After about 35 years both as a trained therapist (clinical psychologist) and being _in_ therapy for a number of them, I would say that a truly competent therapist is extremely rare. I do not include myself in that group, which is why the great part of my career has been as a teacher (not of therapy) rather than a clinician. I am an excellent diagnostician–meaning, I can work with people pretty quickly to help them (and me) get a sense of what’s going on–but that is a different skill than being a therapist.
What I believe is most important is not on Langs’ list at all. It is genuine love of emotional life, in all its vividness and complexity. A lot of people become therapists only intellectually–they know a fair amount about subjectivity, but they avoid the actual thing. Indeed, becoming a therapist helps them do that.
Being a good interpreter of dreams, which I am, is only a small bit–kind of like being good at card tricks. In itself, it has little to do with the kind of profound engagement in another person’s emotional world (and, therefore, comfort with one’s own) which is what is required.
By Therapy Patient, April 3, 2009 @ 1:30 am
My psychiatrist is a traditional psychotherapist who was trained as a Freudian though he has kept up with research and altered his practice over time and he’s no longer a Freud follower per se. He’s about 67 years old and is alert, brilliant, creative, knowledgeable, and he thinks for himself. He is extremely empathetic. He is totally with me emotionally in sessions and he’s doing for me what other types of therapy are not good at. He has been helping me to learn to feel and express and differentiate my feelings. It is life enriching to experience greater depth of feeling. I agree that everyone isn’t going to FIND a psychiatrist like mine, but working with him is life altering especially for someone like me from an abusive home with problems accessing and expressing feeling. I feel SO lucky to have found him. He’s amazing.
By Doug Bremner, April 3, 2009 @ 7:49 am
I think adding a love of emotional life to the list is a good one. That may have been what was lacking in general from the Freudian era of psychiatry. I guess I have been trying to do that through my writing here and here and here. I don’t do psychotherapy myself and always thought that I would have to have a better handle on my own emotional life before I subjected others to my “treatments”. As seen in the other thread there are far too many “therapists” out there doing more harm than good because of the fact that they don’t have a grip on their own emotional life. I think the first requirement of a therapist is that they not be insane. And Psychotherapist the fact that you recognize that a love of emotional life is an important quality in a therapist means that you probably wouldn’t be so bad after all. I hadn’t thought of that. Maybe my tendency to intellectualize things. Maybe Langs and I have that in common. Who btw said that all dream interpretations are done by the dreamer, and the therapist is just a helper at best.
By Marian, April 3, 2009 @ 8:12 am
“Who btw said that all dream interpretations are done by the dreamer, and the therapist is just a helper at best.”
Ha. I think, all work in therapy – dream- or other – is, or should be, done by the client. With the therapist being a guide, or helper, yah, but never a leader. I see a lot of “therapists”, who seem to be rather bothered by this idea, though.
By Gianna, April 3, 2009 @ 9:27 am
re: therapist as leader or guide…
In Take These Broken Wings a documentary that tells the story of two severely “schizophrenic” women who heal completely through psychotherapy (one being the author of the classic “I never promised you a rose garden” and who is now a professor at a university…
ah, well..the author describes therapy as a mining expedition with the therapist holding the flashlight…but the she, the patient, had the map!!
I thought that was an awesome analogy!!
buy this awesome documentary here:
http://www.iraresoul.com/dvd.html
By Gianna, April 3, 2009 @ 12:35 pm
well…here’s a post whose author jests about provider pathologies:
http://bipolarblast.wordpress.com/2009/04/03/provider-psychopathologies/
some therapists certainly fall into these categories. and I saw evidence of much of these phenomena when I worked as a social worker in mental health systems…
By bernie Beitman, April 3, 2009 @ 1:52 pm
I presented a case to Robert Langs in front of 200 psychiatrists. His need to humiliate was aptly demonstrated to this audience. He was extremely rigid (if person leaves her sweater on the chair, do not pick it up–that is a boundary violation). Yalom has show good clinical results when therapist self revelation is relevant to the patient.
The notion that therapists have problems that mesh badly with the patient’s is hardly excluded from Lang’s list.
By Stephany, April 3, 2009 @ 1:59 pm
I’m glad you like my blog, I always assume I’m on a dart board somewhere from what I write sometimes.
My dream last night was putting the car in reverse, coasting down a long driveway and then down a steep hill, all roads full of cars.
I’ve been increasing speed in my walks/hikes and sometimes I remember trauma from childhood and it’s been therapeutic, moving this stuff out by embracing it and letting it go.
By Psychotherapist, April 3, 2009 @ 5:31 pm
Thanks for word, Doug. I don’t lack in love for emotional life. But I think what being a truly excellent therapist requires is also the resilience to “go there,” hour after hour, day after day. I’m “good” for one or two sessions. But not necessarily as a full time job.
That’s fine, as far as I’m concerned. I’m a pretty fine teacher, playwright, activist, and a few other things. Not everyone has to do everything! But it would be nice if something more besides a license were required to be considered a competent clinician!
By Therapy Patient, April 4, 2009 @ 2:06 am
I agree that it takes a pretty exceptional person to be a great psychotherapist. I do think that the psychiatrist needs to be sane and have personal emotional issues worked out It also helps to have seen lots and lots of patients and have intuition and experience. The ability to empathize and feel what the client feels (or should feel) in a session is important, too. I don’t know how my psychiatrist does do this session after session. I asked him if he “takes it home” with him, and he said he often does.
I do not agree with Lang regarding self-revelation.
My psychiatrist uses his own life plus experiences of his clients and friends as examples when we have discussions and it really helps me understand my situation better. He also DOES give advice when he thinks a client is not acting in a self-protective manner. In addition he acts as life-coach, for me anyway. I am trying to stand up for myself more and he helps by giving examples of how a person might react in a more self-protective manner. The whole process works because we are both so committed and invested in the process. I just could not say enough how life-transforming my psychotherapy has been and continues to be. I feel that I am permanently changing for the better. I have been moving living life in my head with feelings unacknowledged, to more fully being able to tap into my emotional reactions, feelings, and self-interest and being able to communicate my feelings.
By Marian, April 4, 2009 @ 2:57 am
Therapy Patient: “The ability to empathize and feel what the client feels (or should feel) in a session is important, too.”
Maybe I got you somehow wrong, but I don’t think, that there should be any such thing as a “should feel” involved in therapy. The client feels what s/he feels. Period. If anyone had tried to tell me, what/how I should feel, I’d been running for the hills, instantly. Being told what/how to feel (think, do, say, etc.) was exactly which brought me into trouble, initially. And it’s what brings most people into trouble, initially.
Experience: I’d say, a kind of “self-experience”, being in touch with one’s own self, is important. Professional experience is secondary, IMO. Otherwise, Soteria would never have worked out.
By dog meat, April 7, 2009 @ 6:31 pm
A mental Health Consumer Provider’s experience working on two Programs of Assertive Community Treatment
After an accident I was disabled for five years. During this time I received Social Security Disability Income and counseling. I joined a club house in Newton Massachusetts for vocational counseling. After volunteering there I got a temporary employment placement. I did janitorial work on two days each week for two hour shifts at some group homes. On one night each week I attended a vocational support group to discuss issues related to the job. After this I found a part time telemarketing job. This independent employment was a step in the right direction. I had an excellent college education and had difficulty getting hired. I thought this could be related to having been disabled. Employers are careful in hireling people and this can exclude people who can do the job but have been unemployed. I was grateful that a program was available in my community to help disabled people get jobs. Being excluded from the work force creates a unique poverty of the soul. I vowed that someday I would help disabled people with finding jobs.
A year and six months into my recovery I got a residential counselor job working with individuals called mentally retarded. I slept overnight three nights. This was an excellent situation for someone with depression. I got off public assistance and was self supporting, productive and responsible member of society. After you worked for a year at the agency you were eligible for tuition reimbursement. I took advantage of this and enrolled in the U Mass Boston’s Rehabilitation Counseling program.
After taking one course a semester for a few years I moved into a therapeutic community where I worked as a counselor with mental health clients. Working in a supportive environment as a counselor and learning about mental health counseling helped me grow as a person and nurture the growth of people I worked with. I worked in this position and studied rehabilitation counseling for five years. After I earned a Masters in Counseling I got certified as a rehabilitation counselor.
Then I took a job with a Program of Assertive Community Treatment (PACT) in central Massachusetts. I was able to advocate for clients and help them with a lot of problems. I liked the fact that we did outreach and helped clients where ever they were. This type of work brought me to homeless shelters, schools, work places, hospitals, jails and client’s homes. The psychiatrist and staff were supportive. Because the program was associated with a University teaching and learning were emphasized. I received good performance reviews over my four years of employment. I handled numerous crisis situations effectively. I helped clients to find jobs.
After four years I was offered a better paying position at another PACT. I had twelve years experience and not one complaint on my record. I moved near to Malden take a position as a Vocational Counselor with a PACT in Malden at Tri-City Mental Health Center (TCMHC). The company was merging with Eliot Community Mental Health (ECMH). This was because TCMHC had committed fraud in billing Medicaid and the director of rehabilitation stole from clients. I understood that the company was in transition. I was confident in my ability to help clients and I knew I had a good work ethic and thought that would be enough to succeed. No one new I had a disability when I took the job. I had the experience of being on an effectively operated PACT. This experience was needed because the program had problems.
After taking the job I saw that clients were not getting services they needed with housing and employment. Clients needed help. Staff would say that clients were to “symptomatic” to benefit from help with these important issues. Staff treated clients in a condescending manner. I raised my concerns about client treatment with Aaron Katz the new program director. A Katz did not have the required credentials or experience to manage the program. This program was designed to serve the most disabled and vulnerable mental health consumers in the area. The response I got was “mind your own place and business”. I could see his approach to management was to bully subordinates, use intimidation and push people around. For example he and another manager would co supervise a counselor while A Katz sat at a computer taking notes like it was a disposition. You never knew what was being written. I asked if I could take notes during a meeting but was told this was not allowed. I do not respond well to this approach by a manager.
In my first month of employment I was asked to take a client to get a toxicology screen. The test results could get the client in legal trouble. I thought that this task was a bad idea for our first meeting. I found out latter this client had been charged with attempted murder. I was not told about his background but just to take him to get tested. I refused to do this. This is just one example of a number of problems where clients and staff were put at odds because of poor management. (Reports to DMH never told what was going on.) In a PACT program clients are often under court order to get treatment and have the program manage their money. The only way to be sure clients are not coerced and staff is acting ethically is for there to be effective communication between all staff and management. However this was not possible at the ECHS PACT all communication was one way. Aaron Katz gave orders and expected staff to obey his orders without question. It was as if the clients weren’t people but animals to be feed anti-psychotic medications. A Katz the program director would say “I have to micromanage everything”. If a team meeting was going on counselors were expected to raise there hand and ask permission to go to the bathroom. We were in team meetings ten hours a week.
The work place became hostile. I think it was because other staff saw that I advocated for clients in meetings and management felt threatened. I got the “you aren’t fitting in talk” from the manager. Then I got a written warning that threatened termination. This was for late paper work. Some of the paper work was the program directors (A Katz) responsibility. I explained that I had dyslexia and I asked for some extra time to complete the paper works. I advocated for my self and asked for the accommodations that I am entitled to under the American’s with Disabilities Act. Other than this minor issue I had demonstrated leadership in important matters. I helped client’s find jobs and housing. I managed crisis situations. My request for more time to do paper work was denied by a Katz.
Then after a client in crisis did not get help from management in a timely manner a blame game started. I had brought the client in crisis to meet the manager. I got blamed because this client who needed to be hospitalized ended up driving in Malden. This happened after I warned the manager that he needed help. A staff person from the day program was in his car. He could have crashed his car into someone. But I was blamed for this management neglect. I filed two grievances with the SEUI union. Management ignored them. I developed health problems as a result of the stress I was under. The management created a hostile work place. I even got treatment for job related stress. I let A Katz and M Mathews a senior manager know I was being treated for job related stress. The work place got more hostile. I requested time off but this was denied. Even though I had a doctors note as evidence that I had job related stress and both vacation and personal time.
Basically I was thrown out like the trash. The reason was because I advocated for clients, workers rights and would not accept unethical behavior by management. ECHS management contested my unemployment claim. At hearings M Mathews and Aaron Katz committed perjury. After four hearings the Massachusetts Department of Employment and Training found I had an urgent and compelling reason for ending the job. I was paid unemployment compensation. ECHS management also refused to pay me for my last two weeks work. I went to small claims court and named Pam Burns the Human Resources Director in my complaint. I had an excellent case but the hearing officer was a Malden court clerk named Paul Burns. Without considering the facts I lost my case.
Because of all this I lost my health insurance and couldn’t continue treatment. Now, I can not get a good job because I do not have a reference from my last employer. My health problems have not been treated. I am applying for Social Security Disability. I found management’s main interest was in misleading the Massachusetts Department of Mental Health about how the PACT was operated. Ethical issues were not to be discussed. Dishonesty and hostility were the foundations of management’s practice. They treat counselors like dogs and laugh at the SEUI union.
Signed,
Dog Meat
By Therapy Patient, April 7, 2009 @ 11:15 pm
This is in answer to this comment:
By Marian, April 4, 2009 @ 2:57 am
“Maybe I got you somehow wrong, but I don’t think, that there should be any such thing as a “should feel” involved in therapy. The client feels what s/he feels. Period. If anyone had tried to tell me, what/how I should feel, I’d been running for the hills, instantly. Being told what/how to feel (think, do, say, etc.) was exactly which brought me into trouble, initially. And it’s what brings most people into trouble, initially.”
I understand your point, but my “issue” with feelings is NOT FEELING AT ALL in certain circumstances in which other people would feel “bad” feelings. At these times I retreat into my head. I know what happened or is happening, and know it is not good, but I don’t feel pain, or anger, or sadness over it, just nothing.
For example, I was raped with a knife blade at my throat when I was about 19 years old. I do not feel angry or sad or pain about it. I could see in session with my terrific psychiatrist that HE felt strong emotions when he heard the details. I think it’s really useful in a situation like that to have a psychiatrist ask how I feel about it, which he did. He has commented on my inability to access my own anger, my own sadness and other “negative” feelings. This isn’t the same as telling a patient WHAT to feel. He has seen over and over that I feel “happy” feelings but feel nothing at times others might feel anger or sadness. I was an abused child (the reason for the anomaly). Learning to access my feelings and then using those feelings to protect myself from current abuse is one of the goals of my therapy. It’s not being told what to feel, but being encouraged to open myself to my own feelings.
By Marian, April 8, 2009 @ 4:09 am
Therapy Patient: Getting in touch with one’s own emotions through communication with someone who is in touch with theirs – that’s a different story.
But I also think, while it may be an anomaly to not feel at all (or to be completely alienated from one’s feelings) – although, when I look around, I see almost nothing but people who are more or less alienated from their feelings, and, in addition, I see a culture that promotes this alienation as normal… – , it is perfectly natural and understandable, the circumstances taken into account, and has to get recognized as being so, if change is is to be achieved.
Well, it looks like you get that recognition from your therapist. That’s great.
By Doug Bremner, April 9, 2009 @ 4:29 am
why am I not surprised about the Robert Langs comment
By Sabina Bremner, April 13, 2009 @ 3:33 pm
you had dinner with Aldous Huxley?
By Doug Bremner, April 14, 2009 @ 8:56 am
Yes, as a six month old. Probably didn’t get much out of it though.
By Susie, April 19, 2009 @ 6:59 pm
Cool, on your Berggasse 19 picture, it says “Second Hand Sh” right between your head and the Freud sign. You couldn’t make this up…
By Doug Bremner, April 19, 2009 @ 9:05 pm
Nice snag, Susie! Second hand sh*t is right. Can we all move on now please?
By Linda Chapman, January 29, 2010 @ 1:38 pm
I loved the work of Robert Langs when I was a young therapist. Over the years of work on my own personal growth as well as as a therapist, though, I have come to more of a relational/feminist and holistic standpoint. Most clients I see are not planning to sign up for years of work. They need whatever help they can get in 6, 8, or 12 weeks. Some use me on a consultant basis and pop in every year or two. For the school of psychotherapy Langs represented his guidelines are good ideals. But there is room for a kind of therapy which is more immediate and which does not foster the same levels of authoritarianism, distance, and (sometimes destructive) transference we see in traditional psychotherapy where neutrality reigns supreme. Sometimes clients crave the presence of someone who will be genuine and authentic with them “in the moment.”