Category Archives: Therapy

Is Your Therapist Your Best Friend? Yes…and No

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new4Of course she is…Who else knows more about you?  Who else welcomes you in all your glory…with your good, your bad, and your ugly?  Who is the one person you look forward to seeing when the shit hits the fan?    Or even if you don’t, who else welcomes you to come in and tell her that you would rather be in bed , hiding under the covers, than be here in this lousy office, having to talk about these horrible, shit-hitting-fan feelings?

Yes,  I am happy to be make my office a comforting haven for  my patients.

But there is a real,… make that very real, …danger in therapists who are too invested in the role of best friend.

For one thing, therapists who over-emphasize this part of the relationship with their patients are often self-serving.   Whether we want to admit it or not, some of the Hollywood stereotypes are out there…the lonely or the egotistic or  the very misguided therapist who blurs the boundaries between professional and personal relationships in the service of his or her own needs.

Fortunately, many people can see through the most egregious of these transgressions, …(Think Barbra Streisand).  Therapists who make the most obvious transgressions are usually spotted more easily, and it is usually easy to understand the harm they cause when taking advantage of vulnerable people who have often been similarly abused in childhood.   But more ubiquitous are the subtle forms of boundary transgressions.   Subtle transgressions may seem benign and “helpful”, and this makes them all the more dangerous.

For example, think about the overly-indulgent therapist, one who is available ’round the clock, or one who seldom challenges her patients, or even has frequent out of session contact.  Here is what they are missing….

Maladaptive behaviors and symptoms are frequently traced to feelings of disappointment.   When we are young, we cope with disappointment as best we can,  but we often get stuck in destructive ways of thinking about ,and dealing with, the disappointments in our lives.  In the course of every well-executed therapy, individuals must face disappointment.   It may be disappointment in current figures in their lives, but most frequently, it has earlier roots that are being re-lived in the present.  At some point in time, it is not only inevitable to feel disappointed in one’s therapist, but it is actually desirable because it gives us the gift of exploring the original feelings, current feelings, and responses to them.  Sometimes it emerges as a relatively-pure displacement known as “transference” ie., old feelings displaced onto the therapist, or it may be more “reality”-based in a reaction to something the therapist has just said, done, or not said or not done.  In any event, the individual must feel as safe as possible to explore his/her feelings of disappointment in the therapist.

Therapists who continually blur the lines between friendship and professionalism risk losing a great deal of opportunity for helping their patients undergo real change.    Additionally, they may create a “good patient” who wants to please the therapist as much as the therapist wants to please his/her patient.  Therapy may seem like it’s going along swimmingly, but in reality, nothing much is taking place at all.

How can you tell if your therapist is overly-indulgent or just a nice person?

When choosing a therapist, it’s important to ask about  her theoretical perspective.  This doesn’t have to mean a heady dissertation.  But she should be able to explain , in clear layman’s language, how she understands the human psyche and behaviors, and how this informs how she works with patients.  If she has a clear rationale for her work, and you can understand  her interventions in the context of this rationale, chances are you are on the right track.  Otherwise, she may be more reactive to his or her own whims, which may not always be in your best interest.

Therapy should feel safe.  Safety must mean safety regardless of the feelings that are invoked.  We must be able to tolerate a full range of emotions if we are to feel safe in the world.   If therapy starts feeling like a tea party, chances are you are on the wrong track.

In short, therapy should involve a healthy mix of discomfort in a relatively-comfortable relationship.  Basic trust needs to be there, but if it is feeling too good too much of the time, it may be time to question what , if anything, is going on.

As always, feel free to ask questions…

sb

Finding the Right Therapist

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If I were not a psychologist, I think the idea of finding the right one for me would be daunting.  In a world filled with too much info., in which everyone claims to be an expert with the magic bullet, I imagine I’d be more than a little confused.  But it doesn’t have to be this way.

While the right fit is very personal, there are some basic starting criteria that are relatively easy to look for. 

At the very least, stay clear of anyone not licensed in your state.  Anyone can call him/herself a therapist.  Sadly, this is true.  Make sure he/she is a licensed psychologist, registered social worker, or licensed psychiatrist.

Research the differences between these three disciplines.  The basic training for each is very very different.  Psychiatrists begin with medicine.  Their basic understanding is biological.  Social workers begin with an overview of society.  Psychologists begin with an understanding of individual dynamics and behaviors.  While there are individual differences, and anyone can receive post-graduate training, each discipline starts from a very different basic understanding of the human psyche.

Research the different orientations: psychodynamic, behavioral, etc. or ask the therapist to explain them.

Beyond these basic guidelines, your best research will start with the first phone call you make to your prospective therapist.  Look for these signs of Yes or No Way…

Does she call you back within a day or two?

Does  she offer you a few minutes over the phone before scheduling an appointment with you?  I always spend 10-15 minutes on the phone first.  Any reputable therapist will have no interest in wasting your time or money, or hers!  Establishing some understanding of your needs in relation to how the therapist works can be done very quickly in a phone call.  This doesn’t guarantee that the fit will be right for you, but it can make sure that you are on the right track.

When you meet, is the therapist willing to be transparent about how she works?  Though many of us are, indeed, trained to listen, listen, and listen some more, the first few sessions should be clear and collaborative.  I do want to know your concerns and questions about therapy, and I will help you understand how these are meaningful to you individually, but I also appreciate that you deserve  clear, honest answers to  basic questions about my training and approach.  A therapist who dodges these questions may not have a good theoretical understanding, or may not be someone with whom you will feel at ease.

Does she tell you she wants to hear everything on your mind, including how you feel about her and the sessions themselves?  This is really important, and perhaps one of the most important pieces of a good working alliance.  Your therapist should be not only willing, but eager to hear how you feel about her.  It’s important for your relationship as well as being important information about how you experience the world.  If you say you are uncomfortable about something during the session, she should be eager to address it with you!

When in good hands, the psychotherapeutic experience is a rewarding journey.  It may be painful at times, and you may hit blocks along the way.  It’s crucial to begin with a solid foundation, a shared vision, and as much trust as possible, so that when you hit the inevitable bumps along the way, you can remember why you trusted this person with your emotional well-being in the first place.

As always, I welcome questions!

Timing is Everything

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Timing is Everything: A Realistic Approach to Positive Thinking

“He just doesn’t get it”, “She never really listens to me”, “What is wrong with me? I should be so happy”…
If you’ve ever uttered phrases like these, (and most of us have), you know first-hand what it’s like to be affronted by the well-meaning, but perpetually-out-of-sync friend or relative who is eager to share his or her personal version of “You’re too negative; you have to think positively”. The implication is that if only you adjusted your attitude, all would be well with the world. Even more importantly, the implication is that the elusive gifts of confidence, self-esteem, peace, and happiness would now be yours.

Don’t get me wrong; there may be times when an attitude adjustment is called for and necessary. We can all fall prey to an excess of self-pity…Especially on one of those miserable days when caught in the midst of a downpour without an umbrella and no cab in sight.
But quite frankly, the world has grown a bit too intolerant of anything “negative”. People forget, or don’t realize , that sadness is not depression, and that anxiety is a signal that something else needs to be dealt with. When we feel sad or anxious or see the world through grey lenses, this is a signal that our brain is not fully processing something important. It may be as simple as a recent neglect or an insult by a neighbor, or it may be the culmination of multiple rejections over the years. But if you haven’t had a chance to fully process and understand your hurt, and often anger, these unmetabolized feelings eventually catch up with you.

Most people mean well. When they offer the proverbial “you’re too negative”, they’re not trying to be dismissive; they are usually trying to help. What they don’t realize is that our brains are usually programmed- enough to try to avoid sadness and to present a good front to the world. Hearing an external source of “look on the bright side” only serves to reinforce most people’s self-accusations and shameful feelings, rather than providing the intended opportunity for healing.

So the next time you or someone you care about is feeling down or upset, remember to take a moment and listen…to yourself, to him, to her. First things first. In many instances, the moment passes and the outlook is brighter. At other times, you may find out that more needs to be explored. But in any event, the positivity that emerges will be genuine and realistic, and ultimately more rewarding.