Great post,**Aeschines. ** I am a psychologist, and it’s frustrating when people don’t understand the difference between psychology and psychiatry. Although psychiatrist to learn some therapy techniques, taking time with clients is a money loser, so they seldom do it. They have medications, medications don’t take long to prescribe, so medications it is.
Therapy can take different forms and it is done by people with different licenses and training. The licenses differ by state to make it even more confusing. In my state, Tennessee, we have psychologists (must have a PhD in psychology), licensed Professional counselors (master’s degree), and licensed clinical social workers (masters degree). It would be handy if the different degrees matched up with the different types of therapy but they don’t. The types of therapy is just too much for me to type with my carpal tunnel problems, plus there are good resources online. Most therapists do some version of cognitive behavioral therapy or acceptance and commitment therapy. Psychoanalysis is virtually nonexistent, but the occasional concept is important.
The “rule of thirds” Signe mentioned I had always heard applied to schizophrenics, not clients with more treatable problems. In fact, my understanding of the meta-analytic research is that about 75% of clients seem to benefit from therapy.
My general approach to therapy is to try to understand what the client is struggling with, and what they want. Sometimes, they want to change themselves. That’s great. I can help with that. Sometimes, they want to complain about someone else in their life. We can’t change that person. And they usually aren’t interested in changing themselves or their lives. What they want is sympathy, and while I can do that, it is a waste of my skills. Others want to understand what is going on with them, and why they act the way they do. These are the ones who don’t know they have anxiety, or OCD, or bipolar disorder. For them, what I can do is help them understand, then learn to manage their disorder.
So do I believe in psychiatry? Yes. For some clients, medication has been a miracle. Do I believe in therapy? Yes. For some clients, therapy has been a miracle.
You don’t want to be judged by your thoughts or behavior? I guess you could find a therapist who will sit and listen to your nonsense for $300 per hour without saying anything. Or you can save your money and start a blog. Or you could PM me, and I’ll do it for $150 per hour. If you just want someone to listen, then you don’t really need a therapist.
I absolutely, positively hate the idea that drugs can help everybody. If you geti nvolutarily commited, you will be given drugs. Anti-depressants help with chronic, long term depression. I was diagnosed with situational depression. How the fuck was three days of anti-depressants supposed to help me with that???
No, there are people who need and want what spaghettifrierdescribed, and there is value in that. Being able to share your experience freely, with a caring, nonjudgmental person, can be healing. I get it, and would be willing to do that. Some hide so much from others that to really reveal themselves to someone and be accepted would be therapeutic.
Yeah, three days of anti-depressants is useless. I suppose they were hoping you would stay on them. If you were involuntarily committed, was there threat of harm? If so, imagine if they hadn’t tried medication, and you were released and killed yourself or others. I wouldn’t want to be the hospital in that case.
Since we both agree that three days of anti-depressants is useless, what difference would it make if they released me and I killed someone? The pills would not have affected my behavior in any case.
You’re the psychiatrist on the stand. Which answer would you rather give to the question “what treatment did you provide during ms. X-mas’ stay?”
A. I followed medical protocol, and prescribed XYZ. She was instructed to continue taking the medication.
B. I observed her, and released her after 3 days without medication.
This is like saying that because arthritis and musculoskeletal diseases are often genetic, then physical/occupational therapy is “iffy”. Sorry, that just doesn’t work for me.
I took meds for a few years. Only a couple of pills actually did anything positive for me; the majority made me feel a lot worse. But if it hadn’t been for “talk” therapy, I wouldn’t have tried any of it. I had to be “talked” into giving it a try, and I had to have someone “talk” me through the horrible side effects. And if I hadn’t eventually found some pills that had worked, then therapy would have been an incredible waste of time. It’s kind of hard to work on one’s issues if they are crying all the time, or (like in my case) too dead inside to care about anything.
Sometimes I wonder if some people shoot themselves in the foot by steadfastly refusing one approach (medicine versus psychotherapy). Though I do understand financial limitations and that kind of thing.
Doesn’t it matter what spaghettifrier is talking about? What if spaghettifier is a terrible person? Do you think it would be good for him (and everyone else) if his therapist just listened and did not judge?
I think what he needs is someone who will judge fairly, not someone who won’t judge at all.
In my experience, people in therapy aren’t terrible people. I don’t know any terrible people, although I suppose they exist. What I see are flawed, and even broken people. Sometimes they hurt others out of their own pain, but usually they feel guilty about mistakes, not terrible behavior.
For example, I have had clients who needed to confess that they had been molested. Others who then went on to confess that they, in turn, molested another child. From my perspective, what happened to both was terrible, but the person was hurting, not terrible.
The most “terrible” thing I have heard lately is a client who steals from wal-mart, and doesn’t feel guilty because it’s wal-mart. That I find harder to understand.
Yeah, I did. Being molested is terrible. But a child who is molested who then, while still a child, molests another child? The act may be terrible, but the person is not. People who are hurt tend to hurt others. How can I call them terrible when they are just acting out of their pain?
An adult pedophile? I have a harder time with that, even though they were likely abused as well. By the time of adulthood, though, we need to find ways to heal, and not turn our pain to hurting others.
Brynda is a therapist. Do you think she’s going to tell a client they are a terrible person, even a child-molesting one? Her job is to help a client get better. Not to insult them.
A therapist can ethically decline to treat a patient they can’t possibly jibe with. They aren’t required to treat someone they think is terrible.
A child acting out is more understandable. However, how can you treat him without letting him know his behavior is morally unacceptable? Do you think he’ll get better if he doesn’t stop molesting other children?
I don’t think I said a therapist should insult her patient. You can judge someone’s behavior without insulting them.
I have never met a client I thought was a terrible person. That may be partly because the clients I see are choosing to come to therapy, but it is also because of my philosophy that actions may be terrible, but people aren’t. People may be acting out, or misguided, or broken, but they aren’t terrible. I believe that most therapists think this way.
Do you ever tell your patients that you disagree with their actions? Or that their actions are unhealthy? Isn’t that a form of judgment?
Personally, I think if someone does terrible things all the time then they are a terrible person. Even if they have good intentions or the terrible things they do were a product of unfortunate circumstances (e.g. poverty, sex abuse, domestic violence, etc.). But I also believe that anyone can stop being a terrible person at anytime by changing their behavior.
Yes, but when spaghettifier’s therapist gave him suggestions on how to change his behavior, he claimed he did not want to be judged. That’s why I replied that if he is looking for a therapist who won’t question his behavior, then therapy won’t help him.
There are some people who don’t go to therapy to change their behavior, but to change their feelings. If you know you can’t or aren’t ready to change X, Y, and Z in your life, but you do want to change how you think and feel about X, Y, Z, then you probably won’t want to hear someone’s advice or judgment. You just need a place where you can process what’s going on and listen to an expert’s insight (which is neither advice or judgment.)
Also, advice is pretty much what everyone gets when they disclose problems to friends and families. Some of it is useful, but that doesn’t mean you want to hear it. Sometimes just having your feelings validated is all you want. I could also see how, if you are in a situation where you have to be the strong one all the time, it would be nice to have someone who allows you to whine, kvetch, and cry as much as you want. Rarely do friends and family let you “wallow” since it makes them feel uncomfortable.
I once participated on a message board for people in psychotherapy. I didn’t really like the place, but it was insightful. I learned that there is no one way of doing therapy, and that just because something works for me, doesn’t necessarily work for others. Like, apparently it’s standard practice for the therapist not to say much during session. When I told the other posters that mine does most of the talking and that I actually like this fine, they labeled my therapy as “bad”. Have they never heard of different strokes for different folks? It’s really not that hard to understand.