Wednesday, April 25, 2007

Empathy Ends Where Political Correctness Begins

There is interesting discussion at both Ann Althouse's and Neo-Neocon's blogs about an article in The New York Times entitled, "Understanding Empathy: Can You Feel My Pain?" Richard A. Friedman, a psychiatrist, asks an important question, "Is shared experience really necessary for a physician to understand or treat a patient?" In answer to that question, he states:

What is critical to understanding someone is not necessarily having had his or her experience; it is being able to imagine what it would be like to have it. Thus, I do not have to be black to empathize with the toxic effects of racial prejudice, or be a woman to know how I would feel about being denied promotion on the basis of sex.


So Friedman believes that empathy is the most important factor in treating someone, not the race or gender of the therapist. "In the end, empathy is what makes it possible for us to read each other. And it is the reason your doctor can understand your problem without actually having to live it."

Yet, as I read over the NYT piece, I get the sense that Friedman does not seem to take his own advice to heart; he seems to think that empathy and help should only be available for those he deems to be politically correct. He mentions a gay man who wants a gay therapist. Friedman helps him find one, although he does mention feeling "uncomfortable" about it. In another case, he sees it as appropriate to give the patient the therapist she asks for:

Sometimes, though, patients should get exactly what they ask for in a therapist. One of my residents once saw a young woman from Africa who had survived hideous torture and rape and said that she didn’t think she could see a male therapist.

That struck me as entirely appropriate. Given her trauma, she simply could not have put her trust in a male therapist, no matter how empathic he might actually be.


He does not extend this assistance to a man he deems politically incorrect:

What about patients whose demand for a particular therapist springs from nothing more than everyday prejudice? I remember a patient who once stormed into my office and demanded a white therapist to replace his therapist, who was black.

That’s a request I turned down, even knowing that this patient’s biased beliefs were an appropriate target for treatment. To do otherwise would have vindicated his prejudice and fundamentally compromised the therapy from the start.


For a psychiatrist who mentions how empathetic he is, this did not seem like a very empathetic response. I remember a case I had years ago in NYC--a male in his 40's just out of prison. In our first session, he told me that I would not want to see him for long."Why?" I asked. "Because I am angry at blacks." He was hesitant to say more, stating that the culture did not allow him to voice his feelings. I told him that I was willing to hear his feelings. I saw a tear roll down his cheek as he told me about being raped in prison by several black gang members and watching helplessly as other younger men were raped. He had built up years of anger and resentment and felt he had no dignity left. Had I simply told him that I could not hear what he had to say because internally I deemed it "prejudiced" I would never of heard his story and been able to help him with understand what had happened to him, and subsequently, to heal the trauma that he had lived with for many years.

I will let Neo-Neocon's words summarize my post, for I think she says it better than I could:

As referenced in the Friedman article, patients often come with pre-existing prejudices and preferences about what they want in a therapist. Some of these are considered therapeutically valid, such as a woman whose been severely abused by men being more comfortable with a woman therapist. Some are arguably less so, such as a request for a therapist of the same race. I disagree with Friedman that the latter request should be refused; if a client is that uncomfortable with someone of a different race, whether it be a black person uncomfortable with someone white or vice versa, than the therapy can and should deal with the issue. But it’s not best dealt with by placing the client with a therapist who makes him/her acutely uncomfortable at the outset.

A lesser-known issue is that of therapist discomfort with certain clients. Theoretically, therapists can work with anyone, but in actuality they tend to specialize and refer out those patients who press their buttons (such as, for example, child molesters).

And, although this sounds like some sort of bad joke, I know quite a few therapists who say they would have difficulty treating a client whom they know to be a Republican. So it’s not just clients who want therapists who are as much like themselves as possible—some therapists return the favor.


If therapists only want patients they deem to be "deserving" of empathy, how empathetic can they really be?

Labels:

53 Comments:

Anonymous Anonymous said...

Gosh, and here I though the most important aspect of a doctor is how knowledgable he or she was about treating disease.

11:17 AM, April 25, 2007  
Blogger Webutante said...

I am a student of Bowen Theory and have done a post-graduate course in D.C...so be forewarned, a little knowledge is a dangerous thing.

However, I have come to the understanding, through study and experience over the years, that therapists are only as good and effective and neutral in proportion to the work they have done on themselves.

There are many immature therapists out there, and in many of the helping professions, who simply have not dismantled their own early programs and biases enough to be of any help to anyone but the most immature of clients. They, like the clients they purpost to serve, fall prey to projecting on their clients and acting from those projections.

There, there is no neutrality, which is the case above with Friedman.

So I think more people need to know there are many, many immature therapists out there.

Let the buyer beware.

11:23 AM, April 25, 2007  
Anonymous TMink said...

Good post Webutante.

Neo-Neo wrote: "Theoretically, therapists can work with anyone, but in actuality they tend to specialize and refer out those patients who press their buttons (such as, for example, child molesters)."

I am not familiar with the theory that says therapists chould be able to work with anyone. I do work better with some people than others, and I tell people that up front. I don't work well with actively using substance abusers and addicts. I don't work well with particularly passive people.

There are groups of people and presenting problems that I have had a lot of experience and success with. I also tell people that.

I do not work with child molesters for a few reasons. They receive the best help in groups with each other, and I am not a member of that group. I have no training working with that group of people. And finally, I have worked with too many of their victims to have any empathy of their situation at all. They deserve better treatment than I can give them. It is not a matter of buttons, but of what they need and deserve.

It is also for me not a matter of being PC, but of my limits of competence. I can't offer competent treatment to someone toward whom I cannot be empathic.

Helen's story of the abuse survivor is powerful and touching. She made a powerful intervention on the very first meeting: she suspended judgment and sought to accept and understand another person's experience.

Powerful stuff, it makes for good therapy. And the lack of it dooms therapy to a waste of time or worse.

Trey

11:53 AM, April 25, 2007  
Anonymous Sofasleeper said...

It seems to me that allowing a patient to pick his therapist is a good thing, regardless of what motivates his tastes.

11:54 AM, April 25, 2007  
Anonymous Jim said...

"Gosh, and here I though the most important aspect of a doctor is how knowledgable he or she was about treating disease."

The problem with that is that diseases don't exist out there in some vacuum on their own as independent entities. Diseases are states in living organisms, so it follows that you have to have a good working knowledge of the organism to treat the disease, and also, since indiduals vary , often enough to make a difference in the progress and treatment of a condition, you have to have a working knowledge of the individual. Ths is true when it comes to thngs like nutrition, where genetics play a certain role, and it is certainly true in psychology or pain mangement, where culture plays a very large role.

1:05 PM, April 25, 2007  
Blogger Sarebear said...

This post made me think.

Thanks, Helen.

1:36 PM, April 25, 2007  
Anonymous Anonymous said...

"therapists who say they would have difficulty treating a client whom they know to be a Republican"

They could not possibly work with someone so far beneath them. Being liberal simply makes them too good for that.
\
Q

1:37 PM, April 25, 2007  
Anonymous Anonymous said...

Knowledge of a culture would be a necessary element to facilitate understanding and communication. But there's a point of empathy beyond which you have the blind leading the blind.

That's one of my concerns about these so-called "self help" groups as well. Frankly, too often it's a bunch of people who spend their time comiserating and stroking each other but very little new perspective is introduced.

1:56 PM, April 25, 2007  
Anonymous Nom dePlume, Ph.D. said...

I have read many times that the best predictor of success in therapy is the degree of rapport between therapist and patient. It seems obvious to me that rapport is more likely if the patient doesn't have a lot of discomfort with the therapist right from the start.

I can believe that a patient may have serious racial prejudice issues, but the purpose of therapy is to address the problem that is troubling the patient. If that problem is itself not related to his prejudices, then the therapist should focus on helping the patient with the problem for which he is seeking help. The therapist has neither the responsibility, nor the authority, to mold the patient into someone the therapist wants him to be.

2:07 PM, April 25, 2007  
Blogger Helen said...

Non DePlume, p.h.d.,

Yes, most studies show that the number one reason that the patient improves is that they feel that the therapist likes them. So, I do believe it is important for a patient to like a therapist and vice versa. I also agree with you that that it is not the place of mental health professionals to "indoctrinate" others into a particular way of thinking that is deemed "proper." Holding oneself out as the "thought police" is ludicrous.

2:17 PM, April 25, 2007  
Anonymous Bugs said...

Do you think that state programs and insurance companies often force together patients and therapists who don't necessarily belong together?

If you're paying for therapy yourself, you're free to expect a service that you're comfortable with. If you're not, you pretty much have to go where the gov or the company sends you.

FYI - I've been in this situation before. During a period of depression, I went to my company's Employee Health service, which referred me to a mental health clinic nearby. The therapist I drew wanted to hypnotize me and advised me to masturbate more frequently to boost my seratonin levels. Not a good match...

2:38 PM, April 25, 2007  
Blogger Helen said...

Bugs,

Generally, there is a list of providers with an insurance company that you can pick from. If you call the company and tell them about what type of specialist you are looking for, they can often help you to find someone who treats your particular problem. If they are not helpful, you can try someone else. Clincs are often a problem because they often give you who is available. But you are always "free" to see who you want. You just have to pay for it.

3:22 PM, April 25, 2007  
Anonymous Econ-Scott said...

Shocka !

Therapists have bias and prejudices they can't overcome in their detached clinical setting.

You mean they are Mortal ? With all the problems, arrogance and utter lack of pulchritude of .... humans ?

The problem is time.

When you need a good emergency Brain Surgeon, plumber, auto mechanic, or even Therapist (match) it is too late to shop.

... at the moment of maximum pain.

Watch out Republicans ... this profession is hostile to your mental health, marriage and family.

4:59 PM, April 25, 2007  
Anonymous Richard Aubrey said...

Years ago, I was splitting wood when the wedge--about the size of a sledgehammer head--popped out of the log and smacked me. I was not seriously hurt, being struck in the head, but I was bleeding. I told the (Indian) doctor at the ER what had happened.
He poked and poked until I asked him what he was doing. "I am looking for de vedge." So I figured either he came from a part of India which hasn't had a tree big enough to need splitting in a thousand years, or he was from a caste for whom physical labor is unclean. Maybe he was orignally a Manhattan liberal or something.
Anyway, it occurred to me that it is important to know something about a culture before you can do much for somebody.
It is not so much empathy as not knowing what a client is really saying. As the Indian ER doc didn't know what a splitting wedge was, would a, say, Indian therapist know what it feels like to be crowded, when he comes from a country in which there are always people all around and personal space is minimal? He may be capable of feeling my pain, so to speak, but is he fully capable of understanding that I am uneasy being crowded? Or perhaps I mention I don't like being alone and his idea of alone is being in a room full of the sounds from other rooms and from the street while mine is looking out a window of a farmhouse in Kansas and seeing not a human artifact to the horizon.
I have worked with exchange students for years. Discovered that Brazilians, whom we think of as sophisticated and modern, probably because their beautiful girls wear very little on the beach, actually are puzzled at the vigorous athletic activities of American high school girls.
And, according to a GM management type, they're making a bit of progress addressing sexual harassment in Mexican plants but haven't bothered to start south of Mexico. Might cause a riot, or mass resignations.
Cultures differ. Can therapists from one culture do good work in another?

5:16 PM, April 25, 2007  
Anonymous CaptDMO said...

"So I figured either he came from a part of India which hasn't had a tree big enough to need splitting in a thousand years, or he was from a caste for whom physical labor is unclean. Maybe he was orignally a Manhattan liberal or something."
Or is so in tune with manual labor tools they were looking for the small wedge that is used to retain the tool head to the handle?
Ever heard the expression ".. fly off the handle? It happens.

The inter-cultural point was not lost however.

May be stretching.
Did you ask?

6:26 PM, April 25, 2007  
Blogger a psychiatrist who learned from veterans said...

Dr. John Meeks said that in family therapy with an adolescent an avenue of progress could be to go to the point where expressiveness could be framed in the form of "I feel that.." with the idea being that, regardless of an underlying truth of an 'allegation,' a person's 'feelings' could be true to the person experiencing them. In my time at university, the editor of the radical paper said that there was no 'objective reporting.' Chaos has not ensued in leftist quarters however because feelings rather than facts have become objectively correct. That makes Dr. Meeks' point of view, that one was allowed one's feelings, old school.

7:07 PM, April 25, 2007  
Anonymous Richard Aubrey said...

captdomo.
The little wedge wouldn't have given me a four-inch gash from compression or impact or whatever they call it between the eyes. And, since the field of the wound was the thin skin and flesh over the forehead, nothing bigger than a paper clip could have been stuck there.
Nope. He had no clue.

8:31 PM, April 25, 2007  
Anonymous Bgs said...

Maybe he was hoping you'd turn out to be the next Phineas Gage.

9:08 PM, April 25, 2007  
Blogger dadvocate said...

richard a. - I know plenty of city folk who have no idea what a splitting wedge is.

As for empathy, I think it starts with exploration. If I am going to be able to empathize with you, I need to know more about you, your feelings, your past life experiences, etc. That is the biggest part of the mistake the therapist made in denying the man who was "prejudice" against black a different therapist. He, apparently, did no exploration of these feelings but made an uninformed judgment that the man was prejudiced.

As Helen described, there may have been much more behind these feelings. But the superior feeling therapist felt he already knew everything he needed to know.

The "deserving" comment is an excellent point. I've known plenty of therapists who automatically favored people because of gender in particularly.

11:17 PM, April 25, 2007  
Anonymous Anonymous said...

Since I think a patient who wants a different therapist should be free to state no reason at all for the action, the idea of barring those who do state a reason is inappropriate.

It's still appropriate for a therapist to take reasonable steps to resolve that issue first though.

Although some situations may be untenable. Such as an inpatient who continually requests new clinicians.

12:10 AM, April 26, 2007  
Blogger jw said...

I note they always speak of a woman badly abused by a man and NEVER about the reverse. This is a problem which infests all of therapy and a problem I have run into (with two exceptions) every time I tried therapy. As therapists demand I cannot exist (and almost all do) there is no possibility of therapy, there is only their attempt to find a way to make me wrong. It is deeply frustrating.

In saying this I should note the exceptions: One was a woman I saw once. She ran crying from the room after I had outlined the basics of my story. In a very real way, she helped more than any other person I have ever seen. At least there was some human emotion! Some sort of decency. Obviously, being a woman born and raised in Canada I could not tell her everything. For me to tell everything to a woman she would have to be one raised completely outside of the first world and its anti-male meme. (Don't mean to hurt your feeling Dr. Helen ... just stating the facts as I see them, fully aware that I could be wrong.)

The other exception was a man who was trained in working with men molested as children. He was OK. Mind you, his degree was education, not therapy and his approach was to both listen and ask respectful questions: This was really quite a refreshing difference. The problem (of course) is that I had to spend well over half of our sessions teaching him the basics of the various views of gender, the history of law as it applied to fathers and the history of sex assault law. I spent more time teaching than I did undergoing anything related to therapy. But that will be the case for all therapists seeing a male (adult-crime) survivor who also did public advocacy for fathers.

HMPH! Everything I taught him is available in books (including the opposing viewpoints), but no therapist would read such books.

We talk of political correctness, but it seems to be like talking of the weather ... no one ever does anything!

3:58 AM, April 26, 2007  
Blogger jw said...

I need to add a partial explanation to what I said above and how it relates to me and to empathy.

In speaking of returning to college as a lone father I spoke of my hurt and frustration at all of the single parent programs being female only and of how that hurt my children.

ALL therapists I have run across simply block that out by saying that I cannot be hurt as such discrimination never existed. That leads me to spending hours teaching the therapist the history of law as it relates to single parents ... a HUGE topic and one where several hours are needed just to teach the basics.

No empathy CAN exist as the therapist does not know enough to know that a person could have been hurt!

Men run across that one constantly.

4:14 AM, April 26, 2007  
Anonymous Wait and see, maybe. said...

Opening up made me uncomfortable enough--I personally wouldn't care about race, but I wonder if that kind of situation would've made me completely mute.

On the other hand, I always thought I would strongly prefer a male therapist (I'm female but relate better to men and have far more male friends), but the woman I "got stuck with" I'm probably as comfortable with as anyone. Guess I didn't have as big of a hang-up about it as I thought.

6:45 AM, April 26, 2007  
Anonymous TMink said...

In thinking about the posts and what I do I think one thing is missing from the conversation and that is the importance of being seen by your therapist. Seen in terms of him or her looking at you, watching your face and body language, listening to your vocal tone, looking for what is alive in your body.

It sure saves time for me when I say something like "I noticed that you winced when you mentioned your brother" or "Did you know that your neck has gotten all red and blotchy? It looks like you have some strong feelings about this."

So it has not been my experience that I need tons of background info on a particular issue that a motivated client faces, I just need to care, watch, listen, and work with them. But I think the watching helps a lot. It helps me follow the affect which is often where the issue resides.

Trey

9:51 AM, April 26, 2007  
Anonymous Anonymous said...

Bugs, thanks for sharing.

I've also used Employee Health Services. The therapist herself wasn't actually that helpful; but she had me journal, so I was able to help myself. The pyschiatrist tweaked my medications. From internet research, I asked him to switch me from a generic anti-depressant (post-partum depression) medication to one supposedly for Obsessive Compulsive. I'll never know how much the medication change actually helped, or my own (yeah obsessive) studying of the psych literature and personality stuff and journaling all to learn to adjust my behavior. I'm an OC personality, now off all medications (gradually over 2 or so years). When I get under stress, I consciously make an effort to NOT emotionally react OCD: obsessive compulsive to a disorder extreme. So the different therapists didn't really help much, but the act of going to therapy let the people around me feel comfortable enough to have the patience with my quirks as I worked through learning to adjust my behavior and have calmer emotional reactions. I can have an instinctive self-righteous reaction (emotional) that I now consciously over-ride (intellect for acceptable behavior).

Recently though my work situation put me on a team with an extreme paranoid. He's had multiple complaints about him, including Baldwin-like rants. But the customer likes his 'big ideas' (elements of the John Nash movie character) that appear to be resulting in new big project wins. Unfortunately, I got rattled enough by the rants that I got one of those 'We suggest you get counseling' brocures from my new employer. At first, I was self-righteous defensively angry; it's the other guy who needs that darn brocure. (Gender discrimination folks?) After a couple days, I did decide to try the therapist. Maybe it would be just going through the motions, to sate the company HR, and maybe it would help. But I wanted to reuse my psychiatrist, who wasn't on this company's in-network plan. And the gal on the phone wanted a whole bunch of information in order to justifying paying for out-of-network. So I didn't go to the therapist, but was able to find a some co-workers to talk things out and help me through it.

The paranoid is still around, and still scares me. But I'm on a different project (no thanks to my supervisor, by the way, and no thanks to the HR gal either). I'm having to help myself, and my spouse now understands my behavior and reactions more and is supportive. (Before, we were heading towards divorce. We're okay now.) And I know which friends I can talk with.

On a closing empathy point, sometimes I feel sorry for the paranoid guy: He has few friends, and may be losing more. But the literature has shown me to let go of my mothering instinct that wants to reach out and help him. 'Well meaning attempts to reassure or reason with or help the paranoid can produce unfortunate consequences. The paranoid will view you, the person trying to be his friend, as an object of suspicion -- a threat -- and act out towards you.' (J. Post 2004, pg 111)

I empathize with the co-workers that still have to deal with this guy. But I no longer act on my OC's idealism instinct to 'save the world'; I'm away from the team, and leaving it to management to deal with whatever comes. I can be highly competitive with my peers, but this paranoid guy can't emotionally handle comments on his work. I and my co-workers actually know our technical is better than his; but it is not my responsibility to get the customer to realize this.

I find it sad, because the paranoid guys big stretch ideas combined with my OC ability to fill in the engineering details could be a valuable combination. The customer guy is either/both of a fellow paranoid (which is why those two understand each other and get along) and narcissist personality; hence, we can reason with him. He has to figure out on this own time and methods that the paranoid guys work products need more scrutiny, from us technical folks not just other management (business development) who are bamboozled by the buzzwords and dollar signs.

Sorry so long. Thanks for letting me journal :-) Maybe others can learn from it, too.

10:28 AM, April 26, 2007  
Anonymous Anonymous said...

Typos: ...hence, we canNOT reason with him...

10:28 AM, April 26, 2007  
Anonymous Anonymous said...

From anon 10:28 AM.

Oh, yeah, one for thing.

The original purpose of this thread is on the Empathy of Therapists. Personally, I've learned a lot from realizing that other people THINK in drastically different ways than I do. The degree that I can empathize with or relate to a circumstance is becoming less important. I refer to Post's Chpt 5:
(a) think about what is the person's base personality type, and
(b) Is he/she under a moment of stress, and therefore may be reacting with an extreme version of his base personality or the stress has switched him/her to one of the others. [Under extreme stress, I can be instinctively paranoid, blaming others for not understanding because they don't see all the details that I have thought through. If they'd only listen...Ahhh, well. I cannot make others change; I can only change myself, my emotions and my behavior.]

In summary, a therapist should have training on personality types, how to recognize them, and thus help each client mitigate their own behavior so it doesn't manifest itself in extremes, as disorder state (extreme depression, suicidal self-violent, violent towards others). My post-partum state and multi-year physical exhaustion (and too much coffee with sugar) contributed to a chemical imbalance. Combine that with stress from marital problems and a car accident PTSD led to a hallucination episode. Some medication plus sleep/rest (help with the kids care) plus exercise (serotonin maintenance) managed my symptoms; now I can manage them with only the latter two: healthy sleep and exercise patterns.

Certain therapists may work best with certain personality types; they'll fail with some clients if they try to change every client to their own version of how people should act. Just work with the client so the client can change his/her behaviors to avoid extreme episodes. Perhaps work with the client's family as well, so spouses can each other's stress and when a vacation or day at home is needed instead of being work-a-holics.

11:03 AM, April 26, 2007  
Anonymous Anonymous said...

I am tired of left-leaning therapists who try to tell me that I should "never show anger"--that's BS, plain and simple. There are times one *should* get angry. (I wonder if they ever get angry at President Bush? LOL) I don't need some touchy-feely girly-man therapist telling me to get in touch with my feminine side, as I'm a man and quite happy with that. Let's just say I identify with John Wayne and not Alan Alda, and am not going to change--and no, there's nothing wrong with that view!

I also am tired of so-called therapists who only want to put me on drugs instead of really digging to find what's bugging me.

The last time I was seeing a shrink, I was put on Welbutrin. I thought that damn stuff was going to kill me. I had horrible side effects. My heart was racing all of the time (I'd even wake up with a heart rate of 112 to 120 when I should have been around 70), my adrenaline and testosterone were running full blast, which was making me manic and hyperactive, and way too aggressive. But when I told the psychiatrist about the side effects, she just said that I quit the drug that she wouldn't be able to see me any more. I told her that she *wouldn't* see me any more, and also told her that she should resign her profession since she obviously didn't seem to be aware that some folks do have bad reactions to some drugs, and that if she didn't believe me when I said I was having side effects, that obviously there was no trust relationship between us, anyway

-- anonymous in the People's Republic of Ann Arbor

12:33 PM, April 26, 2007  
Anonymous Anonymous said...

There are times one *should* get angry; you are entitled to your feelings. The "never show anger"--that's BS, plain and simple; do BECOME AWARE of who/how/where to "show" anger. It's okay and appropriate in some settings, but not in the workplace (except to slip out to the restroom from a meeting, or to privately talk with someone who's a good listener and able to let you have a vent session. After you've cooled down, only then decide if your emotional reaction is a valid intellectual one requiring action behavior.) Noone can tell you how to feel; but settings can apply limitations on behavior.

For me, it's showing tears. (And I work around mostly guys, yet I am 'a sensitive soul'. So it was quite confusing for awhile to get use to the 'boys rough housing' style. Also, as a woman, I couldn't be offended by the rough house style AND I couldn't just adopt and use it either. It's been interesting.)

Best wishes to you, in Ann Arbor.

1:21 PM, April 26, 2007  
Anonymous TMink said...

Ann Arbor, sorry you went through that garbage. Yuck. Anger is one of God's good gifts to us. Just like sadness and fear, wonderful ways we have of communicating with ourselves and others.

People who confuse acting out with anger really piss me off! I am angry about how they hurt and limit people and try to shear to balls and pluck the backbone from men. And they seem to want to turn all women into potential victims.

They do the same thing with aggression! Aggression is a wonderful thing! Protective parents use aggression to scare off predators, strong women tell people who would hurt them to step back and mean it, kids shout "don't touch me there" and a pervert is arrested, Hitler was stopped by brave men and women and their aggression.

People spend so much time talking about and fearing acting out that they ignore or hide the gifts and accomplishments of anger and aggression.

It pisses me off.

Ahh, I feel better!

Trey

2:38 PM, April 26, 2007  
Anonymous GM Roper said...

One of the responsibilities of a therapist at the very beginning is to attempt to establish a comfortable rapport with the client. Not change prejudices (unless the client comes in asking for help with his/her prejudices) and not to reject a client out of hand. I never thought I could work with MR's, but when I had to, I found it a delightful though exhausting experience. The same with OCD and BPD. But a therapist must also recognize that the client is the ultimate chooser of who to work with and feeling uncomfortable because a client asks for your help to find say, a "gay" therapist is, in my opinion, beyond stupid. But, then I'm prejudiced against that kind of therapist anyway. ;-)

6:27 PM, April 26, 2007  
Anonymous Mike G in NH said...

I knew a few social work majors while I was in school, and they all had more mental problems then anyone they could hope to help as a client. I wondered if this was universal

I asked a 50 year old social worker turned lawyer about this. (Her father is a noted psychologist)

She said that most social workers are in fact crazy, and that psychologists are worse.

Now I know we're talking about therapists here and I don't know where you draw the line between psychs, therapists and social workers. I certainly have all the respect for Dr. Helen that one can possibly garner from a blog.

I'm not sure where I'm going with that. It seemed relevent anyway.

10:58 PM, April 26, 2007  
Anonymous Anonymous said...

dr. helen,
I read the article and really enjoyed neo-neo's post on it. Thanks for putting it up here.

What I find interesting about the article is the assumption that a shared identity necessarily equals a shared experience or an ability to empathize. I can understand that a woman may feel more comfortable with a woman therapist, or a gay man with a gay male therapist or a black person with a black therapist. But gender, sexual orientation and race are just a part of any person's experience, and the therapist with the same gender/sexuality/racial identity may have little else in common with the patient.

Another danger is that the shared identity then becomes central to the therapy relationship. Something like "I am a woman, my therapist is a woman, my therapist understands me, therefore only women understand me". Well, no, your therapist is a professional, and how lucky for you that your therapist also appears to be good, but a good male therapist would also understand you.

I'm a vetran of years of therapy, some of it very good, some of it not so good, some of it very bad. I recently had a particularly bad experience with a therapist who was so unprofessional I considered reporting her to-I don't know, to whom should a bad therapist be reported? Anyway, a big part of her unprofessional behavior was, I suspect, a result of me not feeling the way she thought I would based on my experience and identity. It was unacceptable to her that I didn't fit into her mold of a (fill in the blank), and she didn't know what to so with me other than denigrate my value system.

Well, it was interesting reading through the posts about some bad therapy experiences other people have had. Seems like a topic that could get a lot of milage on your blog, doc. Maybe if you keep this going, I'll tell more about my bad experience. I'd love to get some input on it.

11:36 PM, April 26, 2007  
Blogger jw said...

tmink: While I agree that being "seen," being watched by the therpist is a good thing, I really must disagree with your core asertion that knowledge is not important. The problem being one of mis-diagnoses and mis-thinking.

I've had this particular one MANY times:

I talk of March 20-23 1981, I nearly died as the result of a female offender sex assault (she used drugs). Now, the most common, BY FAR, concept coming from therapists is one of delusion & possible paranoia. It is a matter of therapists simply stating "there are no female offender sex assaults against men, so you were not hurt by one; therefore, you are delusional."

Now, how can there be any connection? Any therapy? Any humanity? Any EMPATHY?

Hmmmmm?

There cannot! There is no knowledge and therefore zero connection.

The BIG trouble is this form of not-knowing is all too common in therapy.

4:03 AM, April 27, 2007  
Anonymous Anonymous said...

I realized I didn't leave a proper citation in the 11:03 AM post.

"Leaders and their followers in a dangerous world", by Jerrold M. Post, (c) 2004.

Consulting the list of cognitive impairment under stress, pg 104-105, sometimes helps me catch poor reactions in myself.

Consulting pg 107-114 off and on has helped me see actions by others from their viewpoints. For example, *I* love help and talking things out and examining every detail. I find the paranoid syle impatient and rude, but it seems there are more paranoid-style managers than sensitive/patient ones. Perhaps that's my industry; or, at the moment, I am over-sensitized to applying the paranoid label since it fires up my nerves.

Post claims 'Severe paranoids usually do not last long in a hierachy, at least in an open society.' But my industry is a big bureaucracy. I'm noticing paranoids survive there, and seem to find/know each other instinctively and team up, or use their team network to spat with another. "Indeed, in a ...bureaucracy, a touch of paranoia with its heightened readiness to see bureaucratic rivals around every corner can be adaptive and help the individual to survive the bureaucratic wars."

Reading about e.g. Gen McClelland in the Civil War has helped me a lot: even highly successful and smart people can make big mistakes from personality biases. In producing work-product, I'm learning to balance the amount of technical detail and content (and decisional agony of whether it's good enough or not) versus deadlines. While *I* feel better knowing and showing all the details, I'm getting better at picking out only a bit of the info to show the bosses -- especially if its a paranoid-leaning one -- so he/she sees enough to be happy with me. I learn which co-workers work well with me and like also learning the details and helping me through questions versus dislike emails of more than one sentence. My emails can easily get long, since I type fast, which was leaving some recipients overwhelmed/confused, and perhaps intimated and insecure.

Oops, I'm rambling on again.

Recommend have a high OC journal in therapy: they'll learn as much from themselves as in the therapy session. Only talking would have mean going on and on and on with a therapist, and the therapist would lose track of my chain of thought. And, at first, I had some 'loose associations'. I was absolutely certain A meant B meant yadayada; but really I was, under stress, jumping to false conclusions while desparately trying to find that magic solution.

Life's not about magic solutions. And one of my solutions is to focus, instead of procrastinate, avoid a project if I am nervous about it for some reason. So now it's back to forcing myself to focus on work.

One of my other solutions is to NOT be a regular commenter on any blog nor edit Wikipedia. I can too easily lean obsessive about communicating my viewpoint and knowledge, and spending too much time here. Thanks for letting me visit. Cheers.

10:52 AM, April 27, 2007  
Anonymous TMink said...

jw wrote: "I really must disagree with your core asertion that knowledge is not important. The problem being one of mis-diagnoses and mis-thinking."

I guess I wrote that wrong. I think it is VERY important to know how people change and what helps them change. I think it is very important to know about common neurological problems and personality disorders. It is also very important to know yourself enough as a therapist to know what you do not know, and who you cannot be empathic toward.

What you do NOT have to know is what it feels like to be a black left handed lesbian to be a good therapist to a black left handed lesbian.

Here is my point. My pain feels JUST like hers. My experience of fear is just like hers. We feel happy in the same way as well! Now different or similar things may make us happy, sad, jealous, whatever, but our experience of our affective states is so similar that I can be helpful.

And she changed her life and situation in the same ways I do, in the same ways that hundreds of patients I have worked with have. Humans have more in common than we differ. Social science research bears this out. When people are looking for a therapist who is a black left handed lesbian, they are really just looking for someone who will accept, understand, and prize them as a human being worth those things.

I bet when you were victimized you reacted just like a rape victim. Damn, I am sorry you were raped, that sucks bad. I do not see where your gender has anything to do with it at all. The problem was sexist therapists, not therapists that had not been raped or had not been raped by a woman.

I imagine your experience with a therapist would have been VERY different if the therapist had said "Oh my goodness, that is awful, how are you coping?" than if they said "Same exact thing happened to me. Get over it I did." Shared experience is not the issue.

That is what I meant to state.

Trey

11:49 AM, April 27, 2007  
Blogger jw said...

tmink: Trey, I quite agree that a therapist does not have to have gone through the same thing or even BE a similar person.

That said, the problem is not as in your last paragraph! The problem is not one of "get over it" or of "Oh my, that is terrible." NO! Not at all.

The problem is of pure information pollution or 'Martha Mitchell' error ... The problem is one of the therapist saying "that cannot have happened."

This exact same type of problem has shown its ugly head in a great many areas of therapy. Without a therapist having the basic background knowledge to not-state a truth as a falsehood, we end up with a seriously wounded population of people.

This is called Martha Mitchell error by many due to her therapist's error in regard to the US Watergate break-in.

I'm making a very important point here, one that all therapists must know:

a) You need to have a good overall grasp of social studies.
b) Sometimes a patient will make a statement that sounds false to YOU, but is, in reality, truth.

3:51 AM, April 28, 2007  
Anonymous TMink said...

JW wrote: "The problem is one of the therapist saying "that cannot have happened."

Oops. I misunderstood. We are in complete agreement. Thanks for taking the time to show me that!

Trey

9:52 AM, April 28, 2007  
Blogger Maxine Weiss said...

Social Workers are, indeed, crazy. They are at the bottom of the mental health hierarchy. In Mental Health, you find extremes at the very bottom, and at the very top. So there would be a higher incidence of Mental Illness among both Psychiatrists, and Social Workers.

The mid-level ---Psychologists, not as much.

The idea that another individual is going to "fix" things, or solve life's problems is absurd, anyway.

Rent-a-friend.

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