Thursday, October 6, 2016

Cranky Therapists Anonymous

Therapists have feelings, too. Besides caring deeply about your mental health, or lack of same,  they get cranky. They also get angry and judgmental.

If that is their problem I recommend that they join up a new recovery group: Cranky Therapists Anonymous.

The New York Post has the story. And a rather sad story it is.

Perhaps it will stand as a footnote to the national conversation about New York values, but apparently New York City is a world leader in mental illness. Unless mental illness represents a superior sensitivity to the world’s problems, this is not good news. Apparently, the great melting pot, the most diverse city on the planet, a city where there is a monstrous level of income inequality, produces far more anomie than happiness.

Who knew?

The Post reports the extent of the problem:

New Yorkers are a notoriously neurotic, self-absorbed bunch — and it goes beyond the usual Woody Allen clichés. A 2015 survey by the New York City Department of Health found that 1 in 5 adults living in NYC (that’s 20 percent) suffer from depression or some other kind of mental health disorder, compared to 6.7 percent nationally.

Time to whip out the crying towels. Time for a warm bath in empathy. One does know how many of these patients are on medication, licit or illicit.

If the city has that much mental illness, you would have thought that it would have been great for therapists. A never-ending supply of patients is good for business. At the least, it’s a great challenge for any serious therapist.

On the other hand, the Post does not notice that if the city is chock-a-block with mental illness and if many of these people, presumably, are in therapy already… we must conclude that many of these cracker-jack therapists are not doing such a good  job. They are, one might say, so closely in touch with their feelings that they do not know how to get in touch with their patients.

Anyway, they want your pity. They believe that they deserve it.

The Post continues:

And if these city dwellers have it bad, just think about the people who have to treat them.

It’s really hard for therapists — we really care, but we’re people, too, and we’re just as crazy as you are,” says Sherry Amatenstein, a licensed clinical social worker with offices in Long Island City and Manhattan. 

If that does not drain your confidence in therapists I don’t know what will. They really care. They really, really care. And they are "crazy." What does it say about whatever therapy they themselves have undergone if they have been unable to overcome their whiny, cranky natures and if their greatest concern is that their patients do not care about them?

How would you diagnose that one, doctor? Self-involved narcissists, perhaps-- more concerned about themselves than their patients. When you start complaining about how much you care you are trying to talk yourself into caring.

The only thing these therapists care about is themselves. Allow me to tell you a secret. If a therapist only cares about herself, she will never be able to connect with any of her patients. And if she cannot connect with them, she will never help them. She will see their problems as a threat to her own self-absorption.

If this does not convince you that you have had enough therapy, I don’t know what will.

If you want to know where you should send any extra sympathy you don’t know what to do with, try psychologist Beth Sloan [a pseudonym]. The Post explains her difficult situation:

Psychologist Beth Sloan is fiercely protective of her patients. She’s invested in their problems during sessions, worries about them even after they’ve left and genuinely wants them to be happy.

But, she admits, there is one former client from her private practice whom she “hated.”

“When 2 p.m. would roll around, my stomach would get tighter and tighter,” says the Bergen County, NJ-based Sloan, who asked to use her nom de plume for professional reasons. That’s when the “dreaded” patient would walk in, her arms weighed down with designer shopping bags, and begin whining about how she couldn’t subsist on her $2,500-a-week allowance from her husband — or about as much as Sloan made in a week as a full-time professional.

“I felt terrible feeling that way, but I didn’t care for her as a human being,” Sloan says. “I felt she was soulless.”

And what about the state of Sloan’s soul? What about the blatant disrespect she is showing toward her patient. We have no sense of what is bothering this patient. We do know what is bothering Sloan.

One suspects that she has drunk a bit too deeply of the sophisticated intellectual critique of consumerism and looks at her patient with contempt. Being an ideologue—though probably not knowing it—she cannot relate to her patient. She probably cannot even have a conversation about shopping. Because she thinks that her intellectual brilliance transcends the world of fashion and shopping.

In the end she is not serving the best interests of her patient. If the patient feels soulless perhaps she is responding to her therapist’s contempt for her. And we are especially impressed by the judgmental attitude. She believed that her patient had sold her soul for filthy lucre and designer duds.

Rather than consider how she might connect with this woman, and even help her, Sloan feels bad about her feelings. Time to join Cranky Therapists Anonymous.

In the end, Sloan decided that she was having her own countertransference issues. The woman reminded her of her narcissistic mother. This blinding insight taught her never again to treat anyone who is narcissistic.

If this is what passes for therapy, you understand why New York has so much mental illness.

Or else, take the case of Lisa Brateman. She is an expert therapist, a specialist, a leader in the field. And yet, she too has a bad attitude. I suspect that she would do better if she learned to like her patients as much as she likes herself.

The Post reports her complaints:

Lisa Brateman, a psychotherapist and relationship specialist in Midtown, says that she’ll often meet with first-time clients — and they’ll immediately want to know how long it will take to cure them.

“When I meet a client for the first time, and they’re 30 or 40 years old and have had issues for a long time, they start asking me, ‘How many sessions do I need?’ or ‘How long will this take?’ she says. [Theres] this expectation of instant gratification.”

And the small talk can be borderline painful.

“I get a weather report probably eight times a day,” adds Brateman. “Especially when it rains.”

It would be nice if Brateman could engage in a little straight thought. When a patient asks how long treatment will take, he or she is not looking for instant gratification. The patient knows that cognitive therapists set down a prescribed number of sessions. And some insurance companies will only pay for a limited number of sessions. Interpreting it in terms of instant gratification represents a failure to respect a patient’s legitimate concerns.

As you know, I have recently—and not just recently—written some posts extolling the importance of small talk. Brateman, however, considers it to be “borderline painful.” One is tempted to ask whether that is painful in the good or bad sense, but one will refrain.

Apparently, Brateman does not understand the value and the virtue of small talk. I suspect that she considers it beneath her own brilliance. In truth, small talk is a conversational lubricant. When a patient offers to discuss the weather, discuss the weather. It is not very difficult. You can complain about your agony at your next meeting of Cranky Therapists Anonymous. For now, when you patient reaches out and greets you, reach back and engage the discussion. If you believe that such discussions are meaningless and mindless, revise your thinking… post haste.

If you think that small talk is bad, take a look at some of the other horrors that therapists have to endure. While considering these indignities I invite you to consider what an ER physician or an oncologist deals with on a minute-by-minute basis.

These therapists have mastered the art of whining. The Post offers some examples:

Other times, patients are just plain rude: answering their cellphones in the middle of sessions, yelling if things don’t go their way and even eating on the couch.

“This isn’t necessarily a therapeutic issue, but I have a candy dish in my office [containing] Life Savers. Most people understand that you take one or two, but one guy takes four or five every time,” says Brooklyn-based therapist Eli, who requested that his last name be withheld for professional reasons. “It puts you in a spot, because you have to act parental and say, ‘There are others here besides you.’ Or you have to be passive-aggressive and hide it or empty it and say, ‘I forgot to refill it.’

Therapists who refuse to make small talk are rude. Be that as it may, sometimes patients answer the phone because they have to answer the phone. Sessions are not sacred spaces. When you are in session the world does not stop.

When patients yell one should discern whether they have a reason to yell. If not, they perhaps you should explain that it is counterproductive to do so.

As for eating on the couch… a good therapist will tell the patient that he does not allow people to eat on the couch. If he must eat, he should eat elsewhere. Or else, save it for later. It’s the therapist’s office. He should have a say in what happens there. Who knew that therapists were still using the couch?

Just in case you were imagining that the Post was singling out female therapists for special consideration, it adds the case of Eli, an excellent candidate for Cranky Therapists Anonymous. Eli leaves a bowl of Life Savers lying around the office. He feels that it’s appropriate for a patient to take one or two but he feels that there is something seriously wrong when a patient takes four or five.

Quick question: does that sound more like the thinking of a serious professional or the thinking of a child in the playground.

The solution is simple: cease caring about the two extra Life Savers. It is not going to break the bank… or, at least, I hope not.

Finally, what is a poor therapist to do when a patient refuses to change? Chloe Carmichael has faced this dire and difficult situation:

“Say someone starts therapy because she wants to [end] an unhealthy relationship,” says Chloe Carmichael, a licensed clinical psychologist in Midtown East. “And three or four months later she doesn’t seem to be making any effort to break it off. In that situation, it’s best to be transparent about your frustration.”

When faced with a clinical conundrum the therapist does what she knows how to do. She expresses her feelings. How many years of advanced education did she undergo in order to learn that?

For her edification I would point out that when someone wants to end an unhealthy relationship the situation is often far more complicated than it seems. Without knowing any facts and details about the people involved we cannot know whether the patient is dealing with the issue judiciously or not. We do not know whether it is a good or a bad thing to break off today or whether ending the relationship takes time. Effectively, we know nothing about the people or the problem. We do know that someone who wants to end a bad relationship has every right to doubt the decision. For all we know, the relationship might have gotten better.

Expressing a wish is not a commitment. It is not a vow or a promise. Carmichael is missing the point if she is treating it as though it is.

For your edification, Dr. Carmichael’s approach is what some therapists call eclectic. I see it as a hodge-podge. She offers a little bit of every kind of therapy. I suspect that she is not alone in so doing. From her website:

Dr. Chloe’s approach to therapy is a combination of the genuine care, empathetic skills, and a non-judgmental pscyhodynamic [sic] approach coupled with several evidence based strategies such as meditation techniques and cognitive behavioral therapy.


Sam L. said...

First-world, first-city problems. My sympathy tank measures zero.

Anonymous said...

In the stupid shallow West, people rely on celebrities and pop stars for political views.

They should shut up and just make music.