Tuesday, March 5, 2013

Psychotherapy Today

I missed last night’s premiere of Bravo’s new reality show LA Shrinks. Eventually, I will watch it, because what could be more fascinating than learning what shrinks are really, really like.

Ever since Freud mental health practitioners have been seriously circumspect about revealing details of their personal lives. They have aspired to become perfectly blank screens, surfaces on which their patients can project—like a movie projector, of course—their fantasies.

Sad to say, but many of them have succeeded only too well.

The few reviews I have looked suggest that LA shrinks and their patients spend most of their time talking about sex.  Freud would have been proud.

Perhaps it is more important that LA therapists would embrace the brand of “shrinks.” Labeling a once-noble profession with a derogatory term does not feel like a good omen.

So, I can’t reasonably review the show, but I can examine a Daily Beast article that purports to show what shrinks really think, about their work and about their patients. It’s a useful way to take stock of the current state of the therapy world.

Therapist Eris Huemer, for example, tells us that psychoanalysis and long term psychoanalytically oriented psychotherapy has been largely eclipsed by short-term solution focused therapy.

She explains this shift by saying that the newer therapies are more effective.

In her words:

I’m finding more that more short-term, solution-focused therapy is something that patients are wanting to do, rather than long-term care. Also, evidence-based practices are popular in mental health right now. Meaning, there are proven interventions that work, for specific problems, and there’s evidence-based treatment for those problems.

In the new therapies, shrinks help their patients to find practical solutions to practical problems. They pay lip service to what are called root causes and address everyday dilemmas directly.

Therapist Drew Perlmut explains:

For example, somebody comes in, and they’re having problems at work. They’re a chronic procrastinator. In the course of getting to know this person, you realize they grew up with very critical parents, making them afraid to submit work. But you may decide we’re not going to talk about their family history right away—we’re going to have to get to that obviously—but there are things this person needs to navigate immediately at work. So you’re saying, I know where we’re going, but let’s deal with this practical issue now.

Naturally, I find this encouraging.

Of course, some shrinks still retain the bad habits that they inherited from Freud and his followers. They refuse, for example, to offer advice.

Perlmut offers the standard rationalization:

Therapy is supposed to be about helping the person develop themselves and their own capacities. If you become the person that answers questions and gives advice, in a way what you’re doing is preventing the person from developing themselves.

Therapist Michael Simon, however, has no problem with giving advice:

I’ll tell you what to do. I have no problem with that. Here goes: Dude, get a good night’s sleep. You work too hard.

On this score, Simon is right and Perlmut is mired in the past. If a therapist refuses to offer advice or to express his opinion he is being rude to his patient. He is treating him as someone who could not possibly profit from advice and would not reasonably be able to evaluate it.

When a shrink addresses everyday problems, he should begin by analyzing the situation. But then, he must help his patient to evaluate the different options. He ought also to offer some options that his patient has not thought of. If he doesn't have any, he is not doing his job.

Among other bad habits that many shrinks have not yet overcome is that of answering a question with a question.

Here Simon rationalizes the outmoded practice:

What makes you feel your therapist is always asking a question when you ask a question? Sorry, couldn’t resist. It’s a technique I don’t use often, but it’s part of the traditional therapeutic response to try to get you focused and attentive to what you think and feel, instead of the therapist’s response. It’s often based on a respect for the client’s ability to find answers based on the material they produce in therapy and eventually for the therapist to become kind of obsolete over time.

Refusing to engage in a normal conversation is not respectful. It is rude. Happily, Simon himself no longer uses it. It’s goal is to make the patient introspect, thus withdraw from the challenge of connecting with another individual and get lost in his mind.

Huemer takes the opposite side of the argument:

I think that patients should ask their therapists what they think, and that therapists should tell them. I also think they should be allowed to ask them personal questions. There’s this fear that therapy is some ivory tower, that your therapist is some god-like image.

There you have it. Shrinks are not gods. They need not pretend to be above it all. They need not pretend that they cannot be bothered to lower themselves to deal with practical problems.

For all I know, the Bravo series is going to shrink the shrinks.

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