Mar 03

Hardest Part of Being a Therapist (“7 Questions Project”)

Being a therapist: what’s it really like?

Several years ago psychologist Ryan Howes conducted The Seven Questions Project in which he asked “big names in the world of psychotherapy” a series of pertinent questions. Although not everyone answered his request to participate, the ones who did were thoughtful in their responses.

When I recently found his series of Psychology Today blog posts about this and reviewed his queries, the one I found most interesting was the fifth: What’s the toughest part of being a therapist? (For the others, click on the link provided above.) And then I read Howes’s own conclusion regarding the project, which included the following:

“Best Question: I thought it would be questions one, four or seven, but question five (the toughest part of being a therapist) turned out to be the most revealing.”

Below are selected excerpts of some of the therapists’ answers to this specific question.

Thomas Szasz (1920-2012)

Individual psychotherapy — that is, engaging a distressed fellow human in a disciplined conversation and human relationship – requires that the therapist have the proper temperament and philosophy of life for such work. By that I mean that the therapist must be patient, modest, and a perceptive listener, rather than a talker and advice-giver…

Even if the foregoing conditions are satisfied, the therapist’s task may not be easy or enviable, as he may be required to be passive in the face of the client’s self-destructive behavior and tolerate the client’s choosing to stick to his familiar, self-limiting life strategies and not risk entering on the path of liberation.

Harriet Lerner

The toughest part of being a therapist is that you constantly run up against your limitations.

Jeffrey Barnett 

One major challenge of being a psychotherapist is to pay attention to our own functioning, monitor our effectiveness, and to practice ongoing self-care…Just like our clients we must deal with life’s challenges and stresses.

Nada Stotland

Perhaps the most difficult aspect of doing psychotherapy is listening to and absorbing patients’ psychic pain.

Irvin Yalom

Well, I think it’s just holding so much pain at times. Worrying about my patients. Seeing some people that I really can’t help, who in some ways are beyond help. Or seeing a sociopath knowing I can’t really do anything for him or can’t reach him. Or watching some people who are throwing their lives away on drugs and there’s so little you can do about it.

James H. Bray

Not taking client’s problems home with you. Many people come for psychotherapy with significant emotional distress and pain. It is important to leave that with the client and not take it home with you.

John Gray

…Whenever I even start to notice a sense of frustration within myself I recognize that I’m not giving a very good message to my client. Whenever you’re frustrated with someone you’re telling them, “you’re not enough, you’re not doing it right, you’re not living up to my expectations.” That’s not helping the client, it’s not helping yourself.

Glen O. Gabbard

The toughest part of being a therapist is being truly “present” with the patient. The demands placed on a therapist in a typical day of psychotherapy are truly extraordinary. The therapist must be present in a way that allows the patient to feel heard, validated, and understood.

Donald Meichenbaum

The toughest part of being a therapist is how NOT to get caught up with all of the questionable psychotherapeutic “BULLSHIT” that pervades the field.

David D. Burns  

…Learning to accept failure on multiple levels is, to my way of thinking, the key to become a world-class therapist. But that means humility, and setting your ego aside, while you develop superb new technical skills.

Mar 01

Could You or Someone You Know Be a Psychopath?

Do you know anyone who’s a psychopath? Yourself, someone in your home, someone in the House—as in the White one? (There are opinions on the latter. It’s Google-able.)

Maybe you don’t know. Psychopathy is actually among the hardest diagnoses to discern. Some of the traits (

  • “The psychopath can appear normal, even charming.”
  • But “underneath, he lacks conscience and empathy, making him manipulative, volatile and often (but by no means always) criminal.”
  • “She is an object of popular fascination and clinical anguish: adult psychopathy is largely impervious to treatment…”

Psychologist Kevin Dutton (The Wisdom of Psychopaths) spells out eight parts of the psychopathic personality:

  • Machiavellian Egocentricity–your own personal needs rule over all else
  • Impulsive Nonconformity–neglect of social norms
  • Blame Externalization–things are not your fault
  • Carefree Nonplanfulness–you often don’t plan ahead
  • Fearlessness–lack of fear or anxiety
  • Social Potency–extremely charming
  • Stress Immunity–difficult circumstances don’t blow your cool
  • Coldheartedness–no guilt or remorse

Psych Central offers a test based on the above traits, which you can take here. Disclaimer: it’s not the end-all and be-all of psychopathy tests or quizzes, but it can give you a basic idea of what needs to be measured.

Robert D. Hare, author of Without Conscience: The Disturbing World of the Psychopaths Among Us, offers his own description: “Psychopaths often come across as arrogant, shameless braggarts—self-assured, opinionated, domineering, and cocky. They love to have power and control over others and seem unable to believe that other people have valid opinions different from theirs. They appear charismatic or ‘electrifying’ to some people.”

His Hare Psychopathy Checklist is considered the best test for measuring psychopathy, but it’s lengthy and can only be administered by professionals who’ve studied it.

On the other hand, as Susan Krauss Whitbourne (Psychology Today) recently reported, there’s now a reasonably reliable “super-short psychopathy scale” via research by Collison et al. It’s the Elemental Psychopathy Assessment (EPA) Super Short Form (SSF), making it the EPA-SSF.

If you take this little test, either on behalf of yourself or someone else, rate each item on a 1-5 scale (disagree strongly to agree strongly). Questions two, five, and fourteen are significant if you rate them on the low end, whereas all the others count more if you go higher.

I have no further details on how to score it, but I’m confident nevertheless that the EPA-SSF will improve your ability to understand what makes a psychopath. The statements to consider:<

  1. I deserve special treatment.
  2. I care a lot about my relationships with others (reversed).
  3. Feeling sorry for others is a sign of weakness.
  4. When someone does something nice for me, I wonder what they want from me.
  5. People would say I am a reliable and dependable person (reversed).
  6. I quit things pretty easily.
  7. I could make a living as a con artist.
  8. I have more important things to worry about than other people’s feelings.
  9. My temper has gotten me into trouble.
  10. I am known as a bit of a rebel.
  11. “Act first, think later” describes me well.
  12. I like doing things that are risky or dangerous.
  13. When I’m upset, I will do things I later regret.
  14. I am a bit of a worrier (reversed).
  15. I’m not the type to get depressed about the things I’ve done wrong.
  16. I remain cool, calm, and collected when things get stressful.
  17. I often emerge as the leader in a group.
  18. I’m pretty comfortable when meeting new people.
Feb 27

“When We Rise”: Must-Know LGBTQ History

In just 50 years, America has gone from a land where homosexuality was an illness treated by psychologists with lobotomies and electroshock treatment to one where gay marriage is the law of the land.

When We Rise is an attempt to explain how that happened, from 1972 to 2013. (Sonia Saraiya, Variety)

Jeff Jensen,, calls it “a beautifully queer thing in a very square package.” Starting tonight on ABC and also ending this week is a four-part, eight-hour mini-series, Dustin Lance Black‘s When We Rise, about the decades-long struggle for gay rights in the U.S.

Stars include Michael Kenneth Williams, Guy Pearce, Mary-Louise Parker, Rosie O’Donnell, David Hyde Pierce, T.R. Knight, Matthew Del Negro, Whoopi Goldberg, and Rachel Griffiths.

Although many reviewers find it “too dense” (Dominic Patten, Deadline) and “overly ambitious” in scope (Robert Bianco, USA Today), most also say it’s well worth the watch, especially for those who are relatively unfamiliar with the subject matter.

Sonia Saraiya, Variety, sets up the main (and, of course, true) story:

…interweaving stories of three activists in San Francisco, who variously devoted their lives to (and were ravaged by) the cause. One is Roma Guy (Emily Skeggs in her youth, and Parker as an adult), a feminist activist who discovers her own sexuality in the process of agitating for the rights of her friends who are lesbians….Roma ends up making a fragile alliance with Cleve Jones (youth, Austin P. McKenzie; adult, Pearce), a gay teenager barely surviving on the streets of San Francisco. Jones would go on to become one of the gay rights’ movement’s biggest figures…

The third protagonist is Ken Jones (Jonathan Majors and Williams), a black Vietnam navy veteran who is both the most tragic figure in the story and the most alienated — from the movement and from the other ‘characters.’ His race cuts him off from the mainstream gay movement brewing in the Castro neighborhood of San Francisco; his sexuality cuts him off from other veterans and the black community…

If for some of us watching this series is bound to feel nostalgically we’ve-been-powerful-in-our-united-struggle, it’s also likely to raise emotional triggers regarding current events in the Trumpism era. Although Trump had promoted LGBTQ rights in his campaign, he chose a Vice President and Cabinet appointees who’ve clearly shown anti-LGBTQ stances.

A few related and compelling concluding thoughts from critic Jeff Jensen,

It’s a story that needs to be told and needs to be heard here at a time when the new conservative administration threatens to roll back the gains of too many years and too much suffering. (In a weirdly fitting and perhaps calculated scheduling choice, [the series] will be interrupted by President Donald Trump’s speech addressing Congress on Tuesday, Feb. 28)…

It’s a story of a marginalized people who deserve to be recognized, a history we all need to know and own, presented as potent mainstream television. At one point, a neglectful president flies above and over an exhibit of the AIDS Quilt on the National Mall in what plays as a willful spurning and taunt, and Pearce’s Cleve leads the crowd in a rebuke: ‘Shame! Shame! Shame!’ Some people, including yours truly, can barely begin to understand and feel everything encoded in that furious shout. When We Rise illuminates, moves us to empathy, and challenges us to join the battle.

Below you can watch the When We Rise trailer:

Feb 24

“No Good Card for This”: Empathy to the Rescue

Uhh…wow. Let me know if there’s anything I can do? “Most of us, most of the time” when receiving word that a loved one is suffering, say authors Emily McDowell and Dr. Kelsey Crowe, There’s No Good Card for This

It’s indeed a common line. And not so helpful.

We often say the wrong things to people who are suffering and/or grieving, something Emily McDowell‘s popular line of “Empathy Cards” has aimed to improve upon. Some examples of her cards’ captions:

When life gives you lemons I won’t tell you a story about my cousin’s friend who died of lemons.

I promise never to refer to your illness as a “journey.”

Unless someone takes you on a cruise.

The Five Stages of Grief:

Crying in public

Crying in the car

Crying alone while watching TV

Crying at work

Crying when you’re a little drunk

Combine McDowell’s humorous caring sentiments with the skills of Dr. Kelsey Crowe‘s “Empathy Bootcamps” and you’ve now got a book—There Is No Good Card for This: What to Say and Do When Life Is Scary, Awful, and Unfair to People You Love—teaching us how to be there for loved ones in need.

Both McDowell and Crowe are cancer survivors; each understands first-hand how others struggle to do or say the right thing. McDowell, on the standard sympathy cards not cutting it for her. “You still appreciate humor, you are still a whole person. There wasn’t really anything in greeting card world that allowed for that” (Ashley Strickland, CNN).

The “Empathy” line McDowell eventually created are “cards for the relationships we really have.” And these have struck a major chord with buyers.

McDowell decided she’d like to help people even further, so she sought an expert to help her craft a book that’s “whiskey for the wounded” versus chicken soup for the soul (Siran Babayan, Los Angeles Weekly).

One of the key ways to figure out what to say to someone, McDowell tells NPR, comes from listening.

…I think a lot of what we go into in the book is that we operate under the assumption that we need to find the right words, and the good news is that Oprah can’t even do that. Nobody can do that. And so you kind of are off the hook in that really all you need to say is, ‘I’m here,’ and ‘I’m thinking about you,’ and ‘How are you doing today?’ and then let the person talk.

As Alex Ronan (Slate) observes, being able to offer the right kind of listening isn’t a strong suit for many. So the authors offer some guidance, including a piece called “What Kind of Non-Listener Are You?”

For example, the Epidemiologist non-listener ‘asks a lot of clarifying, fact-based questions before learning how someone is feeling’ while the Sage ‘gives wise perspective and advice…when it wasn’t asked for’ and the Optimist ‘always offers a bright-sided perspective.’

Strickland of CNN summarizes other significant points of There Is No Good Card for This, which I’m totally paraphrasing below:

  • Avoid doing nothing. Offer something specific you can do versus the standard and not so helpful “let me know if there’s anything I can do.”
  • Take the time to carefully consider what it is you really can offer.
  • Try to learn about the process of grief.
  • Avoid making it about yourself.
  • Problem-solving isn’t the goal here.
  • People appreciate such simple gestures as listening and texting.
Feb 22

“The Gardener and the Carpenter”: Against Helicoptering

Child psychologist Alison Gopnik has followed up her previous books about child development (The Philosophical Baby, The Scientist in the Crib) with The Gardener and the Carpenter: What the New Science of Child Development Tells Us About the Relationship Between Parents and Children (2016). 

It will become clear which of the two types of parents, the gardener and the carpenter, Gopnik prefers:

In the parenting model, being a parent is like being a carpenter. You should pay some attention to the kind of material you are working with, and it may have some influence on what you try to do. But essentially your job is to shape that material into a final product that will fit the scheme you had in mind to begin with. And you can assess how good a job you’ve done by looking at the finished product. Are the doors true? Are the chairs steady? Messiness and variability are the carpenter’s enemies; precision and control are her allies. Measure twice, cut once…

When we garden, on the other hand, we create a protected and nurturing space for plants to flourish…Unlike a good chair, a good garden is constantly changing, as it adapts to the changing circumstances of weather and the seasons. And in the long run, that kind of varied, flexible, complex, dynamic system will be more robust and adaptable than the most carefully tended hothouse bloom.

Gopnik’s favored approach lets kids develop more naturally. Katherine Reynolds Lewis, The Atlantic:

It should be fundamentally both reassuring and liberating for parents to know that children are doing most of the work. All the research that shows how incredibly sensitive and intelligent and powerful and good at learning children are and that they do it by observing and watching the people around them doing the things they do every day and by playing spontaneously. Children learn much more from using their own brains to just observe and play than they do by having someone sit down and teach them.

Not only that, they start right out of the gate. Ruth Graham, New York Times:

In fact, our brains are most active, and hungriest, in the first few years of life. Even as adults, our brains use a lot of energy: when you just sit still, about 20 percent of your calories go to your brain. One-year-olds use much more than that, and by four, fully 66 percent of calories go to the brain, more than at any other period of development. In fact, the physical growth of children slows down in early childhood to compensate for the explosive activity of their brains.

Gopnik prefers taking the verb “parenting” out of the picture. A relevant The Gardener and the Carpenter quote: “’Parent’ is not actually a verb, not a form of work, and it isn’t and shouldn’t be directed toward the goal of sculpting a child into a particular kind of adult…We recognize the difference between work and other relationships, other kinds of love. To be a wife is not to engage in ‘wifing,’ to be a friend is not to ‘friend,’ even on Facebook, and we don’t ‘child’ our mothers and fathers.”

Below Gopnik “examines when caregiving became the art of hovering, and the pitfalls and anxiety of trying to shape children instead of raise them”: