Aug 28

Blogging Minding Therapy: 6 Years Later (Part I)

As my sixth year blogging “Minding Therapy” comes to a close, I offer additional thoughts and/or updates to 10 of the most frequently visited posts. 

I. “Shawshank Redemption: Hope and Other Themes (2013)

Did you know that the movie was based not on a book by Stephen King but his short story “Rita Hayworth and the Shawshank Redemption”?

An excerpt from the story‘s coverage by SparkNotes.com:

Hope, more than anything else, drives the inmates at Shawshank and gives them the will to live. Andy’s sheer determination to maintain his own sense of self-worth and escape keeps him from dying of frustration and anger in solitary confinement. Hope is an abstract, passive emotion, akin to the passive, immobile, and inert lives of the prisoners. Andy sets about making hope a reality in the form of the agonizing progress he makes each year tunneling his way through his concrete cell wall.

II. Therapy Office Design: Why and How to Provide the Right Setting (2012)

Since writing this post, there are additional resources online. Here are some I recently found:

III. “50/50”: Problems with the Therapist/Patient Boundaries (2011) and Therapist/Patient Boundaries in “50/50” (2011)

Psychologist Rachel Mallory, writing on the website of the British Columbia Psychological Association, hated the movie because the therapist violates ethics when she becomes romantically involved with her client—a dynamic that scarcely had worried film reviewers, she adds.

Some of her perceptions regarding the therapist’s actions:

…Abuse of power, exploitation of a vulnerable person, violation of basic ethical principles, grounds for being terminated from a graduate program, career-ending for the therapist and potentially devastating for the patient. All the trained therapists I talked to about this movie agreed, wholesale…
However, when I complained about this plot twist to non-therapists, they thought I was overreacting…
This disconnect between the dictates of the professional codes of conduct, and at least some of the public perception of sexual relationships between therapists and patients, is concerning to say the least…

IV. “What About Bob?”: The Need to Take Baby Steps (2012)

For $19.50 you can have a Baby Steps t-shirt. For less than a dollar more, there’s Dr. Leo Marvin’s BABY STEPS Counseling Center tee:

V. Forgiveness: Not Always Necessary, Often Helpful (2015)

In 2016 therapist Annie Wright addressed the problem of forgiveness shaming and blaming. An excerpt about forgiveness not always being necessary:

The reality is that forgiveness often requires a deep process of grieving and healing that looks and feels different for everyone. There is no prescribed timeframe, no generalized benchmark for the forgiveness process. It takes as long as it takes. And what’s more, some people may never get to the point where they feel like they can or want to forgive someone who has hurt them. And that’s okay, too.

Jul 17

Impaired Therapists: How to Intervene

Unbreakable Kimmy Schmidt and Gypsy are a couple of the latest TV series, both streaming on Netflix, to feature impaired therapists. Kimmy Schmidt‘s Tina Fey has a minor role as Andrea, an alcoholic therapist who somehow still manages to offer the lead character (Ellie Kemper) tidbits of useful advice. Her impairment, however, has ultimately led to losing her license, one possible outcome in the real world as well.

Gypsy‘s Naomi Watts portrays a therapist who’s been described as unethical and a sociopath.

In real life a relatively small percentage of clinicians in any of the mental health disciplines—which include such areas as social work, psychology, and psychiatry—are likely to be impaired therapists. However, in order to protect the clients who may potentially be affected, rules have to be in place.

Therefore, the various professional organizations whose members are providers of mental health services have pertinent codes of ethics. According to a leading ethical expert in my own field, Fredric Reamer, impairment can not only involve failure to comply with those ethical standards but also incompetence (Social Work Today).

The social work code of ethics specifically states the following regarding steps to take when a colleague is deemed impaired:

(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

All of the above takes into account the unfortunate fact that sometimes the nature of certain personal issues—such as addictions, burnout, health issues, and mental illness—can mean they will go undetected by the practitioners themselves.

Pertinent to this is a quote from the NASW Impaired Social Worker Program Resource Book that Reamer cites:

The problem of impairment is compounded by the fact that the professionals who suffer from the effect of mental illness, stress, or substance abuse are like anyone else; they are often the worst judges of their behavior, the last to recognize their problems and the least motivated to seek help. Not only are they able to hide or avoid confronting their behavior, they are often abetted by colleagues who find it difficult to accept that a professional could let his or her problem get out of hand (p. 6).

It’s not only colleagues who have recourse; clients do as well and need to trust their own instincts in this regard. If you notice something is wrong and talking it out with the therapist either doesn’t seem like an option or fails, you can report the impaired therapist to his/her employer and/or professional association and/or licensing board, and/or, if involved in payment for services you’re receiving, your health insurance company.

Jun 30

“Gypsy”: Role Model for Unethical Therapists Everywhere

Coming to Netflix today is Lisa Rubin‘s Gypsy, a widely panned series starring Naomi Watts as a therapist—a vastly unethical therapist.

Let’s just get the trailer out of the way:

 

Rubin offers this official film description:

Gypsy is a ten-part psychological thriller that follows Jean Halloway (Naomi Watts), a Manhattan therapist with a seemingly picturesque life who begins to develop intimate and illicit relationships with the people in her patients’ lives. As the borders of Jean’s professional life and personal fantasies become blurred, she descends into a world where the forces of desire and reality are disastrously at odds.

Psychological thriller? Most critics seriously question how well Gypsy fills that particular bill.

Further plot details from Jen Chaney, Vulture:

Happily married (Billy Crudup plays Michael, her handsome lawyer-husband) with a daughter, a nice home, and a New York City office yanked straight out of a Z Gallerie catalogue, Jean ticks most of the boxes on the ‘she has it all’ checklist. She does have some issues, though, including a strained relationship with her mother (Blythe Danner), difficulty coming to terms with her non-gender-conforming daughter, and a low-simmering jealousy of the relationship between Michael and his assistant. To cope, Jean does what Gypsy the series does: spend minimal time genuinely exploring these matters in order to channel energy into unethically infiltrating the social and family circles of her patients.

Selected Reviews: Comparisons and Conclusions

Dan Fienberg, Hollywood Reporter:

Watts doesn’t play Jean as victim or villain and Gypsy doesn’t judge Jean, though many viewers are probably going to think it should. Professionally, the things she’s doing are wrong and the show’s only real tension comes from playing the same, ‘Is she about to get caught in her latest lie?’ beats over and over without offering an alternative perspective, allowing us to root for the cruelly manipulated patients.

Jen Chaney, Vulture: “It’s like In Treatment with more weird, stalker-y behavior, except when it’s delving into Jean’s conflicts with fellow moms in her chichi Connecticut suburb. Then it’s like a far inferior version of Big Little Lies.”

Maureen Ryan, Variety:

It’s hard not to compare this show to ‘In Treatment,’ the HBO series about a therapist which had the good sense to keep its episodes to under 30 minutes. Not only did that series do a better job of turning most clients into three-dimensional people, it distilled the intensity of sessions into efficient, effective installments.
What transpires in Jean’s office, however, usually lacks insight and spontaneity, and her patients — who nurture obsessions with people who don’t return their interest — are a pallid, moderately annoying bunch. Jean’s eyes often glaze over with boredom, and it’s easy to see why.

Inkoo Kang, Village Voice:

The show is a confluence of interesting ideas: female midlife crises, competitive mothering, the parenting of a very young trans child, the invisibility of female sociopathy, mental-health professionals’ frustration at their own helplessness, and, especially, the vicarious thrills therapists (might) experience when they hear about the life-derailing pleasures that got their patients into trouble. But each scene wastes every opportunity to reach for something fresh or original.

Brian Tallerico, rogerebert.com:

…a depressingly bad show for the talent it wastes on horrendous dialogue, unbelievable characters, and the kind of soapy plotting you’re more likely to see on a Lifetime TV movie than prestige drama…
Worst of all, none of it rings true…If I was the show’s therapist, I’d suggest it stop taking itself so damn seriously. Pick up the pace and give us something to care about. Get to the point and stop dancing around your issues. Because no one wants to dance this slowly.

Jun 26

“My Mourning Year”: Therapist’s Own Grief Process

Andrew Marshall is best known for his self-help books, but his memoir demonstrates that mental health, even for experts in the field of psychology, is a universal struggle. Failed counseling sessions, spontaneous vacations, and romantic dates are all attempts Marshall makes in order to move past “the black holes of Thom.” Zane DeZeeuw, Lambda Literary, reviewing My Mourning Year

Although known in the United Kingdom as a top-notch couples therapist and author of 18 self-help books, Andrew Marshall‘s My Mourning Year: A Memoir of Bereavement, Discovery and Hope, about the death 20 years ago of his partner, may be his best writing, according to Zane DeZeeuw, Lambda Literary.

My Mourning Year is an almost unedited version of the diary he kept following Thom’s death. “He does not offer steps or guidance for how to navigate the mourning process; instead, Marshall uses his experience as anecdotal evidence that a person can survive and learn to live again after being affected by a tragedy.”

As Marshall explains in a Telegraph article, “When my partner Thom died 20 years ago, he was just 43 and I was only 37. I did not have the first idea how to cope with the grief that enveloped me.”

By publishing such a personal book, going against the usual privacy he’s maintained throughout his career, Marshall states, “I want to show that there is no right or wrong way to grieve and everybody – even therapists – make mistakes.”

One significant point Marshall makes in My Mourning Year (and I will continue to quote from Telegraph) is that “Bereavement has the knack of finding the fault lines in your life and blowing them apart. It exposed that my parents were not entirely comfortable with me being gay and I was not comfortable with their polite but distant way of showing they cared.” He needed to take some space from them.

And, adds Marshall, “the most important message of all: grief does not work to a conventional clock. Sometimes it feels like 20 months since Thom died and I still find new things to mourn. (Just recently, I wept about never getting to know him as an old man.) At other times, Thom’s death seems so long ago that it happened to someone else – perhaps because I’m not the same man I was 20 years ago.”

In the aftermath of Thom’s death there were certain things that failed to make Marshall feel better: a rebound relationship, for example—also counseling, it turns out. He actually tried it twice. This “was particularly upsetting because up to then, I’d thought of therapy as the holy grail. The problem was partly me. Just as doctors are terrible patients, therapists make terrible clients.”

(My own take on that latter statement is that it’s overly generalized and certainly not always true. I’ll accept, of course, that he is a therapist and that he feels he made a terrible client.)

Some of the things that did help Marshall’s grief process included the catharsis involved in attending theater, learning to be assertive about specific needs, taking a course in something new to him, and a one-year death anniversary dinner shared with close friends.

Eventually, moreover, he mended the rift with his parents that Thom’s death had provoked. Too, he was able to love again:

Bereavement is a wake-up call that none of us immortal. So I worked hard on improving my relationship with my parents and they have not only learnt to accept me but came to my wedding, two years ago, with joy in their hearts.
Perhaps this is the reality of mourning: you never get over the loss, but if you allow it to open you up to new experiences, you can transform your life into something that might be different, but still rewarding and meaningful.

Apr 14

Lying in Therapy Is a Researched Thing

The topic of secrets and lying in therapy is just one aspect of research at The Psychotherapy, Technology, & Disclosure Laboratory at Teachers College, Columbia University. Dr. Barry A. Farber is the lab’s leader, while doctoral students Matt Blanchard and Melanie Love run the Lying in Psychotherapy element.

From the latter’s online description:

Client dishonesty is a broader category of non-disclosure that includes distorting and fabricating as well as omission, avoidance, secret-keeping, etc. Our initial survey of 547 psychotherapy clients showed large percentages of clients concealing therapy-relevant information, such as suicidal thoughts. We are now preparing a follow-up survey to replicate our initial findings, conducting interviews with clients, and developing a related survey for therapists.

According to the abstract of an article by Blanchard and Farber, the vast majority of clients (93%) admitted to lying in therapy.

Common therapy-related lies included clients’ pretending to like their therapist’s comments, dissembling about why they were late or missed sessions, and pretending to find therapy effective. Most extreme in their extent of dishonesty were lies regarding romantic or sexual feelings about one’s therapist, and not admitting to wanting to end therapy. Typical motives for therapy-related lies included, ‘I wanted to be polite,’ ‘I wanted to avoid upsetting my therapist,’ and ‘this topic was uncomfortable for me.’

Ryan Howes, Psychology Today, interviewed Blanchard about the research, and some of the more interesting excerpts from their exchange are presented below verbatim:

  • Omission is about 3.5 times more likely than fabrication. Similarly, clients report minimizing the truth about 6 times more commonly than they report exaggerating.
  • …(M)ost demographic factors—gender, ethnicity, education, income—had no relationship to dishonesty in therapy.
  • …(Y)ounger clients reported more lying. Those who lied about one or more topics were on average 4-to-7 years younger than those who reported total honesty. This finding matches findings about lying in everyday life outside of therapy, too.
  • Most commonly, clients lie to avoid the shame and embarrassment they feel even in the confidential, protected space of the therapy room.
  • One of the last questions we ask clients is: “How could your therapist help you be more honest?” We imagined that clients would want more warmth or skill from their therapist, or to know their therapist shared their problems, or understood their culture or class. On the contrary, the dominant response was, “If my therapist asked me directly.” So one simple takeaway from our work is: Just ask.

A “spinoff” of the Lying Lab is called Therapists’ Lies & Detection of Lies, run by doctoral student Devlin Hughes. “Specifically, the lab is exploring how therapists respond when they believe a client is being dishonest with them…”

Tori DeAngelis, not a representative of the above resources but a journalist, has compiled her own suggestions for therapists (APA) to minimize lying in therapy. Some examples paraphrased from her article:

  • Establish a safe space for clients; convey a nonjudgmental attitude.
  • Model the practice of honesty.
  • When possible use humor and acceptance regarding omissions and lies.
  • Tread more lightly regarding possible secret-keeping of a more sensitive nature, but do consider how to reach that material, as clients usually benefit.
  • Keep in mind that you as a therapist may have also had difficulty admitting the truth in therapy. One study “found that about a fifth of 800 therapists surveyed admitted there was something important they had kept secret in therapy. In most cases it involved sexual issues.”