In this last installment of the “How to Find a Therapist” Series, I will be addressing the issue of the types of psychotherapy available.

ORIENTATION

There are many kinds but I will stick with the main types.  In the biz we refer to these types as “Orientations”  An orientation is really just a group techniques a therapist will use that have their foundation in a certain philosophy of treatment.   Therapists are usually trained thoroughly in one orientation.  Some have training in more than one technique and my label themselves as “Eclectic”, but usually there is a primary area of orientation.

PSYCHODYNAMIC  APPROACH/INSIGHT-ORIENTED THERAPY

This orientation descends directly from Freud, who believed personalities are established during our childhoods (for him it was by age 5, for some others it is even earlier) and that everything we are now harkens back to everything that happened back then.  From the standpoint of this orientation, there are many things that may have happened to us in our childhoods that we try to block out or repress.  These repressed memories stand in the way of us knowing ourselves and setting ourselves free from any negative symptoms we experience that bring us to treatment.  We can illuminate these blocks by focusing on repressed material that breaks through in dreams or patterns of behavior in our current lives and with the therapist.  Once the repressed material reveals itself, we may have a catharsis and a “working through” of the issues, and hopefully feel unblocked so we can move on with our lives.

When Freud started out and for many decades thereafter, psychoanalysts practiced this type of treatment and sessions were four to five sessions per week.  The typical therapy now is once per week, and is done by psychiatrists, psychologists or social workers.  Psychoanalysts who may come from different backgrounds, still believe that treatment should be at least two times per week.

Some patients are in treatment on an every other week basis, but  I believe for this type of therapy to work,  at least weekly is the goal.  The relationship with the therapist is central to this approach and the more contact the better.

RATIONAL-EMOTIVE THERAPY AND OTHER COGNITIVE BEHAVIORAL THERAPIES

The goals for treatment in this broad area include changing the client’s ideas/cognitions (or in some cases irrational beliefs) that effect emotions and in turn affect behavior.  Big names associated with this approach are Ellis, Michenbaum and Beck.

Some examples of irrational beliefs are:

If I don’t get what I want, it’s terrible, and I can’t stand it.

I must perform all tasks perfectly well.

I must have love and approval from all the significant people in my life.

It’s easier to avoid facing life’s difficulties than to face them and perhaps get even greater rewards.

The treatment usually involves the therapist teaching the client to observe his own behavior so the client can begin to reduce the irrational beliefs that foster destructive ways of feeling and behaving.  Any piece of this triad of functioning (thinking, feeling, behaving) may be addressed since they are all considered to work together from this perspective.

Some techniques in this area involve giving homework to the client where the client’s track their thoughts feelings and behaviors in stressful or potentially stressful situations and then develop alternative scripts or thoughts for these situations.

Sometimes the intervention will be more focused on the behavior where the client is instructed to act “as if” they are not depressed, for example.  The assignment may be to become lessw isolated,  as in going out with friends even if the client doesn’t really feel like it.  The result may be having a good time and the client’s thoughts about the depression and the depression itself may change.

Insurance companies usually love cog-B, as we call it in the biz, because it usually means shorter term treatment.  In my experience, it is fine if you have specific symptoms such as anxiety, and I feel that it works well with couples and families.  If you are looking to go deeper into your relationships with people and discover patterns that you may have not recognized in yourself before, psychodynamic group or individual therapy is to me a better choice.  There is a greater investment of time and money in the second case.

I did not cover the multitude of other therapies out there but there are many:  Marital therapy, Family systems therapy, Existential therapy, Gestalt therapy, just to name a few. However, when it comes to down to individual therapy, insight oriented approaches and cognitive behavioral approaches have the most widespread use at this point.

Most research says that the orientation of the therapist is less important than the  is relationship with the therapist.  I think this is probably true, but an informed client is always a better consumer.

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We have covered reasons why Black people tell me they don’t want to go to therapy in:  Top 3 Reasons Black People Do Not Go to Therapy,

And we covered the historical perspectives related to why we as a group avoid therapy in: More Reasons Black People Do Not Go to Therapy.

Now, I am going to give you an opinion based on 20 years of Clinical Experience about this avoidance:

TRAUMA AND DENIAL OF TRAUMA

We underestimate the effects trauma has had for us as a group.  I think the initial trauma of leaving behind our homes, families, names, cultures in the Middle Passage was too much.  Then you had Black families chronically separated from one another during slavery.  How could anyone cope with these losses?  It would surely have been detrimental for a person (a matter of life and death to be exact) to not get up and work as a slave because you were feeling depressed because your child was torn from you the day before.   

I believe those issues went unprocessed for generations.  This pain continues to affect people in subsequent generations if you believe in the collective unconscious (Asante, 2003).  American Indians call it historical trauma and intergenerational grief (See:  http://www.whitebison.org/magazine/2005/volume6/wellbriety!vol6no6.pdf).  I see too many cases of people emotionally detached from their children and I wonder if this is related to our history in this country. 

We have recurrent traumas.  In some of our neighborhoods there is too much violence.  And there are a host of too many other everyday pressures of work and negotiating life.

The style of coping:  “Keep it moving and deny there is a problem,” was probably passed down through the generations as well.

Sucking it up may have gotten us through some very rough times,  but we are surely not living at our best in too many cases today.  Sucking it up and ignoring the issues just means that we have to put energy into that denial.   Sometimes we find unhealthy ways to  due to what I see as unprocessed grief.  I have talked about them before: violence toward our own people (which too often looks like hopelessness and or misplaced anger), along with alcohol and substance abuse to name a few.  At lot of us seem to walk around on edge because we are not handling our stress adequately.  This can sometimes lead to physical illnesses and early death.

And the reality is we do not have to rely on sucking it up as a way of coping anymore if we do not choose to. 

What was the thing about Tyler Perry?

People, I find, love his movies because they tend to scratch at the surface of our trauma enough to produce cathartic responses.  I have witnessed grown men breaking down at some Tyler Perry movies, those movies with heftier emotional content.  The Madea character often takes the edge off some of the painful parts when she is present.  Tyler was pretty brilliant for including her most of the time because nobody just wants to cry for two hours, right?

In a way it becomes safe to cry at his movies because you know you may be laughing again in a few minutes.  Honestly, I think this is why “For Colored Girls…”  may have not been the commercial success that was anticipated, no Madea (not that she would have at all been appropriate for this film).

But the cathartic responses are not really grieving.  They provide an opportunity to let go of some tension, but there is little to no acknowledgment of what the tension is about.  Without that acknowledgement, you are not healing anything.

My point is we apparently need to grieve more.  I know that doesn’t sound like very much fun.  But not doing so may in fact be preventing you from having fun.  If you are carrying a burden, how can you possibly have fun? 

Sucking it up is not grieving and it is not moving on.  Grieving is about letting go.  Grieving for us may be on different levels.  It may be very personal as in the losses of people we know.   However,  it may also be broader, and include deeper feelings about a lack of freedom, and feeling unseen or unimportant, and inadequacies.   These deeper feelings probably come from generations of ancestors not being seen as full human beings.  That is a painful frustrating existence.  The healing comes with the greatest acceptance of oneself in all his or her fullness now.

How can we accomplish this?  Well, I think the healthier ways to do it are by trying to talk about any painful or overwhelming feelings when they come up with somebody you feel safe with, or if you do not have a person you feel safe with try to write the feelings down. I think about Celie in the Color Purple and how her letters to God were ultimately healing and strengthening, but she had to a tremendous amount of grieving. 

Your feelings deserve to have validation.  They will be less overwhelming and less likely to produce unhealthy responses if you acknowledge them.  Of course, if they are too much and you are having difficulty with day-to-day functioning, it may also be helpful to find a mental health practitioner. I think part of a good therapist’s role is to help the client grieve the past.   See: How to find a Therapist:  https://makeitplainonline.wordpress.com/2010/04/21/how-to-find-a-therapist-part-i/

Grieving provides the opportunity to transcend the trauma.

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Asante, M. K. (2003).  The Afrocentric Idea. Temple University Press.

See: “In Treatment”

July 19, 2010

I just finished watching the first season of HBO’s In Treatment, as it was all the rage with a few of my clients.  HBO will be going into its third season of the show this upcoming fall.  It was a goal for my summer to try to catch up. 

I did not anticipate being so drawn in.  I do not have HBO so I was getting the videos from a service that mails the videos to you.  I started out ordering one at time and that quickly increased to two or three depending on what time would allow.  There were 43 episodes in all, about 1/2 hour per episode.

Dr. Paul Weston, played by Gabriel Byrne, is exquisite as the psychotherapist.  We see four of his weekly sessions with four different clients.  In addition,  Paul is struggling with his own issues when we meet him.  His issues force him back into his own treatment which is an interesting element to the show, and provides the fifth session for the week.   It has been a while since I have seen complex fictional characters on television, and it may have been even longer since I have seen complex African American characters.  Blair Underwood as “Alex”  is just amazing as is Glynn Turman who plays his father. 

If you are pressed for time I would say focus on the “Alex” character.  I found the teenage girl character “Sophie” a little slow at first, but it gets better midway through the season.  Really, all the episodes relate to the others so ideally see them all.

The therapist here is using a predominately psychodynamic style of therapy which focuses on the childhood years of the client’s history as well as howthese  early relationships get played out in the client’s current life.  Information about the client is often revealed in not just what the client talks about but how they relate to the therapist.  Paul makes some decisions that would make strict analysts cringe (what some may call boundary violations), but overall he is a good therapist. 

From the standpoint of learning about this kind of therapy, this program is remarkable.  However, it just makes for interesting and thought-provoking television, and how often does that happen?

If you believe you are ready to find a mental health practioner see: https://makeitplainonline.wordpress.com/2010/04/21/how-to-find-a-therapist-part-i/

Ok, now on to Season TWO!!!!!!!!!!!!!!!!!!!!!!!!!