This was yesterday’s paradoxical tip of the day!
Some people think that therapy consists of codependent schmoozing behind
closed doors, with the occasional bit of “advice” or “tell me more” thrown in.
Are they right?
I am trying, perhaps without complete success, to say this politely, without enraging anybody too much . . . . but
I am sad to say that I think this Tuesday comment is somewhat correct. Many therapists just talk with patients for months or years without much change, often without specific goals, and without measuring anything from session to session to document change, or the lack of change. When I was a psychiatric resident, this type of treatment actually had a name. It was called “supportive emotive therapy.” The patient talks, the therapist listens and provides support, and encourages the outpouring of emotion at times.
Some experts claim that this type of therapy provides a “corrective emotional experience.” The idea is that the relationship with the therapist will correct some shortcoming or void in the patient because of his or her childhood and lack of support and nurture while growing up.
I’m not convinced this non-directive approach corrects much, if anything. In addition, while I know I have lots of helpful techniques to offer, and some reasonably good empathy, I’m not convinced that a relationship with me will ever correct much of anything, to be honest! I’m quite surprised, actually, that so many individuals–colleagues, clients, and students–are even willing to put up with me.
I can be, to be honest, kind of annoying and difficult at times. I don’t see myself as a “corrective emotional experience” much of the time!
I favor therapy that works rapidly, with specific goals and changes that can be documented by assessments of the patient’s feelings at the start and end of every session. This includes testing feelings of depression, suicidal urges, anxiety, and anger,as well as the patient’s feelings of satisfaction with his or her spouse or partner. The assessment of the therapist’s empathy and helpfulness by the patient after every session is also invaluable and, to my way of thinking, mandatory.
While skillful listening will always be an important part of therapy, it will rarely or never be sufficient to help a patient recover from severe depression, or any anxiety disorder, or a troubled marriage, or a habit or addiction. Much more is required, including specific techniques to help the patient change his or her life, as well as resistance-melting techniques to boost the patient’s motivation and collaboration.
Patient homework between sessions will also be a must, in my opinion. You cannot, for the most part, change your life or learn new skills without practice, any more than you could learn tennis or how to play the piano without practice between lessons with your coach or teacher.
All human beings are corruptible, and we all have a kind of inherently lazy streak. So if a therapist has a full-fee private patient, and the patient just wants to schmooze and vent every week for months or years, without being accountable and without doing psychotherapy homework, the therapist will have a guaranteed income and an easy job, since there isn’t a whole lot the therapist has to learn in order to provide this type of non-specific talk therapy, or if you prefer, “non-treatment.”
I apologize deeply if my skeptical / cynical streak is showing, but I sincerely believe our field is in need of reform, and I am saddened and sometimes frustrated, even angered, by the overall poor skill level among mental health professionals.
On the positive side, last week’s intensive in Whistler, Canada was just awesome. Oops, Lisa Kelley has urged me not to go over the top with language, so let me say it was a bit above average. In fact, the ratings for all four days were the highest I’ve received–by a big margin, actually–in the last 25 years or more of doing workshops. I was thrilled and grateful to have such a warm and responsive group.
My dear colleague, Jack Hirose, who organized the conference, said the ratings were also the highest he has seen in the many hundreds of workshops he has sponsored in Canada. I was helped by my dear colleague, Mike Christensen, who attended and assisted with the teaching. Mike was also my co-therapist in the live demonstration with an audience volunteer who had experienced severe trauma and abuse.
Working with her was an inspiring and riveting experience. We were fortunate to due a high definition video of the session, and I hope it will be available for some type of teaching program for you.
If you would like to attend a similar conference, consider my upcoming San Francisco intensive in a few weeks. I will try my hardest to make it a little above average, too! See the details below.
* Copyright © 2018 by David D. Burns, MD.
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Hey, folks, my San Francisco summer intensive will start in a few weeks. it is always one of my BEST training programs of the year. The group will be quite small, giving you lots of chances for Q and A and personal connection with me, plus networking with your colleagues. In addition, many individuals from my Tuesday group at Stanford will join me to provide feedback for you during the small group exercises.
Here are the specifics:
Coming in San Francisco in August
High Speed, Drug Free Treatment of Depression and Anxiety Disorders–
A Four-Day TEAM-CBT Advanced Intensive
August 6 – 9, 2018, South San Francisco Conference Center, California
For more information, click here
or contact http://www.iahb.org/
If you can only attend one of my workshops, consider this intensive! it is simplly
Seating is limited. Register now if you want to get in on the action!
Hope to see you in San Francisco in August! David
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Also coming up soon on David’s Sunday FB Live Broadcasts
Sunday, July 15th, 2018, at 3 PM: The Disarming Technique–Taking a Deeper Dive, with special guest, Mike Christensen
Sunday, July 22nd, 2018, at 3 PM: The Shouldy Approach to Life–How to Crush Should Statements, with special guest, Jill Levitt, PhD
If you attend live, you can ask questions and be a part of the show. However, they are all recorded so you can tune in anytime on my Public FB page!