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Therapy Under Fire
120 Plays5 months ago
In this episode, Grant and Fara discuss the recent criticism that therapy has faced following the release of several publications, particularly "The Therapist Who Hated Me" by Michael Bacon. They delve into the dynamics of the therapist-patient relationship in various therapeutic approaches and the potential challenges that may arise. They emphasize that there is no universal solution for therapy and stress the importance of evaluating treatment options to find what works best for each individual.
We hope you find this discussion insightful and enjoyable.
Key Takeaways
- No treatment is perfect, it is important to evaluate what's happening in therapy. Negative therapeutic experiences are valid, but hopefully shouldn't be the only experiences
- "Therapy is first and foremost meant to help facilitate development in a good direction"
In This Episode
- [0:00] Introduction
- [01:10] Episode Overview
- [04:50] "The Therapist Who Hated Me" and Melanie Klein
- [08:05] Exploring the Therapist/Patient Relationship
- [13:30] Finding the Right Fit, the Right Treatment
- [17:30] Boom in Popularity for Therapy
- [25:00] Different Definitions of Mental Health Care
- [27:15] Countertransference of a Therapist
- [34:30] Negative Experiences in Therapy
- [37:00] Evaluating Your Treatment
Resources and Links
Doorknob Comments
Dr. Fara White
Dr. Grant Brenner
Recommended
Transcript
Introduction and Mental Health Concerns
00:00:00
Speaker
I feel like we're slyly condoning this idea or we're saying, sure, this is healthcare. This is therapy. Well, because the marketing is such, right? Because we're all mental health professionals, but we're on very different pages about what constitutes good mental health treatment.
Meet the Hosts
00:00:21
Speaker
Hello, I'm Dr. Farah White. And I'm Dr. Grant Brenner.
00:00:26
Speaker
We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment. Doorknob comments are important things we all say from time to time just as we're leaving the office, sometimes literally hand on the doorknob.
Concept of 'Doorknob Comments'
00:00:42
Speaker
Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:01:10
Speaker
Hi, thanks for tuning into this episode of
Inspiration from 'Bad Therapy'
00:01:12
Speaker
Doorknob Comments. I'm Farah White, here with my co-host, Grant Brenner. We wanted to talk today a little bit about this idea of, and Grant had the title for the episode, as
00:01:26
Speaker
therapy under fire. And it was sort of inspired by a book that came out recently called Bad Therapy, as well as an article that went around on social media.
Critique: Is Therapy Harmful?
00:01:40
Speaker
Grant, I feel like I am just particularly attuned to or sensitive about this type of content because it sort of reinforces this old fashioned idea of the therapist as
00:01:55
Speaker
someone who has a prurient, unnatural interest in having some sort of power over other people or mind control and that kind of idea.
00:02:08
Speaker
Yeah, I think it might help to step it back a little bit just to give listeners sort of a clearer sense of the landscape of what we want to try to cover. So I think the book you're referring to portrayed psychotherapy as harming people in a couple of particular ways.
00:02:27
Speaker
One of them is what you're describing, the kind of voyeuristic interest where the therapist's motivation is not on behalf of the patient or client, as people like to say nowadays, but it's really because of some need of theirs. In this case, a kind of a need for
Therapy Overuse and 'Therapy Speak'
00:02:44
Speaker
prurient interest. I think one of the other things that that book talked about was that therapy was making people quote unquote weak, basically undermining resilience and the author. Abigail Schreier. Abigail Schreier from, you know, and I didn't, I confess, I didn't read the book. I listened to a podcast of her talking about it, but I did listen to the whole podcast.
00:03:09
Speaker
was saying like sort of kids today the first thing they do is turn to therapy and parents have abdicated the role of authority. I think she told a story about her grandmother who had polio and basically kind of tufted out and went on to thrive and you know that her whole society kind of just looks to therapy as a way to replace good parenting and
00:03:32
Speaker
I think that's a fair critique if that's how therapy is being used. However, I don't believe that it is so pervasive and I don't believe the most therapists or most therapy fall into the category of being misappropriated.
Adapting Therapy Methods to Patients
00:03:48
Speaker
So that's one of the things is therapy kind of overused. I think another high level part is the way that therapy speak, which is one of our earlier podcast episodes, the way that therapy speak is kind of used outside of therapy. And I think that can also be problematic that everything is like, therapist, or that therapy can be idealized and expected to do more than therapy is meant to do, rather than being a part of a person's overall growth.
00:04:17
Speaker
that therapy kind of replaces some other things that are important and finally for me that there's lots of different kinds of therapy and sometimes therapists can be too sort of loyal to their own school of thought or way of working and I think sometimes they can lose sight of the fact that
00:04:39
Speaker
whatever the patient needs is most important, not whatever their allegiance is. Right. And that's an idea that came up a lot. I agree for me through this article that was written by a former analytic patient, someone who was in psychoanalysis as a child with someone who subscribed to this theory of
A Patient's Critical Perspective
00:05:04
Speaker
thought and analysis. And I think that it really brings up how we formulate our ideas about what's best, maybe sort of examines as, let's say, the therapist, what is your role in this person's life? How important or how unimportant are you? How much does that person want to be there? And this is, I think, was an interesting experience because the patient writes about
00:05:34
Speaker
Let me interrupt you and give people the reference in a little more specific context. And it's called The Therapist Who Hated Me.
00:05:44
Speaker
written by Michael Bacon. It's about his work with a well-known Kleinian analyst named Edna O'Shaughnessy, who once called herself, quote unquote, Melanie Klein's handmaiden. It's important for listeners to understand who Melanie Klein was. Melanie Klein was the leader of a British psychoanalytic school
00:06:05
Speaker
in a model called object relations, which was very much focused on kind of deep unconscious and early developmental stuff having to do with the child's relationship with usually the mother and it being suffused with a kind of negative paranoid quality. And so in the article, Bacon talks about reading about himself in Edna O'Shaughnessy's
Psychoanalysis: Past and Present
00:06:31
Speaker
analytic writings later on and essentially it landing for him that it was just a complete like complete miss that may have done him sort of real harm. Yeah, I think there were two parts to the harm, right? One was maybe that he was put in analysis three times a week for years as a kid or four times a week
00:06:57
Speaker
for a few years, which is really typical of an analytic treatment. It's not done so much today. And then the other part. It was the standard of care at the time. I think it's important for anyone who reads that to understand at the time, there wasn't much else going on.
00:07:14
Speaker
Right, right. People had maybe the time to burn or maybe they believed that this was really, really important to development. And I think the other piece is that he read his analyst thoughts about his treatment and about himself and that that was also sounds like pretty damaging.
00:07:38
Speaker
Yeah, and Bacon clearly is not a fan of Kleine and theory, though a lot of contemporary therapists use a lot of object relations theory. It's become part of a relational model. And I think it's important to ask kind of how much of it is the theory, how much of it is the practitioner. But the piece he wrote, it seems very clear to me that he's very angry about it and very, very critical. And I think we have to validate his perspective.
00:08:03
Speaker
Yeah, of course. And I think it brings up a few key points for me. And one is this idea that when we're working as therapists, how we feel about the patient and whether we think about or would write about someone in a disparaging way.
00:08:24
Speaker
I guess that could be kind of disturbing because what we know is that finding the likable parts and finding the parts that are connected and that allow for something called the therapeutic alliance to develop, right? That's really important to the success of the treatment.
00:08:43
Speaker
And so if we don't have that, then to say, well, this was a successful treatment is to me, maybe they didn't know it back then, or they didn't have that reason. I'm not sure. There's like a joke from surgery, which is like the operation was a success, but the patient died.
00:08:59
Speaker
We can do everything right and it doesn't always work. Or I think the sort of great physician of the old days, Ambrose Paré, I'm not sure if I'm getting that right, he would say, I dressed his wounds, God healed him. I think the critique that people have, and it's not exclusive to that particular article,
00:09:21
Speaker
is that, especially
Broad Application vs. Individual Needs
00:09:22
Speaker
at that time, there was almost like a religious faith among classical analysts. And there were certain things they just expected everyone to have to work through. And so one of those things is what is called the edible complex. And that's the idea that there's competition between a boy and his father for the mother's affection. And that's related to the feminist critique of classical analysts analysis.
00:09:46
Speaker
Which i think is a valid critique that women will have penis envy boys will have castration anxiety and so analysts of that time. Who were pioneers in a lot of ways and a lot of times pioneers have to be radicalized.
00:10:00
Speaker
would go into therapy expecting to find these things. And in some cases, clearly, you know, would, would bend the data to fit their theoretical expectations. Psychoanalysis has come a long way since then where there's much more of a highlighting of the uncertainty and the rejection of a lot of those hard truths that you must find that everyone must work through as a result of these critiques.
00:10:29
Speaker
including a much higher valuing of uncertainty, that this is actually more of a unique process for each individual, and the role of the analyst, the therapist, is to allow each person to find their own way with appropriate training, support, and guidance.
00:10:48
Speaker
Yeah, and I do think this idea where we sort of apply a certain theory or even a certain screening, so this is sort of connected to the book, Bad Therapy, right?
Is Therapy for Everyone?
00:11:01
Speaker
When we apply something really widely without any thought to each individual and what their process or development is going to look like, my opinion is that that may work. You know, screening may work for a lot of things.
00:11:18
Speaker
I don't know how well it works with mental health. I don't know how that it's a good idea to put kids or even adults who don't have a presenting problem, like something that they themselves want to work on into any type of treatment, right? Because I think it could just be confusing.
00:11:37
Speaker
Yeah, well, I guess you're talking about in the article, it wasn't clear why he was placed into therapy in the first place. He was described as being extremely depressed, and he doesn't remember being depressed at that time in his life. He remembers hating to go to therapy.
00:11:56
Speaker
You know, I can kind of relate to that. It reminds me when I was a kid, like everyone in my family went to see this psychoanalyst who was an older lady, very kind, but, you know, German accent clearly was classically trained. Dr. Bein, I remember it well.
00:12:13
Speaker
And I remember and thankfully she I think was kind hearted and I have a strong sense of that. I don't get the sense that she hated me the way Bacon describes being hated by his analyst and then having that somewhat verified by her future writings. I remember asking me some weird questions about my body as a six year old. And I remember and maybe my memory is playing tricks on me, you know, because when you look back like things look different. But for as long as I can remember,
00:12:43
Speaker
I remember feeling like those were weird things for an older lady to be asking a little kid maybe i was insightful as a little kid maybe not but i remember after that i really shut down and i can imagine that being interpreted as confirming that i had guilty feelings
Therapy Modalities and Modern Influences
00:13:02
Speaker
about my body.
00:13:03
Speaker
rather than being in medicine, what's called iatrogenic, caused by the treatment. Right. Which is, I think, a very good point in that experience. And maybe having had that experience as the patient makes you less likely to sort of inflict it on someone else.
00:13:23
Speaker
Yeah, I try to be sympathetic, but also I try to be rational. As you were saying earlier, you were, I think, alluding to that aphorism, right? If all you have is a hammer, everything looks like a nail. And we're focusing on psychoanalytic treatments, but the same kind of problem can come up in any modality. Like with CBT, if you try to use that same tool of correcting cognitions,
00:13:48
Speaker
And it's not going to work for a lot of people or dbt. I know plenty of people who say that would never work for me because the way they approach it just isn't a good fit for me. There is a way where you have to find the right fit. So there's these structured treatments that use kind of tools and manuals. And then there are these less structured treatments that are more psycho dynamic or psychoanalytic that are more open ended.
00:14:10
Speaker
which can be great if that's what someone is looking for. If they're just looking to, let's say, have a journey of self-discovery or if they're curious about the unconscious or what this type of treatment could do, I think it's fine for people to sign up for that.
00:14:28
Speaker
But i really do think it's about well when someone is seeking help and our job is to help them rather than to prescribe a type of therapy or behavioral intervention medication.
00:14:44
Speaker
It's like we have to look at that and say, well, this person is the expert on what they're feeling and our theories that maybe people spend years reading and writing and studying are our theories.
00:14:58
Speaker
Yeah, and that can become kind of like an article of faith because it depends. And I think when we were talking through kind of what to bring up here, there's an idea that I think about, which is if one's personal identity is eclipsed by one's professional identity, if their work life is more important to them or out of balance,
00:15:25
Speaker
then whatever they're doing in their professional life can become warped. And I think that's true for therapists. So like I know therapists who have very, very little going on in their personal lives and most of their human interaction is with patients. Or I know therapists who, and this is a great thing, they just love the theory of what they're doing and the research and the reading and the writing.
00:15:50
Speaker
But could that play out in ways where, because it's a little lopsided, can it play out in ways which can interfere with the clinical work? Particularly if whatever the patient needs, let's say, in some ways comes into conflict with what the therapist needs from that particular therapy. Right. And sometimes that's a hard thing to determine. I've certainly
00:16:14
Speaker
had this experience as a therapist and even as a patient, even though I have very warm feelings towards everyone that I work with personally and professionally. At this point in my life, I'm really grateful to have that, but I do often feel like, would it be better for this person to take a walk in the beautiful sunshine than be sitting in my office right now?
00:16:39
Speaker
I do feel like that always has to be a consideration. What am I taking them away from by providing the service? And what am I giving up by seeking that service out myself? Sure. What is the opportunity cost? Yeah.
Choosing the Right Therapy Approach
00:16:56
Speaker
Yeah. And sometimes I feel like the benefit completely outweighs that, but not every time, not for every session.
00:17:04
Speaker
Yeah, we talked about that in one of our podcasts about when to stop therapy. You know, unless you have clearly defined endpoints for therapy, then that becomes an open-ended question. That's more characteristic of psychodynamic, like long-term therapy, brief therapies, which can be psychodynamic or
00:17:21
Speaker
cognitive behavioral, et cetera. There's many, many, many, many forms of therapies. They call them the second wave and the third wave. I don't know if we're onto the fourth wave. The fourth wave is probably arriving. And I'm thinking about this therapy under fire idea. It's also that therapy is being reborn. I'd say AI is a big piece of that, but also the commercialization of therapy. So I'm on social media and I see these advertisements for large therapy services.
00:17:50
Speaker
And they present a certain narrative. Oh, you know, like I'm not only am I a therapist, but, you know, I've been in therapy or, you know, there's ones for psychedelic companies like, you know, I wondered whether ketamine could help me, you know, home delivery of ketamine, the marketing and the way that the perception of therapy has shifted.
00:18:11
Speaker
is, I think, rapidly evolving, including, in addition to that, the disinformation about mental health on social media platforms. There was a study of TikTok that I'm often citing in the last year or so, where they looked at how accurate is ADHD presented on TikTok, and they analyzed 100 videos about ADHD. And they found that only 21% of them were accurate.
00:18:36
Speaker
And I think people don't really know what the different kinds of therapy are. And I think it's pretty unusual for therapists to kind of run through that. I think it's still more common, like someone calls for an appointment and how often do they actually go through it in detail and set goals and plans.
00:18:55
Speaker
Well, that's why I always encourage everyone who's looking for a therapist to speak to people who work in a few different ways. And I think one of the best things that I do, or I guess one of my favorite things to do, is to really try to help someone find the right kind of care, even if it's not me, because I'm certainly not for everyone. But I do find that there's not really a definitive
00:19:23
Speaker
place where people, it's not like a menu, right? That people can say, oh, here's what I want because they need a little bit of guidance because everyone's issues are so different, right? And yeah, I mean, you can, you can probably find a resource that says what the different kinds of therapy are, but treatment outcomes aren't necessarily linked to the kind of therapy that's somewhat misleading. I'm not saying you're being misleading, but the idea of evidence-based treatment is kind of an ideal.
00:19:52
Speaker
And so we don't have a way to know which therapy is going to help which person. We don't have a way to know what medication is going to help what person. There's limited data. No, but a person should be able to say, oh, well, I think I kind of need DBT, but I'm never going to do homework.
00:20:11
Speaker
I'm never going to do these worksheets and actually I don't really want to be in a group setting. Then you have to say, well, okay, what appeals about this and is there another way to get that benefit? But people, I do think a lot of times they don't know exactly what they're signing up for.
00:20:28
Speaker
And no, we're agreeing. I'm just saying what I think what you're saying is that we don't have a good way to tell. So we kind of help people think through it. And that in and of itself is a useful thing to do. You could make a flow tree like you're saying, you could say, well, here's the different kinds of therapies, right? Like, OK, which one, you know, A, B or say, OK, B?
00:20:48
Speaker
A, B, or C. Okay, C. Okay, let's try that for three months and see if you get better. What does get better mean? Are you using rating scales or is it a subjective report? It's essentially trial and error still. And so you're saying you do the best you can do, which is great because a lot of people would be like, okay, now we're working together, I will help you. And they might, the therapist or the coach or whatever might
00:21:14
Speaker
misuse their authority. And that gets back to this therapy under fire idea. If you have an unethical therapist or any unethical business who tries to keep people coming back as paying customers, even if it's not the best thing for them, that just happens all the time in every field. That's why I think that's why I guess I am a little bit suspicious of a lot of the startups that
00:21:43
Speaker
you know, advertise certain services like, oh, and we have so many people, right? Because then I think, well, how can each person be full enough, right? So no, no therapist wants to be, let's say overly, you know, we have to protect our boundaries and protect our personal lives, right? So no one wants to be too stretched, but it doesn't take that much to saturate one person's practice.
00:22:10
Speaker
Yeah, I wasn't, I'm not sure where I went with that idea is kind of like, well, a lot of times there's therapists who are not as well trained, not as experienced, but they've done a certification.
Therapist's Balance and Effectiveness
00:22:21
Speaker
So they do this kind of therapy or that kind of therapy, and then they get advertised for that. And then people go to that practice or that large group.
00:22:31
Speaker
wanting that kind of therapy because they read an article or they saw a video and I've got trauma, I want EADR. But if you have a lot of therapists in the same group and there's a problem with one, you can also try another one, try another one, try another one. And I've seen some of the larger groups say that, like, well, sometimes I just want to talk to someone different.
00:22:52
Speaker
And we as psychodynamic therapists probably have an idea that it's important to establish a relationship with one therapist for certain types of problems that take longer, especially where you form a therapeutic alliance. And the data shows that a therapeutic alliance
00:23:07
Speaker
is one of the variables associated with a good outcome in therapy. There's also data that shows that having one primary care doctor, and I don't know why anyone needs to do this study, but we need to nowadays, it's a sign of the times, that having one doctor you go to who knows what your medical issues are that you can see for years,
00:23:27
Speaker
What I consider to be just a good doctor like your primary care doctor, they did a study in the United Kingdom showing that it's important to have like one doctor instead of just seeing whoever is working that day who tries to look at your chart and kind of right, you know, figure out what happened. There's no continuity. But then what bothers me about all this right is saying,
00:23:48
Speaker
Oh, well, this is so great. You can just drop in any time to this urgent clinic, this urgent care or go there. And then we're saying, well, this is equivalent or even better because look, it's more convenient. Because if you don't like your therapist or your doctor or whatever, you never have to work. Just change. And then I think people are missing an opportunity. So what they're getting
00:24:14
Speaker
missing what opportunities because it's like dating too it's like oh this isn't working i'll just find someone else and then lo and behold no one can find anyone on a dating app and everyone not everyone but people can be miserable right i do think relationships take work relationships take work therapy takes sometimes it's hard
00:24:32
Speaker
And avoidance is a huge symptom. Exactly. People can be doctor shopping because of avoidance, not because it's not going to help. Right.
Countertransference and Client Status
00:24:40
Speaker
And when we avoid, let's say, a certain conversation, maybe we don't want to see the same primary care doctor because we want to keep drinking or smoking or doing whatever else it is. And then I feel like we're slyly condoning this idea or we're saying, sure, this is health care. This is therapy.
00:24:59
Speaker
You know, or well, because the marketing is such right, because we're all mental health professionals, but we're on very different pages about what constitutes good mental health treatment.
00:25:13
Speaker
And there's not really an objective definition of it. Correct. There are people. There could be, but a lot of therapists also really strongly reject any kind of quantification of whether it is working. Which is something that's a bit concerning, right? Because we're taking people's time and money and trust
00:25:36
Speaker
And we should have, I guess, as much information as we can about whether it's effective. Well, it's like you can use a rating scale for depression, which I will often use, and some people won't want to use them. But it's not the same as getting like a lab test. It's not truly an objective value. It's generally subjective, self-reported rating scales or clinician rating scales. Yeah. But I guess
00:26:05
Speaker
You know, the reason that I sort of felt really compelled to respond to some of this is because it makes mental health, like the institution and the clinicians seem like one solid force when it's really not. And that's not what, that's not the theory that I was brought up in. There's as much differing thought within therapists as there is within the population in general.
00:26:35
Speaker
Well, there's a whole debate. Is it a science? Is it an art? Definitely therapy is a craft, in my view. It's something you get better at over time, but there are trainable skills.
00:26:48
Speaker
You know, for example, there's deliberate practice, which is a model say that athletes use, right? You look at a video of yourself, you change your behavior so that you're better the next time. And then you practice it. There's a therapy model for deliberate practice where people watch their own supervision and they get, well, what could I have done differently? How did that work or not work, right? But most people don't do that kind of practice. And some people just reject it as being essentially not therapy, which is an interesting position.
00:27:15
Speaker
Now you're you're kind of leading. There are two things I want to make sure we talk to in the next 10 or 15 minutes or so because you're leading with the prurian interest, like an idea that therapists have a kind of a creepy interest.
00:27:29
Speaker
or like a living vicariously, you know. Living vicariously like. Right, anything that's sort of self-serving. What would be an example of living vicariously? Let's say patients who are higher profile or have really big splashy lifestyles, right? Our lifestyle is one where we kind of like sit in a chair and hear about what, and we, you know,
00:27:55
Speaker
I think you and I have actually very normal personal lives that we don't really talk about. It depends though. There's some therapists who have very famous or very rich clients that can produce in psychoanalysis that can create a lot of what we call counter transference that bring up our own issues. So let's take a hypothetical where you have a therapist who works with a very posh
00:28:23
Speaker
famous, you know, maybe on television, maybe, you know, pulling the strings in the financial markets or powerful or rich and famous people. And that therapist is having a countertransference reaction. The reaction is that they are sort of too enamored and get too much pleasure from their affiliation with someone who's rich and famous.
00:28:48
Speaker
Right. How is that problematic?
Social Media's Impact on Therapy
00:28:50
Speaker
Yeah, because I think it can one lead to some sort of preferential treatment. Oh, this person's so important. So let me give them the desired time, right, rather than someone who may need it more because they're in crisis, right. So I think
00:29:08
Speaker
might it be hard sometimes to do things that more generally displease that person? I'd say, you know, we should prescribe that medication. Right. And with the knowledge that this person can really go anywhere and probably get whatever they want. So if there's a fear of abandonment, that therapist might make greater efforts to retain that patient than they should or would for someone else. Yeah.
00:29:32
Speaker
Yeah, and I think it's pretty well known that the sort of rich and famous don't always get the best healthcare, right? Because sometimes they are capable of shopping around for the doctors who will do what they
00:29:49
Speaker
They find someone who they can dictate their healthcare to. And that's becoming more common in general because people look things up. And I teach a therapy class. We were talking about this the other day. We were talking about the role of branding. And used to be patients, right? Patients wouldn't come in. And we're talking about medication management now. That can happen with different types of therapy. Patients wouldn't usually come in and say, hey, I saw an ad about this medication. Do you think it would be good for me?
00:30:17
Speaker
Right. So these are all things that like we have to contend with. But I think what you're talking about is the sort of counter transference. A lot of that can't be changed, right? But the more we understand it, the more we deal with it, and the more we sort of
00:30:35
Speaker
manage those feelings in our own lives as therapists, right? So just take it as information, right? What are the things that when we hear we get a little wistful for, right? If I have a patient who has a new baby, you know, that was, that's such a wonderful thing in my mind versus old babies. But, um, babies got a few miles on it.
00:30:58
Speaker
I have to be okay. It's still cute, but you know. Yeah, but I have to be. It doesn't smell the same. It doesn't have that new baby smell. So you know what I'm talking about. And so in a way it's lovely to relive that or.
00:31:14
Speaker
Yeah, but I also envy is a big piece of it, right, envying someone with a new baby or envying someone who's more successful in some ways. But the envy is less powerful if we're OK with where we are in life and what we have. Right. And that is why I think we have to attend to not having personal lives that are necessarily huge or involve, you know, some sort of like noteworthy thing, but just that we have
00:31:44
Speaker
the things we need and most of what we want and that we want the same for our patients. I think that's important and I do think it helps to have your own life that's reasonably fulfilling so that you're not too dependent on your professional identity for satisfaction.
00:32:02
Speaker
At the same time, that can also serve defensive purposes where people can say, hey, no, I do have life, I'm reasonably happy, not everything's perfect, etc. I think the most important thing with dealing with that is actually just being candid with oneself that it's there to start and dealing with the feelings.
00:32:21
Speaker
But how do you think that it comes up, let's say, with a therapist who is not as psychoanalytic as you and I might be, like for a cognitive behavioral therapist who works with very kind of fancy patients? Well, I think that they have to be... Fancy.
00:32:36
Speaker
I think that they have to be aware of what's going on with them, but also CBT is something that is more circumscribed, so there's less of a relational, dynamic interaction, and that, I think, is why it's a good treatment and can be widely applied.
00:32:59
Speaker
But is that like a fix? Because a cognitive behavioral therapist who's following kind of a more structured treatment approach just isn't going to have those issues come up.
00:33:12
Speaker
Yeah, and isn't going to have to deal with them. But I do think that there's something really isolating about, let's say, extreme wealth, or extreme success, or celebrity, or even a degree of chaos in life, like a rock and roll, like having that sort of drama.
00:33:34
Speaker
that those people may need therapy more than the average person because they're not going to be able to turn to their coworker and say, oh, yeah, traffic was bad this morning. How about the rain? If they can form that sort of confidant relationship with a therapist and still have it within a treatment frame. Yeah.
00:33:55
Speaker
I think one of the things may be that people who become very successful, and I'm curious if there's sort of research on this, may have a proclivity to be isolated in some ways. Maybe. And may have had certain forms of developmental experiences that lead them to be more self-sufficient or more driven and have difficulty in relationships.
00:34:18
Speaker
I feel like that's a good question and something that we could explore on another episode. But I think for today, I guess what I wanted to say is that we're aware that there are a lot of problems and issues and things that come up and that this treatment
00:34:37
Speaker
any treatment, right, is not going to be perfect. What I hope is that experiences like the one that Michael Bacon had or even the ones that are written about in the book, Bad Therapy, are not people's only experience and that it doesn't put them off from seeking out whatever they believe they need.
00:35:00
Speaker
Well, my sense, my sense is that it's, it's the exception that people have really strongly negative experiences in therapy. And of course I understand people, you know, they sell books because they are controversial and polarizing books that take like an even killed measured approach and look at the pros and cons and see it from multiple points of
Public Perception of Mental Health Care
00:35:20
Speaker
view. It's not as exciting. And you know, you're not going to click on that podcast.
00:35:23
Speaker
bad therapies, you know, like, oh my gosh. But what do you think? Do you think psychotherapy has made a generation of American kids weak? Is it the cause of Gen Z's problems that they're all like, look, watching videos on therapy. And I can tell you in my own family, there's a lot more awareness. Teenagers like are very therapist and the TV shows, right? Like look at, like a lot of the TV shows have therapists in them.
00:35:52
Speaker
Or nowadays, they don't even have a therapist necessarily as a character. But the interactions in the peers, they talk about their therapy or they use therapy concepts. Right. And I think all of that, anything that serves to destigmatize, it's great, fine. But where kids are really influenced and where they get
00:36:13
Speaker
their information and where they can be vulnerable or exploited, I think, is what we've known for generations that kids are susceptible to what's going on with their peers, what they see on social media, and that any programs or screenings or institutions are going to be just a lot less powerful than we imagined.
00:36:42
Speaker
So do you think therapy has ruined a generation of kids? No, I think, I think that, that saying, Oh, it's related to one thing or another is probably a mistake. And instead it's multifactorial. And instead we should be really looking at what we can do holistically to help them.
00:37:03
Speaker
So therapy generally will help people, but it's important to evaluate what's happening in therapy. And I do think that therapists should be quite open to having conversations about how the therapy is going and ought to bring it up from time to time themselves. Right. And I think as parents and as citizens, we have to look at
00:37:27
Speaker
okay, what do our kids need? When and why? And that that has to be looked at as the overall package of what is a well-balanced life, not necessarily like, oh, I'm going to put my kid in therapy. So they get these skills because those skills are going to come from developing and living. The best we can do is hope to, let's say, guide someone a little bit along the way.
00:37:53
Speaker
Yeah, I think that comes back to sort of my closing thought for this one is that therapy is therapy. It's not meant to fix everything. It's not meant to teach everyone about everything about how to live, but that therapy is first and foremost meant to help facilitate development in a good direction. Yeah, just one more thing that I did want to mention that hasn't come up.
00:38:19
Speaker
is that these days we don't have the same type of close family. Oh, it takes a village. Yes. You know, dynamic and these informal relationships. Community is gone. Right. So therefore, whereas, you know, a generation ago, it might have been like, oh, the Little League coach will like, let's say, take one of the kids out for pizza and talk to them and make sure they're on the right path. Like we don't have that these days.
00:38:49
Speaker
to a significant extent. There are relationships like that, but particularly in urban communities, there isn't that kind of baked in community. And then people turn to their online communities.
00:39:02
Speaker
I feel comfortable saying that that's probably less safe than hiring a normal person therapist just so that your kid has someone to talk to here and there, another safe adult. If that's all that it is, a safe adult and someone where people can get a little bit of support during the hard times.
00:39:26
Speaker
I recognize that it's not a lot, but there is a value to it, right? And sometimes I feel like I'm almost serving that same purpose for some of my younger patients and I really appreciate that role and I take it seriously.
00:39:42
Speaker
You know, I think that's very important. And there's data on that in the resilience literature that resilient kids will find mentors. I think the key word there is safe. There is a concern about the risk of predation. When you talked about the Little League coach, I thought of a coach in our hometown who turned out to be running a child abuse ring.
00:40:02
Speaker
Right. That's really. So there's a level of protectiveness that parents have.
Conclusion and Listener Engagement
00:40:07
Speaker
And I can relate to the author of bad therapy, which is like, you know, don't just put your kids into someone else's hands without being aware of what's happening. Correct. Correct. Okay, well, thanks. This is I think we touched on everything I
00:40:22
Speaker
I wanted to say today, I hope it was helpful for listeners. Let us know. We'd love to hear some feedback. If you like our podcast, please rate and review it. Anything else? Yeah, no, that's great. Find us online and let us know if there's anything you'd like to hear from us about. Thanks a lot for listening. Remember, the Doorknob Comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.