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Episode 8: Finding your Therapist: What Nobody Tells You
91 Plays4 years ago
Fara and Grant discuss key elements of traditional insight-oriented talk therapy, focusing on what to consider when searching for a well-suited therapist.
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Transcript
Introduction to Mental Health and Therapy
00:00:05
Speaker
therapy is not for illness, but it's for wellness. Thank you for joining us on doorknob comments a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities presence of health and strong relationships and all the wonderful things that make life worth living.
00:00:24
Speaker
I'm Dr. Farah White. And I'm Dr. Grant
Evaluating Therapist Compatibility
00:00:27
Speaker
Brenner. Today we're going to talk about one of the most important relationships in your life and a relationship that can impact your health and well-being. What relationship is that? The relationship with your therapist. Oh, wow.
00:00:39
Speaker
Yeah, so whether you are actively in therapy or not, I think that there are some important points we want to make about how to know whether or not this therapist is right for you. So one of the most important things is just a very basic general logistical one where the therapist's office is, what kind of hours they keep, and whether or not you can reliably make it there on a weekly basis.
00:01:05
Speaker
Those are important considerations because a lot of people don't think about those things. As in other relationships, something seems really good or people are eager, they're not thinking clearly, but slow down a little bit. Think about, will this really work? Can I get there every day before I get invested too much? Let me find out about some of the logistical issues. What are the fees? Is insurance involved? What scheduling is available?
00:01:30
Speaker
And I think that's something that a lot of people are afraid to ask when they first connect with a therapist, but it's pretty routine and I think it should be discussed in the initial consultation.
00:01:41
Speaker
I think it's also a way to find out how the therapist responds to you because as with any other relationship, both people are watching one another, appraising one another, assessing one another, sizing one another up. If you're not too shy about asking the therapist the most important questions, you can see whether or not they handle them securely and find out whether their answers fit what you need. I like that. If a therapist has a problem with it and they seem really uncomfortable, then you're going to think about that.
00:02:08
Speaker
The other things that I think people want to consider are general policies in terms of everything from cancellation to whether you can bring your emotional support animal to whether you can drink an iced coffee in the office.
Handling Therapy Challenges and Ruptures
00:02:23
Speaker
You can anticipate everything, but if there's any big things like that, you might want to check. A lot of therapists, for example, you can't really bring your child to therapy.
00:02:31
Speaker
but some therapists will be okay with that. And sometimes you wait until something comes up and you navigate it together. And one of the upsides of that is that you can learn and grow together in a sense that that's a therapeutic opportunity. One of the downsides, if there's a negative surprise, it can lead to a rupture. And again, you can make use of ruptures in therapy as developmental experiences, as growth experiences, but it can also derail the therapy.
00:02:57
Speaker
So if you can identify things up front that may derail the therapy and discuss them before you get too invested, that is a good idea. Yeah. And I just want to back up for a second because when you talk about a rupture, can you describe what you mean? Oh, sorry. It was like therapeutic jargon. The term is like rupture and repair, but basically it's like a disagreement. And so you have relatively safe relationship with anyone and something comes up that leads to conflict.
00:03:22
Speaker
Confrontation, a lot of people are, quote unquote, confrontation avoidant. And how you work through that with your therapist is particularly important because it's not just how things look on the surface in therapy. There is the pragmatic aspect, but it's also like, what are you learning from that process of navigating it?
Importance of Boundaries in Therapy
00:03:39
Speaker
And going through something together with your therapist means that the experience is getting a bit deeper and closer in a professional way.
00:03:46
Speaker
Yeah, and I think that sometimes that's one of the trickiest things, right? Like conflict and confrontation, that's why a lot of people are in therapy to begin with. So I do feel like the therapist has to model a healthy way to discuss uncomfortable things.
00:04:02
Speaker
I think that's the ideal and it depends on how you're trained. We're both trained in a psychiatric model with some psychoanalytic background which emphasizes that kind of quote unquote holding environment or containment. Therapists are expected to model mature behavior. We're expected to keep our needs appropriately contextualized in the therapy. We're not supposed to abuse our power or be manipulative. We're supposed to behave in an ethical
00:04:31
Speaker
and relatively controlled manner most of the time. But within that, there's room for spontaneity and creativity. That's the title of a pretty well-known book in psychoanalysis in what's called the relational model because it's much more about the relationship rather than a blank slate classical analytic model called ritual and spontaneity. So there's an idea that there's a frame and the frame is the safety and the pragmatic things as well as the psychological context and the boundaries of the therapy.
00:05:01
Speaker
And then, you know, like a painting within the frame, the creative process takes place. I like that. It doesn't usually spill over the edge of the frame. Sometimes it does, and you can work with that unless it's too much.
00:05:15
Speaker
And I think that one of the most important things to note about boundaries, because this is something that has come up a lot in my own work, the boundaries and the frame are in place really to protect the patient and to give a feeling of security and that it is the therapist's job to make the boundaries clear and be direct about things in a way that allows the patient to feel secure.
00:05:39
Speaker
Yeah, absolutely. That's the therapist's responsibility. Patients have responsibility as well, and that's something that can be discussed and ought to be discussed because it is a process that's collaborative. In some sense, the ultimate responsibility lies with the therapist. Yeah. What would you say are the patient's responsibilities just showing up on time? Is that a pet peeve of yours?
00:06:04
Speaker
You don't mind lateness, you prefer it. As long as they're later than I am. Well, I think whatever they've agreed upon as the way of working, so it's to uphold that and it's to say something if there's a change in the traditional analytic model, which I think is very powerful in certain ways. The therapist's responsibility is to keep the frame and to listen without
00:06:28
Speaker
bias, but the patient's responsibility is to say whatever comes to mind. Don't edit yourself. That's called free association. And so the patient's ultimate responsibility is to be as open as you can be. Yeah, but that's sometimes very difficult to do. Right. That's considered like an achievement to be able to say whatever comes to mind, right? You don't expect anyone to do that right off the bat. And if they can, sometimes you wonder if they're too kind of unbounded in some way.
00:06:55
Speaker
Yeah. Be clear about finances. That's an area that's tough for a lot of people, therapists and patient alike. And if you don't make it clear what the policies are upfront and you run into a surprise that you don't like, sometimes it can be helpful to talk through, but at other times it can really lead to like what we said, a rupture. Right. And sometimes can end a therapy.
00:07:17
Speaker
Right. And I think it's worth noting because I was really surprised to learn this in my training. I don't know who told me, but that the old school analysts would say that basically like you pay for your spot and you have that hour every week, a couple times a week, and that if you're going to be away, the analyst has to find someone to fill the spot or they charge you. So that's kind of like keeping someone on retainer, which is not really done that much anymore, is it?
00:07:46
Speaker
Yeah, I don't know how common that is. I think there are some analysts who still practice that way, but yeah, essentially it's like leasing the analyst's time for the whole year and there's a responsibility for that time. And I don't know the history of how it was done that way, but probably it came from a German therapist, immigrants from Europe in the 40s who practice according to that model.
00:08:10
Speaker
But nowadays, of course, people are much more flexible and there's more of a sense of egalitarianism, like keeping things fair. I think the other part is knowing how far in advance you have to cancel if it's like a regular doctor's office type setup and knowing whether or not you have the option of a phone call if you're sick.
00:08:34
Speaker
Yeah, and there's sort of regulations and legalities around that, and different therapists are more or less adherent to those regulations and guidelines. One of the important things is to spell it out ahead of time and make sure you're on the same page. Officially, therapists, certainly medical doctors,
00:08:52
Speaker
are recommended to have a treatment agreement, which the patient can read all the terms ahead of time and sign it and agree or disagree, and then they consent to the treatment. In practice, a lot of people don't use treatment agreements, which on one hand feels less formal and so it can feel more comfortable.
00:09:09
Speaker
But on the other hand, it does contribute a lot to that frame. It's very clear if you have a treatment agreement. There's no surprises and there's no room for needing to litigate it within the session. There's no chance of bickering over it if it's pretty clear, or at least the person has had a reasonable chance to say, I don't like your policy there. You can always bicker later.
00:09:30
Speaker
about something else. Well, that joke was telling because the point of
Exploring Therapy Approaches
00:09:33
Speaker
the frame is so that the relevant issues don't get played out around the frame. Like the podcast is called Doorknob Comments, which is a boundary comment. But the point of a clear frame is so that the right stuff gets discussed where it belongs.
00:09:47
Speaker
the meaning isn't displaced into other things. So if someone's late and they're late every time, because the train is always late, you start to wonder what's really happening. Is it something about how they feel about coming to therapy? Because the train can't always be late. There are many different ways to arrive at desired therapeutic outcomes. A more secure, confident sense of self, better relationship and professional function.
00:10:09
Speaker
treatment of depression, anxiety, and other conditions, reduced negative thinking, better self-understanding, and so on. Goals also evolve over the course of therapy, making defining goals itself one of the meta goals of therapy. Therapies share common factors, the extent to which the therapist is supportive, empathetic, and validating. Some approaches are more directive, appearing to follow a recipe while still being very much about the therapeutic interaction.
00:10:33
Speaker
Others are more exploratory like psychoanalytic or psychodynamic therapies, focusing on developing insight, seeing how developmental patterns repeat, and using that awareness to change current behavioral patterns. Regardless of therapy type, therapeutic effectiveness is tied to the quality of the relationship between patient and therapist, what's called the therapeutic alliance, sometimes the therapeutic relationship. Therapy is very intimate in a way.
00:10:58
Speaker
But even for computer-based therapies, the way the interface is designed is a key aspect of whether people use it and how much they benefit up to and including designing empathetic AI avatars to deliver doses of therapy. This is a controversial topic as to whether in-person therapy with a human versus computer-guided therapies is the same.
00:11:21
Speaker
But those are the different kinds of therapy. So a psychiatrist is someone who's gone to med school, who then did training in a residency to become a psychiatrist where they learned about the different types of medicines available to treat depression, anxiety, schizophrenia, pretty
00:11:38
Speaker
Serious stuff psychiatry starts out with med school And so like the first thing you do is general, you know gross anatomy general medicine And so it's a very different experience because I mean not not to get morbid But the first thing you do is dissect a you learn anatomy on on on a cadaver, right? Which is in a strong emotional experience as part of training that is often not discussed. That's true So that's a big difference and then you start in psychiatry on the units and you work with the quote-unquote sickest patients first
00:12:08
Speaker
Exactly. Before you learn therapy. Right, which I think is an important distinction to make. Then there are also psychiatric nurse practitioners. You could probably speak to that a little bit better, but they also prescribe psychiatric medicines. Yeah, psychiatric nurse practitioners and psychiatric physician's assistants ultimately act as prescribers.
00:12:30
Speaker
But the training in general is not as extensive depending on the amount of experience the person ultimately has. But schooling is much shorter and the number of clinical hours is a lot less. There's a really big unmet need. And so I think the best approach in some ways is having a team where people with different levels of expertise can work collaboratively. But those groups are all prescribing medications as well as potentially doing therapy.
00:12:56
Speaker
Let's talk about psychologists. They, or inside these, I guess, have a very different course of study where they basically learn about development. Right. That's a doctor of philosophy or a doctor of psychology. It's an academic training. They're much, on average, better trained than psychiatrists off the bat with academic psychology. They may learn a lot more about human behavior. They're going to learn more about psychological testing.
00:13:20
Speaker
Like how the brain functions and how that can be measured. Psychiatrists and other medical people don't do that testing. Psychologists do. And their clinical experience comes later on in training typically and can be pretty diverse. But the intention is usually they're going to go into therapy or they're going to work in an industrial organizational setting or they could do sports performance based work. Psychologists have a different career track. It doesn't necessarily have to be kind of hardcore medical.
00:13:49
Speaker
Then social workers and licensed mental health counselors can also... Social work school is established longer than some of the other master's degrees. Social workers come out of a healing service type of profession, which is another story about the origin of the professions. There's some work there. Social work school has typically been focused on service and a
00:14:14
Speaker
A lot of social workers don't become therapists. They work as case managers. They work in hospital settings. A lot of times they work in the community. They tend to be more pragmatic and sort of connected with the people. And then you're mentioning there's other degrees, and that varies from state to state as to who can be licensed for what. So in New York, there's mental health counselors, there's licensed psychoanalysts, there's creative arts therapists, there's family therapists, and they can get a master's level training. And again, there's a lot of variability in the clinical training. And a lot of it really just depends on the
Deep Dive into Psychoanalysis and Psychodynamic Therapy
00:14:44
Speaker
personality.
00:14:44
Speaker
Yeah, yeah, but I think it was a good point about the degree background because it is something that people just don't know. And ask. Ask your therapist where they went to school, what their training is, what is the difference, do you prescribe, etc. How do you work? Yeah, there's different kinds of therapies, right? Psychoanalysis is like the original kind of general purpose therapy.
00:15:06
Speaker
say everything that comes to mind, don't edit yourself. I will listen non-judgmentally and periodically help you make sense of it. But I think that one of the reasons that psychoanalysis has fallen out of favor just in the general population, even though it still does have a big following, is because it might not be that feasible. It's a huge expense financially and also time-wise and a really big commitment.
00:15:32
Speaker
And it's long-lasting. It's not meant to necessarily address just one symptom or the other. It's really taking a whole look at the intrapsychic structure.
00:15:42
Speaker
Yeah, psychoanalysis is open-ended. Some people are in analysis for many, many, many years. It can be three to five times a week, depending on your formal definition. There's something like people sometimes call an elitist quality because not many people can go to therapy that much, both in terms of time and affordability. And it's not generally accessible to people without resources. Though there's some interesting work in the analytic field about how to make it more egalitarian and accessible.
00:16:11
Speaker
Then you can have one time a week therapy, which is referred to usually as psychodynamic therapy or psychoanalytically informed therapy, which is similar but could be more focused on a particular problem. But a lot of times what brings you in for treatment, you kind of work through that and then you have a choice as to whether you want to work on deeper issues or not. I sometimes think of it like a kitchen renovation.
00:16:33
Speaker
Like, do you want to get new cabinet faces or get them repainted or do you want to kind of rip everything out? And people have a lot of hopes and dreams and fears coming into this open-ended kind of therapy because it's not so, here's the goals, here's the timeframe, here's how I work. Yeah. And I think that sometimes, well, at least what I've seen is there can be a frustration. Like, I came in here because I'm so anxious that I can barely function. Why are you asking me about my childhood?
00:17:00
Speaker
Yeah, a lot of that depends on the therapist too and how they work, but that can come up for sure. Yeah, but I think that it's probably safe to say that psychodynamic therapy is going to look at early childhood experiences, traumas, behavioral patterns and sort of use that to shed light on how you function in the world.
00:17:22
Speaker
Yeah, psychodynamic therapy has some structure to it, though. Yeah, for sure. And we can get a little more particular about that real quick. There's really a paper that made a big hit among psychodynamic therapists by Jonathan Shedler called the efficacy of psychodynamic therapy. And he basically spelled out the
00:17:38
Speaker
the different elements that make a therapy psychodynamic. One is focus on emotion and expression of emotion, and definitely learning the ropes of your own emotions is very helpful for people. The second is exploration of attempts to avoid distressing thoughts and feelings. So avoidance is a coping style, which isn't very helpful, though short-term, you know, it's helpful to be able to suppress or avoid difficult things until you're ready to or you're able to.
00:18:02
Speaker
identification of recurring themes and patterns. That's a good way to learn who you are, to know yourself, because a lot of times these patterns, they're similar in romantic relationships, childhood relationships, work relationships, relationship with yourself, but you also don't want to overdo it, right? That's not everything means something. Discussion of past experiences, which is a focus on developmental factors, like what did happen early on in life is important in a lot of ways, though it's not the only thing. Focus on interpersonal relationships, focus on the therapy relationship,
00:18:31
Speaker
what's happening in the room. Of course, that's very intimate because you're opening up with someone about what's happening right there with the two of you. At the same time, it's very professional because they're your therapist and the relationship is circumscribed as limited. Exploration of fantasy life, that's something a lot of people aren't as used to nowadays, but what is your fantasy about that? What are your wishes about that?
00:18:53
Speaker
And that taps into desire, and it's not just for Netflix, fantasies. You have fantasies of your own. What about structured therapies? Okay, so, well, CBT, we- Cognitive behavioral therapy.
Understanding CBT and DBT
00:19:09
Speaker
Started by someone who decided he didn't like his analysis, right? But he invented a therapy that has a lot of effectiveness, but it's debated.
00:19:18
Speaker
Yeah, but I have seen amazing results. We had a really great talk with Vicky and one of the things... Dr. Vicky Gluchowski, right? Yes, yes. We have an interview with her so people can learn a little bit more about the history and function of CBT. But what I like about it is that it's just a pretty constrained type of treatment that takes place over the course of six or eight or 12 sessions.
00:19:44
Speaker
I've seen it open-ended, but there's an idea that you can have a dose of CBT and you can kind of compare it with taking a medication, sort of a head-to-head comparison. And there's some research on kind of different types of brain activity, predict whether someone will respond to meds versus cognitive behavioral therapy. And usually with CBT, you identify distorted ways of perceiving things. For example, I see myself as bad. And then you identify the specific patterns of thought you have.
00:20:10
Speaker
Then you evaluate them in between therapy, you do homework, and then you reassess how you feel once you've corrected those unhelpful thinking styles. And if you just keep chipping away at that, it can really be effective for a lot of people, including dealing with trauma by directly addressing the trauma and unlearning the fear response, which sometimes doesn't happen spontaneously in psychodynamic therapies.
00:20:33
Speaker
particularly if the therapist is kind of trying not to be too difficult, deal with difficult feelings. What do you think about DBT?
00:20:43
Speaker
I love DBT. And I- DBT has been very, very good to me. It is. It's really great. And I think, underutilized, I think they should teach DBT in every- What is DBT, Dr. White? Dialectical behavioral therapy. It's sort of the way that I conceptualize it, and I'm not an expert by any means. I think we should try to get an expert. What does dialectical mean? It means from one side to the other.
00:21:12
Speaker
Right, so a lot of people have either or thinking. Yeah, or a borderline personality. Right, and it works for complex trauma and eating and a lot of other things, so you split things, right? Black and white, either or, that's dualism, right? Right, and dialectic is like a continuum. Right, and I think what's really hard for people who might struggle with some of these traits and where they can benefit from DBT
00:21:38
Speaker
is to see that there is not so much all good or all bad. Like, one of the, I think, main things about these modalities is they all, starting with psychoanalysis, which says that a lot of symptoms are rooted in this sort of underlying conflict. Everything else sort of builds on that, right? Like, what's the conflict that people are trying to resolve in DBT? It's that.
00:22:02
Speaker
if someone didn't respond to your text message, you know, within 20 minutes that they're rejecting you, that they hate you. Who waits 20 minutes before getting upset? You have to have really good distress tolerance to wait 20 minutes. I mean, that's like you've had a year of DBT already if you can wait. Okay. Okay. But, you know.
00:22:20
Speaker
I mean, it's like a minute, 30 seconds. So DBT is cool, right? Aren't there kind of steps in DBT or skills training? Skills training. And one of the big ones is building distress tolerance and ways that people can do that. Right. You start with distress tolerance.
00:22:37
Speaker
and there's tools and tips. Sometimes it's really simple, like if I want to injure myself instead of really hurting myself, I can do something that doesn't cause me to hurt my body so I could hold an ice cube and maybe that'll relieve distress. Or you could snap a rubber band against your wrist.
00:22:52
Speaker
Those are common ones. And there's mental ways. And then what comes after distress tolerance? I don't know. Well, I think it's emotion, regulation, and then mindfulness. Because once you learn how to regulate your own dysregulated emotional states, then you practice mindfulness. That's a big part of DBT. And you learn to sit with your feelings like you're saying. So you can look at a conflict and it doesn't feel like the end of the world. And the last thing that informal DBT, I think, is interpersonal skills, regulation or training. So a lot of times getting along with people is challenging. Exactly.
00:23:22
Speaker
Yeah, and I think the other thing to note about DBT is it's usually sort of administered in a group format. And maybe in a clinic, in a structured treatment setting. And a lot of times the boundaries are really addressed first because DBT particularly addresses any kind of suicidal thinking immediately because the safety is kind of the first thing you focus on. And access to the therapist is often really prescribed.
00:23:47
Speaker
So you can call twice a week in crisis, but no more than twice a week. You have to learn to wait. And so a lot of DBT programs have sort of strict criteria for who can do them, but some people do DBT kind of in groups or individually as well. So the frame is very well-boundaried in DBT.
Choosing the Right Therapy and Therapist
00:24:04
Speaker
That's one of the characteristic features usually.
00:24:07
Speaker
Yeah, there's a lot of other modalities, acceptance, commitment therapy, compassion-based therapy, motivational interviewing, and there's hoards and EMDRs, and we have an episode on that with Johanna Dobrich, which is interesting. It's a great treatment for trauma. Yeah, we could go on and on about different... That's one of the confusing things is which therapy do I pick and which therapists.
00:24:32
Speaker
But most therapies have certain centers or have an association, and that is an easy way to find a therapist that might specialize in the type of therapy. Yeah. Yeah. Finding a therapist in a type of treatment is often very challenging, even in a well-resourced city.
00:24:48
Speaker
Yeah. But then there's who is the therapist. Right. And whether or not it's someone that you could feel connected to, not too connected, I guess like just the right amount, a comfort level and a sense that this person can really understand you. Right. And that varies a bit with sort of type of therapy as well as therapist personality. In psychoanalytic therapies, the relationship is more important in some ways in some of the structured treatments. The relationship is important, but it's much more clinically detached.
00:25:17
Speaker
Yeah, but I don't know. I kind of when you were talking about the therapeutic alliance, and that's one of my favorite terms really, because I like the idea of therapy being someone who can really be on your team. Being on your team doesn't mean necessarily just a supportive therapist who agrees with everything you say, but someone who really wants the best for you and is pushing you.
00:25:39
Speaker
Right, so you think about kind of what type of personality of therapist do you want to work with? Do you want someone who's very confrontational? Do you want someone who's very soft and gentle? Do you want someone who's going to tell you what they think? Do you want someone who's going to wait for you to come up with it?
00:25:55
Speaker
And then you have to think about things like demographics, like how old are they, gender of the therapist, the vibe you get from them. Sometimes you just like someone right off the bat. You don't always know why, and sometimes you just don't like someone. I think sometimes people find a therapist they really connect with, and that's the foundation of a good therapy, especially for long-term therapies, where the relationship is really a critical part of it. If you're working with someone short-term, I think you have to get along with them well enough, but the focus is really on the structured work.
00:26:24
Speaker
and the relationship isn't as important in the same way. It should be something that people look forward to overall. There may be moments where you've had a bad week and you don't want to come face to face, or you've made an impulsive decision, and it's going to be hard to sit down with a therapist and really look at that, but I think therapy can be really fun.
00:26:44
Speaker
Well, I think a general way of putting that is that you want to feel safe, but not too safe. Some people really love therapy. Other people kind of hold their nose and go to therapy because it's good for them. That can change over time. A lot of times I ask patients who say, well, I'm here because I need to be here and I hate it, but it's good for me. I want to imagine with them what it would be like to look forward to it because it is an act of self care.
00:27:06
Speaker
But a lot of times people are in therapy because they essentially have felt pushed into it for some reason, you know, cornered by life or necessity or sometimes literally someone close to them tells them go to therapy or, you know, I'm leaving.
Therapy Dynamics and Termination
00:27:19
Speaker
You should feel comfortable talking with your therapist about your feelings about your therapist.
00:27:24
Speaker
Yeah, I think there are a lot of things and I think maybe what you're referring to is what we know is like transference and counter transference and all these other forces that are at play if the therapist reminds you of your favorite babysitter growing up. All those things do come out I think in one way, shape or form.
00:27:44
Speaker
You were someone who wasn't so nice to you, and that can change. Like you're saying, transference is kind of like the therapist can be the man or woman of a thousand faces in your mind can take on different things. And one of the weird things with especially psychoanalytic therapies is that part of it is fantasy and theater. So there's a way where what's happening isn't on the surface, right? And part of the task is to take a step back and kind of see it as something to be interpreted.
00:28:12
Speaker
Like you could read a novel in a hundred different ways. You could read a therapist therapy session in a hundred different, you could read your therapist in a hundred different ways. You could read a dream in a hundred different ways. So that's one of the most powerful things about a psychoanalytic model is that, well, the entropy of it is very high, meaning that it can be very many different things at once. But the task of making sense of it is part of the process and you need a good partner in that. People are not married to their therapist.
00:28:37
Speaker
And I think that's something that comes up a lot, how to terminate the relationship if things are uncomfortable. Or how to terminate the relationship in a therapeutic way. And that's the ideal, is to grieve with someone about the loss and kind of come to terms with the limitations of the relationship. A lot of times, termination brings up issues that you thought you had dealt with, so you don't want to rush it. And sometimes it brings up dependency.
00:29:03
Speaker
like I never want to leave. But sometimes therapy can end badly, and that's a shame when it happens. It's sad. It is. It is. And I think that really every therapeutic relationship deserves some sort of resolution. And if the patient decides to leave, and it's unfortunate, we don't always get that. But I do think that's something that a therapist should try to provide, or at least say, I know that you want to end treatment, but why don't you come in and we'll talk about it and have a wrap-up.
00:29:33
Speaker
obsession. Right, without trying to force the person. Unfortunately, sometimes there's a pattern of relationships just ending over and over again that are unresolved or sometimes it's easier for people to leave recreating some kind of rupture or hostility at the end and you still try to do your best to make it therapeutic and that's kind of the responsibility of the therapist is no matter what you're always trying to help.
Therapy for Wellness and Growth
00:29:59
Speaker
maybe sometimes trying to help causes a problem, but that's your Hippocratic oath that you've sworn to try to help. This is something that's very much worth a try for anyone, for people that are going through something. I always say that it's better to try to get into it when it's not a time of crisis. Just because things are going okay doesn't mean that there's no need to see a therapist.
00:30:24
Speaker
Yeah, I mean, I think you can make a strong case that therapy is not for illness, but it's for wellness, and you could look forward to it the way you might look forward to exercising your body. It's exercising your mind, and it can be very good for people. I think Oliver Sacks, the famed neurologist, he said he was in psychoanalysis for, I think it was 44 years, and he did it because it was good brain exercise for him.
00:30:49
Speaker
So, a lot of times people, they go from needing therapy because there's a problem to kind of developing into a deeper, richer, positive type of experience. Yeah. Okay. Cool. On that note. Yeah. Thanks very much for listening. You can find us on the web and you can find us on social media.
00:31:06
Speaker
Thank you for listening to doorknob comments. This podcast is for general informational purposes only and does not constitute the practice of psychiatry or any type of medicine. It's not a substitute for professional and individualized treatment services and no doctor patient relationship is formed. If you feel that you may be in crisis, please don't delay in securing mental health treatment. Thanks.