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Five Things Psychotherapists Shouldn't Do

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Daphne Merkin's recent essay in The New York Times Magazine about her lifelong search for the perfect psycho-therapist has generated quite a bit of buzz.

When I first read Merkin's piece, I was fairly sure that it would serve as another great example of the age-old aphorism "there are two types of people in the world...". On the one hand, I knew that some people would be turned off by this five-page, detailed meditation on Merkin's ongoing relationship to psychotherapy, using it as confirmation that psychotherapy really is just an extended exercise in (pointless) narcissism. On the other hand, I also imagined that there would be people (like me) who -- while acknowledging the self-indulgent nature of therapy -- find both the process and analysis...of analysis...endlessly fascinating. Which is another way of saying that I couldn't put the article down.

Those predictions turned out to be right, as a quick scan of the Letters To The Editor on that post in The New York Times will attest.

But while I'm generally in the supportive camp on therapy-as-life-strategy, I think it's worth looking at the critiques that are emerging from the article about psychotherapy more generally. They seem to come in three varieties.

First, there are those -- like my colleague Donna Trussell -- who feel that therapy is a luxury that most ordinary mortals can't afford. In a world of ever-diminishing insurance reimbursements (not to mention ever-diminishing incomes), the idea of lifelong therapy is, as Donna puts it, "like looking at sepia images through a stereoscope." To which I say: Too true.

Then there are those who think that it's just a waste of time. I think one of my blog readers said it best when -- in response to my post Five Ways Talk Therapy Can Help -- she noted: "I've been to the therapy and none of the five things listed happened for me there. My questions were never answered to my satisfaction and all anyone wanted to do was make me cry. Don't get me wrong, tears can be healing. But I can do that without paying someone else." To which I say: Point well taken.

Finally, there are those who feel that even if therapy is worth it, it's really hard -- if not impossible -- to find the right shrink. A colleague of mine described her own Goldilocks-like auditioning process thusly: "The first guy on my plan was a few days older than God and had no idea what online writing might be...the second one had so much cat hair from the three (!) felines in her office that I told her I couldn't see her because I was afraid I'd develop an allergy..." She did finally manage to find a suitable psychotherapist who not only shared her name (yikes!) but was so much like her that she realized, in the end, that "what we really want in therapy is to talk to a dispassionate and supportive version of ourselves." To which I say: Amen. (And achoo!)

In that spirit, I'd like to add my own critique of the therapeutic process: some psychotherapists just aren't all that good. I've written before about five things not to do in therapy. Here are five things psychotherapists shouldn't do to you:

1. Admit that they are impressed or intimidated by you. A friend's therapist once confessed that she was really impressed by my friend's Ivy League degree. According to my friend, it ruined everything. While therapy may be an inherently narcissistic undertaking, it's also a vulnerable one. After all, you're in there spilling your guts. And you're counting on the therapist's objective evaluation to help make sense of your subjective problems. So if the therapist steps out of that role -- by revealing that there's something about you that "distracts" them or keeps them from otherwise viewing you clinically -- that spells trouble. At best, you're going to question their ability to accurately read your problems. At worse, you'll feel compelled to keep impressing them.

2. Tell you about their own problems. Another therapy no-no. This violates the doctor/patient relationship. The minute your therapist tells you too much about her own life -- as one of mine did when she complained about a dinner party she had to go to later that night -- she's created another distraction. I immediately started wondering about my doctor's husband's profession, their joint income, what kind of dress she'd wear...In short, the therapy had become about her, not me. A reader's therapist (over)shared that she was anti-social and had no friends. Really? TMI! You're not supposed to be friends with your therapist. That's the whole point! I may be way off-base on this assessment. Some of the doctors who reacted to Merkin's article in the Letters to the Editor noted above opined that she had an outdated view of therapy as this detached, impersonal thing. Me? I'll take distant and analytic to "let's talk about me" any day of the week.

3. Give it less than their all. I'm sure most therapy-skeptics all have this classic image in their minds: the psychoanalyst who sits there pretending to be listening to the guy on the couch babble on about his mother while s/he is secretly doodling or fantasizing about tonight's dinner. (For the truly perverse version of that image, be sure to check out Todd Solondz' profoundly disturbing movie, Happiness.) One reader wrote in about a therapist who did yoga while she told her about her troubles. Egads! It's bad enough that you're paying an arm and a leg to see these people. The least they could do is pretend to be interested!

4. Embrace or otherwise touch you. This is tricky, as I'm sure some people are perfectly comfortable embracing their therapists. These are, after all, people who know way more about you than most of your friends. But I don't think it's a good idea. And now we're back to the boundary thing again. I think there's a lot to be said for that ancient psychoanalytic concept of transference where you project your feelings about someone else in your life onto the therapist. But we need to draw some lines. One of my therapists (a female) once tried to hug me when we said good-bye. I still haven't recovered.

5. Sleep with you. Even if you're personally comfortable with your practitioner doing everything I've just said not to, I think we all can agree on this one. Here, again, the movies say it all. Take a look at that classic Woody Allen scene in Husbands and Wives where the shrink played by Bob Balaban silently listens with great intensity to his nubile, young client (played by Juliette Lewis.) At some point during the session, he declares the therapy over because he wants to have an affair with her. Yikes!

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I'd like to add another "no-no" ....please not commit insurance fraud! It really screws witha client's psyche, as much as #5. It destroys the therapeutic alliance which is based on trust. Not sure about anyone else, but I don't exactly trust someone who stole sessions from me and $$$ from the insurance company. (BTW...the LCSW was dropped as a provider by the insurance company and had to pay the money back)

October 20 2010 at 7:18 PM Report abuse rate up rate down Reply

"4...I think there's a lot to be said for that ancient psychoanalytic concept of transference where you project your feelings about someone else in your life onto the therapist." I learned about transference way back in high school when I read Freud. I also took a college course on the founder of psychoanalysis and have read his work extensively, but I had never come across the term "countertransference." I learned its meaning in a very creepy way. I used to see a psychiatrist who not only prescribed antidepressants for me, he also did therapy with me. My pscyhologist said the psychiatrist shouldn't being doing talk therapy with a patient who already had a therapist. He called it a conflict of interest, although I don't know why. I eventually found out why the psychiatrist spent an hour each week talking to me instead of just prescribing drugs, his sole duty. During a session, I mentioned to the psychiatrist, an avuncular, mild-mannered older gentleman, that I was surprised that a guy who was much better looking than I am had flirted by groping me in a business office. Before I finished the sentence, the psychiatrist leapt out of his chair, livid, shouting, "You're always putting yourself down!" (That was not true. If anything, I'm an egomaniac :) He went on, "You're a good-looking guy and you shouldn't be surprised that another good-looking guy was interested in you!" I was shocked by the ferocity of his explosion especially since he had always been kind and helpful before that. When I told my psychologist about my psychiatrist's outburst, he asked, "Have you ever heard the term 'countertransference'?" I hadn't, but immediately deduced that it was the reverse of transference. Countertransference occurs when the therapist falls in love with the patient. Transference, where the patient falls in love with the therapist, happens much more often. My psychologist told me that my psychiatrist was in love with me. As proof, the psychologist noted that the psychiatrist spent an hour each work with me doing therapy he wasn't supposed to engage in...for free because my insurance only reimbursed the psychologist, not the psychiatrist, for talk therapy. When I didn't show up for my next appointment, the psychiatrist phoned and asked me why I wasn't at his office. I mumbled an incomprehensible excuse and never saw the psychiatrist again. Frank Sanello

August 26 2010 at 10:17 AM Report abuse rate up rate down Reply

"1. Admit that they are impressed or intimidated by you." I had the shock of recognition when I read Delia Lloyd's first caveat about therapists. I used to be a noncompetitive, amateur bodybuilder. I've also had 25 of my books published. I was shocked about 10 years ago when both my psychiatrist and my psychologist used the same word to describe me: "intimidating." I didn't like the psychiatrist, a cold fish, so I ignored his statement as one of the occasional games he liked to play with me. But I adored my therapist, was always on my best behavior when I saw him for therapy, and the last thing I wanted to do was intimidate him. So I asked in regard to my being intimidating, "Physically or intellectually?" The psychologist said, "Both." I agree with Ms. Lloyd's criticism of therapists who express admiration or their intimidation by a patient because after the conversation with my psychologist, I started wearing baggy shirts to hide my physique and, worse, resumed what I had done in high school to avoid being picked on by other students. I silently censored my speech and eliminated all "big" or obscure words. It took me years to go back to wearing tight tank tops that showed off my build, but the fear of being intellectually intimidating continues to haunt me. There's nothing more offputting than pretentious vocabulary. The fear of intimidating people, especially my readers, has migrated to my professional writing. Ten years after the session with my psychologist, I still find myself reflexively monitoring my written and spoken words, editing out obscure words that might intimidate people. Frank Sanello

August 26 2010 at 10:00 AM Report abuse rate up rate down Reply

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