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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

Psychological Ignorance and Bliss in Modern Society

The number of unsophisticated beliefs about behavior in today's society is astounding due to widespread public ignorance about psychological functioning and development. But these come from the lips of clinicians too. Consider treatment acronyms like DBT, "Dialectical Behavior Therapy" which I thought to mean "Diabolical Behavior Therapy" when I first heard it. This and others are mere abbreviated corruptions of the basic long-held treatment postures of psychoanalytically oriented psychotherapy (Relationship, Replacement, Supportive, Analytic).
An enthralling Netflix documentary series about a Hollywood teenage burglary ring that robbed celebrities is "The Real Bling Ring." I usually watch only the first episode of these series before reading what happened on Wikipedia but watched this in entirety. As crazed (but clever) was their robbery planning is the celebrity culture they hungered to join.
And as far as being "traumatized" by a scene from a book or film or a comment. When one doesn't know the technical definition of "traumatized" it can mean "feeling upset" or "not liking it" or having "hurt feelings." Development requires learning to cope with such human failings as jealousy and envy and sadism, on jobs and elsewhere.
Long ago a woman told me that her therapist said, "I love you." "Wow! That's a pretty unusual thing for a therapist to say," I responded. "Well, he didn't say exactly that. He said, 'You're lovable.'" When words can mean whatever the speaker wishes them to mean and belief becomes fact, we are in a world in which everything is OK and acceptable, or perhaps a psychotic one. Nuff said.

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How To Insure That An Adult's Psychotherapy Will Fail

In addition to the therapist lacking talent and training, certain professional practices will insure that a patient's treatment fails. (1) Using a vague unintelligible diagnosis will make the patient be considered untreatable. One like "Borderline Personality Characteristics reflective of Post-Autistic Development" would be excellent. To insure confusion and professional acceptance, a biologic or genetic phrase can be added like "A possible malformation of the patient's adrenal medulla causing irregular production of the epinephrine and norepinephrine hormones may influence the patient's moods." (2) Advising that psychological deterioration is inevitable unless many years of twice-weekly individual treatment is obtained since this is rarely possible. (3) Having the most disturbed patient be treated by the clinic's least experienced worker. A beginner trainee would be a wise choice. (4) Making life decisions for the patient. This will further lower their self-esteem by indicating how inadequate their doctor believes them to be. (5) Never responding directly to a patient's question. Thus if asked why their symptom exists the doctor should reply, with an air of condescension and omniscience, "Severe problems like yours take a long time to understand." This, even if the symptom has been long understood since psychotherapy is least likely to fail when a patient receives explanation.

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Transference and Counter-transference During Psychotherapy

Healing during psychotherapy occurs through the therapist-patient interaction which, ideally, is the "good-enough" parenting that the patient lacked during their early development. While emotional expression heals during psychotherapy, unconsciously derived reactions are common: forgetting an appointment, day-dreaming during the therapy session, or boredom. These, termed "transference" on the part of the patient and "counter-transference" on the part of the therapist, are inevitable. Though sometimes reducing the effectiveness of treatment when experienced by the therapist, they are part of the human condition, occur whenever people interact, and can point the therapist toward providing better treatment.

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The Curative Factors in Psychotherapy

Several factors are now considered to comprise the healing elements of individual psychotherapy, both classic psychoanalytic treatment, which is uncommon today and suited for few, and the frequent psychodynamically oriented treatment. Gaining insight into one's behavior has far less effect than has been promulgated by movies since a patient who gains great insight may achieve little life change. A second factor is the patient's attachment to their therapist, the theapeutic relationship, within which a more benign and thoughtful orientation toward themselves is adopted. During this corrective emotional experience the patient comes to view themselves and others differently, and long-held, unconscious terrors are extinguished.

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Defining Psychotherapy and Other "Therapies"

Therapy has become a popular term with people speaking of music therapy, art therapy, horse-back-riding therapy, and even shopping therapy. Yet though relaxing, these activities are not psychotherapy as it has long been conceived. Ideally, a psychotherapist understands the nature of a person's problems and its aberration, this deriving from their training in human development and unconscious processes which these other "therapies" do not. So if seeking permanent emotional change you know which office to call.

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Four Advantages of Audio-Video Psychotherapy

Four Advantages of Audio-Video Psychotherapy:
1. Independence of Weather: Appointments need not be missed because of poor driving weather.
2. Ease of Movement: Parents need not bring their young child, one with their own activity in mind, outside their home.
3. East of Scheduling: Clinicians bunch their appointments to leave their office as early as possible. When practice is conducted via audio-video from a home office, they're freer to schedule an appointment at a time when they would be loathe to do if it required traveling to their office. A patient once phoned me as I was leaving my home. "Give me five minutes," I said.
4. Variable Treatment Venue: Sessions can be scheduled during a patient's lunch hour while they're seated in their parked car; a couple's session can be conducted while they're at different locations miles apart.

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Why Beginning Psychotherapy is Feared By Many

Beginning psychotherapy is harder than consulting a physician or dentist. With these professionals, people had a lifetime of experience, knowing the routine and what will happen from the time they enter the office. But a psychotherapy office lacks the medical gadgets and aura, it appearing more like the rooms in a home and sometimes are having household furnishings. Nor do many therapists in solo practice have the receptionist present in the usual medical office.
The procedure is also different. After being greeted, questions are personally asked with the lengthy medical office questionnaire being absent, and the treatment length is longer and consistent.
Yet despite these differences the goals of psychotherapists and medical doctors are the same: to heal their patient and make their life more enjoyable.

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Why Some Youth Can Benefit From Psychotherapy and Others Can't

Critical psychological development is gained early in life. Later, this may not happen even if the patient is provided the most talented of psychotherapist.

Change is difficult and some cannot tolerate the inherent dependency of this type of treatment. A teenager or young adult may need a firmer path in life before they can accept this childhood-like experience that they struggled to escape though there are great differences between the two. Unlike during childhood, a therapist does not make demands, even that of being liked. Their goal is merely that their patient's goals be achieved, so long as they are healthy and some  of which they may be unaware.
Yet for some youth the completion of education through college or graduate school or technical training comes first. They must try to ignore their anxiety and depression until the better day when they feel confident that they can--independently--survive financially in the adult world.

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Reducing the Terror of Psychological Symptoms and Length of Treatment

The treatment of a psychological disorder is often long. Yet to paraphrase Freud's comment of a hundred years ago, it would be nice to have a rapid cure for severe medical problems too. But the problems of living do differ. A traumatic event troubling a previously healthy person may require only one to two months of therapy but not those reflecting a lifetime of distress.


For these sufferers it is important to intermittently relate their current (adult) symptoms to the early developmental experiences which produced them, as can result when one lacked a "good enough" parenting. This enables the patient to understand their life, why they repeat their mistakes. It also reduces their fear from believing that anxiety and depression are magical and may invade their consciousness at any time. All symptoms have a logical reason for existing. Learning their unconscious cause reduces the terror they inspire and gives hope.

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The Unspoken Unavoidable Pain of Psychotherapists

A psychotherapist's work is catalytic, fostering the patient's unconscious mind in its quest for greater emotional health and improved functioning. While this cannot be guaranteed, it usually happens and patients leave therapy satisfied. Likely without achieving as great joy as they wished but that is not a reasonable goal since life gets in the way.

 

But there is also sadness for the doctor who, with rare exception, never learns how their patient's life progresses, like reading a novel with missing chapters. Unlike parents who, after surrendering their grown-up child, do learn of their offspring's continuing life.

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