Being in love with the image of your mother or father

[1001001]

Holdfast, that's a very good argument for your profession.

Still, it's all about the intent for me, is it a genuine altruistic helping hand, or is it about pay by the hour and making a career and name for yourself (I'm not talking about you personally, of course, but the practice in general). I will however concede that there may be many who enter the profession to help others, just as many are there to help themselves.

It's an awful lot of work to become a psychologist (or in Holdfast's case, a psychiatrist). I spent 10 years in school, 5 years in post-graduate internships, and a year taking exams to get licensed. People don't go through that kind of effort just for money.

Now of course people may become complacent, or cynical, after a time in this business. It's hard work and we're not greatly appreciated or respected. And there's incompetence and just general shittiness, but I don't think there's more of it in Mental Health than in any other field.

Of course we want to help people. AND we want to get paid. In the best case scenario, it's a win-win for everyone.

 

[Tora Ziyal]

...is it a genuine altruistic helping hand, or is it about pay by the hour and making a career and name for yourself (I'm not talking about you personally, of course, but the practice in general). I will however concede that there may be many who enter the profession to help others, just as many are there to help themselves.

You can say that about virtually any profession. Human nature being complicated, most people who help others also get something out of it. If not money and fame, at least feeling good about themselves.

 

[Holdfast]

Holdfast, that's a very good argument for your profession.

Still, it's all about the intent for me, is it a genuine altruistic helping hand, or is it about pay by the hour and making a career and name for yourself...

That's an interesting perspective.

I'm far from convinced that intent - beyond a general professional benevolent desire to see your clients get better - is particularly important. I get the sense that this general professional benevolence is not what you mean by altruism...

... although personally, I think it is actually significantly closer to true altruism than a friend trying to help another friend. Financial remuneration is a much simpler, more understandable and more containable confounding variable than having a direct emotional investment in the outcome of a situation. In fact, the therapy/supervision that therapists themselves have is often directed towards understanding the emotions that clients raise within the therapist, in an effort to try to understand and contain that potentially therapeutically useful, but also potentially dangerous and volatile, element in the course of therapy.

I don't think there are therapists who want to see their clients get worse; even if one is purely motivated by money, logically it would be very bad for your business/career to have clients who consistently got progressively worse. Clients would leave due to lack of improvement and you wouldn't get many new referrals, and eventually you would face disciplinary proceedings. So the idea of a malevolent shrink keeping a patient deliberately unwell to continue getting their business is implausible in practice, at least in the long-term. So if both the financially-motivated and the financially-unmotivated therapists have reasons to want clients to get better, both groups are going to adopt a similar position of general professional benevolence regardless of intent.

Incompetence and stupidity are another matter entirely, since I think we can both easily agree that these can exist irrespective the intent of the therapist! They're not really the issue we're discussing.

More generally on intent, and to really put the cat amongst the pigeons by playing Devil's Advocate, it can be argued that provided the models and interpretations are used thoughtfully (ie. general professional benevolence, allied to competence/intelligence), whether the therapist cares about the outcome is relatively unimportant.

For instance, there's RCT-level evidence indicating that computer-delivered CBT can improve outcomes in some milder types of depression. While live feedback from a practitioner improves those computerised outcomes still further, the fact that it can work to any extent at all without a human being involved indicates that therapist intent isn't the core determinant of improvement, since a computer has no intent whatsoever.

An interesting and possibly inflammatory analogy would be to consider what your response would be if you were up on a murder charge at the Old Bailey. Would you want a well-meaning dear friend with no deep understanding of the law defending you, or a experienced expert QC, even if he didn't care about the case beyond what his professional pride and reputation required?

 

[iguana_tonante]

For instance, there's RCT-level evidence indicating that computer-delivered CBT can improve outcomes in some milder types of depression. While live feedback from a practitioner improves those computerised outcomes still further, the fact that it can work to any extent at all without a human being involved indicates that therapist intent isn't the core determinant of improvement, since a computer has no intent whatsoever.

Wait, someone actually used ELIZA as a psychotherapist... and it worked?

 

[Holdfast]

For instance, there's RCT-level evidence indicating that computer-delivered CBT can improve outcomes in some milder types of depression. While live feedback from a practitioner improves those computerised outcomes still further, the fact that it can work to any extent at all without a human being involved indicates that therapist intent isn't the core determinant of improvement, since a computer has no intent whatsoever.

Wait, someone actually used ELIZA as a psychotherapist... and it worked?

ELIZA works on a different psychotherapeutic model to CBT. Mind you, I prefer ELIZA's model, so...

No, the CBT programs trialled have far more twee names; horridly patronising titles like Beating the Blues, FearFighter and The Serenity Programme (one for those depressed at Firefly's demise perhaps?)

 

[1001001]

In fact, the therapy/supervision that therapists themselves have is often directed towards understanding the emotions that clients raise within the therapist, in an effort to try to understand and contain that potentially therapeutically useful, but also potentially dangerous and volatile, element in the course of therapy.

This is a good point which bears repeating.

The emphasis in graduate school and clinical supervision on managing countertransference is formidable. One of my professors said something to me that I use with my graduate students all the time:

"The task of a great therapist is relentless self-reflection."

I love that.

To keep our own selfish motives out of the room is one of the highest goals of professionalism. And I also agree with holdfast that the clarity of the relationship with your therapist should provide comfort and safety. I don't need anything from my clients. How often do people get advice, even from well-meaning loved ones, that is at least in part based on selfish motives and hidden agendas?

 

[iguana_tonante]

Wait, someone actually used ELIZA as a psychotherapist... and it worked?

ELIZA works on a different psychotherapeutic model to CBT. Mind you, I prefer ELIZA's model, so...

Oh boy, I just can't stop laughing.

 

[Holdfast]

To keep our own selfish motives out of the room is one of the highest goals of professionalism. And I also agree with holdfast that the clarity of the relationship with your therapist should provide comfort and safety. I don't need anything from my clients. How often do people get advice, even from well-meaning loved ones, that is at least in part based on selfish motives and hidden agendas?

That's a beautifully brief way to put it.

I wish I could have put the point across so crisply instead of waffling all around the houses.

(I like the quote on self-reflection too, and will steal it. What I particularly enjoy is that it implicitly recognises the diagnostic and therapeutic benefits of counter-transference, as well as the risks, and that balanced awareness of both the light and dark side of the force - so to speak - is so very crucial.)

 

[An Officer]

You gentlemen do have some sound points there, there is definitely something to be said for clear agendas/transparency. To explain my meaning further though, the client may simply be soothed by the knowledge the person who is listening actually cares and feels some affection and attachment and will not consider ejecting them after the hour is up! There is a tremendous power in accepting help from a loved one and the special bond, cementing of a relationship, and give and take which results (opportunities which are lost when you bring in a professional). The basics of being a social, healthy member of a community really.

If the person suffers from depression, low-self esteem, and a feeling of being alone and unloved for example, I would think the set-up of having to pay someone to listen and help with problems might somewhat exacerbate and highlight their condition. A problem which would not occur if it is a dear, trusted, sensible friend offering support, and at the same time providing a very real tangible reason not to feel alone or unloved. Pills and talking about your secret love of your dad when you were a baby just can't beat a good hug and genuine sympathy sometimes.

Current society does seem to be geared towards isolating people, whereas someone may have relied on family and friends in the past, now you might hire someone to play such a role. I do think this might create more problems than it solves. If you are seeing someone for mild depression for example, I would think that time and money might be better used giving to and volunteering for a charity... helping others provides just as much of a boost as anti-depressants and the talking cure I'd wager.

I do believe there are instances when this sort of professional help is very necessary, particularly when we're talking about severe mental problems, but it really shouldn't become the universal answer like brushing your teeth, resorted to at every occasion, close-knit, caring, community oriented society.

 

[1001001]

Pills and talking about your secret love of your dad when you were a baby just can't beat a good hug and genuine sympathy sometimes.

While I might argue sematics with you (sympathy can be a very disempowering thing) your point is well taken.

We're talking about mental illness, not temporary upsets and "normal" life struggles. Although even then, there can be value in (relative) objectivity. Nevertheless, a strong support system can go a long way.

And for the record, I do not do "secret love for your Dad" stuff. As I tell my students, most of our clients (in the setting in which I work) will not benefit from an "archeological dig through their toilet training."

There is a specific subset of people who can really benefit from psychoanalytic/psychodynamic theory. Intelligent, verbal, highly motivated to explore their own inner workings....

(I like the quote on self-reflection too, and will steal it. What I particularly enjoy is that it implicitly recognises the diagnostic and therapeutic benefits of counter-transference, as well as the risks, and that balanced awareness of both the light and dark side of the force - so to speak - is so very crucial.)

Agreed. I always say "it's not that therapists don't have stuff, it's that we're aware of our stuff."