gaudior: (saiyuki)
Three notes:

1) This is what I think right now (based on a fair bit of research and experience, but still). It is neither absolute truth nor what all theorists think, nor necessarily what I will think in twenty years.
2) While I've tried to make this sufficiently non-specific that it shouldn't be too triggery, I'm putting it behind a cut-tag anyway.
3) If anyone can tell me how I'm incorrect, I'd welcome additions and revisions.

How Trauma Works, and How You Recover )
gaudior: (be the change)
Note: This entry is not meant to discourage anyone who might be thinking about getting into therapy. For there are many excellent and helpful therapists out there, and even the people complaining about them often said "while this therapist was awful, my current therapist is great!" But I am hoping to learn more about how to be better at my job, and knowing what not to do is very useful.

So, yesterday I spent some time Googling the phrase "terrible therapists" and seeing what I found. This list featured a number of the main ones that people mentioned, including the therapist:

*falling asleep during the session
*talking too much about him/herself, especially about his/her trauma
*touching the client and/or trying to make the relationship sexual
*showing up late
*taking phone calls or otherwise letting him/herself be distracted during session (worst story I found online: the therapist had locked her mother (who had Alzheimer's) in a car just outside her office, and watched her mother over the client's shoulder-- and at one point, ran out of the session to go sit in the car with her mother, who was trying to unlock the door. Dear GODS.)

Other things people mentioned in online discussion forums included the therapist:

*imposing his/her religious views on the client (whether Christians wanting the client to pray with them, or therapists who do things like "turned down the lights, lit some healing herb incense, and started to waft it around the room.")
*telling clients something along the lines of "cheer up, it's not so bad! You're young! At least you didn't get raped! You can get over these feelings if you put your mind to it!" etc. Which are sentiments which might be supportive if said with empathy-- but the way these people describe it, it sounds more like a denial of their pain or their right to their pain than an offering of hope for their eventually feeling better.
*sitting in silence, particularly at the beginning of the session (Interestingly, this is a technique which has often been recommended to me by supervisors. The idea is to let the client guide the session without the therapist's imposing his/her ideas. But I think that if you don't explain that that's what you're doing, and why, it just leads to people feeling socially awkward and uncomfortable, as many, many, many people on the forums complained about feeling).
*not giving advice/feedback to people who want it
*giving advice/feedback to people who don't want it
*giving bad advice, or overly simplistic advice ("imagine your anxiety as a piece of feces, and flush it away down your toilet! Now it's gone!") or advice that clearly won't work for this person
*seeming to not remember what the client told him/her about in previous sessions
*not recommending medication when it would be useful
*insisting on medication when it would not be useful, or to the exclusion of other treatments
*criticizing the client-- implying strongly that the client is in pain because there's something wrong with him/her, or because s/he is choosing to be
*refusing to work with a client who self-injures, or who will not sign a suicide contract (this is also something supervisors have recommended to me. It's in part a way to prevent liability, and to prevent therapist burn-out. Which are, like, worthwhile, but people on the forums seemed to find them really unempathetic.)
*not investigating possible medical causes of physical problems, but insisting that they are psychological
*insisting that s/he is right and the client is wrong
*seeming overly formal, distant, and/or anxious
*seeming to play "games" to make the client admit something, show anger, etc.


An overall theme I noticed is that a bad therapist is one who seems to not "get" you, and to not care about you-- whereas someone who honestly does care and understand can be forgiven lapses. Best example is therapists crying; some people praised their therapists for tearing up when the client talked about something really sad, as they felt that it meant the therapist was really with them, really empathized, cared and understood. Other people criticized their therapists for crying, as they felt this meant the therapist "had issues and could not listen to some one elses' in a professional manner"-- that the therapist was crying about his/her own pain, not the client's. Similarly, a therapist with good rapport can (and, I believe, often should) respectfully point out when a client's behavior is contributing to his/her situation-- but it must be done from a stance of "hey, person I care about and respect, want to hear about a way you could have more power and control and make your life better?" rather than "this is all your fault, and that's why I'm better and smarter than you." And a good therapist will usually know the client well enough to judge which way s/he will take it, and be sensitive to that.

But what else am I missing? What bad experiences have people had with therapists? What would you recommend a therapist do or never do?

--R
gaudior: (saiyuki)
So advice-giving is one of the major temptations in my profession. Because these people come to you with problems, right, and they want help, and they're really sad/scared/etc, and you really want to fix it. And sometimes it seems really obvious that if they just did x, it would be better.

And while some shrinks will go ahead and recommend x, that's not my approach. Because the thing is, if x is really obvious, they've quite often already thought of it (or someone else has already recommended it), and there's a reason you don't know about that x wouldn't work. Sometimes that reason seems stupid or irrational or embarassing, and they don't want to tell it to you. Sometimes it's unconscious. Sometimes they just haven't gotten a chance to say it yet. But in any of these cases, your recommending x either means they argue with you, or they nod and smile and don't do it, or they agree with you that they really should, and then they beat themselves up for not doing it. None of which are productive.

So my usual approach is to not give advice. To ask questions and listen and empathize and give back my understanding of the problem, and let them come up with it on their own. If one solution seems really obvious, I might ask whether they've already thought of it, or ask questions that (if I think I can be subtle enough) lead gently in that direction. But those have to be non-rhetorical questions, questions to which I'm genuinely listening for the answer, and will change my mind if I hear something other than what I expect.

Because a lot of the time, when I really want to give advice, it's because there is no easy solution, and I want there to be. Sometimes, life really sucks, and there's nothing I or the client can do about it. Those are the times when I either have to sit with the sadness and fear of the situation-- or try vainly to find a way of controlling it by saying, "Do this, and it will fix it!" And then if the client doesn't take my advice, I can blame him or her for it, or (more likely for me) blame his or her disorders and issues and past pain. So I can feel like at least it's not my fault, and I have the illusion of control over the fact that sometimes, the universe really, uncontrollably sucks.

I'm getting better, I think, at not doing that. At sitting with the fact that sometimes, it just hurts, and there's no way out but through. At believing I'm useful even if I can't fix everything.

There are, however, times when my wanting to give advice feels very different-- and when I indulge it wholeheartedly. Those are when I'm fairly sure that the advice I have will not be something the person has heard before, or thought of him/herself. Sometimes it's strictly medical (although in the days of Google, those are less frequent). More often, it's social (why, yes, young White woman from the East Coast, you do have a culture. And it's one of the major things you're dealing with right now). I still tend to be cautious about it-- there are very few new ideas under the sun. But in those times, I can tell that I'm not trying to control my clients' pain by telling them what to do. Instead, I'm giving them new ideas, things that might expand their worldview. I don't know for sure that this will help them, and it certainly won't solve all their problems. But if I can give advice that gives someone something new to think about... well, it's fun, is all.

I like my job.

--R
gaudior: (hostility)
At some point, I decided recently, I want to write a book entitled something like Psychoanalytic Concepts in Plain English. And it will explain all of these interesting ideas in human terms, words of one syllable, such that they stop being abstract and actually make sense.

One part of it, I think, will be to have lots of quoted passages-- from memoirs and fiction and such-- that demonstrate each concept.

This one will be for 'transference.' )

It is possible someone has already written such a book. In which case, I hope someone points it out to me before I do too much work on this one. Grin.

--R
gaudior: (hostility)
I totally need to write this article in a few years when I've had more experience and clients.

But who the hell will publish it? )
gaudior: (sable)
This... is a sequel to my long Yami no Matsuei fic, Mercy of the Fallen. Except that this is not actually a good story. My beta-readers gave me useful suggestions as to how it could be made a good story, and I will totally use them at some point, but I just don't have the energy right now, because it involves a great deal of plot, which this just doesn't have. But I'm posting it anyway, because I kinda like it, and I think it's kind of a fun character sketch-- what do these characters look like eight years later?

Better. )
gaudior: (saiyuki)
If you cannot describe what you think is going on with someone using primarily words of one syllable, preferably four letters, you should rethink.

Here are some useful words:
hurt
love
feel
want
pain
need
shit
stop
help
lose
heal
grow

Basic emotions are good, too, but they have more or fewer letters.

I'm not saying that technical, abstract formulations aren't useful, or that people's worldviews and psychologies aren't massively complicated and in need of more empirically validated meaning-making, because they are. But after your journey through theory, you want to be sure you come back to somewhere recognizably human.

--R
gaudior: (saiyuki)
Over the past year or so, a number of people have asked me for recommendations for psychotherapists. In helping them find one, I've realized that most people don't know much about how to choose a shrink, besides a sense of the personality with which they'd feel most comfortable. Now, it's true that personality maters, but there are also other factors to keep in mind. Namely: there are about half-a-dozen different theoretical orientations and types of degrees which therapists have, and these make them differently equipped to help you with different problems.

So, the following is a list of exactly what the different types of therapist are and what they're good for. I hope this is useful-- and please pass it on to anyone else who might need it! Thanks!

These are the shrinks in your neighborhood... )

On Safety

Dec. 6th, 2006 12:47 pm
gaudior: (Default)
I was in the T-stop yesterday when I heard shouting. Loud voices, young, and I couldn't tell whether they were shouting in play or in anger, so I decided to go investigate (there were a fair number of people on the platform, and one man was already moving that direction). I found a girl sitting on a bench, bent over in obvious exasperation, and swearing at two disembodied voices. I looked around, confused-- they weren't next to her on the bench, they weren't on the lower platform... and then with a cry of "Oh shit! Oh shit!" two kids ran out of the subway tunnel, just seconds ahead of the train. They were sixteen or seventeen years old, tall, Black, baggy-clothed and laughing their heads off. The girl glared at them, relieved. I was already right there, so, laughing friendliness, I yelled at them. "Do you know," I shouted over the roar of the train, "how much it would suck if you'd gotten hit?" One boy blinked at me. "What? Police?" I shook my head. "Don't get hit by the train!" He shrugged, smiling. "Don't worry," he reassured me. "We won't get hit by the train."

And what I find myself wondering is-- how does he know that? I mean, I'm sure part of it is bravado (can't admit you were scared, after all, not when you're seventeen...), and maybe part of it is the same sense of foreshortened future some of the kids I worked with last year had. But I imagine that a big part of it was simply the belief that no, of course they wouldn't get hit by the train. They were too lucky for that, too smart, too quick-- too, very simply, themselves.

The thing is, most people do that. I don't have to be a stupid teenager to believe, when I get up in the morning, that I'll get through the day just fine. I won't be hit by a car, I won't be knifed by a crazy person in the subway, I won't have a heart attack or a seizure, no meteorite will fall on my head. I wake up in the morning with a sense of safety.

This is, according to some psych theories, because we all carry the illusions of our specialness and our invulnerability, all the time. Even though these illusions go against all rational sense. We know, intellectually, that we'll all die. We know we're vulnerable to illness and accident and other people and plain bad luck. But somehow, we're able to put it out of our heads. We're able to trust that we can walk out the door and face the world, and be fine.

So my question is, how? How do we do that? What gives us the belief in safety in such an unsafe world? Is it faith in God? Our loved ones? Ourselves? Is it just that we've never died before, so why would we now? Where do these illusions come from?

And if we lose them, can we get them back?

--R

Reading: Hellspark, Janet Kagan. An Empty Spoon, Sunny Decker.
gaudior: (profound)
This idea comes out of a discussion B and I were having the other day, wherein we were arguing (as we often do) whether or not rational thought is more important than emotion. I think I've come up with an answer I'm happy with.

Post-modernists often say that we can only experience subjective reality-- that if there is an objective reality out there, we're far too limited by our own experiences and beliefs to see it. I don't think I buy this entirely, as it doesn't really give a satisfactory explanation for why all of our subjective realities so often match up so well. Almost everyone agrees that the sky is up, that people eat food, that cats are furry. The differences seem to be mostly in matters of interpretation. (I may be oversimplifying the argument).

In fact, I think we all live in both objective and subjective reality. The objective one, we know about mostly by discussing it with other people-- "You see fur, too? This must be fur, then." Objective reality, then, is what can be described with language, what can be experimented on and quantified. Objective reality is rational thought.

Subjective reality is what is harder to express, what is not shared. And I think that the way we see our own, personal, subjective reality is through our emotions. What we feel is what is true to us. It may not be true to anyone else-- it may not even make sense to anyone else, and when we try to put it into the words of objective reality, it stops making sense and we might start to deny it. But it is the clearest reflection of our truth. If you get a promotion, and everyone agrees this is a wonderful thing (more money, more status, more responsibility), and you find yourself terrified and sad, then it is your truth that you loved your old job dearly, more than you wanted "success."

Which is why emotions are important. I do believe that both subjective and objective realities are "real," and both are worth considering. But the world's truth is not always your truth, and your emotions are a powerful tool to let you know what your truth is. Which is worth listening to, because it's your head you're going to be living in for the rest of your life, not everyone else's, so you might want to know what's really going on there.

--R
gaudior: (profound)
With the caveat that I have only (as of yesterday) been involved in two flame-flinging incidents (which probably says something about the circles I move in, and how prone they are to flame wars). But they went so well that I want to brag.

1) Be polite. Incredibly, scrupulously polite, not only in wording but in intention-- you're going into this to make things less heated, not more.

2) Explain clearly how what the person did hurt you.

3) Sincerely wish the person well, and perhaps express interest in further dialogue. (I mean it about the sincere-- don't wish him/her a wonderful, happy life full of puppies if the most good will you can muster is that s/he learn something about being nice to people. But find something.)

As I've said, I've only done this twice. But both times, the person apologized, thoroughly, with some explanation of his/her actions (and usually much more grammatically than in the original flame). I think this is muchly because flamers are seeing the internet as sort of fiction, a place to express aggression and stir up trouble without any real consequences. If you remind them that no, there are real people on the other side of the screen, they often begin to act more as they would if they were looking you in the face. (Which I suppose means it wouldn't always work-- there are plenty of people who have no problem with being rude to your face.) The really tough part is not doing the same thing-- seeing them as people on whom you are totally justified in unleashing your aggression-- because hey, they started it. But getting an apology is really satisfying, where flame-wars I've seen look like they often just keep going until they peter out or someone gets banned, and are more aggravation than they're worth.

--R
gaudior: (be the change)
In a comment to a recent post of mine, [livejournal.com profile] homasse described "White Woman Syndrome," or WWS, a phenomenon discussed on a lot of the minority-focused forums on lj. She said that the usual explanation people there come up with for why White women sometimes act like complete, entitled twits is that "White women, being considered the ideal for beauty and such, fully expect the world to love them and make everything perfect for them because they were the Perfect Little Princesses, and when it's *not*, they can't deal." She says she's not sure she buys this completely, but she can't deny the phenomenon.

Neither do I, and neither can I. But I think I have some ideas about where it comes from. )

On pain

Jun. 9th, 2006 05:51 pm
gaudior: (profound)
The people from Teen Empowerment (a program in the high school where I work which hires high school students to do projects to "improve their school climate") came up with what seemed like a fairly daring project this year. They had an English class of students from our high school, E High (urban, almost all students of color and/or recent immigrants, many of them living in housing projects, and all of them dealing with gangs, drugs, shootings, poverty, racism, and a fuckload of other badness on a regular basis), do an exchange program with a class from W High School (almost all White, upper-middle-class, suburban). They exchanged emails for several months, had classroom discussions about social inequality, and then, finally, went to visit each other's schools.

It seems to have gone well-- better than I expected. The W High kids talked about being happily surprised to see "people, not stereotypes," being shocked/impressed with the sorts of things our kids deal with all the time and how they're able to handle it, as well as enjoying the "colorfulness" of the school. I didn't get a sense of whether they learned much that they hadn't been expecting to learn from the experience. But I was more struck with the reactions of our kids. One thing that was something of a relief was that while they did get a clear sense of the unfairness of the situation, they also found things that they appreciated about their school-- the diversity, the energy, and the teachers who care very deeply about them and support them*.

But the other thing that struck me was how struck our kids were by the problems of the kids of W High. They had, they said, assumed that since the W kids were rich and White, they wouldn't have many problems. And indeed, the kids at W don't have to deal with watching their friends get shot, or watching their parents work three jobs to put food on the table, or trying desperately to learn English on the fly quickly enough to pass their classes. But they have problems, our kids said. Problems with parental expectations, and grades-- problems so bad that they do things like pour vodka into water bottles to drink in class to get through the day. One of our teachers said that when the two classes were talking together, some of the W kids were talking about binge drinking, and our teacher realized, looking around the room, that her students had no idea what this meant. She explained it, and they stared at her in confusion, then said, "That's just stupid."

All of which leads me back to a question I had when I, too, was a White, suburban, upper-middle-class kid-- and I looked around and saw how terribly, self-destructively miserable my friends were-- and I didn't understand. How, I wondered, does it hurt so much when life is just not that bad? Of course, I was young and naive and quite emotionally stunted (didn't let myself feel sadness until college, didn't understand depression until after I graduated, I'm only just now learning about anger, and I haven't touched fear yet)... but it's still a question for me. Why is pain like this? Why is it that outside circumstances don't seem to make a damn bit of difference to how much it hurts?

I don't know, but I have a guess. )
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