Category Archives: therapy

Tibetan Parts Work: Feeding Your Demons (part two)

Lama Tsultrim, Tsultrim Allione

Tsultrim Allione is an American woman from the New England area, who became involved at a young age in Tibetan Buddhism.  As part of her journey, she spent time as a Tibetan nun, but returned to worldly life to raise a family.  She, however, did not give up on her Buddhist practice, but continued to use the foundations of practice that she was given during her period of intense study to make progress in her own spiritual development and get a Master’s degree in religion.

 

She had a particular affinity to the Tibetan woman saint Machig Labdrön, a connection that was affirmed when she travelled to Tibet and two lamas independently stated that she was an emanation of Machig herself.  While being an emanation isn’t exactly like being a reincarnation, its fairly close and shows an intense connection to the teachings, life and history of Machig.

 

Centuries ago, Machig had developed a spiritual method known as Chöd, a practice which is at once a technique for advancing oneself spiritually and for dealing with both outer and inner demons.  The technique calls for, at the same time, singing, visualizing and using a bell and drum.  The Chödpa (Chöd practitioner) is able to use an unusual spiritual perspective to make friends with a demon, whether it’s an internal urge, an external person or even an entity such as a plague. 

 

Lama Tsultrim (she was declared a lama due to her spiritual attainment) adapted the traditional technique for westerners and wrote about it in her book “Feeding Your Demons” and continues to teach it in workshops and retreats.  While it’s too much to go into here (I highly recommend the book and the workshops), it can briefly be described.

 

Once the person settles on a particular problem, either internally (a part of you wants something but you don’t) or externally (a disease, or even a mean boss), you gain a sense of the bodily feeling connected to the thoughts about the problem or demon. 

 

Once a definite feeling is described and stabilized, it is imagined outside the body as a creature or person capable of speaking.  Ultimately, dialog ensues in which you find out what the demon really is seeking in an emotional goal.  Often this goal is positive, with even the most destructive demons ending up wanting peace, acceptance, safety or love. 

 

The final stage is when the practitioner imagines himself or herself, as being changed into the essence of that needed feeling and is then “fed” to the demon.  Three things typically happen: the demon becomes relaxed and slumbers, it winks out of existence or is transformed into a helper “ally” with a whole new form and an ability to assist in a whole new way.

 

Essentially, this is a “mental judo” in which, instead of engaging in a struggle with the difficult part, one unexpectedly resolves the inner conflict by finding the ultimate positive good and giving it to the part in the imagination. 

 

While this technique may seem unique, its interesting to note that it has similar elements to the Core Transformation process of NLP, Dr. Eugene Gendlin’s Experiential Focusing technique and has implications for being used with other parts work models such as Internal Family Systems work.  It appears that the idea of working directly on difficult parts, instead of analyzing them forever in dialog, is starting to come to the fore in the helping professions.  As this happens, people can get more and better (and more rapid) change as a result.

Tibetan Parts Work: Feeding Your Demons (part one)

As more ties are made between east and west, anthropologists, students of religion and psychologists have been studying what concepts and pieces of wisdom can be gleaned from those traditions.  While modern psychology is arguably only 150 years old or so, these traditions have been studying the mind in various ways for hundreds, if not thousands, of years.  Asian traditions are, of course, highly imbued with their cultures and especially religious and philosophical views (just like the west!) and have to be seen in those contexts.

Tibet had a long history of an indigenous religion before Buddhism even reached its borders, this was known as the Bön tradition.  Although scholars debate as to whether this was actually a pre-Buddhist tradition, it differs quite a bit from the others streams of Buddhism and has a strong presence of methods of divination and elements of folk religion in it.  It’s obvious that whatever the case, the belief in “demons” has had a long history in Tibet and that belief intermixed with Buddhism when that stream of thought was imported into the country.

Demons were typically seen as outer phenomena: illnesses, plagues, etc. and were dealt with by exorcists who would battle with the demons in various ways.  While that is still done in some traditions in Tibet, one figure changed the Tibetan religious landscape forever after: an 11th century woman saint named Machig Labdrön.
 
Photobucket
Machig Labdrön studied with a number of masters, but was unique in being a strong exponent of a practice called Chöd which later became integrated into all the schools of Tibetan Buddhism.  There are many stories of her miracles and, like many important Tibetan figures, she was considered an emanation (rebirth) of someone important, in this case she was Yeshe Tsogyal, arguably, the most important historical woman figure in Tibet.

Machig developed a unique practice that combined singing, playing a drum and bell at the same time and practicing a complex inner visualization.  There are several lineages of her teachings, many with totally different visualizations and songs depending on which student they appear to have come from.  Now, what does this have to do with demons and how is this relevant to working with our internal parts?

In brief, the Tibetan belief is that anything that interferes with your enlightenment is a demon.  That means things that we are attached to, illnesses that take our focus off our spiritual practices, even the impression left in our mind from an abusive boss or relative.  Machig had categories that she developed for these demons, but the biggest demon of all was the attachment to our own body!

The legend has it that she knew some demons were coming for her and, in the midst of a flurry of miracles such as walking through walls or flying to the top of a tree, she hit upon the idea of offering her own body up to the demons to feed upon!  Since she was enlightened and no longer attached to it and was full of compassion, even for the demons, this was no problem to her!  The demons themselves were so impressed with this act of generosity that they turned into protectors and allies.

Thus we have the idea of “feeding your demons” that came from this practice.  I will go into more depth on this next posting.

Parts Work – NLP Internal Conflict Method

 

NLP has a number of clever techniques, developed over the years out of its own modeling of human inner experience.  Many of the techniques came from seeing people that were good at a task, figuring out the inner “software” that allowed them to do it and then teaching it to others (most famously, the “good spelling” strategy).

 

While the previous article shows one of the most powerful methods (Six Step Reframing), NLP also has developed a technique that allows for conflicting parts to learn to work together.  This is a common experience for people, with the phrase “one part of me wants to X, while another doesn’t” being the usual way its explained. 

 

The clever thing that NLP does with this situation is based on two things that have been found out about parts:

 

1.  Every part has a positive intention, even if the behavior is seen as bad in the short (or long) run, the intent of the part is to the advantage of the person.

 

2.  Parts that are in conflict often have resources missing, critical abilities that somehow the part doesn’t have access to, but often are found in the part that it’s in conflict with!

 

So, for positive intentions, let’s take an extreme example: a suicidal part of a person.  One has to remember that the METHOD that is being used is different from the goal or endpoint that is being looked for.  One can easily imagine that a suicidal part has the intention of finding peace from extreme pain.  In that sense, while it has only one thing that it knows how to do, it really is trying for a positive thing for the person.  This is really the same concept as found in Six Step Reframing, described previously.

 

In working with conflicting parts though, its often useful to see not just the immediate goal or intention but to “go up the chain” to see the final endpoint, which will ultimately be the most powerful.  Let me give an example with a hypothetical part that wants the person to be a millionaire.  That chain might look like:

 

  • I want to be a millionaire
  • If I were a millionaire I could quit my job and I wouldn’t have to deal with my boss
  • Not dealing with my boss would really reduce my stress
  • If my stress was reduced I could be a lot happier
  • If I was happier, I could enjoy my family more
  • If I enjoy my family more, I’ll be better to them and feel like a good person.

 

So, if asked, that final statement may be the real endpoint or goal.  One obviously doesn’t need a million dollars to feel like “a good person”, so it opens up more possibilities in reaching that goal.  In the same way, no other part could argue with that final goal, once its really understood.

 

The same process if explored with the other part.  Amazingly, it’s often the case that the final goal is the same!  The problem comes in that the two parts have each gotten channeled to just one way of getting to that goal, each thinking its the only path.

 

In our example, the “millionaire part” could be trying to get to its goal through stressful, hard work, ignoring the family, pushing co-workers and spending every bit of extra time on business success courses and books, even ignoring the family.  The other part could be a part that makes the person feel guilty for ignoring friends and family and criticizes the success-oriented part.  It’s the one that notices the disappointment and lack of good will in the people in the environment and may well be very socially sensitive.

 

How does one make a reduction in conflict then?  First of all, through getting each of the parts to listen to the chain of goals and intentions and then to explore what abilities each of them has.  In our example above, being a good person for the millionaire part has led it to have strengths in focus and discipline, to take on a task and keep with it.  These are certainly admirable qualities.  The problem is, being a good person also requires making sure that the people around you like you, a skill that the OTHER part has!  The socially aware part, however, may have little ability to keep to goals and, aside from focusing on where things are wrong, it may not have the ability to DO much about making itself better, its only criticized throughout the years.  It could use the other parts ability to come up with a self-improvement plan to learn to gain rapport with others and to take other people’s needs into consideration.

 

In the NLP conflict resolution technique, both sides are then shown that they are missing abilities the other has and, in the spirit of keeping in mind the ultimate goal (or goals) they are encouraged to make contact with each other and merge their abilities together.

 

The first time that I did this technique; I had two extremely polarized parts.  They were both negative about each other and wouldn’t see any value in the other’s abilities.  Once all the steps had been through, the two sides came together and I experienced a sudden feeling of an almost electrical energy running through my body, lasting about ten minutes, with a lot of feeling attached.  This sensation showed me that the two very polarized parts were making strong connections and my own neurology was being dramatically changed. 

 

While not all problems come in this format, the idea of resolving inner conflicts this way has application to other forms of negotiation also.  One can easily see that if one is working with people with diametrically different viewpoints, going through the ultimate goals and noting the abilities of each other will help to bring the parties together.

 

 

Next: a Tibetan technique for dealing with “inner demons” (and some outer ones!).

Find out more about me and my own work (and how to have a free consultation) at http://alansalmi.com

Parts Work – NLP Six Step Reframing

 One of the ways that I work with people, more and more frequently, uses the idea that we have different “parts” of ourselves.  This is easy for people to grasp and is even in our common language “one part of me wants to do one thing, another part of me wants to do another”.

What’s great about this way of thinking of our mind is that its being backed up by neurological research, especially the ideas of Marvin Minsky, the artificial intelligence expert (The Society of Mind is a popular work that he wrote) and Michael Gazzaniga, one of the researchers who discovered the left brain/right brain distinction (The Social Brain is one of his many books).  Our brains function in different ways for different tasks and it appears that the idea of us having “parts” and even “sub personalities” is a good model for that functioning.

 When I first heard about this, it was when I was taking training in Neuro Linguistic Programming back in the late 1980’s.  One of the great things about NLP is its flexibility and use across many areas: business consulting, education, advertising as well as psychotherapy.  There is a process known as “Six Step Reframing” that uses the idea of parts and has been in the NLP model since almost its beginning.

The essence of the process is this: if you have a “part” which is doing something that the rest of you doesn’t like (jealousy, eating, smoking, anger, etc.) it can be envisioned as having a goal (often unknown to you) that the problem behavior is trying to solve.  The problem is, these parts are like a “one trick pony”, they only see one way to get to the goal.  The surprise to many people is that, no matter how bad the behavior is, the goal is always positive for the person (but it may take some questioning to find the ultimate purpose).  For instance, a “smoking part” may ultimately want the person to relax or, as in one case of mine it wanted to preserve the idea that “I’m a grown up adult, a man”.

Negotiation then takes place between this “problem part” and a presumed “creative part” which comes up with other ways to get to the goal, which the original part decides on, choosing three that are “just as good or better” than what it was doing previously.

There can be problems with the technique, most of which are easily dealt with.  Establishing communication with the part is the first step, sometimes difficult if the part doesn’t use communication as part of its process (an internal critic that is heard by the person often is easy to communicate with, while a physical behavior may take a little finesse to connect with).  The other main consideration is that the new behavior doesn’t cause any new problems, but the final part of the method is an “ecological check” that looks for possible conflicts.  Here is a diagram that may help explain:

Six step reframe

While all this appears fairly common sense, when Six Step Reframing was first taught, many thought it was simply a “symptom substitution” and it was criticized for that.  This was commonly held by those schools of therapy that think that the cause of something has to be known and the emotions behind it attenuated in order for something to change (a classic psychodynamic idea).  My own experience is that the change can be very long lasting.  I contacted one client from 20 years ago who has still maintained the change from the technique.  To be fair, she also discovered the reason behind the problem, but, what’s also possible is that the part doesn’t want to let the reason be known and all the steps can be done “in the back of the mind” without the person’s conscious awareness.

What about part that are in conflict?  NLP has a way of handling that, which will be discussed in the next blog post.

 

Find out more about my work at my website:  http://alansalmi.com

Hypnosis as a way of communicating

In my last post, I talked about one interpretation of hypnosis as being a particular kind of state, one that’s not all that unusual, in fact, seen every day in most people.

Like any other complex, human phenomenon, hypnosis can be viewed through several different lenses, each of which gives it another useful perspective.  One such viewpoint is that of communication and language patterns.

It’s interesting, but I had a client a while ago who, for reasons of religion, didn’t want me to do any formal hypnosis.  During our talk however, she explained how she did sales at her job.  A good portion of her sales abilities were dependent on hypnotic communication patterns! Did she “hypnotize” her customers? Of course not!  However, language IS powerful and the use of special patterns in speaking to someone can determine how well they follow your ideas or consider something that is presented to them.

I remember when I was in college, there was a Brittanica Encyclopedia salesman at the student union.  We talked for a bit, and, considering my own high value on information and its availability (long before the internet), I was really thinking of getting the classic encyclopedia set.  I had, by this time though, already studied hypnotic communication patterns on my own.  The salesman went down the form, talking about how he would fill it in, what each section could be answered and finally, showing me the place that I could put my name on the dotted line to purchase the books.  I noticed how I was being pulled in and recognized the “yes set” of Ericksonian hypnosis!  If you are told enough things in a row, to which the answer is “yes”, your mind moves in a certain direction. That direction can continue for a crucial one or two steps further with something that you MIGHT have said “no” to before.  An example, used hypnotically, would be:

You are sitting there in that chair
You came here to learn something about change
You know that you can learn new things, you’d done it before
You can easily hear me and see me and
You can learn enough today to experience trance.

While that’s not a terribly refined example, it shows how that final statement, which ALSO can’t be argued with (who would doubt their ability to learn something?) leads a person to an obvious direction of thinking.

Many hypnotic patterns of communication are already used in common everyday speech.  Think of the parents who are dealing with a fuzzy child.  It’s important for them to lead the child in the right direction, not cause any resistance to their own directions and get the child to self regulate their own mood.  Not easy? No, but one often used pattern (called, as I recall “another cause”) is: “You are SO tired now!”  If the child buys this statement, (instead of something that would be more confrontational like “You are being a brat now!”) they can be led to a place to take a nap and also learn to see when their mood isn’t working and when they might need to rest.

In the same way, I don’t frequently do a “formal” trance with my clients.  I will, however, use hypnotic patterns to get them to open up to possibilities in their experience or to get parts of them to open to new possibilities (I am currently doing a lot of work with people’s parts).  Because of my long familiarity with trance communication, it is almost hard NOT to use patterns that are intended to open up the mind to more choice.

One final note:  There is an interesting idea out there that hypnotists in fact don’t so much “hypnotize” their clients as “DE-hypnotize” them!  Many times the things that people come in to complain about can be viewed as powerful “self-hypnosis” patterns that people find themselves stuck in!  A certain incident, happening early in life may set a pattern in thinking that, for years to come, may be considered a “post-hypnotic” suggestion, often with commands such as “you aren’t worthy” or “you’ll never get what you want” implied.  When things are implied, the mind has little to do to oppose something but is more often going to simply accept it and those implications can cause us some trouble!

Find out more about me and my own work at http://alansalmi.com

Hypnosis as a Special (or Not so Special) State of Mind

I am asked if I do hypnosis with my clients, often in the context of eating or smoking or some other kind of habit pattern.  Many people think that hypnosis is really only used for breaking or inducing new habits, but the hypnotic phenomenon is actually more complex and interesting than that.

One story that I tell to explain hypnosis goes like this:

A psychologist named Ernest Rossi had been in biology graduate school prior to shifting to psychology.  He also got training as a Jungian analyst and had a special interest in how the mind and body interact with each other.  He was reading a report on how some biologists were contracted to see if they could find out how air traffic controllers made mistakes, in an effort to decrease errors which could, at times, be fatal to hundreds of people.

After considerable study, the biologists found that the error rate rose every 90 to 120 minutes, dropping once again to a baseline level.  While they examined all sorts of biological markers, the ones that they found were based mostly on observation of the air traffic controllers.  They listed such things as:

  • slowed blink rate
  • slowed movements of the body, even stopping completely
  • swallow rate slowing
  • staring in one place
  • slow breath rate

Rossi looked at this list and found it to be the same as what was given him years before by the world’s greatest hypnotherapist, Milton Erickson, M.D. except he called it “signs of the common everyday trance“.

Rossi went on to study this phenomenon and write extensively on it.  From this, he developed the idea of a new “state” theory of hypnosis: that we slip into trance every 90-120 minutes a day, but utilize it mostly to rest. If we DON’T get the chance to take these breaks, then we end up with all those classic problems that come from modern life in the form of stress reactions, along with the chronic health problems connected to them.

This state of hypnosis then is not anything unfamiliar to anyone who daydreams.  While certain religious and spiritual groups have doctrines against hypnosis (most notably Christian Scientists and Theosophists), these arguments are based on a concept of trance that is over 100 years old and talks about control of one mind that is weaker by a stronger mind.  While that idea was useful in its time, usually to bring fame to the hypnotist and instill confidence in his techniques (almost always it was a male hypnotist and more frequently a female subject), it really has no place in the modern theories of altered states.

What does this state allow you to do?  One important component of trance is the ability to connect to states of mind in which memories are more vivid.  Scientists have found that the state of the mind and body in which memories form can be important to remembering them.  If something happens to you when you are drunk, the ability to remember it will be much easier if you are again tipsy.  They have even shown the effect when students take a test in a different room than that in which the lectures took place!

Remembering events and, in a sense, “re-coding” them is one important part to hypnotic psychotherapy.  The trance state can also be used to work with the mind’s natural connection to the body and influence it.  It’s been known for over a hundred years that a hypnotic subject can respond to an imagined lit cigarette pressed against the arm with a blister.  The range of responses in this mind/body interface are still being investigated, but there seems to be evidence of hypnosis being used for breast enlargement, skin disorders and even increasing height in an adult male by several inches.

What happens between the hypnotist and the subject in a session?  That will be the subject of my next blog entry.

And finally, a classical and completely  inaccurate depiction of hypnosis:

hypnosis.bmp

Psycho-WHAT? (Part Six: Life Coaches, hypnotists, etc.)

Many mental health professionals would like to ignore the role that unlicensed individuals have, but, the truth is, there will always be room for, and a place for, those people who haven’t gone through the traditional route in established universities.  I’d like to talk briefly about three of these, starting with the relatively new phenomenon of Life Coaches.


Life Coaches – undergo varied training, depending on the type of program they go through, although there is nothing to prevent someone from taking the title on themselves.  As yet, there is no regulation and no standards, save for some organizations that are attempting to self police the field, outside of government licenses or regulation.  Typically, coaches work either over the phone (which is fairly common) or in person, helping individuals to keep on track with goals that they mutually set in the early sessions.  Some life coaches also focus on business:  keeping an entrepreneur on track with goals, or helping a busy executive to keep focused.


The distinction between Life Coaches and psychotherapists can be a tough one to make at times.  Rhonda Britten, a life coach who has booked more time on reality TV than any other adviser (and, for full disclosure, my cousin) defines psychotherapy as focusing in on the past, while life coaches focus on the present and future. While that may be true, psychotherapy has recently been more future oriented, as exemplified by the schools of “solution focused” therapy, with one of the main exponents, Bill O’Hanlon, talking about the evolution of psychotherapy as moving from past to future focused.


Whatever the case may be, Life Coaching has proven a possible route to being in a helping profession with avoiding government regulation, large university tuition bills and a certain freedom of practice.  For those that are business oriented and like to marketing themselves, this is a great opportunity to put oneself out there and develop a career.  Life Coaches also have the advantage that there is no “stigma” to been seen consulting them, whereas the shadow and labeling of mental illness inherent in other professions that are licensed can be a factor in stopping people from getting help.


As with any profession, some people are better than others and some programs are better than others.  I would note, however, than even a badly trained or practicing Life Coach will mean that you have to tell someone each week what you are doing to reach your goals, increasing the level of accountability and helping you keep on track!  Most of us, if we know we are being watched or followed by someone else, will start to have an investment in looking good to the other person!


Hypnotists and NLPers – have been in practice since the days of Mesmer, with techniques changing over time, sometimes slowly, sometimes quickly.  Nowadays, most non-licensed hypnotists will seek out training with a program connected to the American Guild of Hypnotists, which certifies people at various levels of expertise.  Only a few states regulate hypnosis, but these hypnotists must always be careful of practicing within their areas of expertise.  For instance, while they can note that someone is “sad” to label them “depressed” could get them in trouble, since that’s a diagnosis a licensed professional has to make, no matter if the client themselves uses the term!  Much of the focus of these practitioners is on smoking cessation and weight control, certainly both worthy topics to focus on and an area that is taught in even the most basic of courses.  There may be others that venture into other areas, even spiritual work, looking to use the trance phenomenon as a stepping stone to spiritual progress or even psychic abilities.  Certainly in this last category, the tradition is even older than Mesmer, since traditional, pre-literate societies used trance for their healing methods via what the anthropologists would label as shamanic practices.  Indeed, one hypnotist I was in communication with described himself, rather delightedly, as a “shaman with a neck tie”!


Neuro Linguistic Programming or NLP was invented in the 1980’s, started by a professor of linguistics, John Grinder and a mathematician and general genius named Richard Bandler.  They started out building linguistic models of psychotherapy sessions, trying to find common patterns in speech in the best of therapists.  They also analyzed the language patterns of the then best clinical hypnotist in the world, Milton Erickson, a psychiatrist in Arizona.  Soon, they started to notice non verbal patterns in communication and found that they could use their basic approach to build a teachable model of any mental skill to others.  One of their first successes was to model how good spellers of the English language manage to defeat the very non-phonetic nature of English spelling!  


NLP has been used widely in advertising, marketing, business consulting and, naturally, psychotherapy.  The easiest way to describe the whole field is by means of thinking of the brain as a computer (not an uncommon thing today).  NLP attempts to go into the mind, find the mental patterns or “software” and then “upgrade” the programs to be more efficient and allow the person to have more choices.  Because of the modeling of hypnosis that NLP has done, most NLP trained professionals also use hypnosis.


Astrologers, Tarot Readers and Ministers – As shown by my statements about shamanism, spiritual advisers of all sorts have long been a source of wisdom for people stuck in the various difficult conditions life can bring us.  The parish priest or the pastor of the local church one is a member of frequently receive all sorts of requests of advice and counseling, as do clergy of any faith: Buddhist, Hindu, Wiccan or Muslim.  Most main stream denominations require seminary training which gives experience and classes in Chaplaincy, giving experience in active listening, spiritual counseling and problem solving.  Some clergy go on to advanced training and some get doctorates in pastoral care, further education moving into the area of psychotherapy.  More biblically based groups may have ministers who have simply attended a Bible college and may be actively against any forms of counseling, even those labeled within their faith.  Once again, quality of help depends on personal competency as well as training.


More off beat advisers, such as Astrologers or Tarot readers are consulted by any number of people in all socio-economic classes.  Whatever one thinks of these, at the very least, the effort to formulate a question and to get advice, even random advice, can move the person out of a cognitive “rut” they are stuck in and provide ideas on a new course of action.  The famous writer Edward DeBono calls this “lateral thinking” and conducts courses which even use randcmoe words from the dictionary as a way to start creative thinking about problems, certainly comparable to letting the mind contemplate the possible relationships between a tarot card or planetary position!  While these methods have a socially marginal air to them, their mystique can often compel the person to a different course of action and, as the above mentioned Bill O’Hanlon talks about, doing one thing different can make a lot of difference.


So, with this, we come to the end of my brief excursion into the area of advice giving, counseling or psychotherapy professionals.  The vast array of appears to grow every day, with odd corners such as “Spiritual Direction” or Mind/Body therapists or “Spiritual Companionship” seeming to pop up every day.  As is often the case, referral from someone trusted to a professional of any sort is often a good way to examine your options, but this series is meant to show just how many options there are.

Find out more about me and my own work at http://alansalmi.com

Psycho-WHAT? (Part Five: Social Workers)

Social Workers have been around in one form or another for about a hundred years in English speaking countries.  The profession has changed remarkably over time and come to encompass a large numbers of career choices or specialties, ranging from:

-child welfare and adoption
-hospital and medical social work
-community organization and change
-administration of non-profit and community programs
-psychotherapy ranging from families and groups to individuals
-social policy analysis
-research and teaching

While many in social services agencies call themselves social workers, many states are now restricting the term to those licensed in the field, at least those with a Bachelor’s degree, but often a Master’s degree.  The Master’s is considered the “terminal” or final degree for the profession, with those holding a Ph.D. or less often, the D.S.W. (Doctor of Social Work) being those usually teaching in universities or working in government agencies on larger social problems and policy planning.

For mental health counseling, the largest number of licensed professionals offering services in the U.S. is probably social workers.  Most social workers concentrate in areas that have to do with counseling of one type or another, but even those who focus on administration have to take classes in human behavior and development and techniques for individual or family counseling.

While its often a goal for a social worker to start a private practice, this is often easier said than done.  Most licensing boards require at least two years of work under supervision before you can work on your own and few social work programs actually teach what is needed to do the business of a private practice.  More often than not, social workers find themselves in hospitals or agencies, but, because of their education, they may move in their careers to the point of management if they aim in that direction.

Mental Health professionals often “carve out” certain territories for themselves.  Psychologists have testing as their focus: IQ tests, ink blots, neuropsychological tests and vocational testing are some of the things they are trained in.  Family therapists work with families and couples in counseling.  Psychiatrists have control of medications, putting them in the top position in the often medication obsessed western culture.  Social Workers, on the other hand, look at problems that people find themselves in and analyze the larger social conditions that they find themselves in.  The community resources of an area are one thing that most social workers familiarize themselves with, connecting people to specialized agencies or hospitals as needed.  While all mental health professions work with the poor, social work does so more than any other specialty, both through tradition and training.  As for who they work with, they may find themselves working with any population that the others work with, depending again on their training in family therapy, individual therapy, group therapy or child guidance and psychotherapy.

As with any other profession, the level of knowledge, expertise or competency varies widely.  My own experience of social workers that I’ve worked with has gone all over the board.  I’ve seen some hospital social workers that hid in their office and were only available when a patient needed to go home (discharge planning), others were internationally known presenters and trainers in their field, with most falling in between.  Graduate education, while standardized with certain classes that are needed, can also vary strongly, with some schools demanding more academically than others.  Before I transferred to the University of Michigan (a top three school at the time), the first year of my Master’s was at a school in the top 20.  I noticed the difference in work load, intellectual expectations and level of teaching ability in professors almost immediately.  While my first year had a few, inspiring, good professors, my second year had a professor who even made Human Service Organizations interesting (a class I was dreading and thought would be terribly boring!)

My next entry: who are those people who help people WITHOUT degrees?

Find out more about me and my own work at http://alansalmi.com

Psycho-WHAT? (Part four: Family Therapists)

Family therapy is the latest broad category of mental health providers.  Family therapists broke the mold and actually started to see whole families at one time.  At first, they were accused of “contaminating the transference” and any number of things by traditional (read psychoanalytic) therapists.  While some were working within the basic model provided by Freud, many were breaking new ground and looking at the family as a system, just as an economic system, digestive system or electrical system is studied (and then later, computer systems).  This view, using cybernetic theory and General Systems Theory became a break through method of looking at groups of people, especially families.

Interestingly, one of the main people behind this was Gregory Bateson, an anthropologist who started to study families and communication patterns at the Mental Research Institute in Palo Alto California, along with other pioneers such as Jay Haley, Paul Watzlawick, John Weakland and others.  They were the first to think of therapy as something that could be done briefly and started to use the idea that the therapist could be more directive and be an active agent of change (strategic therapy).  Much of what they did was to see how problems were formed and what kept them going in a person’s mind or in a family, coming up with clever ways of breaking people out of stuck patterns.

Family therapy became very wide-ranging after that.  Family structures were studied and changed, family histories and the emotions that went with them were studied and mapped in specialized family trees called “genograms”.  Individuals were worked with, but coached in how to deal with their families more effectively and for them to have more of a life of their own.

One very interesting development was the concept of “Internal Family Systems”.  The developer, Dr. Richard Schwartz (his Ph.D. was in family therapy), was working with families of bulimics, when he came across a case that should have changed, but didn’t.  He decided to think outside the (at that time) limits of family therapy and ask the person what was going on inside their head!  He thereafter developed, with the help of his patients, a model of the mind that uses many people’s common experiences: we have different parts of us that want different things!  After a while, a pattern emerged and he found that while there are parts that try to run things, either proactively (like the part of you that helps you keep appointments or might even be an inner critic) or reactively (like the part that has to run to the cookie jar for comfort) there were also young parts that held onto pain from early experiences (and sometimes adult experiences) and were often kept separate by the others.  As these parts were healed, learned to deal with each other and to move past their old pains, the Self, the real person became stronger and became the leader of all the internal parts.

Of course, all these internal experiences still interfaced with the family, with society and the world as a whole, but this model allowed Schwartz to be very flexible in his approach and to see that everyone has a Self that is centered, caring, calm and oftentimes courageous in being able to take reasonable risks in life.

In studying Schwartz’s work, I’ve started to incorporate more and more of it into my own, adding in my own perspectives learned from body centered psychotherapy, NLP, hypnosis and other parts models of the mind.  In short, family therapy has come a long way from its early days and continues to develop and enrich the lives of many.

Now, what does one need to be a family therapist?  There are many programs with Master’s level clinicians being graduated, as well as the occasional Ph.D. to research and teach.  Psychologists can get training in their own programs as well learn from free standing institutes that give post graduate education.  Some Social Work programs (such as the one I went to at the University of Michigan) allow you to major in family therapy and focus in on that as your main model of helping others.  A few psychiatrists will even venture into the area, some of them going on to do further work in research or teaching, like the early psychiatrists who helped to pioneer the movement.

Psycho- WHAT? (Part Three: Psychologists)

Sometimes when I describe what I do, I get asked if I am a psychologist.  Since the term is officially restricted to licensed individuals and since I only have a Bachelor’s degree in it, and no graduate degree, I have to explain my training and background to clear up confusion.

It’s not unusual for people to immediately think of psychologists when they think of mental health or counseling.  Many people have taken psychology classes in college, often as a part of their general education and are familiar with at least some of the terms that are common to the field.  Also, there are numerous psychologists in practice, although many would restrict the use of the term to only those with a Ph.D. or a Psy.D. doctoral degree.

Psychologists typically can identify themselves as such when they finish either a research degree (the Ph.D.) or the more practical applied clinical degree (the Psy.D.), finish their internships and take required tests.  While there are also psychologists in universities that study mental phenomenon of all sorts (social, cognitive, cross species and brain phenomena for example), they usually aren’t out serving the public in the way that clinical psychologists are.

One of the “territories” that psychologist have secured for themselves over the years is the area of testing.  They are trained to give a number of tests, like the familiar I.Q. test, as well as more exotic tests for brain function and even vocational testing (usually used by Counseling Psychologists who are almost identical to Clinical Psychologists).  Hospitals and courts make use of psychological testing for various purposes, as do schools (although they usually use their own school psychologists).

In the use of therapy, psychologists get fairly broad training in techniques, with some schools emphasizing certain schools of thought, but all are required by educational standards to give a broad overview of the field.  One on one therapy is the most common, although couple and family counseling are also done by psychologists, as well as working with groups in various settings.

Psychologists do NOT give drugs, that the province of psychiatrists, although lately they learn more and more about the drugs that patients may be taking, often recommending drugs that are then prescribed by physicians of various sorts. 

In recent years, more and more people are also being trained at the Master’s degree level.  There may be specialists in community, counseling and clinical psychology, as well as slightly more exotic areas such as forensic psychology.  The use of the term “psychologist” varies from state to state for these professionals, with some states saying that only those with doctoral degrees can use the term, others allowing practitioners to use the term “limited license psychologist”, etc.  In Illinois, a category exists called the Licensed Clinical Professional Counselor, used as an umbrella term for those Master’s level practitioners.

There are several other directions that can get you to the Master’s level that are not even thought of.  For instance, a person could go through a school of education, get a degree in counseling there and sit for the appropriate tests.  While given in a school of education and typically meant to make school counselors, after an appropriate period of post graduate work, these people can have the same license as those with a clinical psychology Master’s degree (often for considerably less cost).

There are still other mental health providers out there, so keep watching this space!