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!

Begin Again Now!

While the calendar is man-made, it still is a chance for us to think about cycles: beginnings and endings. Each cusp of a change is a chance for us to “re-boot” our own life.  I remember reading a book some years ago by Rabbi Zelig Pliskin called “Begin Again Now”.  Its now, sadly, out of print, but the meaning of the title was that you can fail at something but each moment is a chance to “begin again now”.  I especially think that its appropriate for starting a new year.

 

Many of my clients are engaged in starting anew all the time.  In fact, I encourage it because we then see ourselves as having more choices.  When we don’t see something as possible, we, of course, don’t even attempt it.  Re-booting our personal lives is one way of saying that we can start again and try something new. Each moment contains possibilities that can move us, in small (or sometimes big) ways to a future that we really want.

 

It’s a simple thought, but a powerful one.

 

Wishing you the best in this coming year. So start it NOW!

Psycho- WHAT? (Part Two: Psychoanalysts)

At the end of the 19th century and the beginning of the 20th, several tough, brave people were delving into the nature of the mind. With a reasonable understanding of the way the brain works (but certainly not as sophisticated as today) and a need to actively work to help people, an Austrian psychiatrist named Sigmund Freud failed at hypnosis.  He was trained in France by one of the foremost hypnotists of the day, but, sadly, he wasn’t very good at the art.  After trying a number of approaches and collaborating with another famous psychiatrist, he developed his “talking cure” in which the patient sits, facing away from the analyst (or on a classic reclining couch) and lets themselves “free associate” or talk about whatever comes to mind.  The analyst then interprets the free associations, occasionally along with dreams and unconscious motivations, urges and, importantly, feelings about the analyst are found and brought to the conscious mind’s attention.

Freud wrote a tremendous amount, he created a complex theory that changed over time as he continued to work on his treatment, train others in it and react to criticisms of his work. Some of his students disagreed with him and started new schools of what became known as psychoanalysis, the most famous being Carl Jung, Alfred Adler and Wilhelm Reich.

This method is often intensive: once to three times a week an hour is spent with the analyst and the treatment can take years.  The focus of the treatment is “neurosis” a general term for the maladjustments that people have that cause disturbances in thinking, problems with mood or even, in later years, problems in personality.

Interestingly, one does NOT need to be a psychologist, psychiatrist or other degreed professional to be trained in psychoanalysis.  Although each training institute sets its own standards and the typical person trained has a mental health background, others may become trained in psychoanalysis through going through years of the work themselves, taking classes at the institute and going through more intensive “training analysis” and then graduating with the recognition that they can do the work.  In a sense then, these institute are partially modeled on trade schools, teaching a particular craft, although a decidedly odd one, compared to carpenters or blacksmiths or plumbers!

Freud’s impact on the world became immeasurable in the 20th century.  His ideas became standard training for psychologists, psychiatrists and social workers, even if they didn’t practice the intensive form of psychoanalysis.  A number of new “psychodynamic” therapies based on his theories developed to treat problems and his ideas influenced treatment of children’s psychological and behavior problems.

Even today a variation of “the talking cure” is what most people think of when you discuss psychotherapy.  While various forms of psychoanalysis have formed, the use of pure analysis is much less often seen today, save for people who can afford to do this without typical insurance support.  Insurances now dictate that interventions and goals have to be, in many cases, much shorter and time limited, thus limiting the availability of psychoanalysis. Psychodynamic therapy, on the other hand, has ways of doing things (in some schools) in a briefer period of time and is still a common method for mental health professionals to use in one sense or another.

Psycho- WHAT? (Part One: Psychiatrists)

Psycho- WHAT?  (Part One: Psychiatrists)

I’ve been called a lot of things in my day, not all of them good and certainly not all of them accurate!  In regards to my work though, that’s the point where most people get confused, especially folks that aren’t in the mental health field.

“Are you a Psychologist? Psychoanalyst? Psychiatrist?”

“No, none of these, but I am a Psychotherapist.”

Let me define all these and in the course of it all show you how most mental health providers are Psychotherapists, but not any of the first three.

A psychiatrist is the most well paid of the people that deal with mental problems.  They are a medical doctor who decides to specialize in the problems of the mind and, to a great extent, the nervous system.  They go to medical school, probably spend six to twelve months doing a medical residency (it varies) and then train for several years in their speciality: psychiatry.  They are (with the exception of nurse practitioners) the only ones who can give the pills.  Because of this, they have prestige, power, the ability to commit someone to a mental institution and often direct teams of other providers.  In spite of this, they are often limited: they get trained in “biological psychiatry” more and more, learning less and less about actually talking with people and see things through the lens of their medical model only.

A friend of mine, who is a psychologist, related to  me a very telling story.  She was training 3rd year psychiatrists and was telling them of the value of self disclosure: letting the patient know, for instance, that you also had a rough day this week.  One of the psychiatric residents chimed in: “We’re trained not to let THOSE people know anything about us”.  Her tone was condescending, especially since she worked with chronic schizophrenics and indicated that she had been thoroughly inculcated in the medical model: give them pills for their problems.

There are still some psychiatrists who break out of that model. I’ve managed to work with some of them, much to my delight. They get involved in family therapy, hypnosis and a number of other things, but they are getting harder and harder to find as the drug companies influence the psychiatric establishment.  In fact, the labeling book for disorders underwent a change years ago to simply make it easier to research drug solutions to problems.  That labeling book, The Diagnosis and Statistic Manual is soon going to be out in its 5th edition.

Nowadays, its fairly rare to get much time with a psychiatrist, they often will have short appointments to just see how the drugs are doing, relying on other professionals to provide other forms of treatment.  Is this their fault?  Only partially, I think.  The medical system, insurance and other factors, like a shortage of psychiatrists, especially for children, mean that they have to work fast to see the many patients that they can be flooded with.  It’s a shame, because many of them, I believe, start out well intentioned, but forced into a small box that doesn’t allow them much creativity.

Next will be psychoanalysts!

Surviving Families and the Holidays.

In the last 50 years or so, the face of the family has been changing rapidly. Technology has allowed family members to move further away from each other and pursue education and job opportunities. In addition, families are now made of blends of divorced persons, gay and lesbian combinations and occasionally multiple person relationships such as open marriages.

Whatever we define as family, the holidays bring us together, for better or, sometimes for worse. The shadow of the past is present during these times, with memories of prior gatherings not far from the minds of all those present. For many of us, these shadows are scary with old conflicts lying just around the corner, waiting to rear their heads and bring us into the same old patterns and arguments.

Part of the problem is that often people’s files about their relatives haven’t been updated. Our memories are from years ago and we haven’t seen the change and growth that everyone has undergone in the meantime. Even if we have been in close proximity we are so tied into the old patterns that we remain captured in the dynamic.

We want to keep our family obligations, in spite of mixed feelings about the holidays. The old feelings contain both the good and the bad, so how can we actualize the former and minimize the latter? Here are a few strategies:

Compassion: Remind yourself that we are all in the same boat in life. Even that relative that you can’t stand has gone through some of the same trials and tribulations that you have. If they create troubles for others, remember that this is often a response that has come out of some kind of fear from the past. One simple but true perspective is that for many people, fear runs their lives and when someone acts out its often when they are most fearful.

Be Helpful: The holidays have lots of obligations in one way or another. Keeping yourself busy with being helpful in various ways is a simple way to build up your positive image, both for yourself and your relatives. Remember: people may have old impressions of you that they need to update, show your best self to allow them to do that updating.

Do Something Different: This is in keeping with the last idea, but you should employ it more generally. Breaking out of old patterns with your family can leave everyone able to more relax and try something different. This could be something major like being the first to call and invite someone to your place for a change to suggesting something totally new and fun for an activity. It may be some small change like making a personal gift for everyone instead of buying something from the store. Whatever it is, a small change can snowball into something bigger, often making the holiday a special memory for everyone.

Consider and recognize the positive
: Make sure you tell people what you appreciate about them. Bring up old memories of things you liked in the past. This may set people on a role of what positive things they remember. Old Santa Claus stories or tales of New Years past can bring up good memories if they are done well.

Play With the Children: The kids in the family are often less threatening than the adults. The children appreciate the attention that an adult gives them and you may become their favorite “aunt” or “uncle” even if you’re their cousin! Remember to approach each child in an age appropriate way, an older child can feel misunderstood if they are invited to a game that’s meant for a younger one.

If all else fails become an anthropologist! : Taking a step back and observing may allow you to get the distance you need to deal with all the emotional triggers that you come across. Imagining yourself as a scientific observer studying the family can be one way to deal with the most difficult of situations. Ask yourself what may be behind the behaviors and patterns that you are seeing. Use your curiosity about the people that you’ve known all your life and you may be surprised to see them in a new light.

Using one or, even better, several of the above ideas can really help to shift the holiday experience for you and your family. Setting out with a positive, adventurous attitude is half the battle. You can be the one person to tip the whole event in a positive direction and make it a holiday everyone will remember.

 See my website at:  http://alansalmi.com  or follow me on twitter @DaYooper

Why “In My Own Way”?

Welcome to my general blog.  My title is a tribute to an early influence on my life, Alan Watts, whom I remember reading as early as 7th grade.  “In My Own Way” was the title of his autobiography and the double meaning was purposeful.  I have parts of me that are determined to “make my own way”, as well as parts of me that really are “in my own way”!  I will be talking about all this and more as I try to develop a regular habit of writing down thoughts, adventures, learnings from various sources and perhaps a few personal epiphanies.  I will have some information that will be useful to those interested in the process of modern psychotherapy (in other words, techniques different than just “insight” oriented talk therapy), as well as personal observations.

As I said to a client recently “we’re all bozos on this bus” and one of the things I believe in most strongly is a phrase borrowed from the marvelous writer Spider Robinson:

“Shared pain is lessened, shared joy is increased”.

-Alan

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