Psychotherapy.net Team, Author at Psychotherapy.net

Creative Writing as Psychotherapy

Posted on March 5, 2015February 11, 2026 by Psychotherapy.net Team

“An interesting fusion.” That’s what my project Wild Words was once called by a fellow psychotherapist, and yes, he was looking down his nose at me. But I’ve discovered a huge demand for the fusion of body-based, nature-based, and narrative therapy, via which I help people to find creative flow in their lives. Here’s one recent example.

A stooped 17 year-old man came to me. He had a mop of black hair and smelled of spirits. There were tensions in the family, and his father thought “that some poetry tuition might help relax him.” As I’ve seen many times, my authority as a university creative writing tutor allowed the family to ask for help, without having to admit to themselves or others that what they were really seeking was psychotherapeutic support.

Jed told me that all he wanted to do was to be a poet, but “nothing comes out right.” He didn’t care about my qualifications, but he liked the concept of writing “Wild Words.” He said it would be nice to feel like a wild animal when he wrote, but instead, he usually felt more like his little brother’s hamster, going round and round on its wheel.

As we talked, he asked me crossly why I hadn’t yet asked to see his writing, and motioned to the groaning backpack sitting at his feet. But I didn’t need to look at his writing to understand what was going on, I only had to look at his body. His skin was sickly white. His hands were blue with cold, even though the room was warm. Sometimes, when he told me about the subject of his poetry, color rose in his cheeks, but it was quickly followed by a deflation of his body, and a draining of color. And then, of course, there was the smell of alcohol.

He asked me, even more angrily, why I hadn’t asked him for the reasons for his “writer’s block,” the reason he couldn’t write well. I said that I was sure he already knew the reason, and that he’d probably already thought through it a thousand times to no avail. I was going to try a different approach. He looked skeptical. He told me the reason anyway. Apparently, his father was a well-known poet. “I’m scared that I will never write like my father,” he said. “And it’s ceasing me up.”

I asked him then to remember a time when he did write well, when the words flowed. He told me about a writing competition he had won when he was twelve. I invited him to close his eyes, to remember that experience, and to see how it felt in his body. He told me he felt a warmth, a relaxation spreading from his chest out through his limbs.

Next, I asked him to think about a time when he sat down to write but felt blocked. Where in his body was that physical sense of block? He told me it was in his stomach. At this point he started telling me again about his fears of not matching up to his father’s success. I told him not to think, but to just stay with his bodily experience. If he scanned his body, despite the feeling of block in his chest, was there a place where he still felt the warmth or movement from the writing competition experience? He said yes, there was. It was in his hand. I then got him to move his attention back and forth between his stomach and his hand, touching into the block, and then back again to a place of relaxation.

Through doing this in the session, and by practicing it at home, he gradually found that he could pick away at the edges of the feeling of block his stomach, and integrate it with the feeling of flow in his hand. Eventually that enabled him to find flow in the whole of his body. This process led spontaneously to writing ideas flowing from his body on to the paper. He was an unblocked writer.

The day this happened, he called me immediately. He was excited and laughing, but also confused. He told me, “I’m writing, the words won’t stop coming, but now I have another problem, I’m writing a comedy screenplay, not poetry. That’s not what I want to write. I’ve always wanted to be a poet’.

The psychotherapist Peter Levine has a saying: ‘The body knows.”

This is what I told him. Your body knows what it needs to say. From then, my work with Jed, which lasted six sessions, became about helping him to find his own voice rather than meeting his father’s expectations or trying to follow in his footsteps. He found a creative flow in his life, as well as in his words, and the tensions within the family lessened considerably.

Creatures of a Day

Posted on February 19, 2015February 11, 2026 by Psychotherapy.net Team

The following is excerpted from Irvin Yalom's new book, Creatures of a Day: And Other Tales of Psychotherapy, with permission from the author. Available from Amazon.

All of us are creatures of a day; the rememberer and the remembered alike. All is ephemeral—both memory and the object of memory. The time is at hand when you will have forgotten everything; and the time is at hand when all will have forgotten you. Always reflect that soon you will be no one, and nowhere.

—Marcus Aurelius, "The Meditations"

The Crooked Cure

Dr. Yalom, I would like a consultation. I’ve read your novel, When Nietzsche Wept, and wonder if you’d be willing to see a fellow writer with a writing block.

—Paul Andrews

No doubt Paul Andrews sought to pique my interest in his email. And he succeeded: I’d never turn away a fellow writer. As for the writing block, I feel blessed by not having been visited by one of those creatures, and I was keen to help him tackle it. Ten days later Paul arrived for his appointment. I was startled by his appearance. Somehow I had expected a frisky, tormented, middle-aged writer, yet entering my office was a wizened old man, so stooped over that he appeared to be scrutinizing the floor. As he inched slowly through my doorway, I wondered how he had possibly made it to my office at the top of Russian Hill. Almost able to hear his joints creaking, I took his heavy battered briefcase, held his arm and guided him to his chair.

“Thankee, thankee, young man. And how old are you?

“Eighty years old,” I answered.

“Ahhh, to be eighty again.”

“And you? How many years do you have?”

“Eighty-four. Yes, that’s right, eighty-four. I know that startles you. Most folks guess I’m in my thirties.”

I took a good look at him and, for a moment, our gazes locked. I felt charmed by his elfish eyes and the wisp of a smile playing on his lips. As we sat in silence for a few moments looking at one another, I imagined we basked in a glow of elder comradeship, as though we were travelers on a ship who, one cold foggy night, fell into conversation on the deck and discovered we had grown up in the same neighborhood. We instantly knew one another: our parents had suffered through the great depression, we had witnessed those legendary duels between DiMaggio and Ted Williams, and remembered rationing cards for butter and gasoline, and VE day, and Steinbeck’s Grapes of Wrath, and Farrell’s Studs Lonigan. No need to speak of any of this: we shared it all and our bond felt secure. Now it was time to get to work.

“So Paul, if we may use first names—”

He nodded, “Of course.”

“All I know about you comes from your short email. You wrote that you were a fellow writer, you’ve read my Nietzsche novel, and you have a writing block.”

“Yes, and I’m requesting a single consultation. That’s all. I’m on a fixed income and can’t afford more.”

“I’ll do what I can. Let’s start immediately and be as efficient as possible. Tell me what I should know about the block.”

“If it’s all right with you, I’ll give you some personal history.”

“That’s fine.”

“I have to go back to my grad school days. I was in philosophy at Princeton writing my doctorate on the incompatibility between Nietzsche’s ideas on determinism and his espousal of self-transformation. But I couldn’t finish. I kept getting distracted by such things as Nietzsche’s extraordinary correspondence, especially by his letters to his friends and fellow writers like Strindberg. Gradually I lost interest altogether in his philosophy and valued him more as an artist. I came to regard Nietzsche as a poet with the most powerful voice in history, a voice so majestic that it eclipsed his ideas and soon there was nothing for me to do but to switch departments and do my doctorate in literature rather than philosophy. The years went by, my research progressed well, but I simply could not write. Finally I arrived at the position that it was only through art that an artist could be illuminated and I abandoned the dissertation project entirely and decided instead to write a novel on Nietzsche. But the writing block was neither fooled nor deterred by my changing projects. It remained as powerful and unmovable as a granite mountain. No progress was possible. And so it has continued until this very day.”

I was stunned. Paul was eighty-four now. He must have begun working on his dissertation in his mid twenties, sixty years ago. I had heard of professional students before, but sixty years? His life on hold for sixty years? No, I hoped not. It couldn’t be.

“Paul, fill me in about your life since those college days.”

“Not much to tell. Of course the university eventually decided I had stayed overtime, rang the bell and terminated my student status. But books were in my blood and I never strayed far from them. I took a job as a librarian at a state university where I stayed put until retirement trying, unsuccessfully, to write all these years. That’s it. That’s my life. Period.”

“Tell me more. Your family? The people in your life?”

Paul seemed impatient and spat his words out quickly, “No siblings. Married twice. Divorced twice. Mercifully short marriages. No children, thank God.”

This is getting very odd, I thought. So affable at first, Paul now seemed intent on giving me as little information as possible. What’s going on?

I persevered. “Your plan was to write a novel about Nietzsche and your email mentioned that you had read my novel, When Nietzsche Wept. Can you say some more about that?”

“I don’t understand your question.”

“What feelings did you have about my novel?”

“A bit slow going at first, but it gathered steam. Despite the stilted language and the stylized, improbable dialogue, it was, overall, not an unengrossing read.”

“No, no, what I meant was your reaction to that novel appearing while you, yourself, were striving to write a novel about Nietzsche. Some feelings about that must have arisen.”

Paul shook his head as though he did not wish to be bothered with that question. Not knowing what else to do, I continued on.

“Tell me, how did you get to me? Was my novel the reason you selected me for a consultation?”

“Well, whatever the reason, we’re here now.”

Things grow stranger by the minute, I thought. But if I were to offer him a useful consultation, I absolutely had to learn more about him. I turned to ‘old reliable,’ a question that never fails to provide heaps of information: “I need to know more about you, Paul. I believe it would help our work today if you’d take me through, in detail, a typical 24-hour day in your life. Pick a day earlier this week and let’s start with your waking in the morning.” I almost always ask this question in a consultation as it provides invaluable information about so many areas of the patient’s life. Sleep, dreams, eating and work patterns, but most of all I learn how the patient’s life is peopled.

Failing to share my investigative enthusiasm, Paul merely shook his head slightly as though to brush my question away. “There’s something more important for us to discuss. For many years I had a long correspondence with my dissertation director, Professor Claude Mueller. You know his work?”

“Well, I’m familiar with his biography of Nietzsche. It’s quite wonderful.”

“Good. Very good, I’m exceptionally glad you think that,” Paul said, as he reached into his briefcase and extracted a ponderous binder. “Well, I’ve brought that correspondence with me and I’d like you to read it.”

“When? You mean now?”

“Yes, there is nothing more important that we could do in this consultation.”

I looked at my watch. “But we have only this one session and reading this would take an hour or two and it is so much more important that we—”

“Dr. Yalom, trust me, I know what I’m asking. Make a start. Please.”

I was flummoxed. What to do? He is absolutely determined. I’ve reminded him of our time constraints and he is fully aware he has only this one meeting. On the other hand, perhaps Paul knows what he is doing. Perhaps he believes that this correspondence would supply all the information about him that I needed. Yes, yes, the more I think about it the more certain I am: this must be it.

“Paul, I gather you’re saying that this correspondence provides the necessary information about you?”

“If that assumption is necessary for you to read it, then the answer is ‘yes.’”

Most unusual. An intimate dialog is my profession, my home territory. It’s where I am always comfortable and yet in this dialog everything feels askew, out of joint. “Maybe I should stop trying so hard and just go with the flow. After all, it’s his hour. He’s paying for my time.” I felt a bit dizzy but acquiesced and held out my hand to accept the manuscript he proffered.

As Paul passed me the massive three-ring binder, he told me the correspondence extended over forty-five years and ended with Professor Mueller’s death in 2002. I began by flipping the pages to familiarize myself with the project. Much care had gone into this binder. It seemed that Paul had saved, indexed, and dated everything that passed between them, both short casual notes and long discursive letters. Professor Mueller’s letters were neatly typed with his small exquisitely fashioned closing signature, while Paul’s letters—both the early carbon copies and the latter photocopies—ended simply with the letter ‘P.'

Paul nodded toward me, “Please start.”

I read the first several letters and saw that this was a most urbane and engaging correspondence. Though Prof Mueller obviously had great respect for Paul, he chided him for his infatuation with wordplay. In the very first letter he said, “I see that you’re in love with words, Mr. Andrews. You enjoy waltzing with them. But words are just the notes. It’s the ideas that form the melody. It’s the ideas that give our life structure.”

“I plead guilty,” retorted Paul in the ensuing letter. “I don’t ingest and metabolize words, I love to dance with them. I greatly hope to be always guilty of this offense.” A few letters later, despite the roles and the half-century dividing them, they had dropped formal titles of Mister and Professor and used their first names, Paul and Claude.

In another letter, my eye fell on an important statement written by Paul: “I never fail to perplex my companions.” So, I had company. Paul continued, “Hence, I shall always embrace solitude. I know I make the error of assuming that others share my passion for great words. I know I inflict my passions onto them. You can only imagine how all creatures flee and scatter when I approach them.” That sounds important, I thought. ‘Embracing solitude’ is a nice cosmetic touch and puts a poetic spin on it, but I imagine he is a very lonely old man.

And then, a couple of letters later, I had an ‘aha’ moment when I came upon a passage that possibly offered the key to understanding this entire surreal consultation. Paul wrote, “So you see, Claude, what is there left for me but to look for the nimblest and noblest mind I can find. I need a mind likely to appreciate my sensibilities, my love of poetry, a mind incisive and bold enough to join me in dialog? Do any of my words quicken your pulse, Claude? I need a light-footed partner for this dance. Would you do me the honor?”

A thunderclap of understanding burst in my mind. Now I knew why Paul insisted I read the correspondence. It’s so obvious. How had I missed it? Professor Mueller died fifteen years ago and Paul is now trolling for another dance partner! That’s where my novel about Nietzsche comes in! No wonder I was so confused. I thought I was interviewing him whereas, in reality, he was interviewing me. That must be what is going on.

I looked at the ceiling for a moment wondering how to express this clarifying insight when Paul interrupted my reverie by pointing to his watch and remarking, “Please Dr. Yalom, our time passes. Please continue reading.” I followed his wishes. The letters were compelling and I gladly dived back into them.

In the first dozen letters there seemed a clear student-teacher relationship. Claude often suggested assignments, for example, “Paul, I’d like you to write a piece on comparing Nietzsche’ misogyny with Strindberg’s misogyny.” I assumed Paul completed such assignments but saw no further mention of them in the correspondence. They must have discussed his assignments face to face. But gradually, halfway through the year, the teacher-student roles began to dissolve. There was little mention of assignments and, at times, it was difficult to discern who was the teacher and who the pupil. Claude submitted several of his own poems seeking Paul’s commentary and Paul’s responses were anything but deferential as he urged Claude to turn off his intellect and pay attention to his inner rush of feelings. Claude, on the other hand critiqued Paul’s poems for having passion but no intelligible content.

Their relationship grew more intimate and more intense with each exchange of letters. I wondered if I held in my hands the ashes of the great love, perhaps the only love, of Paul’s life. Maybe Paul is suffering from chronic unresolved grief. Yes, yes—certainly that’s it. That’s what he’s trying to tell me by asking me to read these letters to the dead.

As time went on I entertained one hypothesis after another but, in the end, none offered the full explanation I sought. The more I read, the more my questions multiplied. Why had Paul come to see me? He labeled a writing block as his major problem, yet why did he show no interest whatsoever in exploring his writing block? Why did he refuse to give me details of his life? And why this singular insistence that I spend all our time together reading these letters of long ago? We needed to make sense of it. I resolved to broach all these issues with Paul before we parted.

Then I saw an exchange of letters that gave me pause. “Paul, your excessive glorification of sheer experience is veering in a dangerous direction. I must remind you, once again, of Socrates’s admonition that the unexamined life is not worth living.”

‘Good going, Claude!’ I silently rooted. ‘My point exactly. I identify entirely with your pressing Paul to examine his life.’

But Paul retorted sharply in his next letter, “Given the choice between living and examining, I’ll choose living any day. I eschew the malady of explanation and urge you to do likewise. The drive to explain is an epidemic in modern thought and its major carriers are contemporary therapists: every shrink I have ever seen suffers from this malady, and it is addictive and contagious. Explanation is an illusion, a mirage, a construct, a soothing lullaby. Explanation has no existence. Let’s call it by its proper name, a coward’s defense against the white-knuckled, knee-knocking terror of the precariousness, indifference and capriciousness of sheer existence.” I read this passage a second and third time and felt destabilized. My resolve to posit any of the ideas fermenting in my mind wavered. I knew that there was zero chance that Paul would accept my invitation to dance.

Every once in a while I looked up and saw Paul’s eves riveted on me, taking in my every reaction, signaling me to go on reading. But, finally, when I saw there were only ten minutes left, I closed the folder and firmly took charge.

“Paul we’ve little time left and I have several things I want to discuss with you. I’m uncomfortable because we’re coming to the end of our session and I’ve not really addressed the very reason you contacted me – your major complaint, your writing block.”

“I never said that.”

“But in your email to me you said … here, I have it printed out…” I opened my folder but, before I could locate it, Paul responded:

“I know my words: I would like a consultation. I’ve read your novel, When Nietzsche Wept, and wonder if you’d be willing to see a fellow writer with a writing block.”

I looked up at him expecting a grin but he was entirely serious. He had said he had a writing block but had not explicitly labeled it as the problem for which he wanted help. It was a word-trap and I fought back irritation at being trifled with. ““I’m accustomed to helping folks with problems. That’s what therapists do. So one can easily see why I made that assumption.””

“I understand entirely.”

“Well then, let’s make a fresh start, ‘tell me, how can I be of help to you?’”

“Your reflections on the correspondence?”

“Can you be more explicit? It would help me frame my comments.”

“Any and every observation would be most helpful to me.”

“All right.” I opened the notebook and flipped through the pages, “As you know, I had time to read only a small portion, but overall I was captivated by it, Paul, and found it brimming with intelligence and erudition at the highest level. I was struck by the shift in roles. At first you were the student and he the teacher. But obviously you were a very special student and within a few months this young student and this renowned professor corresponded as equals. There was no doubt he had the greatest respect for your comments and your judgments. He admired your prose, valued your critique of his work, and I can only imagine that the time and energy he gave to you must have far exceeded what he could possibly have provided the typical student. And, of course, given that the correspondence continued long after your tenure as a student, there is no doubt that you and he were immensely important to one another.”

I looked at Paul. He sat motionless, his eyes filling with tears, eagerly drinking in all that I said, obviously thirsting for yet more. Finally, finally, we had had an encounter. Finally, I had given him something. I could bear witness to an event of extraordinary importance to Paul. I, and I alone, could testify that a great man deemed Paul Andrews to be significant. But the great man had died years ago and Paul had now grown too frail to bear this fact alone. He needed a witness, someone of stature, and I had been selected to fill that role. Yes, I had no doubt of this. This explanation had the aroma of truth.

Now to convey some of these thoughts that would be of value to Paul. As I looked back on all my many insights and at the few minutes remaining to us, I was uncertain where to begin and ultimately decided to start with the most obvious: “Paul, what struck me most strongly about your correspondence was the intensity and the tenderness of the bond between you and Professor Mueller. It struck me as a deep love. His death must have been terrible for you. I wonder if that painful loss still lingers and that is the reason you desired a consultation. What do you think?”

Paul did not answer. Instead he held out his hand for the manuscript and I returned it to him. He opened his briefcase, packed the binder of correspondence away, and zippered it shut.

“Am I right, Paul?”

“I desired a consultation with you because I desired it. And now I’ve had the consultation and I obtained precisely what I wished for. You’ve been helpful, exceedingly helpful. I expected nothing less. Thank you.”

“Before you leave, Paul, one more moment, please. I’ve always found it important to understand what helps. Could you expound for a moment on what you received from me. I believe that some greater clarification of this will serve you well in the future, and might be useful for me and my future clients.”

“Irv, I regret having to leave you with so many riddles but I’m afraid our time is up.” He tottered as he tried to rise. I reached out and grabbed his elbow to steady him. Then he straightened himself, reached to shake my hand and, with an invigorated gait, strode out of my office.

The Book of Woe: The DSM and the Unmaking of Psychiatry

Posted on February 7, 2015February 11, 2026 by Psychotherapy.net Team

Editor's Note: The following is excerpted from The Book of Woe: The DSM and the Unmaking of Psychiatry by Gary Greenberg. Published by arrangement with Blue Rider Press, a member of Penguin Group (USA).

In 2002, the APA officially announced that [the DSM-IV] had had its day. In A Research Agenda for DSM?V, a book that kicked off the official revision effort, the APA acknowledged that the reification of the DSM?IV’s categories, “to the point that they are considered to be the equivalent of diseases,” had most likely “hindered research.” Nor was “research exclusively focused on refining the DSM-defined syndromes [likely to] be successful in uncovering their underlying etiologies.” Searching for the causes of the illnesses listed in the DSM was proving to be not unlike a drunk looking for his car keys under a streetlight even if that’s not where he dropped them. Scientists were unlikely to find the causes of Generalized Anxiety Disorder or Major Depressive Disorder or any of the other DSM categories—as descriptive psychiatrists had been promising to do since Kraepelin—because it increasingly seemed unlikely that they really were the equivalent of diseases.

So the APA did what organizations everywhere do when they find themselves flummoxed. They convened a committee. To be exact, they convened thirteen committees that, beginning in 2004, held a series of “planning conferences” at APA headquarters. Because the conferences were explicitly devoted to finding that new paradigm—which, according to the Research Agenda, was “yet unknown”—the NIMH helped pay for them.

Among the people appointed to organize the conferences was a Columbia University psychiatrist named Michael First. First had been the text editor for the DSM?IV and the editor of the DSM?IV?TR. Since 1990, part of his salary at Columbia had been paid by the APA, for which he consulted on all matters related to the DSM. He’d already worked on DSM?5, editing the Research Agenda and writing its foreword.

When he’s not traveling around the world, lecturing on diagnostic issues or consulting to the Centers for Disease Control or the World Health Organization or teaching clinicians how to use the DSM, First can be found in a basement office at the New York State Psychiatric Institute, part of Columbia Presbyterian hospital on the northern tip of Manhattan. He’s bent over in his office chair when I arrive, searching for something amid the piles of papers that have spilled over from his desk and tables and onto the floor. Bearded and rumpled, he looks like a psychiatrist in a New Yorker cartoon. When he talks, thoughts tumble out like the papers in his office, one on top of another, but somehow usually making sense. So you’d be mistaken to think that he’s absentminded. If I hadn’t interrupted him, he would surely have reached into the mess and found just what he was looking for, just as he seems to be able to rummage around in his memory and retrieve the slightest detail of the DSM’s history.

“In a way, I was born to do the DSM,” First told me. But he didn’t always think so. “When I first saw DSM-III”—at the University of Pitts-burgh’s medical school in 1978—“I thought it was preposterous. I saw the Chinese-menu approach and thought, ‘This is how they do diagnosis in psychiatry?’ It seemed overly mechanical and didn’t fit my idea of what the study of the mind and psychiatry should be.”

First had a second love: computer science, which he had pursued as an undergraduate at Princeton. He’d almost chucked pre-med for computers, and during medical school, he continued his interest, working with a team using artificial intelligence for diagnosis in internal medicine. He took a year off to earn a master’s degree in computer science, working on a program to diagnose neurological problems. When he returned to medical school, he settled on psychiatry as his specialty, and his interest in using computers to aid diagnosticians made that Chinese-menu approach seem not quite so preposterous. “I thought, ‘Well, psychiatry is actually relatively straightforward. It’s got a book with rules in it already—an obvious good fortune if I was going to try to get a computer to be able to do this.” Which he was, and which is why he decided to go to the New York State Psychiatric Institute, the professional home of Bob Spitzer, where he planned to exploit his good fortune.

Spitzer had already flirted with computer-assisted diagnosis in the 1970s, when he was first developing the criteria-based approach. He’d abandoned the attempt, however, and soured on the idea. First managed to negotiate a bargain: he could work on his program so long as he helped out with one of Spitzer’s—an old-fashioned paper-and-pencil test Spitzer was developing called Structured Clinical Interview for DSM Disorders, or SCID. The SCID, which is still in use, is straight forward to use. If you answer yes when the doctor asks you if you’ve been sad for two weeks or more, then he is directed to ask you about the next criterion for depression—whether or not you have lost interest in your usual activities. If you answer no, then he moves on to a criterion for a different disorder. This goes on for forty-five minutes or so, the questions shunting you from one branch of the diagnostic tree to the next until you land on the leaf that is your diagnosis.

First eventually did develop his own diagnostic program. He called it DTREE, but it was a commercial failure. “I learned a lesson,” First said. “Doctors don’t care much about diagnosis. They use diagnosis mostly for codes. They don’t really care what the rules are.” When a patient comes in complaining of pervasive worry and jitters, with a little dread thrown in, most clinicians don’t take the time to climb around on the diagnostic tree. They don’t bother consulting the DSM’s list of criteria to diagnose Generalized Anxiety Disorder. They just write the code, 300.02, in the chart (and on the bill) and move on.

“That was my first lesson in how people think about diagnosis,” First told me.

First doesn’t think the solution is more reverence toward the DSM. Indeed, there may be only one thing worse than not paying attention to the DSM and that is paying it too much heed. “I think people take diagnosis too seriously,” he said. The DSM may appear to be a master text of psychological suffering, but this is misleading. “The fiction that diagnosis could be boiled down to a set of rules is something that people find very appealing, but I think it’s gotten out of hand. It is a convenient language for communication, and nothing more.” The rules are important, but they should not be applied outside of a very particular game.

In this respect, First thinks, “the DSM has been a victim of its own success.” If it was merely the lexicon that gave psychiatrists a way to talk to one another, then it might live in the same dusty obscurity as, say, Interventional Radiology in Women’s Health or Consensus in Clinical Nutrition does. If it was treated as a convenient fiction fashioned by expert consensus, and not the embodiment of a scientific understanding of human functioning, then newspapers would not be giving psychiatrists valuable op?ed real estate to debate its merits. If it hadn’t escaped its professional confines, it would not be seen as a Rosetta Stone capable of decoding the complexities of our inner lives. If it had not become an epistemic prison, psychiatrists wouldn’t be languishing in it, trying to find the biological correlates of disorders that don’t really exist, that were invented rather than discovered, whose inventors never meant to make such mischief, and whose sufferers, apparently unreasonably, take medical diagnoses seriously enough to expect them to be real.

First is right about at least one thing. Most clinicians don’t care what the DSM’s rules are. I know I don’t. I rarely take it down off my shelf. I use only a handful of the codes and by now I know them by heart.

At the top of my favorites list is 309.28, which stands for Adjustment Disorder with Mixed Anxiety and Depressed Mood. Here’s how the DSM?IV defines it:

A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)

B. These symptoms or behaviors are clinically significant as evidenced by either of the following:

marked distress that is in excess of what would be expected from exposure to the stressor
significant impairment in social or occupational (academic) functioning

C. The stress-related disturbance does not meet the criteria for another disorder

D. The symptoms do not represent Bereavement

E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months

I’m sure you can see why 309.28 is popular with clinicians, and why insurance company claims examiners probably see it all the time. It sounds innocuous, which makes it go down easy with patients (if, as I do, you tell your patients which mental illness you are now adding to their medical dossier) and with employers or insurers or others who might have occasion to scrutinize a patient’s medical history and be put off by a more serious-sounding diagnosis. It offers all kinds of diagnostic flexibility. Take Criterion B1, for instance. It is easy to meet; it is easy enough to use the fact that the patient made an appointment as evidence of “marked distress.” And that lovely parenthetical in Criterion E makes it possible to re?up the patient even after the six months have elapsed.

But Adjustment Disorder also has a special place in my heart because it was my own first diagnosis, or at least the first one I knew about. I got it sometime in the early 1980s, when I was in my early twenties and the DSM was in its third edition. I don’t remember why I wanted to be in therapy or very much of what I talked about with my therapist. I do remember that my father was paying for it. He was probably hoping I would discover that my self-chosen circumstances—living alone in a cabin in the woods without the modern conveniences—were a symptom of something that could be cured. What I was being treated for, however, was not “Back to the Land Disorder” or “Why Don’t You Grow Up Already Disorder,” but rather, as I discovered one day when I glanced down at my statement on the receptionist’s desk, Adjustment Disorder.

I guess the tag seemed about right. I definitely wasn’t adjusting; and if it occurred to me that by calling my lifestyle an illness (if indeed that’s what he meant to do, as opposed to just rendering the most innocuous-sounding diagnosis possible), my therapist had passed judgment on exactly where the problem resided, I didn’t think much of it at the time. But I do remember that I noticed, for the first time, that I’d been going to these weekly appointments in a doctor’s office. It happened to be in a building adjacent to the office of my childhood pediatrician, but it did not smell like alcohol or have a whiteshoed woman bustling about, nor did its business seem a bit related to the shots and probes I’d suffered next door, so the discord stood out. But still the fact of that diagnosis, right there in black-and-white, was undeniable. I was a mental patient.

I was eventually cured of my maladjustment—not by therapy, but by a family coup that resulted in my grandfather’s being relieved of the farm he’d inherited from his mother. That happened to be the land on which I’d built my home, and so I was evicted, my cabin eventually bulldozed and the land converted to McMansions, and it became necessary for me to earn a living. Of the many adjustments I have had to make, diagnosing people in order to secure an income was one of the strangest—not only because the DSM’s labels seemed so insufficient, its criteria so deracinated, the whole procedure so banal in comparison with the rich and disturbing and ultimately inexhaustible conversation that was occurring in my office, but also, and much more important, because of the bad faith involved. I didn’t mind colluding with my patients against the insurance companies; sometimes I actually enjoyed the thought. I brought them in on the scam, explaining exactly what diagnosis I was giving them, sometimes even taking out the book and reading the criteria and occasionally offering them a choice. But the fact that we were sharing the lie didn’t make our business any less dishonest.

I know therapists who diagnose everyone with Adjustment Disorder unless the insurance company limits benefits for its treatment on the grounds that it isn’t enough of an illness to warrant much treatment—at which point the patient often contracts a sudden case of something much worse, like Major Depressive Disorder. Myself, I prefer to mix things up a little. But mostly I prefer not to do business with insurance companies, so I often don’t have to bother with such dilemmas. Of course, that means I get paid less money, since not everyone can afford my rates without a little help from their friends at Aetna, so I end up giving people a break in return for steering clear of the whole unsavory business. Over the thirty years I’ve been in practice, I’ve probably left a couple million dollars on the table by avoiding the DSM. It’s an expensive habit, but I think of it as buying my way out of bad faith.

And it’s not just my rankand-file colleagues and I who think of the DSM as if it were a colonoscopy: a necessary evil, something to be endured and quickly forgotten, and surely not to be taken seriously unless you have to. I once asked psychiatrist and former president of the APA Paul Fink to tell me how the DSM was helpful in his daily practice.

“I have a patient that I’ve been seeing for two months,” he told me. “And my secretary said, ‘What’s the diagnosis?’ I thought a lot about it because I hadn’t really formulated it, and then I began to think: What are her symptoms? What does she do? How does she behave? I diagnosed her with obsessive compulsive disorder.”

“Did this change the way you treated her?” I asked.

“No.”

“So what was its value, would you say?”

“I got paid.”

It is at least ironic that a profession once dedicated to the pursuit of psychological truth is now dependent on this kind of dishonesty for its survival. But I suppose that any system guided by the invisiblehand—financial markets no more than healthcare financing—is bound to be gamed. And the DSM, whatever its flaws, has proved to be a superb playbook.

In Search of the Perfect Private Practitioner

Posted on February 4, 2015February 11, 2026 by Psychotherapy.net Team

It all began in my undergraduate abnormal psychology class after I made the curious observation that our faithful professor was absent for each and every one of our exams. The professor's pattern of behavior struck me as odd. I leaned over and asked a fellow student who worked as a teacher's aide what he knew about this since I figured he might just have the inside scoop.

My cohort whispered, "You really don't know. The guy is in private practice and he charges $50 an hour, man."

Seriously?

I nearly choked on my Adam's Apple. I didn't know a single soul who commanded $50 for an hour back then. I decided at that very moment that since I wanted to devote my life to helping others, I might as well do it with a bank account that rivaled the worth of US Bullion Depository at Fort Knox. I was going to be a private practice therapist. Yes indeed, a private practitioner, the most noble profession on the planet.
Soon after snaring my master's degree I set up shop in a plush psychotherapeutic district of the city. I wanted to be on the strip where all the other greatest local minds in the field of psychotherapy practiced their craft.

I was able to afford the raised gold leaf lettered ink business cards (okay barely), but renting an office in this venue was a whole different story. The rent was extremely expensive and was way out of my league. But I knew I was living right when I spied an ad for a choice office location for under $100 a month. It had to be a mistake. Nope, I contacted the real estate office and it was for real. Some guys just have all the luck.

But it didn't take long to see why I landed this lead airplane of an office for less than a C-note every 30 days. The office was heated by radiators and the temperature was controlled by the real estate company. When the radiators kicked in they generated a banging noise that sounded like a steel drum band. Try to do a little creative visualization here. I am attempting to perform hypnosis, systematic desensitization, or relaxation therapy, and it sounded like Gene Krupa, or perhaps the lead drummer from Led Zeppelin, had set up shop in the suite next door. Worse yet, the office temperature soared to Death Valley levels, to the point that it was wilting my books and artwork. I coped by showing up for some of my clients' sessions wearing a light short sleeve golf shirt on days when the thermometer was hovering near zero and the streets were covered in ice and snow.

To fight off the intense heat I installed two window AC units that raised the already high decibel level to a fever pitch. In case you are missing the point, this was not turning out to be the private practice made it heaven.

But an even bigger problem emerged. The slick business cards and the cool custom white lettering I personally purchased and mounted on the office suite door did nothing to bring in clients. What in the world was I thinking when I opened the practice? Was I pondering that somebody would be strolling down the street and just happen to mosey into the building for no special reason, and make the sojourn to the second floor? Then, while on the second floor, spy my compelling sign replete with my degree and think, "Awesome. I'll march right in and see this Rosenthal guy. Now would be a great time to do something about that anxiety problem of mine."

Actually, that's exactly what I was thinking would occur.

Then came the dawn. I needed a role model, a hero, someone to pump me up and make me optimistic. While spending time in my, ahem, comfortable cubby-hole excuse for a private practice, I read numerous books on psychotherapy since the office wasn't exactly brimming with clients.

Enter my savior, Dr. Karen Asch. Luckily, the neighborhood had a free community newspaper replete with a column called "Ask the Counselor," penned by a therapist named Dr. Karen Asch. Her distinguished confident mug shot graced every issue.

Each week she would take clients' questions and answer them. Her answers were solid and beyond insightful. I loved it. I finally knew there was psychotherapeutic light at the end of the tunnel.

In my mind Dr. Asch had it all. Here was a practitioner who was so well liked that clients were writing the newspaper weekly just to correspond with her. I imagined she had the perfect private practice. I didn't know how big it really was, but I knew it was big!

I made up my mind right then and there that one day I would be like Karen Asch. Indeed, I too would live the good life. I would write my own "Ask the Counselor" newspaper column and head up a mega private practice, packed with clients, just like hers.

I had never met Dr. Asch, but it is safe to say that I admired her from afar.

Fast forward approximately five years into the future. Although I was still running a part-time private practice (several miles down the road from my old office where the radiators and the twin window boxes kept things jumping), I had acquired a day job working for a nonprofit agency, where I gave numerous mental health lectures to the corporate world, schools, community groups, and organizations.

One evening I presented to a burgeoning mental health center. The lecture went well. But it was what occurred immediately after the talk that was significant.

As I was packing up my handouts to leave I froze. There she was. In the flesh. My hero, Dr. Karen Asch was standing in front of the coffee pot adding a dash of cream to her brew. She looked just as confident and successful as her picture in the throw-away paper made her out to be. She had not attended my lecture, but then again, who could blame her? Would you expect Albert Pujols to come to a beginning course on baseball for little leaguers or Martin E.P. Seligman to sit in on an introductory lecture on positive psychology? Well would you?

I nervously approached her. I didn't want to blow it. This was a seminal point in my career. "Dr. Asch."
She turned to face me. "Yes, may I help you?"

Me, behaving like a ten-year-old kid who just ran into Taylor Swift at a yogurt bar, "Are you the Dr. Karen Asch?"

"What do you mean the Dr. Karen Asch? Why do you say it like that?"

In sixty seconds or less, I encapsulated the saga of my anemic private practice and how she had been my much needed role model and hero. I described to her precisely how in my mind she had become the poster child for running a successful private practice.

What came next was totally unexpected.

Dr. Asch, the open, honest, and candid person that she was, revealed she could honestly never remember a single question submitted for her "Ask the Counselor Column." She created (translation: made up) the questions herself. She added that she just couldn't make it in private practice, because it was too darn difficult to get clients. Her dream private practice, I so vividly had created in my mind, didn't exist. She was now working full time at the agency where I had just given my speech as an administrator.

The next day my first call was from Dr. Asch. She candidly admitted that she was not happy at the agency where I had run into her the evening before and wondered if I could give her a few viable job leads. I did.
So in the end, the moral of the story is that the carpet is not always greener in your neighbor's private practice, though to be sure, their heating and cooling system might be a hairline quieter than your own. Or perhaps that we shouldn't judge a fellow private practitioner's business by our insides . . . or something like that.

Why Some Therapists Always Get Their Books Published

Posted on December 23, 2014February 11, 2026 by Psychotherapy.net Team

It's a shame for you not to write a book when many therapists do it so easily. The problem: Most psychotherapists know about as much about the publishing business as they do about building a nuclear power plant.

When I listen to therapists talk about writing their first book I generally hear something like, "Gee, I'd like to write a general, counseling, psychotherapy, or self-help book."

Let me assure you that the general counseling, psychotherapy, or self-improvement books are some of the most difficult topics world to get published. It worked in the 1960s and 1970s, but the chances of it working today are slim to none.

Yes, Gerald Corey is a master at pulling it off, Raymond Corsini was a maestro as well, Lewis R. Wolberg accomplished it big time, Sam Gladding does it exceedingly well, but it's an extremely difficult route to take. These folks are accomplished professionals. I am not saying it is not possible, just that there are easier paths. As an analogy, your child could become a professional athlete, but the odds of doing so are about 1 in almost 25,000. Translation: Little Jimmy or Sally is more apt to win the lottery. You could become the next Muriel James or Eric Berne, but you get what I am saying.

Believe it or not, there is one idea that is even worse than attempting to pen a general counseling, psychotherapy, or self-improvement book. This flawed plan goes something like this, "I had an interesting childhood. I grew up in South St. Louis, my father was an alcoholic and never paid attention to me, and my mother suffered from panic attacks and liked my sister best. I'll write a book about my life."

Folks, get over it! Tell your neighbor. Book an appointment with the therapist you don't know down the hall, but don't write a book about it. Almost anybody on the face of the globe could come up with a similar book about his or her own life. But why? Most publishers don't give a hoot that your mom liked your little sister best. Moms always do for gosh sakes!

As I often say in my lectures with a small degree of sincerity: If you lost a lot of weight with Atkins, exercise, or eating fruits and vegetables, trust me, you don't have a book. On the other hand, if you shed your pounds and drastically improved your blood chemistry markers while wolfing down a dozen ice cream bars each day, sitting on your duff watching "Saved by the Bell" reruns, then congratulations my dear reader, you have a book.

An editor of a publishing company is looking for something new, something exciting, and something different. (Or, on very rare occasions, something that has not been done in years.)

Let's examine the anatomy of a good book idea. Say you wanted to write a book on alcoholism. Would you be able to sell the idea to an agent or an editor? The simple answer is probably not. Now, let's assume you wanted to write a book on rational emotive behavior therapy (REBT) and alcoholism. That's a little better idea, but I certainly wouldn't consider it a strong idea. Assume you beefed it up a little and wanted to pen a tome on using REBT for alcoholic teens. Wow, now we are getting somewhere. And finally, you put together a book about using REBT for alcoholic teens who are disabled. Hmm, you might just have a winner.

Of course you are cutting down on the size of your audience, but in today's society the more specific the idea, the higher the likelihood you will dominate your market. Again, in today's market, the more specific the idea, the better.

Most authors in general (therapists included) search the entire globe in search of the perfect book idea, when in many instances that creative gem of wisdom is staring them in the face.

As a case in point, after I had written a number of books I therefore decided I was going to write a dictionary of counseling. Sure, there were other counseling dictionaries, but I was convinced mine would be the best. I mean come on, let's be brutally frank, isn't that what every psychotherapy author thinks? What happened next is very typical. Everybody rejected my idea.

Then one day, I had a powerful insight. What do I teach in college? Is it psychology or psychiatry? No, technically, the psychology program is two doors down from my office. Is it social work or counseling? Actually it is not. Well, what do I teach? We call our program human services. And then a bright light bulb lit up in my head. Had anybody ever written a dictionary of human services? At the speed of light I checked Books in Print, Amazon, B&N and anybody else I could think of. Nobody had composed a dictionary of human services. I had struck pay dirt. Within the year my CV was sporting "author of the first ever Human Services Dictionary." I don't know about you, but I really liked the way that looked on my vita.
The ultimate rule of publishing a book in this field is to write about what you know best.

7 Surprising facts about the book publishing business

Here are 7 sure-fire ways to jump-start your career as a book author:

1. Your first book is the most difficult to get published, but moving a book into print is never easy even if you are the author of 50 texts. Expect to be rejected a lot.

2. The most common question I receive is: "Dr. Rosenthal, how do I find an agent?"
Unless your book has massive appeal and you want to appear on the "Rachel Ray Show" or "Brian William's NBC Nightly News," you don't want an agent. In fact, most academic publishers won't speak to you if you have an agent. Most therapists reading this blog do not—I repeat do not —need an agent.

3. The second most common question I receive is: "Dr. Rosenthal, how do I copyright my book?"

My answer: Don't waste 30 seconds of your valuable time worrying about this process. Most publishers want to retain the copyright so it won't be an issue.

4. Another thing I hear is: "Should I send a publisher or editor my manuscript by mail or via an email attachment?"

The question is irrelevant because you should never send an agent or an editor a manuscript. If you do send a manuscript it is a red flag you don't know what you are doing and you won't be taken seriously. Instead, mail them a query letter, a book proposal, your first chapter, the strongest chapter from your work, and a CV. Since you probably don't understand what I am talking about here, I will put in a shameless plug and refer you to my new You Tube video. Click Here.

5. "Will I get rich off my monthly royalty checks?"

Yes, when the moon turns to green cheese! Most publishers send out royalty payments just twice a year, and I once worked with a company that paid just once a year.

6. "Should I hold out for a big advance?"

Yes, when the moon turns to green cheese a second time! First, if you get a $1000.00 advance, realize that the publisher will subtract a grand from your first royalty check. Second, keep in mind that a lot of academic publishers often offer no advances, and in fact, do the direct opposite. In an attempt to recoup their expenses for creating your book, they will pay you nothing (that's nada, zip, zero) for the first 500 or so copies. Check your book contract for specifics. Yes, Bill Clinton really received a ten million dollar advance and Dr. Phil no doubt rakes in a sizable sum as well. But in the case of celebrities, the publisher is buying a name.

7. "Isn't self publishing the best route?"

For most of us the answer is an unequivocal no. A publisher sends out 100,000 copies of their catalog at a time. Let's see, just 100,000 postage stamps would cost you $49,000. Gulp! Now add in your printing and paper costs. If you are one of the top direct mail marketers in the world, then yes self-publish. That eliminates virtually everybody who will ever read this blog.

Kevin Trudeau's self-published work Natural Cures They Don't Want You To Know About was at the top of the charts few years ago, but he literally put millions into infomericals and related advertising. Richard Nelson Bolles created What Color Is Your Parachute?, the best selling job hunting book in history. Initially, the text was a self-published work, but was later picked up by a creative mainstream publisher who catapulted the work into stardom.

If you give hundreds of workshops a year related to your book, then self-publishing might be a valid strategy.

And finally, if you try everything under the sun and it fails, then what the heck, self-publish.

I would be remiss if I didn't mention the hot topic of electronic books, or e-books, for short. E-books, or so-called digital works, can be read on electronic devices such as a computer, tablet, or Kindle. Books of this nature now account for approximately 30% of all book sales with over half of those sales taking place on Amazon.

Initially, e-book sales were surging and a lot of folks were worried that the paper and print versions of works were dead in the water. Not so. Digital sales seem to have leveled off. If you publish a book with a traditional publisher, you need not worry because if the publisher thinks there is any chance the book will sky rocket to stardom in an electronic version the company will create one for you.

In terms of self-publishing (also dubbed indie publishing) the e-book offers a viable route, but trust me when I say it is definitely no panacea. Have you ever sold books at a conference and told a participant who is eager to buy your text that it is only available in a digital format? There goes the autographed copy you could have sold.
If you do go the self-published e-book route I highly recommend you go through a firm who is skilled in putting these works together. Why? Unless you are a total computer geek there is an excellent chance the final product will not be easy to navigate and readers will shower your self-proclaimed masterpiece with negative reviews. Just as an example, your reader might click the chapter on group psychotherapy in the table of contents and takes her to the section on sports psychology. Expect to pay an e-book conversion firm approximately $300.00 or more for a job well done. What's that? You thought it was going to be free. Come on folks.

Another key hint is to keep the price of your self-published e-book very low. Although it sounds insanely low, some research indicates that a price tag under $5.00 would be prudent.

Unfortunately, the indie authors raking in money hand over fist with e-books are mainly in the fiction and romance genre and not psychotherapy. Several of my books sold via traditional publishers do indeed have e-book versions, but at this point in time the sales pale in comparison to their paper and ink counterparts. And yes, I have penned a single self-published e-book. As for sales of this digital masterwork, the number of readers is so small you'd need an electron microscope, and a good one at that, to get a sneak peek at the action.

So here's a toast to your bestseller. I'll see you on the Dr. Phil. Then again, maybe not.

Bad Therapy: Lets Talk About Torture…Wait, What????!!!

Posted on December 16, 2014February 11, 2026 by Psychotherapy.net Team

Well, this blog got awfully serious quick. I was going to write this one about addiction and alcoholism—not the lightest topic either—but with the release of the Torture Report, also known as the Senate’s highly-redacted executive summary from the Committee Study of the Central Intelligence Agency's Detention and Interrogation Program, I realized it would be morally remiss of me not to take this brief hot minute when the public eye is trained on this issue to share some information with you.

You see, I wrote my dissertation on psychologists’ involvement in the creation and implementation of the torture program at Guantanamo and other CIA “black sites” during the War on Terror. I was immersed in it for an embarrassingly long time (the dissertation that is), and I frankly had hoped the whole issue would be resolved by now—the perpetrators would be in prison, the system would be reformed so that it could never happen again, psychologists would have organized and taken a powerful stand against this misuse of power in their name. Yet here we are, 10 years after the first revelations of torture appeared in the media, my dissertation long since bound in obscurity in my school’s library, and not only are the revelations still coming, there is only now the first hint of a real investigation into the specific role psychologists played in this process. But as psychologist Steven Reisner states in his new piece in Slate, there would be no torture without psychologists. Also, just this morning there was a very informative and comprehensive segment on Democracy Now! featuring both Steven Reisner and Alfred McCoy, whose book A Question of Torture: CIA Interrogation, from the Cold War to the War on Terror provided the original road map to many of the issues I covered in my dissertation. I was at the 2007 APA Conference in San Francisco shown in this segment, where psychologists made a desperate plea to the APA to put an end to these practices, while military officers in full camo fatigues stood menacingly around the room and Col. Larry James (chief psychologist at Guantanamo) made the case that "if you remove psychologists from these facilities, people will die."

I’m obviously not going to be able to dive deeply into this issue for purposes of this blog, but I want to offer a few key points for you to keep in mind as the discourse around this recedes out of public consciousness and we all go back to business as usual.

This was not the case of a “few bad apples” defaming the good name of our profession. The CIA and the psychology profession have been tight since the beginning of the Cold War, when hysteria about communism led the CIA to begin hiring psychologists to perform research on “mind control.” At the time it was believed that, Manchurian-Candidate style, the whole United States would be hypnotized into communism (it was even believed the Soviets had bought the world’s supply of LSD and were planning to drop acid on the entire U.S. population) and it was important that the U.S. be able to preempt that terrible fate by developing mind-control mastery of our own. Huge Defense Department contracts started rolling out for researchers, who soon became known as “behavioral scientists.” Seriously, google “CIA and LSD”—it will blow your mind.
The most notorious of all the research programs commissioned by the CIA was known as MKULTRA. The CIA sent scouts out to APA conferences to find the best and the brightest to study mass mind control and individual coercion. The 25-year program included research on unwitting participants, prisoners of war in Vietnam, and an unknown number of deaths around the world. The Kubark Counter Intelligence Interrogation Manual, a distillation of all of this research, formed the basis of training programs adopted all through Latin America, and guided the CIA’s training of the secret police in Iran and the Philippines.The most famous of these training programs, the School of the Americas, has alone trained over 60,000 Latin American soldiers who have tortured, raped, assassinated, “disappeared,” massacred and made refugees of hundreds of thousands of people throughout Central and South America.
With professional psychology emerging out of war, 15% of psychology internship programs and 40% of post-doc programs funded by the Veteran’s administration, and over 60 years of Department of Defense funded research, the psychology profession has a long history of financial embeddedness with and indebtedness to the American military.
The American Medical Association and the American Psychiatric Association both condemned participation in any kind of “coercive interrogations” (not just enhanced interrogations) at Guantanamo and other black sites, which left psychologists in a power vacuum. Psychologists, some of us at least, get very excited about power, since we are, among the sciences, considered a “soft science.” In giving the Bush Administration an assurance that these enhanced interrogation techniques were based in “good science” (in actuality all experts agree that torture is excellent for producing false confessions), and that they were necessary to avoid further terrorist attacks, psychologists provided the legitimacy the Administration needed to subvert both constitutional and international law around the detention of prisoners of war and their treatment therein.
Bruce Jessen and James Mitchell, the rich, idiot psychologists who “reverse-engineered” torture tactics to employ on “detainees” of the War on Terror are actually just the tip of the iceberg. There were other psychologists involved in torturing prisoners and, what’s worse, the American Psychological Association actively covered it up with their much-maligned APA PENS Task Force (six of the ten task force members had close ties to the Department of Defense, and five of those six had direct experience with coercive interrogations at Guantánamo, Afghanistan, Iraq or other CIA black sites). There has been no serious investigation into the actions of these psychologists until the recent revelations in Pulitzer-prize winning reporter James Risen’s new book, Pay Any Price: Greed, Power and Endless War. Risen, who had access to hundreds of previously undisclosed emails involving senior APA staff, reports that the APA “worked assiduously to protect the psychologists…involved in the torture program.”
Just a reminder: Most of the people swooped up into custody and sent to CIA black sites were completely innocent. These roundups included farmers, cooks, taxi drivers—in short, anyone who had been “turned in” for the large bounty (as much as $5,000 per head) that the U.S. promised to Afghan informants. I’m linking here to an article reported on Fox News about revelations by Bush’s Republican former chief of staff to Colin Powell so you know this is not Lefty propaganda. Their lives have been ruined. Here’s a short video about one kid, Fahd Ghazy, 17 when he was kidnapped, now 30, who has been trapped at Guantanamo for 13 years despite being “cleared” to return to Yemen in 2007. Notice the kindness and humanity of his family and the sweet life he used to have.
Not a single person involved in the torture program, from psychologists on up to folks in the Bush administration, has been prosecuted. Oh, except for the CIA whistleblower who revealed the existence of the torture program. He’s in prison.
No safeguards have been put in place in the American Psychological Association’s ethics code to keep this from happening again. They have made several good sounding statements, but no actual changes have been made. As Steven Reisner states, “In 2008, a group of APA members appealed to the entire membership in a referendum to prohibit psychologists from participating in any operation that violates the Geneva Conventions or the United Nations Convention Against Torture. The referendum passed overwhelmingly and in February 2009 was made APA official policy by the member-run council. Yet to date, APA leadership refuses to implement the referendum, claiming the APA cannot determine when U.S. national security policy violates international law; the APA holds to this position even in the face of judgments rendered by the United Nations Committee Against Torture, for example, as to the illegal status of indefinite detentions at Guantanamo Bay.”
It’s just us chickens, folks. No one else is going to make this right for us, and the same handful of vocal psychologists have been out on the frontlines for the last 8 years, doing their best to sound the alarm. We therapists are all busy, I know, and we’re doing our best to help individuals transcend and heal from the pain of their lives and find joy and meaning. But the very people who accredit our institutions of learning (you know how everyone goes to APA accredited schools and gets APA accredited internships?) supported an illegal and immoral program of torture because…power and money. That and an atmosphere of fear after 9/11 that, generally speaking, is extremely hard to resist unless our guidelines, punishments and incentives (to be instruments of healing) are clear as the bright blue sky.
Psychologists, psychotherapists, anyone professing to have an interest in the psyche, which is the Greek word for soul (in fact, we've got an article this month by Care of the Soul author Thomas Moore on this topic!), simply have no business being anywhere near torture, either in spirit or law. Given that things have only gotten worse politically and economically over the last decade, with violent extremism at an all time high, there is nothing to keep this from happening again. Get educated. Get involved. Join Psychologists for Social Responsibility and Coalition for an Ethical Psychology. Or email me about your organization, or one that you know about that is doing awesome work out in the world—I want to know about it! Sign this petition calling for a special, independent prosecutor to investigate and prosecute (if there is sufficient evidence) any former officials involved in torture. If you are not a psychologist, spread the word to psychologists you know and, everyone, be sure to teach this history to folks in the field. The dark side of the profession needs to be known, made conscious, and integrated into our training curricula that is otherwise filled with so much self-congratulatory expertise.

I will argue in various ways in upcoming blogs that psychotherapy is fundamentally about love. It is through love that we connect and heal one another and is, in my humble opinion, what is being referred to when we talk about the “therapeutic alliance,” or refer to the ineffable healing process in therapy that scientists just can’t quantify, try as they might. But we mustn’t be content to keep our love confined to the therapeutic hour or the individuals with whom we work. Just because our work with clients is private and confidential doesn’t mean that we must live private and confidential lives. As Martin Luther King, Jr. said, “Power at its best is love implementing the demands of justice. Justice at its best is love correcting everything that stands against love.” As a group we tend to be conflict-averse and we’re used to holding a great deal of space for complexity, can imagine the inner lives of perpetrators and victims alike, and have trained ourselves to reflect instead of react. In this way we have a great deal to offer the suffering world, but we must step out of the confines of our cozy offices and actually find one another first. Otherwise we are just passing each other in life’s hallway for a quick pee break between sessions.

And for any of you brave souls who would like to know more about the dark side of the psychology profession and its role in torturing people the world over, feel free to request a copy of my dissertation. I’m hoping to turn it into a book, but if the dissertation was a slow process, well—let’s just say it might be awhile.

Until the next "Bad Therapy" installment, just know that torture is really the worst therapy of all. (Actually, you can read my subsequent blog on this scandal, written after the Hoffman Report was released in July of 2015, which finally brought the full gravity of the APA's collusion with torture into the bright light of day—also known as the front page of the New York Times.)

*The ideas expressed here are those of the author and not necessarily of Psychotherapy.net, which is gracious to offer a platform for their free expression.

Psychotherapy and the Care of Souls

Posted on December 13, 2014February 11, 2026 by Psychotherapy.net Team

To Serve the Soul

In Greek mythology, the wise healer and teacher Cheiron is part horse and part human, a centaur of sorts, but quite different from his wild and hardly civilized half-horse/half-human brothers. He did his work of healing and teaching in a cave. As a therapist, I sometimes think of myself as part animal, sitting in my cave, dealing with primal aspects of human existence, barely able to distinguish healing from teaching.

The modern therapist seems to think of the problems that come to him or her as deviations from the standard of normalcy and health. The point is to restore a person to a point where the presenting symptoms have been removed, as if by psychological surgery. I don’t see it that way. People come to me because deep down they can’t experience the joy of being who they are. They don’t feel in the positive flow of life. They may feel stuck in some repeating pattern that seems to go back far into their history. They may be focused on, or better, mesmerized by some symptom like an obsession or paranoia or anxiety. Generally, it’s the nature of life to flow, like a river, and not to be stuck or stopped.

Whenever I want to get on track with my work as a psychotherapist, I think back on the word. It is made of up two key Greek terms: psyche (soul) and therapeia (serve). “Psycho-therapy” means “to serve the soul.” Psyche is not mind or behavior, and therapeia does not mean healing or making better. I always keep in mind that my job is to serve the soul, or care for it. When I used an ancient phrase, common in Platonic literature, as the title of my most popular book, Care of the Soul, I was simply putting the word “psychotherapy” into English.

I think of the soul as the life in us that is immeasurably deep. Sometimes it feels like a spring or font of existence, making us feel alive and giving us something of a direction and identity. To a large extent it is autonomous, having its own purposes, desires and intentions. When you delve deep into it, you encounter basic human themes and patterns, what Plato and Jung and others call “archetypes.” The need for love, the desire to create, the comfort of home, the excitement of travel—these aren’t the characteristics of any particular person. They are, at least potentially, ways in which all people may experience life.

When these archetypal patterns come to life in a person, they usually have a strong force and allure. You are happy to be in love and can think of nothing else. You fear illness and death, and that emotion, with its clinging thoughts, gets hold of you. You glimpse a certain career, and you go after it with a passion.

Soul is intimate, embedded in life, vital and energetic. It seems to constantly want more life and vitality and therefore can be a threat to the status quo. “As you tend your soul, you may try to sense what it needs and wants, and you may discover that its needs may not dovetail with your own wishes.” In that spirit, the Irish poet W. B. Yeats said that his poetry came out of a tension between his own ideas and those of an antithetical self he felt inside him.

As I see it, this other being in us, the soul, is vaster than our small minds can contain. It’s strong and mysterious, and at times a true adversary. Our job is to get to know the soul and cooperate with it, understanding that our happiness and peace on earth depends on a positive and creative response to it. Psychotherapy may entail simply living in a way cognizant of the soul and its purposes.

Soul offers a deep and powerful sense of identity that counters any tendency to be caught in the limited understandings and values of the family or the culture. It asks that we each become individuals, not so identified with the structures around us. This need is so strong that I imagine it in the familiar imagery of rebirth: we are born into biological life and culture, and then we have to be born again into our own individuality and uniqueness. Along with Socrates, I would describe psychotherapy as a kind of maieutics, or midwifery. We have to assist at the birth of the soul into life, which implies the arrival of a unique person. Socrates said: “My concern is not with the body but with the soul that is in the travail of birth” (Theatetus, 150 b).

The Travail of Birth

The travail of birth is exactly what happens in therapy, to one degree or another. Travail means labor, but I see it more as a process. In formal therapy you reflect openly and seriously on the past, on dreams, on emotional difficulties, on relationships and a number of other issues, the material of a life, and process them. As you look more deeply and imaginatively at them, you see better what wants to be born and what hinders the birth. For many people, early traumas and bad parenting and unfortunate adult influences and threatening injunctions keep their longstanding hold and stand in the way of the soul’s movement into life.

Years ago I read the religion scholar Mircea Eliade’s unsettling description of a primitive rite of passage, and it has stayed with me. Young people would be placed in the earth, naked, perhaps under a pile of leaves, overnight or for several days, within a ritual context of masks, drums, body paint and dance. Then they’d be taken out and washed and clothed, adults now and fully part of the community.

I see therapy along these lines. “To be born into your individuality is no light matter. You need an impressive experience of death and rebirth.” Most of the time a real and transformative round of therapy is a step-by-step process of being reborn. The therapist is the elder in charge of the rite, but he or she is only the guide, not the healer. The point is to arrange an effective rebirth, letting the person then go on to discover his life. The therapist does not decide what life is best for the person, whether to be more dependent or independent, emotionally contained or effusive, whether to be married to a different person or to live somewhere else. The therapist doesn’t know what is best for the person, he or she can only assist at the birth of the soul.

Above all, a therapist needs purity of intention, the capacity to hear stories of suffering without responding unconsciously out of his own prejudices. A therapist has to know himself so well that he will pass on any temptation to engage in his own typical reactions. He will not take credit for any progress, and in fact will not think in terms of progress, but only care. Care is not heroic, it isn’t getting anywhere and it has no need to solve problems. A good therapist doesn’t see life as a problem to solve but as a gift to be observed closely and supported.

A therapist will not be deluded by the delusions of his patient. He will not be taken in by any loose complexes in his patient that try to trip up the therapist. If a patient says, “You haven’t given me your full attention today,” a good therapist won’t defend or explain himself. He might simply say, “You’re right. I’m preoccupied with my own situation today. Let’s start again.” He will not feel the guilt the patient wants him to feel and will not accept any adulation the patient tosses his way. Both are traps. He is neutral, not willing to get pulled away from his center by a patient’s neurotic need. In the face of sober and heavy influence, he may find neutrality in lightness of spirit and good humor. He may laugh easily but never sardonically.

Overcoming Our Complexes

A good therapist has moved past his need to help. While it’s true that doing therapy is being in therapy—the therapist may work through some of his own issues while being with another—the therapist is also neutral about his life work. He is not thrown when a patient doesn’t respond well to the therapist’s ideas and efforts. He doesn’t himself need a patient to get better or to go through the therapeutic process the way the therapist thinks is best. The therapist surrenders any pet enthusiasms, such as hoping that his patient will become more independent, artistic, self-aware, or emotionally expressive.

This neutrality is not indifference but an achievement in the therapist’s own opus, the work of his soul. He is not led on by his complexes in relation to his patients, the deeper meaning of the interesting classical notion of counter-transference. He is not at all perfect, but he is not acting out with his patients. He has an unusual degree of self-possession. He can reflect effectively on his own allegiances, philosophies, theories, techniques and ideals. He has developed his own approach and is not completely identified with a given figure in psychology or with a special theory.

A therapist also has to know how to deal with complexes of the people he assists. Jung described a complex as a sub-personality. I would put it differently: a complex has a face. Acting out a complex is like putting on a costume, though you don’t know that you’ve put it on. These figures of the deep psyche that take over a person, like Dr. Jekyll swamping Mr. Hyde, are unusually intelligent, convincing and full of shadow.

A person with a mother complex may strike you at first as being caring, thoughtful and capable of deep emotion. Only later do you see that this figure, this daemonic possession, dominates the person and may suffocate and overpower others who come into its domain. A mother who is atrociously critical of her daughter may believe that she is only doing what is best. Others may tell the daughter how lucky she is to have such a wonderful mother, and the daughter is thrown into painful confusion. Should she be grateful, or should she run away?

The therapist has to deal cautiously with the complex that enters his consulting room. He must not get caught, but that kind of neutrality is not easily achieved. He may be especially susceptible to certain complexes and not see them for what they are.

Complex is not the best word, perhaps, but it is traditional and important. A complex is more like a powerful presence that can assume the cohesion of a personality, although sometimes it is only an urge or an impulse. It can completely overwhelm a person or it can be merely an influence. In any case, a therapist needs courage and circumspection to deal with one, whether in his patient or in himself.

Religious traditions teach as much about these presences as psychology does, and it might help a therapist to do some study in religions and even see his role as being both psychological and spiritual. Religion specializes in rituals that help us meet the complexes in highly symbolic ways. In traditional Catholic confession, for example, you acknowledge dark spirits that invade your life, and the confession of these presences goes a long way toward dealing with them.

Personally, I have cultivated powers of intuition, skill at working with images, and knowledge about traditional spiritual rites and images so I can be prepared for images people use in telling their life stories and reporting their night dreams. I have drawn on the model of C. G. Jung, who was concerned both to be an intelligent, rational thinker and researcher and at the same time to go to great effort to employ the non-rational methods of the spiritual traditions. He was a stone-cutter, calligrapher, painter, and architect in his own way, making his personal environment link closely with his inner life.

Guide of Souls, Leader of Rituals

My mentors—Jung, James Hillman, and Rafael Lopez-Pedraza—have emphasized the role of the mythic Hermes in the work of therapy. Jung said that the work or opus begins and ends in Mercury (the Roman name for Hermes). This means that in this work you have to be imaginative, clever, quick-witted and skilled with language. You appreciate paradoxes and apparent opposites. You see past and through any material that is presented, and you go beyond the modern notion of the highly educated, trained expert. You need a deep and probing appreciation for the intricacies of the psyche, and your preparation has to be both scholarly and personal.

I have a deep appreciation for the work of therapists and I honor and support any therapists I meet. They have a key role in modern life as they address matters of the soul and spirit. In some ways they are the modern priest, priestess, guide of souls and leader of ritual. Their work is challenging for all its depth and mysteriousness, but it is equally rewarding precisely because it goes so deep.

But some therapists make a mistake in thinking of their position as one of a trained advice-giver or aid to adjustment and smooth living. Their job, rather, is to be courageous enough to face the demons with their patients and get tangled in the complicated mysteries of a human life. To do their job effectively, they need to know depth psychology, philosophy, solid religious thought and art. They should be at home with dreams and extraordinary fantasies. They should be able to see through aggression and masochism to glimpse the positive mysteries trying to be expressed and lived.

This kind of therapist has thought deeply about the mysteries of human personality and doesn’t reduce them to simple patterns. Throughout his life and career this therapist continues to explore complex matters, prizing any resources that help, and faces his own complexes. He is always on the border, Hermes-like, between the inner and the outer, the personal and the universal, ordinary life and the sacred, and the surfaces and the depths. He is shaman-like, able to traverse levels of reality and experience. He has adapted to the mysterious nature of his work by being himself a mysterious person, not too easy to read and comfortable being neutral in the face of another’s passion.

The Cheiron therapist works in a cave, a place set apart from the normal way of seeing things. He needs a lot of animal in him to sense the many messages from his patient and from within himself. He has to take on the mythic dimensions of a centaur because work with the soul is too much for the human mind. “The therapist is willing to be bigger than life and almost other than human, a person of huge imagination, able to hold almost any manifestation of human struggle.” He has to be naturally religious, in the sense of honoring the natural life flowing through himself and his clients and responding effectively to the great mysteries that only the best art and religious forms have been able to grasp. He is a person able to contain the immense joys and sorrows that visit every human life. And all of this in an ordinary person, humble in the best sense, in love with life and able to love those in distress. It’s a wonderful calling and a grace to those who accept it.

Bad Therapy: What You Didn’t Learn in Grad School

Posted on November 18, 2014February 11, 2026 by Psychotherapy.net Team

The Problem with the "Great Masters"

Going through graduate school training, we were barraged with examples of “good therapy” from every well-known therapist of the last century. We learned unconditional regard from Carl Rogers, the empty chair technique from Fritz Perls, the nature of deep intrapsychic conflicts from Freud, the collective unconscious from Jung, group therapy from Yalom, EFT from Sue Johnson. We were treated to endless case studies of poor souls trudging through the morass of their unmanageable lives, whose problems were deftly transformed by analysis, exposures, emotion-focused “interventions” and, when all else failed, that ineffable “therapeutic alliance” the great Masters of therapy seemed to so effortlessly form with their clients.

We learned the art of “case formulation,” whereby a complicated human’s life was distilled into three or four paragraphs of neutered narrative, followed by a plan of action that conformed to the theory and world view of whoever was supervising us. Depending on the supervisor, we either shared our real anxieties about our work with clients, or we manufactured false narratives to avoid their opprobrium—but in either case, we endeavored to tie the loose ends of our work into pithy parables with tidy endings. We all make mistakes, our teachers said. Even the great Masters made mistakes! But fortunately for them, through concerted effort, self-analysis and the lucky fact that clients tend to make good use of us even when we suck, everything always seemed to work out in the end.

Notably absent from our lectures, case conferences and readings? Terrible, no good, very bad therapy. Irreparable empathic failures, sexual transgressions, narcissistic hostage-taking, wounding reservedness that traps clients in unrequited longing, client suicides, damaging advice, damaging refusal to give advice—these topics weren’t on our syllabus. If we were really lucky, we found a friend or two in our training cohort who we could dish the truth with, and if we were really, really lucky, we had a supportive supervisor somewhere along the way who encouraged our self-honesty with their own. Otherwise, it seemed that the collective ego of the therapy profession was a bit too fragile to handle its own dark side.

This is tragic, if you think about it. It has created a professional culture that values vulnerability on the part of clients while encouraging therapists to keep tight-lipped about our own. When we are stuck in the mire of our own crappy work, we’re taught that our clients must have “primitive defenses” and just can’t “take in” our “good breast.”* As we progress through training, the laid-back, open, casual style of interacting with clients we began with takes on a weighty “professionalism” that turns what is simple into something complex, and what is complex into something simple. Love, which one might argue is the basic foundation of good therapy, becomes “countertransference,” a narcissistic use of the client’s idealized “transference” with us. Meanwhile, a complex amalgam of "bio-psycho-social factors" (a favorite grad school term) are boiled down to “maladaptive patterns,” “unconscious drives” and “negative thought cycles.” With no one showing us how to fumble and fail, we become very invested in our “look good,” at great cost to both us (it’s a straight jacket that literally takes the form of our therapy “outfits”; I once had a supervisor advise me against wearing open-toed shoes—too suggestive) and our clients.

Thankfully, I was one of the lucky ones, with both colleagues and a few supervisors willing to be authentic and vulnerable, as well as a therapist who shares her weaknesses and vulnerabilities with me. The safety of these relationships allowed me to come to terms with the bad therapist in me. The one who wants all of her clients to love her, who has omnipotent savior fantasies, sometimes fuzzy boundaries and who, in my first year of training, felt compelled to continually ask a client, “How is it for you that I’m white and you’re black?”—a directive from my multicultural therapy class—to which she replied, “I don’t give a shit!” She was a poor, old, disabled widow living alone and I did house visits. I brought her baked chickens and occasional groceries, even though I was explicitly forbidden from doing so by the agency I was working for. I was supposed to be doing psychodynamic therapy with her, but how do you do psychodynamic therapy with someone who doesn’t have enough to eat and doesn’t give two sticks about her unconscious? Was baked chicken good therapy? Yes, I think it was. Would I do it again? Probably not. I had very little sense of my own boundaries back then (nor the financial ruin that lay ahead of me due to years and years of school loans that were never enough to live on) and today would be more self-protective. But do I regret it? Nope.

In future "Bad Therapy" blogs, I will dive into some vulnerable, messy material in an attempt to correct for the “look good” problem we therapists have. Besides, bad therapy is incredibly good learning material, an object lesson on what not to do, and an opportunity to reflect on how and why we miss the mark. I will share some of my bad therapy experiences, on both sides of the couch (I will heavily encrypt those in which I’m the bad therapist), and want to hear yours. I am more interested in your experiences as a client than as a therapist, since it’s hard for therapists to really deliver the bad word on ourselves—and we are also bound by confidentiality—while as clients we can be more truthful about the badness of our therapy.

A Case Study

For example, when I first moved to the Bay Area in my early twenties, I innocently tore off a phone number of a therapist posted in a local grocery store. In that first session, he took off his shoes and sat with his legs wide open, his dick bulging against his pants unfettered, like a co-therapist. After recounting my travails (sweet, naïve thing that I was), he said, “Are you sure you want to be telling me all of this in your first session?” What therapist says that??! I left Dick Guy’s session feeling horribly exposed and vulnerable, knowing something wasn’t quite right. The following day I got the courage to leave a message for him saying that I didn’t think we were a good fit. He then proceeded to phone stalk me for the next week, alleging that we needed a few more sessions to really process this and I was giving up too early. Shouting “leave me the hell alone!” at his voicemail ended the sordid ordeal. Almost. The following year I went to a local hot spring where people go to relax and be naked in nature for retreats (this is the Bay Area, remember) and … well, you see where this is going. We pretended we didn’t know each other and I got the heck out of there. Sometimes a cigar would be a welcome relief.

What caused this guy to be overly familiar, strangely awkward around my self-revelations, and a stalker? Honestly, I think he was kind of a sicko, but it does bring to mind this thing we do with clients when they want to leave: “OK, how about we take three months to talk about termination?” “Let’s explore your resistance a bit further before making any changes to your therapy schedule.” Sure, sometimes that’s appropriate, but a lot of times clients feel trapped, and if there is any care-taking of family in their past, they’ll take care of us…for years!

What I know is these stories are not unusual. There is so much bad therapy going on that it deserves some attention. I’ve got lots of stories in my arsenal already, both from my life and those of my friends, and I want to invite you to send me yours. Now that I’ve introduced the idea behind this blog, we can dive right in.

One favor: Please don't reveal the identities of the therapists in question, as these are meant to be anonymous anecdotes that will serve as object lessons, help us therapists hone our craft and view ourselves with a bit more humor and humility. I don't want to be in the position of having to report illegal behavior; please do that directly with the Board of Psychology, or your version of the equivalent in your state.

If you (or a friend) would like to submit anonymously, you can set up a pseudonymous email account with gmail or another service provider, and submit your email from there. Again, this isn't about nailing anyone publicly (we all fail at times) and I will take every last precaution to make these stories as generalized and unidentifiable as possible. If you're fine telling me your story directly, you can email me your anecdote and your identity will be kept confidential. Send your stories to: deborah@psychotherapy.net and spread the word to others who may have bad therapy stories!

*True story.

When the Therapist Loves and Hates

Posted on November 13, 2014February 11, 2026 by Psychotherapy.net Team

That creatures must find each other for bodily comfort,

that voices of the psyche drive through the flesh

further than the dense brain could have foretold,

that the planetary nights are growing cold for those

on the same journey who want to touch

one creature-traveler clear to the end;

that without tenderness, we are in hell.

—Adrienne Rich

The Embrace

She looked deeply into his eyes and he looked into hers. Their bodies were very close, melding with one another. He touched her breast, grazing, and then holding it. Responding with her all, breathing in his fragrance, she embraced him. They were enthralled with one another, the love chemical flowing with the delight that they shared.

Although this may sound like a description of lovers in the first phase of their sexual relationship, it is a description of a mother-infant embrace. Many mothers, myself included, can easily call to mind and re-experience the intensity of having newborn infants. Longing for skin-to-skin contact, needing to engage in the reciprocal dynamic of breastfeeding (the baby needs her empty belly to be filled, the mother needs to have her swollen breasts emptied), the baby’s absolute dependence on the mother and the mother’s experience of total responsibility for the baby—in the earliest days between mother and child, only the other exists.

This “altered state” of consciousness, shared by new lovers and the mother-infant dyad alike, is also commonly experienced by the psychotherapeutic “couple” in much the same way—with longings for contact, a desire to feed and be fed, and the shared experience of total dependence on the other, as if no one else exists during the therapeutic hour. Yet unlike the merging love experienced by mother and infant, this love between therapist and client remains somewhat taboo in therapeutic culture. Because of this, clinicians often unwittingly (and unconsciously) let their clients carry all of the loving feelings for the dyad. “We’ve all heard many stories of therapists abusing their power and acting out sexually with clients in the name of “love.” But what of the damage inflicted by avoiding, denying, or otherwise minimizing love in the therapy relationship?”

Hate

And then there’s hate.

We have all felt critical, angry, hateful, and exasperated toward others at some point, so it only makes sense that therapists have both hateful and loving feelings toward our clients. We need to be flexible feelers, comfortable with the variety of feelings we experience and also wiling, when appropriate, to express these feelings with clients. But feeling hateful toward clients is extremely uncomfortable for therapists; it is defensive in its very nature when we are expected to be open, undefensive, unreactive, thoughtful.

In the history of psychoanalytic ideas, aggression has generated enormous controversy and continues to be the subject of sustained and intense interest. Sigmund Freud wrote extensively about aggressive impulses and, for him, they were more than a mere branch of human motivations. In Civilization and Its Discontents, he characterized antagonistic tendencies as the primary, dominating, “central and abiding part of human experience.”

Like love, hatred is enormously complex, and warrants serious reflection when it comes up with clients. Without self-awareness, hateful feelings can lead us to hurt and blame our clients, to harm them. How therapists understand and relate to aggressive feelings is critical in the clinical setting, but too often we suppress and repress them, just as we do with love.

In my experience, making room for—welcoming, even—our deepest feelings of love and hate for and with our clients is what makes the relationship truly transformative. If we can bear the vulnerability (which, frankly, we should), our work can be deeply healing for both our clients and ourselves. I present my therapy with Lucy to illustrate the depth of feeling that arises in our work, and to caution against repressing and denying these feelings out of a mistaken belief that we are somehow serving our clients by staying more “neutral.”

Lucy

My new patient was a hooker. She spit this out right after my conventional introduction of “Hello, I am Chris Peterson. Please come in.” There it was, right up front, as if Lucy needed to get past this, deal with whatever she might have expected my reaction to be, and move on.

I felt an immediate liking for Lucy. She was 30, beautiful in a Bohemian way, and sported multiple piercings on her ears, eyebrows, and nose. Her face looked younger than her years, her eyes sparkled, and she practically bounced with energy. She talked about the various men she serviced in lurid detail in an attempt, I surmise, to shock (and test) me. I was rapt, but not ruffled. This was the third time a sex-worker had found her way to my consulting room and, like the others, Lucy was dealing with a past that included abuse, abandonment, and conflicted relationships. All such patients struggle with their own histories, which can include an abusive parent or parents, a competitive relationship with their mothers, and/or leaving home at an early age to escape further pain or degradation. These women want to be loved and to be healed, but are often “looking for love in all the wrong places.” Growing up in an emotionally volatile and abusive family, Lucy had little experience with feeling loved and nurtured. Love came to her through pain, abuse, and incestuous boundary violations.

I focused intensely on her stories, trying to understand her perceptions of herself and her fear of and longing for relationships with others and the greater whole of life. She seemed to have a sense of engagement with me and it seemed like she was open when we were in session, but for many months there was little carryover from one session to the next. She struggled with exposing herself and being vulnerable, and so did I.

I often found myself frustrated—sometimes to the point of utter exasperation—with what seemed like the snail's pace of Lucy’s progress. The stagnation and endless repetition of highly predictable and ritualized patterns in each session were difficult to tolerate. When she was feeling vulnerable and too dependent on me, she would attempt to control the situation and create distance between us by moving into a blatantly seductive role. She would arrive to session dressed in provocative attire, and when the end of the session drew near, she would jump up to leave, announcing that both of us had someone waiting.

This kind of behavior happened most consistently when there was a break in our usual session time or when I left on a scheduled vacation. I wondered aloud with her about how she experienced these changes and absences. Initially she responded to my queries with a look of stunned astonishment, a negation of the importance of the break, followed by a cavalier comment discounting any connection between our separation and her behavior. My attempts to connect with her in a loving way were effectively blocked, and I was aware of how I began distancing myself from her.

After many months of treatment, however, I grew more optimistic and heartened by the increasing depth and overall sense of warmth and engagement that began to evolve in many of our sessions. Lowering my own distancing defenses—and my heightened awareness and sensitivity to how these functions served Lucy—helped me to do a better job of helping her modulate her responses, which in many instances recapitulated her early childhood traumatic experiences and painful feelings. At the beginning of treatment she knew no other way to respond to invitations of what she thought was intimacy; she knew no other way to survive. Yet gradually she developed an awareness of the sources of her difficulty in maintaining relationships.

These obstacles to relationship intimacy had begun during her earliest childhood, followed her through her grade school years, and continued into adulthood; consciously she did not recognize the empty and often self-degrading aspects of her encounters with others. Lucy had been a prostitute for close to 15 years, having started at the age of 15 in a desperate attempt to survive in a very primary way. With few exceptions, her experiences of sexual intimacy were comprised of her being penetrated in an abusive manner. Sexual vulnerability and human dependency carried risk for Lucy and challenged her sense of her capacity to survive.

The Breakthrough

In the real world of therapy there are few “breakthroughs” of the Hollywood kind. However, Lucy and I did experience such a moment in our work, which we both continued to recreate in later sessions. In the beginning of the third year of our work, following a month of increased focus on her longings for and terror of close and loving connections, a silence fell on us during one session. It was not an awkward and painful silence; rather, we both felt it as a deep and meaningful stillness. As we sat together, she looked up at me and I met her gaze directly. We held this gaze for several moments, both enthralled with each other, both moved to an almost orgasmic connection. The long months of avoiding emotional attachment began to give way to a new and intimate connection between us. The energy she had so desperately needed to use to hold me at arm’s distance was now more available for the task at hand—to begin to get critical needs met and to experience a safe, nurturing, and healing relationship.

Throughout the course of my work with Lucy I was brought to the brink of both love and hate. We had to navigate through both extremes in the service of helping her first allow dependence and then to separate. As a psychotherapeutic “couple” we both longed for contact, wanted to feed and be fed, and initially feared one another, but with time enjoyed the occasional shared experience of total dependence on each other. I came to understand the frustration I felt initially as my longing to have her work at my pace and to accept me quickly as a safe and reliable mother. Her defenses against that kind of merging were difficult for me to withstand. I wanted her to taste how sweet and warm my breast milk was and to know I would feed her well—to trust me and depend on me. Her resistant defiance enraged me at times, and as much as I intellectually understood some of what had occurred in her life to create this defensiveness, emotionally I felt rejected. She triggered feelings in me of inadequacy and powerlessness—feelings that, I came to appreciate, she had carried throughout her life. With time we could begin identifying what feelings were hers, mine, and ours.

The more loving feelings arrived gently, but grew steadily. These did not completely replace the hateful feelings, but balanced them in such a way that while both were in play, they were more tolerable and open to a deepening analysis. Lucy initially enacted a bit of sadomasochism in her mode of relating with me, creating pain for both of us. In response, I felt her resistance to my attempts to care for and nurture her, which triggered a sense of impotent, hopeless rage in me.

Lucy and I were able to explore the sexualization of her aggression, along with its possible roots. She recalled moments of intense longing for her withholding mother. The transference-countertransference enactment that occurred early in treatment was interesting and demonstrated an aggressive but essentially erotic interplay. When I was able to ask what she noticed when the seductive behavior took over, she could only say that she worried I was frustrated with her (and I was) and seduction was her way of dealing with that worry. In time, we were able to explore this. Lucy was moved to frustrate me or make me angry in some way so as to defend against the longings she felt at the beginning of many sessions. She also added that she became more certain of where she stood with me if she made me angry.

Her seductive relating was a defensive effort to change negative experiences into positive ones. As noted by Harriet Wrye and Judith Welles in their book The Narration of Desire: Erotic Transferences and Countertransferences, this idea is based on an associative model, which claims that both positive and negative experiences occur together in childhood and can become fused so that seduction (sex) is in the service of an irresistible pull toward a destructive interplay. This destructive interplay had been the only way Lucy could make contact with people, and her aggression projected the illusion of strength. It summoned the armor surrounding and hiding her vulnerability, making her feel self-protected rather than relying on my goodwill. But, to paraphrase Ellen Liegner in The Hate That Cures, although at times the therapeutic relationship might be characterized by a mutual hatred, the patient wants a positive relationship. The therapist must not act upon his/her own feelings of outrage, vexation, or exasperation, but through self-analysis recognize her intense emotions and use them in the service of authentically understanding and connecting with the patient.

Lucy’s feelings of hate subsided and, in time, were replaced by feelings of appreciation. She began to act like a loving person. It is likely that the narcissism of her early caretakers and their failure to act in mature and loving ways toward her were responsible for the development of her pathology.

The Primacy of Love

Why is it challenging to honor the healing potential of loving feelings in psychotherapy? What gets in the way of valuing and expressing love? Is it easier to abandon the issue than to be vulnerable and do the self-reflection and analysis that such feelings call upon us to do?

The capacity for love and concern on the therapist’s part is actually evidence of a healthy and thriving individual, and was considered by Winnicott to be an accomplishment that “develops out of the simultaneous love-hate experience, which implies the achievement of ambivalence, the enrichment and refinement of which leads to the emergence of concern.” In other words, a clinician’s ability to love is vital to the therapeutic endeavor, no matter what theoretical model is being used.

If we as therapists value others and are genuinely interested in serving their well-being without displacing or diminishing our own, we don’t respond first from within a theoretical model—we respond with our hearts and let love guide us. Having our needs felt by an influential and trusted other is critical when we are children, and dynamic, loving relationships remain important throughout our lives. Healthy dependency is embedded in Winnicott’s capacity for concern; it is needed to prevent psychological rigidity and to foster a willingness, and even enthusiasm, for being influenced by others. Loving is a distinct way of perceiving and being with our patients, ourselves, and others. It is rooted in vitality and wonder, and in therapy this feeling comes alive in an emotionally interactive, mutually transformative dance.

People have been grappling with definitions of love for thousands of years and there is no uniform agreement on what exactly love is. Erich Fromm defined loving as commitment of oneself to another without a guarantee. That is hard work. It means trying again and again despite pain and hurt, teaching others how to help us, extending a helping hand toward others at the exact moment we need a hand extended toward us. Is it possible that love is often sidelined in our field not because it is ineffective, but because it is so demanding?

Whereas there is considerable lip service given to what Carl Rogers referred to as “unconditional positive regard,” it is often misconstrued as neutralized affect, not the deep and authentic love and caring Rogers meant it to be. There is an undercurrent flowing steadily through many psychoanalytic tributaries that whispers, “Care less, keep your distance, don’t work too hard.” The implication is that if we as therapists care too much, believe too readily, or get pulled in too deeply, we are foolish. But love is an experience of a deep human connection—on an unconscious as well as a conscious level—that involves generosity, recognition, acceptance, and something like forgiveness.

Being with patients in the therapy room, allowing for an intimate exchange (intercourse, in fact), holding them with words rather than with arms, and containing their intense feelings as they learn how better to contain these themselves is the very essence of my work. It is important that we as therapists devote our clinical, educational, and personal consideration to our love for the client within the therapeutic context as an essential and valuable element of effective therapy, regardless of our theoretical orientations. Psychoanalyst Judith Vida, when asked how love contributes to psychoanalysis, responded:

"It is not possible for me even to enter my office in the morning of a clinical day without the hope and the possibility of love. How can I say what it 'contributes' when it is not an option or a conscious choice whether it is there or not? This is like saying, 'Does it contribute to the therapeutic action that the analyst draws breath, has a blood pressure, and a pulse?' For me, the proper question is not 'whether' or 'if' but 'how.' How is love present—and absent—in the therapeutic situation, and how is it manifested?"

In essence, it is love that makes psychotherapy work. It is the element, beyond theory or technique, that makes transformation possible. And there is no love without hate, as they are inexorably linked. We must we willing to experience all of it so that our clients can too.

What every therapist needs to know about the new natural remedies for mental health

Posted on October 15, 2014February 11, 2026 by Psychotherapy.net Team

Yesterday I was doing some research at a local library. A bus full of middle school children on a field trip was letting the students out in front of me. I made my way around the facility for a good twenty minutes when I overheard a frustrated woman struggling with her computer. She bolted from her computer terminal and marched up to a librarian and asked her for technical assistance.

"I don't have a clue," the librarian candidly responded, "go ask one of those eighth graders."

Welcome to the new age. An age in which the average eighth grader might know more than us about our computer and definitely knows more than we do about our cell phones. But there is another societal dynamic which is somewhat analogous, but decidedly more important. This is the first generation of psychotherapy clients who are often better informed about natural mental health remedies than their therapists.

The object of this blog is not to rectify the lack of knowledge. That journey might entail reading scores of books, perusing endless articles, and watching enough You Tube videos to give you severe eye strain. The idea herein is merely to provide you with enough information so that when a client mentions a natural approach you won't wrongly think he or she has lapsed into speaking a foreign language.

Finally, since the data in this area are so voluminous, not to mention controversial, I will merely give you enough information to fit on the head of a pin. Ready? Let's do this.

St. John's Wort (SJW), an herbal remedy, has become the darling of the alternative mental health treatment movement. Incidentally, that's wort, not wart, so you need not see a dermatologist. Wort is Old English for plant. Your more educated clients may refer to it as "hypericum" the scientific name, but thanks to this blog, you'll know they are referring to good old St. John's Wort. In some statistical studies St. John's Wort ran neck and neck with prescription counterparts for depression and anxiety. Detractors often point out that St. John's Wort can cause sun sensitivity, but so can antibiotics and pain relief medications.

SAMe (Typically enunciated SAMMY) was discovered in Italy many years ago. This nutraceutical has been used for depression, fibromyalgia and arthritis in other countries with a high degree of success. The key selling point is that SAMe often works faster than prescription medicines and negative side effects are extremely rare.

5 HTP or 5-Hydroxytryptophan. This super star is reputed to be superior to psychiatric medicinals in terms of raising serotonin levels in the brain. Some folks also insist it can help you shed a few pounds and swear it works wonders as a sleep aid. Rumors abound that athletes involved in extreme endurance sports have used it for years to counteract the depression brought on by very high levels of aerobic exercise.

Increase your exposure to sunlight or full spectrum lighting. Psychiatrist Dr. Norman Rosenthal (no relation to this author) first described Seasonal Affective Disorder (SAD) which afflicts 7 million women and a rather large number of men. SAD is a type of depression which manifests itself when the days get darker and shorter limiting one's sun exposure. Alternative mental health practitioners worry that the recommendation to wear sunscreen at all times and to avoid the sun has made individuals more prone to SAD. For those who cannot spend time in the sun, full spectrum lights and phototherapy devices are available. Word of warning: Your friendly neighborhood dermatologist who is determined to prevent cancer and related skin damage is not a fan of this theory!

Vitamin D, or should I say hormone D. Cutting edge theory asserts that vitamin D is not a vitamin, but a hormone. Appropriate levels of this nutrient, um I mean hormone, help fight mood disorders and seemingly drastically boost the immune system. The problem: It is possible that traditional government recommendations were way too low. Some clients now ingest 10 to 125 times the amount of vitamin D suggested by Uncle Sam just a few years ago. Interestingly enough, even mainstream physicians who initially scuffed at this idea are now routinely insisting that patients get their vitamin D levels checked. Skeptics warn that we don't know the long term effects of taking such high doses. Zealots, insist that a day on the beach is the equivalent of taking a handful of vitamin D pills. Stay tuned, this one should get interesting.

Fish Oil to raise Omega 3 EPA/DHA levels. In at least one research study, the experiment was stopped because bi-polar subjects receiving fish oil were progressing much better than those who did not, and quite frankly it didn't seem fair to the group who was not ingesting the supplement.
Many therapists have heard the rumor that kids living in fishing towns have lower levels of ADHD and adults residing in these areas suffer from fewer bouts of depression and anxiety. Fish oil, in addition to its ability to stabilize one's mood, also theoretically promotes cardiovascular health and is often championed as beneficial for eyes, skin and joints. As of late, a couple of anecdotal reports indicate massive dosages might even help in cases of seemingly incurable brain trauma (e.g., after an auto or mining accident). The prescription to "eat more fish" is likely not the ideal since our waters are polluted. Moreover, studies in this area use fish oil capsules (not a generous helping of salmon) to enhance scientific rigor and the ability to regulate the dosage.

Supplement critics warn us that fish oil capsules can contain mercury and other toxic heavy metals. This argument may have been true at one time (and early on seriously good fish oils cost an arm and a leg), however, in this day and age, even many low cost drug store brands boast pharmaceutical grade processing and "mercury free" capsules. New research seems to indicate that the urban legend suggesting that fish oil can make one bleed to death is . . . well . . . just that; an urban legend.

The argument against fish oil: Cult biologist Dr. Ray Peat — who proponents say is 100 years ahead of his time — says the omega 3 fatty acids in fish, EPA/DHA are anything but essential. Simply put, Dr. Peat does not recommend fish oil citing studies indicating it actually hinders the immune system. Surgeon and former Olympic rowing champion, Dr. Caldwell B. Esselstyn Jr., the cardiologist who nursed Bill Clinton back to health after his life-threatening heart problems, is famous for yelling "no oils" in his popular lectures. Okay Dr. E, we get the point!

If you, or your clients, do purchase fish oil, it is best to stick to brands packaged in dark glass or plastic bottles and keep the supplement refrigerated to avoid rancidity. Finally, be acutely aware that the number of milligrams on the front of the bottle — generally a huge selling point (say 1200 mg) — has nothing to do with the actual milligrams of the beneficial omega-3 content (which might be 324 mg or some such number). Always scope out the label that graces the back of the bottle to determine the actual omega 3EPA/DHA content.

Niacin vitamin B3 therapy. All-right, here's a question that I'm betting not a single reader can answer correctly: How did Bill Wilson (aka Bill W) co-founder of AA cure his longstanding anxiety? If you said, "duh, he used AA," then you are absolutely, positively wrong! (Nice try though.) Question number 2: What did Bill Wilson say he wanted to be remembered for on his death bed? If you said, "AA" congratulations, you are zero for two!

Bill Wilson loved AA and believed in it with all his heart and soul. He used it to help his own drinking problem. Nonetheless, AA did nothing to help his debilitating anxiety and depression. What did help? Seriously large dosages of vitamin B3, also known as niacin. Bill Wilson spent nearly the last third of his life trying to get AA groups to promote niacin as a treatment for alcoholism, depression, anxiety, and even schizophrenia. It never happened and worse yet the saga has been virtually absent from all the major sources on addiction treatment.

Why didn't Bill W.'s ideas catch on? That's a story for another blog. But the short answer is that high dosages of niacin cause a flush that can be painful and downright scary. Many folks experiencing the flush end up in the ER not knowing it is likely a positive thing! Multivitamin pills rely on small doses of the nutrient or niacinamide to avoid this problem. Modern timed release or so-called "flush free" niacin supplements sold by health food stores and prescribed by physicians to help control cholesterol may or may not have the mood stabilizing effects of pure niacin. By the way, Bill W wanted to be remembered for his contributions to niacin therapy.

Probiotics. These are supplements that promote healthy bacteria in the intestinal tract. Many practitioners are convinced probiotics can be helpful in an array of mental health and digestion disorders; especially autism spectrum disorder. Probiotics have virtually no negative side effects, but some brands require refrigeration or freezing temperatures to survive. Like automobiles, television sets, and vacuum cleaners, every brand claims to be the best, so it's difficult to make a purchase decision.

Eliminate wheat. Wheat and mental illness(most notably schizophrenia) have a longstanding relationship. Although mainstream medicine insists wheat is healthy (if not a required food group), newer research posits that ingesting wheat based products has a detrimental effect on one's blood sugar, emotional state, and might even be implicated in Alzheimer's. The problem may not be so much the wheat itself, but the fact that today's wheat has been hopelessly genetically altered. Or to put it a different way, this isn't your father's whole wheat bagel! The bun that graced a 1970s fast food burger bears no resemblance to the bun you wolfed down for lunch. Proponents of the new don't eat wheat theory, feel strongly that whole grain, 7 grain, gluten free whatever (!!!) products may be just as bad if not worse for you than the run of the mill white bread type foodstuffs.

Take a look at David Perlmutter, M.D.'s book Gain Brain if you think I am exaggerating.

Strategies to boost cholesterol. Say what? Al-right, I'll admit it. I save the most controversial alternative strategy for last. Although most doctors are prescribing statin drugs to lower your so-called bad LDL cholesterol, a number of avant garde thinkers point out that higher may be better. If your cholesterol is below the 160 mark, your physician will give you a big hug and a smooch. But some research shows that if you have low cholesterol your chances of suffering from a major depression or committing suicide goes through the roof. The brain, as they point out, is basically cholesterol. Proponents of the cutting edge, increase your cholesterol theory if you want better mental health, have gone as far as suggesting that a minimum requirement for cholesterol should be added to the food charts in the near future. There is also the issue of longevity. Older adults in good health seem to have elevated cholesterol.

It would be an understatement to say that the aforementioned information seems totally the opposite of what we have been told for years.

I think I'm going to end here, because the eighth grader next door just returned home from school and I have a cell phone question. I wonder if he knows much about DHEA, pregnenolone, or NADH to combat depression my clients have been pondering over. It couldn't hurt to ask.

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