Category: Blog

In Search of the Perfect Private Practitioner

Posted on 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 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 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.”
  6. 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.
  7. 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.
  8. 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.”
  9. 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.
  10. 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.

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

Posted on 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.

Counseling Kids: When a Cigar Is Just a Cigar

Posted on by Psychotherapy.net Team

Nine year old Malcolm was one of the fortunate clients. Because his family had a very modest income a local counseling center with a sliding fee scale was seeing Malcolm on a pro bono basis. Better yet, the agency was providing free transportation for him on a school bus. His emotional difficulties began two years ago after his parents got a divorce. He was now living with his natural father and his new step-mother.

Treatment seemed to be working well. Then it happened and it changed everything. One day while riding to the agency, he pointed out the window at a very upscale, plush shopping center and exclaimed, "My mother owns that shopping center."

The bus driver (who was trying to talk some sense into the young man) said, "Now Malcolm, that's not true. You know your parents don't have a lot of money and they surely do not own that shopping center. You lied. Now you need to admit to the other kids you a not being honest and apologize."

Malcolm began crying and insisting his family really did own this center. The kids on the bus starting yelling at Malcolm and insisted he owed all of them an apology. The incident ended with Malcolm screaming at the top of his lungs at the children who taunted him.

The bus driver dutifully reported the entire incident to the clinical director of the organization who thanked him and swung into massive therapeutic action. They knew Malcolm was depressed since the divorce, nevertheless, the clinicians had never seen anything resembling this seemingly psychotic like break from reality and tendency to lie, combined with extreme hostility.

The treatment plan was stepped up to a whole new level. Instead of Malcolm seeing only an individual counselor, he would also be placed in group counseling and play therapy. He was also referred for an extensive battery of psychological tests, a medical management session with their psychiatrist, and a session with the neurologist at the agency. He was also referred to a therapist specializing in anger management. Malcolm's progress (or lack of it) would be assessed 30 days later at a case conference in which all the aforementioned psychotherapeutic players would be present.

Finally, it was the day of the big staffing but there was one new treatment player on the field. David, a graduate student serving his practicum at the facility.

The meeting began with the clinical director turning to David and asking, "David, this is a fascinated case. How do you think we should proceed with our intervention with Malcolm?"

"Well sir," said David, "since this is my first day here I haven't had time to read the record. Like everybody else, I just recall that his natural mother is filthy rich. I'm sure we can all remember the firestorm of publicity in the newspaper and on television when she built the upscale giant mall down the street from us. Right?"

The room was dead silent for what seemed like eternity. You could hear a pin drop even if you were using construction worker grade ear plugs during the staffing. Score one for Malcolm!

Since Freud was the master of symbolism, the story goes that around 1920 somebody wanted to know about the symbolism of Freud's own propensity to smoke upwards of 20 cigars a day. The Freudian interpretation at the time was that a cigar was a phallic symbol. When confronted by his fellow analysts about his own behavior Freud remarked, "Sometimes a cigar is just a cigar."

As of late, scholars have come to the conclusion that the famous "sometimes a cigar is just a cigar" statement attributed to Freud is false. Or to put it forthrightly, Freud never said it. My humble two-cents regarding Freud is that even if he never said it, he should have!

But here's the point. If 20 years from now Malcolm is lying on an analyst's couch babbling on about his tendency to smoke cigars, the analyst would do well to keep the notion in mind that sometimes a cigar really, truly is . . . well just a cigar.

A Short Piece on Disrespecting Teenagers

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We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:

  • Naturally difficult
  • Not willing to listen to good common sense from adults
  • Emotionally unstable
  • Impulsively acting without thinking through consequences

Wait, most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric tends toward dismissing and disrespecting teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would consider unwise—at least if we were treated similar ways in the workplace.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to keep them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations are likely to come true.

The No-Fee Session

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I live in a neighborhood in New Jersey where people say hello to one another in the street even if they don’t know each other well. One man stood out for me in the many years I am living here: He doesn’t say hello even though he sees me several times a week. He doesn’t even bother to nod his head. I could never understand what I had done to him, but I just felt as if he hated me.

One day not too long ago I was surprised to get a telephone call from him. “I really need your help, he said. “I need to talk. My son who is in his early 20's punched me in the face – lightly, but still a blow.” I understood very quickly that though he wasn’t injured physically, to be attacked by one’s son had to be a trauma. I gave him an appointment – a midday hour the following day and he showed up at the given time.

He went into detail about the incident and asked me all kinds of questions. His main purpose was to be helpful to his son, get him “the right medicine” as he called it. He wanted to know who I could recommend that might “help him.”

“Does your son feel he has a problem,” I asked.

“No, he thinks I have the problem.”

And then the man gave even more detail about a long and somewhat tortured relationship with his wayward son. “I could never give him what he needed.” He described his son as “lost and adrift” and again asserted that his son was in great need of “psychological help.”

“What does your son want from you?” I asked him.

“I don’t know,” the man said. “I don’t think I ever knew. All I know is that I have got to send him somewhere to get help.”

I can’t put my finger on exactly when, but I had the distinct feeling somewhere within the first 20 minutes of the session that this man had no intention of paying me for the session. He was going to take and take. He asked question after question about my experience. He sighed and talked, sighed and talked. The idea occurred to me that just as he had failed to say hello to me all these years and perhaps just as he had failed to give to his son, he would fail to give to me. Although it was hard to tell from one session, it seemed that he had little interest in knowing anything about himself and evinced even less interest in knowing something about his son. He wanted a 'solution.' At the same time as this realization dawned on me I threw myself into the work, giving him the best possible session I could give, listening and feeling the feelings as if he were giving me a million dollars.

As I listened to him, I saw the lines of trauma etched on his face. He was 57 years old, but looked somewhat older. I caught a glimpse of him as he walked toward my office. He didn’t walk so much as trudge as though he were walking through invisible snow drifts even though it was summer. Further discussion revealed that he was the son of elderly holocaust survivors. His relationship with neither his mother nor his father was what you would call “loving” or even “pleasant” in his words. “They are very bitter, un-giving people,” he explained. Apparently, he had inherited and internalized one thing from his parents: the idea that “nothing good can or ever will happen to you” and he lived his life accordingly, investing as little as he possibly could get away with.

It was not long before the session time was used up and beyond. Even as I rose to signify the end of the session, he remained seated, being both talkative and acquisitive. It felt that he was trying to extract as much as he possibly could from me.

It would have been tempting to broach the fee with him then. After all, he wanted something from me, wasn’t I entitled to “get” something from him. Quid pro quo, give something, get something. Isn’t that an idea that everyone can understand, even one with a distorted sense of entitlement?

I have come to understand, however, that often people’s sense of entitlement stems from not from evil or even greed, but is a maladaptive way of addressing their traumas. They are still angry about the long-ago past, but they don’t know that. Instead, they seek reparations perversely — through something that feels like exploitation to the other, but they are unaware. For such damaged, wounded people, the language of quid pro quo, though utterly reasonable to you and me, can be experienced as a trauma. It is especially ironic (and enraging) because his own stance with the world is far more exacting and exploitative than the language of even exchange. It was more like: do for me and maybe, just maybe I will do for you.

Finally, he got up at the end of the session and weakly thanked me for my time. He made no mention at all of payment and neither did I make mention of it. We shook hands and he left.

When he walked out of the office, surprisingly, I did not feel the way I thought I would feel. Oddly, I felt enriched. He had given me a chance to understand him even as his view of the world and his son were distorted. I had made up my mind that my only objective was to provide him with a healing experience. Under no circumstances would I allow him to be re-traumatized even as he was a traumatized man who unconsciously traumatizes others, I knew he could only ingest kindness. Nothing else.

I had honored our profession and was nourished by the feeling of having done the right thing.

A few weeks later I saw him in the street. To my utter surprise he said hello to me for the first time. He updated me on his son’s status and then said, “You can send me a bill for the session.” He said it half-heartedly, I think, hoping that I wouldn’t actually do it, but there was a trace of sincerity there. It gave me cause to feel that perhaps with my kindness, I contributed a little bit to his healing.

Fear and Consciousness: What I Learned from a Bike Accident

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"Smile, breathe, and go slowly." — Thich Nhat Hahn
 

I got doored on Saturday night. I was riding my bike out to dinner with my husband and a guy in a big SUV opened his car door into the bike lane without looking and knocked me over. My face hit the pavement, I still don’t really know how my teeth weren’t knocked out, but my lips were cut and bleeding and my forehead was gashed and scraped. It happened so quickly and was so scary and weird.

Immediately kind people came up to me and asked over and over “are you ok?” “are you ok?” I didn’t want to answer yes because I didn’t really know. I was sitting on the street with blood all over me and I wasn’t sure if I was ok. I assessed my pain, my mind, my body. But when I didn’t answer immediately people began to say, “she’s in shock”; “she might have a concussion.” Although I was reluctant, the hostess at the Chapel bar across the street called the EMTs to come and assess me, and I didn’t argue.

When the EMTs arrived, they crowded around me, about four or five people, and began firing questions at me about what happened, “were you wearing a helmet?” “do you take any blood thinners?” “do you remember what happened?” “is this painful? is this?” Again I had the impulse to stay quiet and try to think before I answered questions, a state of being that was a bit unfamiliar to me, a person who normally anxiously blurts things out, responding as quickly as I can to anything that comes at me.

When they determined that I might have head trauma and drove me to the hospital on a back-board, an epic round of this activity began. At the trauma center people swarmed around me, some asking questions, some doing things to me, sometimes introducing themselves and explaining what was going on, sometimes not, questions, questions came one after another. I began to feel at home in my temporary (of course it was temporary) stillness. I was alive, I was still a human body, my man was with me, I was going to go home. I thought about the questions and answered them. At one point I said, “I need to cry a bit now” and I did. It was strangely wonderful.

And the funny thing was, the more chaotic it became the more calm I grew. I felt like a still, benevolent presence in my neck brace, slowly breathing and thinking about what was happening‚ exactly what is usually so hard to achieve internally. It was only when I was home and quiet later that I felt shaky, scared, and overwhelmed, but I think I had more tenderness for myself than I normally would. For instance, I would not let that internal voice berate me that the accident was somehow my fault. A breakthrough for sure.

What all these interactions reminded me of was nothing more than my own mind. It was as if by experiencing a state of high-anxiety all around me I was given some distance from that way of being in the world. All the pedestrians and EMTs and doctors were like representations of all my worries and concerns, they were each vying for attention so they could do their job, and so they could help and even save me. But what helped me was being safe in my own mind, feeling calm, thinking about what was happening and speaking when I knew something.

I greatly respect and feel gratitude towards all the kind people who helped me that night, they were doing their jobs wonderfully and I would not want them to behave any other way. What I mean to offer here is idea that life’s experiments with us can lead to a better sense of how we’d like to be present in the world.

I don’t recommend a bike accident to get to experience a tiny little shard of perception, but I bow to its terrible wisdom.
 

I’m Rubber, You’re Glue

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“I’m rubber, you’re glue, what bounces off me sticks to you.” Recently one of my colleagues taught me this childhood taunt and response to name calling. It is one of the simplest and most accurate descriptions of projective identification that I have ever heard and makes me think of my client Nancy.

Nancy and I occupy different ends of the political spectrum. It is interesting to me that I can work comfortably with clients who are different from me in very many ways, yet the issue of political ideology is one that I have frequently found internally troublesome. Nancy hates Obama. She listens to conservative talk radio. She makes racist comments and I squirm in my chair, miserably caught between my values as a human and my experience of what is effective in a therapist. When she launches into a political rant, which is not uncommon in spite of my best efforts, I find myself backing up so far I could tip myself right out my window. I feel pissed off, defensive, and, weirdly, a little afraid.

I have a lot of theory at my disposal to think about this. Melanie Klein comes to mind most of often with this particular client, because Nancy occupies the paranoid-schizoid end of the spectrum more often than not (and oh how tempting it is to view our political differences in these developmental terms). Her world is peopled with mother and father substitutes who withhold and reject in ways that feel to her completely random and unpredictable. In this world, she is both utterly powerless and omnipotent. At a slightly different angle, her internal world (and through this lens, her external world as well) is peopled with victims, perpetrators, and passive observers. She bounces on and off these different self-concepts, always in motion, always caught within their confines. Or, afraid and disconcerted by her own aggression and hostility, she locates it in others. I think about all these things, and more, and these thoughts provide me with a little distance, a little room to process my own uncomfortable feelings, a space from which to offer observations, and, on good days, genuine empathy.

Nancy believes I am naïve about the nature of evil. She is certain that my trust in others and their motives is dangerous. Often, she accuses me of being the passive observer, allied with those who would stand by without protest and allow Jews to be herded into boxcars (and I share with her my thought that she fears I am like her mother, standing apart and not protecting her from her father’s abusiveness). For my part, I feel that, in her fantasy life at least, she would give Goebbels a run for his money. We are both right, in our way.

She hits a nerve with her accusations. It is true that I am uncomfortable with aggression and confrontation. I hope I would risk all for what is right, but confronted with risk to myself or my family, would I stand up to real evil? Or would I rationalize my cowardice? I have been fortunate enough to have had relatively few opportunities to test myself on any really grand scale, but on a smaller scale I am well aware that have sometimes been less courageous or morally upright than I would like.

The problem between us is not new, on the grand scale or the small one. Our worldviews are so wildly different that just expressing our perspectives feels like a fundamental and dangerous challenge to our disparate values and perceptions of reality. Hers is a world of impingements and threats, a world that requires constant vigilance and active self-protection. How can I say she is wrong, with all the objective evidence to the contrary? She feels like I counter the Holocaust with Sesame Street. I feel like she would be perfectly willing to napalm my village to secure her safety from the very people—gay, black, poor, Muslim, “Others”—that I wish to protect. We scare each other at a very primitive and regressed level.

What I end up doing is what we all do as therapists. It seems so simple when I write it. “You are frightened to think that I might not stand up for you if you were really in danger. You are right, I can be naïve. Is it possible sometimes you are afraid to see, or trust, what is good in people? Maybe we are sometimes both wrong, or both right.” Though it is a trial, I do not defend Obama or taxes or affirmative action or gun control or “socialist” medicine to her. I will not convince her through argument, that is certain, and there is no therapeutic gain to be had. Sometimes we are invigorated and challenged by our dialogue.

We have years between us, a small room, a therapeutic contract, and many opportunities for repair. Without this, I wonder, how easily could it happen that we would be willing to harm each other, each deeply convinced of the malign intent and potential for cruelty in the other? I fear it would be very, very easy.

Listening as Meditation

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In 1975, Herbert Benson of Harvard University wrote that to achieve a “relaxation response” you only need four ingredients. These included (a) a quiet place, (b) a comfortable position, (c) a mental device, and (d) a passive attitude. Benson’s relaxation response was, of course, roughly equivalent to the meditative mental state. His work presaged the mindfulness movement in psychotherapy. He identified a psychological place of exploration, discovery, and acceptance. His research linked the relaxation response to a variety of physiological and psychological benefits.

Carl Rogers and his daughter Natalie have often lamented that modern American therapists simply don’t understand person-centered counseling. As I watch students and professional therapists all-too-often engaging in premature problem-solving with clients, it’s easy to agree with Carl and Natalie. No one values listening much; it’s too slow and plodding for our caffeinated culture. Therapists wish to be helpful. Clients wish for solutions. And together they conspire to avoid whatever might lurk beneath the surface. At my present institution we even have a one-session group counseling experience called, “Feel Better Fast.” Perhaps what’s most amazing is that these explicit efforts to embrace and engage in the quick-fix are sometimes effective. This may be nothing more than a testimonial to the power of expectation and placebo.

But it’s equally likely that the help that happens comes primarily from two valid sources: First, clients may perceive their therapists as genuine and sincere. This is perhaps a small measure of Rogers’s person-centered congruence communicated through a fog of directive or solution-focused problem-solving. Second, some clients show up for therapy ready to learn. This is an example of Prochaska’s readiness to change—a pleasant situation wherein whatever stray skill that happens to graze the client’s psyche may be adopted, adapted, and applied, with some success, to the client’s particular life or problem. Obviously there are some good skills out there (including mindfulness meditation) and, as Otto Fenichel might have said—referring to psychoanalytic interpretations—timing is nearly everything.

Instead of indiscriminately engaging in procedures or firing off solutions, I wish that students and young professionals could step back and experience listening as meditation. I wish they could follow Benson’s advice and get comfortable, breathe deeply, and let their clients’ words into a quiet space. And while continuing to breathe, I wish for them to explore, discover, and accept what their clients are thinking, feeling, and experiencing.

Sometimes, when listening to therapy recordings with students I ask questions like:

  • Do you hear a value rising up in your client’s voice? Just listen and accept it and reflect it back.
  • Do you sense that your client is expressing perhaps a taste of bitterness mixed with unhappiness? If so, help your client hear and understand her or his own emotional state.
  • I wonder if you could tune into the call of the psychodynamic here; let the repeating interpersonal relationship patterns become clear; and then, collaboratively explore and discover with the client the nature, cost, and alternatives to these patterns, keeping your mutual and evidence-based goals in mind.
  • Do you notice in your client’s words the scent of the somatic or the spiritual? That’s okay, just notice it and then try to be the mirror that enables your client to see it right along with you.
Lately, the main message I’ve been trying to give my students, my supervisees, and myself is to integrate Benson’s and Rogers’s perspectives and use listening as meditation. The point is to let what the client says become the central focal point (Benson’s mental device). This is then followed with mindful acceptance and empathy, leading to a collaborative and interactive search for meaning or solutions or insight or behavioral prescriptions or cognitive reframing. And it ends with my conclusion that one of the coolest things about listening as meditation is that you can do it using virtually any theoretical perspective because excellence in the art of listening is the foundation that virtually all excellent therapists share.