One Therapists’ Thoughts on the HBO Series In Treatment
BLOGGER: MARK J. HILSENROTH, PhD
I’m a big fan of the HBO series In Treatment and think it provides the general public with a fairly good representation of one type of psychotherapy, primarily treatment from a Psychodynamic orientation. The show’s protagonist, Dr. Paul Weston, discusses being a Psychoanalyst at the Washington (DC) Psychoanalytic Institute, which really exists, as well as having received his Ph.D. from the New School for Social Research, again a real Ph.D. program with a Psychodynamic orientation. A Psychodynamic orientation is a focus of treatment that examines a persons’ relational patterns from childhood through the present and how this pattern plays out in the relationship between therapist and patient. In addition there is a focus on the experiencing and expressing of emotions-especially in the moment during the session, as well as increasing insight, understanding and perspective on themselves and others. This is important with regard to Adelphi because the Derner Institute has a long and distinguished history of training and service to the community from this approach to treatment.
It is clear that the writers, directors and producers of the show have consulted with people in the field and have likely been in treatment themselves. This intimate knowledge of the interior of psychotherapy sessions translates into several well developed story lines and rich interpersonal narratives. These stories are brought to life by award winning actors and has garnered the series both critical and popular acclaim.
Now, while I enjoy the show and think Dr. Weston portrays what I believe to be fairly good treatment with many of his patients, that doesn’t mean he’s perfect. In fact, far from it as he struggles to deal with a wide assortment of issues in his personal life, not the least of which is the end of his marriage. I think what makes the show so compelling to watch and why people might connect with Dr. Weston is the open window into his struggle to balance his personal life and work, while exploring these issues in his own personal therapy. The show provides a unique perspective not only how a therapists’ own life events, strengths, weaknesses and vulnerability might affect their work; but also how the work with one patient may impact the work with another. Sometimes this confluence of issues can be very useful to facilitate the treatment process and sometimes it can be particularly detrimental. These negative effects can be especially pronounced and harmful to the treatment when the therapist is under high levels of stress. The show also demonstrates a phenomenon well known in the field regarding therapist burn out and an over identification with the caretaker role. When this occurs, therapists may use their work as a form of escape from problems in their own personal lives.
Regarding what Dr. Weston says and does during the sessions I find myself agreeing more often than not for much of the session, with most of his cases. Although in some of his cases I think he makes some errors that range from rather mild to very serious. This, I think, is another reason I like the show so much because again it portrays a complex perspective of therapeutic work. The “good,” the “bad” and the “I’m not exactly sure what to say or do” aspect of doing psychotherapy. And this is mirrored in research that demonstrates even with very good therapists there can be substantial variability across their caseload. That is, even the best therapists are not always as effective with all the people they treat. In sum, there are no perfect therapists, but many are “good-enough” to make a meaningful impact on the lives of those with whom they work.
As far as the reception to the show in the field, that I’m aware of, it tends to be mixed. I find that very many of the graduate students and trainees I speak with enjoy the show very much. They often report finding it useful to watch a therapist deal with different issues and intervene in different ways. As shocking as it may sound it’s not so often that trainees get to view other therapists’ work. This can often be very useful by having multiple reference points on how you could communicate different interventions to people seeking help for a variety of problems. With my more experienced colleagues, I hear far more varied opinions on the show and several that are very negative and critical. I get the sense from these colleagues that they seem much more focused on the less effective interventions or problems aspects in Dr. Weston’s work, as well as expressing a concern that the show might undermine the faith people may place in their therapist. In addition, I have heard criticisms that some of the issues portrayed in his personal life and their impact on his work are often exaggerated for the drama of television. While these concerns are certainly reasonable, in the end I believe the show will have a positive impact on psychotherapy in general, and psychodynamic psychotherapy in particular, because it affords the public one perspective of what therapy “might be like” for themselves. That is, it may make some people curious about the possibility of psychotherapy to help improve their lives. I think anything that creates curiosity for a person to try and understand themselves better is a good thing and think most therapists, including Dr. Weston, would agree.
To read Dr. Hilsenroth’s other blog “ How to Find a Good Therapist”, click the link below.
http://blog.imagineage.com/how-do-i-find-a-good-therapist-a-few-practical-suggestions/
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Posted 2 years, 6 months ago at 12:08. 1 comment
How Do I Find a “Good Therapist?” A Few Practical Suggestions
BLOGGER: MARK J. HILSENROTH, PhD
I’m often asked by friends, neighbors and, sometimes, family “How do I find a ‘Good’ therapist?” I suspect this is because when people actually know a therapist and they’re struggling with a problem they’d like to get some professional advice. This is similar to the way I ask my neighbor who’s an electrician about problems I’ve had when trying to hook up new appliances or install those automatic outdoor lights (the kind that turn on when people walk by). In some respects the answer is about as straightforward as the wiring of my old 1952 colonial. So first I usually let out a deep exhale and say, “Well, that’s a really good question and I’m not sure there’s a simple answer. What makes a ‘Good’ therapist for one person, might be different for another person.” After making that and additional disclaimers that this is a complex issue with no clear cut answer, I provide a few practical suggestions which I own as being more what I personally would look for in a therapist, but which I hope may be helpful.
The first thing I suggest is that you gather a list of phone numbers for several potential therapists (at least half a dozen). You can then contact these therapists about their availability and price, both of which can vary widely. If you intend to use your insurance to pay for a therapist you can usually obtain a list of providers from your health plan. However, if you don’t have insurance to use for therapy, the phone book usually has several pages of licensed therapists from which you can choose. Concerning availability, it’s important to think ahead about the time and place that would be most convenient for you to attend therapy. Specifically you may want to work with someone who has an office either near your home, place of work, or on the commute between the two. Related to this, think about days and times that would work best for you. This way when you speak with someone on the phone about scheduling you’ll know what will work out and what won’t. Generally, I suggest that people schedule a session when they don’t need to be anywhere or do anything immediately afterwards. Psychotherapy is one of those things, not unlike a physical workout, where you might need some time to “stretch” emotionally and psychologically afterwards to solidify your gains as to not cramp up or pull something later.
What therapists charge for a session can also vary widely, and if you are paying out of pocket it is worthwhile to inquire if a therapist has a “sliding fee scale.” This means a therapist will adjust (i.e., the “sliding” part) his/her fee depending on your yearly income (i.e., the “scale” part) in order to make psychotherapy more available for those who may normally not be able to afford it. While this practice is becoming increasingly rare, it may still be possible to find some therapists willing to engage in this socially responsible behavior. One place you’re most likely to find a sliding fee scale is at a university training clinic. Many universities, especially those with graduate programs in either psychology or social work, have an outpatient clinic in which graduate students provide therapy and are actively supervised by licensed faculty members. This is usually a very economical treatment option and the available data suggests you’ll likely get effective treatment and realize substantial benefits. Although, the trade off for seeking services at a training clinic is that you’ll have less input into choosing a therapist and you’ll likely get assigned one based on caseload, availability, etc. However, concerns and requests are often taken into consideration. Related to the issue of your fee, ask how long the sessions are that you’ll be paying for. You see psychotherapy is one of those things, not unlike an episode of Twilight Zone or Outer Limits, where an “hour” generally isn’t really an “hour,” but rather 45 or 50 minutes for a session. Check to see how long you will have.
Even more important than availability or price issues, an additional reason to make phone contact with your pool of potential therapists is to provide you with initial information on how they relate to you. That is, how long does it take them to return your call? And when they do speak with you on the phone, how comfortable did you feel during that interaction? I suspect that this step will help you narrow your original number down to one or a few people who are available during some of the times you are, in your price range and who, most importantly, interacted with you in a way that led you to feel some comfort and connection with them. If you find you can’t decide between two or even three people you may want to consider setting up a time to meet each for an “initial consultation,” in order to get a better sense of how they might work with you. Now let me be clear, ethically, one therapist can’t see someone who is already working with another therapist. That is, you can only be in one individual therapy at a time (this doesn’t apply to individual therapy plus couples, family, or group therapy, that is ok) and I am not recommending that you do anything other than this. Rather, I would say to each that you’re trying to find a therapist and you’d like to meet them for a “one session consultation” in order to get a better sense of how you might work together. I expect that many therapists would respect such a request, and I personally wouldn’t want to work with someone who didn’t. In sum, it’s ok to be an informed consumer, especially with something as important as picking an individual with whom you intend to share the most personal of information.
The reason I keep suggesting that you pay careful attention to your sense of connection with the therapist you choose to work with is related to the “science” part of my advice on this issue. One of the strongest predictors related to eventual improvement in psychotherapy is the strength of this “treatment relationship” between you and your therapist. Referred to as the “therapeutic alliance” in the research literature it consists of feelings of trust in, and bond with, the therapist, a sense of shared purpose and collaboration in determining the goals of treatment, as well as an agreement on the tasks, or route, to achieve those goals, and a confidence that despite being a painful process, you are moving together toward something better. What is also striking about the research in this area is that this relationship develops very quickly, usually within the first few sessions, and that these feelings from even the first month of treatment are often highly related to the ultimate success of treatment. This information can be very helpful in choosing the therapist that may be right for you, and also in evaluating your decision once you start treatment.
I would also suggest that if after the first month of working with a therapist you don’t feel this sense of connection, bond, trust and collaboration you bring this up with your therapist. I know this sounds like a scary thing to do, but your therapy is very important and if you’re not feeling like your therapist is an ally invested in you or that process then it’s vital that this be discussed so your work together becomes effective. I am not suggesting that you simply stop going to therapy if you feel a lack of connection, as I think doing so might foreclose an important opportunity for growth. As the old saying goes, “It takes two to tango” and it’s possible that this could apply to someone’s lack of connection to their therapist. Why I suggest bringing up these feelings in therapy, before you consider leaving, is so you could check this out. I would expect a ‘Good’ therapist to take your concerns seriously, responsibly explore their own contribution to that lack of connection and then work with you to understand what each of you may be contributing to the process that has led to the current situation. Such an interaction can often lead you to a greater awareness about yourself and your patterns of relating. It can also provide an avenue for deepening the relationship with your therapist. On the other hand, I would be very concerned if, after voicing this issue, you were to feel blamed or attacked, or that your concerns were ignored, dismissed, or simply met with silence.
At this point people usually ask me if I know anyone who might be a good match for them. Whenever I do make a referral, I always end by saying “Now, no matter what I may think about this person, it doesn’t mean that they will be a good match for you. Again, sometimes a ‘Good’ therapist for one person might not always be a ‘Good’ therapist for someone else.” I would say this is true of any therapist, even one who may come highly recommended or who is well respected in the community. No matter how highly recommended a therapist may be, always trust your sense of what seems right for you regarding that sense of connection and trust. This is much more important than “reputation.” Again, in my opinion, you can express such concerns to a ‘Good’ therapist and they’ll respond to you in a way which allows you both to move forward effectively in the work to come.
So in summary, I believe that a ‘Good’ therapist, much like the wiring in my old house, helps to provide light in dark places, warmth in times of cold, and power to the adaptive abilities (i.e. appliances) that help us to live most effectively.
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Posted 2 years, 11 months ago at 12:08. 7 comments
