Saturday, February 1, 2014

Dear Young Therapist: Don't Call People Names

The liberatory potential of psychotherapy is immense. Conversely, without careful thought or reflection, our tools can rapidly become an oppressive force that perpetrates violence rather than forwarding the potential of humanity. We can do so much damage to fellow human beings through carelessly (or willingly) referring to patients as categories of diagnostic representation. Individual and institutional violence can be perpetrated against our patients when we collapse our understandings of the complexities of our human experience into a label. It is so easy to lose sight of the dangers of misusing our power and position.

It is important to deeply consider the way in which we speak and think about the fellow human beings who we are privileged to share a portion of life with us.

In 1974 David Hawkins wrote an essay about the dialogue of I, Thou, and It. Extending his writing from education to psychotherapy, we might think of our work as a dialogue and interplay with these three points of an interconnected triangle. The I is therapist, Thou is patient, and It is the complex tableau of sexuality, race, culture, ethnicity, gender, family, theories of change and psychopathology, and scores of other factors.

I think a good psychotherapist is a reflective psychotherapist: one who constantly reflects and learns from what has happened and what is happening; who is continuously open to incorporating the experience and ways of knowing of their patients; who reflects on the interplay of I, Thou, and it; who constantly cultivates space for a voice that has not been heard to be heard. As an invitation to this reflective dialogue, I ask myself a lot of questions. Here are a few that are often in my mind:

  • What are the effects of labeling people transgenders, schizophrenics, borderlines, and narcissists? 
  • How are our diagnostic categories reflections of societal values that are rooted in male, European, middle/upper middle class, heterosexual centric values? Does it matter? Why or why not?
  • In what ways do we knowingly and unknowing remain ignorant of our implicit biases? How is are practice and impacted by knowing or not knowing (and believing or not believing) in implicit biases?
  • Do our interventions and theoretical orientations reflect our personal needs or the needs of our
    patients? How? Does it matter? Why or why not?
  • How do we help others make sense of a punishing world where the experience of the other is often demeaned, denied, or dismissed? How does our practice change if we do not acknowledge or agree with notions of microaggressions and institutional racism?
  • Are we willing to examine how we demean, deny, or dismiss the experiences of others?
  • Are we awarded special power by society as licensed therapists to categorize, describe, and label people? 
  • Do our patients have the power to name, describe, and understand their own experience? 
  • Do we share the power to name and understand experience? Do we keep the power for ourselves?
  • How does our theoretical understandings dictate our use and understanding of power?
  • Are we aware of how our position in society influence our ability to perceive our uses of power?
  • In what ways are our interventions designed to force people to conform to our expectations?
  • How do our answers and understandings of these questions (and the ones not asked) influence, limit, and expand our abilities to be helpful for any given patient?

What questions have I forgotten to ask? What questions don't I know to ask?

The other day I came across a disturbing trio of blog posts (here, here, and here). This blogger's posts are problematic on a variety of levels. Most notable is an apparent lack of awareness of how easily a therapist can abuse their position of power by enforcing their own personal heuristic of understanding a particular phenomena as the only heuristic of understanding a phenomena. The blogger appears to have no interest or ability to engage in any form of reflection that allows the experience of the other to be heard.

The final line of my of my previous letter to a young therapist is a good place to end once again.

Can you let a person sing their song and make meaning of it without encumbering them with your notions of what music should be?

Be reflective in your practice, young therapist. Keep asking questions. Keep listening to the other. Keep learning how to get out of the way to let the voice not yet heard be heard. Dare to let the tools of psychotherapy to bring liberation. Do not become a tool of control and colonization.

“The insistence that the oppressed engage in reflection on their concrete situation is not a call to armchair revolution. On the contrary, reflection – true reflection – leads to action.”  ― Paulo Freire, Pedagogy of the Oppressed

In the varied topography of professional practice, there is a high, hard ground where practitioners can make effective use of research-based theory and technique, and there is a swampy lowland where situations are confusing “messes” incapable of technical solution. The difficulty is that the problems of the high ground, however great their technical interest, are often relatively unimportant to clients or to the larger society, while in the swamp are the problems of the greatest human concern.” ― Donald A. Schön, The Reflective Practitioner: How Professionals Think in Action

“We do not learn from experience...we learn from reflecting on experience.” ― John Dewey

Society is one word, but many things. ― John Dewey

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the DarkDear Young Therapist: That Time My House Burnt DownDear Young Therapist: Cultivate Patience and Listen to the MusicDear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie IncidentDear Young Therapist: Are You Ready to JumpDear Young Therapist: Perspective is EverythingDear Young Therapist: Sometimes We Can't Put Humpty Back Together AgainDear Young Therapist: Sometimes Race and Sex MatterDear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

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