Dear Young Therapist: That Time my House Burned Down

It all started with my StarTAC flip phone ringing. Don't judge. It was 2002.

Without saying hello my friend Tina said "I'm so glad you finally have cell phone service. I got to your apartment a little early. Are you here yet?"

"No," I said. "I'm about 20 minutes away in Concord."

"Okay," she said softly into the phone. I'm having trouble getting to your apartment. There are fire trucks blocking the main entrance to your complex. I'll call you back when I figure out what's going on."

I continued on my way back home not really thinking much of the phone call. I lived in a large complex of apartment buildings and fire alarms went off all the time. Opening the oven door would often trigger the alarm in my apartment. Especially when I attempted to make naan on a pizza stone. 

My phone rang again. 

"Are you still driving?"

"Um, yes," I said.

"Can you pull over?"

My heart sank. "Yes?"

"The fire trucks are in front of your building. There are flames shooting out of the roof."

I accelerated toward home.

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.

Dear Young Therapist: Cultivate Patience and Listen to the Music

Rivers know this: there is no hurry. We shall get there some day.
― A.A. Milne, Winnie-the-Pooh

La cathédrale engloutie (The Sunken Cathedral) was my nemesis as a 17 year old piano student. I checked out a recording of Arthur Rubenstein playing this piece by Claude Debussy from my local public library. I was in love with the slow, watery, misty cords. The parallel fifths each create powerful waves of sound and sensation that pass through me every time I hear it. The music draws me into the mystery of the sunken cathedral rising up from the water to a place that is neither here nor there.

Technically, the music was out of reach for me.

I brought the score into my lesson with Robert Mayerovitch. He closed the cover on my piano and sat down in front of the other piano in his studio. He asked me to close my eyes and pretend to play the piece while he played it on the other piano. Freed from the technical challenge of the music, he gave me the opportunity to experience the feeling of playing the music through my physical body without being encumbered by the notes.

At least that was the idea. I was uncomfortable and embarrassed and don't really think I got what my teacher was trying to tell me until I was much older.

Dr. Mayerovitch scrawled on a yellow sticky note the word "patience" and affixed it onto my sheet music. We continued on with my lesson for the week.

A careful observer in my office might notice, off on a bookshelf, Dr. Mayerovitch's sticky note held within an inexpensive metallic frame. This note has been in every office of mine since 1997. It reminds me to get out of my head, stop thinking about the technical aspects of what I'm supposed to be doing, and feel and listen to the music.

My gift as a pianist wasn't my technical skills at the keyboard. Myriad were the students who surpassed my skills. It wasn't until years later, well after I stopped making music, that someone happened to discuss the notion of synesthesia and auditory-tactile synesthesia in particular. Suddenly it all made sense. I didn't know that other people didn't feel sound, The gift I had was my ability to sense and experience music (and words) in ways that other people can't.

I've yet to be able to fully understand or describe this experience. I probably never will.

What I do know is that my musical training combined with my auditory-tactile synesthesia and training as a psychologist, has allowed me to think about structure, pattern, dissonance, and harmony in the things I hear/feel. Words, feelings, culture, race, sex, sexuality, ethnicity, history, experience, gender, body language, and the empty spaces all form together into a complex score that I hear, see, and feel.

This comes in handy. More often than not, people walk into my office with a bag full of notes that have fallen off the page and no longer make sense to anyone. It's my job to hear these notes, pick them up, and create a space where each patient can figure out how their song is supposed to go.

Modern day notions about therapy have taught clients to expect that I'll scoop my hands into the bag, arrange the notes on the page, and send them on their way. That's not who I am.

I often find myself smiling as I catch a glimpse of Dr. Mayerovitch's note on my bookshelf. I put the music away, close my keyboard, and listen, feel, and see the music that's unfolding in front of me. My skill as a pianist was my ability to feel the music and translate that into something that other people could experience. The notes rarely mattered to me (though mattered a lot to everyone else).

I've learned the same holds as a psychologist. What I'm really good at is paying close attention to the things that I hear and feel and see. I notice things. My patients figure out the song.

So young therapist, this is my challenge for you today. You've learned a lot of technical skills in your schooling and supervision. It is important to get the notes right. Technical skill, however, is not sufficient.

The difficult business of the psychotherapeutic enterprise is paying attention. Hearing the songs our patients sing and finding ways to help our clients hear the sounds they are making is the challenge that meets us at our door every time we welcome another human into our office.

Can you hear a person's song?

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

When I hit a rut, she says to try the other parent
And she's so kind, I think she wants to tell me something,
But she knows that it's much better if I get it for myself...
And she says

Oooooooh,aaaaaaah, what do you hear in these sounds?
And... oooooooh,aaaaaaah
What do you hear in these sounds?

―Dar Williams

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident

image credit: Nicholas Ruiz. Bow Tie #10. Assembled November 2011.
 Acetaminophen pills, multiple adhesives, plastic knife. Forest Hills, Queens, New York.

The man interviewing me for a postdoctoral fellowship unwrapped the aluminum foil encasing his dry turkey sandwich and proceeded to stuff it into his mouth.

"Do you mind if I eat? Not that you really have a choice. I'm doing the interview and have the power in this situation."

He continued to masticate and fill his office up with the seasonally incongruent smell of Thanksgiving. This was going to be a fun filled interview.

"I'd like to ask you why you aren't wearing a tie today for your interview. Before you answer, I want you to know that as a psychologist I think everything has a meaning. I hope you have thought about the meaning of why you didn't wear a tie. If you haven't, then you aren't what we are looking for in a post-doctoral fellow. We'll end the interview here and I'll wish you good day."

I had a variety of inside-thoughts that I considered sharing. They included:

• Asshole. 
• Drop dead. 
• Who the hell do you think you are? I just had fucking brain surgery, a post-operative infection, and joint damage from an adverse reaction to the antibiotics that treated my infection. 
• Your turkey sandwich is making me want to throw up. 
• I'm scared because I can't find a job. 
• Do you know who the fuck I am? 
• Am I going to fail as a psychologist?

I took a middle course and smiled politely. I noticed the air flowing in and out of my nose. I watched as my agitated thoughts floated like clouds in the wind from the center of my awareness, to the edges of my mind, and then off into places where I can no longer notice them.

Thanksgiving | The 45 Top Influencers of my Irreverent Ways as a Psychologist

So many people have come in and out of my office since I started figuring out this business of the therapeutic enterprise. In 1990 the very first person I ever worked with walked through my office door. He was a survivor of childhood sexual abuse. I was terrified--I was still a teenager and had absolutely no idea what I was doing. Two decades later he wrote to me and thanked me for being such a kind listener. 

Since then there have been 1,000s of people who have walked through my door. Each have left with me some piece of learning--some knowledge of the human experience. I'm thankful for what you have taught me. Time has sadly obscured some of your faces. Still, when I look back, so many of your stories remain vivid in my memory even if I've lost a connection to your physical presence. I often see glimpses of you in my office in the present day, standing around my patients and I, reflecting back lifetimes of experiences.

My work and skill--fairly or not--is built upon these memories over my past 25 years of work. 

I've been thinking a lot over the past few weeks of the other people who are in my office with me. I've had so many teachers who have helped me find the pieces that I needed in order to become a psychologist. 

It being Thanksgiving weekend, I thought it might be an interesting process to make a list of those people who stand with me when I work. I will add more as they come to mind. 

Lorene Mihalko - Yeah. My mother. The first psychologist I knew.

Michael Dwyer, Ph.D. - My mother's teacher and then years later mine.

Robert Mayerovitch, Ph.D. - My piano professor who taught me to slow down and be patient.

Denise Youngblood - The high school psychology teacher who knew before I did.

Sherri Bair, Ed.D. - Piqued my interest in how television reflects our psychologies. 

S. Lee Whiteman, Ph.D. - His big smile, warm heart, wisdom, and curiosity still follow me around. 

Nancy Gussett, Ph.D. - Her self discipline finally got me look for my own.

David Prock - The first person ever to make it okay to talk about the dark side of life.

Daniel Kirk, Ph.D. - The English professor who made the room quiet so I could tell my stories and truth.

Claire Cygan Young - Gave me the first client I ever worked with.

Edwin Hollander,  Ph.D. - Drove me nuts demanding that the whole world conform to the bell curve.

Manolo Guzmán, Ph.D. -  Gave me the courage to explore the New York that I needed to find.

Helen Marshall - Taught me to love, respect, and believe in those who no one else did.

Stephen Friedman Ph, D. - Taught me to talk out of turn and discard the rules.

Zora Meisner - Who showed me powerful lessons can be learned from those I dislike.

Mary Chipman - We discovered it together. Didn't we? And truffles. And catalogues. 

Jody Tellfair, Ph.D. - My therapist who noticed everything--every time--without demand.

Amy Barto - Who showed me a social conscious with boundaries.

Rev. Richard Sering - The holy man who made me make a promise.

Barbara Fields - My other therapist who made it okay to play. 

Steven James, Ph.D. - The professor who gave the space to be iconoclastic.

Judy Harden, Ph.D. - The first professor to convince me I have a gift to develop.

Shoshana Simons, Ph.D. - The woman who took years to bring me out of my shell.

Harriet Lubin - The professor who silenced me for critiquing orthodoxy. 

Maggie Jackson, Ph.D. - The professor who told me I had every right to critique orthodoxy.

Lisa Drogosz, Ph.D. - The young psychologist that convinced me to return for more

Maryann McGlenn, Ph.D.  - My first supervisor who gave me (a little) room to be myself.

Marshall Rosenberg, Ph.D. - The peacemaker and student of Carl Rogers.

Diana Shultz, Ph.D. - Still working on forgiving you for ripping up page 6 of a 5 page paper.

Glenda Russell, Ph.D. - Launched me on my journey learning about social constructionism.

Janis Bohan, Ph.D. - Her clear observations helped me see bigger pictures

Robin Cook-Nobles, Ed.D. - Everything, Robin. Your gifts are endless.

Lisa Desai, Psy.D. - Who made me feel safe enough to think multi-culturally.

Judy Jordan, Ph.D. - The most human, real, and honest person I've met. 

Barbara Lewis, M.D. - The first physician who thought I had important thoughts.

Peter Baldwin, Ph.D. - Who showed me anything is possible and I can be free.

Daniel Brown, Ph.D. - Introduced me to hypnosis and changed everything. 

Susan Hawes, Ph.D. - My dissertation chair who rescued me when I needed it.

Ken Garni, Ed.D. - I still laugh like a crazy Frenchman. I just close my door now.

LaTonya Sobzack, Ph.D. - I hope you still laugh like a crazy Frenchman

Kim Davenport, Psy.D. - You too. Keep laughing.

Paul Korn, Ph.D. - Courage. 

Wilma Busse, Ph.D. - You just rock in all ways. 

Kathryn Jackson, Ph.D. -  Her quiet nature showed me to look deeply.

Linda Field, Ph.D. - Who knew a psychologist could be playful and disciplined?

Joe Shay, Ph.D. - Next time you interview me I'm brining a sandwich, and I'll be just one man talking.

Joan Wheelis, M.D. - You reminded me to decide what kind of therapist I wanted to be. 

Debora Carmichael, Ph.D. -  You called me into the water and let me know it was okay.

Louise Ryder, Ph.D. - Who let it be okay to be human and imperfect.

Amy Briggs Bledsoe, Ph.D. - My hardcore friend.
Jennifer Strong, Psy.D. - Rainbow bright. You know what I mean?

Dear Young Therapist: Are You Ready to Jump?

Hieronymus Bosch / The Stone Cutting / Prado

The anti-psychiatry movement has garnered increasing popularity within the last few years. Criticisms have been lodged against the medicalization of the human experience. In particular, many observers have noted the increasing movement toward pathologizing human suffering and categorizing that pain as a psychiatric disorder requiring medical intervention.

This phenomena isn't particularly new. As long as we've had emotions, we've sought ways to control experiences that are viewed as unpleasant, unwanted, or otherwise out of the norm. Starting in at least neolithic times, we attempted to drive out unwanted behavior through trepanning--drilling burr holes into the heads of those suffering. In fact, it is still occurring, assuming this website isn't some sort of strange parody. In our quest to help alleviate suffering we've also tried hydrotherapy, cold wet sheet packs, continuous baths, hot boxes, metrazol therapy, insulin induced shock, electroconvulsive shock, magnets, and lobotomies. 

Ouch.

I've worked with clients who have undergone all of these treatments with the exception of trepanning. I'm not that old. The video below offers glimpses of many of the various treatments. 

And then there is psychotherapy. So many kinds of psychotherapy.

The director of training of my postdoctoral fellowship, Joseph Shay, once handed us a list of every type of therapeutic intervention for mental illness that he could find. It ranged from some of the ones mentioned in this YouTube clip, to primal scream therapy, to dialectal behavioral therapy. We laughed at some and mostly we felt superior because we were being trained in the modern best practices.

As I've written before, Joe reminded us that in 10, 20, or 30 years we'd look back on our careers as psychologists and be horrified at what we thought constituted good therapy. Times change. We move forward. Joe taught us to remember that we have always tried our best to help, we can only help in the ways we know, and we can only know what we know when we know it.

We get better.

Dear Young Therapist: Perspective is Everything

When I was in fourth grade I became somewhat obsessed with learning about the native people of the Americas. I poured through all the age-appropriate books in my school and public libraries, wrote age appropriate papers, and made a few age appropriate art projects. 

Somewhere tucked away in a box is a coffee stained crayon drawing that I made depicting the life of Seminole Indians. Mr. Sturgeon, my fourth grade teacher pictured on the left, wrote me an apology for the coffee stain. 

I was particularly fascinated with the people who lived in Central and South America: The Aztecs, Incas, and Mayans. The age appropriate books I read showed images of the savagery of the Aztecs. My young mind was particularly aghast over their sacrifice of humans to their sun god. I was horrified at the descriptions of beating human hearts being removed from people with flint knives. I worried about how that must have felt for both the sacrificed as well as the priest wielding the knife. 

It was such a strange juxtaposition--being attracted and repulsed at the same time. 

What I didn't know in fourth grade was that the history I was learning was from the perspective of the conquerors. We tell stories of native peoples as savages, in part, to reinforce a white Western European superiority. 

Myriad are the things that weren't included in suburban grade school lesson plans.

Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again

Meeting Humpty Dumpty/Joanna Pasek

Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the king's horses and all the king's men
Couldn't put Humpty together again.

--Mother Goose

We don't like to admit that things that are broken cannot always be repaired. We develop empirically supported interventions that demonstrate our facility for erasing symptoms of mental illness and curing the ills of the psyche. Chemists and biologists develop powerful substances that right the wrongs of the miniature chemical metaphors for mental illness inside the synaptic cleft.

We wrap ourselves in god-like metaphors of power, control, and authority. We heal the wounded. We restore the broken to a state of wellness. We right that which was wronged. 

We try to place all of the evils, pains, and terrors of our world back into Pandora's box with the hope of this cure called psychotherapy. Our way out of mental illness, a hope for a different future, has become interwoven with these notions of restoration and repair. Returning things to the way they were.

I've grown convinced this is not always possible. Even if it was, I'm not sure it is advisable. 

...and for those we can't repair? We call them treatment resistant. We tell them they don't want to get well. We tell them they are not ready to get well. We find any number of ways to subtly make them responsible for being broken, for not allowing us to repair them, or for having experienced a trauma from which there is no repair.

I don't think that's advisable at all. 

On any given day any number of survivor stories pass by my eyes on the internet about those who have experienced sexual abuse. As our seemingly endless "war on terrorism" slogs on, I see an increasing number of wounded soldiers displayed for pubic consumption. Stories like these make me angry and sad, hopeless and hopeful. Thousands of tales of lives broken by sexual and physical trauma. Thousands of tales of lives restored through the power of hope, courage, caring, and empowerment. 

As someone recently mentioned to me, some do come out of a traumatic experience stronger. Some find a certain kind of beauty in the growth that occurs after a trauma. Some isn't all. In fact, some is a far way away from all. 

Every 65 minutes a veteran of the US Military commits suicide.

Adults who have experiences sexual abuse are twice as likely to have a suicide attempt. 

What happens when that which was broken cannot be restored? Who speaks for those who are broken and either cannot or will not be repaired?

A huge industry of self-help groups have grown up around the books A Courage to Heal and Victims No Longer. While both books, in many ways, put childhood sexual abuse on the map, they both also perpetuate a disturbing trend toward a wish to repair that which remains unrepairable. An industry has grown up around us depicting survivors of sexual and physical traumas as strong, proud, and invincible warriors. I wince every time I see this meme replicated. I realize saying this may make me somewhat unpopular in some circles of the sexual abuse healing industrial complex.

I think we've lost our way, young therapist. In following our culturally prescribed roles to be powerful healers we've forgotten that not everything we touch can be restored. Sometimes, no matter how hard we try, we cannot put Humpty Dumpty back together again.

I'm not even sure it is important that we even try.

It is not that I am against strong, proud, and invincible warriors. I think those who find their journey takes them to these places are mighty fine. They've found their voices and found ways to make their lives a life worth living. 

What about the ones who find that no measure of gold or silver can hold the pieces together again in a fashion more beautiful than that which existed before? What of those who tried kintsukuroi and found they have nothing but a pile of pretty broken pieces?  What of those who, like Humpty Dumpty, have fallen and learned that all the kings horses and all the kings men cannot put them back together again?

Who speaks for them?

“If people bring so much courage to this world the world has to kill them to break them, so of course it kills them. The world breaks every one and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.” -- Ernest Hemingway

Somewhere along the way, young therapist, we've forgotten that our most powerful tools are not those which fix broken things. Our most powerful skill is our presence and our attention. 

Don't get lost in the illusion that therapy is about fixing the broken parts of people. It's nice when we can fix things. Don't get me wrong. It's just that fixing isn't our most important task. Somewhere in our training and acculturation as a therapist we learn to stop listening and get lost in our own theories of how to fix things. We move from being having a role of a midwife of dialogue to the role of a high-tech mechanic. 

The map is not the territory. -- Alfred Korzybski

The description is not the described. -- Jiddu Krishnamurti

The map is not the thing mapped -- Eric Temple Bell

Sometimes we therapists have a very helpful map to offer. Other times our maps are a hinderance and obscure the road ahead for our patients. In the end, the best maps are those which our patients create. The ones we have to offer are just temporary aids. 

Therapy is about helping people see the broken parts of themselves. Therapy is about being witness to that which was broken. Therapy is about co-creating a space where our clients have a place to feel fully broken, to feel helplessness and despair, and for clients to discover in their own ways the contours of the territory ahead. 

Don't forget to listen, young therapist. Create the space for people to be broken. Allow your patients the dignity of the agency to decide what lay ahead. 

Help them find their own maps and their own territories. 

Do not accept any of my words on faith,

Believing them just because I said them.

Be like an analyst buying gold, who cuts, burns, 

And critically examines his product for authenticity.

Only accept what passes the test 

By proving useful and beneficial in your life.

--The Buddha 

I can describe the mountain, but the description is not the mountain, and if you are caught up in the description, as most people are, then you will never see the mountain.

-- Jiddu Krishnamurti

Or as my mentor Joseph Shay used to say, "I'm just one guy talking."

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Dear Young Therapist: Sometimes Race and Sex Matter

In a recent post on Psychology Today, psychologist/blogger Todd Kashdan wrote a post entitled "Sometimes Race and Sex Don't Matter: An Attempt to Stop the Madness with Political Correctness Run Amok." He starts with a story about his six year old twin girls:

Its beautiful to observe how at 6-years of age, my twin girls do not describe friends, teachers, neighbors, or strangers by race. This is rather typical: 

"Dad, you know who I'm talking about, the guy with the nose that kind of bends around, with the puffy cheeks. Why are you looking at me like that, you know him, I've seen you talk to him." 

"Why does that guy with the round head and bunched up legs walk his dog in the rain?" 

"My best friend at school right now is Tamina. She wears glasses, her hair is long and crunchy, and she talks really fast." 

These interactions require my full mental capacity because unfortunately, I have no idea who the hell they are talking about. In my career as a psychologist, race becomes a paramount descriptor. And while there are many reasons to do this, I want to suggest that this has gotten out of control, causing more harm than good

The blogger appears to be promulgating a color-blind perspective that involves seeing a person as a whole rather than a person with a complexion of a particular skin tone. In the above quote, the blogger/psychologist  describes his children as not seeing people by their race because they make observations about stereotypical phenotype differences in people they encounter (texture of hair, shape of nose, etc.) rather than making a specific mention of their complexion.

Hidden within his proud fatherly talk about his children, Kashdan obscures a significant body of literature within the field of psychology about the color-blind approach to race and human differences. Here are a few highlights of the thousands of peer reviewed articles written about problems of being color-blind:

Never do this young therapist. Never.

Yesterday I wrote about an adoption agency that posted photos and protected health information about children who were in a disrupted adoption (their adoptive parents were going to sign them away to another parent because things didn't work out). Through the efforts of many individuals, Wasatch International Adoptions was pressured to take the information down.

I found the blog of the Wasatch International Adoptions.

We use the internet to post a story about the child, using a false name, but using real photos. Our Second Chance Facebook site has over 10,000 members, and when we post a child, there are 10’s of 1000’s of cross posts. Our administrative page shows that we often have 100,000 or more people view the post! It has been as high as 300,000 views of a child.

I'm just floored that a licensed social worker would appear to have such little understanding and knowledge of the ethical codes and laws which govern their practice. Maybe I'm being generous in my assessment. Perhaps these licensed social workers are wantonly ignoring the expectations of privacy that the ethical codes of Social Workers demand.

Licensed therapists don't show real photos and real stories about their clients. There is no excuse for this. There is no reason for this to happen. Ever. There is absolutely no reason to display a client's picture and personal story to 10,000 facebook members, who cross post that information 10s of 1000s of times, making a child and their personal experiences displayed to 300,000 strangers.

How would you feel if your therapist told everyone in the city of Anchorage Alaska (population 298,610) or Pittsburgh Pennsylvania (population 305,704) about what you talked about in therapy last week? What would it feel like if the population of Valladolid Spain (312,434) knew that your mother sexually abused you? Would you be comfortable if I told the everyone in Suncheon South Korea (population 304,528) that you had problems with inappropriate masturbation?

This is just the kind of information that this adoption agency displayed on the internet--intentionally displayed on the internet--and acted as if it was ethical, legal, and the right thing. The agency felt that because they had a release of information from the parents of the children (parents who want to abandon their adoptive children), they had discharged their ethical duty to protect their patients privacy, dignity, and confidentiality.

Never do this young therapist. Never. 

Dear Young Therapist: Don't Be Afraid to Love

"Graduation" by Caroll Lewis

Dear Young Therapist:

Love is a word you've probably not heard in your training. It's probably not appeared in your textbooks, been a topic in seminars, or come up in conversations with your clinical supervisors.

If you've talked about love at all, you've probably talked about avoiding it. You might have even been taught that love is a hinderance to therapy.

The messages about love that I've learned in the past twenty-one years of clinical practice are clear. Love is something that must not be discussed between patient and psychotherapist. It certainly is not something to be experienced--and if it is--it should be concealed and unspoken. Love is too dangerous. It is too confusing. The risks are too great. Patients get confused in therapeutic relationships and mistake care for love. Some patients, traumatized by violence, are too fragile to understand that love does not have to be sexual.

Perhaps you've been taught to be neutral, objective, relatively non-emotional, and essentially impersonal. Perhaps you've even been taught that it's useful to deprive your patients of the emotional connection they want in order to foster growth and achievement of therapeutic goals.

I was admonished by a supervisor once for gratifying a terminally ill patient's needs by expressing care for him. She was concerned that I wasn't giving him the opportunity to work through his infantile infintile (thanks CS for finding my parapraxis) dependency needs.

Later, as a postdoctoral fellow, I was taught to never tell a patient that I was proud of them. It was explained that it was too complex of a feeling and patients would get easily confused. I must not ever express love or pride. Patients need to learn to accept the limitations of the therapeutic relationship so they can learn to tolerate not getting their needs met in their other relationships.

I've also learned some other things along the way.

• I wasn't even 20 years old when I had an internship at a rape crisis center. I was left alone in a room to be supportive and helpful for people who endured unimaginable traumas. I had no skills, no words of advice, and certainly no therapeutic interventions. I did the only thing I knew how to do: I cared deeply for my patients and loved them. I never said a word of this, of course. I had already absorbed the notion that love is an unmentionable word in clinical contexts. Still, this was the first time I became aware that expressing care and concern (and genuinely caring and being concerned) for people--in and of itself--can be healing. 

• Two years later I was living in Ithaca, New York. It was my last day working at a supervised apartment program for adults who had developmental disabilities and mental illness. The residents threw a surprise party for me. I walked into one of the apartments to do my last check and I was surprised with a song. After a rousing chorus of "For He's a Jolly Good Fellow" each one of the residents and staff gave me a hug. Most of the residents whispered in my ear that they loved me. I whispered quietly into each of their ears "I love you too." I worried what people would think but said it anyway. It was true.

• Two years after that I sat on the back stoop of a shelter for runaway and throwaway teens. A male resident had ran away from the runaway shelter. As he was thinking of returning, I sat with him while he raged against the world and how poorly he had been treated. I looked at him with all the love in my heart. I remained silent fearing what would happen if he heard those words. 

• Three years later I sat with an gentleman in his late 50s. He'd been diagnosed with HIV before the virus even had a name. He was having a bad day--filled with pain from the side effects of his medications. He was afraid of dying alone. I sat next to him on the couch and held his hand. I loved him and wished I had the courage to tell him that.

• Three years later, I met two women that forever changed the course of my career. My supervisors and teachers, Robin Cook-Nobles and Judy Jordan, regularly--and fearlessly--talked, taught, and told me that it was okay (and powerful) to love my patients in appropriate ways. I vividly remember the rainy afternoon Robin said that it was okay to love patients, and okay to talk about it. I've never heard a psychologist say that aloud before. I've never heard a psychologist say it again since leaving the Stone Center.

• Later that year I drove to do the oral section of the second part of my comprehensive examinations. My intervention, though concealed with flashy prose and the relational cultural model of the Stone Center, rested in my love of my patient and this song. I almost failed. My intervention was not seen as a strong one. I was not doing things like I was supposed to--I failed to conform to accepted protocols. My stubbornness and belief in the inherent worth of my patient carried the day. I passed.

• A few years after that, as a post-doctoral fellow, I worked with a rather ornery teenager. Rather than talk with me and tell me how much he disliked me and the rest of the world, he sprawled himself out on the couch and pretended to sleep. Every so often one eye would peep open to see if I was still paying attention. I sat for the entire hour focused on him, loving him, and imaging how his parents might have (or might not have) just sat gazing at him with love when he was a tiny baby. My supervisor, Louise Ryder, seemed moved to tears when I told her this story. I was too. 

I've developed a good deal of technical brilliance in the last twenty-one years of working with people. I can create masterful interventions in a variety of modalities and nimbly conceptualize people and problems from a variety of theoretical orientations. You'll need to learn how to do this too, young therapist. It's a necessary part of learning to be a good at what we do.

Technique and skill, however, are not enough. Don't let yourself dwell too much thinking you are something special. Most trained monkeys can develop technical brilliance with the number of hours we spend in supervision and class.

There are more important things that cannot be taught. They must be discovered.

You'll need to learn to love. Loving patients is a dangerous method. Yet in the end, I think you'll learn that it is the only method that you'll keep by your side--day in and day out--for your entire career.

Love is the only method and theory that I have. It is the place from which every action I take as a psychologist originates from--at least on days in which I am not cranky. I suspect many other therapists, of all training and orientations, would discover the same after wading through years of injunctions against and fear about love.

When I graduated from high school my mother gave me the book her mother gave to her when she graduated from high school. In some ways, this passage started my development as a psychologist. Vicktor Frankl writes in his book Man's Search for Meaning:

Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware of the very essence of another human being unless he loves him. By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he should become, he makes these potentialities come true.

More recently, reading Gail Hornstein's book To Redeem on Person is to Redeem the World: The Life of Frieda Fromm-Reichmann,  I came across this passage from Erich Fromm's book The Anatomy of Human Destructiveness:

To have faith means to dare, to think the unthinkable, yet to act within the limits of the realistically possible; it is the paradoxical hope to expect the Messiah every day, yet not to lose heart when he has not come at the appointed hour. This hope is not passive and it is not patient; on the contrary, it is impatient and active, looking for every possibility of action within the realm of the real possibilities. 

So there you have it. Love and Faith. The two bookends of my professional practice as a psychologist. Deceptively simple. Incredibly powerful. Often scorned by the professional community.

I'm old enough to no longer care how my fellow psychologists evaluate me. I'm skilled enough to know how to wield these twin tools of relational growth and change within the safe boundaries of a therapeutic relationship.

I'm thankful that I've never met a patient that I couldn't love or couldn't learn to love. It's from that space that I begin to see the seeds of where a person might be able to go, grow, and let go. It's from that space that I can find the confidence to let go of wanting a patient to be something I need them to be (or society needs them to be) and let them go about finding what they need themselves to be.

Still, young therapist, I don't frequently tell my patients that I love them. It is often dangerous and disruptive to use the word. Patients can become incredibly confused and conflicted. Too many therapists also become confused and conflicted.

Just because love is dangerous, doesn't mean it shouldn't be thought about.

I am not afraid to love and to say that I do when a moment of genuine honesty is the best intervention. Don't forget this, young therapist. Don't forget that our work is built on a foundation of faith in humanity and love of the person who sits across from you.

The flashy (or boring) masterful interventions and protocols you learn are necessary. Caring and loving and believing in humanity is necessary. Neither, on their own, is enough to accomplish much of anything. Joined together you have the possibility for movement and growth.

You need to both become a master at your craft and a master at loving a fellow human being--being with a patient, loving them, caring for them, and having faith in them--in combination with masterful interventions--that allows another person to find themselves.

We wither and die alone.

We grow in connection with others. We grow in being loved by another. We grow in finding that after all we've experienced, you've got the love inside--it's been there all along.

I had a dream that our hearts are like flowers

opening up every time that we love

and I'm wondering if we just try and risk everything for love

how can we ever go wrong

Nobody said it would be easy

nobody said it would be fair

all we can do is try to keep our fears from running us

just let our innocence be our cure

#radiowisdom

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Dear Young Therapist: Allow for the Unexpected

Dear Young Therapist:

No graduate program can prepare you for everything that is going to happen in your career. As you embark on your journey as a therapist you'll want to be sure you make allowances for the unexpected to happen. It will--in ways that you'll never expect. 

My training did not prepare me for what happened on April 15, 2013. Bombs went off just two and a half miles away from my office in Cambridge. While I could not hear the explosions, I could hear sirens and helicopters as the day progressed. My heart sank hearing the news between my appointments: my city--my home--was under some sort of assault. 

I reached out to friends and family. I was safe. They were safe. 

My mind quickly turned to my patients--some forty people scattered across the Boston region who call me their psychologist.

Were they safe? 

Some volunteer every year at the finish line of the Boston Marathon. Others live or work within the area of the blasts. Some, experienced survivors of all sorts of trauma, were likely to be stimulated and flooded with fear. I worried about them reliving their own personal hell from the past.

I wasn't trained to reach out to patients when I think they might be in distress. I wasn't trained to know what to do when bombs exploded just a couple of miles away from my office. What teacher could anticipate such a thing?

You'll learn in your practice that sometimes the right answer to the situation isn't the thing that your supervisors taught you. Ethics are important. It's important that you spend years studying your ethical code so you can develop a deep understanding of the complexities of being ethical in your practice. You'll need lots of colleagues to talk things over with. You also need to learn how to be responsive in ways that codes and protocols cannot teach you.

You've got to make allowances for the unexpected and know how to make decisions when the world around you has fallen apart. Days will come when you'll have no supervision, guideline, or protocol to follow. You'll be on your own. You'll know you've finally earned your license when you know how to make a path of your own that's strong, clear, ethical, and wise.