How does a consumer, shopping for answers to life's dilemmas, know whose wisdom to buy? Hire a therapist who leads a life that seems desirable to you, insists psychiatrist Frank Pittman III, M.D.
For 33 years as a psychotherapist, I've sold myself by the hour. People pay to talk to me about themselves. They come singly, in pairs, and in small groups. Some of them ask me to help them figure out what they could do differently to make their life and relationships work better. Others just bitch and moan and demand pity.
I sell them my time and whatever wisdom I have developed. If they expect their insurance to pay for it, I may apply a psychiatric diagnosis to them as well. If their brain chemistry is too messed up for them to think through their situation and to do whatever needs to be done, I sometimes prescribe medicine to fix the problem in their brain so they can then go on to fix the problems in their life. I also give them my humor; I try to make an hour with me entertaining as well as enlightening. I feel honored that they have brought their pain to me. The least I can do is make the removal of their pain as painless as possible.
I used to be proud of what I did. That has changed. Perhaps it was the unsettling experience of trying to explain to friends from abroad—for whom American psychotherapy is a foreign culture—how perennial psychotherapy customer Woody Allen could have undergone therapy for most of his life and still not have seen anything incestuous in his sexual relationship with his de facto stepdaughter, the sister of his children. When asked about his analyst's reaction, Allen is rumored to have said, "It didn't come up. It wasn't a relevant issue for my therapy."
Most humiliating for a respectable psychotherapist is the recently popular application of the format and jargon of psychotherapy to people's search for a victim identity. The victim identity is like a doctor's excuse from a gym class or history exam, only it is an excuse from life itself. People who want to be victims may nurture their inner child, may style themselves as adult children of imperfect parenting, or may announce that they are survivors of real or imagined unpleasant experiences. Either way, they resign from the adult world, eschew responsibility for their conduct in relationships, and whimper that the world owes them a life.
Values And Psychotherapy
There is such a thing as mental illness. It is real and it is horrible, whether it occurs as schizophrenia or mania or depression. Treating real mental illness may be the major professional expertise of mental health professionals, but it is a minor activity of psychotherapists. Most psychotherapy is about values—about the value dilemmas of sane and ordinary people trying to lead a life amidst great personal, familial, and cultural confusion. The therapists who do psychotherapy effectively do so because they understand value conflicts and they convey, without having to preach about it, values that work.
Psychotherapy is a process in which people in pain and/or turmoil purchase the time and expertise of a therapist who helps them: 1) define the problem; 2) figure out what normal people might do under these circumstances; 3) expose the misinformation, the misplaced loyalty, or the uncomfortable emotion that keeps the customer from doing the sensible thing; and 4) provide the customer with the courage (or fear of the therapist's disapproval) to change—that is, to do what needs to be done.
Psychotherapists vary widely in the rapidity with which they provide their customers with answers to the questions being raised, and the degree to which they take credit for providing the answers. Some will simply tell people what to do; others will make the customer guess for a few years before subtly signaling they've finally gotten it right.
Most therapists work hard at trying to get people to do what we think is right and to take credit for it themselves. The trick is to keep pushing and hinting without seeming so bossy, controlling, or disapproving that we run them out of therapy before they have changed their behavior or solved their problems. It's not an easy job and, while it doesn't require brilliance or magic or even a loving nature, it takes both talent and skill—the talent to keep the customer in therapy long enough for it to work and the skill to define the problems and solutions to the dilemmas of human existence.
Psychotherapy ordinarily offers a safe and accepting format for helping people come to grips with their emotions and then go ahead and do sensible things with their lives, whether they feel like it or not. It's a process by which people identify and talk about what they feel, rather than act on their emotions and do what they feel like doing. In the process, there may be a transfer of sanity and reality testing from therapist to patient. The therapist's calm may soothe the frantic patient. Sometimes the therapist is the one who must get frantic in order to alarm an inappropriately calm patient who fails to see the dangers in his or her actions.
Either way, psychotherapy involves applying the value system of the therapist to the dilemmas of the clients. The most important work of psychotherapy takes place inside the therapist's head as he or she thinks through the patient's snag points in dealing with this latest bump along the road of life.
When you go to a psychiatrist for medication or shock treatment, or to a psychologist for psychological testing, it may not matter very much what sort of person the professional is. But if you're choosing to bring a psychotherapist in to your life as a consultant, his or her value system is more important to you than training, credentials, or even a professional degree.
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