In Therapy

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Seven Questions for James H. Bray

Seven Questions for the President of the American Psychological Association

Today the Seven Questions welcomes the 2009 president of the American Psychological Association. It just seems fitting to hear from a president this week. Dr. Bray joins an esteemed panel of influential authors, theorists and policymakers who impart their views on fundamental issues in psychotherapy.

Psychologist James H. Bray (Ph.D. University of Houston, 1980) is associate professor of family and community medicine and psychiatry at Baylor College of Medicine and adjunct psychology professor at the University of Houston. Dr. Bray directs the Family Counseling Clinic at Baylor, which specializes in collaborative primary care for children and families and training psychology students in primary care psychology. He also leads a psychology clinic at the Northwest Community Health Center that provides training and psychological services for indigent and disabled people, and for those without health insurance.

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Dr. Bray has more than 100 publications to his credit, including several books. His research on Stepfamilies is considered a landmark contribution to the field. He has been a consultant to the National Institute of Mental Health Consortium on Families and HIV/AIDS research program, and a member of both the Texas Supreme Court Advisory Committee on Child Support and Child Visitation and the National Leadership Coalition for Health Care Reform. In addition to his internationally recognized research, he maintains an active clinical practice specializing in children and families and behavioral medicine. It's good to know the APA has a leader with a heart for children.

His successful APA presidential bid ran on a familiar platform: change. Here's an interesting excerpt from his candidate statement:

Over 50 percent of health problems are caused by psychosocial and lifestyle factors, yet less than 7 percent of the NIH budget is spent on researching these factors. Primary-care practitioners treat over 60 percent of mental health problems, usually without involving psychologists. This must change.

Dr. Bray was kind enough to step away from his presidential duties to contribute to our ongoing discussion of therapeutic style. I particularly appreciate his comments regarding mind reading (Q2) and his stance on managed care (Q5). This kind of attitude in leadership gives me hope for the future of psychotherapy. My deepest gratitude to psychology's Commander in Chief.

Seven Questions for James H. Bray:

1. How would you respond to a new client who asks: "What should I talk about?"

Many new clients are unclear about how to begin psychotherapy, especially when it is their first experience. I usually start with, "What would you like me to help you with today? " Or "I suggest that we talk about what brought you in today to see me." Most people come for help because of a problem they recognize and with their own motivation for treatment. However, many people come for psychotherapy because a loved one or another healthcare provider has recommended that they seek help. In the first case, the "real" client may be that family member who was recommending treatment. In the second case, the healthcare provider may have not fully explained the rational for the referral.

2. What do clients find most difficult about the therapeutic process?

Initially, if they have not been in therapy they are not sure what to expect and have some fear and concern about what might happen. Many people believe that psychologists can "read people's minds" and are concerned that we will find out things they are not ready to reveal or will judge them. This leads to the second issue.

People also have difficulty trusting the psychologist to share their thoughts and fears with someone who they have not developed a relationship with. Even after they have developed a good working relationship, they may have difficulty facing some of their hurt or pain.

3. What mistakes do therapists make that hinder the therapeutic process?

Not developing a good working relationship with their clients. Some psychologists try to move to intervene before they have developed a good working relationship. If the client is not ready to change or discuss certain things, then they should speak up and let the psychologist know.

Not listening to their client's goals for therapy. Unfortunately in this age of rationed, managed care and brief manualized psychotherapies, psychologists sometimes do not listen carefully to their client's reasons for seeking treatment and what they want. They try to change the client in ways that are not acceptable to the client-this is not good for either party, as the psychologist feels frustrated with the process of psychotherapy and the client does not feel like he/she is getting the help they need.

Moving to fast for their client's desire for change. Many clients come to treatment and are not ready for change, so they first need help to get ready for change. Trying to change before you are ready is not wise-it is important to move at the client's pace and not the psychologist's or insurance company's pace.

4. In your opinion, what is the ultimate goal of therapy?

Help people change in ways that help them accomplish what they want in life, feel better, and be more productive in life. The goal varies by the client's needs and want. Some people just need to get unstuck to move forward, some need to learn new skills, while other's need substantial help with making a total make-over.

5. What is the toughest part of being a therapist?

Not taking client's problems home with you. Many people come for psychotherapy with significant emotional distress and pain. It is important to leave that with the client and not take it home with you. Otherwise you will be doing too much work and not a happy person.

Dealing with managed care companies to help client's get the services that they need. Many clients have good insurance, but the companies restrict care to boost their profits. It is a challenge to help client's have access to the services they need when working with these types of insurance companies.

6. What is the most enjoyable or rewarding part of being a therapist?

Seeing people grow, develop and become happy and productive. Nothing is better than to see a client overcome a problem or obstacle in life and make positive changes in life. These are the small treasures of everyday life.

7. What is one pearl of wisdom you would offer clients about therapy?

If you are not getting the results you want within a month, then find someone else to help you with your problems. You should expect some positive change-so if you aren't seeing it then let your psychologist know or find someone else to help you.

If you don't feel your psychologist is listening to your concerns then speak up and let him/her know that you are not being heard. Psychologists are experts in listening to people and understanding people's problems. If you don't feel like your psychologist is exhibiting their skill in this area it is critical that you let him/her know. Otherwise, neither of you will be happy with the process or outcome.

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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