Seven Questions for Nada Stotland

The Seven Questions project continues with Nada Stotland, M.D., M.P.H., President of the American Psychiatric Association and authority on women's health issues. As I stated in the introduction, this project will illuminate similarities and differences between influential figures in psychotherapy, from living legends to high-ranking officials to best-selling pop-psych authors. I'm honored to have the high-ranking Dr. Stotland's answers today for your perusal.

Nada Logan Stotland received her undergraduate, medical and residency education at The University of Chicago and was a member of the faculty for over ten years thereafter, serving as Director of Psychiatric Education. She then became Medical Coordinator for the State of Illinois Division of Mental Health and subsequently the Chair of Psychiatry at the Illinois Masonic Medical Center in Chicago. She is currently Professor of Psychiatry and Obstetrics/Gynecology at Rush Medical College, also in Chicago. She has served as Chair of the APA Committee on Women, Chair of the APA Joint Commission on Public Affairs, and Vice Chair of the Council on National Affairs. She is currently the President of the American Psychiatric Association.

Dr. Stotland has a long-standing interest in women's mental health, psychological aspects of women's reproductive health, medical education and medical ethics. She is the author or editor of seven books and over seventy-five articles, and has won a number of awards. She has also played an important role in public education about psychiatric issues, including frequent quotations in the New York Times and other print media, and appearances on Oprah, The O'Reilly Factor, Larry King Live, and CNN Talk Back Live.

In addition to everything above, Dr. Stotland is also a psychodynamic therapist. Her responses to the Seven Questions reflect these theoretical underpinnings infused with her notable warmth and compassion. I particularly enjoyed the very direct, very psychodynamic response to Question 2.

My deepest gratitude to the incredibly busy Dr. Stotland for taking the time to send in her thoughtful answers. Read on.

Seven Questions for Nada Stotland:

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

This depends on how new the patient is. If I have spent enough time with the patient to have a sense that s/he may be avoiding an important topic, I might steer the dialogue that way. With a brand new patient, I would respond 'What made you decide to come to see me?'

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

In insight-focused, psychodynamic psychotherapy, there are two difficult problems: remembering painful events and circumstances, and facing the fact that you play a major role in your own problems.

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

It is very difficult to categorize the right or wrong thing to do in therapy, because a great deal depends on the patient and the circumstances and the stage of treatment. For example, the psychodynamic psychotherapist should avoid giving direct advice---but sometimes, when the patient is about to make a major and irrevocable decision, advice is warranted. Another mistake is getting overinvolved and feeling responsible for the patient's well-being---although keeping a cold distance is not therapeutic either. Idealistic and dedicated new therapists tend to overextend themselves--seeing patients outside regular hours, allowing patients to delay payment of fees, taking telephone calls twenty-four hours a day.

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

The patient and therapist have to set goals together in each case. Some patients simply want a symptom resolved. Some want to achieve a particular end, like finding a life partner or completing an academic program. Others want to understand themselves as well as they possibly can.

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

Perhaps the most difficult aspect of doing psychotherapy is listening to and absorbing patients' psychic pain. Setting limits can be difficult. Setting limits with self-destructive or suicidal patients requires balancing the risk of letting the patient harm him or herself against the risk of setting off an escalating cycle of more frequent contacts, more desperate threats, and repeated hospitalizations.

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

There is no greater gratification than helping someone realize their talents and their dreams. It is also very enjoyable to hear each patient's narrative and to use one's training and experience to identify the nature of the underlying psychological problem and the best route to get at it with each particular patient.

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

That's a tough question. I would say that it's important to trust your own judgment. Choose a therapist you feel good about. Ask questions about the goals and methods of therapy. If you're not getting anywhere, get another opinion. But don't quit just because the going gets rough---maybe you are on the brink of an important insight.

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Is the Seven Questions project working? Are we illustrating differences between clinicians and their theories? So far so good. Dr. Stotland's references to avoidance, psychic pain and insight distinguish her responses substantially from the CBT concepts mentioned in Donald Meichenbaum's answers last week. But a founder of CBT vs. a solid psychodynamic therapist is a fairly simple comparison. What happens when the distinctions aren't so clear cut? We've only just begun this series; tune in each Wednesday and judge for yourself.