Lessons From the Couch, About the Couch: So you can coach me too, right Doc?

Posted on by TheGoodDrNik
This is the third entry in my series on psychotherapy entitled Lessons From the Couch, About the Couch. This series seeks to educate the potential consumer of counseling/psychotherapy about important aspects of therapy, and how to go about smartly engaging in the process in order to maximize benefit.

I have a confession: I watch Iyanla’s Fix My Life series. And I have to admit, it became a bit addictive and I found myself  hardly able to WAIT until the next week’s episode! And then I started to think about why.  And it dawned on me — it has all the makings of good entertainment; melodrama, a hook, something the viewer can identify with, and a twist to keep you from channel surfing and never coming back. But those attributes of the show, yes The Show —  the drama, the hook, and the entertaining — that was exactly the problem with it. People’s pain, and issues, and desire to be whole should not in any way be held out for public consumption (in my opinion). It shouldn’t be for entertainment purposes. It shouldn’t be for the voyeurs to gawk at. How people experience pain is personal. The work they do to alleviate it adaptively is personal. That brings me to my question: What exactly is the difference between psychotherapy and coaching?

While Ms. Iyanla does not market herself as a psychotherapist, what she does comes across as therapy.  And it starts out very similarly to how a real, therapeutic relationship with a psychologist or counselor begins.  For example, initially Ms. Iyanla tries to establish a rapport before easing into the sensitive issue(s). In many respects, it would appear to the therapy unsavvy layperson that there is very little distinction between coaching and counseling. But then it starts, and I am reminded that no, this aint therapy.  The change in tone. The loud voice. The perhaps overly assertive (code word for what some might call aggressive) confrontation. The touching and hugging and rubbing of backs. The up in yo’ face. The very things that I love about the show because it’s just great entertainment and keeps pulling me back, — is the very problem that I have with it. No, this aint therapy!

See, it would be unethical for psychologists to get in your face, yell, or raise our voices in anger or frustration. I get it though. That’s what sports coaches do. And maybe that’s just Ms. Iyanla’s tactic. It is not customary to have so much (if any) physical contact with the patient at all. We are trained and cautioned to have very strict boundaries. Emotionally, physically, and ethically.  For the five or six or seven years of clinical training we do, we are indoctrinated to knowing about boundaries and understanding lest that WE ourselves are a tool in therapy. And everything we do, say, feel, react — EVERYTHING is interpreted by the client. Can impact the relationship.  That is a key difference between coaching and psychotherapy.

Mental health professionals understand that it is the relationship that fuels the change.  And we know how fragile the therapeutic relationship is. Perceived insults or slights can indelibly impact it. And when that occurs, there is no sustainable change that can occur.

So boundaries, the ethics and strict professional standards, and the regulation of our professional practice by law are key differences between mental health professions and coaching. Anyone can become a coach. And while there might be a couple hundred hours of training needed, there is no process of vetting. No process of intense supervision, feedback or opportunity for correction.

The focus on the past (because we understand that to move forward, you oftentimes first have to go backwards), the type of client (we work with pathology, mental disease, and people who at times are very entrenched in their illnesses), and the many years of academic study, rigorous clinical training, supervision, and practice to hone our craft are important differences that separate us from coaching. Last, but certainly not least, counseling and psychotherapy are based upon the sciences of psychology, human behavior, neurobiology, and physiology among others. We have over a hundred and twenty years of research and scientific study to back us. And we use the research to form the basis of our interventions.

What we (psychologists) do is treatment. While we fuel change, motivate, and seek to shape human behavior just like coaches do, we treat. Period. We treat the wound. We dig deep and look for the wound because nine times out of ten, there is a wound. It isn’t always in the form of abuse, or assault. Sometimes it is much less salient, but just as profoundly impacting on a life. We know that there is always a wound. And that wound, and that lack of healing is what keeps people in a perpetual state of stuck.

So naw, I can’t coach you. I cannot put on my metaphorical happy face and cheer you along to the job, salary, business or life you dream of.  While mental health professionals aspire to move people forward, that’s simply not all we do. I can figuratively hold  your hand, take you on a long journey, guide you to the deep places, find the hurt, partner with you to heal the hurt, and allow you to own your story. I can empower you to be the best you by empowering you to do the hard work. And being perhaps the only constant you have ever had in your life while you do it. Once you’ve done that, the job, the salary, the life…will follow.

Don’t get it twisted; there are some uber talented, TALENTED coaches of all sorts. And there is a place for coaches. And yes, I still do love so many things about Ms. Iyanla! But the place for the coach is not with the couch, or with those who would be best served on the proverbial couch. And the techniques should not in any way mirror psychotherapeutic techniques.  Because simply, coaches do not do therapy. They encourage, they motivate, they empower, they move people towards their life goals and towards positive change. But that is not therapy. And that is not treatment. And the very best coaches understand that. And they don’t blur the very definite lines. And with that, they are ok.

There is room for both of us. There are more than enough people in need of some type of assistance. We’ll take the people in need treatment. And we’ll leave the coaching to the coaches.

Be well,

The Good Dr. Nik

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Dr. Nicole M. Alford is a DMV-area Clinical Psychologist in private practice. She is a prolific blogger, teacher, mentor, compassionate activist and media commentator. To learn more about Dr. Nik’s services, please visit http://www.TheGoodDrNik.com, and please follow her @theGoodDrNik on all social media platforms.

Lessons From The Couch, About The Couch: How to find a really good, effective therapist. (Or better yet, where’s that darn needle in this haystack)?

Posted on by TheGoodDrNik
This is the second entry in my series entitled, “Lessons From The Couch, About the Couch.”  As we are on the cusp of Mental Health Awareness Month (May, annually), and with the advent of spring, what better way to set yourself up for a new beginning than to set yourself on a path to a New You?  The road to this novelty, for many, begins with psychotherapy. But finding a good therapist can itself be a barrier to seeking services; particularly for people of color.

Finding a good therapist is hard. While therapists abound, (and to be perfectly honest, at times it feels like there’s one every corner), we differ in style, therapeutic   and level of training, treatment paradigms, skill sets, and of course fees.  Here are my tips, from the couch; both as a therapist and having served at times as a client. Here are some things to look for and to be aware of when trying to find a therapist:

  1. Know who you are going to, and what they can offer:  There are various types of mental health professionals, and they each vary in terms of education and training, expertise, and types of professional services they can provide.  Understanding these differences is key.  For example, psychiatrists are licensed medical doctors (MDs) who specialize in the diagnosis and pharmacological treatment of mental disorders. In others words, they can write prescriptions and administer certain types of medical treatments that must be performed by a physician (like ECT). Most psychiatrists only do diagnosis and medication treatment and management; NOT psychotherapy.  Psychologists have either a Ph.D. (doctorate of philosophy) in psychology; this is an academic degree with an emphasis on both clinical skills and research on mental disorders and  psychotherapy, OR a Psy.D. (a doctorate of psychology). The latter is a relatively new professional degree with an emphasis on clinical training; research — not so much.  Many clinical and counseling psychologists directly practice psychotherapy, but we are all trained to do psychotherapy.  Social workers are master’s level practitioners whose training is really more so on the welfare and community services available to families, groups and individuals. Clinical social workers are trained specifically in psychotherapy and the diagnosis and treatment of mental disorders, as are licensed professional counselors (LPCs), another type of master’s level clinician. However, the latter 2 categories have half, if not less than half of the years of clinical training and education than psychologists or psychiatrists; that said, there are many kick-ass, clinically astute social workers. So decide which clinician might be best based upon your issue(s) and potential treatment needs.
  2. Search for a therapist like you search for a babysitter (the parents know what I mean!):  This is a serious matter. You wouldn’t let just anyone care for your kid; do you really wanna just let anyone care for your mind? So here I  appeal to the consumer in each of you, and I encourage the consumer of psychotherapy to take this bull by the horns! Research finding a potential therapist just like you would a babysitter. Be meticulous and detail-oriented in your search. Your therapist should be vetted. This could mean getting recommendations from trusted friends or family members (yes, many of them might currently be in therapy or have been in the past, and may be willing to share resources and experiences).  You can read the online profiles on the therapist’s website, their profile on your health insurer’s website, or on any of the major psychotherapy referral services. This will give you a feel for his or her educational and professional background, areas of specialization, style, etc.  And last, call and engage the therapist you are considering in a brief discussion. Interview the therapist and ask important questions such as how long he or she has been practicing, how many cases of (depression, anxiety or whatever your issue is) has the therapist seen, etc. Get a vibe, and then think about the conversation you just had. Did you feel rushed? Did you feel heard? Were you given an opportunity to ask questions and were your questions answered? This will give you some indicator of therapist professionalism, demeanor, and style.  And this might likely give you some understanding of whether or not this is the person for you.
  3. Use your available resources to find a therapist:  Your medical doctor likely has a vast network of both medical and mental health professionals, and could therefore be a good resource to tap into (especially if you like your doctor, respect his or her professional recommendations, and have developed a good relationship with your physician).  Second, many churches also have direct links to community-based providers or Christian counseling practices. Another untapped resource is the state! Our tax dollars paid to the state go towards vetting, licensing, and regulating the practice of mental health practitioners. Every state has a board of psychologists, social workers, and/or counselors that has a public website whereby you can search for a specific provider, search the status of his/her license, and learn whether there are any active ethical complaints or malpractice suits against that person. I strongly encourage this type of search be done on any potential therapist you are considering employing.
  4. Assess your needs and choose accordingly:  Do you need someone to see your child? Are you looking for a couple’s counselor? Are you a Christian and only wish to see a Christian counselor? Do you think you would feel more comfortable with someone who is of the same cultural background? Did you have previous therapeutic success with a certain type of therapy or intervention? These are all important questions that should absolutely drive your selection of a therapist.  Find someone who has the expertise, years of experience, and training in the area that you are presenting with. For example, if I am a veteran with a diagnosis of PTSD, but I want to see someone outside of the VA system, then I would look for people who are certified in trauma treatment, and who have experience treating veterans and/or those with PTSD. If I need someone to see my child, then I want someone who has vast educational training and experience and perhaps special credentials in working with children (i.e. board certified in child/adolescent psychiatry).
  5. Trust your gut: All too often, we Monday morning quarterback the situation that ensued when we didn’t listen to our initial gut feeling about a situation. The minute a therapist says or does something that makes you feel uncomfortable or fearful, or makes you question his or her ethics, or does not answer your basic questions, it’s time to switch. Now keep in mind, you should feel uncomfortable in therapy — if it is all roses, if you are only hearing what you want to hear, then nine times out of ten you are not being totally open and forthright in the sessions. However, what you should not feel is whether or not this is ‘right,’ sexually hit on, disrespected, or any of those emotions. The therapists office, and demeanor, should communicate safety and compassion. If that doesn’t exist, trust your gut.

Where to look:  Last, there are a number of free referral services that exist solely to help consumers to find local mental health providers in their area, that take their insurance, and which list specific areas of expertise. http://www.PsychologyToday.com and http://www.GoodTherapy.org are the two largest ones that millions of people turn to.  Second, each state’s psychological association has a referral list on their website. Google your state’s psychological association and start there. And lastly, your health insurer’s website will also list in-network providers, by specialty.  However, also keep in mind that you can also pay for you mental health treatment out of pocket, which allows you to be the driver and to be open to see whomever you choose. Flexible healthcare spending accounts can reimburse you; just make sure the therapist provides you with the appropriate documentation. You can also seek reimbursement through your insurer, however, check first to ensure that out-of-network mental health benefits are reimbursed — and at what percentage.

I really hope this helps to demystify the ofttimes gargantuan task of finding a good therapist. And I wish each of you the very best in your quest to change. The more of us that really do the work on ourselves, the better off the world will be.

Be well,

The Good Dr. Nik

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Dr. Nik is a DMV-based Clinical Psychologist, prolific blogger, speaker, media commentator and compassionate activist. For more information about her services, go to http://www.TheGoodDrNik.Com, and follow her @theGoodDrNik on FB, Twitter, and Instagram.

 

Lessons from the couch, about the couch: What is therapy really and how does it work?

Posted on by TheGoodDrNik

This is a piece for the uninformed yet potential therapy user that I hope will be equally esteemed by therapists themselves. In an effort to demystify the process of healing and change that we call psychotherapy, I decided to put pen to paper with the hope that the more one knows about a thing, the less anxious one will be about trying that thing. So I’m going to offer my thoughts on what I have learned from being a practicing psychotherapist and working with people from all walks of life dealing all types of issues, using all types of psychotherapies. This is what I have learned, so far:

  1. Therapy is a journey:  From the very first session, you start out on a quest together — doctor and patient. As the pilot, the therapist is keenly aware of where you the patient needs to go (at least most of the time).  And much of the the therapist knows where you have to travel to get there. But oh, the places we’ll go! It’s the twists and turns that you can never predict and that you don’t quite expect that make the journey. It’s the loopdey loops and the slow ascensions followed by the steep drops that leave you, the therapist, sometimes breathless. Thoughtless. Speechless. And truth be told, sometimes very frustrated. And many times scratching your head in sheer confusion. The therapeutic journey is real. And sometimes it’s a real trip! Sometimes it feels like a trip on the highest, fastest rollercoaster ever built. But I’ve learned that there is magic in the journey. And that is what makes the journey worth it.
  2. Therapy, like life, is about relationships: The therapeutic relationship — that between patient and doctor, is indeed, a rare one.  In fact, I am going to go so far as to say that I don’t know of any other relationship quite like it. It’s a special bond forged by mutual trust, honesty, compassion and vulnerability.  But unlike other relationships with a similar foundation, rarely is there ever the type of implicit trust that this relationship packs. As the patient you’ve given your therapist carte blanche to give you his or her honest interpretations and clinical opinions of you and your thoughts. And your behavior. And your decisions. No matter how HARD it is to hear. And you have made the explicit decision that since this therapist is an expert in human behavior; he or she must know what the heck she is talking about. So you trust what they say. Most times. And you keep coming back. Most times. Because you feel that this doctor cares in a way that no one else has or can. And you trust that if you keep coming back, and listen to the recommendations, and do the work then change will come at some point.
  3. The therapist is a tool (it’s not what you think)! I’ve been practicing professional psychology for exactly two decades. I was 24 when I saw my very first therapy client in graduate school. Not only was I green to therapy, but for real, I was green to life! And while I had a few tools in my toolbox and a bit of skills, I had no wisdom. Like Zorro with the proverbial sword, I didn’t know how to use the sword. I had no context to marry the skills with. While many of my colleagues may disagree, here is what I know for certain: I know that I have become a thousand times more comfortable in this role over time and with  experience: life experience. I’ve become more genuine with those on the couch the more I came into my own being and my own acceptance of me. Of what I know, and more importantly, of what I don’t know. The more life I had lived, and the more experiences that I had (both good and bad), the more I understood life. These are the experiences that I rely upon in my sessions. They have given me street creds. They are my bona fides. They are the passport that gets me into a foreign land (the minds of my patients). And so because I have lived some life, I have some wisdom about some things. There are just some things you know because you have lived enough life to have seen them over and over again. I know that trouble doesn’t last always. I know that emotional pain isn’t permanent. I understand that there are hills and valleys in life. So with that said, I am a tool in therapy. And my near 50 years of life are the scrapes and scratches and marks that have well seasoned me to be of good use: to drill down to the issues and get to the depths of the pain. And to facilitate the journey.
  4. Therapy is part art & all science lightly sprinkled with a pinch of miracle dust: Though it may seem so, therapy is not hocus-pocus conjury. On the contrary, psychotherapy is based on hard science. Its foundation is built on the integration of various schools of psychological thought and a century of research in human behavior, with a smattering of miracle dust and a sprinkling of Wonka juice. I jest, of course, but sometimes that’s what it feels like. Though there is no proverbial waving of a wand by the therapist, something magical happens in therapy. At the end of the journey, if the therapist is truthful with herself, she acknowledges that it was very little of her own skills or talent. And maybe it wasn’t even much of the science implemented or the techniques recommended. Rather it was a great deal of trust, courage, consistency, and difficult individual reflection done in the comfort of the patient’s home. Outside of the therapist’s office.
  5. Therapist As Superhero: In the end, we are not superheroes. We are mere mortals with the same emotions, issues, and insecurities as our patients. We aspire to be just a bit more authentic, self-aware, real, and emotionally healthy as our clients do. But the truth is, we are not superheroes, or even super human. Truth is, this is hard, emotionally taxing, and really heavy work. It weighs on us. And we hurt sometimes because of it. There is no cape we wear; no red cape to hide the wounds. No suit that gives us special strength, no wand we wave. There is no magic in us, yet I am clear that very magical things sometimes happens through us.

The therapist is simply a mirror. We simply show you…YOU in a realistic way. The way the world sees you. Like the queen in the fairy tale, you must have the courage to ask the mirror (metaphorically speaking), what it sees and even more courage to accept the response. That right there; that’s the magic. And when therapy is done right, you get to see the you that you are and begin moving towards becoming the you that you were destined to be. It will be a journey. I don’t guarantee much, but I can guarantee that. But in the end you’ll say it was the greatest ride ever.

So, consider therapy. Find a good therapist. It can and will change your life!

Be well,

The good Dr. Nik

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Dr. Nik is a DMV-based Clinical Psychologist, prolific blogger, speaker, media commentator and compassionate activist. For more information about her services, go to http://www.TheGoodDrNik.Com, and follow her @theGoodDrNik on FB, Twitter, and Instagram.