Thursday, January 31, 2008

What is a "Therapist?"

There is no more common word in English than "therapist."

The public sometimes prefers “counselor,” and refers to therapy as "counseling." But having a serious conversation and receiving advice about your behavior is not therapy.

We are a frail species that does not survive early childhood physical and emotional damage easily. A few moments of violent or improper behavior to an infant produces lifetime, often debilitating symptoms. Unfortunately, abuse is usually continual and hidden. It does not matter what may be in the mind of the adult who does the damage, because the infant has no intellectual knowledge. But its little body knows.

There is a vast difference between physical abuse to someone over 6, that can be remembered and talked about, and abuse to an infant. I know women who were raped once in their teens, who twenty years and much therapy later cannot fully recover. But abuse to a child before 6 is much more dangerous and difficult to treat. Forgotten abuse before three is the most problematic, because recovery is only accomplished by physically and painfully reliving it. For that to happen one must courageously work with an equally courageous and properly trained therapist.

For over a century we have evolved the notion that someone we call a therapist can somehow intervene in the present -- go back into the infant psyche, still active in the suffering adult, and heal the wound. You may judge the efficacy of this notion by the state of the world. The planet is in peril. Insane wars abound. Genocide is common. We torture innocent children and animals. We cannot stay committed in marriage. We are greedy and selfish. We do not know how to love, and are angry and confused. Because of this therapy has become a huge growth industry. Anyone of reasonable intelligence can become a therapist -- and the pay is terrific.

“Backlight” was written because, in addition to entertaining, I want to increase understanding of a genuine, healing therapeutic process that works. The novel presents a perfected notion of an enlightened and ego free therapist. We remain tragically confused over how to recover from even the simplest and short-lived attack on the infant's body -- to say nothing of sustained and sadistic abuse.

Philip McGraw Ph.D., a hugely successful TV personality, is an example of public figures who have added to the confusion. The title Dr., attached to the soothing diminutive of his first name, proclaims that here is a healer, a caring physician, a sensitive therapist. He is none of these. The man is a brilliant speaker, with a charismatic personality and genuine insight into human behavior. These of themselves do not heal. The fault lies not only with Dr. McGraw, but with his backers, sponsors and television network. The greed of all concerned has led him away from what might have been a TV show about healing.

Reportedly, a complaint has been filed against McGraw with the California Board of Psychology, who is powerless to discipline him, since he has not been licensed by them. It accuses Dr. Phil of practicing without a license when he “visited” Britney Spears at Cedars-Sinai Medical Center, after her breakdown earlier this month.

He apparently went to the hospital, under the guise that he wanted to help her solve the crisis that brought her there; talked his way onto a floor housing fragile patients, and waltzed uninvited into the 27 year old woman's room as she was leaving. It's amazing what sheer will and self-confidence can accomplish!

The Board may conduct an investigation, build a case for practicing without a license, and turn it over to a district attorney. These charges might result in a misdemeanor conviction which could result in jail time. Unlikely.

McGraw is also accused of violating the Health Insurance Portability and Accountability Act. The complaint alleges Dr. Phil practiced clinical psychology without a license by talking to Ms. Spears (as, in effect, he does every day with relative strangers) and further violated doctor-patient privilege by discussing the pop star’s case with the media. That's his show!

These complaints will probably come to nothing, since McGraw is unlicensed and could not have had a “doctor-patient” relationship with anyone for many years. Of course he discussed her “case” with the media! It was clearly the purpose of his hospital visit. He was also planning a television circus “intervention” with her parents, who wisely withdrew. All of this he did sincerely and selflessly in the interest of preserving the mental health of a young woman.

On a recent Dr. Phil show I witnessed what seems to me a violation of laws against performing therapy without a license. It was also abuse of common sense and human compassion. It doesn't matter that the victim had no doubt signed a release holding the Dr. Phil Circus harmless. I saw a weeping, out-of-control, serial womanizer, who had injured his wife's feelings and destroyed his marriage – endure a screaming attack from Dr. Phil that bore no relation in its intensity, to the crime.

As Oprah did with James Frey, Dr. Phil pounced on the helpless guy, taking out far more anger than any legitimate therapist would do. He elicited that the man was currently in therapy. Then, most amazingly, McGraw gave instructions that were to be passed on to the man's therapist -- who, one presumed from the instructions, would not pass muster in the Dr. Phil pantheon. The poor fellow tearfully agreed. Brilliant Dr. Phil was collaborating in his guest's therapy!

If I were the man's therapist I would immediately report Dr. Phil and demand that the network remove him. McGraw then turned to the poor guy's wife and demanded that she confirm she would never have anything to do with her husband (or ex-husband) again. She nodded solemnly, agreeing to the obvious -- but I doubted she would follow instructions. The heart cannot be ordered around.

Dr. Phil did give good psychological advice (something he is not entitled to do under the law), since getting a handle on compulsive womanizing inside a marriage is extremely difficult, as Bill Clinton and millions of other men can attest. Womanizing is often resistant to talk therapy (or bullying) which deals with recent events: and in the opinion of some legitimate therapists, arises from pre-verbal abuse. It arises from the same place in this poor fellow as Dr. Phil's desire to browbeat his fellow man.

I wonder how well the TV "therapist/performer" would stand up under a similar angry cross examination about what might have been his predilections for young women in the past. I got the eerie feeling Dr. Phil was so out of control and angry, because some elements of the fellow he was ripping into reminded of himself. What would the 19-year-old girl who accused him of improperly touching her say if she were willing to appear on television? What could Dr. Phil's wife and children tell us about his personal behavior around women other than his wife?

Immediately after this "performance" a commercial appeared announcing that Oprah was going to appear on Dr. Phil shows the following week. Of course. She is an owner of this charade. How can this brilliant, charismatic woman associate herself with such inhuman and absolutely useless treatment. It cannot possibly do any good for anyone to have an overbearing, overweight, brilliantly verbal TV personality screaming at you about failings that obviously haunt you every day.

Of course there were many shots of women in the audience nodding approval, as the righteous Dr. gave this poor fool his comeuppance. More importantly, I never saw any examination of why this man's wife was drawn to somebody who must've displayed, before they were married, some signs of psychological damage.

The word "rehab,” which presumably involves treatment by "therapists," further compounds the injury to the public psyche -- since most rehab fails. Many therapists who work with rehab patients are not trained in dealing with post traumatic stress disorder resulting from early childhood abuse, and that (usually combined with a genetic predisposition) is inevitably what is behind substance-abuse.

A “psychotherapist” can be someone trained in Psychology. A simple master's degree in will do to get a license. In California that is a MFT (Marriage, Family Therapist). From state to state the rules differ, but usually additional training and supervised therapeutic experience is required to work with patients, as well as some hours of personal therapy.Tragically, in every state with which I am familiar, the amount of personal therapy required to treat any mental and emotional problem is so small as to be virtually useless. From my experience it matters not if the psychotherapist has a Ph.D. in psychology. I’d rather they spent the time in getting their own head straight.

Psychiatry is a branch of medicine that deals with the mind. One can receive an M.D. in Psychiatry, having (depending on the medical school) received very little psychotherapy. Being a psychiatrist brings with it the lucrative privilege of prescribing powerful psychotropic and other drugs. So psychiatrists don't just talk, they can take "action."

I was treated for many crucial years by a highly recommend M.D. Psychiatrist, who was an associate clinical professor at a well-known University. Not much good came of it. He was a repository of classic sexist information. He spoke inappropriately about another patient I had met in his waiting room. He did great harm by giving poor advice about how to live my life. A competent therapist is loath to give any advice -- something Dr. Phil knows nothing about.

Later, when I got to know my therapist, I discovered he lived alone in a tiny apartment with the windows painted opaque black and walked around on a floor covered 6 inches deep with crumpled paper. Unfortunately this was not the craziest therapist I have encountered.

Many psychiatrists are skillful physicians and could save your life in an emergency room or deliver your baby. That same physician can also receive a Masters or Ph.D. in psychology -- thereby receiving more education in what are supposed to be the workings of the mind. I cannot imagine anything more useless in the training of a good therapist than an expensive medical school. It numbs and judging by the personalities of many doctors, it may be a negative.

The “Psychoanalyst” is therapy’s King Kong. He may draw his lineage from Freud, Jung, Klein, or a dozen other brilliant thinkers and theoreticians on the workings of the mind. To become a psychoanalyst one has to have at least a Masters degree in psychology and attend one of the many Psychoanalytic Institutes (many featuring dramatically conflicting theories of the mind) scattered around the United States. Many Psychiatrists, after medical school, take additional training to also become psychoanalysts. It’s expensive, because in addition to years of training, becoming a psychoanalyst involves hours, weeks, perhaps years, of Psychoanalysis by a practitioner from the Institute.

By the end of such training even the freest spirit has been broken under the deluge of impenetrable theories and jargon. The Freudians feud with the Jungians, who feud with the Kleinians – a list of competing therapies would be longer than this blog. If you are interested in the process read, “How Analysis Heals,” by Heinz Kohut. Of course the acolyte has to repay what are almost always loans. Graduates are the folks who give you the $200 and up an hour, four days a week for 10 years, “talking cure.”

In my late forties and fifties, I benefited enormously from working with a brave, young psychoanalyst who unfortunately never realized how badly I had been abused. My guess is her unanalyzed shadow injuries prevented her. But, in the course of treatment, by chance and on my own, I was able to return to life-threatening psychic damage that occurred while I was nursing. I don't think my analyist understood the meaning of what happened, but as I evolved I realized that was the beginning of real healing. From that day on my stuttering began to end.

After having paid a huge sum for what I now see as minimal progress, toward the end of our treatment my psychoanalyst got me to invest over $100,000 in a screenplay and film project which she wrote with an associate of hers. It was a disaster. Even well-intentioned and well-trained therapists fall prey to the love of power and money.

Many other forms of therapy may be licensed. I briefly worked in couples therapy with an MFT licensed sex therapist. The additional sex therapy license came from what turned out to be one of the most corrupt institutions unimaginable. This woman broke every rule of psychotherapy by stridently siding with my troubled partner, who had been violently abused in her childhood by her war damaged father and a mother in denial. The therapist complained about her sex life and the incompetent man she was living with. She continually stroked an enormous pink quartz phallus on her desk that she reminded us had been carved by her son. It was a Robin Williams skit. The damage further drove us apart and we soon left. Complaints were unavailing, since the California Licensing Board doesn't care.

I have had excellent, healing experiences with is two RCST -- Registered Biodynamic Craniosacral Therapists. Training and a license are required for hypnotherapy, although most of these therapists are trained psychologists and are licensed in family therapy. I worked with a brilliant Hypnotherapist, a disciple of Milton Erickson, who against the background of my psychoanalysis created a dramatic breakthrough in which I remembered unspeakable events in my early childhood. Initially those were crushing, but after time became the foundation for healing what had happened in my infancy.

Some therapists specialize in child therapy and one may receive a Psychoanalytic degree for that. Not enough people, in response to the great need, specialize in adult and child therapy for recovery from emotional and sexual abuse. A new field is rising which promises to release stresses from pre-birth, birth, and childhood trauma.

Against this background it is astonishing that Oprah Winfrey, who knows the value of good therapy, brought us “Dr. Phil.” She apparently met him when he was hired as a consultant when Oprah was being sued by the Texas beef interests. His job was to help her spin the attack from a psychologically manipulative position -- play the mind game and win.

He had problems before which she must have known about. In the early 1970s Dr. McGraw reportedly left Topeka, Kansas ofter being accused of defrauding customers at his health spa business. In 2006 reportedly he paid 10.5 million dollars to dieters who claimed they had been bilked by weight loss products he fronted for. He was linked to a psychological treatment referral service that at least one therapist claimed was a blatant scam.

Dr. Phil has often said he was a "lousy therapist" because he lacked patience. His brilliant mind saw the problem and he wanted to "cut to the chase," without all that bothersome growth and self-awareness. Nothing to it. You just shout at the compulsively philandering husband and order him to quit. You deal with the obesity epidemic by ordering the compulsive overeater to cease stuffing their mouth. You insist your patient be reasonable and follow the righteous path. That apparently doesn't work on either Dr. Phil or Oprah. An attempt to see obesity as a result of early childhood abuse might be more helpful.

In Canada the code of conduct prohibits giving psychological advice on television. They recognize the lack of confidentiality and proper therapeutic relationship. Would it were so here.

Oprah must know Dr. Phil has never been licensed to practice in California, and is no longer licensed to practice psychology in his home state of Texas. She might have instructed that there be a posted disclaimer at the beginning of every show. “What you are going to see is not therapy as practiced by a trained and licensed therapist. ‘Dr. Phil’ is not a physician or therapist.” He is not licensed to practice any form of therapy anywhere -- except on television -- for a lot of money.

Reportedly, in the late 80s a nineteen year old former therapy client filed a complaint against Philip McGraw Ph.D., with the Texas State Board of Examiners of Psychologists, claiming he caused their relationship to become “inappropriate.” McGraw admitted giving the ex-patient a job but denied her claim that he “touched her.” Uncertain who to believe, the board imposed disciplinary sanctions on Dr. Phil for violating the basic therapist/patient relationship by employing her. He failed to follow the conditions imposed on his practice by their sanctions, which reportedly involved his undergoing therapy, and was officially reprimanded in 1989. Then he closed his private practice.

Oprah, who we count on for good taste and judgment, must have known all this, yet chose to allow the creation of a television circus around Dr. Phil which takes the form of "therapy." She appears to have a blind spot which prevented her from seeing through James Frey, the author who lied so dramatically in his best-selling novel about his drug history. Many in Los Angeles, and those I know who knew Frey personally, laughed at the illogical and unreasonable claims in his book. No one with any sense or experience with Fry or with drugs, believed the fantastic things he claimed.

Yet Oprah, a sophisticated media expert, with a large and diligent staff, took this fraud under her wing, and when there were more worthy novels, promoted him to the top of the best-seller list. She finally had the ecstatic experience (in an unnecessary confrontation) of lip trembling anger as she unraveled the poor fool in public. This obvious fraud duped her! I had the feeling during this incredible interview that it was some other man, some figure from her dim pre-verbal past that Oprah was righteously ripping to pieces. Frey, so greedy for publicity that he went on her show, was unable to defend his lies, and allowed himself to be destroyed. Any publicity works. His bogus book continued to sell.

The presence of Dr. Phil on television has done harm to the notion of "therapist." Many observe him bullying and posturing, demanding instant corrections for conditions resulting from ancient wounds, "throwing his weight around" -- and think they want nothing to do with therapy. He is an example of someone who is not what most people think of as a decent caring doctor, or a therapist. He is a carnival barker -- the lord of a moneymaking machine.

Those who appear on his show apparently sign a contract saying that "no doctor patient relationship exists," that what Dr. Phil does on the show does not constitute therapy -- they appear for "entertainment purposes only." Every show should open with an announcement to that fact. Announce that to an audience who may be led to believe that this is what competent therapy is like. His behavior would be considered unethical for a licensed professional. Do ethics matter when these folks are making millions?

Dr. Phil apparently received a Ph.D. in psychology from a university in North Texas. For that reason he is entitled to put doctor before his name. He is not a doctor as most people would understand that title. He cannot, without additional training, and a license, practice "psychotherapy." Most states have a requirement that before anyone can practice clinical psychotherapy they have to receive "therapy" themselves.

How much and what kind of therapy Dr. Phil might require, after comporting himself as he has in public, is something only his wife and children could tell us. Since much of his advice is to couples, one wonders how he could survive if his legal problems resulted in the failure of his highly publicized (and some say, troubled) marriage.

Training is not what makes a good therapist. It may not even matter, because the premise upon which most training available today is flawed to its core. Peter Levine’s “Somatic Experiencing” is closer to what works. That combined with elements of Psychoanalysis, Hypnotherapy, EMT and Craniosacral would be more like it. In a perfect world there should also be a greed filter and ethical imprints placed in all therapists. The therapy community needs to acknowledge that talk – even though it is the easiest on the therapist – will not connect with the injured pre-six year old who might need to be healed.

Real therapy is an entirely human matter: involving compassion, intuition, insight, self understanding (perhaps the hardest quality to find of all), emotional discipline, self-control and patience. It is also advisable to be free of ego and greed. Maybe therapists have to be non-human, since the qualities described above are so difficult to find any one person.

Perhaps, Dr. Phil, you would like to go back and relive where and when your arrogant bully was implanted and get some real help to heal that part of yourself. Once you figure that out you might pass it on to people like Bill O'Reilly. My guess is it resides in the same place in your psyche that is driving your weight up and down. Side effect – you will become once again forever thin. Multimillion dollars stakes for you, Opera and ABC prevent your show from being therapy, so for the sake of your karmic soul, stop calling it that or pretending that you help anyone in the long term.

Unfortunately, in my experience with therapists, I’ve encountered only a small percentage not driven primarily by money. The worst condition conceivable is to be a TV personality -- presumably trying to do good in the world -- but also responsible for making millions for yourself and your boss and your network. Within that framework common sense flies out of one's mind and one irresponsibly invades Britney Spears’ hospital room.

Dr. Phil has claimed he visited Britney at the request of "concerned family members." He said he planned to tape a show focusing on the serious issues surrounding her case. That's a surefire way to aid in her recovery. Later, he came to his senses, and decided to not create a public carnival on television around her problem.

Sources say that Britney's father, Jamie Spears, refused to be part of a public airing of what might possibly result in the emergence of more than he wants the world to know about his poor daughter's first three years. I believe you will not find a therapist who thinks that a man who is not a therapist and is not licensed to practice therapy, should interfere in the psychological life of a sick young woman. Dr. Phil must know, in some non-egotistical part of his body that he should not pretend that his interaction with the Spears family was for any reason other than publicity.

Ms. Spears will never regain custody of her children unless she heals herself. I see no sign that the people surrounding her are leading her on the arduous path to mental health. Where would be the fun in that? I have not read of any clinic she might attend that has any chance of accomplishing real healing. Those wishing to cover up blatant, early childhood abuse often call the tortured reaction of the damaged adult "severe bipolar disorder." An attempt to treat her with drugs, without getting at the underlying causes a dangerous and will result in failure.

Of course she's drinking and popping prescription meds. Of course her doctors are prescribing these because they don't know any better. I feel, from my own experience, the pain she is in. At some point she has to accept the pain, cease any efforts at alleviating the agony she is going through with substance abuse, and have the courage to go back into the nightmare it came from. I have already made a suggestion that will absolutely transform the course of her life. She will not listen because I am not a famous TV personality.

No comments: