"On Healing" August 2003

Posted on Mon, Aug. 18, 2003
Alaska trip teaches lesson in humility
By Dan Gottlieb

Recently I had dinner with a friend who raised the following provocative question: "Whatever you think about Kobe Bryant, President Bush, the war in Iraq - what would it take to change your thinking to the other side?" He further suggested that, until I could answer that question, I would likely not be successful in my efforts to change someone else's opinion.

Two weeks later, I headed off to Alaska for a vacation I had been dreaming about for many years. I told my friends I wanted to see this land while it was still pristine - before large corporations such as Starbucks and Wal-Mart moved in and took over. (By the way, I did find a Starbucks and a Wal-Mart.)

The flight to Anchorage took us over the Alaska Range and majestic Mount McKinley. The breathtaking beauty of these miracles of nature brought tears to my eyes (and to those of many others in the plane). I have always considered myself an environmentalist, believing this planet is a gift and a responsibility. So I devote time, energy and resources to its care. Who in their right mind could argue with that?

We arrived in Anchorage, drove to Seward, took a cruise through the Gulf of Alaska, and visited several glaciers and cities in the southeastern corner of the state. Each city was interesting, beautiful, unique - and economically depressed. Our last stop was at Ketchikan. Our land tour took us to Saxman, a native village that is inhabited by the Tlingit Indians, who still document their lives through totem poles.

As we drove to Saxman, I asked the young cab driver about the apparent economic depression. "I don't know your politics," he began hesitantly, "but President Clinton promised to save our forests. In the process, he destroyed our principal industry of logging. My father was 55 years old and had worked for the mill for 30 years when he was laid off last year." Our cab driver went on to describe his dream of going to college and Seattle to study film production so that he could return to Alaska to tell the story.

I sat in the cab feeling a strange combination of sadness and confusion. They were mixed with another emotion I couldn't identify right then but felt through my whole being.

Until that moment, whenever environmentally friendly legislation was passed, I applauded. My thinking has always been that if an economy must degrade the environment in order to survive, ultimately it must change its direction and find a different way of supporting itself.

Until I sat in that cab, I did not realize how arrogant my thinking was. I could almost feel my mind opening as I tried to identify with the driver's father, who is about my age. I tried to imagine what great sadness or hopelessness I would feel. Then I tried to put myself in the place of this 20-year-old man, who had just lost his safety net; I felt anger and a sense of betrayal.

And how did he lose it? He and his community lost their economic stability at the hands of a government they felt wasn't listening. And now this young man, by wanting to become a filmmaker, was planning to devote his life to simply telling his story. Ultimately, that's what we all want. We want to have our story heard and understood.

Many years ago, I treated a young woman who was raised by parents who were probably incapable of loving her. When I asked her whether anyone had loved her as a child, her eyes sparkled and she quickly said, "Yes, my uncle loved me." Continuing, I asked how she knew her uncle loved her. "Because he asked me a lot of questions." He took the time, interest and compassion to ask questions.

You see, the problem with "knowing the truth" is that it steals our ability to ask questions. Because we already know the answers. Before that encounter with the cab driver, I thought I knew the truth.

And then I identified the emotion that had puzzled me earlier. It was humility. I thought I had a position that was correct. But as I lost confidence in my truth, I felt humility. Humility is the position we take when we ask for help - either divine or human. Sometimes, humility makes us feel great shame or confusion, so we pretend we know what we really don't know. So in order to avoid these painful emotions, we tell ourselves that we are smarter, have more insight - that "they" don't get it.

This business of humility certainly doesn't feel good, but maybe that's the first step on the path to wisdom. Maybe it's the only way to open our hearts and minds.

So I still consider myself an environmentalist. And I am not about to contribute to a loggers' political action committee. But I do feel less right and more open-hearted then I did before.

Posted on Mon, Aug. 04, 2003
'Shopping' for a psychotherapist is a crucial first step
By Dan Gottlieb

Several years ago, Consumer Reports devoted an entire issue to the subject of psychotherapy. It published a study that found that, overall, psychotherapy works. But finding that kind of help can be a challenge. Almost daily I get e-mails or telephone calls from people who don't know how to find a good therapist or don't know how to assess the quality of treatment they are getting.

So, here is a primer that I hope will remove some of the mystery and confusion.

Because of today's medical climate, you may have to start by contacting your insurance carrier to see if it pays for psychotherapy, if it has a list of providers you must choose from, and how much of your therapy will be covered. Some carriers will pay a percentage of the cost to see a therapist who is not on their provider list, and some will not. If this is an issue for you, then the insurance company is a good place to start.

Generally, the best way to find a good therapist is to talk to a friend or family member who has been in therapy and see if they were happy with their therapist. Other than a direct recommendation, the choices get more complicated.

Psychotherapy can be provided by social workers, psychiatrists, psychologists, family therapists, addiction counselors, nurse practitioners, and on and on. Each of these disciplines is represented by national organizations and most by state associations as well. Professionals in any of these disciplines could provide excellent therapy and many could provide poor therapy. What's the difference?

Psychiatrists go to medical school and complete a psychiatric residency, so they can provide medication and are knowledgeable about medical issues. Most psychologists are trained in both psychological testing and psychotherapy.

On the issue of medication, many people begin by seeing a family practitioner and are placed on psychiatric medication and find great relief. However, treating psychological problems with medication can be complicated business. And if the medicine your family practitioner has given you does not work, then you should see a psychiatrist.

Social workers and some counselors may have received less graduate study, but the majority of their training is often focused on psychotherapy.

The most critical issue is finding a good therapist - not necessarily the right discipline.

So where do you find a good fit?

Psychotherapy starts with the initial telephone call. How does the person sound on the phone? Is he or she willing to find time to answer a few questions? Of course, a therapist's income is based on time, so most cannot spend 30 minutes on the phone with everyone who calls, but it is reasonable to expect five minutes or so. Ask about credentials, whether or not the therapist has worked with previous clients with your problem, and what that experience was like. Inquire about fees and insurance.

If you decide to make an appointment, remember the first session is a mutual evaluation. The therapist will want to know about you - and you should want to know about the therapist. Explore his or her approach to psychotherapy and your problem; after a few sessions, it's reasonable to ask for an estimate of how long your treatment will take.

I am generally hesitant to recommend a therapist who practices only one specific psychotherapeutic technique for everyone he sees. There are exceptions, though. For example, there are specific techniques that work well with phobias and anxiety disorders. Someone with a major psychiatric disorder such as schizophrenia or bipolar disorder should be on medication in addition to any other form of therapy. But generally, a good therapist integrates many types of therapy and works with the patient rather than the therapy model.

If you can afford it, spend a session or two with the new therapist before you commit completely. You should feel as though the therapist understands you or has the ability to do so. You want to make sure the therapist doesn't come with too many assumptions about you and what you need. You should feel safe and in a caring place in which you are not judged. Ideally, you will see genuine curiosity and interest. If not, find another therapist before you get too deep into the process.

If you have been in therapy for weeks, months or longer and are frustrated, discuss your frustration. You should find that your therapist is open to a dialogue and that you are not being blamed for the problem. It is not unusual to feel some frustration in the process. Frustration is part of any relationship, and resolving these feelings through open dialogue can be very therapeutic.

The Consumer Reports study showed the benefits of therapy start to slow down after 18 to 24 months. If you still have questions about your treatment, discuss with your therapist the possibility of getting an outside consultation. Most good therapists will be open to this.

And bear in mind that not all emotional healing must take place inside an office. Sometimes things like meditation or yoga, community activity, music or massage can be quite therapeutic. A great deal of emotional pain is caused by unhealthy lifestyles. Unhealthy eating habits, working too hard, sleeping too little, eating or drinking too much, complaining, unreasonable expectations and holding onto resentment can all contribute to unhappiness. Sometimes changes in these patterns can be made without psychotherapy and can provide great emotional relief.

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