Archive for February 19th, 2010

Inevitably, a few times a year, a new patient refers to me as “doctor.”

I always flinch.

First of all, I’m not a doctor.  I don’t have an MD, which would make me a medical doctor – or even a PhD, which would make me a “Doctor of Philosophy” like a college professor.

Well, actually, I am sort of a doctor, kind of.  I have a JD, which makes me a Juris Doctor, or Doctor of Law – which means I’m a lawyer.  But I don’t think that’s what you mean when you call your psychotherapist “doctor.”

The fact is, people with a lot of different educations, backgrounds and degrees practice the art of psychotherapy.  Here’s the run-down of the most common professionals in my business, at least in the New York area:

1.  A psychiatrist. This is a medical doctor, who went to medical school and got an MD, and could, I suppose, probably remove your appendix.  In the mental health field, psychiatrists are the people who handle medication.  I occasionally refer one of my patients to a psychiatrist colleague when I think he might benefit from an anti-depressant or anti-anxietal or some other type of psychiatric medication.  Some of my patients get psychiatric drugs from their regular family doctor, but psychiatrists are the experts in this area.  They also work with patients who are very ill, such as those suffering from severe cases of schizophrenia, depression and bi-polar disorder.  Often these patients are seen in a hospital setting, due to the severity of their illness.

2. A Psychologist. A psychologist has a PhD, and many of them are affiliated with universities, where they may do research.  When you read an article in the newspaper on the results of a “study” – something like “people who have sex after 60 are more content with their marriages” or “teenagers who watch less television have higher reading scores” – that kind of social science study would be done by a psychologist.

Psychologists also work in Human Resources at corporations, advising on how best to manage employees, and they do psychological testing.  For example, if you want to give someone a test to see if they have Attention Deficit Disorder, you might send him to a psychologist for a set of tests.

3.  A Social Worker. This is the degree I hold.  Social workers are people who work with people in all kinds of settings.  “Clinical social workers” are social workers who, perhaps in addition to helping people navigate their way through social services, obtaining housing and so forth, also do psychotherapy with their patients.

It might seem like this is a list in order of quality.  After all, if you can get a “real” doctor – why settle for a mere PhD posing as a doctor or some measly social worker?

Freud was plagued by just such questions.  When his trusted protege, Theodor Reik, came to America and tried to practice psychoanalysis (which was more or less another word for psychotherapy), he was attacked by a group of medical doctors, who accused him of illegally practicing medicine.  Freud ended up, in 1926, writing an entire book in Reik’s defense, “The Question of Lay Analysis.”  In it, he said essentially that there’s no reason a psychotherapist needs to be a doctor, unless he’s doing something – like working with a severely mentally ill patient, or prescribing medication, which would draw on medical training.

I agree with Freud (which is convenient, I admit, since I’m a social worker.)

But there is a deeper issue here.

Anyone can do psychotherapy.  It is an art, and there are many different schools of thought regarding the details of how one works with a patient in a psychotherapeutic way.

The truth is I didn’t learn most of what I know about psychotherapy from Social Work School – I learned it from my own work with other therapists, both as a patient and as a student.  I worked with two excellent psychotherapists in psychotherapy institutes, which is where young therapists (psychiatrists, psychologists and social workers) sometimes go to train.  Both had doctorates, but (I found out later) one’s doctorate was in Theater and the other’s was in Education.

I guess my point is that it doesn’t matter all that much what education you have.  Psychotherapy is experiential – you don’t learn it in a classroom or from a book so much as from doing it yourself.

I also believe it is an innate skill, like playing the piano or being good at math.  At some level, you’re just born able to work as a therapist, or you’re not – and it doesn’t matter if you’re a dentist or a fireman – you might be a good therapist, or you might not.

Most of the degree and licensing stuff is pointless.  It would probably be better – as in the old days – to let anyone go to an institute, study with some therapists, and – if they feel the urge – hang a sign and practice psychotherapy.  If they’re good, they’ll flourish.  If they’re not, they won’t.

That might sound crazy, but that’s how Taoist fortune tellers get started.

A few years ago, visiting Hong Kong with a friend, we happened to wander into a Taoist temple, and he suggested we visit a fortune teller.  This is very common in Hong Kong – some people visit a fortune teller regularly, some just when there’s something troubling them that they want to work out.

First, you shake some bamboo sticks from a cup.  The ones that fall to the ground have numbers written on them.  Those numbers somehow guide the work of the fortune teller, who sits in the back of the temple in a special booth (there may be many fortune tellers working in a large temple.)

So, I shook my sticks, recorded my numbers and went with my friend for a consultation.  It was entirely in Cantonese, so my friend had to translate.  We paid a small fee (there’s always a small fee.)

The fortune teller turned to me first, eyed me curiously, and said “You are kind to your former lovers.”

I was staggered.  My first partner died young, many years ago.  I’ve always made it a point to reach out in affection and friendship to former partners, after having lost someone who was so precious to me.

Then he turned to my friend.  “You act confident at work, but you are not so confident inside.”  Of course, my friend had started a new job that month, with a major promotion.  He was demolished by this insight.  “How did he know?”  he kept asking for days afterward.  It was the first time he’d admitted to himself that he was feeling overwhelmed by his new responsibilities and needed support.

I had the clear sense that this “fortune teller” – an old man in a silk jacket at a Taoist temple – was a colleague.  Clearly a skillful psychotherapist, he was working in a different modality, but essentially doing what I do – observing, listening, and offering insights intended to create awareness.

He offered us longer, weekly sessions – for a slightly larger fee.  We had to decline.  I think we were both tempted, but we had to fly home the next day.

It doesn’t matter what degrees you have.  What I do – psychotherapy – is practiced in one form or another by fortune tellers, palm readers, priests, shamans and people holding every other crazy title you could imagine.

We’re all doing the same job, which is as old as humanity itself.

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