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Posts Tagged ‘choosing a therapist’

Towards the end of a session a while back, one of my patients, who was African-American, laughed out loud, like he was sharing a personal joke.

“What’s so funny?” I asked.

“Oh, I don’t know.  I still can’t get over the fact that my therapist is a white guy.”

I shrugged and smiled – there wasn’t much else I could do.

But I was pleased.  I admit it.  I liked being his therapist.  And that patient has referred a bunch of people to me since, mostly African-Americans.  That felt good, too.

I wish I had a simple, clear answer to the question posed by the title of this posting.  But like so much else in psychotherapy and human life in general – it’s complicated.

On the one hand, a strong case could be made that a person’s background, and his experiences, should shape who he is, and his ability to connect with someone who has had a similar or different background or experiences.  By that logic, an African-American should be better off with an African-American therapist.

But it doesn’t always work out that way.  For one thing, the patient I was working with was gay – so did he have to find a gay African-American therapist, or was a gay white therapist okay, or a heterosexual African-American therapist?  And what about the fact that I’m Jewish?

I think one of the reasons I worked so well with that patient was that I studied African-American history and literature in college, and am a connoisseur of jazz and other African-American music.  It might also have helped that, as the Program Coordinator for a counseling program at a large urban hospital for a few years, I assigned myself lots of African-American patients, partly because I was interested in learning more about their culture and experiences, and partly from necessity.  We had a small, mostly-white staff, and the other full-time counselor spoke Spanish and Portuguese, so he was occupied with immigrant patients.  I became a sort of resident African-American expert.

Maybe that’s why I did so well with this patient.  Or maybe we just clicked.  He was an elegant, educated man, and a jazz fan, and, well, we liked each other.

Choosing a therapist is a bit like choosing a Supreme Court justice.  You collect all the information you can – and then you take your best guess.  An African-American jurist ought to have a better understanding of the issues affecting African-Americans – right?  But then, sometimes you get Thurgood Marshall – and sometimes you get Clarence Thomas.

Many therapist list their “specialties” on their websites, or even their business cards.  I don’t, because I find it limiting.  I don’t see why, if a patient with a new issue comes into my office – whether it’s bulimia or childhood sexual abuse or crystal meth addiction – I shouldn’t be able to get some books, talk to colleagues, and do whatever it takes to get myself up to speed. That goes with human diversity as well.  I’ve treated Kazakhs, Navahos, Cameroonians, Indonesians, Peruvians and Dubaians, among others.  They all taught me something about who they were and where they came from.  That’s part of my job – a fun and necessary part.

I once commented to a transsexual psychotherapist that it must be great to help others within her community.  She let out a rueful sigh.  Sure, she admitted.  But the real issue was that she worked within a ghetto.  She wanted to treat all sorts of people, not just transgendered patients.  Being seen as someone who worked only with other transsexuals limited her practice, and her ability to grow as a clinician.  I realized I was losing something, too, when transsexuals went to see her instead of bringing their unique diversity to my practice.

Seeking out the “logical” therapist for you can have drawbacks for the patient as well.  I once did a session with a deaf woman who was dealing with a domestic violence situation.  We worked with a sign-language translator, but afterward I discovered the hospital had a limited budget for translation services.  An administrator recommended I refer this patient to an American Sign Language-fluent psychotherapist.  I found two names, and gave them to the patient.  She only rolled her eyes.  She didn’t want to see a psychotherapist who worked with the deaf – those two therapists were already seeing all her friends in the deaf community, and she didn’t feel comfortable opening up to them.  She said she would much rather work with me, through a translator.  I was surprised – but I got her point.  I wanted to work with her, too – but I couldn’t find an ASL-translator, so we didn’t have that option, which was heart-breaking.

I ran into a similar situation with a Japanese patient.  His English wasn’t very good, but he could communicate.  I suggested he might be more comfortable working in Japanese instead of English, and proposed two Japanese-speaking therapists.  The problem, he confessed, was that he was gay, and working on coming out to his friends and family.  Of the two Japanese therapists, one was straight, and the other knew all the other gay Japanese people living in New York City.  He wanted a gay therapist to work on gay issues, which are sensitive in Japanese society – but he didn’t want someone who knew his friends.  He decided to stay with me.  Yes, he sometimes had to repeat things two or three times so I could understand him, but we did okay.  He’d come to America, he said, to live like an American – and he liked having an American therapist.

It’s worth pointing out that therapists spend most of their time listening, not talking.  When I do talk, I’m usually asking questions or taking a guess at interpreting something I’ve heard.  My job is to listen, and try to understand.  Theoretically, I should be able to listen to anyone – anyone – and understand him, whether he’s black, white or purple.

I take pride in showing off my bits of cultural competence.  I enjoyed greeting a Chinese patient from Hong Kong the other day with “Please come in!” in Cantonese.  Last month I shared a laugh with a Dominican patient when we realized we both have little half-Dominican nieces who call us “Tio.”

These touches might help make a patient feel more at ease.  But in the big picture, they’re minor details.

What really matters isn’t whether your therapist looks like you, or acts like you – it’s whether he understands you.  Just like a Supreme Court Justice – his competency depends not only on his background or experience, but how well he does his job.

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How can you choose a therapist who’s right for you?

Here’s what to look for:

1. Your therapist should be actively engaged. I was surprised,  years ago, when I read an account by Theodor Reik, an early psychoanalyst, of his analysis with Freud.  The founder of psychoanalysis didn’t just sit there, stroking his beard like a sphinx.  That’s a myth.  Reik described their work together as a 50/50 give and take, a conversation about what Reik was thinking and feeling.

Another myth is the “strict Freudian.”

There’s no such thing as a “strict Freudian.”

Freud wasn’t strict – or grim and serious all the time, either.  He was adventurous, exploratory, flexible, and constantly questioning what he was hearing and seeing, and what he believed was going on.  No one wants a therapist who acts like a punishing father-figure, or just sits there and nods.

That doesn’t mean your therapist should be talking about himself all the time and distracting from your joint task of exploring your thoughts and feelings.  Every good therapist knows that sometimes his job is to shut up and listen – especially when a patient is full of feeling and needs to get something out.  But you should be working together.  Actively.  If you ask him “what do you think?” he shouldn’t just say “what do YOU think?” back at you.  That’s a cop-out.

2. He should enjoy what he does. Every therapist has to look at the clock sometimes.  But if he seems to prefer looking at the clock to looking at you, it’s a problem.  This isn’t a job you do for money – trust me on that.  You do it because you were born with a strange gift – like mathematics or playing the violin – and you feel drawn to it.  And because you love it.  I hope to die sitting in that chair, listening to a patient telling me his thoughts and feelings (or maybe right after he’s left – I wouldn’t want to traumatize him.)

3.  He should welcome all your feelings – including your anger at him. A good therapist needs you to trust him enough to tell him the truth, even if the truth is that you’re unhappy with the work he’s doing.  He doesn’t need you to love him.

It is his honor and privilege to have your trust, and share your secrets.  You pay him.  That’s enough.  He’s not your guru.  He’s your therapist.

4. He should admit his mistakes. We all make them.  Nothing shows you can trust a therapist like his admitting he isn’t perfect.  If he gets something wrong, or chases an idea that’s off the mark, or just has a bad day – you should be able to say so, and he should be able to own it.  No one’s perfect – not even The People’s Therapist.  But any therapist becomes a better therapist if he’s willing to admit he’s human.

5.  He shouldn’t just be the President of Hair Club for Men – he should also be a client.

A good therapist has put in his own time in that other chair, and shed a few tears and had some anger too.  That’s how you get to be a good therapist.  You don’t learn most of it in classes, or from a book.  You learn it by doing it.  A good therapist has had his life profoundly changed in positive ways by psychotherapy.  He wants to share that opportunity with you.

5. He should be a bit of a kook. The best therapists are a little nuts – but good nuts.  Part of the joy of living is reveling in your own uniqueness – enjoying being you.  Lena Furgeri – my first therapist -dresses in flowing purple dresses and lots of big jewelry.  I love it.  She loves it.  She loves opera, too.  She’s a lot of fun.

Freud was a bit of a kook, too.  His office was filled with weird little statues and doo-dads from various primitive cultures.  He loved that stuff.

He was also hopelessly addicted to cigars.  And he was willing to chase any crazy idea if he thought it might lead him to somewhere useful.  He knew you have to get lost sometimes if you’re going to find your way to someplace new.  He came up with a lot of theories, and some were doozies.  Others changed the path of human thought.  But he had to be a little nuts just to take the risk of “thinking different.”

6. He should be a non-conformist.

Psychotherapy is improvisational.  Every patient needs a different therapist, which means every therapist has to be a different person for each patient.  A good therapist loves that challenge.  But you can’t improvise if you’re just reading the notes on the page.  You have to break free, and be yourself.  The best improvisation – think of jazz – balances an established structure with freedom and personal expression.

That’s why your therapist should be a gangsta.  He shouldn’t be afraid to drive close to the edge, take risks, stretch a bit.

The so-called “gangsta rappers” – folks like N.W.A., Eminem, Lil’ Kim, Snoop Dogg, Dr. Dre, 2Pac, the Wu-Tang Clan, Slick Rick and The Notorious B.I.G. – are a loosely-aligned group of musicians and poets whose work has combined a mastery of rhythm and verbal fluency with a desire to surprise their audience and challenge its assumptions – often by taking on sacred cows in ways designed to stir controversy.

In this sense, they’re not so terribly different from other musicians and artists, poets and comedians over the years who have intentionally challenged the “acceptable” in order to show us truths about ourselves – people like Jeff Koons, John Cage, Sam Kinison or Allen Ginsberg.

Your therapist should be like that – willing to take the critical and philosophical tools of psychotherapy and apply them to your life, and your world – the world you live in right now – in a way that makes them fresh, relevant and powerful.

Freud was bucking societal norms just by admitting he was thinking about the stuff that fascinated him – sex, the unconscious, primal drives.  It’s amazing he was able to get away with it, let alone found a new profession.  He was clearly a gangsta.

Just for the heck of it, I’ll close with a musical selection by one of my favorite non-conformists:  Frank Zappa.

Zappa broke plenty of rules.  A brilliant musician – a child prodigy – he took doo-wop music as seriously as symphonic music, and wrote both, as well as pop songs, art songs, chamber music, jazz and outrageous parodies, like his classic, “Valley Girl.”  Zappa did his own thing.  There’s no doubt he was a gangsta.

Here, then, for no apparent reason other than the sheer fun of it, is a Frank Zappa composition titled “Sofa” as played by – you guessed it! …a Bavarian brass band:

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