Thursday, December 14, 2017

Join the Psychotherapy Book Discussion Group

You are invited to join the group PBDG.
If you have questions about this invitation, send them to
To join click here.

Articles on the Psychotherapy Book Discussion group are discussed and we look forward to your ideas.

David G. Markham, L.C.S.W.-R
58 Market Street
Brockport, NY 14420

Therapists learn from their clients as much, if not more, than their clients learn from them.

Irvin Yalom writes on page 8 of his book, The Gift Of Therapy, in the chapter entitled "Therapist and patient as 'fellow travelers'":

"Instead I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between “them” (the afflicted) and “us” (the healers). During my training I was often exposed to the idea of the fully analyzed therapist, but as I have progressed through life, formed intimate relation-ships with a good many of my therapist colleagues, met the senior figures in the field, been called upon to render help to my former therapists and teachers, and myself become a teacher and an elder, I have come to realize the mythic nature of this idea. We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence."

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (p. 8). HarperCollins.

It is an important idea in A Course In Miracles that we learn what we teach, and we teach what we want to learn. One of the primary factors that is satisfying in doing therapy is the vicarious learning that goes on by the therapist. Clients and their families teach us a lot. Therapists who are humble are very grateful for what they learn from their clients.

Wednesday, December 13, 2017

"How Can You Do This Work?" invites consideration of joining with others to make the world a better place

Sue Mann in her essay, "How Can You Do This Work?" in Trauma: Narrative Responses To Traumatic Experiences asks how therapists can find ways to document, and find an audience for, the skills and knowledges which people who have struggled with problems in their lives have learned and developed? In the Narrative model these knowledges and skills are called "local knowledge" and are aquired from what is called "co-research" conducted and engaged in by the therapist and client team.

In Alcoholics Anonymous there is common agreement that "it takes one to know one." This means that people who have struggled with the problem are the most perceptive and helpful if they are working on the twelfth step and trying to share what they have learned with others impacted by the problem.

Ms. Mann suggests a few questions which help us articulate what has been learned that could be shared with others:

  1. Who else would have an interest in the management of this problem?
  2. How could we join with others in planning how to better manage the problem?
  3. How can what we have learned be applied to policy development, organizational responses, education of other therapists and helpers?
  4. How can we influence those in authority over people with problems so they are more understanding, compassionate, and helpful?
  5. How can we change cultural norms and attitudes in a more positive direction towards people affected by the problem (decrease stigma)?
  6. How can we honor and celebrate the accomplishments of people who have successfully managed and/or overcame the problem?
  7. How do we support other helpers who help people with the problem?

The title of Sue Mann's essay, "How Can You Do This Work?" is so rich that it's deconstruction helps us appreciate it's multiple nuances. The devil, they say, is in the details. Rising above the details it is important for us to remember that as helpers we are on a mission from God to help make the world a better place by removing the blocks to awareness that Love is our natural inheritance.

Tuesday, December 12, 2017

New Psychotherapy Book Discussion Group forum.

 A Psychotherapy Book Discussion Group has been started on You can sign up to be a member of the group in the right hand column. I look forward to some interesting and stimulating discussions. The two books we are continuing to read in December and probably into January are The Gift Of Therapy by Irvin Yalom, and Trauma:Narrative Responses To Traumatic Experience. You can participate in the discussions even if you haven't read the books. We look forward to your ideas.

Nominations for books for discussion are welcome and appreciated.

Wednesday, December 6, 2017

For psychotherapists, the work itself is its own reward

A lot of time and energy is spent in Social Work training on helping aspiring Social Workers to understand their motivations for getting into the field. Students are asked to consider their values, hopes, dreams and wishes for how the world should be and the problems, blocks, and obstacles which prevent their vision from being realized.

Sue Mann in her wonderful essay "How Can You Do This Work?"in the book Trauma:Narrative responses to traumatic experiences,  describes how workplace practices may support or detract from therapists' work with clients who have experienced trauma. For example she asks:

  • What opportunities are available for workers to talk about the many experiences of the work?
  • Of the many different stories of work that could be shared, what stories and whose stories are being privileged?
  • How are the connections people have to what is important and of value to them shared in the workplace?
  • What opportunities are there for celebrations in relation to the achievements in the work?
  • Are there opportunities to share moments of sadness, moments of beauty, moments of joy? p.17-18
Because of confidentiality therapists rarely have opportunities for their work to be publicly acknowledged. Therapist service, competence, integrity, and accomplishments are rarely recognized let alone acknowledged. The profession, consequently, is an isolating and lonely one and the professional's motivation for engaging in it must be the satisfaction and fulfillment of the work in and of itself. The work is its own reward.

Tuesday, December 5, 2017

People are not their diagnoses

"And what therapist has not been struck by how much easier it is to make a DSM-IV diagnosis following the first interview than much later, let us say, after the tenth session, when we know a great deal more about the individual? Is this not a strange kind of science? A colleague of mine brings this point home to his psychiatric residents by asking, “If you are in personal psychotherapy or are considering it, what DSM-IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?”

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients (p. 5). HarperCollins.

Dr. Yalom has it so right about a person not being their diagnosis. The diagnosis is for the insurance company. It may have some clinical value if it is accurate, but it rarely is. Psychiatric diagnosing is as much an art as a science and is notoriously unreliable between diagnosticians. I personally diagnose mostly as a perfunctory exercise so I can get paid from the insurance company. The DSM-V diagnosis has very little, if anything, to do with the treatment plan. Problem formulation, on the other hand, is very important to good therapy and is a collaborative process, one in which the therapist is better off taking a de-centered approach.

Bill O'Hanlon has said that when patients tell him they are seeking help for depression, he asks "How do you do depression?" Great question. What is depression like for you? When did it start? How can you tell when you are depressed and when you are feeling better? What seems to make it worse and what seems to alleviate it somewhat? The answers to these questions leads to a more personal customized description and definition of what the problem is that plagues the client. Once it can be named, it can be better managed, but without naming it more specifically the therapy is doomed to failure.

Monday, December 4, 2017

Mann - Therapists serving stigmatized populations are often stigmatized as well

In Sue Mann's article, "How Can You Do This Work?" she describes the effects of trauma on clients but also on therapists who work with clients who have been impacted by trauma. She notes that clients who have experienced trauma often isolate for numerous reasons and also therapists who work with clients suffering from trauma become isolated as well.

Ms. Mann describes workplace processes that may inadvertently promote and reinforce isolating experiences for therapists. She mentions a number of such processes such as therapists being left on their own without appropriate supervision and opportunities for collegial support. An expectation that therapists "measure up" and not complain about their stress. Further, work loads can become heavy with multiple demands for increased paper work and reporting and time required to enter data in computer data collection systems. In, therapists are often expected to be "experts," "professional," and have the answers contributing to feelings of shame at being inadequate and deficient in some way. Workers are often burned out by sometimes contradictory expectations and requirements from multiple stakeholders in their work. It often is impossible to please everyone. Therapists are often "people pleasers" by temperament and personality type and are very sensitive to "letting people down" and being a "disappointment."

Therapists serving clients who are impacted by trauma experience high levels of burnout without appropriate professional support for the work. An important question I have often asked in my career is "who is taking care of the caretakers?"

Lastly the stigma attached to clients who have been traumatized is often also attached to the professionals who serve them, thus, the question "How Can You Do This Work?"

Sunday, December 3, 2017

Good therapists are not mechanics. They are healers.

It is written in The Purpose of Psychotherapy in A Course In Miracles:

"Everyone who needs help, regardless of the form of his distress, is attacking himself, and his peace of mind is suffering in consequence. These tendencies are often described as “self-destructive,” and the patient often regards them in that way himself. What he does not realize and needs to learn is that this “self,” which can attack and be attacked as well, is a concept he made up. Further, he cherishes it, defends it, and is sometimes even willing to “sacrifice” his “life” on its behalf. For he regards it as himself. This self he sees as being acted on, reacting to external forces as they demand, and helpless midst the power of the world."
Schucman, Dr. Helen. A Course in Miracles, Foundation for Inner Peace, p.2

To use the terminology of ACIM, this "self" the person has made is named the "ego." This "ego" is a little different from the term that Freud coined in his psychodynamic theory of psychological functioning. The "ego" in ACIM is considered an illusion, something that has been made up and perceived as if it were real. In postmodern philosophy, it is called a "social construction," an identity which changes through time and is impermanent. In some psychologies, a distinction is made between the "false self" and the "authentic self", but they both are figments of the imagination and false perception.

Psychotherapy clients don't know that their identities are illusions, entities that have been constructed by them and others to serve certain purposes which usually are unconscious, below the level of awareness. Believing their "self" is real some people even try to kill it and sometimes succeed in attempts to make this illusion real by denying it what they believe to be further existence.

The role of the psychotherapist whether he/she knows it or not, is to help the client rise above his/her illusions and come to the understanding and experience that they are loved by Creation. True psychotherapy is a spiritual experience not a medical one limited to just treating symptoms. Psychotherapists are not mechanics, they aspire to provide a healing experience to clients in distress.

Twilight of American Sanity - The U.S. manufacturing and sales of weapons.

The tenth topic which Dr. Frances discusses in his first chapter, Confronting The Facts Of Life, in his book Twilight of American Sanity is "Gun Happy." Dr. Frances describes the societal delusion about
"Gun Happy" as "The more guns the better. Guns don't kill people, people do. An armed populace is a safe populace" p.44

Frances writes further on p.44 "And crazily enough, we now have as many firearms as we have people—more than 300 million—concentrated in the hands of 45 million gun toters. With less than 5 percent of the world’s population, the United States has 50 percent of the world’s civilian guns. The deathly dark side: 11,000 gun homicides, 20,000 gun suicides, and 2,000 accidental gun deaths (and who knows how many nonlethal woundings). The murder-by-gun rate in the United States is 70 times greater than for England, 300 times more than Japan. It is recklessly asking for deadly double trouble that 10 percent of adults in the United States have the combination of impulsive anger and gun ownership."
Frances, Allen. Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump 

It should also be noted that the United States is the major weapon maker and exporter in the world. The weapons making business is $66 billion dollars per year. America's profit making on weapons manufacturing and sales is sick and toxic to human beings and other life on this planet. The profiting from death and destruction is not a mentally healthy business for people to be involved in.

Sunday, November 26, 2017

Most popular article on PBDG in October, 2017

The sixth topic which Dr. Frances discusses in his first chapter, Confronting The Facts Of Life, in his book Twilight of American Sanity is "Happy Warriors." Dr. Frances describes the societal delusion about "Happy Warriors" as "The United States can bully other countries into doing whatever we want." p.33

Frances writes on p.34 "Our troops came back wounded in body, mind, and soul. We wasted trillions of dollars in national treasure desperately needed to improve our infrastructure and stimulate our economy.

Frances, Allen. Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump p.34

For more click here.