PROFESSIONAL MUSINGS:
(NOTES ON THE PRACTICE OF PSYCHOTHERAPY)

• Psychotherapy is an intuitive art perched on a foundation of theory, research, and tested technique.  Without the freedom to take flight into your very personal and unique world, therapy cannot inspire much trust that it will be more about you than about accepted (and questionable) standards of mental health.  But if the therapeutic process fails to find its way back to the perch of professional standards and accumulated clinical wisdom, it likewise risks being more about the therapist and what he fancies than about you. 
   
• What are often considered psychological or mental 'disorders' are in fact old 'orders' or best solutions to problems and pressures that we were not capable of mastering before we became attached to the people who exerted those pressures on us or taught us the problem - whether positive (abusive and intrusive) or negative (negligent and abandoning). 
   
• The notion that we suffer because we are inherently defective, deficient, or pathological ("diagnosable") is more a symptom  than a cause of emotional suffering  and one easily supported and exploited by professionals intent on believing themselves healthy by contrast to others defined as ill.  We all have diagnosable segments of our personalities.  What should distinguish therapists from clients/patients is that therapists know their 'disorders' intimately enough to empathize with instead of project outward in order to treat in others instead of in ourselves.
   
• It is a standard error of thinking about 'mental health', a misassumption based on narrowly and defensively linear notions of development,  that we start life immature and that growing up consists of giving up our 'childish' emotional reactions.  The idea itself is a grandiose one, as if we had any such conscious control over what emotions we experience.  The illusion of control results more often than not from deadening our capacity for emotional experience. This has been the traditionally sanctioned means of attaining maturity as a man.   I believe that it makes more sense to measure maturity by a capacity to tolerate states of intense feeling or vulnerability than by trying to get rid of them, especially since getting rid of them doesn't work, except when we get rid of what is most vital about us.
   
• Perhaps the greatest virtue of a diagnosis, aside from giving us clinicians the tools to make distinctions among the complexities we see and experience in our work, is that it gives the 'patient' a chance to externalize a source of suffering that was most likely imposed from the outside in the first place.  The risk is that the negative connotations of carrying a diagnosis will rob it of this advantage.
   

revised 6-19-08