Wednesday, July 11, 2012

Guest Blogger Louis Breger on Psychotherapy-- More of the Good & Bad

Why change the subject while everyone is having such a good time?  Perhaps Sarebear could pass around some cheese and crackers and Rob could pour some wine?  Alison, do bring some fruit or a baguette.  So I asked Dr. Breger if he had any thoughts, and from his vacation, he was kind enough to write us a guest post. 

In my book "Psychotherapy: Lives Intersecting", which Dinah was good enough to review, I talk about failed cases as well as successful ones and try and spell out the general ideas of what makes good and bad therapy.  Many of the commentators have already touched on the main points, which I can sum up with what I call The New Fundamental Rule: you can do a lot things as a therapist but they must be for the patient's needs and not the therapist's.  This would include revealing things about yourself, the use of humor, apologizing for mistakes (almost always a good idea), and the like.  Many of the things reported by the commentators are examples of what I would see as always bad therapy: not listening attentively, being judgmental or critical, laying on diagnostic labels (though sometimes appropriate if the patient asks for it), and -- very common -- cramming the patient into one's theory rather than listening to what is being said and working out an understanding in a cooperative manner.

Some of the later commentators discuss psychoanalysis and contrast it with other forms of psychiatry.  This is a complicated issue since there are many forms of psychoanalysis and many analysts some good and some terrible.  Having trained years ago in a classical psychoanalytic institute, and having written two biographies of Freud, I think I am in a position to say that old style Freudian analysis is, for the most part, useless if not harmful.  Freud himself did his best work when he didn't adhere to his own rules.  The idea of a fixed fee, or charging for sessions no matter what, are bad ideas.  Even worse is the ever silent analyst who gives theory based interpretations rather than closely listening to the patient and working out understanding in a mutual fashion.  Caring, being friendly, being open minded, honesty, and acting like a real person rather than an all-knowing god, are all helpful to patients.  These are the things to look for if you are trying to pick a shrink.  There is also the very important issue of the match or fit.  Not every therapist will be good for every patient so you have to basically trust your emotional reactions or instincts.  If, in the first session or two, it just doesn't feel right, try seeing someone else.
Do check out Dr. Breger's website  where you'll note that he has written two books on Freud.