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Psychotherapy Today 

Not Your Grandfather's Psychoanalysis

Last Updated: 01/19/2020 4:06 am

When several life issues turned truculent in my early thirties, I took a friend's advice and sought a psychotherapist. To this day (many years later) I am still immensely grateful and in awe of the patient, wise, and compassionate therapeutic angels who helped me evolve a healthy way of looking at, and feeling about, my life and my deepest self. And while it is impossible to do justice here to the field of psychotherapy, I want to offer a few morsels about its basics and peek into what a few practitioners in our region are up to.

Psychotherapy is not just for those with serious mental illness: Many people need help with issues that are interfering with life's activities. "Often, the people I see are having trouble with a relationship—a marriage or partnership, with children, with a boss, with a landlord," says psychotherapist Bob Hausman, MA, director of the Woodstock Therapy Center and current president of the Hudson Valley Guild of Mental Health Professionals. Other reasons to seek psychotherapy include depression or anxiety (from mild to severe), phobias, trauma and PTSD (post-traumatic stress disorder), dealing with a change in family structure, problems at school or work, or conflict among peers.

Increasingly, people also want help feeling fulfilled: to find balance among the demands and desires of life, to gain a deeper understanding of themselves, to empower and enrich their dreams. It may be distress that initially leads them to a first appointment, but the discovery process from then on is often life changing.

Foundations and Diversity

A basic definition of psychotherapy, Hausman offers, is "a conversation between two people that is about one of them, the client. This is distinguished from a friendship, where presumably there is a reciprocal caring and balanced sharing. Having said that, from my point of view and that of many other therapists, the curative or ameliorative aspect of what happens is about the relationship between client and therapist."

Hausman cites a famous phrase of eminent psychologist Carl Rogers, whose perspective and research underlie the approach of many psychotherapists today: "The therapist has unconditional positive regard for the client." That manifests as a nonjudgmental and supportive presence from the therapist. "In that sense the helping part of it is about readjusting the client's perception of themselves," says Hausman, "which is a much more active approach and a major step forward from Freudian analysis, in which the analyst was supposed to be pretty much a blank screen and mostly listening."

Conversation is foundational to many psychotherapeutic approaches, which nonetheless vary in premise, emphasis, or technique. For instance, Hausman explains, "cognitive behavioral therapy is based on the premise that a person's issues or problems are rooted in inappropriate beliefs that they carry about themselves and the world, and that affect their behavior. So therapy is looking carefully at their belief systems. Psychoanalytic and psychodynamic approaches postulate that a person's history and experience in early life have a powerful influence on their adjustment as an adult, and that it's worth looking at those things."

As other examples, narrative therapy emphasizes that a person's life and way of behaving are related to the story they have developed about themselves within their culture; play therapy draws on nonverbal creative expression (and is not just for kids!); body-centered therapy uses postures, movements, and sensations in self-discovery and healing. There are several other approaches, including group methods for families, coworkers, or people affected by a similar issue.

Many psychotherapists have trained in more than one approach, and bring wisdom and perspective from their own life journeys as well. For instance, Irene Humbach, LCSW, combines traditional with bioenergetic therapy and Kabbalistic spirituality. "It's really all about a holistic approach to life, seeing everything as connected—body, mind, spirit. If we have an experience that has amotionally effected us, it will also be held in our body and spirit. If it gets blocked in one area, it will come out somewhere else. If you follow it in your mind/body/spirit and allow it to flow and move, it is a more natural healing process." A big part of healing, she says, is accepting our so-called negative parts. "We tend to push away the things we don't like, or try to transcend our personal issues by getting to a different spiritual mentality about it. If we would stop resisting and invite everything in, something actually happens that brings us into more of a whole state."

EMDR

What excites Cindy Dern, LCSW, most in her work these days is EMDR: Eye Movement Desensitization and Reprocessing. First introduced in 1987 by Francine Shapiro, EMDR has proven effective in reducing the impact of trauma, and is recommended by the American Psychiatric Association, the International Society for Traumatic Stress Studies, and the US Departments of Defense and of Veterans Affairs. EMDR also is helping those with anxiety, depression, addiction, anger, grief, eating disorders, and stress.

"EMDR is a holistic tool that works with the mind and the body," says Dern. "It begins like other approaches by creating a relationship and safety with a therapist, and getting clear on what's happening in your life that isn't working for you. You explore where that may have started. If you've been traumatized, you need to get stable emotionally, and have gained some skill to handle the emotions that will be brought to the surface. The goal is to get the memory into a clear perspective that fits into a context, and is not so disturbing emotionally."

The next step is what distinguishes EMDR: simultaneously recalling difficult events or thoughts while repeating a simple sensory input, such as watching the therapist's fingers move back and forth (for which EMDR is named), listening to tones that alternate between ears, or alternately tapping left and right fingers. That sort of input, called dual attention stimulation, engages both right and left sides of the brain. Doing so while recalling the traumatizing events appears to allow the brain to reprocess the trauma in a more balanced fashion that doesn't elicit such profound symptoms.

"When we are traumatized, the brain cannot fully process it, and we get stuck," Dern says. "EMDR allows you to reprocess that from a neutral place." For example, one of Dern's clients describes her improvements in dealing with PTSD this way: "Before EMDR, it was as if the emotions had a life of their own, floating through me waiting for opportunities to attach themselves to an event and exert their will. Since EMDR, the feelings seem to have been tied down, tethered to their appropriate context, filed in their correct slot, and are no longer roaming free, inserting themselves where they don't belong. It is quite liberating."

What's more, EMDR can do more than heal: It can empower, by focusing on new, positive thoughts and beliefs during dual attention stimulation. For instance, a client of Dern's got a strong parental message as a child that musical performance wasn't an acceptable career path. He chose other work, but is a musician as well who found that EMDR helped him clear the old messages so that he is freer and more alive on stage than ever before.

Kids at Play

Dennis McCarthy, a therapist based in Kingston, has been using creativity and play as therapeutic approaches for 35 years. He authored If You Turned Into a Monster: Transformation through Play and edited Speaking About the Unspeakable: Nonverbal Methods and Experiences, which emphasize that kids can communicate and heal without having to talk about what's going on in adult terms.

"One of the great things about play therapy with kids, besides that it's the most effective because it's their language, is that we aren't imposing a therapeutic model on them," McCarthy says. "The essence of Jung's work and his Red Book is that the imagination is a way of being able to experience otherwise intolerable feelings. I think that's what kids are doing with their play. Paradoxically, they can be speaking about really intense things, but they are protected from the rawness of it because they are speaking through sand or clay or some other modality. Even if they know we're going to address a particular problem, they have a good time."

At his office, McCarthy has hundreds of small objects and figurines kids can incorporate into scenes they create in a sandbox, blending fantasy and reality and giving him inroads into their worlds. "The role I play is a mixture of witness and container of the play, and also being a visionary—having a belief in the health of a child and not focusing on the pathology. If kids know I'm not busy trying to figure out how screwed up they are, but that my interest is about the health that's within them, that's going to make it work. We can really make enormous changes doing this." McCarthy also invites kids to draw monsters (they all do so easily), because "monsters are really our first creative act," he says. "They used to be seen as just pathological, as negative instinctual urges or representing monstrous adults, but many have some positive function."

Creative expression also gives people healthy outlets for emotional or psychological challenges before they become problems. Unfortunately, McCarthy notes, "kids don't have the outlets of free, imaginative play that they used to 30 years ago. It's rare in schools and parents don't encourage it at home. There are some great teen camps designed for creative play, but it seems like that hasn't really trickled down to younger kids yet. Parents can help by having materials around—clay, art materials, blocks—and giving kids a space to move around, literally, to get some whole-body activity."

It may seem that child therapy is a luxury, but if insurance won't cover it and finances are the problem, each county in New York is mandated to have a community health clinic where nobody is turned away for lack of funds. "They are especially important in counties like ours where there are few private therapists," says Doug Engel, LCSW, clinical coordinator of the children's division in Greene County's Mental Health Center. "For many people we are the only game in town. We'd like treatment for the kids to involve the family, though older adolescents are seen by themselves. But for younger kids, a tremendous amount of work is systems therapy, working with the family."

Engel notes that for the kids they work with, "it's not just the therapeutic process that's important, but also that we hook them up with services in the community and almost serve as surrogate parents. Kids do not have the natural family and community supports they've had in the past." Engel knows that parents are suffering economic and other stressors nowadays, but encourages them to spend time playing games or reading with their kids. Studies show that an interested parent is a fantastic defense against childhood problems. He adds, "It's healthier for a kid to be in a happy home with a single parent than a toxic and destructive one with both parents. It only takes one parent to love a child."

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