The Journey to Psychotherapist

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As a prototypical nerd child I had interests in things like astronomy or paleontology. Growing up in an area that was once an Ordovician sea, invertebrate fossils were seemingly in every rock. I would spent weeks chiseling out a fine crinoid specimen while skipping phys ed class….

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Embracing agnosticism at early age it was clear that science was going to be my future. Like many  latency age intellectuals I pondered mortality and  had death anxiety. I gave up on the idea of being famous and embraced the view that I didn’t want to achieve immortality through my work rather I wanted to achieve immortality through not dying. So I took up an interest in organic chemistry and later molecular biology. I had a rough start when in high school I was suspended for 3 days for clearing out a classroom by cooking up chlorine gas in the chem lab without permission…..

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In university I acquired a nerdy Asian girlfriend and worked part-time in a lab researching pulp and paper products. My boss was tasked with finding ways to improve the absorbancy of cotton. The health and happiness of millions of women hung in the balance as we would subject tampons to 20,000 volts to generate ozone or to rads of Cobalt 60 gamma rays to cross link cellulose and improve absorbancy. It worked fine but could not compete economically with styrene.

My goal was to get a PhD in biochemistry, invest in designer lab coats and drive a Volvo, but the family on both sides opted for medical school. So it goes. Parents live out their unfulfilled dreams vicariously through the offspring. This is the etiology of neurosis.

In med school the basic sciences were not too difficult and in the clinical rotations I learned that the way to diagnose a problem was through listening to patients. And the best field that offered the time to do that turned out to be psychiatry. A recent contemporary example would be  that of a 50-year-old man who woke up around 4am with paralysis on one side and confusion lasting an hour or so. He underwent the usual tests to identify the usual suspects the thinking being that it was a stroke: scans, EKG etc. However, as it turns out he had migraines and suffered a rare variant known as hemiplegic migraine-diagnosed entirely  by communication and the sharing of information.

Having been raised by three women of three generations and thus by virtue of what Freud called positive maternal transference I held women in great esteem. As such my highest grades on the board exams were in gynaecology.

Nevertheless I entered psychiatry residency which at the time had a strong emphasis in dynamic psychotherapy, an interest augmented by the plethora of crappy drugs (with unpleasant side effects) available at the time. My supervisors also made it clear that any idiot could prescribe drugs but the study of the mind required intellect. The training included 4 years of supervision designed to hone analytic skills. The case I worked most closely with at the time involved anorexia nervosa.

What I learned: The quality of the relationship and connection between therapist and client trumps any modality or technique. Essentially what makes a person better is the process of therapy, not any particular epiphany inducing intervention or brilliant technique. Freud might have referred to this as the transference cure-people get better because you want them to and they do so to please you. This supports the view that humans are essentially altruistic. Of course there are negative therapy reactions with people with cluster B traits. And this means therapy can go on for years.

I like to combine elements from several styles of psychotherapy. In fact, most therapists don’t tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client’s needs.

I also came to realize over time that  therapy is not a field that should make someone rich. Somehow it never felt right for me to get rich off someone else’s misery. Thus the therapy business would appeal to left-wing democratic socialists.

A deep part of me also felt that children didn’t belong in therapy. I believe it sent them a bad and incorrect message: that somehow they, and not the people who hold the real responsibility over their lives, are the problem and they are the ones who need the fixing. In essence I don’t there is such an entity as child psychiatry only parental. ADHD and Autism spectrum disorders are exceptions however.

As I inexorably progress toward my twilight years I am focused now on the treatment of the worried well – the disenchanted and disaffected. They are a more attractive group than the socially marginal, often impoverished and ill-educated substance dependent people who overwhelm mental hospitals.

What I have learned from my patients can be summarized thus…
1.The essence of society is repression of the individual and the essence of the individual is repression of the self. As such neurotic conflict is a universal constant. The ensuing anxiety is dealt with through unconscious defence mechanisms or coping strategies such as consumerism or other distractions or substances.This means that mental health is an elusive ill-defined goal and something we strive for but can seldom reach.
2.Men and women are capable through sustained effort of having harmonious cohabitation even though they are biologically programmed to get on each others nerves. I have no personal data on homosexual unions but research has shown that they have longer lasting happy relationships probably due to mirroring.
3.Finally I have learned that medications do not cure a psychiatric “disease” as no one is sure what the disease actually is.

Therefore psychopharmacology without therapy is like treating an infection with only Tylenol.

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2 Responses to “The Journey to Psychotherapist”

  1. Carole Kocian says:

    I got nothing out of school except the ability to balance debits and credits.

  2. kristina nadreau says:

    only the individual patient can decide if they feel better or worse while on any pharmacologic regime, and they are seldom asked their opinion. when their opinion is given it is usually discounted. Most people would like their lives to be better and almost all do not wish to make the effort to achieve this.

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