Tuesday, July 21, 2009

Making therapy more useful

I recently read an interesting article by Scott Miller entitled Supershrinks: what is the secret of their success?
Though this is geared towards the professional psychologist/ therapist, there are examples in other areas of study in which he applies the same kind of thoughts.

So what is a
supershrink? It's a term to describe the exceptional therapist. These are therapists who not only have a low drop out rate but are effective in helping their client make changes in their lives.

From various studies, Miller says:

We know that who provides the therapy is a much more important determinant of success than what treatment approach is provided. The age, gender, and diagnosis of the client has no impact on the treatment success rate, nor does the experience, training, and theoretical orientation of the therapist.

The article goes on to talk about what makes supershrinks and the formula for success.

This article reminded me of my therapy session a week ago which was the week where I mostly discussed eating disorder issues. My therapist C. is blunt and clear that eating disorders are not her specialty. I already knew this when I began seeing her again last year after a 6 1/2 year hiatus. (Side note: July 5
th marked 10 years ago from when I first met her. Why I remember this date, I have no clue)

The appointment was slightly frustrating on both ends, because, well, that was what I wanted to talk about. C. has always let me take the reins of what to discuss when I first arrive. Lately the eating issues, anxiety over work, and family have dominated my mind much more than the trauma-related issues, so C. was very understanding and supportive of discussing these topics. I was honest with her, even telling her about my
eye which you would have been blind not to notice.

When the session ended, she asked if this was helpful. It was but her reiteration of "my specialty isn't eating disorders" ruminated with me. After reading this article, it segued nicely into exactly what I wanted to say to her.

On Monday, I asked her if she was familiar with the article (she said it sounded familiar), pointing out that it was the
clinician that made the difference, not the specialty or treatment intervention. I told her this, because in some bizarre sore of way I wanted to reassure that yes, she was still helping me even if her specialty wasn't eating disorders (and I wasn't exclusively seeing her for that anyway). She then told me why she felt she wasn't very good with ED people, mostly because she felt like she wasn't able to truly help them enough--that some behaviors would lessen but they still left unhappy. I understood this but pointed out that notoriously (and yes, I hate saying this, it's a horrible label) eating disorder clients are difficult populations, take many years to treat, (I'm truly not saying this in a mean way, just that it is often very hard to break through the mindset of ED individuals) but that lessening destructive behaviors is progress.

What was nice about this exchange we had was that it allowed for us to effectively communicate better. I finally got a better sense of why kept saying
EDs were not her specialty, though I actually think she is more effective than she thinks (another college friend of mine saw her for awhile and also agreed). I learned that she felt perhaps by saying EDs were not her specialty that maybe she was closing me off from really discussing that area of my life. That was true after the session a week ago. I was really hesitant to bring up any ED-related topic at all in fear that she was going to ditch me and refer me to someone else. I should say this would be the understandable, ethical thing to do if I got to a state where she no longer felt comfortable in treating me.

The point of this post is about communication. I think there are many times we, eating disordered or not, have difficulty in discussing what might be working or not working in therapy. Or (if you are anything like me and worry immensely of what other people are thinking of you, including professionals who are there to help you), we are afraid of upsetting the therapist, not truly revealing what we feel even if there is a high comfort level already established. That session was such a fabulous reminder of this and why I continue to see C.

Note--*This post is not to say that you should see an ED specialist or not, but rather that much depends on the individual/ clinician and what the relationship is between therapist and client. Sometimes, more progress can be made with an ED specialist, while at other times there is no bearance whatsoever.


cbtish said...

Yes, an interesting article and partly true, I think. The difficulty with it is that Scott Miller's true purpose is to market his online services. I'm not so sure that therapists who sign up will really find themselves on the road to supershrinkdom.

To add a footnote to your footnote, think about that from a therapist's point of view. No therapist is a specialist to start with. Suppose you're just starting out as a therapist, and it turns out you are very talented. Why would you specialize?

If, on the other hand, it turns out you're pretty useless, how are you going to advance your career? Increasing your knowledge of some specialist area is going to seem attractive.

So to some extent specialisms tend to attract poor therapists who are trying to make up in knowledge for what they lack in skill. I think you are completely right to value your relationship with C over specialist knowledge.

Kim said...

This was really interesting! Having been through a number of therapists, I believe 100% that it really isn't about the specialty, it's about the clinician. My therapist now specializes in EDs, but we hardly ever even talk about "eating issues." She's best with helping me with anxiety. I imagine it's very frustrating helping ED patients. Like you said, it's a difficult population and "progress" is often very vague. It's great that you were able to have this open dialogue with your therapist. Sometimes I have to remember that they are just people too! They have their insecurities and need certain reassurances. They may not always know what works and what doesn't. I guess that's where you come in -- to be proactive in your own treatment. People think therapy is just sitting on a couch, but it's a very dynamic thing (or I think it should be).

Anonymous said...

I'm also afraid of my T asking me to go elsewhere. I was so afraid to just go to someone haveing to do it all over again would not work too well. Fear of abandonment.

Maeve said...

This is a really interesting article, thanks for sharing.

Your point about your therapist being helpful, even though she isn't an e.d. specialist, is a good one. I think it can, in some ways, go both ways too. My shrink is officially an e.d. specialist but, although he has helped my eating disorder, I think he has been much more helpful with my other issues. I am not suggesting he is a bad e.d. specialist, just that there is obviously more to effectiveness than specialty. I think it probably depends on the ability of the therapist and the way they interact with their patients (obviously therapists will be more helpful to some patients than others). It's finding that perfect fit that's the hard part.

Smudge said...

Your therapist sounds really good for you. She is open and honest, which I think is what makes her good at what she does.

Tiptoe said...

Thanks for the comments, everyone.

Cbtish, I don't know enough about Scott Miller to know what his intentions are. I do agree that probably the majority of therapist aren't looking to be "super shrinks," but I do think therapists care about drop out rates and successfully helping their clients.

I see your point about specializing, and I'm sure there are some therapists who are trying to make up for knowledge. But I think for most, they specialize, because they have success and they find that topic particularly interesting.

Kim, I'm glad that you have such a great relationship with your therapist. I truly think that makes the most difference in therapy.

Anon, fear of abandonment can be scary. I encourage you to discuss your fears with your T. Most therapists know how difficult it is for people to start therapy.

Maeve, I agree that finding the fit is the one of the hardest parts of therapy. If the fit isn't right, it won't work too effectively.

Smudge, yes, you are right that C. is good at what she does. We've had rocky moments in the past, but this time around, we've both been the most open and honest.