In New York City where I practiced for over twenty years, it seemed as if everyone knew what psychotherapy is, even if they hadn’t ever experienced it personally. Occasionally I’d meet with an older patient whose primary physician or psychiatrist had referred them to me for treatment, and they’d say something like, “I don’t know why I’m here or what I’m supposed to do.” A discussion would follow, and soon we’d be “doing psychotherapy” every week. But many elderly people are psychotherapy-savvy, a case in point being a ninety year old woman in New York who had undergone a lengthy psychoanalysis fifty years before she came to me to address a current issue.
The techniques I have employed throughout my career, including the newer ones I’ve learned along the way, offer the individual an opportunity to explore experiences and articulate thoughts and emotions never before expressed or if so only incompletely. When someone opens up aloud, insights and meanings often become more clear. I also use the session time to offer information, often referred to as psychoeducation, about the science and processes at work with emotion, cognition, memory, identity, consciousness, and perception. Sometimes I explain the mechanism by way certain medications work to alleviate symptoms and why sometimes they cause other problems.
Not long ago, I closed my New York office, after several years of careful planning and preparation, and opened an office in the college town of East Stroudsburg, Pennsylvania. I’m fortunate to work with an excellent psychiatrist who sometime refers patients to me, and I find myself explaining again just what psychotherapy is. In the early days, I devote session time to asking questions about the individual’s history, family of origin, and what brings them in. The answer to the latter often is simply, “The doctor said I should see you, so I’m here.” When someone relates certain problems, I will administer a questionnaire to clarify symptoms and experiences.
So these days, I’m explaining psychotherapy a little more often, and helping shed a light on experiences that have baffled, frightened, confounded or annoyed my patients. I’m describing how certain medications treat depression and why they aren’t good for people with the mood swings of bipolar disorder. I’m cataloging symptoms of obsessive compulsive disorder (OCD) and helping patients gauge how much those symptoms interfere with functioning and their overall quality of life. Sometimes just asking a question about obsessions triggers access to a deeper emotional issue never before spoken to another. As I was psychodynamically trained, I enjoy helping a patient explore a dream for its value in clarifying issues, past and current. I take my role as therapist and guide along this most challenging journey very seriously.
As we prepared to move out of New York, I considered retiring. For about five minutes. I got a late start on my career as a psychologist so there’s a practical, financial incentive to continue, but there’s an even more important reason I am still actively working as a clinical psychologist who provides psychotherapy: I love the work. I enjoy meeting new people and sitting down with them to see what we can do together to alleviate their distress, resolve their conflicts, arrive at healthier alternatives to their problematic habits and behaviors, and find greater and deeper meaning in their lives, both in terms of the past, the present, and into the future.
I find it to be a great blessing helping people traverse very intense points on their path, such as dating, marriage or divorce; pregnancy, miscarriage, or birth; seeking, losing, improving or getting new jobs; illness, accident, treatment, death and grief, and as the late death and dying pioneer Dr. Elizabeth Kübler-Ross taught us, acceptance. Acceptance of what has been and of what is, even when we wish it were different. Acceptance of what we’ve done and who we are, and acceptance of our ability to learn and grow and change despite the past, even though it can be extremely challenging and a lot of hard work.
I alway end these posts with the Sanskrit word namasté, which basically means, “The goodness in me bows to the goodness in you.” And so it is.