Psychology Articles

When it came time to assess my supervisee, I focused on her diagnostic and treatment planning skills, her theoretical basis, the stage of her professional development and skill level, and her interpersonal style:

The supervisee had many of the characteristics expected at the novice level: confusion between textbook knowledge and practical application, insecurity about the “doingness” of therapy, and lack of therapeutic techniques and case management skills for a variety of issues. She needed to become comfortable with client sessions, learn how to conduct an intake, take session notes, and how to present a case. She didn’t know how to identify when a client might have an Axis II diagnosis, and as novices often do, tended to under-diagnose. She needed to learn to research issues online or elsewhere.

My supervisee was very much in awe of skill and technique that had taken twenty years to develop and measured herself against that. She wanted to be able to do Narrative Therapy as well as Michael White with all her clients, and when this didn’t happen, blamed herself. I worked with her to broaden her view and be able to honor the personal strengths she brings to the therapy setting, such as her previous career as an educator.

On the plus side, my supervisee had a very pleasant, engaging demeanor and self-presentation that helped her establish a good bond with most clients. She has an innate sense of how to help, and good clinical instincts.

The specific goals I had for the supervisee were at times different than the goals she had for herself:

The supervisee identified her goals as: to become comfortable with the intake process, to know how to recognize and deal with a crisis, to have confidence when sitting with a client, and to “learn something about treatment planning although we don’t call it that.” She said she might have transference issues during supervision due to growing up with a highly critical authority figure. During the course of our work together, it became apparent that she also had the goal of being able to do Narrative Therapy as well as Michael White (while still in her traineeship).

My goals were: to help her develop counseling skills, to learn the rudiments of case conceptualization, to increase her professional role development and her ability to self evaluate. I also wanted for her to learn the benefits of an eclectic approach, to be able to enjoy this beginning stage and “not knowing,” that she honor the particular strengths that she brings to therapy, i.e. her background as a teacher, instead of trying to eradicate it. I wanted to help her be easy on herself for her learning curve, and to understand that she may someday be as good a clinician as Michael White, in not less than fifteen years time.

© 2010 Catherine Auman

Catherine Auman, MFT is a CAMFT Certified Supervisor and psychotherapist with over 25 years experience based in Los Angeles, Calfornia. She has advanced training in both traditional and alternative methodologies based on ancient traditions and wisdom teachings. Visit her online at http://www.catherineauman.com

The methods used for evaluation were self-report, record review, and self-evaluation. I had the supervisee complete several written evaluations of her progress in acquiring clinical skills and of the supervisory experience.

The supervisee gained a great deal during the time I knew her. She became increasingly comfortable with diagnosis, treatment planning, case management, legal and ethical issues, and note taking. She understood the dictum “First do no harm” and was careful and alert to issues of client safety. She exhibited a good sense of how to help, and bonded well with most clients. She developed in her ability to observe interactions, choose and implement interventions, and assess their effectiveness. She began to learn to identity personality disorders and devise treatment strategies for working with them.

The supervisee struggled with non-postmodern strategies. She was resistant to treatment planning and documentation (as are most therapists) and had unrealistic expectations of progress. She will need to increase her willingness to be confrontive with patients and not strive to be liked at all times.

She was being taught by her supervisor at school to learn one theory completely and only later to venture into other theoretical work, and this clashed with my viewpoint. We agreed to disagree, and I helped her develop in the ways I have outlined above.

I had some good feedback about this, although it came from the supervisee somewhat grudgingly. One day she told me she realized she couldn’t use Narrative Therapy with all clients because, “Sometimes the clients think the narrative questioning is just being weird. They don’t like it.” Then one day toward the end, she came in very proud to tell me she had done the best in her class on the Mock Orals and “Thank you, that was directly due to the work you did with me that the other students didn’t get.”

Her parting comment to me was, however, “You’re modern,” said like it was an insult. I felt like I was just not hip enough, even though I had never cared before.

I enjoyed the supervisory experience and see my major strengths as a supervisor as my breadth of experience and love of mentoring. Perhaps my biggest weakness is that I enjoy taking over and formulating and theorizing a bit too much, instead of encouraging the supervisee to do it. I will watch for this in the future.

© 2010 Catherine Auman

Catherine Auman, MFT is a CAMFT Certified Supervisor and psychotherapist based in Los Angeles, Calfornia. She has advanced training in both traditional and alternative methodologies based on ancient traditions and wisdom teachings. Visit her online at http://www.catherineauman.com

Maria Montessori was born in the town of Chiaravalle (province of Ancona, Italy) in 1870. She became the first female physician in Italy upon her graduation from medical school in 1896. Then, she was chosen to represent Italy at two different woman’s conferences, in Berlin in 1896 and in London in 1900.

Her clinical observations led her to analyze how children learn, and she concluded that they build themselves from what they find in their environment. Shifting her focus from the body to the mind, she returned to the university in 1901, this time to study psychology and philosophy. In 1904, she was made a professor of anthropology at the University of Rome.

Maria Montessori is known as a developer of Montessori approach based on a child psychology. It can be established only through the method of external observation. We must renounce all idea of making any record of internal states, which can be revealed only by the introspection of the subject himself. Her intention was to keep in touch with the researches of others, but to make herself independent of them, proceeding to work without preconceptions of any kind. She confirmed that “all methods of experimental psychology may be reduced to one, namely, carefully recorded observation of the subject”. Treating of children must necessarily intervene the study of development. Discipline is another very important part of Montessori approach and it must come through liberty. She calls an individual disciplined when he is master of himself, and can regulate his own conduct when it shall be necessary to follow some rule of life.

Such a concept of active discipline is not easy to comprehend or to apply. But it contains a great educational principle, very different from the old-time absolute and undiscussed coercion to immobility.

What about lessons in school?
In Montessori method the lesson corresponds to an experiment. The more fully the teacher is acquainted with the methods of experimental psychology, the better will she understand how to give the lesson. In the first days of the school the children do not learn the idea of collective order; this idea follows and comes as a result of those disciplinary exercises through which the child learns to discern between good and evil. The lessons are individual, and brevity must be one of their chief characteristics. Another characteristic quality of the lesson in the is its simplicity. It must be stripped of all that is not absolute truth. The teacher must not lose herself in vain words. The carefully chosen words must be the most simple it is possible to find, and must refer to the truth. The third quality of the lesson is its objectivity. The lesson must be presented in such a way that the personality of the teacher shall disappear. There shall remain in evidence only the object to which she wishes to call the attention of the child.

Montessori approach is also based on exercises of practical life such as personal cleanliness, intellectual exercises (objective lessons interrupted by short rest periods;nomenclature, sense exercises), gymnastics (ordinary movements done gracefully, normal position of the body, walking, marching in line, salutations, movements for attention, placing of objects gracefully), free games, directed games (if possible, in the open air), manual work (clay modeling, design, etc.), collective gymnastics and songs, and exercises to develop forethought – caring for the plants and animals.

In order to protect the child’s development, especially in neighborhoods where standards of child hygiene are not yet prevalent in the home, it would be well if a large part of the child’s diet could be entrusted to the Montessori school. It is well known today that the diet must be adapted to the physical nature of the child. The diet of little children must be rich in fats and sugar: the first for reserve matter and the second for plastic tissue. In fact, sugar is a stimulant to tissues in the process of formation. As for the form of preparation, it is well that the alimentary substances should always be minced, because the child has not yet the capacity for completely masticating the food, and his stomach is still incapable of fulfilling the function of mincing food matter. Consequently, soups and meat balls should constitute the ordinary form of dish for the child’s table.

There are many crucial parts of Montessori method that I will try to explain on my own website, and in the other articles. Montessori method as every other method has some positive and negative sides that other
psychologists are researching.

http://parenthomecareer.webs.com

Parent with experience
http://parenthomecareer.webs.com

Abstract:

In this paper I want to review the investigations from the Citizens Committee for Human Rights in Mental Health. It is this organisation in the United States and other countries that have consistently brought the dangers of psychiatry to the attention of the general public who by and large are the victims of a marriage between pharmaceutical companies and their paid distributors of lethal drugs, psychiatrists. This alliance has been based on the greed for money, profits and kudos all in the name of a science that as one leading authority called – “hokum”

Introduction: A Short History

The history of psychiatry is strewn with the deaths; torture and misadventure that would make any sane person wonder why it has been allowed to continue to practice this black art for so long. Of course the anti-psychiatry movement has been around for almost as long as the profession itself. How did this all begin? You have to go back to the days of the asylums that grew up in the early part of the 1800’s particularly in England and the USA. These places were no more than prisons for the mad, those souls that could not function within the societies norms that dictated how one should act and behave. The head of the asylums was a medical doctor, the first psychiatrist. This man caged the mentally ill in cells, with no heating, little food but rotten scraps and in order to cure them of their madness the inmates were tortured by flogging, burning, immersion in water and many other inhumane acts called treatment. The down fall of the asylums started in England with the York Retreat a Quaker run institute for the mentally ill run on very different lines from the asylums that were government institutions. In the York retreat the inmates were given jobs to perform, were helped by keeping simple rules and rewarded for following them.

They received humane treatment that would lead them to God and sanity. While the York retreat had some success it was still based on control of the mad. Later as the years went by and the 19th century ended the rise of the huge mental hospitals arrived. Psychiatry had new weapons to defeat the mentally ill, this time with brain surgery called lobotomies, hydro-treatment, fire hoses to spray patients with forced jets of water, wet blanket wrapping, where patients would be bound in wet sheets on a bed unable to move for hours, insulin injections, to cause artificial brain seizures and of course electric convulsive therapy – shocking patients with bolts of electricity in order to numb the brain into not remembering why they had problems in the first place. As the 21st century arrived the cost of these hospitals became so burdensome to governments they closed them down and in their stead introduced “care in the community” which ironically did not care at all and most mental health patients became homeless and the new beggars in our streets. It was not until the early 1900’s that finally Freud introduced his “talking cure” a humane way to try and understand the plight of the mentally disturbed and a way of giving them insight and a possible cure. Of course you had to have money for this treatment much as you do today.

Psychoanalysis is for those who can pay the price. As the century blossomed so did Freud’s theory which was to become many types of therapy from behaviourism, cognitive, transactional and many more variegation of his original idea. In fact without Freud there would be no modern psychology as we know it. From about 1960 a new ear for psychiatry emerged. All those barbaric treatments that never worked were about to be replaced, not by another type of institutions but by a chemical straightjacket that came from the pharmaceutical industry. Now drugs were the new form of treatment, suddenly the lowly carer of the insane, and the psychiatrist could become a real doctor and prescribe psychopharmecutical drugs to all. So an era of drug pushing began, where new mental disorders were manufactured in order to sell more drugs. Early in the century Krapelin invented a small book called the DSM (diagnostic statistical manual of mental illness) in this book he gave lists of mental symptoms that if added up in one person lead to a label for their problem, such as depression, anxiety, mania, hysteria, homosexuality, immoral behaviour and much more. As the years went by the profession of psychiatry kept adding to this book and inventing new labels in order to match a drug to manage it.

Today we have the DSM IV version with the next one almost completed as number V. Over the years it has discovered all sorts of new ways to classify human emotions as being mentally ill. Bipolar disorders, ADHD in children, PTSD for soldiers (shell shock of WW1) and many others. While these labels may have some usefulness and have been recognised as genuine problems for a few people, now of course according to psychiatry we are all mentally ill, if not at this moment but in our lifetime. So they divide populations into existing clients of drugs and potential clients of drugs. Today mental health is not a profession, not even a scientific medical branch but simply a marketing arm of the pharmaceutical industry that pays millions of dollars annually to keep the myth of mental illness alive and expanding.

The Evidence;

Here I would like to list some facts that speak for themselves.

• 100 million people worldwide are on psychotropic drugs
• In addition to crippling scores of people daily, every month psychiatric drugs kill an estimated 3,000 worldwide.
• 70% of all psychiatrics drugs are prescribed by general physicians.
• 374 mental disorders are listed; almost all with out a single scientific test to prove they actually exist biologically.
• Psychiatric drugs in 1966 were 44 but by today that has risen to over 180.
• The top five drugs gross more money than half the world’s nations.
• Drugs make over a third of a trillion dollars a year.
• 20 million children around the world are prescribed psychiatric drugs (USA 9 million alone). Most under 5 years old for non-scientific problems.
• Every 75 seconds someone is involuntarily committed a mental institution in the US alone.
• Electric shock therapy is still in use even though it causes memory loss and has little long term benefit to the patients. This is straight forward abuse of Human Rights.

All the above were researched by the Citizens Commission on Human Rights and backed worldwide by some of the most eminent psychiatrists and psychologists today.

The long list above is only the tip of the psychiatric abuse saga. It is a profession based on money and more money. Most drugs in the market are only tested for less than eight weeks in clinical trials before being given FDA approval by a panel of psychiatrists paid for by the very drug companies they are supposed to be regulating. Not a single medical drug on the market today is free of side effects which of course are the real effects of taking dangerous drugs for often fictisous mental illnesses. You cannot solve a life issue my masking it with drugs and expecting to feel better. The issue is still there – so you have to take the drugs for a lifetime in order to never think about your real problems. Of course with the side effects of one drug you are prescribed many others all to combat each others effects – so most people with a diagnosis of mental problems end up on a cocktail of drugs for life. It is amazing the amount of money people spend to chemically anesthetise themselves when a tiny proportion of that cost could be spent seeing a counsellor, psychologist and therapist and actually dealing with their issues and never having to take a drug in the fist place.

Conclusions

Psychiatry, disables, kills and creates drug addicts. Simple really when you add up the costs to society. Do they still have a place in modern medicine at all? Well yes, they could concentrate on helping severely disturbed people with understanding, kindness even when they may have to assert some control over that individual for a short time. However for the vast majority of patients taking psychotropic drugs they could stop them tomorrow (or at least phase them out to minimise withdrawal effects) and start going to see a therapist. I would recommend a counsellor skilled in Cognitive Behavioural Therapy for depression and anxiety, Transactional Analysis for parenting, communications skills, stress at work and many other day to day issues that require some practical skills insight. For personality problems with anger, emotional turmoil, long term unhappiness and dysfunction then a psychoanalyst would be perhaps your choice. Most psychologists who treat patients in counselling are Eclectic this means they borrow from many styles of theory and practice to use the most appropriate approach based on each clients needs. The list is endless but any therapy that helps you to become stable, responsible for your own actions and gives you the insight into choices is better by far than a life time of drugs and unhappiness.

If you feel the need – go see a therapist today – find out how to get away from dispensed drugs and start to find a purpose in life again.

References:

Citizens Commission on Human Rights – 2009 – Psychiatric Violations of Human Rights
DVD Making a killing – Exposure of Drug Companies links to Psychiatry

DSM-IV Statistical Manual of Mental Illness – Version 4

R. Gross (1996) – Psychology – Theory of Mind and Behaviour – refs to historical notes. Hodder and Stoughton Publications (Words 1622)

Dr. Stephen Myler is from Leicester in England, an industrial town in the Midlands of the United Kingdom. He holds a B.Sc (Honours) in Psychology from the UKs Open University the largest in the UK; he also has an M.Sc and Ph.D in Psychology from Knightsbridge University in Denmark. In addition to this Stephen holds many diplomas and awards in a variety of academic areas including journalism, finance, teaching and advanced therapy for mental health. Stephen has as a Professor of Psychology many years teaching experience in colleges and universities in England and China to post 16 young adults, instructing in psychology, sociology, English, marketing and business. He has been fortunate to travel extensively from Australia to Africa to the United Sates, South America, Borneo, most of Europe and Russia. Stephens favourite hobby is the study of primates and likes to play badminton. He believes that students who enjoy classes with humour and enthusiasm from the teacher always come back eager to learn more.

The field of psychology encompasses many aspects that must be dealt with on a daily basis. Psychologists and others working in the field are often faced with moral dilemmas that may cause them to question the place of morals and spirituality in psychology. Those who practice some form of religion may use their specific values and morals when it comes to finding resolutions in these situations. There still lies the question of whether religion has a place in the day-to-day practice of psychology and if so, where to draw the line.

In part, psychology is considered a science. Though it is not exact in all situations, it does carry with it various similarities to science where theories and decision making are concerned. Ethics play a big role in psychology for both the roles of the psychologist or psychological professional conducting evaluations and providing treatment and the client or patient receiving the services or treatment. The code of ethics was put into place to protect both parties involved. Ethics is based on right and wrong and, can therefore be closely related to morality in many instances. Because of this, it can be argued that religion plays a role in the ethical decisions that are made everyday. Though the code of ethics does not specifically site religion as a part of what is contained there in, various aspects of morality and common values are found.

Spirituality as a whole has become even more prevalent in the field of psychology over the past several years as evidenced by the number of Christian counseling centers that have opened around the country. The professionals working in these settings offer what some say is the perfect combination of treatment, psychology based on Christian values and beliefs. Here the psychological principles and ethics are used with various aspects of religious values and beliefs interwoven into the treatment plans. Patients are often counseled on how spirituality can help them through their difficult situations. In these settings, professionals strive to find a balance between psychology and religion, a challenging task at times. Psychology is based on various principles, theories and ethics while religion is based mostly on faith. Psychological issues are proven in a scientific way while a good part of religion is based on belief in the unseen. While many people don’t question their faith, it can be difficult to intermingle what can be physically seen with what cannot. This causes many people to question the place of spirituality in psychology.

Because faith is often questioned, it has become necessary to receive proof. This proof often comes in the form of answers that are a direct result of the testing of ideas (Myers). When ideas are tested and found to be correct, faith is easier to maintain; however, then they do not survive the test, faith can become a very shaky prospect. When this principle is applied to psychology, the outcome can change on a regular basis. Different situations call for different ideas which may or may not prove to work. Also, what works in one situation may prove impossible in another. The key to understanding where spirituality fits in is knowing how to apply it to each individual situation and idea and make determinations and assessments based on the information that is gathered and the particular values that are relevant to the end result.

To better understand where religion fits into the psychological realm, let’s take a closer look at the human attributes that make up each. Where religion is concerned there is the theological wisdom. This deals with the acceptance of divine love in order to enable individuals to accept themselves. Psychological wisdom, however, deals with self-esteem, optimism and personal control (Myers). The ability to use the two together to make important decisions will provide the freedom to use what we know, admit what we don’t and search for the answers. Because we are both the creatures and creators of our own social world, people and situations matter (Myers). While ultimate control lies beyond us, we carry responsibility for making important decisions that have a lasting effect on us as well as others.

Psychologists face these dilemmas everyday. They must make important decisions that will directly effect their patients. Each decision is made on an individual basis and is dependent on each specific situation and its own set of circumstances. Each decision will carry with it a separate set of ethical issues and dilemmas and the solution will remain unique to each. Religion is said to heal people while medicine was designed to do the same. The two often work in different contexts, but it can be argued that medicine was discovered because of ideas and values based on religious beliefs. Because of this, it is believed in many situations the two are used together to come up with treatment plans that will be both effective and long lasting.

In many ways, people who have great faith have found the insights and critical analyses of psychology to be supportive of the understanding they possess of human nature. Their assumption that religion is conducive to happiness and good health is also attributed in great part to psychology. The science of psychology offers principles that can be applied to the construction of messages that will prove both memorable and persuasive. Here the tasks of peacemaking and reconciliation are promoted in a way that offers solutions that will provide the means by which others can achieve happiness by establishing healthy relationships (Myers). While the science may challenge our way of thinking, the same can be said of religion. Faith is often questioned in an effort to find answers. This has proven to be helpful in many situations where the answer wasn’t clearly defined. Here, the science of psychology is used along with the religious beliefs to find solutions to problems that seemingly have no immediate or clear resolution. Still, faith is not always a negative aspect of psychology.

A strong value and belief system can help a psychologist working as a professional in the field deal with situations where the traditional psychological theories aren’t showing a definite answer. Here the process is reversed because religion is used to clarify a particular set of circumstances based on the lack of information that can be gathered at a given time. There are also times where one can support the other. Religious beliefs are often used to support the reasoning behind many ethical situations whereas psychology is often used to prove various religion based ideas. This is where the two can be used in tandem to come up with a truly unique solution that will work.

It has also been argued that faith plays an important role in a psychologist’s ability to use the information found in the code of ethics and psychological practices that are present everyday. This is based on the belief that people who possess strong faith are better able to understand the science of psychology because they can use the two together to come up with answers that are suited to each new set of circumstances. Here psychologists are not heavily relying on either faith or science, but instead are using them both to gain a better understanding of the situation as a whole. Those who believe in the contents of the code of ethics understand its importance and why it must play a role in psychology on a daily basis (Kafka). Those who possess strong religious beliefs usually strive to use them everyday when making ethical decisions and are often working toward an outcome built on both science and faith. Still there is a very important line between when to use the science of psychology and when to rely on the beliefs and values that often assist many in making daily life decisions.

When it comes to the co-mingling of psychology and spirituality, each has its own place. The scientific aspects of psychology are necessary in order to solve a wide range of problems and provide successful treatment to those in need. Still, spirituality can play a very important role in the rehabilitation of patients by making it easier to understand the psychological ramifications and why they exist. Spirituality and science can be used both during and after treatment. During treatment, religious beliefs may guide both the psychologist and patient toward making the right decisions and understanding difficult situations along the way. After treatment, religion can continue to help the patient as he or she moves onward through life while the scientific aspect may still remain present in the form of ongoing counseling or use of medication.

Psychologists can use both in their profession to make difficult decisions and deal with hard to solve problems. Aspects of each can be relied upon to provide the means by which to draw important conclusions that may help throughout the entire treatment process. Evidence has also shown that psychologists who know their profession but also possess strong religious beliefs are able to help their patients throughout treatment by passing on various virtues that promote positive thinking (Myers).

The end results of melding together both science and spirituality have been studied for a number of years. Some argue psychology should remain only a science while others feel the intertwining of science with religion can only serve to improve the overall outcome of treatment situations. The argument is also made that science as a whole has strong ties to religion and the two often give cause for the questioning of each other. Science can often prove what religion cannot and religion was the basis for the need to know, thus people began studying the how and why of scientific matters (Myers).

Some have explained the boundaries between psychology and religion by bringing up a few points that express how one relates to the other. One point is the correlation of scientific ideas presented in everyday human nature to religion and being able to site the information to show how it is all related. Another important point is the link between religion, prejudice, altruism and overall well-being (Myers).

When dealing with various psychological situations, it is just as important to realize the importance of the science as it is the religion. This is often difficult to do because of the differing beliefs and values possessed by each professional working in the field. Because of this, it is necessary for each to make decisions based on the psychological code of ethics along with the specific circumstances of each given situation. For those who are religious, spirituality will most likely play a role in the decision making process in a professional setting because it very likely does in any other. Those who utilize spirituality in day-to-day situations often rely on it to guide them in their professions. Though the psychological code of ethics may not have been created based specifically around the religious beliefs and values directly associated with spirituality, there are many similarities between ethical dilemmas and resolutions and those of a moral nature.

Correlations have also been reported between faith and subjective well-being. One example of this can be found in a National Opinion Research Center survey of 42,00 Americans that was conducted after 1972. Here 26 percent who never attended religious services reported being very happy while 47 percent of those participating in spiritual services on a regular basis, sometimes more than weekly reported also being very happy (Myers). Though this does not sho3w a direct link between religion and well-being, it does indicate that many people seek spirituality in various aspects of their lives. Whether the science of psychology and spirituality should be co-mingled in a professional setting can be a bit subjective as it is dependent upon the differing situations and those directly involved in the treatment processes. While there are correlations between the ethical code used by psychological professionals everywhere and the morality associated with religion, the two remain separate and can be called upon in any given situation where they may be deemed necessary or important. The code of ethics is used every day in the psychological setting, but whether or not spirituality is involved may be up to each professional working in the field.

REFERENCES

Code of Ethics: Understanding the Professional Conduct of Psychologists. Taken from http://clinical-psychology.suite101.com/article.cfm/psychologist_as_professional

Myers, David G. Psychological Science Meets the World of Faith. Taken from http://psychologicalscience.org/observer/getArticle.cfm?id=1861.

For more information, please contact Dr. Joseph Coleman at jcoleman05@bellsouth.net or via phone at (504) 621-0966 (504) 621-0966

Ethics plays an important role in psychology from the beginning of the treatment process through rehabilitation. There are many ethical concerns that can arise all of which must be dealt with along the way. These various concerns can also vary from one psychological setting to another. These settings include: hospitals, physical rehabilitation centers and facilities specializing in chronic diseases to name only a few. As the number of psychologists and other professionals working in this field increases, so does the need to focus on areas of ethical concern (Lucignano and Lee). The ethical issues that can arise reach far beyond the medical setting and are present in other situations as well.

Important Ethical concerns include: role delineation, working within the medical model, taking on multiple responsibilities and maintaining confidentiality (Lucignano and Lee). Before any ethical issue can be recognized it must first be clearly defined. Though this article cannot encompass them all, those listed here are commonly encountered and must be dealt with on a regular basis.

The first ethical concern that will be discussed is role delineation. This is a primary concern because it lays the ground work for the responsibilities and expectations of the psychologist; however, there is not a consensus on specifically what constitutes the role of the psychologist in a medical setting. Since many psychologists work in the medical profession, this can present somewhat of a gray area. Instead, diverse terminology has often been used to define this particular role. Terms used include: health psychology, medical psychology, clinical psychology and behavioral medicine. This has presented past arguments over whether or not this lack of clarity in actual definition of terms is more than semantic confusion (Lucignano and Lee). The primary argument here is whether a psychologists’ actions and activities are included under one of these terms that are, for the most part, considered to be unstandardized in this context.

Working within the medical model is another ethical concern that must be considered in the medical field. In these instances, psychologists are usually working on teams that include a physician, social worker, speech pathologist, physical therapist and occupational therapist. Though all teams may not include every role listed above, it is very likely there will be at least two members on each. When this is the case, it is necessary for each person to work within his or her role in order to provide maximum treatment. Ethical awareness is an essential part of providing psychological treatment within the medical model. In a hospital, for instance, unique areas of stress may be present which effect both patients and members of the treatment team (Lucignano and Lee). As a result, there may be difficulties when it comes to the overall decision making process. There may be several causes for this because many people are working to rehabilitate one person. There are several patients so that team may, in effect, be responsible for rehabilitating a wide range of people all of whom are dealing with very different situations. Team members will not always agree on everything and important issues may need to be carefully examined by each team member when it comes to resolving them.

Taking on multiple responsibilities can also bring up ethical issues for psychologists no matter where they work. When treating patients, psychologists take a look at each as an individual and treat each situation accordingly. There are, of course, many responsibilities that come with providing treatment and the solution to a particular need may not always coincide with traditional means and methods of resolution. A psychologist in this type of situation may feel pressured by the many responsibilities he or she must tackle on a daily basis and may be torn between handling a specific one through traditional means or in a way that is unique to the situation. The more administrative duties the psychologist is given, the less time he or she will be able to spend rehabilitating patients. While this may not be an issue that is of top concern, it can arise nonetheless and will need to be dealt with in a way that allows the psychologist to take care of important job-related duties and provide the best treatment possible to all patients.

Maintaining confidentiality is a very important concern. While psychologists don’t have a problem keeping important patient details confined within the facilities with which they are employed, ethical issues can arise when it becomes necessary to discuss certain situations with other professionals. When this occurs, the psychologist involved must decide whether or not the information needs to be passed onto the person requesting it or if a particular piece of information needs to be disseminated to someone else for treatment purposes.

In other situations, a psychologist may be asked for specific information about a current or former patient. While the information in question may be important in the given context, the confidentiality of the patient may be breeched if it is provided. Here the psychologist is faced with a moral dilemma of sorts. He or she knows the information is important and the person requesting it probably should be made aware, but is under a professional obligation to the patient to keep from sharing it. Should this occur, the psychologist can talk to the patient about the situation, informing him or her of the request and why it was made. The final decision of whether or not to provide the information will then be left up to the patient who will be responsible for its dissemination should this be the end result.

When it comes to solving ethical dilemmas, it is important to first understand the code that has been established. When going to work for a particular entity, psychologists will receive information that will instruct them on the various policies and regulations. In order to solve the issues that are bound to arise at one time or another, they will need to assess the individual situations and make a determination on what to do based on the ethical principles that have been set forth. Some dilemmas will be easier to solve than others and will be based around more black and white issues of right and wrong. Other times, distinguishing between right and wrong will not be so easy to do. In some cases, the answer will not lie in a simple context of right and wrong, but instead will be specific to the various factors involved. When this occurs it is often not quite so easy to make the determinations that solve these ethical dilemmas. When this happens, psychologists depend heavily on the ethical principles they have learned as well as the specific policies established by the entities for which they are employed.

One common problem that occurs is in solving particular ethical dilemmas by using the principles when the situation is not completely clear. Sometimes problems arise that call for extensive decision making based on individual factors that cannot be figured into the original ethical principles. Each situation is different and must be treated as such and therefore, will have an individual set of issues that may arise. When this occurs, the psychologist must make a determination based on the specific factors involved while using the ethical principles in a way that will solve the problem without causing an ethical conflict.

Ethics are present for a reason. They are necessary when solving a wide variety of problems that may arise on an individual basis. Though these issue are just that, individual, a uniform code is needed to help psychologists understand and deal with certain types of situations. The place of ethical concerns in psychology applies to psychologists both as researchers and practitioners. Ethics are present in every aspect of psychological practices and must be adhered to in every context. A set of ethical guidelines has been established to aid psychologists in figuring out what to do when these situations arise. All psychologists are bound by these guidelines.

Though ethical guidelines have been established, there is often a debate on whether or not certain issues fall within them and what psychologists should don when they occur. Still, the place of ethics in psychology is not newly found. Aristotle made several important psychological observations concerning the limits beyond which humans cannot control their own behavior, sanity and their capacity for emotional response (Upton). Though these principles have been studied for many years, other issues have arisen specific to new situations and debates. That is why understanding the code of ethics and why it has been established is essential to solving various issues that can, and often do occur.

The code of ethics outlines the responsibilities of the psychologist and establishes what is considered acceptable and unacceptable in regards to the practice of psychology. This code of ethics is multi-dimensional and must be adhered to in order for a psychology to maintain his or her license (Kafka). Since licenses are granted by each individual state of residence, a psychologist working in any particular location is bound by the specific practices established in that place. This practice is defined through roles and obligations a psychologist will possess so there will be consistency within the field. Likewise, the license a psychologist obtains will have meaning to the public who can easily learn what is expected of a professional working in the field.

The main goal is the psychological code of ethics is to insure that all clients and patients are treated in a professional, lawful and respectful manner when seeking treatment (Kafka). Here behaviors are defined that specify how the psychologist will handle the various situations that may arise during the course of treatment for all clients or patients. The ethical code regulates the way in which many behaviors are dealt with and how situations may be resolved. This includes both the private and institutional practice of psychology. This guarantees that anyone who receives service from a psychologist who is adhering to the code of ethics is insured professional, humane treatment that causes no psychological or physical harm. Should the ethical code be breeched for any reason, the situation is investigated and handled accordingly.

The code of ethics is also designed to protect the public from uses and abuses that may result from the mishandling of a particular situation. These protections include: physical, emotional or even financial and cover a wide range of factors related to the practice of psychology. The code contains numerous clauses that clearly specify practices that are considered to be acceptable in regards to billing procedures, file maintenance procedures and even what should occur during appropriate therapy termination. Many aspects include: job handling, office management and client handling. The acceptable versus unacceptable behaviors are defined as well as what actions should be taken if any part of the code is breeched.

The code of ethics directs both the psychologist and client or patient away from conflicts of interest. The existence of dual roles is one conflict that can occur when inappropriate relationships are established between psychologists and those they serve. The ethical code specifies how these situations should be handles and helps both parties in maintaining lawful, socially responsible behavior. This insures the psychologist will be able to treat clients or patients in a positive manner that will promote rehabilitation while clearly drawing the line for those receiving the treatment that clearly defines the appropriate relationship of psychologist and patient. While there may be many arguments surrounding specific situations and what actually constitutes an ethical dilemma, the code is clearly defined and should be closely followed at all times. There are many situations that can certainly present ethical dilemmas, but the code remains in place to help guide psychologists when they must deal with issues that may prove rather difficult. This well-established code not only serves as a guide but also as a way of protecting everyone involved in the treatment process. The ethical code is an important part of the psychological practice because it clearly defines how to deal with important issues that can arise during the course of treatment. This aids psychologists in making important decisions and helps them to better understand the psychological professional as a whole.

REFERENCES

Kafka, Pauline. May 7, 2008. Psychologist Code of Ethics
Understanding the Professional Conduct of Psychologists. Taken from http://clinical-psychology.suite101.com/article.cfm/psychologist_as_professional

Lucignano, Geraldine, Lee, Sandra. Ethical Issues Involved in the Role of Psychologists in Medical Settings. Taken from http://www.questia.com/PM.qst?a=o&se=gglsc&d=5002168429.

Upton, Candace L. The Journal of Ethics. Virtue Ethics and Moral Psychology: The Situationism Debate. Taken from scienceofvirtues.org.

For more information, please contact Dr. Joseph Coleman at jcoleman05@bellsouth.net or via phone at (504) 621-0966

How do I start? It’s gonna be difficult to write this post in a way that everyone can ready it and at the same time don’t commit heresy by not being rigorous and awaken the wrath of my colleagues.

Also, I don’t want to get into the “politics” of Freudian Psychoanalysis and the “war” it’s into against other branches of Psychology such as cognitive sciences. The point I’m trying to prove is that Freudian Psychoanalysis and the people who study and has studied it (including me) have some points and miss some others.

I think Freud was dead right regarding the dynamics of the unconscious mind (the existence of unconscious processes is not arguable). (mental note: avoid being technical) Once you understand the theory and articulate it, you can trace behaviors back to its’ elemental state. It’s a tool to comprehend how the human (animal) mind functions while in contact with culture.

The error (I’m not being modest here, sorry) I often see, is that its’ application to our “real world” (I’m really using those two words very loosely) often fail. And why do I think so?

Because some people tend to extrapolate the exact Freudian Theory to current cases. I could say that studying Psychoanalysis during the 1900s was a lot easier. Today we need to make an extra effort. Why?

Because Freud wrote at the end of the XIX century and beginning of the XX in a much more different society. With no mass media, no internet, no cell phones, no cars… and let’s not start about the social differences of Victorian Europe. Spring Break could have killed half of the Old Continent’s population of heart attacks.

Today, the effort we have to make is to dismount that carpet of social fantasies put together. We have new ones 100 years in the future. Our society is a lot different than that of WWI. We see the world, we interpret it, in a different way. We can’t pretend that the world hasn’t changed. We have to put the new carpet of our post-modern world on top of the naked roots of Psychoanalysis. Same basic rules of cognitive functioning still apply, we just need to connect them to our current individual and collective fantasies, goals, desires.

Psychoanalysis was popular because it addressed the exigencies that that world posed. And that’s a criticism that many branches of Psychology are making. We could even find something new, something we haven’t been looking for.

I realize that if I keep writing, this post would reach an asymptotic line on the “Over” axis. I know I’m leaving a lot of loose ends, maybe one every 10 words. But my goal was to address a point and stick to it. Lots of ideas come to mind but it would make this post lose its purpose.

PS: Flak welcome

Fernando Tarnogol is an Argentinean psychologist, currently working as Program Coordinator at the Devereux Foundation in West Chester, Pennsylvania.

He has studied Psychology at the University of Buenos Aires and Human Resources Management at UADE (Argentinean University of the Enterprise). His professional experience includes work in HR for HSBC Bank Argentina and in two mental health facilities performing psychological evaluations and other clinical work.

Visit his blog at http://fernandotarnogol.com/

The year is 2009 and it has been over a century since popular consciousness has widely accepted the fact that humans are just another type of animal. Curiously, even as humans are increasingly accepting of political and cultural pluralism, there is still insufficient focus on how pluralism in general arises from differences in breeds of humans. Populous mammals like dogs and cats have a number of breeds that cluster by physiological external differences like size and internal neural differences like aggressiveness, friendliness, and task specialization. Humans of course are no different (even if their neural computers are able to run remarkably advanced virtual simulation and symbol manipulation programs).

The implications stand to improve the psychological quality of life and raise consciousness for billions of people. Although short sighted knee jerk idiots may think implications will automatically cause a return to forced eugenics (as practiced by countries like Sweden, USA, and Germany in the first half of the 20th century) or measurement of skulls to filter potential criminals, such proclamations point more to the pessimistic nature of those who make them. Scientific inquiry and further development of concepts known to be true have historically brought more net positives (raised the living standard of the human herd by allowing them to live longer and do less labor through technology) than net negatives such as destructive wars (brought on more by non-democratic political arrangements than technology used to wage them). Advancing study of implications from humanity being comprised of numerous unequally distributed breeds is worth the risks. Treatment of different breeds and self esteem of individuals within each breed stand to improve if there is strong emphasis that each breed is logically as important as the other in its social usefulness (although social usefulness should never be the only or even main criteria in social sciences or policy).

Right now we have a world where the German Shepards, the Pitbulls, the Poodles, the Border Collies, and the Golden Retrievers are all rightfully treated the same but they suffer from the problem of more numerous breeds (as well as the most vicious/cunning ones) determining what breed is the universal ideal for a human. Each person judges all others based on what the one judging is good at physiologically. A very empathic person judges others based on empathy. A conservative one judges the rest on how good of a conservative they are. Same applies to all the others be they a partying hedonist, an introverted scientist, an artist, an athlete, or a social butterfly with highly developed taste buds (“how can others eat that crap!?”).

This is a very natural problem to have for humanity. Since every person subconsciously wants to expand personal power in all directions, for thousands of years, the strongest or more numerous breeds have tended to not just make their personalities and ideas into universal law for others but to actually buy into their own lies that everybody else should strive to be like the rulers. Even societies with caste systems were not immune as seen by India’s inegalitarian caste valuation (warriors over farmers) and transformation from a caste system with social mobility to the entrenched stagnant system we now mentally associate it with.

A previous article touched on how Myers-Briggs personality test is a good quick way to get a glimpse of what neural breed a person is, how numerical predominance of some breeds helps preserve status quo, and how the differences in neural architecture split and unite people a lot more than externally visible characteristics like skin and hair color. If we use a typology system like Myers-Briggs, it soon becomes obvious that although breeds can form natural dominant coalitions (SJs) and (SPs), there will still be a lot of socially tangible differences within each coalition. That is enough to pose a serious problem not just for rare breeds like INTJs but common ones as well.

That problem is depressed self esteem from comparison of one self to those breeds that thrive in whatever socioeconomic system exists at the time (and whose mode of being are widely emulated for this reason) and from feeling alone and excluded since no breed exceeds 15% numerically. Whether it is an athlete, an artist, or a scientist, they are always outnumbered which leads to wishing that everybody else or themselves was different. Even within dominant pro status quo coalitions of SJs and SPs, a difference, between an ISTJ and an ESFJ for example, can be so great as to make them not get along well at all. This problem is heightened for NF and NT coalitions. Depression and various neurotic behavior thus results on a large scale. When a person says that nobody understands them, the case often is that vast majority (90%+ people) really don’t fundamentally understand them. How can a German Shepherd understand a Chiwawa and vice versa? Only mutts provide the imperfect understanding bridge.

The often failed emulation of the most able to “make it” (or seen as more able) may be a more serious threat to the health of people’s ego, their self respect, and their pride. Just as an emotionally cold and aggressive person may feel distressed when living in a hippy commune, a naturally empathic and kind Golden Retriever will feel distressed and alone in a society that values warrior Pitbulls. Similarly, when the types who make it in United States financial sector (children of the rich, psychopaths, and some of the more cunning SPs and NTs), a vast social pressure is created to pound in square pegs in round holes and be more like what is deemed “successful”. It is no different than if soldiers were in charge and we all had to admire wars and go to bootcamps to be seen as having the right stuff.

As for psychopaths, their natural ability to blend in (so they can live off the herd better) makes them strong candidates to make it in any system. A super inegalitarian monetarist imperial system like our own is an extra juicy jungle to thrive in. Proportionally to psychopaths’ population (1% for the true clinical ones and up to 6% for the subclinical ones), they are overrepresented on Wall Street and in prison (8% and 20% respectively for clinical ones).

Subclinical psychopaths can just be some breeds backgrounds seem like good general prerequistives whose T function and lack of empathy is so high as to make them exploit the herd (rather than improving it as has been the trait most admired in leadership by history) without a second thought. In fact it may be unfair to even have the concept of a “psychopath” as it represents just another breed of human that is adept at preying on fellow humans with elaborate disguises. Psychological pathology after all, represents mental “sickness” and mental “sickness” is just majority’s flawed way to single out and focus on fringe breeds and individuals whose backgrounds make it extra difficult for them to make it. Not one breed is logically and generally more normal/abnormal or maladaptive/adaptive than the other since “normal” and “adaptive” is the bell curve average for a particular society.

Understanding these physiological differences can allow people to have more pride in who they are and develop towards a truly pluralistic and more compassionate society. Human breed science doesn’t have to be a nightmare world. People like Foucault, Rousseau, and Kaczynski have made strong and effective arguments on how the more technologically advanced society becomes the less free we are. We need to understand these concerns and consequences of progress in social sciences but we can’t turn the clock back since luddite solutions are not just impractical but inhumane.

Understanding that there are different breeds of Homo Sapiens (with often different needs and modes of thought) can allow society to:

1) Treat, help, and nurture each type better so as to make healthier hyperspecialized types. We can have healthier and better artists, cops, scientists, etc.

2) Treat, help, and nurture mutts better so as to have better ambassadors and communicators between the strongly specialized breeds

3) Develop better science as to which breeds work best with each other so as to prevent, mediate, and solve social conflicts

4) Help identify and isolate predatory humans better so as to lessen their abuses, reduce the number of their victims, and integrate them into society more productively

5) Strengthen proportional representation democracy and bring more harmony to the herd while preventing unhealthy caste structures from reemerging

6) Increase efficiency, productivity, and general happiness of society by allowing individuals to make full use of their strengths and be more proud of their neural architecture

Lets fully embrace what science has been telling us so we can graze on this planet with less confusion. A confused herd will make a poor recipient for when the singularity arrives. Lets end with a pro-mutt quote to balance the article and emphasize perils of too much specialization.

“A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.” -Robert A. Heinlein

I’m in the midst of reading a fascinating book by Philip Alcabes. The very title, “Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu” gives me fodder for at least one article without even reading the book.

There is so much fuel for thought in this book, that you will have the opportunity to read several articles as my mental juices are stimulated.

As a Mind-Body Psychotherapist I work with the concept and the emotion of fear. From the lowest level of anxiety to full blown panic, this emotion can cause the heart to race and one to shudder in anticipation of the possible event that one’s life feels out of control.

Decisions made when in a state of fright are not, by their very nature, rational. It’s an emotion, not logic.

The amygdala in the limbic brain becomes activated when we are overwrought. The cortex, the rational part of the brain takes a back seat. The admonition to be reasonable has no effect other than to induce anger in someone in a state of severe agitation.

Let’s look at the word “epidemic.”

Do a “gut check” right now. Just reading the word, does your abdomen twist a little, perhaps even hurt? Do you want to act on emotion or are you calm enough to look beyond the hype to the facts and evaluate the pros and cons of your actions.

Think of your beliefs regarding this word bandied about by FOX, CNN and other national and local news sources. Looking in the thesaurus, one of the phrases is “widespread disease.” That’s what the “ordinary” person thinks of. The mind then runs to such things as the plague, AIDS, SARS, bio-warfare, H1N1 and so on.

People are in such panic they are ready to take any vaccine the pharmaceutical industry dishes out, even though it has not been tested, to avoid getting sick.

What does “epidemic” mean to epidemiologists. Alcabes, who is an associate professor of Urban Public Health at Hunter College of the City University of New York, as well as a visiting professor at Yale’s School of Nursing, describes it as a “disease” appearing more often than usual.

When flu season hits, the outbreak hits the news. When another teen dies in an automobile accident, unless he or she is prominent, the family grieves privately. The number of teens who loose their lives on the road while in a car is four or five times that from illness. Yet the tragedy of the lost future in our youth is not continually in public awareness.

The flu outbreak is unusual. The death from another car crash is tragic but not unusual.

How we handle the out of the ordinary depends upon our own beliefs as well as the attempt of public agencies to influence feelings and actions.

The question for you to examine is, “Are you able to gather information before following the hysteria driven sound bites, or do you allow yourself to be swept away in the artificially created tsunami of fear?”

Cathy Chapman, Ph.D., LCSW is a licensed clinical social worker assisting people achieve their dreams of health, wealth and abundance through Mind-Body Psychology. She works from a spiritual and energetic model employing BodyTalk and Psych-K to balance the body and change beliefs. Cathy offers free of charge a powerful spiritual healing tool anyone can use. Get your Soul Healing Prayer now at http://www.distancegrouphealing.com.

The Source of All Good Healing

Psychology and fundamentalism at best have been polite opponents. In recent history, say the last 50 years, this opposition has become vigorous and often less than polite. Many churches, such as Calvary, completely eschew all mental health practitioners (whether social workers, psychiatrists or counselors) and staunchly maintain that all healing comes directly from God or prayer and that all you need in order to develop and maintain a robust mental health may be found in Scripture or a prayer session.

This rejection of psychotherapy may have been a reaction to the “I’m okay, you’re okay” generation of therapists who did very little for most people except to allay the anxieties of narcissists and sociopaths by telling them “if it feels good, it is good.” In the eyes of both Orthodox Jews and Christians, the field of humanistic psychology took the whole program of self-improvement one giant step too far, putting man in the center of the universe, particularly his own.

Their objections were not wrong. And I say this as a holistic psychotherapist with almost 25 years of experience in the field.

I have seen far too many well-meaning therapists do little more for their patients than make them feel better about being sick. They are loath to challenge or confront negative behavior or unhealthy thinking because they fear being seen as judgmental. As a result of their tentative relationships with the truth, they fail in their relationships with their patients. They do not see what needs to be healed so the patient is left unhealed. This is truly a disservice to the patient because what it ultimately does is feed the pathology and starve the essence of the person.

I think all good and true healing flows from the same Source which means that there can be an alliance-and an important one-between the Biblical and Mental Health communities. But only if we have an understanding of our terms and are actually seeking the same results.

What is Healthy? What is Unhealthy?

According to Samuel Hahnemann, M.D., after whom dozens of medical colleges around the world have been named, physical health presents with a very clear picture which is eternally derived from a healthy spiritual state.

“In the healthy human state, the spirit-like life force (autocracy) that enlivens the material organism as dynamis, governs without restriction and keeps all parts of the organism in admirable, harmonious, vital operation, as regards both feelings and functions, so that our indwelling, rational spirit can freely avail itself of this living, healthy instrument for the higher purposes of our existence.”

He goes on:

“The material organism, thought of without life force, is capable of no sensibility, no activity, no self-preservation. It derives all sensibility and produces its life functions solely by means of the immaterial wesen (the life principle, the life force) that enlivens the material organism in health and in disease.”

Therefore…health depends on a healthy wesen or life force or spirit. It is a process that proceeds from above down, from the inside out. This is also the philosophical underpinning of a proper holistic psychotherapy and the pivot point of all Scripture on the subject of good health.

Biblical Healing

Let us start with basics. What has the Bible been saying about health (whether mental, emotional or physical) for the past several thousand years? The following is a small sample of references:

“Do not be wise in your own eyes; fear and respect the Lord and shun evil. This will bring health to your body and nourishment to your bones.” Proverbs, 3:7-8

“Hope deferred makes the heart sick; but when hopes are realized at last, there is life and joy.” Proverbs, 13:12

“Look at the birds of the air, that they do not sow, neither do they reap, nor gather into barns and yet your heavenly Father feeds them. And are you not worth much more than they?” Matthew, 6:26

“This is what the Lord says: ‘Your wound is incurable, your injury is beyond healing. There is no one to plead your cause, no remedy for your sore, no healing for you. All your allies have forgotten you; they care nothing for you…. But I will restore you to health and heal your wounds…’” Jeremiah, 30:12-14, 17

“Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid.” John, 14:27

Even in this cursory perusal, it’s easy to see that the biblical concepts of health are the same as those taught to graduate students in counseling: Hope, faith and an acceptance of reality, an understanding that we are not the center of the universe, peace of heart (a release of worry), generosity, service, humility, joy, and love. I am sure there is more, but I believe this is a good core to start with.

Clinical Healing

I have worked with individuals, families, couples and adolescents for almost 25 years. They have been both mandated to see me under duress and crawled in desperate for help. I have seen a wide enough range of people to ask a few pointed questions and hopefully seen enough recovery and healing to offer a couple of observations.

The first question: What are the things that lead to poor health, whether physical or mental/emotional?

In my experience, they are the same things the Bible warns us about over and over and over: Pride, Sloth, Greed, Gluttony, Envy, Lust and Wrath.

Almost every single patient I have ever had was doing battle with pride in some way. Some were engaged in battle with nearly all of them at once. And I admit openly that almost every pain I have ever suffered myself had something to do with at least one of those sins or as some people call them, “character defects.”

One woman whom we shall call Sonia came to my office about 15 years ago. She was addicted to pain killers. She had some physical symptoms, but they were not the reason for the prescription or the solution for the pain she needed to heal. She complained about her mother, even though she had not spoken to her in many years and was enormously indignant (a combination of pride and wrath) about how she had been wronged. As she spoke of all the things her mother had done to her, she clenched her jaw and her hands.

When later in treatment I offered up the possibility that her continued rage (wrath) at what had been done to her those many years ago was actually only hurting her and that perhaps it was time for her to accept the fact that her mother had failed her and begin to consider forgiveness, she became outraged (pride). In her mind, accepting the reality of her mother’s inadequacies (without making them her own) was unthinkable. Her mother had to be shown who was right and who was wrong. Sonia equated acceptance with excuse and could not, would not see it any other way. The end result? She stayed in pain and addicted to pain killers. Her pride would have it no other way. When the choice between being “right” or happy was presented to her, she chose to be right.

The second and perhaps more pertinent question: How do we treat these problems in the modern world? What is a psychotherapist to do if the purpose is to facilitate true healing and he or she is not a priest, pastor, or rabbi? We are not preachers. Our job is slightly different and the people who come to us are not always ready for (or necessarily interested in) an extreme spiritual make-over. People who may not be ready to go to a church or synagogue may need to someone objective who will just listen to them and hear their suffering. Many people need to talk before they can learn to pray. And the therapeutic relationship-if it is handled properly-can be the training ground for having other relationships, including one with God.

There is a difference between preaching and manifesting. It is good to inspire others with great thoughts about God. It is also good to manifest God’s love through presence and compassion. There are times that a patient may be too angry at God to hear someone say, “God loves you,” but not too angry to have God’s love quietly demonstrated through patience, understanding, and honest integrity. And this may be the first time he or she has ever experienced it.

In my experience, what we have to do to be healing in psychotherapy is not all that different than scripture prescribes even if it is presented and packaged a little differently.

After working with patients for these 20+ years, I have broken it into five segments or stages, all of which I believe are biblically supported although none of these are dependent on one particular faith or point of view. All the seven deadly sins (or character defects) may be individually or collectively addressed at any point along these five stages. These stages are only clinical observations, not rules and shouldn’t be approached legalistically.

I: Hope

All recovery-whether from drugs, depravity, or desperate fear-begins with a promise of hope, that there is “another way” to be, to live, to feel, to love and be loved. This hope is offered in different ways by different people, but I have found it best received by my patients in the form of personal and true stories of redemption (mine or others), of living examples of other people’s recoveries, of their emotional, mental and spiritual salvations.

When we see the pain of the other person’s struggles, feel the roller coaster of his unfolding temptations and challenges, identify with her frustrations and longings and then witness her release and deliverance…we can begin to hope. If it happened for them, perhaps it can happen for me…? All a good psychotherapist needs is one good perhaps and the work can at least get started.

Most of my initial work with patients is an infusion of hope. Some are so habituated to sadness, to pain, to loss, to deprivation, that they simply cannot imagine anything but the way they’ve always been. “But you are here in my office, so there must be some small ember still burning,” I tell them. But many need quite a bit of tender care-a very careful fanning-for that flame to begin to burn again. So I pace them. (Pacing (*1) is a clinical term meaning that I am walking with the patient rather than running in front of him or dragging behind him.)

II: Surrender

Surrender is a word that gives moderns the shudders. What we are told to want for ourselves is power and control. We are carefully and consistently taught in graduate school to nurture in our patients their “self-empowerment” and imbue in them a solid sense of control. This can be important and necessary in very measured doses, particularly when a person has been abused and even the most personal controls have been denied them. But it can go too far and be endowed too freely.

Even some evangelists have done that with “prosperity gospel.” In that philosophy you can tell where a person is spiritually by what he owns and how well his career is doing. Ask and ye shall receive, they remind us. But instead of its focus on the spiritual it has become a modern, media spin on the Doctrine of the Elect and Predestination: How do we know you have found God’s favor? Because you’re successful. How do you get to be successful? By God’s favor. So, the goal is to acquire wealth, prestige, and power. Somewhere along the line even the ministers have forgotten, “Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven.”

In the beginning of my own rebirth into sanity, the idea of surrender terrified me. I know from my own experience that surrender is at the very least an uncomfortable concept for most people. And some are not just tentative about it, they are panic-stricken, which is only reasonable since they have not yet come to trust that the universe is purposeful, creative, and meaningful. (For me that is God and, again, my surrender only came when I came to believe that God actually loved me.) For many of those just coming into therapy, the universe has been a hurtful, oft-meaningless, chaotic, unfair place. We cannot surrender to the abyss, to a vast darkness, to a deist blob that couldn’t care less whether we existed or not, to a universe without love or meaning. I certainly can’t imagine doing that. And I didn’t. I couldn’t. So, I present it in the way it was successfully presented to me-with great care and in small steps: Initial surrender means to accept reality. That’s it. Not to like it or excuse it. Just to accept it as real.

Accepting reality is something people can consider even when reality is harsh, even when they are scared, hurt, or confused. Accepting reality is the underpinning of sanity. Denial is the basis for all insanity. When surrender is presented initially in this way, it becomes manageable.

So, what can they surrender to? I keep it simple. They can surrender to the fact that their lives are not working, or the unhappiness they live with at home, or the way they feel and make other people feel when they’re drinking. They surrender to the facts first.

Why? We surrender first to reality because as we’ve been told: “The truth shall set you free.

Surrender in this way, taken in these gentle, baby steps, is what gets us strong enough to make the fuller, sweeter surrender, to take the leap into the love-both human and Divine-that is, as C.S. Lewis and Peter Kreeft call it, our heart’s deepest longing.

III: Honesty

If truth is what we need, then honesty is what we must give. Why isn’t my life working? Why is my spouse always angry? Why am I so easily offended? Why do I have trouble stepping out of the house? What do I feel? What do I need? What do I stumble over myself again and again and again?

This is a coming-clean, a venting, an admission of wrong-doing, a confession of mistakes and a map of wrong turns. It is what Alcoholics Anonymous has called a Fourth Step, what the Church calls a moral reckoning or examination of conscience, and the Jews a “tikun” or correcting. And it is absolutely necessary, whether one is an alcoholic or not, whether one is in a 12-step program or not, whether one belongs to a religion or not.

It is a brave step, this one. It takes courage to say “I really loused up that relationship,” or “I was a coward when it came to my career,” or “I was as abusive as she said I was.”

Interestingly, it is at this point that the need for hope returns. It is very painful to look at all we’ve done wrong and terribly hard to imagine that it can ever be any different. In my work, this is a good time to remind someone of what is possible, returning again to the stories-the true stories-of redemption and the view from the top of the mountain.

Some ways back I knew a young woman (details disguised to protect identity) who had been seen by numerous therapists. She’d been diagnosed with PTSD, Bipolar disorder, and borderline personality disorder. She’d been medicated, treated with a dozen techniques, restrained for cutting, and finally written off as hopeless.

We spoke about her life, current and past. After about a month of piecing together her history, we landed on the issue of an abortion she’d had when she was 15. She had been so afraid: the boy who had father the child had abandoned her, her parents were busy with work and a very high-level social life, and she had no older or wiser siblings to guide her. Her life with the family’s church had been cut off earlier because everyone had been simply too busy to bother with it. (She had been raised and baptized Catholic.) Ultimately her support and direction came from the media and from the information available at school.

I asked her about the abortion and how she felt about it. She answered with honest curiosity, “Why are you asking?”

“Because it’s a big event, especially for a little girl,” I said.

“No one else seemed to think so.”

“What do you mean?”

“Everyone else seemed to think it was no big deal. You just go and do it.”

“Did you see it as no big deal?” I asked.

She started to cry.

It took some time and many tears, but she was neither borderline, bipolar, nor hopeless. She was guilt-ridden, not by my accounting but her own. In an effort to be what her surrounding culture believed she was supposed to be, she had to lie about how she felt, what she wanted, and what she really needed. Telling the truth was her first step out of the pain and the pathology.

This accountability is a way of owning our mistakes so we can move forward to owning our achievements. If everything is everyone else’s fault, then we are the victims of happenstance and there truly is no hope. People are awfully skittish about being accountable because they have been shamed and blamed to excess, but this is not about shame. This is the yellow brick road to freedom.

IV: Service

What does it take to make it better once we know what we’ve been doing wrong?

This is actually a more controversial question than one may imagine because according to many people in the field one must always focus on the positive. And by in large, they make a convincing point. Noticing what works often works. For some patients, I am the first one in their entire lives to say, “I see you. I see what is good in you. Let us look further to see what else you have that is good and can get better.”

However, I think going fully in either direction-focusing only on the positive or focusing only on all the wrongdoing-is a mistake. There must be a balance, an acknowledgment of both aspects or inclinations of our natures. As the first story of Adam and Eve illustrates, we are not wholly good or wholly evil. We have capacities in either direction and to become good or to continue to be good, it takes a conscious effort and awareness of both those inclinations. We must nurture the one and starve the other.

How is that best done?

First and foremost, through service and good works, even when we don’t feel like it. There’s nothing better for someone full of self-pity and hypochondria than to get out and volunteer. I had one young woman volunteer at an old age home. I had another at a soup kitchen. It doesn’t matter how we give, but in order to grow, we must start somewhere.
Through humility even when we feel boastful or proud or angry or indignant. We must do for others, like say we are sorry, even when we want to dig in our heels.
Through patience and generosity even when we feel deprived and impatient.

Service to others is seen by many as a healing of a higher order, which is why it comes later in the 12-Steps of A.A.-we can only offer what we have learned or gained. “If you want to keep it [recovery], give it away,” recovering addicts and alcoholics are told. The meaning there is clear-you must first have it to give it.

There is another side to this, though. Some of us call it “Act as if” and contend we only learn what we teach and only get what we give away. I think it works both ways and it is up to a good clinical team (meaning the patient and the therapist) to determine when and how to go about this. I am no Solomon. What I know, though, is that service-at any time it seems possible and right-is beneficial to the mind, the heart, the body, and the soul.

V: Forgiveness

Without forgiveness, we are stuck in the wrongdoing and don’t get to move forward into our new lives. My feeling is that pride is usually the blockage on this. We won’t forgive because we’re right, damn it! And we want to be vindicated even more than we want to be free or happy.

Forgiveness never denies the wrongdoing (Romans 3:10,23). But it forgives the doer, who clearly knows no better or is too sick to ever see the difference.

Forgiveness doesn’t mean we need to open our door to thieves. It doesn’t ask us to be fools. The irony is that the less one forgives, the more hardhearted, vengeful and angry one becomes and therefore the less one is able to see the truth of any kind. Hatred does not only reject joy, it rejects truth and can’t recognize a real threat when it’s there.

Forgiveness is often the last step in this small ladder to emotional and spiritual freedom.

As Corrie Ten Boom, a Christian woman who survived a Nazi concentration camp during the Holocaust, said, “Forgiveness is to set a prisoner free, and to realize the prisoner was you.”

One of the best examples of forgiveness is the story of Joseph and his brothers, who had collectively betrayed him and left him to die because of their own envy and greed. He crawled to survive, then was enslaved and thrown in prison. Many years passed. Still, when his brothers came to Egypt many years later, he not only forgave them after he saw that they had changed (and showed true repentance), he rejoiced in them.

Suffering: Is it Necessary?

There is one last issue I’d like to briefly address and that is the notion of suffering. I haven’t allotted it its own stage of recovery because it involves all of them.

The worst part of modern psychotherapy is that it does not allow for the existence of suffering. It insists on happiness as a human “right” and promotes its open-throttled pursuit along with everyone else in mass media and entertainment. This is the parting of ways between what is ordinary psychotherapy (and even those preaching the Prosperity Gospel I mentioned earlier who believe they can petition God for whatever worldly goods or emotional rewards they desire, quoting “ask and ye shall receive” as if it offered proof of God as the Great Pez Dispenser) and a holistic psychotherapy that is based in traditional Biblical values.

Part of the problem is that the modern age of psychotherapists see happiness-which is defined as the attainment of some desired goal-as the end goal of healing.

Orthodox Jews and Christians have a different take on this subject. While it is seen as normal to want to be happy, to be healthy, even to have material comfort it is not seen as the purpose of our existence. It is not even seen as terribly important. It is considered far more critical to be good than to get what you [think you] want. Happy is fine. Goodness and purposefulness and joy-they are far better and reach in far deeper.

What is even more troubling to me is that I see people wanting the rewards of happiness without even the minimum of self-sacrifice. Americans particularly believe it is their “right.” We have been told so repeatedly by the media and psychologists, and even a whole generation of “hip” preachers. Do what makes you happy. It’s all that counts.

The philosophical pinnacle of this thinking is in New Age theology, where sickness, injury and tragedies are defined as self-inflicted manifestations of poor core programming. In that epistemology, Mystery is abolished and we are responsible for everything that happens to us and around us. If abundant health and wealth and beauty are our birthrights, then suffering means we have either done something wrong to deserve it or written bad scripts for our lives.

Given this mental and emotional mulch we are planted in, it is no wonder that we are so worried about our bodies, our bank accounts, and our images. We fret about face lifts more than we do about whether we have a neighbor that needs our help because she has been bed-ridden for a week.

Denying suffering has a price that is incomprehensibly enormous. Because when we deny suffering (which as Buddha said is inevitable in this life), we must also deny death. And to deny death, we must deny life.

Why should it be included in psychotherapy, though? Shouldn’t we want to banish it forever? Why shouldn’t we want to avoid it altogether? What’s in it for us, anyway?

This is the answer I came up with: By being present for suffering, we become present for the whole of life, for the wholeness of another person. And the reward is nothing less than the ability to love-and be loved-fully. We suffer because we love and want to continue loving. It is a poignant irony, I think. In our attempt to avoid suffering, we cut ourselves off from the one thing that can mitigate it: each other.

Judith Acosta, LISW, is a licensed psychotherapist, crisis counselor and classical homeopath in private practice in New Mexico. She is the co-author of The Worst Is Over: What To Say When Every Moment Counts, hailed as the “bible of crisis communications” and Verbal First Aid (Penguin, 2010), the new book on therapeutic communication with children. She lectures around the country on Verbal First Aid, trauma, stress, and animal-assisted therapy. She may be reached at her website: http://www.wordsaremedicine.com, where she has an interactive blog.