It seems therapy has recently grown quite a bit in popularity, and you need look no further than bestselling books like Maybe You Should Talk to Someone by Lori Gottlieb, shows like Couples Therapy with Dr. Orna Guralnik, or podcasts like Where Should We Begin with Esther Perel (all of which I personally recommend). Therapists have even taken over Instagram with bite-sized recommendations for managing burnout and anxiety, or gentle reminders that you are not defined by your trauma.
So, while my first quarter was not yet focused as much on treatment or applicable takeaways for the everyday person, I thought that given the newfound interest in therapy as a field I’d still share some of what I learned from the therapist-side of things in my classes this past quarter.
Below I’ve included one of my biggest personal takeaways, as well as a favorite resource for further reading from each:
Assessment of Psychopathology
This was essentially our first ‘diagnosis’ class, in which we got to know the DSM (Diagnostic & Statistical Manual of Mental Disorders) quite intimately. I have to admit, coming into the class I had my reservations about the DSM and medical model as applied to psychology: Why such an imbalance in emphasis on what’s “wrong” with people, rather than people’s potential, or what’s right? How do labels and clinical language like “disorder” propagate stigma? How can we speak in such starkly categorical terms about something as complex people? Yet over the course of the quarter I began to understand that not only was I not the only one who shared those sentiments - even many of the people behind the DSM themselves recognize and its shortcomings and aim to evolve it into a more dimensional system (think: more spectrums than labels) - but I also began to understand that as a field most are doing the best they can do with the limited information and scientific progress we still have on the mind and the brain to-date.
Despite amazing and continuous advancements in the field, I think Aldous Huxley put it quite nicely in The Doors of Perception when he said we’re essentially at a place in mapping the mind not entirely dissimilar from where we were in mapping the world before we had ventured into all the deep, hidden corners, jungles and forests in the farthest reaches of the earth. So, we have many theories about what causes certain mental conditions, and we have even more theories about how we should treat them, but at the end of the day the practice of therapy is still partly science, partly an art. Our professors never failed to remind us that at the end of the day, diagnosis and the DSM are vastly valuable as tools - which consolidate years and years of research, precedents, and individual cases - yet at the end of the day we are treating human beings.
A video I recommend: Nancy McWilliams Talks to New Therapist
Child & Adolescent Development
There were just too many things from this class to contain in one blog post, but an interesting one that may have been a development since your last AP Psych class has to do with the plasticity of the adolescent brain. To start, the brain is highly malleable from the ages of 0-3 - major neural connections are forming, and those which don’t get used actually get “pruned” away to make other connections more efficient. This is one of the reasons attentive parenting becomes so important - babies’ brains need to be stimulated constantly, and stress and trauma experienced in childhood can have a major impact on a biological level (see Nadine Burke Harris’s TED Talk below).
While new connections continue to form throughout our lives, at no other point in time did scientists believe that our brains were so damn mold-able - that is, until they found that puberty kicks it back into high gear during adolescence. Once again, we can have a much greater influence on the way the brain becomes wired than we do when we get older, and this time the most significant changes occur specifically in the prefrontal cortex (think: executive functions like planning and attention) and limbic system (think: emotional regulation).
There are a lot of implications of this understanding of the brain - perspectives on school shootings and the juvenile criminal justice system being just a couple of them - but one of the areas which interested me most was the idea of taking advantage such an extraordinary opportunity to create positive change in the teen brain in areas of higher-level thinking and emotional regulation to integrate mindfulness and more social and emotional learning (SEL) into their everyday experiences in or outside of school, especially if such structure is something they lack at home.
A video I recommend: Nadine Burke Harris: How Childhood Trauma Affects Health Across a Lifetime
Law & Ethics
This was a much more fascinating class than the name might lead you to believe, mainly because often I found myself revisiting the question: why is there such a pervasive stereotype about therapists sleeping with their clients? A few things, actually, not least the fact that many of the early household names in psychology actually were guilty of such offense. But today, in 2019, even if it is mostly an unfortunate reputation that has stuck, there are a couple reasons why therapists might find themselves in gray territory - both intentionally and unintentionally - when it comes to sex more so than in other professions.
The first: transference. This is essentially fancy therapy-speak for redirecting or projecting feelings onto another. While not perfect, the easiest way I often think about it is that thing that happens when you initially put a romantic lover on a pedestal: you fill in gaps and create stories about them based on your desires, your background, and your previous relationship experience - little of which may actually turn out to be true. Well, as someone who is trained and literally paid to act as a type of mirror, sounding board, or for you to literally stick your shit onto, therapists become the target of a lot of projection from their clients. And - once again, as someone who is trained and literally paid to listen to you, accept you, and embody many of the qualities that make a perfect “partner” - it’s not actually crazy to see how a client can end up with feelings for their therapist. And it transference can be a two-way street, too.
Then there’s the idea of actually working with the erotic in therapy. Once again, images of Freud might immediately spring to mind, and the first couple times we discussed this I have to admit I was quite hesitant of subscribing to such approaches in my own practice one day. If the erotic came up, I figured my standard protocol would simply be to cut it off immediately - don’t even open the door to something that could eventually lead down the “slippery slope.” However, the more we explored it, the more I realized just how important sex really is in our lives, and if you can’t talk about it with your therapist, then are they really holding the space you need to safely travel to some of those often not-talked about depths of the mind, especially without the shame often associated with them? It doesn’t mean therapy should be erotic - you should absolutely never feel violated by your therapist, and sexual contact of any sort is always 100% of the time unethical and can be reported - but such intimate content can actually be incredibly important to address, if managed by the therapist properly. So, while I am still a bit away from having to experiment with my own approach to addressing sexual content in the therapy room, suffice it to say the issue can be slightly more complicated than it initially lets on.
An article for thought: What’s In a Name? “Couples” vs. “Marriage” and Family Therapists
Society & The Individual
Definitely my most Berkeley-esque class (and one of the reasons I originally chose the program I did), this course probably challenged me the most this quarter, as I was forced to check my privilege, and take it from an intellectual level to a personal - even visceral - level. I could recommend a million books and documentaries explaining systemic oppression, or historical disenfranchisement, or social justice, but it quickly became apparent in this class that all of these resources have always allowed me to stand at arm’s distance from my own connection to such issues, and to blame or get angry at others for the state of the world today. Instead, as a white, heterosexual, able-bodied person in a class of just 12 people from vastly different backgrounds discussing these issues day in and day out, I really had to look at myself and not try to distance myself from the privileges I have, but to own them. It also made me explore how the dynamic might change in the therapy room with someone who identifies very differently than me. Once again, transference (i.e. lots of projection and redirection) can come into play in both directions - no matter how subtle. This subject matter, of course, requires much, much more than simply one class, but rather asks for lifelong commitment to continuing to stay educated, sensitive and empathic to social and cultural issues and experiences outside of my own.
A book I recommend: The Working Poor: Invisible in America
