Sunday, April 11, 2010

Rethinking psychotherapy.

If you’re a law enforcement officer reading this, you’re an odd duck. “Police Mental Health?” Really?

When I first created this site, I told my work partner about it. He said it sounded as interesting as underwater basket weaving. In response to a mass text message to all my cop buddies about the blog and what it’s about, I received multiple versions of this simple reply: “I DON’T GIVE A FUCK.” Cute. Mental health isn’t interesting to most cops. Shrinks are seen as “quacks,” unnecessary, overly-sensitive hippies who want to give hugs all day.

Of course, our problem with psychotherapy is illogical but phobias are impervious to reason. Us cops tend to be psychophobes (I just made that word up). Seriously, if you want quality emotional kevlar for this career, you’ll develop, introspection, psychological mindedness and honesty within yourself. Introspection means looking inside yourself for clues about why you do things. Psychological mindedness is a curiosity about your emotions and thoughts and all the factors that go into making who you are.

I’ve come to realize that most officers are really masking their apprehension and “fear of the unknown” about psychotherapy by demeaning it. It’s simply not logical to dismiss an entire science with childish proclamations. I’ve learned this through countless conversations I’ve had with officers about the counseling process. It seems many of us cops believe shrinks have special and frightening powers, including mind-reading and the ability to “get in my ooda loop.”

So let’s talk about this, shall we?

I myself am a fairly harsh critic of therapists and therapy. Having taught, practiced and clinically supervised many therapists over the years, I have developed strong opinions about what makes therapy work. First, however, let’s briefly cover some basics.

THE CASE FOR PSYCHOTHERAPY.

The idea that our emotional life is or should be separate and distinct from our physical life began to die in western culture when the roman poet Juvenal (second century CE) advocated for mens sana in corpore sano ("A healthy mind in a healthy body"). Our psyche is an essential part of us. It should be cared for in the same way we care for our bodies. Through socialization we learn that only crazy people need therapy. We think, “yeah, I’m irritable and a little depressed, but I don’t need therapy. I’m not that fucked up.” This sentiment is pervasive and it’s killing us. Psychotherapy does NOT equal crazy. It doesn’t equal mentally ill or weak or feminine. You may be one of the innumerable police officers around the world pushing a beat car around town while privately suffering immense pain. You may continue suffering privately and taking it out on the ones you love. You may continue refusing to get the help that’s available to you because you continue to hold on to the horse shit you learned about what it means to be in counseling. If that’s you, on behalf of your children and loved ones I say, shame on you. There’s no excuse for that. None.

HOW DO I KNOW IF I SHOULD BE IN THERAPY?

You’ll never know if you should try therapy if you don’t have the capacity to be honest with yourself. It’s a prerequisite of sorts. If you’ve met that prerequisite, here’s a short list of indicators that you should go try therapy:

If, in your honest moments you feel a significant amount of emotional upset (anger, anxiety, sadness etc.) that goes beyond a fleeting mood and you don’t know what it’s about or can't figure out and fix alone.

If your marriage or long term relationship is taking a shit and your efforts to fix it haven’t worked.

If you want a long term relationship but manage to blow it up every time.

If others around you (friends, supervisors, family members) are saying any version of “Hey buddy, you have some issues.” We call this “convergent feedback.” If your girlfriend, sibling and good friend are all saying you’re drinking too much, you’re well advised to LISTEN.

WHAT TO LOOK FOR IN A THERAPIST.

Competence. That’s what you need. You don’t need a shrink who specializes in working with first responders (though that would be nice). Why? Because one of the biggest problems with counseling is that results are hard to measure. It’s very subjective. This fact has done a lot to damage the endeavor of therapy. This, because it tacitly gives permission to incompetent therapists to continue their lame ways. Oncologists don’t have this problem. The patient comes to you for cancer, you treat them and then they either still have it, you zap it out of them or it goes into remission. Psychotherapists have all manner of explaining away why a patient doesn’t get better. We have a lot of fancy words to put the onus on the “resistant” or “defended” patient. HOWEVER, this does not mean therapy in GENERAL is worthless. It simply means you have to be a discerning shopper.

The therapy relationship is pardoxical, in that it’s both a real and an unreal relationship. It’s real insofar as your therapist is a real person, with real foibles. It’s unreal in that you should be able to tell your therapist things that you wouldn’t usually tell others. You should be able to practice ways of being in the world that are new and frequently uncomfortable. THERAPY DOESN’T ALWAYS FEEL GOOD. Sometimes people feel worse...a lot worse, than they did initially. Sometimes we have to feel like shit in order to get better. If you’ve been in therapy for a year and you feel great every time you leave something is seriously wrong with your therapy.

If you don’t like the shrink you’ve chosen after the first or second session, keep looking. If you don’t like them after five sessions it’s probably because they’re calling you on your issues and you should talk to them about it. You should feel safe and accepted by your therapist before he or she starts pointing out sore spots.

There are many, many different types of therapists practicing many, many different types of therapy. You should ask a potential therapist, “What’s your theoretical orientation?” If they can’t answer that question, hem and haw or tell you something you don’t understand, keep looking. Look out for words like “eclectic.” Eclectic is a fancy word for “I use a little of this theory and a little of that theory.” Usually it means, “I don’t know any theory so I’m faking it.”

Therapists treat people using theory as a framework. I’m a cognitive therapist. I can tell you what that means in a language that you’ll understand. I’m also influenced by Object Relations theory, specifically D.W. Winnicott. I can also tell you what that means. The point is, if your potential shrink has no framework from which to do the work, they will be “supportive,” as in “I do supportive counseling.” What THAT means is they’re like a rent-a-friend. They make you feel good. YOU DON’T NEED THAT. You already (hopefully) have friends that can make you feel good when you’re down. You need a COMPETENT therapist.

To say you don’t get counseling because the shrink won’t understand police work and what you’re up against in this work is an excuse. A good therapist doesn’t need to know all about police work. They just need to know psychology.

The Badge of Life (badgeoflife.com) is an organization dedicated to mental health for all police officers. I'm a proud member of this organization. The Badge of Life recommends annual mental health checks for all cops. Most of us are required to get annual physical examinations, so why not check in with a licensed mental health professional annually as well? It's not like you won't have things to talk about. E mail me if you have specific questions regarding therapy.

Cheers.

3 comments:

  1. Fabulous piost, Jeff! "Mens sana in corpore sano."

    Andy

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  2. ok, interesting but too long, especially for the depressed. nyc cops don't seek help because nothing is kept a secret. the men and women there to help you are cops at heart. so what does that mean? well you know when you're on a job and all hell breaks loose, cops after the job are either laughing at the events or laughing/criticizing another cop. we have psych services that have cops running the unit. i've been there and done that...getting the help that is. i found one individual i bonded with and thought she really gave a shit until one day i bumped into her in criminal court. she asked to speak with me but first had some errands to run within the building so she wanted me to tag along. at her second errand she told me to wait for her outside an ADAs office and this is how he greeted her...hi, what are you doing here, got another psycho cop to save...and he laughed. i don't know if she knew i heard or not but it was obvious to me that she shared stories not only with other cops but with attorneys as well. needless to say that set me back a little. its been a while but i feel as if i have alot to say regarding depression and being a cop. i just started a blog...i am just a retired cop...but i may be able to reach one and thats good enough for me. please visit www.nycpblue.blogspot.com thanks

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  3. It's really true that, at some time in our lives, each of us may feel overwhelmed and may need help dealing with our problems. For this reason, sometimes we need outside help from a trained, licensed professional in order to work through these problems. so many thanks for sharing such an important article.



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