An affluent young woman is caught shoplifting Beanie Babies from a variety store.  

A twelve year old boy is found torturing the family cat. 

A man exposes himself to three young boys and then invites them into his van. 

A woman attempts suicide by wrapping her head in plastic, but is found by a friend who summons assistance. 

A man loses interest in every aspect of his life. 

Each and every one of these individuals has psychological difficulties in desperate need of remedy. 

In our society, such troubled or troubling people are sometimes referred for psychotherapy, a form of treatment that means many things to many people. What does happen to a psychologically-disturbed individual when such assistance is attempted? The process remains a mystery to almost everyone. Untroubled individuals are unconcerned about these matters.  

For the person seeking such treatment, the obstacles in his or her therapeutic path are usually formidable. As he begins the search, the patient might check out the Yellow Pages of the telephone directory. This can be an incredibly demanding and challenging exercise. For example, in one small town directory, there were over 30 listings of “providers of mental health services.” There is little information that would be helpful in deciding which of these to select. In addition, there were as many as 25 psychologists and psychiatrists advertised elsewhere. The choices confronting a seeker of help in larger cities would be little short of overwhelming.

How else might the patient proceed? Does he ask friends and fellow workers about a “good therapist” they might know? That doesn’t seem very likely. Who then will be approached? How does one make this approach? The person may rely upon a personal physician for the most appropriate referral. Mental health brochures often suggest the university psychology department as a good referral source. Few, if any, go that route. While the various helping professions usually trumpet the value of free choice on the part of the patient, insurance companies become involved by decreeing whom they will pay, how much, and for how long. If nothing else, these considerations will narrow down the options available to the person seeking assistance.

In a very real way, the seeker enters into a minefield. Not knowing where to turn, he often becomes discouraged early on. He may simply try to live with the problem. If discomfiture is sufficient or if a person is required to seek treatment under court order, our hypothetical patient will proceed by calling for an appointment. The person answering the phone will ask questions about insurance coverage and basic identifying information. Eventually, an appointment will be made. The caller, convinced of the importance and immediacy of the problem, may find it very disconcerting to be given an appointment four or six weeks down the road. Most professionals will acknowledge that such built-in systemic delays do not augur well for the patient. 

Treatment delayed is treatment denied 

There seems to be no end of obstacles in one’s path. The client must take time off from work, explain to the boss and fellow workers the reasons for an absence, contend with clinic secretaries, re-arrange a work schedule to accommodate that of the clinic and/or the therapist, and fill out innumerable forms and questionnaires. The internal or external motivations must be great if he is to continue to try to negotiate this therapeutic thicket. 

If a patient enters into treatment, a diagnosis will soon be established. While ostensibly a guide to treatment, the diagnosis serves a more basic purpose. 

Without a diagnosis, no payment for services will be forthcoming from insurance companies. 

It would be distressing to patients if they knew that their diagnosis, understanding, and effectiveness of treatment depended more on the orientation of the professional they chanced upon than the special problem they present. There is no standard method of providing psychotherapy. And a patient has precious little knowledge about the personal and professional qualifications of the therapist who suddenly looms so large in one’s life. 

Let us make this very personal. Enter Dr. Sean Patrick, a psychologist and psychotherapist: 

When someone is seeking psychotherapy from me, Dr. Patrick, professional credentials are all too often taken for granted. The framed license on the wall behind a desk tells the patient very little. To some, my affiliation with a recognized clinic is evidence of my competence. Sad to relate, still others may rely upon their insurance company’s accreditation of me as a legitimate payee or provider. If the company will pay my fee, it follows that I must have some degree of legitimacy.
 

The first therapeutic session involves a meeting of two strangers. One is the seeker of help, and I am the provider of that assistance. In the course of psychotherapy, I will come to know a great deal about the patient/client. There is no question that I will not ask; there is no personal area that is off limits for me to discuss. To deal with an individual’s personal problems, I must become deeply personal with him or her.

What I contribute in the course of therapy is a function of my personality and my professional training. If I were in the position of simply prescribing medication or conducting surgery, my persona is of little consequence. As a person, and as a practicing psychotherapist, I am many things to many people. Many facets of my personality come into play in my dealings with a patient. The psychotherapy that I conduct is unique unto me. Psychotherapy is a very individual and highly personal matter involving the interactions of two people. No two therapists proceed in the same fashion.
 

Everything I do in the psychotherapeutic setting is, of course, determined by my personal history, my training, and my experience with clients. In the course of therapy, why do I pause at a particular juncture and wait for a response? Why do I interject a word of encouragement or a possible interpretation at another time? Why do I lie back in my chair at one time and lean forward eagerly at another? Why do I sometimes refrain from speaking for ten or fifteen minutes at a stretch? Why do I do anything in the course of psychotherapy?
 

The answers lie in the professional I have become. Linking specific actions on my part to their sources is similar to connecting many personal, diverse dots. This is a very tricky operation. Even friends and colleagues of mine would find determining this linkage next to impossible. And, of course, my clientele are absolutely in the dark in this regard. They see me as I am in the office. They only hear what I say during the course of a treatment session. They have absolutely no idea as to why I say or do whatever I say or do. Most couldn’t care less. Each has a pressing problem and wants it solved. They see me as a helping person who encourages them to talk and who talks to them in return. It is often as simple as that. To some, I just “hang out” or “shoot the breeze” with them for an hour. Initially, most expect me to solve their problems for them.
 

Of course, therapy is anything but simple. None of my utterances take the form of idle conversation. Similarly, much of my behavior has specific therapeutic purpose. And none of this can be contrived if it is to be effective. My therapeutic talk and behavior emanates naturally and authentically from my being. I am a therapeutic instrument. When I am in the company of a patient, I am a professional. I am a practicing clinical psychologist. I proceed quite naturally and honestly in the performance of that profession.
 

During the course of a treatment program, the patient will come to know very little about me as a person.  For example, the client will know next to nothing about my life, my religious views, my family situation, my vacations, my pets, or hundreds of other personal things. While I have no objection to personal questions directed toward these areas, they are rarely, if ever, asked of me. Some professionals would bristle and take umbrage at such inquiries. The check-out girl at my supermarket knows more about me personally than any of my patients. And I do not believe that my circumstance is the exception to the rule. Few patients know anything about their providers as people. Such knowledge might bother some patients. They might have strong needs to believe that their mental health providers are god-like, even though this is anything but the case.

Is it important that the patient has this knowledge? Maybe not. A degree of impersonality may be reassuring to a troubled person. Maybe a patient would be more comfortable in some blind trust of the person treating him or her. On the other hand, some may want to know a great deal about the person who is being relied upon for help. After all, this is a high stakes operation. But as these things go, a patient would have difficulty knowing anything about a therapist that a therapist wouldn’t choose to reveal.
 

Among other things, this book is designed to provide something of a “behind the scenes” look at certain aspects of my personality. These characteristics play an important role in determining my effectiveness as a practicing psychotherapist.
 

Tempting as it might be, it is impossible and unnecessary for me to tell everything about myself. Any such abundance of information would be overwhelming, even to a reader who was intensely interested in understanding me. Accordingly, I will provide selected bits of information about myself as a person. From these, the interested reader can then enter into some conjecture about how my personality affects my treatment style.
 

First, I will provide some autobiographical material. I began writing this book as a serious and straightforward effort to convey information regarding my roots, experiences, and training. Then an element of whimsy entered into the picture. I thought it would be fun and instructive to write part of my personal history in a form which would demand some active involvement on the part of the reader. Within this biographical section, there will be contradictions, if not outright lies. The truth is there. The reader has to ferret it out. The role of the reader is thus not too different from the therapist as he tries to separate the wheat from the chaff in a patient’s verbalizations. The fact that I wanted to proceed in this fashion may tell the reader a bit about me, my approach to life, and my therapeutic style. I do have a sense of humor. I believe humor to be an essential component of the personality of any competent therapist. It is lacking in many of the therapists I have known.
 

I’ll not subject the reader to detailed accounts of my extensive psychological research efforts. People have been known to lay down my research articles before they finish reading them. Most importantly, this research involvement speaks to my desire to learn and the manner in which I approach problems. I shall provide the reader with a distillate of this knowledge and understanding. I shall attempt to be brief and to the point.
 

I’ll also provide two university lectures from the course in abnormal psychology that I teach. These convey broad perspectives regarding many basic mental health issues.
 

All of this material will be presented in conjunction with information derived from a hypothetical patient of mine, Diana. There will be a brief account of her history and her efforts to get help. Verbatim excerpts of sessions, including the final one in which mandated psychotherapy is terminated, will be provided. The reader also will be able to share perceptions of what I think is going on as well as those of the patient. The patient’s viewpoint will also be illuminated.
 

By reading this book, a reader can come to know more about me as a person than any patient I have ever treated and probably much more about the client than I will ever know. This truly reveals “Sides Seldom Seen.” S.P., Ph.D.

 

Nancy Clark Scobie/John R. Thurston