June 14, 2011

Believe Me

Behaviour doesn't persist for no reason. Any habit or way of being that you repeat or maintain even though it causes problems for you is probably being reinforced, often through underlying beliefs. This holds true for both everyday habits and chronic mental health problems.

Everyday Habits

Say you're someone who is always late. Your lateness frustrates others and means that you're often stressed out and rushed. You always tell yourself to try harder to be on time and promise to do better next time, but you're still always late. Why? Examine your beliefs: what do you really think about promptness? You might realize that you believe that people who are on time must be less busy and are therefore less important. Alternatively, you might realize that you believe that being late (e.g., for a work meeting) makes you look good--like you're working so hard you couldn't tear yourself away from your desk.

Say you just moved to a new city and you're always tired because you stay up late every night emailing or chatting online with friends from your old city. Every day when you're falling asleep at your desk in the afternoon, you promise to get to bed early, but every night, you go online to catch up with your friends. What beliefs are preventing you from getting into bed at a decent hour? Maybe you believe something like "Out of sight, out of mind," and are scared your old friends will forget about you if you don't talk every night.

Finally, say you're someone who is constantly in conflict with your partner, who unfailingly answers the question "How's it going with your boyfriend/girlfriend?" with a litany of crises and dramas. You may purport to envy a friend who always replies "Pretty good, nothing to report" to the same question, but look at your beliefs: do you secretly believe that your perpetual drama makes you seem intriguing? Alternatively, do you believe that if you don't create conflict and "keep things interesting," your partner will get bored and leave you?

Chronic Mental Health Problems

Individuals who suffer from Generalized Anxiety Disorder--a disorder characterized by chronic and excessive worry--have beliefs about worry that make it hard for them to stop. They believe that worrying (e.g., about their children) demonstrates love and support, that worry helps control outcomes (e.g., if I worry about my plane crashing, it makes it less likely to happen), that worrying in advance can prevent negative emotions if the worry comes true (e.g., if I worry that my partner will leave me, it will hurt less if it happens).

People with other chronic mental health problems also have beliefs about the usefulness of their condition. I had a client whose belief about her chronic anxiety made her reluctant to change: although being anxious most of the time decreased her quality of life, she believed that if she reduced the anxiety that fueled her spotless home, compulsive list-making, and hyper-organization, she would no longer be productive or efficient. She believed that if she weren't anxious, she'd never get anything done.

People with chronic depression may also develop beliefs about the advantages of certain aspects of their condition. An individual whose depression is such that she goes through life spotting flaws and seeing the world through a negative filter may fear that if she becomes less depressed, she'll lose her ability to think critically and spot potential pitfalls, decreasing her effectiveness at work. Similarly, someone who believes that his depressive tendency toward moody contemplation or rumination is the foundation of his artistic career may fear that working on his depression will make him less creative.

People may also have beliefs about happiness that make them reluctant to embrace or strive toward happiness: they may believe that happiness is boring, that it's shallow or ignorant, or that it's selfish.

Try identifying and testing the beliefs that motivate your habits and behaviour. If it turns out that your belief isn't true (e.g., your partner is actually considering leaving you because of all the conflict and drama), you may find it easier to change your behaviour. If your belief turns out be true (e.g., your old friendships fade when you go to bed early instead of chatting online), you can still use that information to change your behaviour (e.g., chat with your friends on your lunch break instead; accept that friendships change and seek friends in your new city).

Unidentified underlying beliefs make problem habits resistant to change. Identified beliefs provide insight and a springboard for change.

June 08, 2011

Few Good Men

The New York Times recently published an article about the pervasive lack of male psychologists and psychotherapists. It's unequivocally true that clinical psychology has become a female profession: about 95% of the students in my PhD program are women, and the majority of the psychologists at the research centre where I work are female. This gender disparity is new: at least half of my professors and supervisors are male and most of my female professors and supervisors are relatively young, indicating that a shift occurred in the last generation.

Following the NYT article, a Psychology Today blogger wrote that the evacuation of men from psychologist and psychotherapist positions corresponds to the increased difficulty of earning a good living in these professions. Men seem to be less willing or less able to afford to work in low paying jobs. Moreover, the decreased proportion of men in psychology corresponds to a decrease in the field's status and prestige. The same blogger wrote that, rather than being seen as respected and qualified health care experts, clinical psychologists are viewed as part of a generic mass of mental health workers, indistinguishable from counselors, social workers, and other professionals who do not enjoy the power of psychiatrists to prescribe medication. (NB: psychiatry has not witnessed a gender shift to the same extent.)

Does it matter if your psychologist is male or female? Is one gender better suited than the other to deal with certain issues?  Another Psych Today blogger argues that the overrepresentation of women in the field is problematic because it decreases the appeal of psychotherapy to men. Men are already traditionally reluctant to seek therapy, and the inability to find a male therapist may discourage them from getting the help they need. This is a plausible argument: male would-be clients might feel more comfortable speaking with a male therapist about sexual dysfunction, anger or dominance issues, or the pressures of fatherhood,. That said, men may feel more comfortable opening up to a female therapist about less "manly" problems like sadness, fear, and anxiety. Similarly, female clients may feel less confident in a male therapist's capacity to understand body image issues or motherhood or fertility issues, but more comfortable disclosing to a male therapist about traditionally unfeminine issues like aggression or partner abuse.

But if men need male therapists and women need female therapists to properly understand their experience, do disabled people need disabled therapists, visible minorities need visible minority therapists, and elderly people need elderly therapists? As someone who is pro-therapy, to some degree I believe that anything that encourages someone who needs help to get help is good. That is, if the prospect of having a therapist who looks like you or is of your gender will encourage you to seek therapy, that's positive. However, this type of client-therapist matching introduces the risk of a client (or therapist) assuming that her South Asian therapist (or client) has had the same South Asian experience as her, or that his blind therapist has had the same blind experience as him, creating a significant risk of stereotyping, misunderstanding, and disappointment.

Our training as psychologists is supposed to be broad enough to allow us to be empathetic and helpful to clients of both genders and of a wide variety of experiences and walks of life. I have never had a male psychotherapist: I've had a few good and a few bad female therapists, but I can't say that any of them seemed particularly suited or particularly poor at helping me address my problems because of their gender.

Would you prefer a therapist of your own gender? How come?