Category Archives: mental health

How Therapy Works — Cinderella Redux

At a friend’s birthday party in third grade, I saw the animated movie Cinderella. I sobbed through the entire film, terrified that the evil cat would devour the mice. When the credits rolled and the beloved rodents triumphed, I was vastly relieved — but also confused. Cinderella’s happily-ever-after finale made no sense. She lost both parents. She suffered emotional abuse and neglect. She survived extreme isolation and had no human friends. Cinderella couldn’t possibly erase her traumatic past with a hasty marriage to a man, flashing epaulettes, who knew her shoe size before her name. Cinderella didn’t need a prince; she needed a therapist.

Fast-forward twenty years.

I completed a doctoral program in mental health and began a career that lasted more than two decades. Along the way, I’ve been asked several times to explain how therapy works, how words can become catalysts for emotional change. I’ve fielded this question at dinner parties, teaching classes, in sessions with clients, supervising trainees. It’s a worthy question, superficially simple, deceptively complex.

I was always annoyed when therapists spoke Jargon rather than English. When I was in grad school, training to work with patients, my role-model mentors conveyed ideas with an artistic simplicity. They helped their patients explore the depths of their emotional worlds, speaking with clarity and heart, in no way sacrificing scientific knowledge or human intricacies. They chose clear words, to show their patients how unresolved issues from the past became superimposed on the present, derailing the ability to make healthy choices. Simple language is our telegraph line into the tangled, layered, lush emotional life we all hold deep within.

Some adults survive backgrounds that match Cinderella’s early trauma, and resist the emotional pathology that seems inevitable. Some of these children (like Cinderella) look unbreakable, immune, invulnerable — which of course isn’t true. In our offices, our patients show us that their survival has rested in part on their ability to manage potentially incapacitating feelings of vulnerability, a vulnerability which often surfaces in the safety of therapy, as a part of healing. These children carry bruises, even scars into adulthood, but they survived because they were, in many ways, healthy. Like Cinderella with her animal friends, these folks figured out ways to interact with the situation at hand, allowing their own psychological development to continue a forward motion.

But what happens to forward motion when that child stumbles over a roadblock? What happens when that young emotional core needs bolstering from a more mature emotional core? And what if that more mature helper is not available? Then, in the service of forward motion, the child skips over that building block in development. It’s those potential but not yet solidified building blocks that our patients present to us, sometimes in the moment, sometimes decades later.

Into adulthood, people can create lifestyles that accommodate those not-yet solidified building  blocks. But if life throws them a curve ball, or if their own emotional needs call for these building books to be cemented into place, then these people bring to us their pain, bewilderment, vulnerability, both past and present. They begin to examine their own youthful coping strategy, a strategy that was beyond their own years at the time, and to initiate the process of psychologically catching up to themselves.

Each person is an emotional tapestry — interwoven threads of strength, weakness, illness, health. The unique blend in each individual forms an emotional fingerprint of textures, colors, patterns. As clinicians, we strive to understand each thread, and how it intertwines with all the others. Therapy helps patients explore their own internal tapestry, and move from images centered around illness and trauma to norms allowing for a more healthy range. In other words, in the course of treatment, patients shed the constraints that, by necessity, they themselves created in order to grow up.

So how does therapy work? Together, the therapist and patient create a safe place to feel vulnerable, which allows the patient to take charge of that vulnerability. The hunger in each patient becomes a measure not only of need, but also of capacity. If both health and illness are vital to this picture, then the patient’s own strength can be enlisted to engage the patient’s potential to heal, which empowers the patient (instead of the therapist) to become the primary agent of change.

Throughout treatment, the therapeutic relationship is essential. Every word, every nuance, every gesture is an opportunity for the therapist to communicate an optimism of repair — an optimism which no amount of drugs, predictable program regimens or technology can replace. Whenever a sign of health emerges, the therapist can reach for it, weaving it into the tapestry of the therapeutic relationship, and into the patient’s core tapestry as well.

If Cinderella, grown up, had entered my office for treatment, I would have listened carefully to the words she chose to tell her story. Together, we would have developed a language to understand her emotional landscape. I would have helped her own the importance of her relationships with the animals — their warmth, their love, their limitations. Layer by layer, we’d walk through her losses, anger, fear — interwoven with her perseverance, tenacity, resiliency. Inevitably, at some point, she’d become upset with me — possibly she’d experience me as mean (like her step-mom); possibly she’d become terrified that I was about to die (like her Dad); I’d point out that her past was shaping her present world view, causing her to relate to me as a stand-in for someone who had hurt her. When the moment was right, I’d comment on her stunningly graceful movements and her unusual gift relating to animals. I’d wonder — did she hold any interest in dance? In veterinary medicine? I’d ask if she liked her glass slippers, or if she preferred Birkenstocks. I’d guide her to redefine her existence as more than an exercise in endurance, her goals as more than escaping from pain. We’d find words to expand her emotional repertoire, as she discovered new frontiers of empowerment. I’d help her become the person who, by her own definition, she was meant to be.

That’s how therapy works. Just that simple. Just that complex.

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Amy Kaufman Burk is an author and blogger. She graduated cum laude from Yale University with distinction in the major of psychology. She has a masters degree in Health and Medical Sciences from U.C. Berkeley, and a Doctor of Mental Health degree from U.C. San Francisco. Before she became a full-time writer, Amy was a therapist for over 25 years. Her second novel, Tightwire, follows a rookie psych intern through her first year of training, working with a patient who is feisty, brilliant, stormy and troubled. The story portrays a fictional version of the therapeutic process, and the healing potential of the therapeutic relationship. The perspectives of the therapist, the patient and the supervisor are all parts of the plot line. Check out Amy’s Author Page on Amazon.

https://www.amazon.com/Amy-Kaufman-Burk/e/B00R0S66Y4

 

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Filed under mental health, psychological, psychology, therapy, Uncategorized

Let’s Lose The Stigma Of Therapy

Before I decided to write fiction full-time, I was a therapist for 25 years. With my patients, I didn’t use scalpels or imaging, stethoscopes or bandages. Sometimes medications were helpful, but my primary tool was the spoken word.

In my office with clients, I used language to create a treatment. I chose my words with care, hoping to start a chain reaction which began with curiosity, then led to alternative ways of processing thoughts and feelings, and finally to the potential for different life choices. Words became catalysts for change.

As a therapist then and a novelist now, I’ve chosen careers based on language – first the spoken word and now the written word. With my second novel, my two careers collided. Tightwire is a fictionalized version of my first year of training to become a therapist. The story follows the rookie year of a psych intern (Caroline Black, from my first novel, Hollywood High: Achieve The Honorable), as she works with her first patient – a stormy, seductive, feisty young man who challenges her at every turn. The therapist, the patient and the training program are all entirely fictionalized.

Although fiction, the story’s foundation is “real” — how it feels to be new to the field – what went through my mind as I scrambled to figure it out – the exhilaration of a great session — the immense talent of the teachers who showed me the field – my love for the work. As I wrote, I was careful NOT to use any pieces from my sessions as a therapist, because that will always belong to the patients. The only pieces lifted from actual psychotherapy sessions were taken from my own experience as a patient, working with a gifted therapist.

I hope Tightwire encourages people to let go of the stigma often attached to psychotherapy. The novel describes a treatment in detail, a story of hope – hard work for sure, but nothing bizarre or weird. If therapy is done well, if the match between the patient and the therapist is strong, then words become powerful, productive tools. Together, the therapist and client create a unique path to discovery, insight and healing.

Let’s lose the stigma.

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Amy Kaufman Burk is a novelist, blogger and mother of three grown children. Amy wrote her first novel, Hollywood High: Achieve The Honorable, in reaction to seeing gay students bullied in high school. Her second novel, Tightwire, follows a rookie psych intern through her first year of training. Amy blogs on a variety of subjects including parenting, LGBTQ+, gender equality and a Rolling Stones concert. She also collaborates with educators who include her books in their curriculum. To learn more about Amy, visit her website.

http://amykaufmanburk.com

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Filed under mental health, psychological, psychology, stigma, therapy