Must Therapy Be Warranted by Mental Health Diagnoses?

sunshineIs psychotherapy purely a medical treatment warranted only for treating specific mental health issues? Can psychotherapy also be used to address the multitude of emotional, cognitive, and physiological ways in which people suffer, ways that do not meet the diagnostic criteria for categorically based syndromes? Additionally, is psychotherapy of any use to those seeking self-growth, wisdom, clarity, compassion, self-esteem, and consciousness?

If you’re a psychotherapist trained in the psychodynamic or humanistic schools of thought, the questions above may seem absurd and the answers blatantly obvious. If you’ve been heavily influenced by the medical and psychopharmacological models, you’re probably not going to like my answer.

The debate, however hidden it may seem, lurks in a fundamental difference between those psychotherapists who see the value of psychotherapy as a means of self-exploration (in addition to treating syndromes) and those practitioners who subscribe solely to the medical model and, I’m guessing, have never experienced depth psychotherapy. The issue arose in response to a recent GoodTherapy.org poll designed to measure whether therapists believe prelicensed therapists should undergo their own therapy as a licensure requirement. In this poll of 6,760 respondents, 69.30% of respondents were in favor of this requirement, 23.82% were against, and 6.88% were undecided.

As part of the poll, respondents were able to elaborate on their viewpoints by leaving comments. Roughly a dozen of the respondents who were against prelicensed therapists being required to attend therapy argued that, in the same way it makes no sense to require brain surgeons to undergo their own brain surgery to become better surgeons, it also makes no sense for therapists to undergo their own therapy to become better therapists. For example, a counseling psychologist from Melbourne, Australia wrote, “We don’t require doctors to provide evidence that they’ve had intensive medical treatment.” Essentially, members of this group were in agreement that participating in therapy must be warranted by illness.

In this post, my aim is to address both the “apples to oranges” logic of comparing physicians to psychotherapists and to explain why psychotherapy is warranted for a wide range of issues outside of mental health and diagnostic categories. Let’s start with the former.

I agree that the idea of requiring brain surgeons to undergo their own brain surgery, based on the assumption that the experience of one’s own brain surgery makes for a better brain surgeon, is absurdly humorous. Imagine how scarred and bruised some of the nation’s best surgeons would be as a result, and try to wrap your mind around how these hypothetical patient-doctors would actually learn anything while under anesthesia. Beyond being silly, it’s an error to make an analogy between therapy and brain surgery. Although a good bedside manner is always appreciated, successful brain surgery does not necessitate the presence of a healthy doctor-patient relationship—in fact, surgery can and often is performed without the surgeon and patient ever meeting each other.

Successful therapy, unlike brain surgery, requires a healthy and attuned client-therapist relationship, and a therapist who is technically skilled, emotionally intelligent, and adequately self-aware. Why? Psychotherapy does not use a scalpel and precise incisions to cut body parts out. Rather, the main tool of change in therapy is the relationship between the therapist and person in therapy, and, given the landmines which present themselves within emotionally intimate relationships, this inter-psychic realm cannot be effectively navigated by therapists who have not identified their own projections and countertransference patterns or who lack the emotional awareness to sense when their own baggage is interfering with the therapy process. I’m sure there are a number of roads leading toward an examined and emotionally intelligent life, but in my experience, therapy is a very effective process for getting to know oneself and becoming conscious of one’s own stuff, regardless of what we call that stuff: baggage, ego states, complexes, scripts, parts, burdens, exiled aspects, wounds, defense mechanisms, etc.

Unlike medicine, psychotherapy is not intended solely for dealing with medical-model disorders; psychotherapy also helps people recognize more subtle personality issues and can be used for personal growth, self-actualization, and improved relationships. Frankly, I am frightened by the number of practitioners who commented to the poll expressing a firmly held belief that therapy is meant only for treating mental health issues. I can only assume that these respondents are not psychotherapists and/or have been fully steeped in the psychiatric and medical-model approach. Perhaps these are clinicians who have never sat in the seat of a person in therapy or did not experience emotional growth as a result of their therapy. Whatever the origin of the viewpoint that therapy must be warranted by illness may be, it’s clear to me that it is held by a very small minority of respondents. My hope is that members of this group are open to considering an alternative viewpoint and are willing to try different forms of psychotherapy. As therapists, we should all be willing to practice what we preach.

© Copyright 2011 by Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Sandra

    Sandra

    May 6th, 2011 at 3:03 PM

    I happen to not think that therapy is not only for the mentally ill. This was a great way for me to find someone to talk through my issues with me when I felt like no one else in my life was supplying me with the advice and just the ear that I needed. Sometimes you need someone out of the loop to talk with, someone who is going to be objective and honest and not have a real vested interest in the issues at hand. If you have to pay for that then so be it but it beats always being angry with friends and loved ones because ultimately they all love you but may not always know what you need.

  • Tom Miller

    Tom Miller

    May 7th, 2011 at 7:19 AM

    I am in total agreement with the above post by Noah Rubinstein, LMFT. Unfortunately for therapists we do and will continue to encounter the medical mental illness pharmacological treatment only mindset. However, in like mindedness with Noah and his position posted above we the readers and therapists on both sides need to be careful not to see it as ‘us versus them’. We do need the medical department as many who network regularly would agree. But we also need to establish a caring, safe and open line of communication encouraging and clearly explaining; expressing the importance of a thorough understanding of the therapeutic benefit of psychotherapy and approach regarding the individual person and psychodynamics.

    I say individual person as each of us whether client or therapist has both a temperament identity we are born with as well as a life history starting in the womb that has clearly shaped us in ways that much like fingerprints each person while members of the human family we are all still very different from one another not just personality wise but behaviorally.

    While pharmacological mental illness treatments are often necessary and I network quite often so that clients get the best possible care, I find that clients that have medically treatable mental illness do better combining medical treatment with psychotherapy. What they believe about themselves, God and the world they live in has a lot to do with their ability to accept or respond to their need for medication whether it is short or long term. Helping a person understand the source and cause of discomfort for their recovery versus giving them a label and a prescription is quite different.

    Healing in part is brought about by change through understanding ourselves and why we feel and respond the way we do to life, circumstance and our personal experiences. For example, some who struggle with anxiety and/or depression for any reason may also experience a sense loss of self, separation from God feeling shame and guilt and partly due to painful experiences past or because of issues in the lives of loved ones. It is not always the experience although many are terrible and painful but often we are affected by what we now believe about ourselves in light of these experiences. In practice and in my own life I have found that experiencing the truth of God’s love and concern for us while learning the false beliefs one may hold about themselves and others can be transforming and healing.

    That said pleas allow me to quote Noah as I concur in that “Successful therapy, unlike brain surgery, requires a healthy and attuned client-therapist relationship, and a therapist who is technically skilled, emotionally intelligent, and adequately self aware. Why? Psychotherapy does not use a scalpel and precise incisions to cut body parts out. Rather, the main tool of change in therapy is the relationship between the therapist and client, and, given the landmines which present themselves within emotionally intimate relationships, this inter-psychic realm cannot be effectively navigated by therapists who have not identified their own projections and counter-transference patterns or who lack the emotional awareness to sense when their own baggage is interfering with the therapy process.”

    Sincerely,
    Tom Miller, MA

  • Beth M Stoddard

    Beth M Stoddard

    May 7th, 2011 at 8:37 AM

    I agree! I see clients who come in for “normal” issues such as help getting a child more involved in school work. This is certainly not a medical issue but we are forced to give a dx for these clients so that the insurance companies will pay. It is a bit ridiculous.

  • Tom Miller

    Tom Miller

    May 7th, 2011 at 11:26 AM

    @ Beth: actually if you consider it, companies want to know what they are paying for and they depend on the medical/psychological departments to verify the authenticity of a claim. Some clearly just try to get out of paying-out of course. The more professionals that encourage and engage in the updating of the DSM the better it gets for all. As it is there are diagnosis for relational issues etc and others which may apply that one can use when working with a number of family issues. Hopefully the future updates will include the human condition without having to label someone as mentally ill just to help them think a little more rationally which is in some cases thinking outside the box.

    Blessings,
    Tom Miller, MA

  • Peyton

    Peyton

    May 7th, 2011 at 2:01 PM

    A diagnosis code just so insurance will pay? Are there some ethical issues involved with this? I mean I know that people have to do what they have to do to get treatment but it would seem a little more warranted to bring the child in for help than the parent.

  • blake

    blake

    May 8th, 2011 at 5:01 AM

    Therapy can be a great way to get to know who you are and your needs, even those that you may have never paid attention to in the past before. I do not think that it is at all necessary to have to have some thing”wrong” to have therapy. In fact I think that it can be a really wonderful experience to undergo therapy when there is simply nothing wrong, but you just want to explore a little deeper who you are and the issues in life that are meaningful to you.

  • Tom Miller

    Tom Miller

    May 8th, 2011 at 9:03 AM

    @ Blake: I totally agree Blake and in my experience I have found that sometimes problems start with parents skills, insight and understanding. Sometimes folks need consultation regarding life choices and problems and have no idea where to start.

    @ Peyton: Regarding ethics and insurance payments, please note that I for one do not accept or submit for insurance payments nor I was I suggesting anything unethical. I have had clients that come for consultation regarding a teen that refuses to come for therapy due to the stigma attached. Not wanting to force their child the parents come to find out how they might handle their situation.

    I do not recall if “failure to communicate” is in the DSM but it is one of the common problems accompanying relational issues I encounter in therapy.

    Sincerely,
    Tom Miller, MA

  • RON

    RON

    May 8th, 2011 at 7:08 PM

    It would be great if therapists would mandatorily have to go through sessions themselves because it gives them an opportunity to stand in the shoes of the people they’re going to be dealing with on an everyday basis…It will not only help them understand their patients better but will also help them give solutions much better.

  • Sam

    Sam

    May 9th, 2011 at 4:44 AM

    I am so happy to see real therapists here engaged in the feedback and communication process! That makes me happy!

  • Elvita Kondili

    Elvita Kondili

    May 9th, 2011 at 11:11 AM

    This is a very interesting debate. I’m a therapist who has gone through her own therapy for personal issues. I have to say that I feel I’m a better person and therapist because of it. However, I would caution against mandatory therapy. In my experience, people who are mandated to therapy for a reason or another, often benefit less (not to say that there isn’t potential for real change). I’m a strong believer in clinical supervision and I believe every therapist licensed or not should be required to participate in clinical supervision.
    As for the other debate that’s developing here, I believe in the medical model and feel that our profession has a responsibility to be as scientific as possible given that we seem to have to prove ourselves to other helping professions. Having said that, in reality, what we do is as much of an art as it is science and sometimes we deal with issues which are not clearly defined in the DSM. However, there has to be a clear cut difference between how therapy promotes personal growth in compassion to say, how church or friends perform that same function (which raises the issue of therapy being a paid service).

  • Tom Miller

    Tom Miller

    May 9th, 2011 at 3:49 PM

    @ Elvita Kondili: I fully concur, especially with “what we do is as much of an art as it is science and sometimes we deal with issues which are not clearly defined in the DSM. However, there has to be a clear cut difference between how therapy promotes personal growth in compassion to say, how church or friends perform that same function (which raises the issue of therapy being a paid service).”

    Sincerely,
    Tom Miller, MA

  • Dr Dina Evan

    Dr Dina Evan

    May 9th, 2011 at 7:08 PM

    Good therapy is not only about DSM diagnosis, it’s about life skills, character and pesonal growth. I absolutely believe all therapists should go to therapy for at least 6 weeks with three or four different therapists so they can experience different syles, if not modalities, personally as part of their licensing process. Not only would they gain insight and experience first-hand some of the issues, resistances, transference and counter-transference that arise but they will quickly learn subtle skills such as safe coming ( not jumping into issues too quickly) and safe going (not closing too abruptly,) making sure the client is grounded and safe before leaving, and too many other insights for a well rounded tool bag to list. A good pracitioner knows that he or she can only take a client as far in their growth as the practitioner has gone in his or her own process. Like Daniel Amen said, we are the only healthcare givers that never examine the organ we treat. Therapy for us is the best way to examine the organ we will be using to treat our patients

  • nancy edwards

    nancy edwards

    May 9th, 2011 at 11:06 PM

    I spent several years in psychodynamic therapy and simply cannot imagine not having the hard-won growth, healing, and conscious understanding of my own painful childhood. As painful as it was, this process greatly enriched me personally & later professionally. I was blessed to have a one-in-a-million therapist whose patience, nurturing and airtight boundaries formed the core of how I would later practice. My seven years and two masters degrees pale in contrast to actually doing my own work. I still go for a couple of sessions every now & then, but for focused issues not core work. I do believe that we cannot help our clients go where we’ve not been, but most importantly, we have a moral obligation to be ever so conscious of where we’ve been. Therapy is the surest route to this level of self-awareness for sure. If I were a client interviewing for a new therapist, my first question would definitely be, “Have you done intensive therapy yourself?” If the answer is “No”, I’d keep looking.

  • nancy edwards, LICSW; MPH

    nancy edwards, LICSW; MPH

    May 9th, 2011 at 11:16 PM

    I have a few other thoughts – I hit “submit” too quickly! In 30 years of practice, I’ve never treated what I’d call “mental illness”; I treat human beings who’ve been poorly equipped or wounded in ways that prevent any quality of life. I see my role as helping them move from surviving to thriving and the “instrument” used to accomplish this is the relationship we form. I do see folks who’ve been diagnosed with bi polar, ADD, clinical depression, etc. by others, but I treat their attending problems with living. Every client I’ve ever had arrives with major relationship problems, starting with the one he/she has with the self. I consider this work a privilege and a joy.

  • David Cunningham

    David Cunningham

    May 10th, 2011 at 4:57 AM

    I taught in a graduate counseling program for 10 years and am currently a supervising counselor in private practice. I’ve seen the benefits of a future counselor going through counseling. I’m sure there may be a very few who have had a bad experience with counseling, but the only people I have encountered who did not agree with the “counselors going through counseling” approach were those who deny having wellness issues. The counseling profession needs a way of insuring that counselors are healthy (we all know those who are not and should not be practicing). Graduate programs typically will not intervene because they need to keep up enrollment. Supervisors are put in delicate positions about the mental health of their supervisees. What better way to address the issue than by counselors going to counseling. I’ve seen it work time and time again.

  • Dawna Grigsby

    Dawna Grigsby

    May 10th, 2011 at 6:57 AM

    I felt it is my responsibility as a therapist to know what “my stuff” is personally. I decided during graduate school,when I was doing my practicum, that when my personal stuff bubbled up it was simply human but if it spilled out it was unprofessional.

    I advocate for therapists to keep track of thier issues, which bubble up in a counseling session where they are the professional, in a personal log. Then use that fortuitous awareness to discuss past or present concerns with someone who mirrors the kind of professionalism they strive for in practice.

    It can be excellent professional development.

  • Espen Klausen

    Espen Klausen

    May 10th, 2011 at 10:19 AM

    Reading this post, I became rather uncomfortable with at least three things, all of which are contrary to what I have learned in good therapy. To begin with, the honest response of a surveyer would be to set out to challenge the main arguments both for and against mandatory therapy. If going through good therapy teaches us anything, it is to be able to examine the information fitting both sides of a situation, and not just approach something from the standpoint of our pre-existing beliefs.
    It also seems to me that the author sets up straw men that he beats down – these are effective literary tools, but not entirely honest, and based on judging intents that can not be fully concluded from a short comment. The point of therapy for a therapist is to a large extent to be able to be less judgmental and acting less on snap assumptions about what others are saying. It is important to keep in mind that most survey respondents gave a short comment regarding their standpoint, not complete white papers on them. The author used those short comments as a basis of arguments against what appears to be much more valid points that the short version of the comments indicate. My guess is that several of the respondents believed that therapy should only be mandatory if there is a mental/emotional illness, but that therapy is still useful for most.
    Thirdly, we learn in good therapy to differentiate between person and message and a situation and the message. In the author’s arguments, however, he starts to make comments about the people with the dissenting view – discrediting them based on his assumptions of where they are coming from and their life experiences.

  • Marcy

    Marcy

    May 10th, 2011 at 11:40 AM

    Well said Espen! I think the argument is a good one in that everyone benefits from better mental health professionals, but this article isn’t well presented. If it’s a personal stance being defended why bother with a survey?

  • Jennifer

    Jennifer

    May 10th, 2011 at 12:12 PM

    I am strongly opposed to requiring therapists to undergo their own therapy for licensure purposes. I do not dispute the importance of a therapist’s own therapy experience…it has been personally meaningful for me. However, nowhere in the argument is any empirical data to suggest that therapists undergoing their own therapy is at ALL beneficial to the outcomes of clients. If there were any carefully controlled studies to show this, then further examination of the best method of delivering the kind of learning that MAY come from individual psychotherapy should be examined. For example, I believe that the function of undergoing one’s own therapy is to ensure that therapists are able to work through their own difficulties, recall with compassion just how difficult change can be, and ultimately to be better, more compassionate therapists. However, not all therapists or therapies are created equal, and simply engaging in one’s own personal psychotherapy may not serve the intended function (in fact, in my experience some very ineffective therapists succeeded at reifying some very impairing personality characteristics in some of my graduate school colleagues). Further, in my clinical training, many of the types of treatment I have learned engendered quite a lot of personal growth (e.g., through personal growth workshops with colleagues and experiential trainings), helped us examine ‘countertransferrence’ (though not called this in my training) by watching for and learning how not to overly react to our own buttons being pushed by our clients. If quality psychotherapy is the outcome, there are many means by which that can be achieved. In my particular case, my personal psychotherapy experience during graduate school was an enormous financial hardship, but one I CHOSE to pay for personal reasons. I also chose NOT to seek counseling from anyone associated with the University, a right I think we all should have. Since there is NO data that I am aware of, in terms of licensure, this is already difficult enough in many states. Therefore, I am of the firm opinion that adding something as a requirement across the board, particularly when individuals seeking licensure come from MANY different theoretical orientations that may be more or less in favor of/consistent with such requirements, is absolutely ludicrous.

  • Renee Flatter

    Renee Flatter

    May 10th, 2011 at 12:23 PM

    i disagree with espen. it’s no secret goodtherapy.org takes the position that therapists should do their own work and i see nothing wrong with them doing a poll to see what others think and to speculate on why there are practitioners who think therapy should only be used to address mental illness. marcy asks why bother with a survey if goodtherapy.org is taking a personal stance. i think it’s obvious goodtherapy.org wants positive change and in order to make it they need to demonstrate to lawmakers that the public and the license holders are in favor. i’m not a statistics expert, but it seems to me the results are significant.
    from what i have seen, GoodTherapy.org is a strong advocate of reducing harm in therapy and based on the hypothesis that therapists become more skilled and effective as a result of doing their own therapy, they are trying to find a solution to the problem: that many therapists do not actually do their own inner work. i applaud GT for their courage to address this issue, something that has been swept under the rug by many professionals organizations, associations, and licensing boards.
    i also assume, knowing the balanced and open-minded approach that goodtherapy.org takes that they will address the other concerns the naysayers raised and try to come up with solution that works for the majority. i’ve read noah’s work and seen his updates over the years and i’d be really surprised if he doesn’t want what is best for consumers and for the professionals who make up our field. i’m guessing, based on that history, he and his organization will take all of the feedback into account and hopefully find a fair pathway to addressing the issue. now although i support the idea of therapists doing their own work, i voted no in the poll because i think requiring or encouraging therapy is better done at the graduate school level. i also think that there needs to be research to determine if therapy actually does make for better therapists. unhealthy therapists may always remain unhealthy and maybe there are better ways to weed out these folks….mmpi?? anyway, that’s a whole other conversation.

    so my reaction: good job goodtherapy.org!

  • Frank D. Young Ph.D. R. Psych.

    Frank D. Young Ph.D. R. Psych.

    May 10th, 2011 at 2:14 PM

    Psychotherapy can and does include a wide range of interventions and models for not only healing but growth through transitions into transformations. Only in the narrowest of definitions can psychotherapy be relegated to healing mental illness only. We practioners often call our work counselling and coaching when applied to life readjustment and enhancement. Undergoing personal growth therapeutic relationships can enhance your effectiveness as a professional, but it is by no means necessary. FY.

  • maria

    maria

    May 10th, 2011 at 2:48 PM

    What about warranting therapy in order to prevent, lessen or help deal with factors that untreated would lead to a great deal of suffering or “lack of control”?
    There is something to be said about a patient that agrees to examine imminent issues that they only sense coming their way without a labeled diagnosis? It takes more courage to do that than to pretend everything is fine.

  • Jean

    Jean

    May 10th, 2011 at 6:09 PM

    Any psychotherapist-in-training who is resistant to experiencing what they are committed to practicing well should well, have their head examined. Then they will more deeply understand such important concepts such as intellectualization, avoidance and “working with the resistance.” OK, I’m half kidding. But defending such a notion deeply concerns me for our profession.

  • Mariposa

    Mariposa

    May 11th, 2011 at 2:40 AM

    I am a believer in work samples and personal interviews used as one of the steps in ongoing licensure. This is a profession about relationships and to have clinicians review each others relating in a supportive manner can be self supporting for the development of our profession.

    Licensure is a public safety tool as a bottom line. This tool has been needed due to confusions in the past and harm that has occurred. List of currently compromised clinicians is enough to warrant review of what happens for us as we continue with the profession which is demanding and can be isolating in the layers of protections needed for individuals on either end of receiving services.

    Clinical Supervision, well designed continued training where enough safety is built for honest work and support of one another can help give perspective on oneself as person and professional.

    Diagnostic criteria are designed to provide some type of uniform measure of describing results of a phenomenon to provide common language. It has its strengths and limits.

    Medicine is by definition corrective so follows illness model. When we look at the multiple axes of diagnoses those that are seen to arise from biochemical phenomena in the body are seen as medical. Stress response arising from diathesis.

    I have always struggled with the inherent conflict that exists in this profession regarding money related to services. One’s livelihood is supported by the services provided. What a bias challenge!

    I commend and am grateful for goodtherapy.org’s opening up of this discussion. We may need many rounds of this for our clarity and growth.

  • Toni Hanson

    Toni Hanson

    May 11th, 2011 at 8:57 AM

    There are many fortunate people who are not ill who find personal growth through therapy. Additionally, I believe that therapy can actually prevent the worsening of emotional/thinking/behaviors so they do not result in illness. The idea that therapy should occur only because of illness is ridiculous. Anyone who wants to become a therapist can only benefit through accessing therapy.

  • Joael

    Joael

    May 11th, 2011 at 9:23 AM

    Having just graduated with my Masters in School Counseling on Saturday, I can give a different perspective than the above comments. My program did not require counseling and I sure wish that it had. Why?

    Although I am new to the psychotherapy profession, I have been an Admission Counselor for almost 17 years. What I have seen in my profession is that most people choose a particular major because, sometime in the past, they were helped by someone in that field. For example, students tell me that they want to be a physical therapist because of the experience they had after an accident.

    Many times, I have met students who are going into the helping professions and from my perspective, need psychotherapy themselves. I saw this in my own counseling classmates.

    I can also say that, personally, going through practicum was a very emotional experience. I was feeling terribly insecure and thus all of my other problems and insecurities were exacerbated. So, I could have really used some help and maybe validation.

    My last comment: If my psychotherapist stated that there was nothing that he/she needed to personally work on then, I would find another therapist. We all could use a little tweaking!

  • Tina

    Tina

    May 11th, 2011 at 9:54 AM

    I have been a professional counselor for 12 years. I think my own experience in a theraputic relationship has helped me improve my skills. I have insight into what it feels like to be sitting in the client seat.
    Also, I am suprised by people who are in the business but dont see the value in it for themselves.

  • Judy Chan, RPC 2181

    Judy Chan, RPC 2181

    May 11th, 2011 at 10:37 AM

    Yes! I most definitely agree! I believe my clients experience healthy progress & results because I first chose to complete 2 yrs of personal psychotherapy & group work, graduated from KCPC’s Applied Psychology & Counseling & evaluated by a Psychologist Dr 30 yrs exp., and CPCA’s professional licensing requires Competency Standards – verified education & validated experience. Since living well is a ‘journey of discovery & experiences & life lessons’, I continue to engage with colleagues who share similar values.

  • Margie

    Margie

    May 11th, 2011 at 10:51 AM

    I see one problem concerning a therapist who has been in therapy, and that is–what if a court orders subpoenas the therapist’s records. I was testifying in court in a case involving a child when the opposing lawyer made a comment about my being biased because I had been sexually abused by my father. I was thankful that the judge stopped her, but some may not, thinking that it might be relevant. I had a wonderful relationship with my therapist and told him everything. He therefore had been able to help me get past the effects of the abuse. It would not be helpful for therapy if a person had to be careful what they said due to the possibility of their confidentialty being broken. Although I am thankful I had therapy myself, and I did have a client who was required by her university to have therapy for her licensure (which was helpful to her because she saw some things about herself just like I had done), I am not sure it would be helpful to everyone.

  • kate

    kate

    May 11th, 2011 at 11:10 AM

    If therapy is viewed as only appropriate when mental illness is present then one has already begun to pathologize their clients as well as add to the stigma of therapy itself. With solely a medical model a therapist will seek out symptoms rather than seeing their client as a fellow human struggling with the challenges of life. The stigma surrounding mental illness and inability to see beyond the symptoms will only keep clients from coming in when they need help or support regardless of whether or not they meet a criteria for diagnosis. You treat, support, respect and have compassion for the person not the diagnosis. This view only serves, in my mind, to bolster support for the notion that all therapists should go through the therapy process as a requirement for licensure.

  • Bruce Bibee, LPC

    Bruce Bibee, LPC

    May 11th, 2011 at 6:52 PM

    I think ‘doing one’s own work’ is imperative, but that doesn’t necessarily mean counseling. I used vipassana meditation, for example, to get rid of ‘hot buttons.’ But what I think is also true is the requirements within different fields. For example, I’ve worked in abuse recovery for 25 years and those who haven’t done their work burn out in about 20 months. On the other hand, folks who work more as life coaches probably don’t need to do their work… So, this is a complex question, and I’m not sure the ‘question’ as proposed is as sophisticated as it needs to be.

  • Rachel

    Rachel

    May 11th, 2011 at 10:13 PM

    I love this conversation and that so many therapists feel so strongly that we should partipate in our own therapy. I did not read all the comments, but it seems that those who feel differently are not participating–so we’re all just affirming our convictions with each other. That’s fine with me… I just want to name it and mention that it doesn’t go far towards convincing those who disagree :)
    Anyway, I would like to say first off–if therapy should only be for the “mentally ill,” most of us would be out of practice! Anybody who feels that they do not have personal issues that could use some work SHOULD NOT BE A THERAPIST!! And to those who caution against mandating, I will say that again in another way: if people have no interest in participating in their own therapy and learning about themelves, any idea that they want to “fix” or learn about or get into others heads seems to me to be hypocritical, dangerously projective and invasive. Go find another field and stop contributing to stigmatized fears about therapy! Leave it to those of us who value personal growth for it’s inherent contibution to the improvement of society and the betterment of humanity! Thank you!
    Second, that the idea of comparing therapists to brain surgeons, or any medical practitioners (aside from Psychiatrists) is absurd! Let’s look at diagnostic facts: in the medical field, you look at symptoms, assess possible diagnoses and test for organic manifestations that confirm; then you treat based on those organic manifestations: you see a tumor and cut it out, you find a bacteria and kill it, etc. etc. In Psychology, a cluster of symptoms in and of itself makes a diagnosis! There is no test for organic manifestations. There is no, “we have located the schizophrenia and will remove it.” If, in fact, we were able to do such a thing, therapy would not be therapy–it would be surgery! I wouldn’t expect a surgeon to sit with the tumor, get to know it, build a relationship with it. Come on now! Seriously!

  • Tom Miller

    Tom Miller

    May 12th, 2011 at 6:01 AM

    @ Margie and Kate: You both present some important and necessary thoughts for consideration. BTW: I see people who share their personal experiences as you did Margie as courageous. You will continue to be a blessing to those in your care and neither you nor anyone else should ever be re-victimized by anyone especially the legal system. In part it’s due to a fear of being publicly humiliated and abused that victims do not come forwards. I am thankful as well for the judge who stopped it. Blessings.

  • Regina Sewell

    Regina Sewell

    May 12th, 2011 at 3:36 PM

    Argh. I agree with you that it’s ridiculous to compare therapy to brain surgery. I’ve been studying interpersonal neurobiology of late and feel validated in the notion that the medical approach to therapy is beyond misguided. There is so much data now that supports the importance of relationship above all else. I imagine sitting in the client’s seat gives us a chance to experience what clients go through, to feel their lack of trust, their shame, the need to go slow and even to, in some cases, lie to save face or to avoid facing issues that may feel too scary or too shameful to face head on.

    And who doesn’t have issues? If we can’t ask for help working through our own issues, how can we expect others to ask for help.

    I think of Scott Peck and how his arrogance led him to make horrifically judgmental statements about clients even as he had one ego driven affair after another.

  • Dr. Yaacov Kravitz

    Dr. Yaacov Kravitz

    May 12th, 2011 at 9:59 PM

    Great discussion. Some of these points have already been made, but I would like to put my own spin on this. I believe that psychoanalysts are required to undergo analysis. Meditation teachers are required to have their own meditation practices. There is tremendous value in knowing the process from the inside and I endorse the practice, but not as a mandatory requirement. However, there is no data I am aware of that demonstrates that therapy is required to be a good therapist. Those who advocate making therapy a requirement should at least offer some data to support the claim.

  • Tom Miller

    Tom Miller

    May 13th, 2011 at 4:32 AM

    @ Dr Kravitz: Thank you for your “spin on this”, well said.

  • Ruth

    Ruth

    May 17th, 2011 at 11:56 AM

    Although I did not respond to the original poll, I would like to add some comments to the discussion. In my opinion, a therapist’s level of effectiveness is deeply connected to the depth of their own personal work. With this is mind, it seems logical to consider the requirement of asking pre-licensed therapists to undergo their own psychotherapy. We are deeply invested in seeing therapists do effective and significant work. However, I do not think we have the ability to monitor this outcome through licensure requirements. Many folks have undergone psychotherapy earlier in their lives before ever entering the field themselves – does this “count”? Some graduate schools require their students to do counseling concurrent with their program. Some graduate schools build the counseling experience directly into their program. These variables result in students graduating at very different places in their own journeys. I think graduate programs have an obligation to address this with their students, but this occurs in the context of years of contact between students and professors in multiple settings. It is not possible for a licensing board to monitor the level at which any individual has done their own “work”, and requiring a given number of counseling sessions will not guarantee it. Although we could hope that attending counseling sessions would ensure that deep growth has happened in the licensee, that is simply not possible. So although I agree with the premise behind the possible requirement (that counselors will be more effective if they have done deep work of their own), I do not think it can be monitored with a licensing requirement.

  • Paula Susan

    Paula Susan

    May 23rd, 2011 at 7:57 AM

    Yes, I think all therapist should undergo therapy in order to be licensed.

  • Dr. Paul Jenkins, Psy.D.

    Dr. Paul Jenkins, Psy.D.

    June 6th, 2011 at 12:22 PM

    I agree whole-heartedly with your post. To add a related point, I would remind the medical model folks that two of the primary types of therapy addressed by MFTs and psychotherapy in general are family and marriage therapy. Neither of these therapy approaches incorporates the medical model or has specific ‘disorders’ related to it.

  • Mary Alice Long

    Mary Alice Long

    April 10th, 2012 at 11:16 AM

    Thank you Noah. For my masters thesis, I researched school of masters level social work students to find out how many of those students were ACOAs (Adult Children of Alcoholics) and then suggest improvements to their program of education and training. The research found that 70 per cent of those students researched were ACOAs and I suggested adding a requirement that each student participate in their own therapeutic process while in training (the majority of these students had never engaged in a therapeutic relationship). My own masters in social work program did not have this requirement–I have found in my own training and life that being part of a therapeutic relationship with therapists and Jungian analysts has been invaluable for my growth and learning.

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