Yoda and Columbo

Therapy is whatever people want it to be, and the therapist is, too. Some are looking for a spiritual/behavioral guide, others a detective. Some want a therapist to dress up and play the consummate professional; others are more comfortable with the cargo pant look. It is the difference between Detective Joe Fontana of Law and Order, who wore expensive shirts and asked pointed questions, and Columbo, an average guy in a crumpled hat and raincoat, who asked unassuming questions to solve the crime. Columbo even seemed a little slow. Therapists act like this, too, a little slow, like we’re just not catching on. We want the patient to tell us more, is all. The patient knows the answers, so we put a lid on our own thoughts and poke around in his.

Whichever methodology, no matter our school of thought, we are out to detect sources of pain and anxiety (diagnosis) and relieve it (treatment). It’s not all about the money (a little professional humor, here, a disarming tool, meant to relax the patient).

As are many detectives, we’re married—to some theory or another, perhaps several. There are many such theories; some even explain why therapy works. One builds upon the genre of relationship therapy, only that it is the relationship with the therapist that matters, or the therapeutic relationship. A weekly or bi-weekly schmooze with a nonjudgmental, wizened, objective, empathetic guru never hurt anyone. We all need a Yoda in our lives.

Not that the guru has to be your therapist, of course, but if you can kill two birds with one stone, why not? The force, any self-respecting guru will tell you, is within you. Therapists are only one cloth available to help you not only find it, but use it.

Whether the patient needs guidance for the present, or a fresh eye to the past, therapists who have had any professional training within the past twenty years see everything psychological as biological, too. That means our experience is in the here and now, which is why a visit back to the past to solve the mystery isn’t quite enough, even when the past is clearly riddled with trauma. A trigger may have originated in childhood, but the patient is suicidal today, and the family will certainly look at us as accountable if we don’t prevent it.

Whether it is the past raising its ugly head, perhaps the anniversary of the death of a child, or the memory of a sexual assault, or the thought of father pounding mother, or a nasty confrontation with a pit bull last week, therapists are quite worried about the state of the patient’s brain in the moment, the organic variable, or organicity—no matter our theoretical preference. Or we should be. The crime may be old or new, but the imprint is relevant today.

Thus the patient walks into therapy, for the first time maybe, or for the first time with a new therapist, and he is aware that he has issues, perhaps really old ones, or maybe new ones, or some relatively new, hoping to find experience and wisdom, at least one of the two, preferably both. It would be unnatural not to be skeptical under the circumstances, at least a little, and reticent, reluctant to spill the most intimate details of life, past and present, to a perfect stranger.

That perfect stranger’s ability to dispel anxiety quickly will influence the entire process, even if his skills are otherwise lacking. This explains so many bad therapeutic experiences: a prospect of great therapy, come to find, the therapist doesn't quite cut it.

And yet, to put a new patient at ease from the very start takes skill. Personality does matter. The relationship with the therapist matters, but training matters as much, perhaps more, in the end. Which is why we have consultants.

The goal remains, no matter the style, whether ala Columbo, unassuming, open, clueless at first, eventually annoying (like most good parents), or like Yoda, wizened over the years, to establish a safe, drama-free setting. And we want you to want to come back, naturally. Nobody likes to stop in the middle of a good story.

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Educating Eric

He killed his principal. The man who gave him shoes.

It's front page Saturday/Sunday Weekend Edition, WSJ, May 12, 2007 and you CAN'T read it on-line, I'm sorry, although there are some excellent graphs in the Journal about special education and a video. Go out and buy this edition of WSJ if you can. It's an incredible story.

I'll quote it liberally here to show you that diagnosis is not easy and that the causes of violence are multivariate.

Eric Hainsock

Eric was a troubled boy who threatened others, who threatened suicide, who had an ADHD diagnosis, who bullied and was bullied, who disrupted class, whose parents divorced when he was a toddler, who lived with his father, who relished hunting and fishing with his father, who missed his mother who promised gifts that didn't arrive, who rolled on the floor in class making pig noises, who was beaten by his father with a paddle, who needed Ritalin but didn't take it because his father said he didn't need it, who needed a special school but didn't go because his father said he didn't need it, who came to school disheveled and smelling of smoke from the wood-burning stove that heated his home, whose head was held down in a toilet by other students at school, who failed over and over again at his studies, who chose to sit in a wastebasket in class, who brought a shotgun and a pistol to school 2 years ago, not intending to shoot either, he says.

Who accidentally killed his high school principal with the pistol after the maintenance engineer wrestled away the rifle.

Now Eric sits in a jail cell and talks to reporters. He is schooled by a teacher who pays him daily visits at prison. He's making A's and B's.

Robert Tomsho and Daniel Golden, journalists who posted the story from Cazenovia, Wisconsin make the point that Eric should never have been mainstreamed. He was in need of special education and he didn't get it. When he has individualized attention (as he is has in prison) he's able to learn and seems happy. Had he had CONTAINED special education, Mr. Klang, the man he shot and killed, would be alive today.

Diagnose Eric? What's the point?

His mom is probably alcoholic (I say that because she made promises and didn't keep them). His dad was overwhelmed and didn't parent well. For sure Eric was depressed, for sure he had learning problems. He had SOCIAL problems, maybe Asperger's, who knows. I will tell you what I've learned about that disorder soon. Misunderstood is a good way to describe individuals with Asperger's. WSJ blames mainstreaming, and who wouldn't agree, considering that streaming clearly wasn't a good idea.

I like how the way the journalists put it, actually, "troubled." His dx, for everyone had at least one, the social worker, the psychologist, the educators, didn't save Mr. Klang's life.

Oh, and did I mention there were 2 guns? Guns don't kill people. People who HAVE guns kill people.

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