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Posts from the ‘Opinion’ Category

Aug 16

Scholastic Action Magazine Cover

In the Press: Texting while Driving

I was quoted in an article about the dangers of texting while driving in the September issue of Scholastic Action, a magazine for teens. Back in the mid-90s, I worked for a government contractor in the area of Human Factors psychology, studying issues of driver distraction. This was before today’s era of widespread text messaging. At the time, the main concerns were around the distracting effects of cellphone use and early forms of navigation systems.

In 2008, almost 6,000 people were killed and half a million were injured in crashes related to driver distraction. Texting is a big distraction. “It’s like driving blindfolded,” says Dr. Geoffrey Steinberg, a psychologist who studies driver distraction. He says texting is especially dangerous for teens. Because teens are newer at driving, they need to be extra careful.

Today in my clinical practice, I often see how pressured adults feel to check and re-check text messages, and how emotionally fraught the experience of receiving (or not receiving) a message can be. I often try to help clients tolerate the distress of waiting. Perhaps there is a merit to a well considered reply, and perhaps even more satisfying to speak in person. The challenge often seems to involve holding on to an internal sense of constancy in a significant relationship, in the absence of repeated reassurance through the phone.

As emotionally intense as compulsive text checking can be while stationary, this is potentially lethal at 65 mph: In five seconds of texting, a distance of 440 feet is travelled blindly. Can we adults take a lesson from 18-year old Madison in the article and, for the duration of a drive, turn the phone off? Perhaps I can extend that challenge to pedestrians stepping off curbs here in NYC.

Full text

Scholastic Action, September 2010

© 2010 Scholastic, Inc.

Jul 28

Man Walking Dog

In the Press: What’s In a Name?

I was quoted in the online magazine Edge New York in a story about the power of language to both liberate and oppress. My quotes are copied here, or follow the link for the full article:

WHAT’S IN A NAME: EMPOWERMENT OR INSULT?

by Scott Stiffler
EDGE Contributor
Monday July 28, 2008

“Very early on, [the word ‘homosexual’] became a term of stigma that was used pejoratively.” In doing so, conversation shifted from the behavior and worth of the individual to the matter of orientation. “The word homosexuality connotes bias by giving it a very clinical focus — as if being gay was only about sex.” says Geoffrey Steinberg, a licensed clinical psychologist.
…
As a medical term, Steinberg reminds us how it was a psychiatric diagnosis used to “pathologize gay men and lesbians” until 1973. That’s the year when the American Psychiatric Association removed homosexuality from its list of mental illnesses. Today, we’ve still not recovered from homosexuality’s 104-year run as a “narrow term of bias that ignores the identity, culture and relationships of the LGBT community in favor of this focus on sexual behavior.”
…
Still, Steinberg counters that “It’s important to allow people to define and identify themselves as they want. This is an internal debate amongst subsets of the gay community — but that debate is a very different story than the use of language by an outside group as an attack against gay people in a way to control and oppress.”
…
But for Steinberg, the very notion that we’re engaged in debate about what we should call ourselves (as well as what were allowed to call someone else) is an opportunity to “reach an understanding that can be healing instead of further fracturing an already oppressed group. My hope would be that it’s an opportunity for dialogue as opposed to attempts to control.”
…

Full article
© 2008 Edge Publications, Inc.

Jun 9

Bridge

In the Press: Gay Travel Safety

I was quoted in the online magazine EDGE NEW YORK in a story about safety precautions–both practical and emotional–for gay people when traveling. My quotes are copied here, or follow the link for the full article:

OVERSEAS TRAVEL CAN BE RISKY BUSINESS
by Scott Stiffler
EDGE Contributor
Monday Jun 9, 2008

…Because travel to a new and unfamiliar place requires stepping outside of your queer comfort zone, clinical psychologist Geoffrey Steinberg (chelseatherapy.com) notes that, for gay men and lesbians living in the relative safety of the gay ghetto, “venturing out can be anxiety-provoking. Even if a destination doesn’t appear openly hostile, the lack of visibility of other gay people and gay friendly establishments may make a traveler feel conspicuous and vulnerable.” Exposure to homophobia in another country can trigger memories of experiences “that bear similarity to where the person encountered homophobia in the past. What we’re talking about is basically a variation of post-traumatic stress disorder. Just as a soldier returning from Iraq may be triggered into feelings of panic when hearing a car backfire, a gay person who was bullied or made to feel inferior in the past may be triggered by all kinds of environmental stimuli that bring back the feelings of fear and anger.” Those who feel they may by vulnerable to these emotions can prepare for what’s to come by “simply reminding yourself that you might feel uncomfortable where you’re going and recognize such feelings for what they are–a fear reaction that’s triggering past memories of being the target of homophobia. It can also be helpful to talk to the person you’re traveling with about what you’re feeling; or, if you’re traveling alone, to call a good friend back home.”

Full article

© 2008 Edge Publications, Inc.

Jan 24

Inside Light

In the Press: Psychology Today feature on Bringing Therapy Outdoors

I was quoted in the February 2008 issue of Psychology Today:

Therapy in the Great Outdoors

Just you, the wilderness… and your therapist? Many experts in Psychology Today’s Therapy Directory say there’s potential in field trips, but a few insist that you’re both better off just sticking to the couch.

Release the Pressure

“Some clients feel more comfortable opening up when not in the face-to-face position, when it just feels like too much attention or scrutiny,” Elyn Tromey says. “A walk can really help take that pressure off.” Tania Paredes concurs: “When someone is blocked off, helping them drop their guard with nature makes us less scary.”

No Place Like Home

Why get away? “Many of us spend quite a bit of time creating workspaces that are anything but rote and confining,” Lisa Dale Miller says.

Sit and Think

Geoffrey Steinberg also sticks to the indoors: “Engaging in an activity outside the office encourages action—just the opposite of what I try to accomplish as a therapist, where one of my main tasks is to help clients put their raw, unverbalized experiences into words.” On the other hand, Tromey notes that “moving the body can help loosen up thoughts.”

No Friend of Mine

Emphasizing professionalism, Leslie Gustafson says, “an office declares that the relationship is not a friendship and has boundaries put in place to create safety, resulting in disclosure and growth.”

Jun 30

Orchestra Group S

In the Press: Psychology Today feature on Group Psychotherapy

I was quoted in the August 2007 issue of Psychology Today:

When might group therapy be a better choice than one-on-one counseling? We asked the experts in Psychology Today’s Therapy Directory for their advice.

Reenactment: Interpersonal problems are group therapy’s forte, according to Geoffrey Steinberg. “The way clients respond to their social worlds will get acted out within the here and now of the group process. Focusing on those interactions is the active ingredient in group therapy.”

In the Same Boat: Jamie Snethen always hears the same thing from her anxiety group members: “It is so helpful to know that I’m not alone, and that other people can relate to what I’m going through.’ “

Many to One: Steinberg suggests group therapy as preparation for individual work: “Some people have an allergic reaction to the closeness of individual therapy but become very involved and active members in a group. The group can prepare a client to be able to engage in individual work for the first time.”

A Note of Caution: “For people who have complicated intrapsychic problems to work through, nothing beats one-to-one,” Gibbs Williams counsels. “Too many cooks spoil the broth.”

Hutson, M. (2007). Collective Subconscious. Psychology Today, 40(4), 26.
© 2007 Sussex Publishers Inc.

Apr 5

shadow post

Forbes Magazine ‘Dump the Couch’: Unbalanced, Misleading

The story, and my reply:

Comparing CBT as practiced today to psychoanalysis as practiced by Freud in the 1890s is like comparing a 2007 Chevrolet to a Model T Ford and concluding that Chevrolets are vastly superior. The author failed to discuss how over the past century psychoanalysis has developed in technique, proliferated in contemporary applications, and amassed both empirical and qualitative evidence for its effectiveness. Both CBT and psychoanalytically-informed practices can and do coexist in the mental health marketplace. Rather than extolling the merits of one at the other’s expense, why not help your readers understand the value of each so they may make informed choices about psychotherapy?

Geoffrey Steinberg, Psy.D., New York, NY

Mar 27

Tree Building Sky

Empirical Evidence: Psychodynamic & Psychoanalytic Psychotherapy

Clients have a right to know that the psychotherapy they are engaging in can really work. It can be confusing, however, to sort out the rhetoric, biases, and politics involved in descriptions of the effectiveness of psychotherapy.

Some sources of funding (certain government agencies, selected managed care companies) may make incomplete statements regarding the effectiveness of one treatment compared to another without disclosing how their vested interests in conserving resources may bias their conclusions.

Even worse, some groups of clinicians pit their favored form of therapy against another, each camp convinced they have the answers. This kind of infighting hurts the profession and does a disservice to the public.

Lately, psychodynamic and psychoanalytic psychotherapies have been favorite targets for derision, often lampooned in cartoons and movies (granted, there’s humor in it, but the stereotype isn’t the whole story). All the while documentation of these treatments’ effectiveness remains conveniently ignored.

Compiling the Evidence

Dynamic and analytic clinicians are hereby invited for commentary on and submissions of empirical evidence of dynamic/analytic practice. A wealth of such information exists, yet it’s consistently excluded from so-called ‘evidence based practices.’ So what counts as persuasive evidence: the politically expedient, or those treatments that truly work?

Selected Evidence for Psychoanalytic/Psychodynamic Practice

Let’s start here–a recent, a widely circulated, peer-reviewed article on the effectiveness of psychoanalytic therapy in the treatment of panic disorder:

Milrod, B. & Leon, A.C., et al., (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry (164), 265-272.

Though work of this kind isn’t new: Here’s 90 years of psychoanalytic therapy research, briefly summarized (Wallerstein, 2002):
http://www.psychomedia.it/spr-it/artdoc/waller02.htm

Reading Lists

8,000+ articles on empirical evidence for dynamic and analytic therapy: Google Scholar List
A collection of articles on effectiveness of psychoanalysis (in German).

Attempting to sort through the major works is a work in progress, contributions welcome:

Westen (1999) discussed empirical evidence supporting the existence of unconscious phenomena, and by extension, validation of methods used in psychoanalytic psychotherapy to bring such phenomena into consciousness.

Westen & Bradley (2005) on the sometimes restrictive use of the concept of “evidence” in evidence-based practice, with suggestions for broadening the program of study.

A broader concept of evidence, the APA Presidential Task Force (2006) on Evidence Based Practice in Psychology, including discussions of research methods, culture, and clinical expertise.

Ritvo, R. (2006). Is there research to support psychodynamic psychotherapy? American Psychoanalytic Association.

The vast majority of successful psychotherapy outcomes take place within the private confines of thousands of individual practitioners’ careers. While such outcomes are usually not included in quantitative research programs, their qualitative evaluation within an individual practice constitute another form of evidence for psychotherapy effectiveness. Here’s an excellent, recent example of such evaluation within a single psychoanalytic practice:

Young, B. (2007). Long-term effects of psychotherapy: The internalized therapeutic relationship. Psychiatric Times, 24(4).

Read more

Mar 18

Tree Building Sky

College Mental Health: Should Parents be Involved?

The New York Times ran “Off to College Alone, Shadowed by Mental Illness” (12-08-06) and invited reader responses to the question, “Should colleges involve parents in the treatment of their child’s mental illnesses or should the privacy of these young adults be protected?” My response:

The question, “Should colleges involve parents in the treatment of their child’s mental illnesses or should the privacy of these young adults be protected?” is more complex than a simple yes or no response.

Historically, colleges have assumed responsibility “in loco parentis,” that is, not only to educate students but also to offer the guidance and protection that, under the best of circumstances, a student would receive at home. Indeed, such has been the legal argument against a university in at least one widely publicized case of a student suicide in which the parents were not informed of the student’s deteriorating mental status.

Legally and in terms of professional ethics, a mental health practitioner’s duty to protect a client from harming him/herself or others trumps privacy. In actual college counseling center practice, such cases are relatively rare. Most often, the question of involving parents can be explored as a clinical issue between a student and his/her mental health practitioner.

The clinical benefit of family involvement may then be evaluated on a case-by-case basis. While some students may benefit from the involvement of a supportive family, other students benefit from maintaining a firm boundary between the student and the family, particularly in cases where the student’s emotional condition has been exacerbated by abuse or neglect in the family.

When the student and mental health practitioner agree that family involvement would be beneficial to the student’s treatment, the student may authorize in writing a disclosure of information from the practitioner to the parents.

Parents concerned about mental health care on campus would be wise to inquire about the resources allocated to mental health care at the colleges their children attend or are considering attending. The length of the counseling center’s waiting list and the number of counseling sessions offered can be important indicators of that college’s commitment to mental health care.

Parents may wish to advocate for more of a university’s financial resources to be devoted to mental health care. Financial constraints have forced many college counseling centers to shorten treatment length to as few as four sessions. This is completely inadequate for those students with a serious emotional disorder. Mental health practitioners working in counseling centers realize this, and some end up stretching themselves to their personal limits to ensure a student in need will receive mental health treatment as long as it is needed.

Alternatively, when a student’s mental health needs exceeds the usual treatment offered on campus, referrals to mental health practitioners in the community may be an option. In either case, the point is for the student to have the necessary continuity of care throughout the college years so that he or she may simultaneously succeed in college and gain mastery over mental illness.

Mar 17

copyright Angela Taormino licensed to Geoffrey Steinberg, Psy.D.

Is psychoanalysis ‘good therapy’? A response

Goodtherapy.org is a new site dedicated to non-pathologizing models of psychotherapy. The question came up as to whether psychoanalysis should be included as a “good therapy.” My response follows, or read the whole discussion here.

I strongly support including psychoanalysis in goodtherapy’s list of approved treatments. The detached, cold, impersonal analyst is just a negative stereotype fueled by countless cartoon and movie depictions. It couldn’t be further from reality.

I practice from a psychoanalytically informed perspective, which was how I was trained, and I aspire to join an analytic institute for postdoctoral training. Meanwhile, to be clear, I talk with my clients. I have emotions and I show them. And I view the relationship as an egalitarian exchange. I’m a lot less interested in insight and interpretation than I am in understanding what’s unique about the relationship I’ve formed with each client, and using that relationship to help the client achieve their potential.

The way I see it, the values of goodtherapy.org are aligned in a broad sense with contemporary psychoanalytic work. I also want to say that such values are held by individual practitioners more so than by theoretical orientations in any collective sense. In my experience, many analysts and analytically-informed practitioners hold the kinds of values to which goodtherapy aspires, and others probably hold different views. The same could probably be said for members of any grouping along theoretical orientation lines. That’s why individual practitioners may self-select their participation in a group such as the one formed on goodtherapy.org.

I have difficulty responding directly to the five questions that were posed. Perhaps others will have an easier time of it. I think my difficulty comes from the dichotomies that are posed and my inability to speak for the totality of analytically informed clinicians. For instance, when asked is our belief in our clients’ potential “unwavering”: Well, if we as therapists didn’t believe our clients could grow, then what would be the point? But “unwavering” sounds kind of superhuman.

The reality of a human interactions is much more of a process. Psychoanalytic approaches are especially helpful as a theoretical roadmap for the clinician to understand when such a belief wavers, to understand why. It provides a map to look within the clinician, to look within the client, and within the unique relationship between the two. So the challenge is to understand the wavering and collaborate as two people to repair it. When such a rupture is repaired within the therapeutic relationship, this can generalize to other relationships in the client’s life.

Among contemporary psychoanalytic approaches, including Modern Psychoanalysis, Object Relations, Self Psychology, and Inter-subjective approaches, the relationship between two people is key. The experience of engaging in such a relationship with another person in psychotherapy is fundamentally a human endeavor, with the twist being that the relationship can be a crucible for change in the client.

In my opinion, this happens precisely because the therapist is actively involved in shaping an interpersonal relationship that will allow the client to develop capacities for growth and development that the course of ordinary life has not provided.