Interview With a Psychotherapist
Which is your specialty in psychology?
Do you mean my specialty in psychotherapy? Let me clarify that I am a licensed psychotherapist, not a psychologist. Psychologists are typically psychotherapists as well, and so, as a lay term, these two terms tend to be used interchangeably, like the use of Band-Aid for bandage, or Kleenex for tissue. (Most of us, regardless of which academic discipline we chose, have many years of post-Master’s level training and clinical supervision.)
I have a few specialty areas. I work best treating symptoms of anxiety, anxious-depression, virtually anything related to a couple’s communication, difficulties with interpersonal connection in general, and cultural acclimation or reacclimation.
What types of patients or clients do you work with?
I work with individual adults and with couples. I particularly enjoy working with people who have an international background of one kind or another—people with one foot in this culture and another foot elsewhere, either by birth and immigration, professional circumstances, or some combination thereof.
What methods do you employ? Could you briefly explain the principles on which your approach is based?
I base my approach on what the person’s or couple’s struggles appear to be—and then I check my formulation with them to see if it matches. There are many, many variables in this type of work, so my approach tends to be broad-based, pulling in aspects of theory and evidence-based practice that I think will get the best results in the shortest amount of time. I try to get a sense of what, and how, a person wants to live and be in the world and then figure out what seems to be getting in the way of that. Once we know what the obstacles are, the path for the work becomes fairly clear. The same applies to each member of a couple and the union itself.
How do you market your services? Where do your new patients or clients come from?
Most of the people I see are referred to me by other mental health professionals at this point. Primary care physicians, gynecologists, the State Department, and other organizations also request my assistance from time to time. Recently, several of the couples I’ve been seeing have said that they found me on the internet, which doesn’t surprise me at all, given how much I, personally, research potential health care professionals on the web.
How obsolete is Freud today?
What an amusing question! People love to denigrate Sigmund Freud, especially with the ascendance of cognitive-behavioral therapy over the last three decades, or so. It almost seems like there has been a collective movement to relegate Freud’s body of work to the fields of literature and cultural history. But this sort of dismissal seems rather simplistic and unnecessary, in my opinion.
Yes, Freud came up with a lot of imaginative, self-indulgent conclusions based not on science, but purely on personal observation and conjecture. However, no one can dispute the fact that some of his notions have withstood the test of time. People refer to the emotional defense mechanisms that he identified quite frequently—denial, projection, passive-aggression, acting out, intellectualization, repression, and so on. In another example, how many times have we watched, sometimes painfully, as friends and family members repeat self-defeating behaviors, playing out patterns that even they know are problematic, probably because, as Freud suggested, the underpinnings of these patterns lie outside of their current level of awareness. Besides, even the most devout cognitive-behavior therapists work with Freudian concepts and nomenclature, such as transference and counter-transference, the use of “borderline” and “narcissistic” as descriptors of personality organization, and, of course, the defense mechanisms.
In my professional opinion, the best therapists employ a sort of psychotherapy integration that makes room for more than one theory—yes, including older and newer takes on psychodynamic theory. My firm belief is that we limit ourselves as therapists if we try to squeeze our understanding of a person’s or couple’s experiences into one or another paradigm. Life doesn’t work so well that way, so why should therapy? (Okay, that said, therapists that know that they linear thinkers or associative thinkers, or have extraversion or introversion tendencies, can have very good cause to favor and hone one main theoretical model. It might simply be what works best for how they want to help others. That should resonate with people, too, of course.)
Why is it so difficult for us to forgive ourselves?
Guilt, shame, and/or perfectionism can be mighty powerful things, to be sure. If we haven’t yet developed the ability to clearly understand our motivations and actions, and the way that these might have been influenced a bit by our past experiences, then we have no consistent means of seeing them—and the inner turmoil they can cause—as anything other than inevitable.
I wonder if a lot of the difficulty we have in forgiving ourselves stems from the self-feeding quality of guilt and/or shame. Could it be that a perceived need for self-punishment often accompanies these feelings? Perhaps we convince ourselves that we should feel guilty or ashamed, and so there’s often limited motivation to even question its presence: “I deserve to feel this guilty or ashamed, because I screwed up (or I’m not a good enough person).” If not somehow disrupted, this punishment cycle—conscious and, especially, unconscious—can spill over into our ability to relate to others in a fulfilling way, thereby creating the additional punishment of isolation. In other words, a sort of self-alienation can set in, and that can affect how present we’re able to be with people we care about, and how rich those relationships can become, or not.—This self-alienation can, in turn, keep us looping back to being hard on ourselves and hard on others.
What are the keys to creating healthy relationships?
May I boil it down? There are no replacements for healthy self-assertion in communicating our feelings and needs as soon as possible, frequent demonstrations of appreciation and respect, and a genuine curiosity about the other person. Healthy relationships, I believe, are less about “hard work” and more about good communication habits and self-awareness. These can and should be developed, both in the individual and in the couple, provided that we’ve chosen the right partner (and communities).
What new trends in psychology have stirred up your interest the most?
More and more, the advancements made in the field of neurobiology and its relationship to behavior and mental health concerns, such as depression, anxiety, and bipolar disorder, are informing psychotherapeutic work, and I believe that this aspect of medicine will lead to more refinements in the interventions we make as therapists, which, in turn, will help people to feel better faster. That’s our ultimate goal as therapists, after all. I also very much appreciate the growing trend toward psychotherapeutic integration---CBT emphasizing the relationship a bit more; contemporary psychodynamic therapy borrowing from cognitive therapies’ success with reframing things early and often as well as working more in the here-and-now; and more and more consideration given to Attachment theory, both for individuals and couples. There’s still (forever?) a healthy debate happening, for example, between the ontological positions of monism vs. dualism.--Maybe attachment, in the here-and-now, while making good use of cognitive reframing for scaffolding and support, provides a bridge between the two.
What is a “healthy” ego?
The capacity to observe one’s own thoughts and behaviors from moment to moment, as necessary, makes for a healthy sense of self and self-worth. The act of observing one’s own thoughts and behaviors—at least every now and again--generates patience, productivity, empathy for oneself and others, a deep and satisfying sense of interpersonal connection, and noticeably more emotional flexibility—even in stressful times.
In the past there was a lot of stigma associated with going to therapy, but now it is rather fashionable. When is and when isn't help from a psychotherapist necessary?
We therapists are here when all the things you’ve already tried for yourself to get out of an unhappy situation haven’t worked. I agree that the stigma associated with therapy is waning, which is a very, very good thing for people. Please—life is too short to bend to the myopic judgments of others, which is what created the stigma in the first place. An examined life makes for a better life, in my humble opinion.
Where do you practice, and is there a website or blog where we can learn more about you?
My office is in Washington, DC, in the mid-point between downtown (K Street) and Dupont Circle (P Street). The address is 1234 19th Street, NW, Suite 901. Because the world has changed, I see people via HIPAA-compliant video and also have limited in-person/in-office hours. You can learn a little more about me from my website: http://www.KarenOsterle.com