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April 25, 2007 - 3:17 am

There is interesting discussion at both a href=”http://althouse.blogspot.com/2007/04/psychotherapists-confidence-in-his-own.html” Ann Althouse’s /aand a href=”http://neoneocon.com/2007/04/24/feeling-too-much-of-your-pain-therapists-and-clients/”Neo-Neocon’s /ablogs about an article in emThe New York Times /em entitled, a href=”http://www.nytimes.com/2007/04/24/health/24beha.html?ex=1335067200en=4d40eb8b7b8a4e8fei=5124partner=permalinkexprod=permalink”"Understanding Empathy: Can You Feel My Pain?”/a Richard A. Friedman, a psychiatrist, asks an important question, “Is shared experience really necessary for a physician to understand or treat a patient?” In answer to that question, he states:br /br /blockquoteWhat is critical to understanding someone is not necessarily having had his or her experience; it is being able to imagine what it would be like to have it. Thus, I do not have to be black to empathize with the toxic effects of racial prejudice, or be a woman to know how I would feel about being denied promotion on the basis of sex./blockquotebr /br /So Friedman believes that empathy is the most important factor in treating someone, not the race or gender of the therapist. “In the end, empathy is what makes it possible for us to read each other. And it is the reason your doctor can understand your problem without actually having to live it.”br /br /Yet, as I read over the emNYT/em piece, I get the sense that Friedman does not seem to take his own advice to heart; he seems to think that empathy and help should only be available for those he deems to be politically correct. He mentions a gay man who wants a gay therapist. Friedman helps him find one, although he does mention feeling “uncomfortable” about it. In another case, he sees it as appropriate to give the patient the therapist she asks for:br /br /blockquoteSometimes, though, patients should get exactly what they ask for in a therapist. One of my residents once saw a young woman from Africa who had survived hideous torture and rape and said that she didn’t think she could see a male therapist. br /br /That struck me as entirely appropriate. Given her trauma, she simply could not have put her trust in a male therapist, no matter how empathic he might actually be./blockquotebr /br /He does not extend this assistance to a man he deems politically incorrect:br /br /blockquoteWhat about patients whose demand for a particular therapist springs from nothing more than everyday prejudice? I remember a patient who once stormed into my office and demanded a white therapist to replace his therapist, who was black.br /br /That’s a request I turned down, even knowing that this patient’s biased beliefs were an appropriate target for treatment. To do otherwise would have vindicated his prejudice and fundamentally compromised the therapy from the start./blockquotebr /br /For a psychiatrist who mentions how empathetic he is, this did not seem like a very empathetic response. I remember a case I had years ago in NYC–a male in his 40′s just out of prison. In our first session, he told me that I would not want to see him for long.”Why?” I asked. “Because I am angry at blacks.” He was hesitant to say more, stating that the culture did not allow him to voice his feelings. I told him that I was willing to hear his feelings. I saw a tear roll down his cheek as he told me about being raped in prison by several black gang members and watching helplessly as other younger men were raped. He had built up years of anger and resentment and felt he had no dignity left. Had I simply told him that I could not hear what he had to say because internally I deemed it “prejudiced” I would never of heard his story and been able to help him with understand what had happened to him, and subsequently, to heal the trauma that he had lived with for many years. br /br /I will leta href=”http://neoneocon.com/2007/04/24/feeling-too-much-of-your-pain-therapists-and-clients/” Neo-Neocon’s words /asummarize my post, for I think she says it better than I could:br /br /blockquoteAs referenced in the Friedman article, patients often come with pre-existing prejudices and preferences about what they want in a therapist. Some of these are considered therapeutically valid, such as a woman whose been severely abused by men being more comfortable with a woman therapist. Some are arguably less so, such as a request for a therapist of the same race. I disagree with Friedman that the latter request should be refused; if a client is that uncomfortable with someone of a different race, whether it be a black person uncomfortable with someone white or vice versa, than the therapy can and should deal with the issue. But it’s not best dealt with by placing the client with a therapist who makes him/her acutely uncomfortable at the outset.br /br /A lesser-known issue is that of therapist discomfort with certain clients. Theoretically, therapists can work with anyone, but in actuality they tend to specialize and refer out those patients who press their buttons (such as, for example, child molesters). br /br /And, although this sounds like some sort of bad joke, I know quite a few therapists who say they would have difficulty treating a client whom they know to be a Republican. So it’s not just clients who want therapists who are as much like themselves as possible—some therapists return the favor./blockquotebr /br /If therapists only want patients they deem to be “deserving” of empathy, how empathetic can they really be?

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