What does it take to feel understood?
This is arguably the single question helping to reshape the modern psychotherapeutic landscape.
Perhaps nowhere is this phenomenon more evident than in the realm of psychotherapies designed for people who identify as L.G.B.T. Therapists, both gay and straight, have increasingly started practices geared specifically toward lesbian, gay, bisexual and, most recently, transgendered patients. (Not to mention those patients who prefer not to identify with any one category.)
For Matthew Silverstein, a psychologist in West Hollywood, Calif., this development springs from dire necessity. “There’s a tortured history of practices that have been called psychotherapy,” Dr. Silverstein said, referring to notorious techniques like “conversion therapy” that purport to change patients from gay to straight and that continue to be practiced to this day. “There’s still a vulnerability that many L.G.B.T. patients feel when coming into a psychological treatment,” he said.
For Dr. Silverstein and others, the advent of specialization has created “safe refuges” for patients who for so long were without recourse to anything of the kind. “Until the 1970s, we simply didn’t have the tools,” he said. “There wasn’t an understanding of gay identity, or of gayness as a cultural or developmental process.”
For the psychologist Douglas Sadownick, a colleague at Antioch University in Culver City, Calif., there is an added layer of emphasis. “We work on the assumption that gay people have their own psychology, they have their own blueprints,” he said.
It is with this conviction that Dr. Sadownick runs one of the country’s first and only clinical psychology master’s programs dedicated to L.G.B.T. studies, which he helped found at Antioch in 2006.
Undoubtedly, the Internet has contributed to the shifting therapeutic landscape. Where before, word of mouth was crucial to the search for a therapist, prospective patients are now likely to take to the web, and faced with thousands of anonymous possibilities, look for some way in which to determine who may be the best fit, whose boxes check their own boxes.
And many therapists, in turn, feel the pressure to fold themselves into recognizable categories. For Rachel Sussman, a psychologist in New York who self-describes as a “relationship specialist” (from first date to breakup), it seemed necessary to carefully brand herself to build a practice.
And then there are those therapists who become accidental specialists, stumbling into a niche, as Lawrence Josephs did, after appearing in a documentary that made its way to YouTube. “Thanks to Google I am getting more patients looking for someone they think of as an infidelity expert,” he wrote last year in The New York Times.
Like so much to do with psychotherapy itself, the new specialization is largely an urban phenomenon. Take Jocelyn Charnas, known as “the wedding doctor” in certain New York circles, who came to her specialty through personal experience.
A practicing psychologist, she had recently gotten married and was aware that there was all too little conversation revolving around the psychological challenges of the experience. “When you get engaged, it’s the ring, the venue, the flowers, which is all wonderful and interesting, but nobody seemed to be talking about the universal experience that this is also difficult,” she said.
For Dr. Charnas, weddings are not just weddings, but rather pressure-cooker moments that contain layer upon layer of psychologically fraught material. “Typically, it’s really not whether you’re having roses or lilies that is keeping you up at night,” she said. “While that may be the manifest content of it, the underlying content could be a number of things, like fears of disappointing your mother, or disappointing yourself. There are so many latent emotions.”
Thus, for Dr. Charnas, within weddings lies the very fullness of human experience. This is what makes every case different, every stressed-out bride-to-be distinct from the last.
In Los Altos, Calif., the psychologist Howard Scott Warshaw has developed his own brand as “The Silicon Valley Therapist,” specializing in everything that he says makes Silicon Valley unique: the particular personality type that is suited for computer programming but less adept at parsing human ambiguity, the environment that seems to expect nothing less than extraordinary achievement.
“Some of these engineers, they love the software world, because it provides a metaphor of looking at life that really makes sense and facilitates their entire worldview,” Mr. Warshaw said. “So if you’re going to deal with someone like that and you can’t speak that language, there’s going to be a real communication problem.”
But many clinicians would contend that shared experience is irrelevant to the treatment of their patients. “This whole idea that when you walk in the door, there’s a template for: ‘We are the same, and out of that sameness we can build an immediate rapport,’ to me that seems like a very problematic notion,” said Michael Garfinkle, a psychoanalyst in New York. “My basic orientation, especially at the beginning, is a great curiosity and openness to what I’m hearing. There’s a recognition that it takes a long time to learn the way that someone speaks.”
Dr. Garfinkle is often asked by prospective patients, “Do you have a specialty?”
This is how he likes to respond: “My youngest patient is 9, my oldest patient is 82. My patient who’s most well is mildly anxious, my most severely ill patient, so to speak, is someone who has been in and out of hospitals with schizophrenia for most of his life.”
Similarly, Justin Shubert, a psychologist in Los Angeles and the director ofSilver Lake Psychotherapy, is quick to note that seeing a therapist whose label matches your label is not without its hazards.
“It can be limiting because you may end up with someone with a narrower perspective,” Dr. Shubert said. “Just because someone understands what it’s like to work with a Hasidic Jew, doesn’t mean that they understand what it’s like to have two sisters, or to be depressed.”
But in all this talk of software development cycles and maximized potential, it’s easy to lose sight of something much more fundamental, a persistent truth that surfaces again and again when therapists talk about what actually helps their patients.
As Dr. Shubert observed, “Regardless of the technique that the therapist uses, it’s the relationship itself that heals.”
His perception is hardly newfangled. Freud himself had something to say on this subject. In a letter to Carl Jung, written in 1906, he put it thus: “Psychoanalysis is, in essence, a cure through love.”
Source: Dear Google, Is There a Shrink for That? – The New York Times