Starting today, I’m going to maintain a list of the ten biggest secrets in the Mental Health field. I humbly request that anyone who feels something is missing (or should be elevated or demoted), please post your opinion. If you have time, please give the rationale. I’ll be writing about them as news emerges and as I prepare supporting information and resources.

Here’s my first top ten list, on 02/08/2008, part one, items ten up to six:

6. Technical proficiency

This is only number six because it is a better known “secret,” but it is not out of the woods, yet, by my count. Too many therapists are content with poorly formed strategies. They may bring intensity to their commitment to be positive or intuitive, but not to nailing down the technical side. That is, the many potential interventions that can be learned and applied in a very systematic way. These range from “use of self” in terms of personality, building rapport, and so forth, to multi-step procedures that help people reprocess trauma, better use their own mental and emotional resources, and so on. I know I’ll have an argument on my hands here, but I believe I can defend this position with examples and statistics.

7. Treatment plans

This is a kissing cousin for number six, technical proficiency. I am including it because it is so specific, and because it is so often lacking. I rarely, if ever, meet people who are able to tell me what their previous therapist believed the goals and strategies of treatment were (where are we going and how do we get there?)–and I would have been happy to at least hear something on the vague side. In fact, many of the therapists I speak with can’t explain this, but it is fundamental. A treatment plan is more than a bureaucratic formality, it is a vision that can have a very positive impact on clients’ progress and morale. It also empowers them to negotiate and “own” the treatment. Yes, I know some people are better worked with unconsciously, and I know clients can’t understand everything you’re going to do. That’s not the point.

8. Religiosity or zealotry

This is only number eight, because so many therapists are immune to this and do recognize it. However, the history of contemporary witch-hunts are too recent for this to slip off the list. Thousands of families were destroyed by false allegations of childhood abuse during a wave of horror that began calming in the nineties, when lawsuits created a level of accountability that was long overdue. I am not covering for abusers, this is well documented and well understood now. Everyone needs to understand this piece of our history. One reason it is so important is that it tells us how vulnerable we are to abusing power, being abused by power, and being swept up by irrational fear and zealotry. If the Third Reich wasn’t recent enough to make you feel vulnerable and respectful of these dynamics, maybe our more recent witch hunts will. Civilization depends on you not to write off things that threaten it as being “in the past.”

9. Biological basis of psychological problems such as personality disorders

Since psychotherapy is a psychological field, you expect psychotherapists to “psychologize,” that is, to view people in terms of psychological happenings (intrapsychic dynamics, psychodynamics). But this under-defines psychology. As science expands the scope of the field, we need to expand our view along with it. The biological basis of mental disorders is in its infancy, yet insurers are beginning to recognize some disorders as being biologically based. This is like the Vatican deciding whether there is such a thing as a black hole, though. Now that the cat’s out of the bag, it’s a matter of seeing how our expanding understanding of biology can inform psychotherapy. Too many therapists, I believe, are too happy psychologizing to really delve into this. If civilization manages not to blow itself up, this will be changing at a faster rate than it is now. It’s partly on the map, so it only gets a nine, even though it is a huge issue.

10. Subliminal pain

Trigger points (a type of tender area in the body) and stuck areas in muscles (myofascial adhesions) cause pain. Until they “break through” into conscious awareness, however, this pain is not consciously perceived, it is subliminal. Nonetheless, it takes it’s toll in terms of fatigue, feeling weighed down, and being irritable. This is an area where stress could be greatly reduced with just a little knowledge. When I become king, I will make sure everyone learns massage therapy beginning in grammar school, and there will be a massage therapist running around in every geriatric facility. I may even station them at all bus stops. Now, I need to assemble an army of serfs. Serfs up! But seriously, more stress equals more impulsive behavior, more withdrawal from activities, poorer productivity, more violence, and more strained relationships.

The Challenge

What would you add to this list? Should there be more than ten items? Am I over-rating anything? Think it’s a figment of my imagination? Challenge me.

And I challenge you. I hope this inspires mental health workers to get deep into these ten issues over the next two years.