5 ms·

> Therapists are supposed to be blank slates, available > for patients to project their conflicts and fantasies > upon. Their distant father, their abusive

> Therapists are supposed to be blank slates, available > for patients to project their conflicts and fantasies > upon. Their distant father, their abusive boyfriend, > their whatever. They must not know you as a person. I don't read Slate Star Codex, nor do I visit a therapist. I don't know if this is something that's peculiar to the author, or genuinely universal among therapists. But it sounds nuts and... kind of creepy? I'm happy to believe in a culture of professional detachment among therapists and doctors, but to believe that you are a blank slate seems kind of delusional. The therapist has some perceived race, gender, and age. They dress a certain way. They have a certain accent when speaking. Patients may prefer a male or female therapist, or a therapist who shares some other background with them. Patients probably want the confidence that their therapist will not dismiss their concerns and will actually help them make progress. At this point calling the relationship a "blank slate" seems delusional. Sure, maybe the therapist is such a perfect mimic that they're not actually female, middle-aged, Black, or have experience working with trans patients. Maybe this is all just a mirage projected by their professionalism. Maybe there is no therapist, and I'm just sitting on a couch alone, in an empty room.

Smaug123 6y ago
He does say "is supposed to be". He's describing some kind of ideal to live up to, not the way anything can actually be once you get down to messy reality.
- legerdemain 6y ago
  Yes, I'm questioning it as a goal. I don't know what fraction of patients project their abusive boyfriend onto their therapist. That honestly sounds like an account of Freudian psychotherapy from 100 years ago. If I was to seek therapy for myself, I would actively seek a therapist who looked and sounded likely to help me. I would hope to have a conversation with them about their background, their experiences, and their familiarity with my culture. If I come from, say, India, I would want the therapist to understand my relationship with my parents, instead of medicalizing it. And if I did walk into a therapist's office and find it barren and grey, and the therapist completely and utterly avoidant of any personal topics... Well, that would remind me of getting polygraphed at the NSA Friendship Annex just outside the BWI airport, by a cold and hostile interviewer. That's not a fun experience.
  - ska 6y ago
    > I would actively seek a therapist who looked and sounded likely to help me. And a therapists goal is to feel like that person for all of their prospective clients, ideally. The less you can pigeonhole them into social/religious/political/etc boxes the better, from this point of view.
    - legerdemain 6y ago
      Yes, and I object to that goal being either achievable or reasonable. I'm sure some therapists believe it is both, and that they are some kind of universal therapists. I assume these are the therapists I hear about from friends and online acquaintances when they describe a therapist as friendly, approachable, but ultimately both clueless and hopeless. I have mostly heard this kind of feedback from non-white and LGBT friends, for what it's worth.
      - mindslight 6y ago
        > I have mostly heard this kind of feedback from non-white and LGBT friends, for what it's worth. It seems to me that your implication is that by therapists skewing white and non-LGBT, it becomes harder for patients to open up. Either the patient has some prejudice they can't get past, or the therapist is actually entirely clueless as to the patient's lived existence. The only way around this would seem to be having more non-white and LGBT therapists. But even with this problem, does it not still make sense to reduce the number of identity facets? The more variables there are, the harder it becomes to find a match, especially for those having a hard time as it is.
      - fragmede 6y ago
        We are woefully uneducated about even the concept of mental health. I don't know of any therapist that doesn't have a specialty and figuring it out is required before you get licensed by the state (CA) simply due to the different licenses available. There's an undeniable undercurrent of racism if the goal is for the therapist to be a blank white slate for their client, but you misunderstand the goal. The goal, in being a blank slate, is for the client to be comfortable expressing themselves. The therapist, as a professional, is working on behalf of their client and can't let personal opinions that conflict with the client's beliefs come to bear, except in the most exceptional of cases when someone is in imminent danger. If the client is scared, to the point of not being able to bring it up, that their therapist will judge them and yell at them and verbally abuse them, therapy won't work. If I hate 'lesswrong' and think its stupid, but yet my therapist has built their online presence and career on it (as SSC has), merely knowing my therapist's beliefs on the matter will pollute any response I could have. A good professional therapist can detach their personal opinion of 'lesswrong' from the client's need to rant, and the theraputic value in helping the client figure out their underlying feelings and possible trauma, and to NOT engage with the concept itself. Thus, by not knowing a therapists personal views on every possible thing they might tweet about, this is achievable. If not achievable, then at the very least, worth striving for, for the client's sake. The therapist's goal is to heal the client. The therapist's opinion on misc topics is irrelevant to healing the client. Is it reasonable? Therapists go to school for years and practice for hundreds of hours, to pursuit of that goal. Some are more successful than others, and still, falling in love and transference - by therapist or client, is simply an occupation hazard. HOWEVER. This is not the same as saying the therapist needs to not be a human being, otherwise we might as well have therapy by texting an AI (Note to VCs: I know it's stupidly tempting, now's not the time, GPT-3 and ML models a therapist do not make). It's incredibly important, on a personal level, that you find a therapist who specializes in the kind of work you need to do on yourself, in a compatible way, and has some level of similar lived experience. If I have to explain what the word "woke" means to my therapist wile I'm working through racism in my personal life, that's just not going to work. If I have to explain to my therapist, why being asked to touch my hair, or being told "smile, it makes you prettier", is rage-inducing, it's really just not going to work. Find a therapist that's like you - in looks, and gender identity+orientation because therapy needs that commonality to serve the client well, but also recognize that's easier said than done.
emtel 6y ago
Did you read the rest of the paragraph that this quote is from? He goes into quite a bit more detail about this and provides several links if you want to learn more.
- legerdemain 6y ago
  No, I presciently scrolled through the essay to find this particular passage, so I could copy-paste it here, and didn't read any of the essay leading up to this passage or anything after that point. My reaction is an unmitigated hot take that I have taken zero time to consider. Is that the theory you were trying to validate with your question?
  - emtel 6y ago
    No, I was actually really trying to figure out why you didn't mention the rest of the paragraph. It seemed like a good answer to your question. If you didn't think it was a good answer, it would have been helpful to know why you thought it fell short.
  - civilized 6y ago
    People are just really confused why you isolated that passage for criticism, when it is embedded within a long paragraph that makes it abundantly clear that Scott isn't saying remotely what you seem to think he's saying. He's not denying that he has a perceptible race or a gender. He's saying that knowledge of the therapist can be a distraction, and therapists generally see it as a duty to minimize such distractions, which makes fame an obstacle to his professional effectiveness.
  - Klais 6y ago
    I had difficulty writing such a document. I did almost everything I could to do the job, but I did not give up. I couldn't, of course, because I worked hard and almost had no time to read. So I decided to seek skilled assistance. More technological problems I know. I know. Therefore, I suddenly decided to look online, somebody can do well at a low price. Now, I hear that there are many providers providing such a service. But I wanted to buy research paper https://www.wiseessays.com/buy-research-papers https://www.wiseessays.com/buy-research-papers and I didn't make the mistake. They were doing really well, without plagiarism or hackneyed thinking. We could also satisfy the deadlines, which made me very happy.
dghlsakjg 6y ago
It is an ideal, not a reality. The idea is that you can discuss your issues without filtering them through what your perception of the therapist is. e.g. If you know that your therapist is a Christian mother of three, you might hold back on how your mother in law is pressuring you to have more children for religious reasons and you think its bullshit. The issue the therapist wants to deal with is your relationship with the in-laws, not whether she agrees on a moral basis with the in-laws. Therapists need to have a very hard line between personal and professional for their own reasons as well. It is not a business where you want to be mixing different parts of your life. For these reasons it is a reasonable effort to try and remove as much of yourself as possible from the counselling relationship. It's not that the therapist doesn't exist in context, its that who the therapist is shouldn't influence the way you present to the therapist.
- waterhouse 6y ago
  Now, it would be ultra-ideal if everyone knew and confidently believed that the therapist could and would look beyond her own background—that she would suppress any personal offense and would be good at understanding and non-judgmentally discussing the perspectives of everyone involved. However, I imagine most people wouldn't believe that, and it's probably not true either. Therapists are humans. Of course, this kind of raises the question: So therapists have their own biases and we're just blinding ourselves to which ones they have? Is that actually an improvement? (Cf. the koan where Sussman says "I am wiring a neural net randomly because I don't want it to have any preconceptions".) Perhaps the therapist having to pretend she has no background actually kind of helps her disconnect from it. A kind of theatre. (And maybe the brain having a habit of "when in this office talking with patients, don't connect anything to your real life" is useful.) But I would still wonder if it would work better to bring the issue into the open, and say "Well, I do have this background, which might lead me to think x, but I will consciously try to counteract that." Perhaps there are cases where this second strategy is indeed better (if the patient comes in thinking "I expect almost everyone to be prejudiced against me", and the psychiatrist says "Well, you're right, but I have lots of practice in noticing my prejudices and setting them aside, and it is a point of professional pride for me to do that"), but most of the time it's just faster and less distracting to not mention the issue at all.
nostrademons 6y ago
In addition to what others have said - most of the work you do with a therapist is emotional. It's okay for the therapist to have a skin color, perceived sex, perceived age, manner of dressing, accent, etc. - as long as those things just are. The therapist's job is to stay neutral, to have no particular emotional attachment to any of these qualities. That way, when there is a moment of strong emotion in the session, it's almost certainly introduced by the client, and then can be explored by them. There's ironically a good example of this in the blog post: "For you, the day [I burned] your village was the most important day of your life. For me, it was Tuesday." Therapists can have race, gender, and age in the same way that it can be Tuesday. They just can't have race in the sense of having their village burned. (And FWIW, it's very difficult to have an effective blog devoid of emotional content. I tried once and got accused of being a Markov Chain.)
- hinkley 6y ago
  Imprinting and transference are real things, and the more you see the caregiver as a fully fledged human being, the more appealing that trap is.
  - gugagore 6y ago
    This is just begging the question, I think! Transference being real requires the idea that the caregiver is a blank slate onto which projection occurs.
    - hinkley 6y ago
      Did you ever develop a crush on someone who had a big positive impact in your life? Sometimes it can be difficult to tell if those feelings are about the person or what they did for you. If you don’t know the person all that well, it’s plain to see.
      - gugagore 6y ago
        Did you ever develop a crush on someone you never really interact with, and who had no positive impact in your life? Perhaps someone who has had a less-than-positive impact? You don't know the person that well.
novok 6y ago
Having a bunch of psychiatrists and psychologists as friends (met one, then made friends with their friends) this is a very universal thing among therapists. To the point it's almost regulation via their ethics codes, that they take a test on made by the 'board' of psychology. It's definitely an industry norm. I found out 'the board' is mostly equivalent to Psychologist DMV and is run by the state, and is about as pleasant to interact with.
DanBC 6y ago
You're right, and this very polite lack of awareness of race is one of the huge problems with his writing. Lack of cultural competence causes huge problems for black people who seek mental health treatment. The answer is emphatically not this blank state stuff, but more awareness.
- civilized 6y ago
  Not sure where you get the idea that being a blank slate means you can't have cultural competence, awareness of race, etc. Some people sure are eager to project onto Scott's words the wrong ways they're sure he's thinking.

Smaug123 6y ago

He does say "is supposed to be". He's describing some kind of ideal to live up to, not the way anything can actually be once you get down to messy reality.

legerdemain 6y ago
Yes, I'm questioning it as a goal. I don't know what fraction of patients project their abusive boyfriend onto their therapist. That honestly sounds like an account of Freudian psychotherapy from 100 years ago. If I was to seek therapy for myself, I would actively seek a therapist who looked and sounded likely to help me. I would hope to have a conversation with them about their background, their experiences, and their familiarity with my culture. If I come from, say, India, I would want the therapist to understand my relationship with my parents, instead of medicalizing it. And if I did walk into a therapist's office and find it barren and grey, and the therapist completely and utterly avoidant of any personal topics... Well, that would remind me of getting polygraphed at the NSA Friendship Annex just outside the BWI airport, by a cold and hostile interviewer. That's not a fun experience.
- ska 6y ago
  > I would actively seek a therapist who looked and sounded likely to help me. And a therapists goal is to feel like that person for all of their prospective clients, ideally. The less you can pigeonhole them into social/religious/political/etc boxes the better, from this point of view.
  - legerdemain 6y ago
    Yes, and I object to that goal being either achievable or reasonable. I'm sure some therapists believe it is both, and that they are some kind of universal therapists. I assume these are the therapists I hear about from friends and online acquaintances when they describe a therapist as friendly, approachable, but ultimately both clueless and hopeless. I have mostly heard this kind of feedback from non-white and LGBT friends, for what it's worth.
    - mindslight 6y ago
      > I have mostly heard this kind of feedback from non-white and LGBT friends, for what it's worth. It seems to me that your implication is that by therapists skewing white and non-LGBT, it becomes harder for patients to open up. Either the patient has some prejudice they can't get past, or the therapist is actually entirely clueless as to the patient's lived existence. The only way around this would seem to be having more non-white and LGBT therapists. But even with this problem, does it not still make sense to reduce the number of identity facets? The more variables there are, the harder it becomes to find a match, especially for those having a hard time as it is.
    - fragmede 6y ago
      We are woefully uneducated about even the concept of mental health. I don't know of any therapist that doesn't have a specialty and figuring it out is required before you get licensed by the state (CA) simply due to the different licenses available. There's an undeniable undercurrent of racism if the goal is for the therapist to be a blank white slate for their client, but you misunderstand the goal. The goal, in being a blank slate, is for the client to be comfortable expressing themselves. The therapist, as a professional, is working on behalf of their client and can't let personal opinions that conflict with the client's beliefs come to bear, except in the most exceptional of cases when someone is in imminent danger. If the client is scared, to the point of not being able to bring it up, that their therapist will judge them and yell at them and verbally abuse them, therapy won't work. If I hate 'lesswrong' and think its stupid, but yet my therapist has built their online presence and career on it (as SSC has), merely knowing my therapist's beliefs on the matter will pollute any response I could have. A good professional therapist can detach their personal opinion of 'lesswrong' from the client's need to rant, and the theraputic value in helping the client figure out their underlying feelings and possible trauma, and to NOT engage with the concept itself. Thus, by not knowing a therapists personal views on every possible thing they might tweet about, this is achievable. If not achievable, then at the very least, worth striving for, for the client's sake. The therapist's goal is to heal the client. The therapist's opinion on misc topics is irrelevant to healing the client. Is it reasonable? Therapists go to school for years and practice for hundreds of hours, to pursuit of that goal. Some are more successful than others, and still, falling in love and transference - by therapist or client, is simply an occupation hazard. HOWEVER. This is not the same as saying the therapist needs to not be a human being, otherwise we might as well have therapy by texting an AI (Note to VCs: I know it's stupidly tempting, now's not the time, GPT-3 and ML models a therapist do not make). It's incredibly important, on a personal level, that you find a therapist who specializes in the kind of work you need to do on yourself, in a compatible way, and has some level of similar lived experience. If I have to explain what the word "woke" means to my therapist wile I'm working through racism in my personal life, that's just not going to work. If I have to explain to my therapist, why being asked to touch my hair, or being told "smile, it makes you prettier", is rage-inducing, it's really just not going to work. Find a therapist that's like you - in looks, and gender identity+orientation because therapy needs that commonality to serve the client well, but also recognize that's easier said than done.

emtel 6y ago

Did you read the rest of the paragraph that this quote is from? He goes into quite a bit more detail about this and provides several links if you want to learn more.

legerdemain 6y ago
No, I presciently scrolled through the essay to find this particular passage, so I could copy-paste it here, and didn't read any of the essay leading up to this passage or anything after that point. My reaction is an unmitigated hot take that I have taken zero time to consider. Is that the theory you were trying to validate with your question?
- emtel 6y ago
  No, I was actually really trying to figure out why you didn't mention the rest of the paragraph. It seemed like a good answer to your question. If you didn't think it was a good answer, it would have been helpful to know why you thought it fell short.
- civilized 6y ago
  People are just really confused why you isolated that passage for criticism, when it is embedded within a long paragraph that makes it abundantly clear that Scott isn't saying remotely what you seem to think he's saying. He's not denying that he has a perceptible race or a gender. He's saying that knowledge of the therapist can be a distraction, and therapists generally see it as a duty to minimize such distractions, which makes fame an obstacle to his professional effectiveness.
- Klais 6y ago
  I had difficulty writing such a document. I did almost everything I could to do the job, but I did not give up. I couldn't, of course, because I worked hard and almost had no time to read. So I decided to seek skilled assistance. More technological problems I know. I know. Therefore, I suddenly decided to look online, somebody can do well at a low price. Now, I hear that there are many providers providing such a service. But I wanted to buy research paper https://www.wiseessays.com/buy-research-papers https://www.wiseessays.com/buy-research-papers and I didn't make the mistake. They were doing really well, without plagiarism or hackneyed thinking. We could also satisfy the deadlines, which made me very happy.

dghlsakjg 6y ago

It is an ideal, not a reality. The idea is that you can discuss your issues without filtering them through what your perception of the therapist is. e.g. If you know that your therapist is a Christian mother of three, you might hold back on how your mother in law is pressuring you to have more children for religious reasons and you think its bullshit. The issue the therapist wants to deal with is your relationship with the in-laws, not whether she agrees on a moral basis with the in-laws. Therapists need to have a very hard line between personal and professional for their own reasons as well. It is not a business where you want to be mixing different parts of your life. For these reasons it is a reasonable effort to try and remove as much of yourself as possible from the counselling relationship. It's not that the therapist doesn't exist in context, its that who the therapist is shouldn't influence the way you present to the therapist.

waterhouse 6y ago
Now, it would be ultra-ideal if everyone knew and confidently believed that the therapist could and would look beyond her own background—that she would suppress any personal offense and would be good at understanding and non-judgmentally discussing the perspectives of everyone involved. However, I imagine most people wouldn't believe that, and it's probably not true either. Therapists are humans. Of course, this kind of raises the question: So therapists have their own biases and we're just blinding ourselves to which ones they have? Is that actually an improvement? (Cf. the koan where Sussman says "I am wiring a neural net randomly because I don't want it to have any preconceptions".) Perhaps the therapist having to pretend she has no background actually kind of helps her disconnect from it. A kind of theatre. (And maybe the brain having a habit of "when in this office talking with patients, don't connect anything to your real life" is useful.) But I would still wonder if it would work better to bring the issue into the open, and say "Well, I do have this background, which might lead me to think x, but I will consciously try to counteract that." Perhaps there are cases where this second strategy is indeed better (if the patient comes in thinking "I expect almost everyone to be prejudiced against me", and the psychiatrist says "Well, you're right, but I have lots of practice in noticing my prejudices and setting them aside, and it is a point of professional pride for me to do that"), but most of the time it's just faster and less distracting to not mention the issue at all.

nostrademons 6y ago

In addition to what others have said - most of the work you do with a therapist is emotional. It's okay for the therapist to have a skin color, perceived sex, perceived age, manner of dressing, accent, etc. - as long as those things just are. The therapist's job is to stay neutral, to have no particular emotional attachment to any of these qualities. That way, when there is a moment of strong emotion in the session, it's almost certainly introduced by the client, and then can be explored by them. There's ironically a good example of this in the blog post: "For you, the day [I burned] your village was the most important day of your life. For me, it was Tuesday." Therapists can have race, gender, and age in the same way that it can be Tuesday. They just can't have race in the sense of having their village burned. (And FWIW, it's very difficult to have an effective blog devoid of emotional content. I tried once and got accused of being a Markov Chain.)

hinkley 6y ago
Imprinting and transference are real things, and the more you see the caregiver as a fully fledged human being, the more appealing that trap is.
- gugagore 6y ago
  This is just begging the question, I think! Transference being real requires the idea that the caregiver is a blank slate onto which projection occurs.
  - hinkley 6y ago
    Did you ever develop a crush on someone who had a big positive impact in your life? Sometimes it can be difficult to tell if those feelings are about the person or what they did for you. If you don’t know the person all that well, it’s plain to see.
    - gugagore 6y ago
      Did you ever develop a crush on someone you never really interact with, and who had no positive impact in your life? Perhaps someone who has had a less-than-positive impact? You don't know the person that well.

novok 6y ago

Having a bunch of psychiatrists and psychologists as friends (met one, then made friends with their friends) this is a very universal thing among therapists. To the point it's almost regulation via their ethics codes, that they take a test on made by the 'board' of psychology. It's definitely an industry norm. I found out 'the board' is mostly equivalent to Psychologist DMV and is run by the state, and is about as pleasant to interact with.

DanBC 6y ago

You're right, and this very polite lack of awareness of race is one of the huge problems with his writing. Lack of cultural competence causes huge problems for black people who seek mental health treatment. The answer is emphatically not this blank state stuff, but more awareness.

civilized 6y ago
Not sure where you get the idea that being a blank slate means you can't have cultural competence, awareness of race, etc. Some people sure are eager to project onto Scott's words the wrong ways they're sure he's thinking.