Tuesday, March 28, 2023

Comments by Daniel Mackler

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  • Hi Martin — it’s hard for me to know what the case is. It’s possible that they’re right (that you have to feel worse before you feel better) but it sounds unlikely to me. Maybe your therapists aren’t any good — or maybe they’re just a bad fit for you. Maybe there’s a good one out there for you. Or maybe there’s something else that you need to do that would be more helpful than therapy. I don’t know what that is. I thought I was a pretty darn good therapist but I didn’t help everyone I met. And I know things other than therapy helped me, and continue to — it’s just a question of finding out what those things are…. all the best, Daniel

  • hmm, i don’t really know much about prakash ellenhorn. i’ve never visited there. i seem to have some memory somewhere that one or more of their staff did the open dialogue training with mary olson. but i am not sure. i think of them as being one of the more progressive treatment centers in the USA, though often that doesn’t say too much, because for starters there’s not much that’s really progressive in the USA (or anywhere), and also many of these places try to be progressive (some do better than others) but still get very stressed out working within the confines of the super-screwed-up mental health system………. wish i had more for you. daniel

  • hi becky
    i haven’t read my article in a while, so i don’t know if i said it there, but when i became a therapist at first (when i was 27) i was terrified of the things you mentioned. i also looked very young, younger than my years. and i was working with people older than i was — vietnam vets then in their 50s. i used to get down on my knees before sessions (early on) and just pray (i didn’t even believe in god) that i could make it through a session and keep my wits about me. then i’d just plunge in. there’s no way to get over the fear other than just doing it. that’s my experience. also, one thing i came to realize over time is that the people who are coming in for help, to talk, to reveal themselves and their deepest problems, are much more vulnerable, in most cases, than we are as therapists. so i think when we can empathize with the inherent anxiety that most people go through coming to a new therapist — so stressful — it can make it easier for us to calm down, be in our own skin, and listen to them…and be there for them. just thoughts… oh, by the way, don’t know if i said in the essay also, but i did from time to time have people comment that i was too young, and sometimes i got fired by clients over it. but others liked me looking young. they felt safer. also, i know some older therapists who get fired for looking too old. so it goes both ways. all the best! daniel

  • Sera,
    i have such respect for you and what you have written. i also have seen different incarnations of this “hot stove” film and i couldn’t stand it — for the reasons you described. i found the film, and the creators’ reactions to the criticisms of it, disingenuous. also, i wish the filmmaker, Sheryll Franko, were involved in this discussion. i do not know if she understands the subject matter well enough to realize what she got herself into, or if she actually believes that people like lieberman actually have something valuable to say. but i think it’s also not fair for alice maher to put some of the blame for the film on her being “young and inexperienced”. if i were Sheryll i would be troubled by this.
    -Daniel Mackler

  • hi aminaoboe — greetings to you. thanks for you comment. at the risk of sounding cliche or simplistic, i would have to say follow your heart!! i was called to be a therapist — a calling from within — and my leaving being a therapist was a calling also……..a calling to a different life, which i’m still exploring. meanwhile, i think it’s great that you play oboe. what a wonderful instrument. i spent my day playing guitar and singing 🙂

  • hi mark,
    well, i’m glad to hear you meet most of the criteria — sounds like we probably agree on a lot then! as for the parent one, i do have many friends who are therapists i consider pretty darn good who have kids. and i recognize that that criteria probably seems out of left field, especially since i didn’t explain my reasoning behind it that much. if you’re curious to hear more of my point of view on parents and parenting feel free to check out my website. ( http://www.wildtruth.net ) maybe my point of view would seem less bizarre then? all the best, daniel

  • greetings John — thanks for the comment — and the ideas in it. well….feeling better after each session…… in a way that makes sense, but also…..sometimes hell comes up in healing, in breaking dissociation, that is very painful……facing previously denied horrors……that could make people feel a lot worse, at least in the short-term. but even feeling those feelings makes some people feel more alive, more on the path to being integrated… daniel

  • hi alex,
    i think we differ in opinion on mother teresa. but just because we differ doesn’t mean that i diagnosed her, at least diagnosed her in the psychiatric sense. i feel i am using my critical judgment about her, and i stand by that. i see nothing wrong with that. would i also be diagnosing hitler if i said he was a callous, out-of-control monster who never dealt with his childhood history of severe abuse and played it out in the most horrendous and brutal of ways? and i never met him either. and i don’t think it’s being judgmental either, rather, again, using my judgment.
    all the best,
    p.s. mother teresa’s rather uncritical biographer, by the way — someone who, from what i remember, really liked her — made many of the same points about her that i did (her inconsistency, hypocrisy, etc.). so i didn’t pull this out of nowhere.

  • thanks for your comment julie — wow! i agree with a lot of it, for sure. however, i don’t inherently see therapy as a form of prostitution, even if a lot of therapists are bad bad news and do prostitute parts of themselves in nasty ways. also, just to be clear, i didn’t say that all therapists who have kids are bad therapists. in the essay i wrote: “And there are some therapists who have kids whom I think are far better than average, even brilliant in some ways.”
    greetings to you!

  • thank you for your comment, Uprising. the things i wrote in this article have not been abstract for me either, which is why i feel inspired to write about them. by the way, i also think it’s terrible to railroad someone into blaming someone for their problems — or railroading anyone into doing anything…

  • Hi Sharon,
    i am curious about this comment, and i would be glad if you would elaborate more, because it seems basically impossible for a therapist who respects and understands the people he or she works with, listens well, develops a good relationship with them, cares about them, honors the pace of their growth process, and doesn’t force anything on them to turn therapy into a “god-forsaken, demeaning, horrifying” experience. Or did i misread what you wrote? the only way i could imagine such a therapy becoming a horrible experience for people is if the caring nature of the relationship somehow facilitated the eruption of so much buried, forgotten trauma in the client that it completely overwhelmed the person and retraumatized him or her. but even that wouldn’t likely make sense to me if the therapist was really good, because a good therapist (as i define a “good therapist”) would sense that possibility before it happened and would help the therapy go at a slower and thus non-retraumatizing pace.
    wishing you the best,

  • hi Getitright —
    just to be clear, i never said (much less assumed) that all childhood trauma “boils down to bad parenting”. that would be a very simplistic thing to say. there is too much evidence to the contrary. but a lot of it does, for sure. after all, parents wield more power and control over a baby’s and young child’s life than pretty much anyone can possibly wield over anyone else. and even if people who are not the parents are more clearly the traumatizers of a child, it’s often not that hard to see how parents had some (or a lot of) influence in setting up the dynamics that led to this abuse, through intent or neglect.

    i see in our world, though, that there is often a big push to let parents off the hook, in one way or another, for the damages they cause either directly or indirectly.

  • Hi Alex and Getitright,
    greetings! the coercion part is true — i’m definitely against people/therapists who pressure others to forgive, even subtly pressure it. i think that is very common. the deeper part of what i’ve observed, though, is that often forgiveness leads to a sort of pseudo-healing, more of a burying of the hurt, a burying of the grief process. it feels good, it makes people and families more comfortable, but it doesn’t really resolve the traumas. i’ve seen many people become comfortable in a state of what is known as forgiveness, very happy. it’s really a state that very much coincides with the ideals of normalcy. and i think the grieving process is much much less so.

    as for mother teresa, i think she was a very disturbed woman. very split off from her feelings and her own healing process. i always felt this about her until i read her biography — not even a particularly critical biography — and saw how troubled, inconsistent, and even hypocritical she was. often the people who are very split-off, though, seem quite healthy. it was people like mother teresa who helped me see more clearly just how much being dissociated can mimic a state of self-actualization…

    all the best,

  • hi duane,
    i don’t totally agree with what you wrote here (though thanks for the comment!), however, one part does resonate with me: the part of the massive responsibility that comes with being a parent. that’s a big part of why i think people, especially those who have young children, when the responsibility is greatest, shouldn’t be therapists, which bears a lot of similarity to parenting, with the devotion and responsibility required.

  • thank you. Interestingly, I’ve learned a lot about being a therapist since i formally quit being one. there are many things i wish i had done differently. i think i did a lot right, but some not. i basically had no great role models (and not for lack of trying to find them) and was following my heart — and also doing a lot of self-reflecting on the process. i also had some really good friends who were insightful who gave me good guidance. and i learned a lot from my clients. but what a tough job!!!

  • p.s. hi ajewinisrael.

    a quick addition: you wrote: “So I don’t agree that children/spouse suffer from a parent being devoted to his job, as long as it doesn’t go overboard. I would say the opposite – that it’s complementary.”

    in most cases i agree with you, but i see the job of therapist as not a normal job. i think it’s more than a job. therapists who treat it as a normal job, and not a calling, well…i basically don’t see them as being much good.


  • hi ajewinisrael–
    you wrote: “I would add that in my experience, having kids opens a person up to levels of compassion for others that people without children don’t easily access.”

    i would actually agree with this. there are many things that that people don’t easily access — and i think i make this clear in the essay. i think for many people having children is simply the easier way. but that doesn’t, in my experience, mean that easier equates to better. i think the more difficult way is actually the much more real and honest way. i think for many people having children is like an addiction — like a drug. it’s an easy access a lot of feelings, but not a solution. the tough inner path, through healing traumas, resolving one’s own childhood dilemmas — not using having children of one’s own as props — that is the solution i’ve seen. that doesn’t mean that most people who don’t have children do this. from what i’ve observed most don’t. it’s too difficult.

  • hi duane,
    this seems like an odd admission to me — odd in that you don’t see a problem with it. basically, you did little or no growth or recognized no growth in yourself until you had a child? that seems very unfair to your child.

    i have heard similar things many times, though. people often say that they didn’t start getting their life together until they had a child. the subtext i read is that they’re using the child to provoke their own growth. often to me it’s a signal that a person doesn’t see a problem with using the child for his or her own purposes. much more fair is to grow up before having kids. people do this, after all.
    all the best

  • hi bpdtransformation — thanks for the comment. i am serious about what i wrote about parents. and you’re right — i don’t see a large pool of potentially great therapists. but the therapists are not “tainted” by their offspring. better put would be “their potential quality as a therapy gets tainted or limited by the fact that they’ve had offspring”.

    the evidence i’ve seen is my observation about people — that once people have children it locks in place a lot inside them such that there are many emotional places they can’t go…and things they can’t see. that of course is not to say that all people who don’t have kids can suddenly go to these places, because, as i suggested in the essay, this isn’t true either. that’s why i say having kids “stymies their potential” — blocks the possibilities of what they can do. that’s what i’ve seen.


  • hi frayed — alas, i think the therapist you described is all too common…..all that fakeness and fake empathy. i do know some therapists who are not like that — and some who i consider to be excellent. but not many!! that’s why i think trusting one’s gut is so important — it weeds out these creepy fake people pretty quickly. wishing you the best — daniel

  • dig it, sera. yes, and i have been to some conferences that moved me. however, even at the better or best ones my favorite time has always been the off-time, when people just hang out and talk….. i might someday like to create a conference with just a few speakers (ones who know how to give a good, unique talk, people with a dramatic flair) and the rest of the time just open for hanging out, talking, eating, getting to know…. just an idea…. always glad to see what you write —- daniel

  • nicely said, Sera. i think what you described is right on the money, and the way you described it is fair. as a slightly side note, i have pretty much grown to hate going to conferences, or at least most of them. all the fake hoopla, the “wow i learned so much” when i can’t quite figure out what was remotely new, and all the self-congratulatory pride that “we can all put aside our differences under this big tent.” i think there is something about coming together to fight a common enemy and stand up for a common cause, but i think a lot of times those are just surface efforts, and underneath it after the conference ends it’s just back to the same-old, same-old…….
    greetings to you —- daniel

  • excellent article. thank you. scary that ISPS (the organization that first connected me with robert whitaker, back in 2005) wanted lieberman to be a keynoter at their big NYC conference last month…”to dialogue with him.” like that was ever going to happen… regardless, he dropped out before the conference. scary guy…but not coincidental that he rose to power in his field of choice, psychiatry.

  • cool to hear jaycee. i know less about what’s going on in the UK than in the USA. i do know some about the UK training, though. i would imagine they are certainly using some of the OD principles — and i really wonder how it’ll go with people going through a “first-episode.” if they’re really going for it that’s great news 🙂

    thanks 🙂

  • great article, sera. it would be a disaster if the western mass RLC had this budget cut. i consider the western mass RLC a flagship community — one that does so much good on so many levels to so many people. i share about your work all over the world — as an example of what can be, and what can happen when people come together with strong common values and actually live them. the evidence i have is not in numbers and figures, it’s in getting to know the people involved, feeling the passion, and realizing that a whole new way is possible.

  • sandra — i’m with you — i like what you say. i also think what you write is so true: “we live in a world that wants evidence.” i think that is what makes me sad — that we have this real evidenced-based program in western lapland that demonstrates just how good therapy and minimal or no meds can be for folks in an initial major crisis, and yet it gets poo-pooed because in part because it hasn’t been replicated, yet the people who are on the front lines with the best ability to replicate it and help others replicate it (the open dialogue trainers and many of the trainees, etc.) aren’t taking a strong or smart enough stand. as an example of this, i read over that umass “adaptation” study and had to blink my eyes. it’s like, who designed that? and why? it’s like, finnish open dialogue created their famous study with people with first-episode psychosis — people who are a lot easier to help therapeutically than people who have been medicated for a long time. the umass study seemed to be all about the latter, not the former. that’s a totally different client base, people much much harder to help to “recover fully.” my two cents: if the goal is to get a strong evidence base for programs that can really help a high percentage of people “with psychosis” — a very important goal, to my mind — we should clearly be designing programs for the people who are the easiest to help — the people in a first-episode. and we should follow the finns and try to do it with little or no meds. and if it’s not political or hard to implement then i think we just need to try harder and work smarter and more creatively. it isn’t impossible. i’m all for trying to help everyone (and as a therapist i worked with many people who had been in the system for years), but i think the point here is to think with more of a long-range view — that is, more strategically. otherwise we’re putting in a lot of energy into programs that will add little or nothing to the evidence base and will do nothing to help change the system.

    i find that disappointing. and it really brings many questions to the front of my mind. are the people who designed these adaptation studies naive? or are they just not so strong at the politics angle, and thus making compromises in the basic designs of the programs?

    i remember when i screened my film open dialogue at Advocates, Inc. about four years back and i talked with chris gordon about an open dialogue study he wanted to spearhead. he asked me what i thought was the most important thing for the study in terms of making it valuable. i said: “insist on working with people in a first episode — and try like hell not to medicate them. and after that focus on all the open dialogue stuff.” but as far as i know it never happened. to me that’s sad.

    to me the original soteria study from the 70s and early 80s still provides more of an important evidence base than any of the open dialogue adaptations.

    but anyway, i’m babbling — it’s late for me. bedtime.

    i thank you for participating in this dialogue — and i do wonder what you (and others) think of all this. i’m sticking out my neck to try to make these points as clearly as i can, and now my neck just needs to lie on a pillow for a few good hours.

    warm greetings,

  • hermes — yep, you put it simply and to the point. and when people—even progressive mental health folks—avoid what you’re saying it makes it easy to jump on the “open-dialogue-as-panacea” wagon train. but what kinds of results will “open dialogue” get if they do use neuroleptics a lot? not so hot. i simply cannot see it otherwise. yes, people like open conversations — and i believe they are a good thing — but i simply cannot see great hope and great outcomes à la Finnish Open Dialogue when people are more medicated. i thought this was rather obvious, but i guess, considering what’s been happening in the spread of open dialogue, that it’s not so obvious.
    all the best to you,

  • hi alex —
    thanks. but i don’t know that many others do agree that i’ve done so admirably by posting all this. from what i see, most of the response here to this essay has been silence — and a rather limited discussion about the points that i’ve made. basically no one directly involved in open dialogue work has commented at all here — aka no dialogue. one might say that’s because i’m a bit rude or something like that, but i think it’s because it’s too hot-button of an issue and they have their work to protect. easier to stay silent, keep on doing the same old limited thing, and not really fight to change the system. comfort rules. that’s my take on it. a big missed opportunity — a disappointment.

    thanks for what you’ve shared — appreciated!!

  • hi ron,
    i also like the idea of promoting open dialogue and bringing it into wider use. i’m all for that. but when some of the most known stuff with the new open dialogue studies don’t even primarily work with people with “first episode psychosis” — let alone “first episode” with minimal or no meds — then i think, what’s the point? also, i think the effect of this can be negative, because clearly they’re not going to get the great results they got in finland, which just leads more and more people to believe that the great results of open dialogue are just finland-specific. that’s a major missed opportunity.

  • nicely said, Alex. and i’m glad the discussion has been helpful to you. it has also been helpful to me — but stressful. yet worth it. i feel for me it is often easier to “call out” the big bad enemy — traditional psychiatry, big pharma, etc. i think this essay and discussion are a bit more nuanced for me. yes, of course i still think that the big bad enemy is still big and bad, but the stress for me is, to a degree, calling out our allies here — and ourselves. i have learned so much these past few years, after making my films. it has opened up a new world to me, and also thousands of people and their experiences and lives. but i guess what i’m coming to is that we — “the good folks” 🙂 — have to be smarter and wiser in moving forward. and i think sometimes that’s not easy. in fact, extremely difficult, given the challenges of changing a system. when i first became a therapist i was interested in working with individuals — and at times individual families. now that has shifted for me. yes, i still see the profound need that individuals and families have, but i’m more interested in changing systems — and so i’m interested in strategy also. i think that’s where this essay is coming from… what we might be doing that’s a bit off-track, and what we might also be doing better. i think it can be politically incorrect in a sense to critique or criticize our own allies — and that’s the stress for me — yet…..i think it’s a good thing. after all, the typical traditional psychiatric criticisms can be so stupid as to be useless. so…….i guess what i’m saying is that although this is stressful for me — writing this, reading some of the responses (as it kicks up stuff from my childhood — painful rejection for opening my mouth) — the fact that it is useful to some people makes it worthwhile. so…..thank you!! daniel

  • thank you Eugene for this post. you said many things that resonate with me. i would like to focus on one, because it (and others’ posts here) have help me clarify some ideas in my head. you wrote:

    “Where things get difficult (if not impossible), is on the level of implementation and system change. The manifold efforts to transform psychiatric (revolving door) in-patient treatment as well as biologically oriented out-patient treatment have proved to be disappointing at best.”

    yes, to me that is the big problem. and here is the idea that nags at me. as i see it, the real challenge in changing psychiatry for the better as regards Open Dialogue is to get it implemented at a systems level — with people in “first episode psychosis” with little or no meds. training individual clinicians to do better family therapy and to have more of a broader, needs-adaptive approach is nice and good and helps some individuals, but it doesn’t really do much to change the system at all, especially since most of these clinicians aren’t even from the same working system. the problem as i see it, and which in part has inspired this article, is that Open Dialogue has become a sort of fad, partially for some very well-deserved reasons. what i don’t like about this fad is that in the midst of the buzz one of the main points get lost — system change!! that is the great opportunity with open dialogue — an inspiration to change systems beyond western lapland, and ultimately to change the whole system. instead, though, more often open dialogue gets reduced to just minor system change and some hope for individuals who want help now for their families and their own individual selves. even some comments here in this comments section reflect that — and it makes sense. people want help now for themselves. i get that. i get emailed constantly by people who want this.

    i think, though, that the people who bear the torch as Open Dialogue leaders (in the USA, those who have branded the phrase “Open Dialogue” for their own exclusive, proprietary uses) have an obligation to do more than just train a few clinicians and perhaps spearhead a rather weak pilot study here and there that can’t hope to get results anywhere near what they’ve gotten in Finland. to me anyone who wants to brand Open Dialogue has an obligation to do a lot more than this, and to be real leaders. otherwise, i believe, their use of the name Open Dialogue just becomes self-serving — and diminishes not just what Finnish Open Dialogue, on a systems level, is really about, but what Open Dialogue in general really could (and should) be.

    thanks for giving me the opportunity to share this!!!

    all the best — and greetings from rainy NYC,

  • greetings marina. yes, the finnish open dialogue therapists were lovely and to my mind their work is radical. but in some ways they are just a regular system, or were when i was there. there was no peer support when i was there, not even much or any knowledge of it from what i remember. and even though there was a flattered hierarachy of power in many ways, there still was a big difference between clinicians and so-called clients. also, the idea of filming clients, especially those in “extreme states” is a complex one everywhere. some places were okay with me doing it, others clearly not. perhaps if the folks who were the leaders of finnish open dialogue had gotten to know me better and trust me more they might have allowed me to ask people who were coming for help if they wanted to be filmed. but they didn’t know me well at all when i arrived — in fact, no one in western lapland knew me in person at all!! i had met jaakko seikkula a few times before i went there, but he wasn’t even in western lapland then, because he’s a professor in jyvaskyla (maybe 500km away). but i always appreciated him and the others welcoming me to western lapland at all, because i have some pretty antipsychiatry views, so that was a risk on their part. greetings from new york!

  • good question john. it bummed me out that i wasn’t allowed to interview families and people in crisis (aka clients) on camera when i was in finland. i was told i wasn’t allowed to do it, mostly for reasons of confidentiality, but also because they didn’t want people in crises or families to feel pressured to talk with me. basically, they didn’t give people the opportunity to say “no” to me. i can kind of understand it, but at the same time i much prefer to give people the option to decide for themselves. that said, i accepted the stipulation because i wanted to do my best to make a film that represented their work, and if i had fought on that issue there probably would have been no film…
    greetings to you — and great article you just put up!

  • that’s part of my point, carina. the other part, ron, is i question how much of what gets legally brand-labeled as “open dialogue” really does emphasize some of the most important things that made finnish open dialogue famous — like not medicating folks (or seriously minimizing antipsychotics) who are experiencing a “first-episode”?

  • you wrote: “I think that having a conversation with family members and the distressed person when the family might have been abusive sounds potentially ok to me.”

    i agree with that — as long as the person “in distress” wants that conversation with the family and it’s not being forced on them. i think those kinds of non-forced conversations can be very healthy and helpful. nice to hear from you, john — daniel

  • Susan and Matt — this is a beautiful piece. Susan, I am forever grateful for the opportunity you gave me to be a part of the Soteria-Alaska family, and Matt — it was wonderful to work with you. Thank you both.

  • hey, dig it julie!!! good to hear what you have to say, and i’m really wishing you all the best on your journey. and i also admit, the idea of giving hurt kids an hour of respite a week is not all bad, that’s for sure!!!
    happy new year,

  • greetings petra. having the boundaries the way i did it was tough — i’d probably be somewhat looser if i did it again. but also i needed some boundaries, and couldn’t just be regular friends with people. some formality was necessary, at least for me, especially just to help me organize my time and optimize the focus of the work. but it did make it kind of artificial, for sure. but i also think it’s kind of artificial to sit for forty hours a week and listen to so many people’s problems and healing processes — so maybe some of the artificial structure reflected that…hmm……not sure…. daniel

  • i see good therapy as a lot more than just doing meta-help and waffling and then collecting cash. that sounds like bad therapy to me. but i also don’t see therapists as “giving” people jobs and homes — though maybe good therapy could help people, even homeless people, attain those things. i’ve seen it.

  • hi sandra,
    i so want to write more and more and more in response, and yet i have to go to bed and catch a plane in the early morning — and then i’m going off the grid for ten days!!!! i hope this isn’t seen as a hit-and-run blog piece by me — not intended that way at all. i will be back in ten days!!! what i want to say is this: i am VERY glad you posted what you did in this blog’s comments. i think you have dramatically improved the dialogue here, and in fact may even be responsible for it becoming a real dialogue. meanwhile, i had no idea what people would think of this piece i wrote. yes, i was mad when i wrote it. very mad. (that is part of my personality.) but what i figured was, “a piece i wrote when mad should somehow find a home on ‘mad in america.’ ” and it seems it has. i respect robert whitaker for letting it stay up. and i respect you for writing about your lack of indifference to it—and for taking what i perceive to be a leap into some pretty hot waters. and then returning to write some more. thank you.
    well, i’m off to sleep—big day tomorrow! and i hope to connect with you more.