Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two)

Interviewer: Scott Douglas Jacobsen

Numbering: Issue 16.A, Idea: Outliers & Outsiders (Part Twelve)

Place of Publication: Langley, British Columbia, Canada

Title: In-Sight: Independent Interview-Based Journal

Web Domain: http://www.in-sightjournal.com

Individual Publication Date: March 1, 2018

Issue Publication Date: May 1, 2018

Name of Publisher: In-Sight Publishing

Frequency: Three Times Per Year

Words: 5,542

ISSN 2369-6885

Abstract

An extensive interview with Dr. Oren Amitay, Ph.D., C.Psych. He discusses: current tasks and responsibilities and his process; clinical and teaching work, and the different therapies such as  Rational Emotive Therapy, Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, etc., having overlap; and additional services within his professional work and much of the work as re-parenting the patient.

Keywords: clinical psychology, media consultant, Oren Amitay, registered psychologist.

Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two)^{[1],[2],[3],[4]}

1. Scott Douglas Jacobsen: Now, what are your current tasks and responsibilities when you are dealing with up to 30 patients and teaching? Can you walk us through that process? Your style in which to engage patients as well as style in which to engage students.

Dr. Oren Amitay: Right, so, for my clinical practice, thank God for my wife. She found me another office nearly two years ago that is more convenient for me and is available 24/7. Before that, I was at my mentor’s office. Because I wanted to keep as many days free as possible to teach, do assessments and write up reports, I would schedule all of my patients on two (or sometimes three) days, meaning that I would see them straight from 8 or 9am until as late as 10 or 11pm.

With this new office my wife found, I can see a few patients here or there at any time throughout the week. Plus, I still have one long day at my mentor’s office, but it is not as bad as it used to be.

As for my clinical work, I see individuals, families, and couples. I do sex therapy. I do relationship counselling. I do family therapy. I used to do group therapy. I incorporate eight different types of therapies or orientations, some of which overlap with others, so they are not entirely different.

As my mentor taught me, part of the therapy is technique but another aspect is adopting the right mindset, understanding a person from a certain perspective and seeing how they came to be rather than using specific tools and techniques. But I definitely need to use the various techniques and tools I have learned as well. It depends on the person, their situation and their needs.

And, as research clearly shows, the most important part of treatment is the therapeutic/working alliance or relationship. It is critical that the patient feel safe and not judged at all. This latter part is easy for me because my upbringing was so “different” that I don’t know what “normal” looks like. And my patients can sense this with me. So there is no judgment, although I make sure my patients know that I will not blindly accept anything they say or do. That is not genuine compassion and it is usually not helpful.

I should add that my parents told my brother and me when we were kids, “We don’t know what the hell we are doing.” My mother had given birth to me shortly before she became 22 and my father was a “crazy hippy artist.” They explicitly encouraged us to always question or challenge them.

I have a memory of them saying that so I was probably about four or five years old. The most important point about them saying such a thing is that, growing up, I never internalized their craziness, their many problems or their bad parenting. I knew that those things were on them. Now, that doesn’t mean I didn’t develop my own neuroses and crazy traits. But it was never because I blamed myself for my parents’ many faults and failings.

The one problem was that, notwithstanding my parent’s encouragement to question or challenge them, my mother didn’t like being challenged. But I was too stubborn and kept challenging her; I never stopped. Her responses to my challenging her were never appropriate, nor were here responses to the very many bad things I did; the punishment was always extremely disproportionate to the crime. But again, I knew she was not acting like a good parent. I always knew I was doing something wrong and I chose to do it, hoping that I would get away with it or that I could talk/lie my way out of it if I got caught. But I never thought I was so horrible that I deserved the kinds of things my mom said or did to me when I pissed her off.

The reason I am saying all of this is that it had a huge impact on how I saw the world, how I saw myself. It did something to me and for me. Interestingly, even though I thought I was always able to recognize and to admit whatever I had done—to myself, that is; I would often lie to others in order to avoid some negative consequence—the crisis I had mentioned earlier caused me to realize for the first time in my life that I was not being 100% honest with myself.

Immediately following the third horrible session with the aforementioned psychologist I was seeing after those major failures that had occurred within weeks of each other, I spontaneously had a moment of profound insight. It inspired me to come up with a thought exercise that, for the first time in my life, showed me that I had not been seeing things as honestly and clearly when I had conflicts with people as I had believed.

Sadly, I did have very many interpersonal conflicts and I never adequately appreciated the nature and degree of my role in all of these unpleasant interactions. On that day, however, I realized, “Holy shit! I am so far off the mark.” Once that happened, I finally fully accepted how messed up I was, how much of an asshole I was, and so on.

It was enlightening. It was amazing. I couldn’t believe it. It was a weight off of my shoulders because I was no longer carrying any self-serving “delusions.” From that point on, I dedicated myself to making sure I never employ any (unconscious) defence mechanisms. I see myself, my actions and the world around me as “objectively” as possible, no matter how ugly, shameful, embarrassing, scary, distressing, discouraging, etc. any of these things might be.

I am able to look at these things—including my patients—without negative judgment. Rather, I accept everything for what it is and focus on making sure that I or my patients are making the most adaptive decisions in light of the reality of my/their actual thoughts, feelings, motives, actions or circumstances.

My patients know they can tell me anything. Not everyone feels comfortable doing so at first, of course, but most feel that they can open up and say things. I relate to them in a human-to-human way. I tell everybody, “Look, I wish I was as good of a father or husband as I am with my patients. I wish I could be that open, non-judgmental, and so on, because I am a judgmental asshole in my normal life. I try not to be, but that is part of who I am.”

I have to work on that. With my patients, it is suspended for that 50-60 minutes with them. I am there for them. I am very Rogerian in that sense. It is empathy. I always tell my students and the people I train, “As long as you can make the other person feel you get them or are doing your damndest to try to get them, everything else is gravy.”

If your only value is being empathetic, you will not be the greatest therapist, but it is the first step. I know many psychologists and psychiatrists who are horrible when it comes to being genuinely empathetic. However, some of them have mastered their technique, which gives them a sense of confidence, and that can have a positive impact on the patient. It can help the patient develop a sense of “I can do it.”

But I have literally lost count of the very many people who have told me horror stories about their experiences in treatment. Look, this is the last place that you would ever want to be judged. Sadly, far too many therapists do make their patients feel judged or demeaned—usually inadvertently.

As alluded to above, I am very empathetic but I do not let my patients live in fantasy; I call them out in a compassionate manner. They know I will do this and they know that everything I say or do is without any bad intentions.

As an example, I tell my students, “When certain patients with a history of bad relationships tell me excitedly that they have met a new person, the first thing I ask them is, ‘What are you going to do to mess this one up?’” They sometimes get shocked or upset. But they realize why I am saying it. If they don’t get it, I explain the reason for such a question.

That is, when you have a typical conversation, you are processing things on one level. If I say something that is a little bit “off,” unusual or otherwise unexpected, you will hear and process things a little bit differently. In the example I just gave, my blunt question puts them in a different emotional state and makes it easier for me to penetrate or to circumvent their defences. It also forces them to reflect on and to recognize what they bring to each and every relationship that they have ended up sabotaging.

For instance, they might end up saying, “Oh, I didn’t know I put up huge walls,” or “I had no idea my supposedly witty comments were actually insulting to someone on a first date.” It is a cliché, but you truly cannot change something if you are not aware of or cannot admit what is wrong.

Helping people acknowledge their flaws in such a way that they do not feel you are merely mocking, criticizing or devaluing them is what will help them make the kinds of improvements they need to make so that they can function better. This is true compassion.

It is funny because many people who love Dr. Jordan Peterson believe he is saying that compassion is bad or not a desirable trait. However, that is a misinterpretation of his message. That is, compassion is very important if employed properly, and Dr. Peterson himself is compassionate with his patients and all of his fans.

What he describes as “bad compassion” is when you are not telling people the truth, even if it may be painful to hear. Or, as their parent or teacher or anyone else in a position of authority, you are “spoiling” or disempowering them by being too lenient or indulgent, or you are being too intrusive and solving all of their problems instead of letting them figure things out (with some guidance) so that they can learn to deal with failure or other adversities. This enables them to become more resilient and resourceful, and we hope to become the best person they can be.

Part of this process involves helping people learn to tolerate discomfort. That goes along with finding the will and the courage to confront whatever it is they might need to confront, whether it is an illness or how shitty their parents are or their bad behaviours in relationships or the realization that their meaningless job is slowly robbing them of the will to live, or whatever.

Whatever it is, they have to learn to confront and to tolerate it. It grounds them. That is one thing that I do. Another thing that I do, and some of my colleagues think I am crazy for doing this, is something that is similar to the system for Dialectical Behavioural Therapy for borderline patients.

I don’t know how it is in other programs, but in Toronto where one of the earlier DBT programs were established, they originally had a pager system. Patients were able to call their therapist at all hours of the day or night and they could expect a call back within a relatively short period of time.

I do something similar, in that I am available 24/7. A few patients take advantage of this but most respect my rules and boundaries. That is, they can reach out to me by phone, text or email at literally any time of the day, whether it is a crisis, they want to vent instead of saying or doing something that they will later regret, they want to share an insight, they remembered something they forgot to say in therapy, they want to suggest something for next session, etc. They know I am not necessarily going to answer or get back to them right away, although I do try to be very responsive.

My mentor was against this because he didn’t want them to develop a sense of overdependence on the therapist, which I fully understand. I tell my patients, “I am not expecting that you will have to call me, but if you ever feel the need to reach out, please know that I am here for you.” And that feeling that someone is out there who “has your back” can be very empowering; it can make you feel that you are a valuable or worthy person who deserves not to mess up your life or to undermine yourself.

Especially with technology, many people have a tendency to act on impulse and send texts or make calls that they really should not do. I tell such patients to text me instead because by doing that they’re taking themselves out of that moment where they are likely to sabotage themselves in some way. If they can step back and not act on emotion right at the moment, that gives them a chance not to be a slave to their limbic system and instead to access their frontal lobes or prefrontal cortex: the part of the brain that controls impulse and enables one to exercise more rational thinking and better judgment.

In short, it can help defuse the momentary urge or compulsion, which is when people often get in trouble. It is similar to the DBT model, which in turn seems a lot like AA. One of my former students, who is in AA, got really turned onto the DBT model when I taught about it, and now he is an expert in it. But when he first looked into DBT further, he came back to me and said, “This is fucking AA” [Laughing].

Jacobsen: [Laughing].

Amitay: He was actually right. A lot of DBT is like AA in some key ways, including the aforementioned “pager” system, which is like “sponsors” in AA. As mentioned, when you are in that rough spot and know somebody is out there to help if you reach out, it can be extremely helpful.

Believe it or not—and this makes me sick to my stomach—I know some therapists who will say, “That was a 10-minute call. We will pro-rate it at $40.” Come on, really?! Jeez. They do the same thing with emails.

If I charged for all of my emails, phone calls, texts, and other things I do for my patients outside of session, it would increase my salary substantially. But I do not need that extra money. I make more than enough as it is. I think it is important that my patients know I do this for them, even though I do not have to do it, and many therapists do not.

Plus, my patients can’t say, “Oh, you are only doing this because I am paying you.” Some do say that about our work in therapy, but with this system, I can say, “I do not have to do this for you; I could spend my free time not thinking about you at all but I do it because I do actually care.” Sadly, many people do not have that feeling that even one person cares about them and/or has their back.

2. Jacobsen: Between the clinical and the teaching work, some things come to mind on reflection. One, the relationship between Dialectical Behavioural Therapy and AA, and the comment, of the person that you knew, that they were basically the same.

Do you think between things like Rational Emotive Therapy, Cognitive Behavioural Therapy, DBT, etc, that there is a lot more overlap than there needs to be in the sense that they do not necessarily need to be disjunct?

Amitay: Yes, I have said this many times. When someone comes up with a “new” therapy or “new” approach, they are often pretty much reinventing the wheel. I prefer to take “the common factors” approach: You look at “What are the shared or common elements in the various therapies that make them effective or beneficial?” Is it the therapist? Is it the approach?

I spend a lot of time criticizing Cognitive Behavioural Therapy in my classes. However, I also tell my students that it is one of my eight orientations and, if someone were to say to me, “From all of the orientations you use, if you had to choose one for yourself, which one would it be?” I would say, “CBT.” Currently, I would also say ACT/Acceptance Therapy, which is similar to CBT in many ways but deals with emotions and other important elements better, I believe.

I tell my students that my criticisms are not about CBT itself but rather about therapists who focus too much on the technique or structure of CBT, to the exclusion of being able to really connect with and to understand their patients. For example, with “CBT for depression,” it may be 16 sessions. Session 1, you do this. Then session 2, 3, and so on, you do A, B and C.

A therapist who does that too rigidly is not a good therapist because mental health issues, therapy and life are not that neat. Yes, treatment should be evidence-based, but we need to also recognize that the work we do is often messy because humans are “messy.” You can’t always do things according to set schedules and expect them to progress as you would like.

That is what worries me: when people are such strong adherents to one approach or the other. If the patient does not act as the therapist expects, they often make the patient feel incompetent, devalued and demotivated.

And, as mentioned earlier, all of the evidence shows that the therapeutic relationship is the most important element of successful treatment. So, to me, it is recognizing the underlying factors that are common to most or all major therapies, having an adaptive personal philosophy, understanding how humans work, having a very strong knowledge base with respect to psychotherapy, and trying to find an approach, technique, and so on that might be most appropriate in a given situation.

Now, my mentor used to say, “Anyone that calls themselves eclectic doesn’t know what they are doing.” He believed that you should not take different approaches to working with a patient because it can make them feel confused or even overwhelmed if the therapist is trying a bunch of different things each week. Patients want a sense of stability and this can undermine such an atmosphere.

I can understand my mentor’s point because I do know some therapists who do that. One thing didn’t work this week, so they try something entirely different the next week, and they do this in a way that makes the patient question the therapist’s competence, confidence and/or effectiveness.

I tell my patients at the beginning that I have eight different orientations from which I operate and, as we work together, I will be able to determine which approach or technique is most appropriate for the person and their circumstances.

I also tell them that, sometimes, we operate on a more behavioural level, whereas at other times we will go to a deeper level. I add, “We do not always have to go to a deeper level or go back to your past in order to deal with your current issues adaptively.”

3. Jacobsen: If you had a knife to cut vegetables or an ax to cut a tree down with, and you’re stuck in the forest and all you have is a can of soup, at some point, you use the ax or the knife to cut the can open.

The techniques are tools. You use them as you deem fit or as the patient needs. There was something that I thought was particularly noteworthy, which you mentioned. You’re permitting or allowing patients to text or email you.

In other words, to stay in contact with you over some period of time, which they may deem important, they may be in an emotional moment. They talk to you instead or text you. Is there a sense that people who have particular problems, even disorders, are somehow having a loyalty lack in their lives, where you are providing that additional service within your services is seen as extra beneficial?

Amitay: For a lot of people who don’t have that at all, yes, it is just the idea that someone is willing to do that for them. Research shows, by the way, when it comes to social support—and I tell people all of the time, “All you need is one person in your life who you believe has your back. They don’t even have to have actually helped you. Simply this positive belief is often sufficient.”

And that is why I allow patients to reach out to me in various ways outside of session. Again, it is not about making them feel they need to do so or that they cannot do things on their own. It is simply making them feel that they are worthy enough to deserve or to receive such support if they need it. Most people get that and I think it is very important for them to feel that someone is willing to give of themselves for their sake.

Another thing I say to students, and I am going to try to articulate it in a way that it does not come off the wrong way. One thing told to me by my mentor and I have also read this elsewhere: “What a therapist does, in many cases, is re-parent the patient.”

Jacobsen: Wow, that’s powerful.

Amitay: Some may take that as “What? Are you being condescending?” No, many people come to therapy because they didn’t get proper parenting, whether they were lacking in love, attention, validation, support, guidance, discipline, etc. in childhood.

When I help train people and they tell me about their patient, I ask them, “Who in their family do you represent to them? Which role do you play in their life?” I then see it in their eyes: “Holy shit, I became their mother!” or brother or whomever.

And that is one way to look at things. It is part of my philosophy. Interestingly, back in the day, I was younger than most of my patients. Now, I am older and many of my patients are in their late teens, 20s or early 30s. Many of them are in my oldest daughter’s age group.

It is funny. I don’t think I come across as a parental figure. My mentor, on the other hand, is a grandfather and is very calming. Some people who want to see me really need someone more like my mentor, who will be low key and slow, and will bring a sense of calm and stability to the person’s life for one hour per week; it can really help reorient them. I will refer them to him, although I will also let them know they can work with me if they would prefer that.

Also, I do in fact act somewhat similarly with certain patients: I am very calm and low key. However, I have to really work on presenting in that way because it is not my nature.

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Appendix I: Footnotes

^[1] Registered Psychologist and Media Consultant.

^[2] Individual Publication Date: March 1, 2018 at http://www.in-sightjournal.com/amitay-2; Full Issue Publication Date: May 1, 2018 at https://in-sightjournal.com/insight-issues/.

^[3] B.Sc. (Honours), Psychology, Toronto; Ph.D., Clinical Psychology, York University.

^[4] Image Credit: Dr. Oren Amitay.

Appendix II: Citation Style Listing

American Medical Association (AMA): Jacobsen S. Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two) [Online].March 2018; 16(A). Available from: http://www.in-sightjournal.com/amitay-2.

American Psychological Association (APA, 6^th Edition, 2010): Jacobsen, S.D. (2018, March 1). Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two). Retrieved from http://www.in-sightjournal.com/amitay-2.

Brazilian National Standards (ABNT): JACOBSEN, S. Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two). In-Sight: Independent Interview-Based Journal. 16.A, March. 2018. <http://www.in-sightjournal.com/amitay-2>.

Chicago/Turabian, Author-Date (16^th Edition): Jacobsen, Scott. 2018. “Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two).” In-Sight: Independent Interview-Based Journal. 16.A. http://www.in-sightjournal.com/amitay-2.

Chicago/Turabian, Humanities (16^th Edition): Jacobsen, Scott “Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two).” In-Sight: Independent Interview-Based Journal. 16.A (March 2018). http://www.in-sightjournal.com/amitay-2.

Harvard: Jacobsen, S. 2018, ‘Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two)‘, In-Sight: Independent Interview-Based Journal, vol. 16.A. Available from: <http://www.in-sightjournal.com/amitay-2>.

Harvard, Australian: Jacobsen, S. 2018, ‘Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two)‘, In-Sight: Independent Interview-Based Journal, vol. 16.A., http://www.in-sightjournal.com/amitay-2.

Modern Language Association (MLA, 7^th Edition, 2009): Scott D. Jacobsen. “Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two).” In-Sight: Independent Interview-Based Journal 16.A (2018):March. 2018. Web. <http://www.in-sightjournal.com/amitay-2>.

Vancouver/ICMJE: Jacobsen S. Dr. Oren Amitay, Ph.D., C.Psych. on His Life and Views: Registered Psychologist and Media Consultant (Part Two) [Internet]. (2018, March; 16(A). Available from: http://www.in-sightjournal.com/amitay-2.

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