YAVIS vs HOUND and how I want different patients

YAVIS is an acronym for Young Attractive Verbal Intelligent Successful. The term is commonly used in psychotherapy as it is assumed that these individuals are most likely to have successful experiences in therapy. I believe they are successful, in part, because therapists (and other human beings) like those who are attractive, intelligent and successful. I don’t know how being young factors into the equation; but being successful in other domains in life, obviously predicts success in therapy (I think… I don’t have any citations for this one). I do wonder if being verbal is *trully* helpful in therapy – or rather, verbal abilities give the impression of achieving therapeutic goals. For example, someone with higher Verbal IQ might be better able to verbalize their internal state, and appropriately use psychological jargon in a way that pleases the therapist.

The opposite of YAVIS is HOUND. Homely Old Unattractive Nonverbal and Dumb. As a heart-bleeding, liberal do-gooder, I used to be scandalized by the concept of the desirable YAVIS patient (actually, I was not scandalized that much, but I’m playing up my naivite for dramatic purposes). Thus, I was excited about the prospect of working with low-SES people with very little education. (Note: I realize that there are many educated immigrants who come to the US with nothing and are thus considered low-SES. So, I do not believe that no education and low-SES are the same; they are just highly correlated). Also, I was not really “excited”, it was more like “this should be interesting and it will look good on my APA internship application”…but please bear with my dramatic license.

I’ve been treating a lot of people who are not “psychologically minded”. I believe this is a euphemism for not very bright/verbal or for people who have no formal education. I feel guilty, but I don’t want to work with HOUNDs anymore. Specially, since I’m not getting paid. (Please see Limousine Liberal). Now, the concept of the desirable YAVIS makes a lot more sense to me.

I feel like I explain VERY basic psychological concepts in VERY plain language and 90% of my patients just nod when they clearly have no understanding of what I’m saying. So I repeat it over and over again.

This is an example: “the way you think, that is your thoughts, influences way you feel. For example, if you think that you are a terrible person, you begin to feel sad or guilty. However, if you think about all the positive things you have accomplished and the good things you have done for your family, you start feeling better.” (Then I ask them to picture an awful scenario and tell me how they feel. Then I ask them to picture a happy scenario and tell me how they feel – here I lose 60% of people). Then I say “you see, the way you think affected the way you feel which in turn affects the way you act”. Since it is difficult to control and change one’s feelings, we are going to work toward changing some of the thoughts that make you feel sad and contribute to your depression. The purpose of counseling is for us to work together to help you think rationally….blah blah”.
Then I hear things like, and I quote “I don’t care about thinking rationally…my husband is a no good *&%&^%%((**!!!!”.

Perhaps I am a crappy therapist – this is always a possibility. However, when I explain to my supervisor what I did in session (almost verbatim) they just tell me that some people simply cannot understand such basic concepts. People have recommended that I learn D.B.T. which apparently is good with low VIQ people. I am afraid that if I learn D.B.T., I will become “the DBT person” and get all the Borderline PD patients. (Yes, I also don’t want to work with Borderline patients. If that makes me a bad human being, so be it. I don’t have an office phone so I’m sick of patients calling my cell-phone).

Next installment – Women who Love Cocaine dependent, Antisocial Personality Disordered Men, (who have cheated on them and been to jail multiple times) AND how the women believe this time he really means it when he says he’s going to change (7 times court-ordered substance use treatment is the charm!).

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