Psychotherapy and Its Discontents, Part 2

I'm always amazed that people pay "therapists" for whatever it is that they do. If I had a pain in my hip and went to a doctor who said that the pain came from my stomach upset, I might be a bit skeptical. If the doctor explained that this was because I was drinking too much coffee and this was triggering nerve endings that ended in my hip, I would begin to look for the evidence--especially if I was a tea-drinker. At the very least I would find another doctor for a second opinion. Now, if the second doctor explained that the real cause was that I had a hidden desire to feel pain but he could give me a pill. . . I would now, maybe, try a third doctor who might offer still a third explanation.

This scenario would certainly trigger some major questions and force me to try to find some logical and scientific support for what these doctors had said. Finding none, would I now return to any one of them? Not a chance.

That is about what a "normal" client faces when approaching the therapy options (Despite my previously expressed objections to the word "therapy" I will use it because it is in common use and my Quixote syndrome has its limits.) for help handling the usual daily problems of life.

There are an almost infinite range of therapy theories, few of them with any real rigorous research behind them. With few exceptions, these theories are based on "clinical research." This most often translates to "Well. . . I've had three of my clients with this problem and I did [whatever the therapist's favorite thing] and they were happy and left after 20 sessions." Or, at best, the research is mono-modal without any control group(s), longitudinal studies, independent verification, or replications.

Of course, like all social sciences, it is much more difficult to create good research, than it is with physics or fluid dynamics. One cannot deny help to half the population. Still some real effort needs to be devoted to making sure that whatever we do really has some long-term positive effect.

That's the bad side. The positive view is all the research has shown that just deciding to deal with an emotional problem has a positive effect. So maybe we should invent "Intention Therapy" where we help people develop the intention to find help. We could even talk knowledgeably about "IT" ( (;-) --which means a winking big grin).

Beyond IT, are there real therapies that seem to be more effective than others? Yes there are. The best proven therapies belong to a group known as Cognitive Behavior Therapy. Some of these are Rational Emotive Therapy, Cognitive Therapy and Dialectic Behavioral Therapy. In over 400 major studies these have been shown to be effective for many psychological problems including anxiety disorders, depression, phobias, eating disorders. DBT is, at this point, the only demonstrated therapy effective with Borderline Personality Disorder. Cognitive Behavior Therapy is available from certified members of the National Association of Cognitive Behavior Therapists, some of whom are also trained to use hypnotherapy as an adjunct.

In the 1960's, a very powerful tool was developed to work with couples and other social groups. Transactional Analysis is rarely encountered in the popular psychology literature anymore but there are still some practitioners. TA focused on the interaction between people. The structure of thought and behavior was schematically described as Parent, Adult and Child. Interactions then could be seen as taking place between the Parent of one person speaking to the Child of another (Or from and to any of the parts.)

The results of TA were generally very good. The weakness came when therapists began believing that the metaphor of PAC was a reality. This led to debates and discussions which sounded like "How many angels can dance on the head of a pin."

In the '70s, Transactional Analysis fell victim to caricature as the media latched on to "I'm OK, You're OK" and created jokes based on this and other TA phrases. It was dismissed as "pop psychology". It was, never-the-less, a very effective mode of therapy and, combined with some of the techniques developed by Gestalt therapists, can make a real improvement in the interactions between people--especially marital couples. More information about TA is available from the USA Transactional Association and the International Transactional Analysis Association.

Other effective options for marital therapy include Emotionally Focused Therapy (The EFT acronym is also used by the Emotional Freedom Techniques "feel good method". This latter does not have the strong research that is, for me, an absolute requirement.) and another that doesn't have a handy 2-3 letter acronym. The work of therapists trained by the Gottman Institute in Seattle is far superior to most other options. The Gottman methods are based on a 35 year longitudinal research program of actual video recordings of thousands of real couple interactions correlated with how the relationships flourished.

Are there other good therapies? Of course, but they are far outnumbered by the "feel-good" therapies and the therapists who call themselves "eclectic." When someone says they are eclectic or "multi-modal" my hunch is that they really don't have any idea what they are doing that really works. It just means something like, "I do a lot of different things and eventually sometimes the client seems to feel better. If they don't it's because they really didn't want to. They enjoy their disfunction too much."

More in the third section.

Ciao, David