Extraordinary Resilience

[joshwriting]

http://www.smithsonianmag.com/issues/2006/december/hauser.php?page=1

I talked a bit ago about a lecture I attended on the subject of resilience. Well, Smithsonian has an interview with the author of a new book. From the page I linked:

Psychiatrist Stuart Hauser answers questions about his new book, Out of the Woods, which chronicles four emotionally disturbed teenagers

I can tell you that I will be getting the book and that just the interview has given me plenty to think about. And it makes an interesting companion piece for this, from the NY Times:
http://www.nytimes.com/2006/12/22/health/22KIDS.html?em&ex=1166936400&en=dc70978d39d5fa8e&ei=5087%0A

Troubled Children:
Parenting as Therapy for Child’s Mental Disorders

And this, also from the times:
http://www.nytimes.com/2006/12/19/health/psychology/19essa.html?_r=1&ref=science&oref=slogin

It's an essay, entitled Sometimes, the Why Really Isn’t Crucial, about the issues and difficulties of causation in therapeutic work.

Comments

[siderea]

1) The last of those links is a... I need a term for this. Perhaps that term is "propaganda". That author is a member of a certain psychotherapeutic faction. The purpose of that article is to make another faction look bad by implication, in the eyes of a lay public who don't actually understand what the fight is.

The two dogs in that fight are psychoanalytics and CBT. The author is a CBTer and he's trying to sway lay people to thinking ill of psychoanalysis.

Basically, the point of the article is to be prejudicial, not to inform. Of course, it's presented as informing; she's not forthright about just what she wants to convince you of, which is that you should prefer the (generally younger) CBT-trained clinicians over the (generally older) psychoanalysts.

Frankly, it's kinda embarrassing. Not only is she being disingenuous, but, sheesh, psychoanalytics? Talk about beating a dead horse. In the CBT vs. psychoanalytics fight, basically CBT has won. Not as much on its merits as CBT partisans would like to think: HMOs are willing to pay for CBT and generally not for psychoanalysis, so guess what most people are trained in these days?

2) This essay, however, neatly illuminates the (previously alluded to) veiled dig on my review form from my practicum. My clincial supervisor, under "Clinical Strengths" wrote "Siderea is very insightful." (Yeah, she's a CBTer. Ha, ha, very funny.)

3) Re: Resilience: What I wouldn't give for an MBTI assessment...

[chenoameg.livejournal.com]

Can you offer any pointers to comparisons between CBT & psychoanalysis?

(I'm a layperson but pick up terminology quickly and spend entirely too much time thinking about humans to consider myself a layperson.)

[siderea]

No pointers, but a quick orientation:

1) Psychoanalysis == What Freud invented. Patient on a couch, free associating, while psychiatrist (usually -- now other mental health professionals are allowed in the US) listens and makes the occasional observation. Psychoanalysis is the oldest form of "talk therapy". It's fundamental premise is that by becoming conscious of what were previously unconscious thought patterns hijacking one's reaction to the real world, one can stop being a puppet of the past and engage with present reality fully will all one's faculties. The way this is acheived is by, quite literally, the analysis of the patient's thoughts by a trained "psychoanalyst". The analyst sits and listens to the patient's thoughts in free association -- traditionally in daily sessions for years -- and notes patterns in the patient's thinking as the analyst discovers them. The idea is that if you know what your subconscious mind is doing, you don't have to go along with it any more. Hence, it is based on "insight" -- having insight into why you do something means you don't have to do it any more.

That's the theory anyway. It is not wholly without merit: people who are largely unaware of their emotional crosswiring do the damnest things, and then say, "Gee, I have no idea why I did that! I really wish I wouldn't do that!" If you point out, "That's your wife, not your mother," if that's all that's ailing them, they smack their foreheads and go "*Doh*!" and stop doing whatever it was.

Of course, that's not the only thing which can be wrong with someone. Unfortunately, sometimes the only want to find out if it is what is wrong with someone is to go on just such a protracted fishing expedition. And when it is what's wrong, until that gets fixed, problems will be like hydra-heads.

[continued]

[siderea]

[continued]

2) CBT stands for Cognitive-Behavioral Therapy. It is the descendant of both Cognitive Therapy and Behavioral Therapy. Cognitive Therapy (CT), founded by Beck, is fixing people's feelings by debugging their thoughts, or, as I like to think of it, "Therapy by telling people they're wrong." For instance, in CT a therapist might point out to a client that he's engaging in black-and-white thinking which is not logically correct. In light of this, I find it grimly ironic that CBTers refer to psychoanalysis as "insight based", as an implicit differentiation with what they do, seeing as it sure looks like just a different flavor of insight to me.

Behavioral Therapy (BT) is using the discoveries of the behavioral psychologists (e.g. Skinner, Watson), clinically. In other words: training people to do or feel things, the way you train dogs, with rewards and punishments. The description in the above article about parenting ADHD kids with rewards and punishments is right out of BT. BT is truly, for better or worse, insight-free therapy. They don't care what happens inside your head at all. (Skinner (a scientist, not a clinician) refused to grant that humans had intentionally at all, and clung to the model that consciousness is an illusion and thoughts pretty much irrelevant.) In pure BT, they treat behaviors, and they really don't care how you think about them. They do "behavioral modification" by classical and operant conditioning. These are the "snap a rubber band against your wrist every time you crave a cigarette" guys.

Added together, they're something of a ponymonkey, but apparently more than the sum of their parts. The way CBT is used is to treat very specific identifiable problems, which can be quantified, or at least specified. In the story I reference above, the parent mentions that rewards are given for dropping the rate of checkmarks by one.

In other words, CBT is very symptom-oriented. It's very, very direct. Beancounters love this, hence it's popularity with HMOs. It's short, sweet, and easily evaluated as to success or failure. No soul-searching involved, and you get to pay for less of it.

It also means it's a great fit for experimental science. It's much easier to do efficacy studies of CBT than any other form of therapy. Therefore studying CBT methods is the path of least resistance for clinical researchers. That's resulted in a positive reinforcement loop where there's more and more research showing how useful CBT therapy is.

Also, CBT fits great with the medical model: pick something, identify it as the problem, make it go away.

3) There are completely other schools/approaches. Here in the US, psychoanalysis was dominant until about 1975; there was a massive coup in US psychiatry around 1968-1974, and psychoanalysis fell out of favor in a big way in a hurry. CBT arose victorious from the ensuing internicine battle between other factions over the vacant throne.