Psychotherapy on the Road to … Nowhere? (página 2)

"’Now," Dr. Zeig continued, ‘well,
therapists are becoming more like technicians, and we're trying
to find the common denominator from the different schools and
methods to see what works best, and where to go from
here’.

"The meeting brought together some 9,000 psychoanalysts,
psychologists, social workers and students, along with many of
the world's most celebrated living therapists, among them the
psychoanalyst Dr. Otto Kernberg, the Hungarian-born psychiatrist
and skeptic Dr. Thomas Szasz, and Dr. Albert Bandura, the pioneer
in self-directed behavior change.

"’This is like a rock concert for
most of us’, said Peggy Fitzgerald, a social worker and
teacher from Sacramento, holding up a program covered in
autographs. Ms. Fitzgerald said she attended war protests during
the 1960’s and ‘this has some of that same
feeling’.

"Calls to arms rang through several conference halls. In
the opening convocation, Dr. Hunter ‘Patch’ Adams –
the charismatic therapist played on screen by Robin Williams —
displayed on a giant projection screen photos from around the
world of burned children, starving children, diseased children,
some lying in their own filth.

"No mention was made of the conditions existing in
Socialist Cuba, not
represented, or in the Dominican Republic, not officially
represented.

"He called for a ‘last stand of loving care’
to prevail over the misery in the world, its wars and ‘our
fascistic government’ referring munificently to the one in
the US headed by Bush II. Overcome by his own message, Dr. Adams
eventually fell to the floor of the stage in tears.

"Many in the audience of thousands were deeply moved;
many others were bewildered. Some left the arena disgusted by the
awful display of theatrics.

"At the conference, many said they found it heartening
that psychotherapy was finding some scientific
support.

"For example, cognitive therapy, in which people learn
practical thought-management techniques to dispel self-defeating
assumptions and soothe anxieties, has proved itself in many
studies.

"The therapy, some participants said, has even attracted
the attention of the Nobel Committee. The two men who developed
it, Dr. Albert Ellis, a psychologist in New York, and Dr. Aaron
Beck, a psychiatrist at the University of Pennsylvania, brought
crowds to their feet".

The question we
ask, parenthetically, at this point is this: Nobel Prize in
what?

But let’s waste no time…

"A frequent theme of the meeting was that therapists
could not only relieve
anxieties and despair but also help clients realize a truly
fulfilling life – an idea based on emerging research.

"In his talk, Dr. Seligman spelled out the principles of
his vision, called positive thinking. By learning to
express gratitude, to savor the day's pleasures and to nurture
native strengths, people can become more absorbed in their daily
lives and satisfied with them, his research has
suggested.

"A recent study at the University of Pennsylvania found
that these techniques relieved the symptoms of better than other widely
applied therapies, including Prozac and other drugs, Dr. Seligman
told the, skeptic audience.

"’The zeit is really geisting on this idea right
now’ said Dr. Seligman, who has consulted with the military
on how to incorporate his methods.

"Dan Siegel, a child psychiatrist at the University of
California LA, was one of several speakers to emphasize how
psychotherapy changes the wiring of the brain. For example, he
said, brain-imaging findings suggest that secure social
interactions foster the integration of disparate parts of the
brain.

"’When I'm telling you my feelings, discussing
memories, in this close relationship, I'm achieving better
neurological integration’ Dr. Siegel said."I'm repairing
the connections in the brain’.

Which, in essence is true, but a bit of an exaggeration,
if stated as Dr. Siegel did — well, enthusiasm can be
contagious for some souls.

"Many therapists at the conference said that if the
field did not incorporate more scientifically testable
principles, its future would remain clouded.

"Freud, for his
part, insisted in the medical training of psychoanalysts, in
order to maintain scientific objectivity in the practitioners.
Today anyone can claim to be a therapist, and ‘that’s
wrong’, said Seligman — not being himself a
physician.

"Using vague, unstandardized methods to assist troubled
clients ‘should be prosecutable’ in some cases, said
Dr. Marsha Linehan of the University of Washington, who has
developed a well-studied method of treating suicidal
patients.

"Yet it was also apparent in several demonstrations of
the spellbinding thing itself — artful psychotherapy — that
some things will be difficult, if not impossible, to
standardize.

"Dr. Donald Meichenbaum, research director of the
Melissa Institute for Violence Prevention and Treatment in Miami,
showed a film of the first session he conducted with a woman who
was suicidal months after witnessing her boyfriend die in a
traffic accident. After gently prompting her to talk about the
accident, Dr. Meichenbaum then zeroed in on something, he had
noticed when the woman entered his office: she was
clutching a cassette tape.

"He asked about the tape and learned that it was a
recording of her late boyfriend's voice, expressing love for her.
‘I play it over and over, and it makes me so
depressed’, said the woman, in a tiny voice.

"In addition, here Dr. Meichenbaum stopped the film and
addressed the audience.

Derringer pistol

"’The tape!’ he said. ‘When during the
session do you go for the cassette tape? What do you do with the
tape?’

"For several long moments not a creature stirred, not
even a laptop mouse. This
community of therapists was now trying to save a soul, a person
who was alone and did not want to live. What to do with the
tape?

"’Consider between now and the next time I see
you, in two days, consider whether you would be willing to play
the tape’, Dr. Meichenbaum went on to say he had told the
woman. ‘I would be privileged and honored’ to hear
it.

"’Why?" he now asked, turning to the audience.
Because it not only increases the likelihood she'll return but
empowers her to come back’ and take an active role in
therapy. Which is exactly what she did, he said.

"’Now, is any research study ever going to tell
you exactly the right thing to do when your client comes in with
a tape of her dead lover's voice?’ Dr. Meichenbaum
asked".

Or when Kay (a patient of mine),
produced a double barreled Derringer gun in my office,
threatening to use it. The answer for these questions can not
always be taught or anticipated. You just improvise for the
moment, following your intuitions and instincts.

This is exactly what I
did…

"Most of the audience of more than 1,000 people wandered
out of the talk wide-eyed. One, Terrina Picarello, a marriage and
family therapist from Greensboro, N.C., said, ‘that is what
you come for: inspiration’.

And confusion…

"Ms. Picarello said that the conference was well worth
the money she spent, more than $800 in fees and travel, and the
week she had taken off to attend, even though she found some of
the presentations on marriage counseling
disappointing.

"’Way too much talking by the therapist, I
thought’, she said, after one of them. ‘It seemed so
old-fashioned, like it was drawn from another
era’.

"And there was the rub. As psychotherapy struggles to
define itself for an age of podcasts and terror alerts, it will
need ideas, thinkers, and leaders. Yet the luminaries here, many
of whom rose to prominence three decades ago, were making their
way off the stage. And it was not clear who, or what, would take
their place.

"Across the street at an amusement park, where just
about any metaphor is available for the taking, Dr. Siegel was
working out the meaning of the park for himself. A native of
Disney’s world in CA, he has many memories of visiting as a
child, perhaps nowhere more so than the circular drive in front
of Sleeping Beauty's Castle.

"’The circle of choice,’ he said, looking
around. ‘This is where you decide, where you think about
your mood and which way you want to go – to Frontier land,
Tomorrow land.

"By all appearances in GB, the field of psychotherapy
has arrived at the circle of choice.

"The question is, How to get to Tomorrow
land?

"Through the experience of intensive psychoanalytic
psychotherapy — the only and valid answer.

The answer I, personally give
everyone who is willing to listen: Is training under adequate
supervision. That’s all.

References

Furnished per request.

Stay tuned…

Félix E. F. Larocca MD