Saturday, March 28, 2009

Sigmund Freud and the Origin of Circular Reasoning

Certainly,, Freud, was not the first person in history to engage in circular reasoning. It seems self-evident, however, that he was the first psychoanalyst to do so. I came across what is probably the classic example of his doing this, while I was reading his "Interpretation of Dreams".

In this book, he lays out his theory of dream interpretation, and he also gives examples of analyses of specific dreams, some of these dreams being his own and some being those of patients he has treated. Now, Freud's theory of dreams employs a fundamental principle whereby a dream is the fulfillment of a wish. He declares this to be true of all dreams, even in those where a dream is unpleasant to the dreamer, or otherwise seems to contradict the principle - once the dream has been properly interpreted, a theme of wish fulfillment is inevitably uncovered.

Far be it from me to dispute this based on my own relatively meager knowledge of dream interpretation (though if I were an expert in the subject of dreaming, I'd probably be more likely to go with the more recent "form theory" of dreams rather than what is now called "content theory", which was the basis of Freud's system). But what I find interesting is that in Freud's classic work "The Interpretation of Dreams", he relates to the reader an anecdote of a patient's dream (and its interpretation) which he believes to be another wish fulfillment, but in this case he has to resort to a circular reasoning of sorts to "prove" this to the patient.

To briefly summarize the anecdote: a certain woman patient is skeptical that all dreams are wish fulfillments, and states this to Freud in a session. Then a couple of nights after that session, she has a dream, and the theme of that dream is such that it seems to directly contradict the notion of wish fulfillment - it appears to be diametrically opposed to the fulfillment of a wish. When she goes to see Freud at the next session, she tells him about the dream, and triumphantly exclaims (paraphrasing), "see...I told you a dream is not always the fulfillment of a wish!!". Freud thinks about this for a few seconds, then he tells her "no, you are incorrect - your dream was in fact the fulfillment of a wish: you had recently been disagreeing with me about whether a dream is the fulfillment of a wish, and so your dream represents the fulfillment of your wish that I should be wrong about this!"

Thus circular reason came to be used in a new field, that of psychoanalysis; and thus was another card placed in the ongoing building of Freud's house.

Friday, March 20, 2009

It's never too early for the therapist to condescend

These days, many therapists call their patients "clients". Patients as a class are "mental health consumers" or some such thing. You know what they say: "The name's the thing." This stuff is all more or less benign, but something more insidious seems to have seeped into the system which is related to this idea of an "active patient" - you know, one who takes responsibility for her own healthcare (except that health professionals become annoyed when a patients actually tries to do that).

What I am referring to here, is the notion whereby the therapist tells the patient at the outset of therapy that she (the patient) is the boss. Here's a typical scenario:

Therapist: Okay, we did your intake last session, and now I'd like to briefly go over a couple of the principles and concepts I abide by when dealing with patients. First of all, the patient's the boss! You're in charge!

Patient (hesitates, sensing a snow job): What exactly do you mean by that?

Therapist: Well, for one thing, it means that in our sessions, we will talk about something, say a specific issue, only if you want to talk about it.

Patient: Okay, sounds good.

.....[twenty or so minutes elapse; the discussion has moved on to issues the patient currently has]

Therapist: So, you are ruminating about work..about how you perceive that some of your co-workers are giving you a hard time.

Patient: Yes, but I'd rather not talk about it anymore right now. I think talking about it a lot will make the rumination worse, in the long run.

Therapist (sensing that the patient is ruminating right in front of him): But..I sense that this is really causing you a problem - you seem very bothered by it...

Patient: Can we talk about something else?

[At this point, the therapist starts to look annoyed, and tries to think of what to say next. The patient then realizes that the fact that she doesn't want to talk about the work issue is really bothering the therapist; then she recalls the therapist's earlier statements about principles.]

Patient: Uh..remember when you said I'm the boss?

Therapist (hesitates, then turns beet red): But..hmmph!'s really important! It's important to me! Ooops..I mean, it's important to you!!

Patient: Was that a Freudian slip? Actually, at this point, I have diagnosed you..this only half-way through the second session.

Therapist: Really? What's wrong with me?

Patient: You suffer from "Phantom Symptom Transference Disorder (PSTD)". What this means is that you become obsessed with a behavior which you believe the patient is experiencing, then you "transfer" the behavior such that it becomes your own. For example, in this case you yourself are, at this point, intensely ruminating about how my work issue should, in your opinion, be my top priority right now.

Therapist: Is there any hope that I can improve?

Patient: Yes, the solution is readily available to you. Take 500 cc (one half liter) of cyanide tonight, and see me next Wednesday. Don't worry if you forget the session, though...I won't be annoyed...

Friday, March 6, 2009

Reality counts - but don't tell the therapist

Trying to explain the importance of reality to a therapist, is like trying to explain the importance of time to a dead person. In neither case does the subject have the ability to comprehend the explanation; and as well, in neither case does what is being explained have any importance in the subject's "universe". This analogy breaks down, however, when one realizes that in the case where the subject is dead, time in fact is of no importance; whereas reality should of course be of interest to a therapist. The mystery is, why do therapists not understand the importance of reality?

I know of no answer to that eternal question. One might ask a psychologist to tell us why, but they tend to be out of touch with reality themselves. One thing I can do here, however, is give an example of a sustained attempt to jar a therapist into reality, thus enabling prospective patients to prepare for the level of difficulty which they will encounter (current patients are probably already familiar with the problem, but they can receive some "validation" here). As I often do on this blog, I will use a (supposedly) imaginary conversation between a patient (in this case, "Sandra") and her therapist to illustrate my point:

Therapist: "Hi Sandra, what's new?"

Sandra: "My arm is in a sling. Perhaps you didn't notice?"

Therapist: "I noticed, but how do you think that might affect the therapy?"

Sandra: "Duh. In our last session we were discussing how I have to hitch-hike to get here since my car broke down. And since it is my right arm that's broken, it makes the situation all the more difficult."

Therapist: "Well, you made it here, didn't you? Now let us begin with where we left off last are things going at work?"

Sandra: "Well, as you may recall I work in an assembly plant, and this small physical problem here makes it nearly impossible to do my job. So now the boss is putting pressure on me to learn how to do the task with my left hand..."

Therapist: "I see. Do you feel that his complaints are unwarranted? In the past, we have talked about your sensitivity to criticism.."

Sandra: "Hey egghead, his complaints are due to the fact that I physically cannot do my job. It has nothing to do with how 'sensitive' I am."

Therapist: "Now hold on right there..did you notice the anger in your voice?"

Sandra: "Yes, and it's because I'm getting angry - mainly, because your pointy-headedness has still not 'validated' the reality of my situation."

Therapist: "Okay Sandra, I recognize that you are in fact having physical difficulty doing your job. All you can do is try your best; if you believe that you cannot get enough time off for your arm to heal, we will just have to see how things go. Well, time's up!"

[note here that the therapist is merely pretending to comprehend the reality of the situation, in order to assuage the patient.]

Sandra: "Okay..I'm off to the beauty salon."


Sandra hitch-hikes to the beauty salon, and begins to converse with her hairdresser:

Hairdresser: "I see your arm is still broken. Thus you are no doubt still having physical difficulty doing your job. Well..all you can do is try your best. If your boss will not give you enough time off for it to heal, you'll just have to see how things go!"

Sandra: "Do you realize that I got here only three minutes ago, and already you have sympathized with my situation and given me some appropriate advice? It took me fifty minutes of wrangling with my therapist, to get to this point."

Hairdresser: "How much are you paying that therapist? It's probably a damn sight more than you're paying me!"

Sandra: "So true. Well, if I lose the job, at least I know who to dump first!"

Thursday, February 26, 2009

Never Take Advice From a Therapist!

Not only is advice given by therapists usually bad, but if it doesn't work and you report back to the therapist stating such, he or she will use one of three "escape methods" (i.e. methods they will use to try to get out of it), all of which are bound to make you feel frustrated. [note: all the following scenarios are real - they are drawn from my own actual experience.]

Method 1 - the therapist attempts to "flee", when she finds out the advice was bad. Example: In a previous session, our therapist has given the client bad dating advice. The client then reports back - the conversation goes as follows:

Therapist: "What are you perceiving today?"

Client: "I perceive you gave me a bad recommendation last session - it did not work."

Therapist (in a huff): "It wasn't a recommendation - it was a suggestion."

Client: "Okay, it was a bad suggestion. Whatever - you screwed up."

Method 2 - the therapist attempts to "merge advice", i.e. make his (revised) advice compatible with that from someone else which turned out to be correct, thus making it appear that his (the therapist's) advice was never wrong in the first place. Example: The therapist has been telling the patient to drink eight glasses of water per day:

Client: "You're wrong about drinking eight glasses of water every day. I started doing that, and found myself getting drowsy and even occasionally dizzy."

Therapist: "Yes, but did you suffer any ill effects?"

Client: "Hello? My doctor said to stop drinking that much water because it dilutes one's sodium level, thus throwing off their electrolyte balance, resulting in these problems."

Therapist (in a huff again): "Well..if it bothers you, don't drink so much!"

Client: "Thanks for the retro-active advice, barf-bag."

Method 3: "Transition viewpoint" - shift advice which was given previously as if it had some general validity, to become instead focused upon the client as if it was tailor-made at the time given specifically for him or her. Example: As do all therapists, the one in this scenario has advised the client to join Toastmasters, since "it is known to improve peoples' confidence, especially when they are speaking in front of others":

Therapist: "How is Toastmasters going?"

Client: "You screwed up again. The meetings with them had been making me extremely nervous and anxious, even continuing well after the conclusion of each meeting. I then found out that research has been done, which has shown that people who are in Toastmasters have a disproportionately high rate of abnormal EKG's*. In other words, your dunce-ed-ness, they are under an unhealthy amount of stress."

Therapist: "Well, if it bothers you, don't go!!"

*a knowledgeable health professional gave me that information about Toastmasters and EKG's approximately eleven years ago.

The moral of all this? Limit validity of the therapist's advice only to subjects pertaining to the therapy itself:

Therapist: "I advise you to see me text Tuesday."

Client: "Yes, I had predicted so, since that is the normal day for our sessions. Is it okay if I wear a blindfold then, however? I really would rather not see you."

Friday, February 13, 2009

Case Files: Therapist puts patient in double bind, then tries to weasel his way out of his mistake

Scenario: it is the beginning of a therapy session, and the patient "John" walks into the therapist's office and sits down.

Therapist: "Hello, John, how's everything going?"

John (the patient): "Well... basically okay...

Therapist: "I perceive that you are a little excited...what's that about?"

John: "When I was driving through the McDonalds just a short while ago, the girl at the window really pissed me off! She messed up my order - she didn't know what she was doing!!"

Therapist: "'s dinner hour, maybe she was too busy and got confused. Isn't it being kind of hard on her to hold her to blame?"

John: "Okay, if you say so. I acknowledge to your royal jackass-ed-ness that I am a terrible monster."

Therapist: "Good. Now, how did things go at work today?"

John: "Could have been better. I made a mistake and the boss got mad at me, he kind of shouted at me...he made me feel bad...”

Therapist: "Let's talk about your sensitivity to criticism, and let's also discuss how you can avoid making mistakes at work."

John: "But, shouldn't you now be suggesting that maybe my boss was out of line, and also be telling me that perhaps I am not to blame for my mistake? In other words, why do you not now apply the same type reasoning toward me, that you did to the McDonalds worker? Aren't you kind of putting me in what you guys call a 'double bind'? "

Therapist (while trying to pull his pants up): "Uh...hmm...wait a minute - well, you're being too philosphical. Er, I can only control your own behaviour...wait! I mean, can you pretend for a moment, that I'm not a complete loser?"

John: "Sorry, I've tried to do that before but realized I was acting in bad faith. You have been debunked. Dee-bunked. Hah! You're fired!! You are free to seek a new patient!!!"

Tuesday, February 3, 2009

What It Says in My Psychology Text - Part 1

I purchased and looked over a revised edition of my college psychology text a few days ago. I came across a couple of interesting things.

One is that it turns out that the reason for the ever-expanding list of diagnoses in the DSM*, is so that insurance companies will pay for treatment! HMO's and the like are not going to pay for years of treatment by a therapist for something vague like "adjustment problems" - they're more likely to pay if the patient's problem is given a medical-sounding name like "Borderline Personality Disorder".

Of course thanks are due the profession for helping to give more people access to treatment. And at least this dispels the notion that the ever-increasing number of ailments is due to some industry obsession or panacea, or the psychologizing of our society. I mean, it does dispel that notion..doesn't it?...

*Diagnostic and Statistical Manual of Mental Disorders - what shrinks and other professionals use to diagnose their patients, i.e. to label the patient's "condition".

Sunday, January 25, 2009

Therapy as an "air-tight" system

"Air-tight system" is perhaps an awkward phrase to use here - basically, what I mean is that,

1) There is "no escape" from therapy. For example, if the patient disagrees with the therapist, he is "fighting the therapy". Or if a former patient starts a blog about therapy, she is is "still working through the therapy". In short, everything past, present, and future comes down to the therapy.

2) Therapists pretend that therapy "subsumes" all in life, for example, no matter what other field or topic may be brought up, it somehow falls under the umbrella of therapeutic principles, or at least the principles of psychology. An example of this would be a therapist or psychologist taking a point of view that, say, physics, with its concepts of matter, energy, etc, can be "explained" entirely from a psychological point of view; as if they have no objective or even empirical existence of their own, but instead are totally "constructs of the mind" or some such thing.

This is ironic in light of the fact that one could consider the theory behind psychotherapy to be, to a large degree, a house of cards. And, should this be pointed out to a therapist, he or she either blows the speaker off by saying something like, " are being too philosophical [or too analytical]"; or the therapist simply changes the subject, redirecting the topic to one of the speaker (patient) herself. Either way the therapist is in this instance showing the attitude of a simpleton who does not recognize the importance or even the validity of any concepts or fields of knowledge existing on their own outside the theories of psychology.

I should mention here that of course, I am not proposing that the therapist spend time in sessions with the patient, engaging in discussions about physics or math or what have you, or that the discussion between patient and therapist should turn into a purely philosophical one. What I am emphasizing here is the nature of the therapist's response to the itself tells us something about the therapist and therapy itself.

This is all tied in with therapists' resistance to anything reminiscent of philosophy, a resistance which can be traced all the way back to Sigmund Freud, father of the "talking cure", who himself was "against" philosophy (Freud himself used the term "resistance", but as a reference to his notion that individuals, and society as a whole, have an innate resistance to psychoanalysis).

Further definition of what is meant by therapy being an airtight system will be given in later posts. I shall also later expand on the specific items presented in this post.