Tuesday, September 19, 2017
"Even as we have congratulated ourselves for becoming more 'benevolent and supportive' of the mentally ill, we have steadily backed away from the sufferers themselves. It appears, in short, that the impact of our worldwide antistigma campaign may have been the exact opposite of what we intended."
link to New York Times article The Americanization of Mental Illness
Tuesday, January 24, 2017
At the Un-National Monument Along the Canadian Border
This is the field where the battle did not happen, where the unknown soldier did not die. This is the field where grass joined hands, where no monument stands, and the only heroic thing is the sky. Birds fly here without any sound, unfolding their wings across the open. No people killed — or were killed — on this ground hallowed by neglect and an air so tame that people celebrate it by forgetting its name.
—William E. Stafford
Thursday, October 20, 2016
Wednesday, July 13, 2016
Can We Save The Hypothetical from Extinction? A Problem of Authority
"It is the power of the hypothetical to explore which lies at the heart of its role in science. It is an imaginative movement that invites a testing. Psychotherapy cannot afford to be without the hypothetical, since the material the patient produces spontaneously has many possible meanings that can be investigated only through hypotheses."--Leston Havens
Psychotherapists and seekers of therapy must know of the possible problems to client autonomy posed by certain approaches to therapy; it is often not the approach itself in the absolute sense, but rather, in particular, a question of "deployment": the way a certain approach is used, the connotations and evocations summoned by it, that can have the unfortunate effect of conjuring an idea of the absolute certainty of technique. Ever seeking to provide more effective treatment, therapists can sometimes err on the side of using techniques identified as "head and shoulders" above the rest to address a given problem. Certain concrete, action-oriented cognitive behavioral (skills-based) techniques can save lives, for sure, and either prevent the need for hospitalization or make for swifter recovery post-hospital. And still, many presenting problems which are not emergencies depend for their resolution on a certain form of mental movement that can best be described as the person's ability to entertain hypotheses. In this age of superlative practices, therapists can lose their attention spans for the still-emerging truths of subjective experience which are, in the end, the most important factor for client success and long-term recovery. Is it possible to turn our attention spans to this area within psychotherapy where client autonomy is still-emerging and needs a carefully-wrought and non-intrusive therapy to help the client hypothesize and flourish? The authority embedded in the use of one-size-fits-all superlative therapy practices can in these common cases be detrimental to the client's long-term recovery.
The book referenced below is from the late period of what I have termed the Era of the Monograph; it's narrative derives from the compressed mental action of only one author, who brought mind to bear upon clinical experience in ways that are sometimes provocative!
In Leston Havens's book Making Contact: Uses of Language in Psychotherapy, the author describes this problem area carefully in a section of the book titled The Hypothetical:
"Therapists carry, in varying degrees, the burden of authority...[in the world of medicine] compliance is the patient's role, not only because the tests and experiments may be painful and time-consuming but also because the patient is essentially ignorant...In much psychological and some medical work, this relationship between authority and ignorance is reversed. The psychotherapist almost entirely relies on what the patient communicates. Moreover, the meaning of what the patient relates is largely dependent on his further productions and the unfolding of the patient-therapist relationship, to which both parties contribute. Finally, the results of these exchanges gain much of their significance from the decisions that the patient makes as to what he wishes for himself. Here of course he can look to the authority of the therapist, who in turn must be careful that the patient's search for freedom does not fall under a fresh domination. [emphasis mine]
There will be many psychotherapists for whom this description of their work will be unrecognizable...[many therapists] believe that the patient need only subject himself to the prescribed procedure and the results will follow more or less directly....In this process, the authority of therapists is a subject of exquisite difficulty.
The difficulty is a result of conflicting needs. On the one hand, the authority of the therapist can easily substitute for the freedom of the patient. The patient in search of himself, especially one profoundly out of touch, can easily replace himself with the therapist. Then the imputation and acceptance of power literally becomes self-defeating. On the other hand, psychotherapy can rarely afford to relinquish the authority of the therapist altogether. For example, demoralized people, which probably includes most who are searching for themselves, need to be in the presence of authority. This is what gives the work its start. [emphasis mine] Furthermore, the exploration and testing of the wishes a patient has for himself requires that he believes in the therapist's ability to accept or contain the often futile wanderings.
Throughout I have suggested that the psychotherapist has to contain radically conflicting attitudes. [emphasis mine] This is technically necessary, and it also serves as an example to the patient, whose need for integration will pose the same demand. [emphasis mine] The willingness to be wrong is a rudimentary example of the same phenomenon, because one's readiness in this also implies the possibility of being right. These concurrent willingnesses are expressed by the idea of the hypothetical." [emphasis mine]
Psychotherapists and seekers of therapy must know of the possible problems to client autonomy posed by certain approaches to therapy; it is often not the approach itself in the absolute sense, but rather, in particular, a question of "deployment": the way a certain approach is used, the connotations and evocations summoned by it, that can have the unfortunate effect of conjuring an idea of the absolute certainty of technique. Ever seeking to provide more effective treatment, therapists can sometimes err on the side of using techniques identified as "head and shoulders" above the rest to address a given problem. Certain concrete, action-oriented cognitive behavioral (skills-based) techniques can save lives, for sure, and either prevent the need for hospitalization or make for swifter recovery post-hospital. And still, many presenting problems which are not emergencies depend for their resolution on a certain form of mental movement that can best be described as the person's ability to entertain hypotheses. In this age of superlative practices, therapists can lose their attention spans for the still-emerging truths of subjective experience which are, in the end, the most important factor for client success and long-term recovery. Is it possible to turn our attention spans to this area within psychotherapy where client autonomy is still-emerging and needs a carefully-wrought and non-intrusive therapy to help the client hypothesize and flourish? The authority embedded in the use of one-size-fits-all superlative therapy practices can in these common cases be detrimental to the client's long-term recovery.
The book referenced below is from the late period of what I have termed the Era of the Monograph; it's narrative derives from the compressed mental action of only one author, who brought mind to bear upon clinical experience in ways that are sometimes provocative!
In Leston Havens's book Making Contact: Uses of Language in Psychotherapy, the author describes this problem area carefully in a section of the book titled The Hypothetical:
"Therapists carry, in varying degrees, the burden of authority...[in the world of medicine] compliance is the patient's role, not only because the tests and experiments may be painful and time-consuming but also because the patient is essentially ignorant...In much psychological and some medical work, this relationship between authority and ignorance is reversed. The psychotherapist almost entirely relies on what the patient communicates. Moreover, the meaning of what the patient relates is largely dependent on his further productions and the unfolding of the patient-therapist relationship, to which both parties contribute. Finally, the results of these exchanges gain much of their significance from the decisions that the patient makes as to what he wishes for himself. Here of course he can look to the authority of the therapist, who in turn must be careful that the patient's search for freedom does not fall under a fresh domination. [emphasis mine]
There will be many psychotherapists for whom this description of their work will be unrecognizable...[many therapists] believe that the patient need only subject himself to the prescribed procedure and the results will follow more or less directly....In this process, the authority of therapists is a subject of exquisite difficulty.
The difficulty is a result of conflicting needs. On the one hand, the authority of the therapist can easily substitute for the freedom of the patient. The patient in search of himself, especially one profoundly out of touch, can easily replace himself with the therapist. Then the imputation and acceptance of power literally becomes self-defeating. On the other hand, psychotherapy can rarely afford to relinquish the authority of the therapist altogether. For example, demoralized people, which probably includes most who are searching for themselves, need to be in the presence of authority. This is what gives the work its start. [emphasis mine] Furthermore, the exploration and testing of the wishes a patient has for himself requires that he believes in the therapist's ability to accept or contain the often futile wanderings.
Throughout I have suggested that the psychotherapist has to contain radically conflicting attitudes. [emphasis mine] This is technically necessary, and it also serves as an example to the patient, whose need for integration will pose the same demand. [emphasis mine] The willingness to be wrong is a rudimentary example of the same phenomenon, because one's readiness in this also implies the possibility of being right. These concurrent willingnesses are expressed by the idea of the hypothetical." [emphasis mine]
Tuesday, July 12, 2016
Friday, July 8, 2016
Wednesday, July 8, 2015
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