Psychotherapy Wars: The Long and the Short of It

A recent opinion piece in the Sunday New York Times written by a psychotherapist trying to sell a book created quite a furor in the psychotherapeutic community. In this article the author questioned the validity of long term therapy while claiming to be able to “cure” people in a few, sometimes not even one full session! He perpetuated negative stereotypes where therapists who work more analytically or psychodynamically, only say “How do you feel about that?” foster unhealthy dependency needs, and keep people in treatment longer than needed because of their own issues or monetary concerns.

Are there some therapists like the ones this author proposed? Absolutely. Most therapists practicing long term psychotherapy? Not the ones that I know.

Therapists wrote responses to the paper, and in various list serves and blogs, discussed their frustrations at this portrayal. One thing particularly upsetting to me and many of my colleagues was the potential harm that this article might do to patients currently in, or seeking treatment. Creating unrealistic expectations of instant cure can further damage someone who already has some feelings of inadequacy and who may have unrealistic expectations about themselves or others in their life. It does an extreme disservice to patients who have chosen to work long and hard to come to grips with painful issues, uncomfortable feelings and the therapists who have chosen to hang in there and work with them so that long term their lives are better and more fulfilling.

He cited certain research that supported his view, while not even mentioning the existence of other studies that showed just the opposite of what he stated.

For instance, he didn’t cite a 2008 study on the Effectiveness of Long-Term Psychodynamic Psychotherapy conducted by JAMA: The Journal of the American Medical Association which “showed significantly higher outcomes in overall effectiveness, target problems, general psychiatric symptoms, personality and social functioning”. (http://jama.jamanetwork.com/article.aspx?volume=300&issue=13&page=1551) Nor did he cite a 1995 study, The Effectiveness of Psychotherapy – The Consumer Reports Study conducted by Martin Seligman, published in American Psychologist that concluded “patients benefited very substantially from psychotherapy and that long-term treatment did considerably better than short term treatment…” http://horan.asu.edu/cpy702readings/seligman/seligman.html.

Anyone can pick research to support their particular view. There is no “one size fits all” approach to psychotherapy. There are some “bad therapists” and “ineffective therapies”, both using short and long term approaches. The best therapist is one who is knowledgeable about a variety of approaches with the experience to decipher which ones are suitable for a particular person and problem at that time. Clinical experience about how best to “tweak” them is what makes therapy an art as well as a science. It’s also important for the therapist to acknowledge their limitations as well as their areas of expertise.

The Times piece also inspired the circulation of an old You Tube clip of a Bob Newhart comedy bit where he promises to cure a patient with many problems in five minutes with two words. Guess what they are? STOP IT! If only it were that simple.

Individuals seeking treatment already have had parents, partners and friends saying the same thing to them and offering them “advice”. But there are reasons, often unconscious, why changing their behavior or life circumstance has been difficult. Offering a “cookie cutter” approach without understanding why someone is in a bad relationship or job, the underlying dynamic or function this might serve, or if this is a pattern, creates the likelihood that it will occur again. An individualized action plan based on their specific resistances to change needs to be devised.

Have I ever said “stop it”, or words to that effect? Offered specific suggestions to a patient on how to approach a particular problem or person? Definitely. But I believe my training as a psychoanalytic psychodynamic therapist has provided me with the tools and knowledge about how and when to integrate them into practice. And it’s usually after working with someone for a while with knowledge of their history, defenses, resistances and a therapeutic alliance has been built.

So when is therapy, “enough therapy”? “Tune into my next blog as that is a “longer” discussion than suggested word count limits for one blog.