A Scientist Looks at Romantic Love and Calls It Limerence:

ACT II The Trial:

Chapters VIII through XI

Chapter VIII Psychotherapy

he facts of Peters trial focused Ruth and Carols attention on psychotherapy. In the public view, the truly ill, as opposed to malingerers and persons of bad character, were identifiable by the fact that their conditions were treatable with medication. Such persons, and there were many, usually consulted psychiatrists, not psychologists. While medical doctors would often prescribe according to a non-medical psychotherapists diagnosis and recommendation, it was, at best, a two-step procedure for the patient. The problem was avoided by going directly to a psychiatrist. Back in the heady, Freudian days, early in the 20th century, those in the know wore being analyzed as today they wear Rolexes. To be a psychoanalyst the top of the prestige hierarchy among psychotherapists one had first to obtain a medical degree. But since the practice of the psychoanalysis included no physical examination, but was entirely limited to talk, the case was often made that the reason for the medical degree was to protect and fortify the otherwise ethereal status of the discipline. A spate of writers complained that there was no valid reason for it, but it explains why the psychotherapy practiced by these highly trained practitioners four years in medical school and, in many cases, an equal time receiving psychoanalytic training, including several years of personal analysis kept the psychiatric departments of American medical schools under Freudian domination for decades. Eventually, however, orthodox psychoanalysis became too costly and time-consuming. The market dried up. So there came psychoanalytically-oriented psychotherapists, mainly psychologists and social workers, who won out both because they charged less, and because the academic departments from which they emerged, as opposed to the medical and psychoanalytic training of psychiatrists, gave them more freedom to deviate from the rigid procedures demanded by the kind of Freud-offshoot authoritarian schools, like the one from which Melita Schmideberg had retreated. Schmideberg was the daughter of the influential child psychoanalyst, Melanie Klein. A psychoanalyst herself, she left the fold in dissatisfaction over the conceptual rigidity and punitive approach to dissenters of the early Freudian schools. Thirty years later, psychotherapists among psychologists were freed from the rigid demands of official psychoanalysis. They could promise results in a shorter time thereby increasing the number of those for whom it was affordable, as well as, from the twenties at least until the fifties, retaining in its label the mystical glow of self actualization inherent in the magical term psychoanalysis. By the time of Peter Youngs graduate education, methods and labels had changed again and psychotherapy became psychodynamic. The psychodynamic psychotherapists were alike in accepting some of the old Freudian ideas that cure of patients proceeded when guided introspection uncovered unconscious but disruptive ideas and motivations. Psychodynamic psychotherapy thus retained a Freudian flavor while allowing transmogrification into various new types. However, by mid-century, self-help groups, such as Alcoholics Anonymous had also captured part of the market. By the end of the century, hundreds of different types of psychotherapy were available to the American public, and the psychodynamic types became a minority. Ruth had explained to Carol that Peters brand of therapy was on the way out as the preferred method, but that it was still trusted by many medical doctors and others from whom referrals were likely to be obtained. Peter received many referrals from older physicians. He deliberately marketed his services to them by speaking before business, community, and medical groups.

The Collected Works of Dorothy Tennov

Are you saying, Carol wondered, that Peter was a businessman? Absolutely, although he didnt think of it that way. For him it was public service. Many were the dinner parties we attended, and even gave. Horrors. Not entirely. They gave me an opportunity I would not otherwise have had to learn what others were thinking, especially when the conversations turned to serious subjects. Like politics? Yes, and social issues, Ruth said. I seldom agreed with what I heard, but didnt usually voice my disagreements. Those social affairs gave me a chance to understand what people outside academia were thinking. Most of the people were lawyers, business owners, and physicians. They were interesting, although I tried to keep the number of such events down to no more than once a month. I can see the political value for Peter having an opportunity to promote his practice in the community, but did he agree with the conservative line you were hearing? He didnt agree with them. On such issues he and I were alike, but he never challenged anyone. He was diplomatic, usually subtly changing the subject. Also, he was entertaining, but didnt overdue that either. He had a touch, a charm. At parties, he would sometimes play the piano, and he adapted his performance to the particular crowd and always left them wanting more. He gave them Joplin, Gershwin, sometimes a short piece by Bach, depending on the audience and the occasion, and could always be counted on to accompany group singing from a spontaneous Happy Birthday to a solemn Silent Night. He was in demand for accompanying sing-alongs, and one time, when the organist at one of the churches developed a sudden illness, they called Peter. Did he play for them? Beautifully. It wasnt that he was the only or best pianist in town, but that he was known and trusted by various people in the community. Members of the clergy occasionally appeared at the dinner parties. So his rigidity was only about his profession. Yes, Ruth explained, he was defensive about it. Partly, Im sure, because, as was so dramatically revealed at the trial, psychotherapy has been attacked lately from so many quarters. Everyone knew that psychodynamic approaches were in decline. Most therapists replaced them with various kinds of what Donna would say were closer to counseling. Others ran a gamut from sheer nonsense to procedures difficult to distinguish from those categorized as counseling. But as time went by, therapists from psychology departments were increasingly caught in a vise formed between psychiatry, with its power to prescribe increasingly effective psychoactive drugs, on the one hand, and counseling, with its attention to behavioral effects and emotional change, on the other. What is it that makes a procedure psychodynamic or psychoanalytic? Carol asked. Basically, its the idea that the patient shows symptoms, the therapists interprets, and, gradually, insight by the patient leads to improvement, Ruth replied. Improvement in what? Carol persisted. Thats a good question, and not one they give a good answer for, Ruth replied. Psychologists responded to the pressures on them by carving out new territories such as support counseling, grief therapy, sex therapy, and art therapy among many others. They also vastly expanded the stock in trade in which they were largely unopposed: psychological testing. The bimonthly catalogues that cross Peters desk contain hundreds of personality tests, IQ tests, achievement tests, and endless books describing various methods of therapy. Researchers found most of the grand ideas that Freud put

A Scientist Looks at Romantic Love and Calls It Limerence:

forth to be wrong, and, with availability of the new medications, psychiatry in the medical schools became more physiological, less psychological. Psychiatry became counseling plus pills that gradually became pills plus a bit of counseling. In some cases, the counseling is provided by another person under the psychiatrists supervision. A psychologist? Usually, but sometimes by a nurse, even by an office manager. I have heard somewhere, Carol said, that predominant psychiatric illness, schizophrenia, had always, even by Freud, been recognized as not responding very well to, perhaps in some cases even being harmed by, talk therapies. Later work by neuroscientists found chemical and genetic bases for schizophrenia and other psychoses. I have a colleague in Pittsburgh who had done some very interesting studies on the biochemistry of schizophrenia, as well as bipolar disorders and depression. It all put the major recognized mental illnesses increasingly out of the reach of clinical psychology, except for the counseling needed to increase the likelihood that the doctors orders would be followed. As public reaction to psychotherapy changed over the course of Peters career, I detected that he, along with most non-medical psychotherapists, became even more defensive about the value of their services. According to Norbitt L. Mintz, writing as early as 1971 in the Journal of Consulting and Clinical Psychology, this issue of fees became especially pronounced regarding fees that often were more than their patients could reasonably afford. Furthermore, Ive always believed that the secrecy that had characterized their ethics was designed to protect them from public exposure of their vulnerability. Diagnoses were kept secret from patients, as were other records. In that, theyre like the medical profession, or the police. Carol said. Theyre a secret brotherhood. They protect each other even when they have doubts about the efficacy of a particular treatment, Carol noted. In that context, Ruth said, it is notable that medicine has become less secretive as its procedures became more effective. But, from the beginning, my major complaint about psychotherapy was its pretense of scientific foundation. Scientific studies of the outcome of the sundry therapies almost always found small positive effects, but from most studies you couldnt conclude that one set of procedures worked any better than another set. The eclectic therapist was self-labeling, the idea being that such therapists commanded skills across the spectrum of types of therapies and were, therefore, able to match procedure to patient by using one form of therapy with one person, another with another. Although the term had largely gone out of fashion, as he himself conceived it, Peter fit the eclectic model. He would be more psychoanalytic with some clients, in which case the psychodynamic aim was exploration of the unconscious roots of symptoms that appeared at the conscious and behavioral levels. But, with other clients, especially, if truth be known, if their insurance coverage was meager or absent, his method would focus on strategies for coping with current problems or of attempting to provide more immediate support for the distressed. Cognitive methods were aimed at correcting what they called dysfunctional thought. Behavioral and pep talk therapies, least used by Peter, were directed more at actions, rather than motives or emotions, and therefore were like the procedures of counseling. There were many other forms. Peter did not, of course, embrace them all. Most often he fell back on the psychodynamic procedures that were fashionable during his training. Why, Carol asked, do people enter therapy? Ive known people who did, but I could never really understood why. Ive often wondered about that myself, now that being a psychotherapy patient has lost its initial glamour in the public mind. Schmidebergs theory of addiction explains why some stay, but why they go in the first place seems to be either that they are truly mentally ill or that they feel an anguish or inadequacy that makes them feel unable to go it alone. Could it also be loneliness, that they have no one else to talk with? Carol wondered.

The Collected Works of Dorothy Tennov

Maybe it is for some. I have a friend who has been in therapy since childhood. She says that the therapist restores her faith in herself, in contrast to the criticism she gets from family members. The therapist, she said, was the one person who let her talk about herself and made her feel good about herself. It reminds me of what I would get from my summer visits with my aunt, Carol said. Psychotherapy has also been compared with religion in the sense that it is something outside themselves to which they can be attached, Ruth added. Arent many sent into therapy, or counseling, by the courts? Carol asked. Thats a real trend. Many of my sisters clients fall into that category. My impression was that Donna disliked psychotherapy. I didnt realize that she was a therapist herself, Carol said. She isnt. Shes a social worker who counsels, and she finds fault with Peters psychodynamic type of therapy that dwells on dreams and free associations in an attempt to get at underlying psychological dynamics that cause the problems that are consciously perceived. Donna makes a big distinction between counseling and psychotherapy, the former much needed and effective, and the latter dangerous. Dangerous? Surely thats an exaggeration! Some people would consider it too strong a word, but there does seem to be a danger of an addiction-like dependency. And theres always the damage to the person and the persons family resulting from the expense. Aside from that, there is the reality of stigmatization and self-stigmatization. And maybe there is also an element of therapy diverting attention and resources from real problems, Carol offered. Thats one of Donnas main complaints. On the other hand, as Donna herself points out, there are people who seem truly to need something that they claim to get from it, and many who swear to have been truly helped. The trouble with that is that, from the scientific point of view, the one held by Pamela Cushing, in her book Patient, Beware!, is that it is hard not to feel helped by something that you have so much personal investment in not just money, but hope, and a lot of self-exposure. Yes, Carol said, I remember something from my psychology courses. I think it was called cognitive dissonance. Right. Anything into which so much effort had been placed had to be worth something. But what about self-exposure? Carol asked. If you mean what about the problem of telling intimate, personal details to a stranger, there is some indirect evidence that patients and former patients fear their therapists. Browne reported that almost no one who read his book and then contacted him about their Love Two experiences wrote anonymously, even though they often revealed very personal details about themselves. On the other hand, the readers of Cushings critique of psychotherapy almost always expressed concern about privacy. Many either did not give their names or they included a request that their confidences be maintained. The differences between the two groups were both large and statistically significant. Thats certainly suggestive, Carol said, but, of course, there may have been differences in the two groups to begin with, that people who enter therapy are more concerned about privacy to begin with. Spoken, Carol, like the true scientist you are. Of course, who can tell for sure, but Brownes interpretation was that patients were afraid of therapists because of how much of themselves they had revealed. If thats true, it is certainly scary. Have you ever discussed this point with Peter? Ruth laughed. Are you kidding? The peace in my marriage is bought by strict avoidance of any discussion of our respective professions, especially his. However distressed his patients might be when they come to him, I do not believe that most are truly mentally ill. But I know that Peter, like others Ive read of,

A Scientist Looks at Romantic Love and Calls It Limerence:

believe that going to therapy is, in itself, a symptom of a psychological disorder. Ironically, many therapists claim that asking for help is a first step toward cure. Wow! Just by walking in the door! Its a variation of a Catch-22 then, except that, in Joseph Hellers book, labeling oneself as mentally ill was considered the height of sanity because it was a way out of the terrible situation soldiers were in. In both cases, merely asking for therapy labels one: insane in the case of psychotherapy, sane on the battlefield. Good point. Donna says that many who seek therapy are really sick, or at least seriously troubled, and that some of those who say theyve been helped really have been, but she disagrees about the reason. She thinks that if Peter helps anyone it is because of the support and guidance they receive from a truly charming individual. But she is also of the opinion that the stigma associated with the process is always a negative. Theres less stigma and much less self-stigmatizing if it is something treatable with medications. Incidentally, do you know what a lifer is? Life in prison without parole? Carol ventured. In a way. Its a term therapists use among themselves to refer to as a person who, once becoming a psychotherapy patient, remains a patient indefinitely as long as finances hold out and life endures. Seeing their therapists is part of their routine as much as getting a haircut or manicure. Such glorification of self, according to former APA president George Albee, was often true of movie stars and other affluent celebrity patients. Usually, such people go from one therapist to another. The non-affluent, when money gets short, consult less professional people, including, as desperation set in, quacks and charlatans. Donna said that among these eternal seekers through psychotherapy or, as William Schofield called it, purchased friendship, are some who, whatever their initial reason for becoming a psychotherapy patient, become addicted to it, the term used by Melitta Schmideberg. Psychotherapy lifers have to have it. It suggests to me that had they never started with it, theyd have been okay without it. David Smith, Director of the New England Institute, claims that a reason why many remain patients forever is that they often seek therapy from a new practitioner to obtain help in recovering from the effects of a previous psychotherapy. Smith found patients seeking psychoanalytic treatment to help them recover from the damaging effects of CBT, or cognitive behavioral therapy, that was in vogue in the last quarter of the 20th century and much praised by its many advocates. The Australian psychologist, Brendan McMahon, also claimed that CBT can make people worse. Poor Peter, Carol said. I know. Thats why he needed me throughout. But I just couldnt pretend to believe what I knew was untrue.

The Capriciousness of Justice