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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by badhaircut on August 11, 2004, at 10:05:32
According to an article in Tuesday's New York Times, psychologists had a conference on the effectiveness of interpersonal psychotherapy that was more like a "civil war" at the APA's annual meeting 12 days ago.
-quote-
The issue of which therapies are based on science and which are not has recently become [very] divisive....The topic was debated before a raucous, packed hall at the annual meetings of the American Psychological Association in Honolulu, held July 28 to Aug. 1. ... "The split in the field is bigger than it ever has ever been," said Dr. Drew Westen.... "The intensity of the acrimony, the distaste, has never been so high."
At bottom, the dispute is over the nature of psychotherapy: Is it an intuitive process, more art than science? Or is it more a matter of a therapist following specific procedures that reliably help people get better?
-unquote-Participants expect the controversy to keep getting bigger.
You can read the original article for the next week free at the NY Times site:
http://www.nytimes.com/2004/08/10/health/psychology/10ther.html
After this week you have to pay to download it.
Libraries should have hard-copy back issues (Aug 10, 2004: "For Psychotherapy's Claims, Skeptics Demand Proof" by Benedict Carey, New York Times).It may also be available online for free later at these sites:
http://www.wilmingtonstar.com/apps/pbcs.dll/article?AID=/20040810/ZNYT04/408100368/1002/BUSINESS
http://www.goupstate.com/apps/pbcs.dll/article?AID=/20040810/ZNYT04/408100374/1051/news01-bhc
Posted by Dinah on August 11, 2004, at 10:23:04
In reply to therapy debate gets 'raucous', posted by badhaircut on August 11, 2004, at 10:05:32
Scary for me, since it affects deductibility and the ability for me to afford therapy. If those manual based therapies (that have never been more than somewhat effective for me) become the sole method of deductible therapy, I'll probably kill myself.
It's also scary because it's so short term oriented... If you can't help someone in eight weeks? Even the manual writers exclude all but the most straightforward of cases. Perhaps that will be the salvation of the rest of us. If you read the exclusion data for the majority of the studies, and we wouldn't be allowed to participate in the study, surely they won't force the results of the same study to guide our treatment.
Posted by Shadowplayers721 on August 11, 2004, at 11:26:54
In reply to therapy debate gets 'raucous', posted by badhaircut on August 11, 2004, at 10:05:32
I thought this was interesting. But, the fact remains that people aren't one size fits all and some go to therapy for so many different reasons.
I know a real person that's in his late 50's. He has been in "therapy" since he was in preschool. He was put in for bed wetting as a child and anxiety. Has he gotten better? Well, he doesn't wet his bed, but he still has anxiety and a lot of somatic complaints that docs can't find a thing. In fact, this guy developed obsessive compulsive disorder as an adult. He is quite the loner type. Now, I can see what the people skeptics would say in his case.
But, how much is the blame on the him or his numberous therapists? Maybe he is the type that just like going to therapy, because its a way of life for him? I don't know, but he can work. He has no intimate relationships in his life, because he says he feels like a freak. Hmmmmmm. I ask him, "What the devil are you telling that t?" But, it's his life and his money. If he wants to be "in therapy" for the rest of his life, that's his beez wax.
Personally, I am more goal oriented. I try to structure my therapy to meet goals and see improvements internally and externally. But, that's my beez wax. It's not really a debate, but a freedom of choice. The person that pays the bill decides in my opinion.;)
Posted by AuntieMel on August 11, 2004, at 11:29:43
In reply to Re: therapy debate gets 'raucous', posted by Shadowplayers721 on August 11, 2004, at 11:26:54
There are many that would suggest that if he is in therapy forever because he likes it, or it's become a way of life, that insurance shouldn't cover it....
Which was the scary bit of the article.
Posted by Dinah on August 11, 2004, at 11:55:11
In reply to Re: therapy debate gets 'raucous', posted by Shadowplayers721 on August 11, 2004, at 11:26:54
The unknown factor is what would have happened without therapy. He can work. Would he be able to work without therapy? He can maintain a functional, if not optimal, place in society. Would he be able to do that without therapy? He pays taxes, doesn't need public assistance for shelter and food. Is therapy a more cost effective solution than the alternative?
I think the only fair way to judge therapy is to judge how *this* person would have done with and without therapy.
It wouldn't be fair to judge my therapy by the areas where I'm not well. It's a lot fairer to say "I'm alive. I hold down a more than half time job. I function pretty well as a mother, reasonably well as a wife. Without therapy, there would almost certainly have been suicide attempts, if not successes, hospitalizations, huge costs to my family and society. Maintenance therapy and maintenance medication is cheap in comparison to the alternative."
Posted by mair on August 11, 2004, at 12:46:35
In reply to Re: therapy debate gets 'raucous' - Auntie Mel » Shadowplayers721, posted by Dinah on August 11, 2004, at 11:55:11
This is a touchy issue. When I first started seeing my current T, she used CBT methods pretty exclusively, but while they helped some with anxiety, they did nothing for my depression or suicidal ideation. And while I've had improvement on drugs, like many people on this Board, medications are only partially successful.
The idea of tracking progress on a session by session basis seems absurd. I have some pretty awful down periods, but my real progress is best charted over a fairly long continuum. There is no question that I'm far more stable now.
I sincerely wish I was a person who could improve with 10 sessions of CBT. Long term therapy is costly, (even with insurance), and painful, and it's tough to have to worry about whether that level of care is going to be available to me before I'm ready to taper down.
I think what works for one doesn't work for another, and it would truly be unfortunate if the industry doesn't allow care to be dispensed accordingly.
Mair
Posted by Dinah on August 11, 2004, at 12:54:20
In reply to Re: therapy debate gets 'raucous' - Auntie Mel » Shadowplayers721, posted by Dinah on August 11, 2004, at 11:55:11
What I said in my previous post could clearly be construed to mean that I judged contribution to society as a purely monetary function. That is not at all my belief.
I was merely putting on a fiscal responsibility hat for a moment to point out that it is not only humane, but economically responsible to provide people with the treatment they need. How many therapy sessions can one inpatient hospital stay pay for? How many therapy sessions can the hospital stay for a failed suicide attempt pay for? What is the lifetime earnings potential of a person who completed a suicide attempt.
And of course, my main point was that I would never judge whether therapy is a personal indulgence because someone still has problems. That can only be judged by comparing the same person with and without therapy. Which admittedly makes outcome studies difficult.
A fictional, but reasonable to me, example is in the TV show Monk. Mr. Monk goes to frequent therapy, yet is still plagued by what most would consider to be extreme dysfunction. Yet in one episode we meet his brother who is not going to frequent therapy and get an understanding that Mr. Monk is actually coping quite well. Fictional, yes. But a good object lesson, I think.
Posted by Dinah on August 11, 2004, at 12:58:32
In reply to Re: therapy debate gets 'raucous' - Auntie Mel, posted by mair on August 11, 2004, at 12:46:35
You put that far better than I could right now, I'm afraid. I'm at my most super-rational at the moment and will soon start to annoy even myself.
Posted by AuntieMel on August 11, 2004, at 13:09:30
In reply to Re: Hmmm... clarification, posted by Dinah on August 11, 2004, at 12:54:20
Oh, I agree perfectly. I've been in therapy for two years now and don't see an end anytime soon.
I was responding to that in terms of the NYT article and the hints that this could be used to "manage care" That's the frightening part.
Posted by Ilene on August 11, 2004, at 13:46:32
In reply to therapy debate gets 'raucous', posted by badhaircut on August 11, 2004, at 10:05:32
Getting back to the contents of the article--I felt it was rather inconclusive. It says that what makes therapy "work" could be not the type of therapy but the competence of the therapist and the bond between the T and the patient. How do you evaluate the competence of a therapist? I've already paid a large sum of money to a pdoc/T with whom I had a good relationship, but I am still depressed. (The only reason I'm not severely anxious is because I twisted her arm to prescribe Zyprexa.)
Posted by badhaircut on August 11, 2004, at 14:52:45
In reply to Re: therapy debate gets 'raucous', posted by Ilene on August 11, 2004, at 13:46:32
> How do you evaluate the competence of a therapist?
Good question! I wonder if the "competent" therapists are simply those who have really good social skills, who are very responsive to subtle cues, and who genuinely enjoy other people. Folks who'd be "competent" in any field requiring a lot of tricky interpersonal navigation.
I wonder if therapists were required to post statistics like those used in the "competency" studies (what % of clients feel "much better" after # weeks or 1 year later; what % dropped out; what % say "He's a jerk!"; etc), would we consumers be better off?
Bruce Wampold, the psychologist in the article who said "therapist competence" is key, wrote a book on his competence research in 2001 called "The Great Psychotherapy Debate: Models, Methods, and Findings." It's available for download at netlibrary -- *free* if your local library subscribes:
http://www.netlibrary.com/Help/HowToAccessNetlibrary.aspxIt'll take me a while, but I really want to read it.
There's a pretty good review of the book on the American Family Therapy Academy web site:
http://www.afta.org/newsletter/88/nelson.html-bhc
Posted by Shadowplayers721 on August 11, 2004, at 14:59:20
In reply to What's 'competence'? Good question » Ilene, posted by badhaircut on August 11, 2004, at 14:52:45
My t said people come in with a troubling symptom, but that's not the real issue. She said she can spot what the really issue is. If she goes for the real issue too fast, the client will run. People have to be ready to face their demons. Sometimes, this can take years. You can't force a person to face their demons. Can you?
Posted by Ilene on August 11, 2004, at 17:49:58
In reply to What's 'competence'? Good question » Ilene, posted by badhaircut on August 11, 2004, at 14:52:45
> > How do you evaluate the competence of a therapist?
>
> Good question! I wonder if the "competent" therapists are simply those who have really good social skills, who are very responsive to subtle cues, and who genuinely enjoy other people. Folks who'd be "competent" in any field requiring a lot of tricky interpersonal navigation.
>That's obviously part of it. A good therapist has to have the ability to put people at ease so they will open up.
> I wonder if therapists were required to post statistics like those used in the "competency" studies (what % of clients feel "much better" after # weeks or 1 year later; what % dropped out; what % say "He's a jerk!"; etc), would we consumers be better off?
>I'd like to steer clear of the jerks, if I could. I've certainly read some horror stories, here and other places.
This is something the HMOs could do. We regard them as craven money-grubbers who want to boot people out of therapy, but the article also demonstrated a more constructive role for them. (PacifiCare Behavioral Health, which claims to call therapists to see what's going on if a patient doesn't improve.) Unfortunately, the mental health professionals, including psychiatrists, that were available through one of my previous HMOs were the ones who would accept minimal reimbursement. I ended up going out of network and using all my disposable income on psychiatry. I also didn't have the wherewithall to do much beyond drag myself to my appointments. My pdoc was overly slow and cautious, but she was very supportive. I might have done better if some third party had intervened and had me to see an actual psychopharmacologist long before I did. I'm sure the same is true for many purely psychotherapy patients.
> Bruce Wampold, the psychologist in the article who said "therapist competence" is key, wrote a book on his competence research in 2001 called "The Great Psychotherapy Debate: Models, Methods, and Findings." It's available for download at netlibrary -- *free* if your local library subscribes:
> http://www.netlibrary.com/Help/HowToAccessNetlibrary.aspx
>
> It'll take me a while, but I really want to read it.Please post your reactions.
>
> There's a pretty good review of the book on the American Family Therapy Academy web site:
> http://www.afta.org/newsletter/88/nelson.html
>
> -bhc
Posted by fires on August 11, 2004, at 20:47:44
In reply to therapy debate gets 'raucous', posted by badhaircut on August 11, 2004, at 10:05:32
> According to an article in Tuesday's New York Times, psychologists had a conference on the effectiveness of interpersonal psychotherapy that was more like a "civil war" at the APA's annual meeting 12 days ago.
>
> -quote-
> The issue of which therapies are based on science and which are not has recently become [very] divisive....
>
> The topic was debated before a raucous, packed hall at the annual meetings of the American Psychological Association in Honolulu, held July 28 to Aug. 1. ... "The split in the field is bigger than it ever has ever been," said Dr. Drew Westen.... "The intensity of the acrimony, the distaste, has never been so high."
>
> At bottom, the dispute is over the nature of psychotherapy: Is it an intuitive process, more art than science? Or is it more a matter of a therapist following specific procedures that reliably help people get better?
> -unquote-
>
> Participants expect the controversy to keep getting bigger.
>
> You can read the original article for the next week free at the NY Times site:
> http://www.nytimes.com/2004/08/10/health/psychology/10ther.html
> After this week you have to pay to download it.
> Libraries should have hard-copy back issues (Aug 10, 2004: "For Psychotherapy's Claims, Skeptics Demand Proof" by Benedict Carey, New York Times).
>
> It may also be available online for free later at these sites:
> http://www.wilmingtonstar.com/apps/pbcs.dll/article?AID=/20040810/ZNYT04/408100368/1002/BUSINESS
> http://www.goupstate.com/apps/pbcs.dll/article?AID=/20040810/ZNYT04/408100374/1051/news01
>
> -bhcThanks for the great link. Glad to see that some are now wanting proof that therapies work! Yes, it's about time. No truth, without proof.
A quote from my former MD, in his book, "Betrayal by the Brain, Jay A. Goldstein": p.181: "I am reminded of a two week period during my medical student psychiatry rotation when I was able to discuss every patient in the context of his/her oral impregnation fantasy. It took quit a while for my supervisors to realize that I was parodying the illusory certainty that contemporary psychiatric thinking provided. Scientifically generated hypothesis testing is much more rational and measurable, and more beneficial to patients."
bye
Posted by 64bowtie on August 12, 2004, at 3:24:35
In reply to therapy debate gets 'raucous', posted by badhaircut on August 11, 2004, at 10:05:32
Posted by Dr. Bob on August 12, 2004, at 3:50:55
In reply to Re: therapy debate gets 'raucous' » badhaircut, posted by fires on August 11, 2004, at 20:47:44
> Glad to see that some are now wanting proof that therapies work! Yes, it's about time.
Please don't jump to conclusions about others, for example, that they didn't want proof that therapies worked before.
> "I was parodying the illusory certainty that contemporary psychiatric thinking provided. Scientifically generated hypothesis testing is much more rational and measurable, and more beneficial to patients."
Also, please be sensitive to the feelings of others, including those who rely on contemporary psychiatry.
I've asked you to be civil before, so now I'm going to block you from posting for another week.
Anyone who has questions about this or about posting policies in general, or who is interested in alternative ways of expressing themselves, should see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Also, follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by AuntieMel on August 19, 2004, at 12:00:26
In reply to Re: therapy debate gets 'raucous' » badhaircut, posted by fires on August 11, 2004, at 20:47:44
I believe your block will be up today. Let me be the first to welcome you back.
Following are hopefully some suggestions about living peacefully in babble land;) Feel free to ignore them if you want, but .......
In case you are wondering about the latest block, please let me explain a bit. (Dr. Bob - please correct me if I'm wrong)The problem isn't so much WHAT you said as it is HOW you said it. There are a couple of things to keep in mind.
The first is that this is, after all, a mental health site. By definition, those who find refuge here are experiencing mental/emotional problems. This means that there are, or could be people here who have a heightened sensitivity - compared to others they meet in real life. Babble, to many, is a safe place where they can feel free to discuss things they wouldn't dare discuss to even those closest to them.
The second is that a lot of the people here have been posting for quite a while. The other posters are like family to them - often better than their real families. If they feel that a friend or the friend's condition is being harshly criticized, they WILL rally 'round the friend.
Most newcomers start gently and wait to be accepted before disagreeing with much. And even then the disagreement is done gently.
So, back to the beginning. WORDING MATTERS. And a poster's history on the board matters.
=================================================
So, for this example post:>>>>> Glad to see that some are now wanting proof that therapies work! Yes, it's about time. No truth, without proof.
You could have said (and I think meant the same thing)
I loved this article. It's been my experience that proven, measurable therapies (like CBT) are more reliable than the others. It is good to see a large group of psychologists agreeing with me.
The first one (out of context, grantedly) could have been construed as personally critical of anyone using a more contemporary therapy method. The second leaves no doubt that it is *your* opinion.
The second part of your post, the quote from your former doctor, seemed a bit gratituous. It's a quote, taken out of context, from an eight year old book. And it really didn't seem as much an indictment of contemporary (eight years ago) therapies as much as an indictment of therapists that swallow a method hook, line and sinker without looking at scientific studies. The problem was the CERTAINTIES of the therapists, not the methods themselves.
=================================================
Anyway, this is a lot more than I intended to say. It's just that I personally believe you have a lot to offer here and would like you to stay. Not blocked;)
I'll be away from computing this afternoon (therapy session), but I'll try to check back this evening.
Mel
This is the end of the thread.
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