In Therapy Forever? Enough Already
Click Here to Read: By Jonathan Alpert in The New York Times on April 21, 2012.
Click Here to Read: “We Have Nothing to Fear, But . . . “We have nothing to fear, but…”; Makari on the Anxieties in Today’s NYTimes on this website.
Click Here to Read: Jonathan Alpert’s Mis-Statements, And Possible Misconduct by Todd Essig on the Forbes Magazine website on April 23 2012.
Click Here to Read: Is Quick Therapy the Best Therapy? Letters to the Editor in the New York Times on on April 23, 2012.
Response to “In Therapy Forever: Enough Already,” (NYT 4-22-12)
Nathan Szajnberg MD Managing Editor
Imagine retitling Alpert’s OP-Ed “In Therapy Forever? Enough Already”: into “In Medical Treatment Forever? Enough Already.”
This is not entirely wrong; it simply doesn’t make sense. If medical treatment is for a runny nose, of course medical treatment shouldn’t be forever; any Doc-in-the-box can handle this. If it is for a diplococcal pneumonia, of course treatment is not forever; perhaps two weeks.
If it is for Type II Diabetes — oops, (forever or until death do us part). How about Rheumatoid Arthritis — forever. How about Parkinson’s — ibid. Then there are the terribles — leukemia, breast cancer. Would you believe a physician who said that he could treat you in one visit with 88% improvement (as Alpert claims in his article)?
So, the degree to which treating the mind is a clinical practice — which it should be, if we respect our minds as much as our bodies — then treatment should be for as long as the diagnoses indicate, provided the clinician makes good diagnoses.
For Alpert, “anxiety” or “depression” appear to be simple matters, needing perhaps one visit, maybe eleven, he says. But, read Makari’s recent thoughtful reflections on “anxiety”: then decide whom you would want to treat you.
But, psychoanalysts have an obligation to articulate, to show that our work over time benefits our patients. Fonagy and Target did so for child analysis. Leutzinger-Bohleber and colleagues are doing so for adult treatment. American analysts should step up to the plate.
Alpert’s article is typically American: faster, better, sooner and doing something to someone. Nothing completely wrong with that. In fact, Alexander and French pioneered such work in Chicago psychoanalysis. But, when Jean Piaget visited the University of Chicago in the mid-60′s, he bewailed the American tendency to try to get babies to do things sooner, faster (and for American researchers to change research problems to fit their methods, rather than devising to fit the problems). It’s possible to get babies to do things sooner, such as toilet training at six months. But, whose achievement is this? Or in clinical practice, our task is to provide the patient with the capacity to guide her or his own life.
Explore posts in the same categories: Editorials, Letters To Editors
April 24th, 2012 at 1:49 pm
Comment by Herbert S. Gross, M.D.
To the Editor:
Alpert (In Therapy Forever Sunday April 22,2012) picks the “low hanging fruit”- patients who have clear ideas about the goals and outcomes they seek and there is not much in the way of getting there. Others seem just as clear- just as “stuck in unfulfilling jobs and relationships ..and fearful of change and depressed” but don’t respond in the first months of therapy. They can’t take advantage of the caring, warmth and empathy of their therapists that is the most reliable characteristic of successful therapy. Many of them are indistinguishable from the others at the outset of therapy. It is only when the optimism of the early months is dissipated and the goals and outcomes sought seem as far away as ever that the long term challenges surface. Both parties have the responsibility to address those challenges and it is a mistake to attribute responsibility to one or the other. Long term therapy is a team effort and Alpert is right to point out that therapists with a need to cur!
e and patients with a need to fail form some of the longest relationships in in contemporary society.
Therapy is an egalitarian partnership and as elsewhere in life partners need to be open and honest with each other.
Herbert S. Gross, M.D.
Clinical Professor of Psychiatry
University of Maryland School of Medicine
Immediate Past-President
Washington Center for Psychoanalysis
http://herbertgross.com
April 24th, 2012 at 6:18 pm
Dear Dr. Gross,
Look at the link to Forbes, with a harsh expose of Alpert.
You seem to be correct about not only his picking low-hanging fruit, but possibly advertising for them.
April 25th, 2012 at 4:57 am
Comment from Leon Hoffman:
Rebecca Meredith wrote: “Like many, but apparently unlike Alpert, I worry about the effect this can have on both those who will now be suspicious of therapists who don’t “kick their butts” and those who will never get into treatment in the first place because they believe that they will be unwillingly sucked into something longer term that a) they don’t really need or b) should feel ashamed of if they do.”
More importantly to me, and to add to Todd’s labeling this as an infomercial for the practitioner, this article is an infomercial for the insurance companies.
This is consistent with what I wrote last week about the denial of longer term therapy (whether in or out of network).
I hope CGRI takes up this very serious problem.
Leon
–
Leon Hoffman, MD
April 25th, 2012 at 5:17 am
Comment from Harvey Schwartz:
I share everyone’s pleasure and admiration for the fine letters from Mark and Deborah that appeared in today’s Times to counter the frankly silly article by Alpert. As a side note for those of us who have been life long readers and devotees of the Times, it is a sad day that the formerly great Old Gray Lady now resorts to quoting a Mental Health Counselor for information about psychotherapy. In addition to the attack on our professionalism, the article highlights how thoughtless provocation has replaced research and insightfulness in much of today’s journalism.
Harvey Schwartz
April 25th, 2012 at 10:48 am
Wow. That’s one of the saddest artilces I have ever read. I hope it doesn’t hurt anyone…
One of the things most thearpist I know agree on, is not looking at the world in a “black or white” sort of way. (actually a very cognitive behavioral idea (which is a short term sort of a therapy)…
Things don’t have to be one way or another. Alpert is doing just that. For some people, and some issues short term therapy is sufficient, perhaps more helpful. And sometimes, longer term therapy is more beneficial. It doesn’t have to be one way or another. Life is full of grey. Even in terms of therapy…
Again, I agree with looking at it like physical illnesses. Because really mental illness is a physical illness as it effects the brain. We just call it mental because it effects the thought processes and behaviors. A short term depression or adjustment disorder, or dealing with a situational event may (or may not) required just something short term, such as having a cold, or the ful. But if you have diabetes, or had a stroke… just like physical THERAPY… you may need a little bit more help to get back to your previous level of functioning.
April 28th, 2012 at 9:28 pm
I join Harvey Schwarts in thanking Mark, Deborah and others for responding to Alpert’s article in the NYT, and am obviously in agreement. I would like to add to their and the anonymous therapist’s above a queery to Mr. Alpert. I wonder if he has ever had to treat a patient with severe PTSD – whether related to the Holocaust as we see in survivors and their children, or more recently to issues ranging from sexual and domestic abuse to war time PTSD. In the climate that we live young men and women are deployed numerous times to foreign countries to participate and witness unspeakable brutalities and come back often destroyed in body and spirit; we read articles about suicide rates going up in current economic downfall in Europe and depression in the USA; children and their families are continually at risk, students are losing friends and teachers in shool shootings by classmates and bullying is a topic at the president’s table. I work and try to help many of those afflicted by the above. They are not few and far between as Alpert would lead the public to believe. Many of these individuals take a very long time to recover and reach a better level of functioning that they would like. Were I to send them out after a week, the consequences, I believe, would legitimately lead to malpractice suit.
Alexandra (Sasha)Rolde
April 29th, 2012 at 12:06 pm
Which is the real purpose of this ? Besides misunderstandings and reduction of concepts, choice is the core issue in Alpert’s article. Choice is based on decision; decision in turn can be persuaded.
Starting at the end and working backwards on Alpert’s article, the article per se reflects an exemplar persuasion – how ‘a therapist is able to encourage smart strategies to help patients to achieve realistic goals’. Neverthless, making use of Alpert’ strategy – asking yourselves – whose realistic goals can be achieved?
Placing patients don’t suffer severe disorders as unable to make their own choices in long term therapy, therefore as victims under the power of ‘tyrannical therapists’ (quotation marks are mine) , is without doubt a smart strategy to encourage readers to take risks and embrace change – to change over to ‘an aggressive therapist’ – hence realistic goal has just been achieved. Unfortunately it is quite true, ‘the therapist, of course, depends on the patient for money, and the patient depends on the therapist for emotional support.’
I deeply regret that business is over concern about people psychological well being, otherwise, instead of writing about which treatment is better or not, we were trying to share different experiences and knowledge, working on a better and realistic goal – people psychological well being.