I don’t like writing about all the nonsense out there; I prefer to be positive and to concentrate on what can help people, but I have to make exceptions. Today in the NY Times (April 21, 2012, Sunday Review) is that exception. I cannot for the life of me figure out why I cannot get an article in the Times while those who write what I consider pure rubbish get a prominent place there.
I read the little rubric at the start of the piece, which said: “In Therapy Forever? Enough Already” and I thought, “My oh my, finally a bit of reality.” Disappointment soon set in. The piece is by a Mr. Alpert, a New York therapist. He is in dispute against long-term therapy, especially psychoanalysis. He begins with a bit of statistics: the longer you stay in therapy, the less you get out of it. Ergo: cut down on the time in therapy. The usual statistical logic. There is no “why” in all of this. Why is it that the longer you spend in therapy the worse it gets? Is it an addiction? Yes. The reason it goes on and on, says Alpert, is that therapists won’t admit defeat. Here is his key finding: “On the first visit to a therapist 88% felt they improved; after 12 sessions it was down to 62% improved. Yes but, say the long-term analysts, complicated cases require much longer time in therapy.
Alpert believes that the reason most people seek treatment is for something in the present that requires precise help; being stuck in bad relationships or a stultifying job. “It doesn’t take years of therapy to get to the bottom of those kinds of problems. For some of my patients, it doesn’t even take a whole session.” I think he is referring to counseling patients, not serious psychiatric problems such as deep depression and anxiety. And for YMCA counseling, he may be right. But it has been years since I have seen anyone who did not have deep, hidden emotional problems.
So let’s follow his logic: “Therapy can—and should—focus on goals and outcomes, and people should be able to graduate from it.” Whose goals are those? The doctor’s? The patient’s? It smacks of present attitudes about so many things: just get it done and be done with it, don’t whine and complain. He goes on: “In my practice, people who spent years in therapy before coming to me were able to face their fears, calm their anxieties, and reach life goals quickly—often within weeks.” Aside from its smug-self-satisfaction, the logic baffles me. He truly believes, “I’ve got the answer and you don’t.”
In case we missed something, this is pure cognitive/behavior therapy. We teach the patient to set a goal, work toward it and voila, in almost no time she is fine. I have been in practice for 60 years and I have never seen deep problems clear up in a matter of weeks; something that took decades to build up isn’t going away in 60 days. But you might think it will if you stay on the surface and think that what the patient thinks is the sole criterion for wellness; how about stress-hormone levels, immune functions, and all the rest? Do we just ignore the body and keep it cognitive? He has the answer for that: he believes “it’s a matter of approach. Many patients need an aggressive therapist who prods them to face what they find uncomfortable….They don’t need to talk endlessly about how they feel or their childhood memories.” There it is. Don’t delve into deep-lying causes, just get on with life. It is the anti-primal approach. Feelings, emotional pain, and childhood events—causes—don’t matter. Will power, strength, and determination do. It is his own modus operandi, his key neurosis elevated to the level of a principle. And he prefers his patients to listen to his advice, because they “need it.”
If you are willing to leave aside all causes and emotional anguish, and just focus on your future, maybe it can work for you—but surely there is no science there at all. Why is it that long-term stays in therapy do not work? The same reason short-terms stays don’t work. It just does not work. It is based on faulty science and a therapist’s own ways of dealing with things apotheosized into the realm of theory. Do we hear anything about what the person’s childhood was about? Not interested. Her emotional pain and anxiety? Not interested. So what are you interested in? Progress…progress according to my manufactured criteria. And what are those criteria? “Whatever I say it is.” And when the patient fulfills my criteria (when she says, I feel better), I pronounce her well. Unbeatable logic. Is she well when she has extremely high blood pressure, or high cortisol levels? Is it really all in your mind?
It is the modern day Charlie Chaplin brought into the machine age; results are all that matters. Jonathan Alpert has, forgive me, the Jewish disease (it takes one to know one)—explain everything, stay in the head, figure it out and then be rid of it. “How do you feel” becomes an anathema. It doesn’t matter in his approach, and yet in what we do it is all that matters. But you won’t know that when you live in your head. Neurosis is a disease of feeling, of repression and the inability to feel. That is why anyone should come to us. If they want something different—advice—they should see a counselor who gives it. I have seen or supervised thousands of patients from 26 countries and I have yet to see anyone who just needs a bit of advice. If that is what you need see a relative, a maven (a maven, the smart, all-knowing one in Jewish life, is usually the one with the most money). But wait, Alpert is not giving advice; he is telling people how to live, what to do, and how to do it. He is a cheerleader. No science there. He doesn’t ask how patients feel because “I already know.” Why bother inquiring.
I could go on, but what is the point. The real question is: How does that nonsense get such prominent placement in a world-renowned newspaper?