“The art of medicine consists in amusing the patient while nature cures the disease.”
In my studies to become a psychologist, I often heard my professors say that, Psychotherapy is both an art and a science. I have come to believe that it leans most to the side of art.
Mom and Dad are in the kitchen doing their taxes while 3 year old Johnny finds himself unattended for longer than usual. Chasing the cat, he trips on the rug, falls into the edge of the coffee table and cuts and bruises his arm. His first reaction is to look around to see if he has been busted for chasing the cat. When he realizes that no one saw him, his attention shifts to the pain coming from his bleeding arm. Suddenly he lets out a piercing cry, predictably, his mother and father dash into the living room. The intensity of their response makes Johnny howl even louder verging on hysteria. Mom and dad quickly survey the situation, look at each other knowingly and calmly and soothingly tell their son, verbally and with a calm demeanor that they will fix it. And so they do with the magic of mother’s kiss and father’s cajoling humor. All is well.
It is not just the innocent child who is master and slave to belief. Our thoughts, feelings and perceptions are passively shaped by our beliefs. I wonder if the powerful placebo effect is the material manifestation of the marriage of hope and belief. Today, wherever we turn, our attention is pulled to inducements to try the latest formulaic solutions to our problems. Few of us can resist being seduced by any number of fixes in the form of a pill, therapy strategy or one of the many forms of self-help. All of which may or may not work depending on the individual and the context and timing. A quick and easy intervention, heavy with promised results with a minimum of side effects has much appeal. Yet we often seem to be bumping against choices that do not take into account the fullness of who we are and offer only a temporary diversion for our immediate pains and concerns.
No one is immune to the physical and emotional pain of living. Such is life and perhaps it is especially so in these times in which we are now living. Having devoted much of my life to working with people who are in various states of distress, I think a lot about what we can do when who we are, and how we are leading our lives has become intolerable. How do we change and develop new ways of being?
We are socially interdependent creatures, rather than the independent heroes who are lauded in our current culture. Young people now live in various states of dependence within families for longer and longer periods of time. Yet Ayn Rand’s myth persists – that the highest ideal is to aspire to become the independent giant of industry who is only responsible to a personal ethical and moral code which is not accountable to anyone. To the contrary, no matter how rich or poor we are, we all need somebody. Of all living organisms, we require the longest period of care to survive childhood. To flourish, the importance of a caring family cannot be overestimated.
Absent the ideal, families may be assessed to exist along a continuum marked at polar opposites of good and bad. Most of us can probably assign our family of origin to a point somewhere within one standard deviation from the good-bad mean. If the family can provide just the right amount of love and protection coupled with a sensitivity to the child’s changing developmental needs, one might see the possible maturation of a capable adult. Probability perhaps, but not inevitable. Even the strongest foundation is likely to meet significant challenges – the greatest being Relationships. What happens to those of us who find ourselves residing closer to the pole of dependence on the continuum of self-sufficiency? What can provide us with what was missing in our development when we have been raised in less than adequately nurturing families?
In our culture, when we are confused and in emotional pain, the expert we are referred to is usually someone who is a psychotherapist. Research has shown that psychotherapy works, but whenever different forms of therapy are compared, the results are inconsistent and are not replicated by later studies. The confounding variable is the therapeutic relationship and its impact on the results. A unique relationship is not amenable to being measured by what is deemed to be the gold standard of research protocols, the Randomized Controlled Trial (RCT).
MedicineNet.com describes RCT as follows: “A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo (“sugar pill”), or no intervention at all. Someone who takes part in a randomized controlled trial is called a participant or subject. RCTs seek to measure and compare the outcomes after the participants receive the interventions. Because the outcomes are measured, RCTs are quantitative studies. In sum, RCTs are quantitative, comparative, controlled experiments in which investigators study two or more interventions in a series of individuals who receive them in random order. The RCT is one of the simplest and most powerful tools in clinical research.”
I believe that RCT, cited above as a simple and powerful tool, is not a valid method for evaluating relationships. Perhaps the most illuminating study of therapy effectiveness was conducted by Consumer Reports and published in the American Psychologist in the December, 1995 issue. The study concluded that patients benefited very substantially from psychotherapy and that long-term treatment did considerably better than short-term treatment. No specific modality of psychotherapy did better than any other for any disorder.
The therapeutic relationship, unique and resistant to quantitative measurement is essential. Since it is virtually impossible to match up therapists, most studies are designed to compare the effectiveness of different forms of therapy. In addition, some studies are designed to discover and evaluate the traits of effective therapists. I believe that the individual traits of therapist and client cannot be isolated or combined so that we can come up with uniform standards. More likely, it is the meeting and connection of two whole people who form a therapeutic alliance that is critical to outcome. Dissecting the characteristics of individuals or the therapy process is not amenable to simple quantitative studies.
At various stages of our lives we look to develop relationships where our better selves can be seen in the eyes of others. Feeling like we belong and are a valued part of a community can comfort us in times of turmoil. It is in relationships where we feel valued that we are able to take risks and are not unduly inflated by our successes or deflated by our failures. A growth-enhancing relationship is not necessarily exclusive to psychotherapy. For those seeking help there are a plethora of choices like hypnosis, neurofeedback, nutrition, exercise, meditation, prayer, spiritual discipline and retreats on the ever expanding list of change agents. A lover, support group, AA, an athletic group, a book club or other interest group can validate our self-worth and be the catalyst for growth. Such pursuits, may not be all encompassing answers, but might be doorways to new experiences that can enhance how we define our worth, meaning and self-acceptance.
For me it is the relationship, the connection, the ability to embrace the positive aspects of a surrogate parent, friend, uncle, or caring sister. I think it is safe to say that with few exceptions we all benefit from a caring relationship. It is within a caring relationship that we are able to look at ourselves and be ourselves in ways that allow us to re-define our goals and reconstruct who we are and how we will attempt to be in the world.