Matarazzo, 1971---Psychotherapy is art, not science.

No viable theory exists to guide the understandably anxious therapist as s/he attempts to help a fellow human being reach a higher level of effectiveness and/or happiness. How much uniform following of Freudian or any other theory can occur in 4.7 visits? Therapists have theories (weak ones) to reduce their own anxiety. An artisan relies on an incomplete, fragmentary body of knowledge and empirically established rules traditionally passed on in an apprenticeship fashion.

Howard, Lueger, Maling and Martinovich--Phase Model of Therapy

I. From demoralization to remoralization. Improvement in subjectively experienced well‑being. Stage 1 (The Expectation of Hope) ends when:(A) P perceives T as trustworthy and competent and P feels a significant and durable emotional connection with T.; and (B) P and T both have established an implicit contract resulting in a working alliance to obtain a greater understanding of P’s psychological functioning. Stage 1 may mobilize Ps own coping resources and they may require no more therapy, or they may move into:

Stage 2: Remediation--- Some P will begin therapy in phase 2, seeking help before demoralization occurs. Treatment facilitates more effective coping skills. For example, ‑Cognitive therapy for elimination of depressogenic cognitions‑--Interpersonal therapy for enhanced assertiveness--- desensitization for phobic avoidance‑---Empathetic reflection to reduce conditions of worth‑--Interpretations to promote adaptive understanding. Phase 2 is over when there is improvement in symptomology. Some P will terminate, others will progress to:

Stage 3: Rehabilitation---The unlearning of troublesome, maladaptive, longstanding patterns; and the establishment of more adaptive way of coping with life and self. Phase 3 is a psycho- educational or preventative phase. Improvements in each phase are hypothesized to be necessary before changes in a subsequent phase can occur.

Bowers and Farvolden, 1996 (B & F)---Freudian Slip: Suggestion disavowed to the “TRUTH” repressed--- and commentary.

Advocates of the importance of retrieving repressed memories of sexual abuse typically adhere to Freud’s initial trauma theory (sexual abuse) of hysteria, which Freud later changed to a conflict‑Oedipal based theory (fantasies of sexual contact with father). How can one determine whether recovered memories are “THE TRUTH” or are false memories constructed by suggestion? B& F believe

1. The most characteristic reaction to trauma are intrusive thoughts and memories. (Repression of trauma is infrequent.)

2. Prevalence of child sexual abuse exceeds prevalence of false memories of abuse.

3. “DO NO HARM” as a 1st principle of treatment.

4. Many clinicians seriously underestimate the impact of suggestion on memory and belief.

Four Kinds Of Adults Entering Therapy:

1. Those traumatically abused as children, who have never been able to forget.

2. Same as 1, but repressed memories of abuse.

3. Those non‑traumatically abused as children, who have simply forgotten abuse.

4. Those never abused as children.

Lindsay (1995) claims that no controlled studies show that recovery of hidden memories is

beneficial therapeutically.

Definitions are important:

Dissociation -- a failure to completely process and integrate information into waking consciousness because of “state” variables; ex. hyper arousal (terror).

Repression -- an active inhibition of threatening information already fully registered and sorted.

B & F (and others) propose a conscious mechanism (avoidance) to account for “repression.” Even if memory has been repressed, retrieval of it is not guaranteed to escape the distortions and constructive features of memory in general. Therapeutic attempts to recall repressed memories is a risk factor for suggesting false memories. B & F believe that suggestion is powerful.

Safeguards:

1. Do not define the possibility of healing (improvement) in terms that require the therapist and patient to understand the patient in the same way.

2. Entertain alternative hypotheses to account for patient’s problems, so as not to fixate on one of them.

“WE ARE NOT PUT HERE TO SEE THROUGH PEOPLE (FIND THE ‘MAGIC BULLET’), BUT TO SEE PEOPLE THROUGH.”

Realizing how difficult or impossible it will be to distinguish between true and false memories of abuse, the therapist should balance in each case the potential for harm that would result from not recovering true memories of abuse against the potential problems that would result from recovering false memories of abuse. Then proceed in a fashion least likely to produce harm.

Meehl (1997)--Credentialed persons, credentialed knowledge.

“Since clinical experience consists of anecdotal impressions by practitioners, it is unavoidably a mixture of truths, half-truths, and false hoods. The scientific method is the only known way to distinguish these, and it is both unscholarly and unethical for psychologists who deal with other person’s health, careers, money, freedom, and even life itself to pretend that clinical experience suffices and that quantitative research on diagnostic and therapeutic procedures is not needed.”

Meehl provides a number of his clinical observations that have not been well-credentialed by the scientific method (the depression eye sign, schizophrenic speech with long latencies and normal rate, the “paranoid” walk, and the psychopath’s animal grace). These clinical experiences should not be viewed as credentialed knowledge.

Here are a couple quotes from Meehl that I believe are not out of context. “If I insist on the validity of Meehl’s depression “eye sign” and reject the need to research it, I am claiming genius immunity from the failings to which all human beings, with or without advanced degrees , are known to be subject......It is simply the distinction between a knowledge claim that brings good credentials and one that does not. ‘I feel very sure’ is a fact about Meehl’s biography; it is not a knowledge credential.”

EMPIRICALLY SUPPORTED BENEFICIAL MATCHES: DR. HYNAN’S CRITERION

Exposure (in vivo)------------------------------Phobic Disorders

Exposure plus response prevention-------Obsessive-Compulsive disorder

Parent Management Training----------------Oppositional and Aggressive Children (pp. 556-558)

Token Economies--------------------------------Chronic Psychiatric Patients

Operant Sr⁺ and S^--------------------------------Autistic Children

Exposure + Relaxation Training + CBT----Panic Disorder

If possible, avoid hospitalizing patients. It increases the probability that they will be hospitalized again.