Unit 4  Section 1Exercise 4 Approaches to treatment: therapy
Clinical correlate #4: Therapy for depression
Libraries have been filled with theories about how therapy works. Freudian psychoanalysis has fallen out of favor but lives on in a watered down version as ‘talk therapy.’ Some therapies are more insight-oriented, and others more behavior-oriented. Because of a better understanding of the neurochemical determinants of mental illness and behavior, as well as the economics of treating mental illness, current approaches to depression favor cognitive behavioral therapy and medications. See the clinical correlate for a discussion of CBT as well as on the effectiveness of psychotherapy. This section focuses on the techniques of talk therapy. Return to Unit 1 Section 1 Why are relationships important? The need for a healthy connection with others is an important tenet in defining the role of psychotherapy. Read the additional excerpt reproduced here from A general theory of love, and view the video interview with Jean Gearon. Answer the study questions.
Excerpt, from Lewis et al. A general theory of love.
Overhauling emotional knowledge is no spectator sport; it demands the messy experience of yanking and tinkering that comes from a limbic bond If someone’s relationships today bear a troubled imprint, they do so because an influential relationship left its mark on a child’s mind. When a limbic connection has established a neural pattern, it takes a limbic connection to revise it. An attuned therapist feels the lure of a patient’s limbic Attractors. He doesn’t just hear about an emotional life—the two of them live it. The gravitational tug of this patient’s emotional world draws him away from his own, just as it should. A determined therapist does not strive to have a good relationship with his patient—it can’t be done. If a patient’s emotional mind would support good relationships, he or she would be out having them. Instead a therapist loosens his grip on his own world and drifts, eyes open, into whatever relationship the patient has in mind—even a connection so dark it touches the worst in him. He has no alternative. When he stays outside the other’s world, he cannot affect it; when he steps within its range, he feels the force of Alien Attractors. He takes up temporary residence in another’s world not just to observe, but overthrow. Through the intimacy a limbic exchange affords, therapy becomes the ultimate inside job.
…the dance between therapist and patient cannot trace the same path that the latter expects, because his partner moves to a different melody. Coming close to a patient’s limbic world evokes genuine emotional responses in the therapist—he finds parts of himself stirring in response to the particular magnetism of the emotional mind across from him. His mission is neither to deny those responses in himself, nor to let them run their course. He waits for the moment to move the relationship in a different direction.
And then he does it again, ten thousand times more. Progress in therapy is iterative. Each successive push moves the patient virtuality a tiny bit further from native Attractors, and closer to those of his therapist…With enough repetition, the fledgling circuits consolidate into novel Attractors. When that happens, identity has changes. The patient is no longer the person he was.
…insight is the popcorn of therapy. Where patient and therapist go together, the irreducible totality of their mutual journey, is the movie.
…The set of all relationship stories, all styles of loving that lead to misery, is illimitable. That infinitude makes the daily practice of psychotherapy a mind-expanding experience. When a patient walks through the door, we can reasonably expect him to strike up the relationship he knows…But a therapist doesn’t need an encyclopedic compendium of every variant. Instead, his indispensable tools are the strong template of healthy relatedness within himself…” Lewis et al. A General Theory of Love, Random House, 2000, p177-179.
Jean Gearon: 
Study questions
- What do you think of Lewis et al’s description of how therapy works? What, according to this excerpt, is the basic problem that brings people to therapy? LINK to Unit 1 Fitness What causes the main character to seek therapy in this story?
- Patients at any stage of depression or psychological dysfunction may resist insight therapy. See Unit 1 Fitness . What might be the cause of the main character’s resistance? What does Gearon mean by the ‘work’ of therapy? How might a therapist overcome this resistance?
- What, in your opinion, determines the length of therapy? Include Gearon’s comments on this subject in your answer.
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