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Case Studies - Page 6

Case Commentary
By David Waters

Seldom have I been so split in my response to a case. On the positive side, I was impressed with how James Gordon brings out the healing potential within his patient, guiding her gently and supportively toward a new sense of self. What patient wouldn't appreciate the kindness and generosity, the plethora of helpful ideas, the almost unlimited availability? I imagine many readers wish he were their therapist or are resolving to be kinder, more available, more spiritual healers themselves.

That said, I'm going to voice the more skeptical part of my reaction. Maybe it's just a rainy day, maybe it's reading the case three or four times as a reviewer, maybe it's wishing that I could be that nice a therapist, but there's something about this case that left me uncomfortable. After 37 years of teaching family doctors to take a mind-body approach, I have reservations about Gordon's approach.

Again and again as I was reading this case, I found myself asking "What exactly is the therapy here?" The hallmark of this case is that Gordon seems to give Theresa almost unlimited access to himself in many different ways: availability by phone, reading materials, sharing his thinking and theory, offering intense personal connection and support in many forms. In addition, he gives her access to a vast range of healing modalities: psychotherapy, meditation, exercise, mantras, self-care teachings, overt emotional support, "a spiritual perspective," herbs and maybe drugs, posthypnotic suggestion, diet changes, drawing, journaling, movement, guided imagery. The list is remarkably lengthy—but when you offer every therapy imaginable, the effective components of the approach get blurrier and blurrier.

Let's not ignore the crucial fact that it seems to work: Theresa feels better immediately, seems to continue to feel better over time, and returns years later for a grateful check-in. She has clearly learned a central lesson of therapy: there's nothing wrong with me; it's how I use what I have that matters. What's not to admire about that kind of approach? From my perspective, it's so unfocused and overinclusive that I can't tell what exactly is helpful and what's therapeutic overkill. In light of all the debate surrounding healthcare reform and the prevalence of excess procedures in the healthcare system, I kept wondering whether such an extensive intervention was the best use of Gordon's time and input. (I also kept wondering how many patients this man sees.) It's the equivalent of a doctor who's treating my multiple vague symptoms giving me 8 or 10 medications in a couple of visits, based on the theory that "one or more of these will probably help; I just don't know which one." I'd be glad to feel better, but next time I'd want to go to a doctor who focused more and could tell me more clearly what he was treating. For me, bringing clarity to the pain the person feels is an important function of therapy.

From my experience as a therapeutic supervisor, I kept noticing that most of the energy in this case seems to come from Gordon, and not much from Theresa. With his gusto and intensively supportive style, and his eagerness to keep offering treatment options, he seems to see providing the oomph for treatment as almost exclusively his responsibility. Frankly, I think I'd have a hard time routinely providing that same energy to all my patients. While I can certainly admire the energy and the caring, I know that offering this kind of treatment hour after hour in practice is just not for me.

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