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Case Studies - Page 7

Author's Response

This commentary by David Waters contains a curious blend of wistfulness and aggrieved professionalism that points to a central dilemma for many practitioners in the helping professions. Most of us feel a genuine commitment to doing the best we can for the people we serve, and our efforts are too often dimmed by the weariness and cynicism that come with working in settings or with attitudes that keep us from being as effective and as compassionate as we can. But contrary to what Waters suggests, working the way I do doesn't make me weary. Just the opposite! What's energizing for me is the spontaneous encounter with each person I work with. While in this case, written for therapists, I emphasized the techniques I prescribed for Theresa, in fact, it was she who did all the work. My contribution was to serve as a guide in, and catalyst to, her own creative and challenging personal work. The 3,000 clinicians who've already trained at my center report to me that working in this way—emphasizing teaching and prescribing along with listening, rather than interpreting and analyzing—is less taxing, more personally satisfying, and often more effective than more conventional forms of therapy and counseling.

Then there's the issue of what Waters calls "therapeutic overkill." He compares my approach to prescribing "8 or 10 medications" and has concerns about multiple interventions obscuring the "clarity" necessary to find the root of a patient's problem and deal effectively with it. But I believe his objections are based on a misunderstanding of this approach. Every medication may have negative side effects, and combinations often promote harmful interactions, but the Unstuck approach brings together synergistic techniques and suggestions, which enhance one another's effectiveness. The sense of hopefulness that may come from meditation or guided imagery may power the effort necessary for dietary change and increased exercise; these activities, in turn, may further decrease the stress that precipitates and prolongs depression and open receptivity to other techniques, like dancing and drawing, which nurture imagination and intuition and open up still more choices. Rather than therapeutic overkill, this is a way of working that's simultaneously comprehensive, organized, and individualized.

I believe Waters's concern about teasing out more specifically which of the techniques is working is largely an academic question. What people want is to feel better—to find hope in the midst of their suffering and learn new ways to heal themselves. Making multiple approaches available allows each person to create, with her therapist's help, a comprehensive program, individualized to her needs and preferences. Endless questioning—in the name of intellectual precision—about which technique is "the one" has in my experience proved a barrier, not an aid, to understanding how best to address the physical and mental health problems that beset our country. It's time to focus our intellectual efforts—and a significant portion of our research dollars—on the development and study of comprehensive approaches that are grounded in self-care. These—with an ongoing, compassionate, therapeutic presence—represent the best, most promising hope for the future of psychotherapy, and for our healthcare system.

James Gordon, M.D., is a clinical professor of psychiatry and family medicine at Georgetown Medical School, founder and director of The Center for Mind-Body Medicine, and former Chair of the White House Commission on Complementary and Alternative Medicine Policy. He's the author of Unstuck: Your Guide to the Seven-Stage Journey out of Depression.Contact: jgordon@cmbm.org; website: www.cmbm.org.

David Waters, Ph.D., is a professor of family medicine, psychiatric medicine, and psychology at the University of Virginia in Charlottesville, Virginia.Contact: david.waters@leagueoftherapists.com.

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