A Step Backward: An Interview with Allen Frances
As the man responsible for the previous edition, the foremost critic of DSM-5 is perhaps the last person you’d expect to trash this latest, biggest version.
The Impassable Divide
More and more therapists have begun wondering how far all our impressive-sounding talk about the brain has gone in improving therapy’s effectiveness. After all, dropping stray neuroscience factoids into therapy sessions doesn’t equal “brain-based” therapy. So we’ve decided to ask some challenging questions about our profession’s infatuation with the brain: when all is said and done, has brain science actually lived up to its promise for psychotherapy? What specific clinical advances, if any, have been guided or encouraged by knowing more about neuroscience?
First Comes the Hard Work
Romantically infatuated with the idea of psychological revelation—aka the therapeutic “breakthrough”—therapists too often ignore the fact that a life’s worth of habitual behavior often trumps, for good or ill, all the insights and emotional fireworks that we like to see as the key to therapeutic “progress.”
Keeping Private Practice Alive
If we wish to stay professionally alive, it’s time we recognize that the idea that we must choose between being dedicated clinicians and being smart business people is a false one.
The In-Session Breakthrough Fantasy
As a growing body of research shows, deep change doesn’t come when clients just talk about their problems: it results from the impact of an emotionally arousing therapeutic experience on the structures and biochemistry of the brain.
When the Tough Get Therapy
There are some clients who yell at us, manipulate us, go broodingly silent on us, have uncontrollable emotional breakdowns in session, disappear for weeks at a time, ignore our advice, and later blame us when their lives don’t improve. The normal rules of genteel reciprocity, so willingly respected by our “nice” clients, are routinely trashed by these “tough customers.” What do we do?
Celebrating the Craft at Symposium
This year, 3,000 practitioners came to our annual Symposium to explore the fundamental question: are we any closer to unraveling the mysteries of psychotherapy than when Freud became the first therapist to complain about client “resistance”?
What’s Wisdom Worth?
The pioneers in our field—Sigmund Freud, Carl Jung, Virginia Satir, Fritz Perls, Salvador Minuchin, and others—all recognized that they were providing something more than just technique. But does today’s short-term, empirically supported, manualized and medicalized psychotherapy really require its practitioners to be wise? Is wisdom even desirable?
Fretting Over the Anxious
Through our lives, most of us develop what can only be called a deeply personal relationship with our anxiety. There’s a good reason for this. A predilection for anxiety was built into our neurophysiological wiring as a kind of evolutionary early-warning system for us hominids in an unpredictable, often hostile environment. Anxiety, in this sense, is like a loyal, somewhat skittish guard dog—maybe too easily aroused, but handy to have growling around the cave when intruders threaten.
Pushing Past Our Limits
This issue of the Networker is about what coaches like Andrew can teach psychotherapists, and the role that challenge and incorruptible truth-telling can play in the change process. A good coach is someone who, however hard he may push you, above all, respects your ability to push yourself to the next level, to become stronger, smarter, braver, and more capable than you think you are.