IN DEFENSE OF TALK THERAPY

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I save things that seem important: old photographs, records of the past I might want to revisit, writing that speaks to me.  Sometimes I forget about these saved things for years and then come upon them by happenstance while looking for something else.

As was the case yesterday when I was rummaging around in the front drawer of my father’s French Provincial desk (a North Carolina copy, not an 18th century original), which is practically useless for real work but decorative enough to keep in the living room to put a lamp and framed family photographs on.  (Also one of the cats likes napping on it in the evening.)  Its thin middle drawer contains, among a few other folders and envelopes, a binder of articles that at one time or another I thought keepers — including a review by Joan Acocella of several books about psychiatry that appeared fourteen years ago in The New Yorker. (May 8, 2000 issue.)  It was called “The Empty Couch: What is lost when psychiatry turns to drugs?” I had to drop everything I was doing and re-read it at once because, like Acocella, I am a member of the talk therapy generation.

I have at times made fun of my years on the couch, or on an expensive chair — expensive in terms of hours sat on, not initial cost. Called myself the Queen of Therapy.  (Woody Allen is King.) Have even dropped at least one light-hearted reference in this very blog to “the Hungarian,” the first of the two shrinks who you could say — not quite literally but not exactly metaphorically either — saved my life. He was the one who called me “honeybunch,” which may not have been quite in keeping with the ethics of the profession, but was what I then certainly needed to hear from somebody.

In fact, I probably owe the existence of my two children to this ebullient representative of the “paprikash of Europe” (his own term for Hungarian men). It’s also an accurate summary of my emotional life to say I haven’t been able leave a husband until I had a shrink, and haven’t been able to leave a shrink until I had a husband.  (You figure that one out: Bill is both.)

Like many things in my life, and in the lives of others who have lived as long as I have, talk therapy seems to be on the way out. It is time-consuming, expensive, participatory — and to those who haven’t experienced it (or haven’t paid for it out of pocket, as most of us in the old days did, going without other things to afford it), it may seem self-indulgent and too self-referential.  Medication, by contrast, is a quick fix for symptoms, once the doc figures out the formula that works.  Moreover, insurance companies love the biomedical approach: one, two, three and skidoo — out into the world again, seemingly good as new.  And what insurance companies love (and pay for) is what insureds get.

Acocella’s review considers how we reached this point, and the merits for certain kinds of patients of each approach.  But she, like me, clearly tips in favor of talking oneself back into balance, unless one is seriously ill. And because I feel I should atone somewhat for my occasional levity about what has helped me get through some very rough times, and also because she is eloquent, I am now going to turn the lectern over to her. She states the case for an approach to life’s problems that I hope will not entirely disappear:

For many people of my generation, especially women, psychotherapy is not so much an issue as a history, a language in which they learned to speak of themselves, and of life. This fact has been widely deplored. Psychotherapy, people say, has taught women to think of themselves as victims. It has made them narcissistic, turned them in on their own minds rather than out into the world, where the men seem to be living. True enough, of some therapies. In others women — and men — have learned to stop being victims and to act in the world…..

What do we think about psychotherapy? I don’t mean for inpatients. (They clearly need it; their lives are wrecked.) I mean for outpatients, the walking wounded — us. For some, it’s damaging. Even when it’s good, it’s very expensive, but compared with the church and family of yesteryear, whose loss it is trying to make up for, it’s a bargain. (In the church, you tithed, gave ten percent of your income. As for the family, it kept women at home. What was the cost of that?)

And when it is good, it is something hard to find in life, a moral dialogue.  [One of the writers reviewed says of one of her therapists that with him talk] “was not only the means to a therapeutic end, but … the central source of moral meaning itself.” …. [T]he truth is that a talk about moral meaning cannot not be therapeutic, if by therapy we mean not just symptom relief but a chance for a serious life.

The matters that people discuss in psychotherapy — whether they are really answerable for their lives, whether they should place their own welfare over another’s — are the things that people in the Bible were trying to decide.  They are the big questions, right? For patients in serious distress, pills are useful, but they cannot provide, don’t aim to provide, what psychodynamic therapy has at its core:…“a sense of human complexity, of depth, an exigent demand to struggle against one’s own refusals, and a respect for the difficulty of human life.”

The italics at the end are mine.  I like to laugh as much as the next person, but I have never wanted to be numbed into accepting what was, when what was was of my own making. You can choose to swallow something someone gives you, not feel the pain, and giggle. Or you can demand the right to struggle against your own refusals. Life is difficult, but if you choose not to experience it, not to work your way through the difficulties — can you say you’ve really lived?

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6 thoughts on “IN DEFENSE OF TALK THERAPY

  1. Tough topic. I am also of the “talking” generation. I did some targeted therapy after two failed marriages. While drugs may have made me feel better, the dialogue helped me to understand why I was selecting the wrong people. (Do they make a drug for that?) I suppose friends can help but sometimes their advice is skewed by their own experiences. I am watching from a distance (across country) as a step-daughter goes through a failed marriage and I watch her make a lot of missteps. She is on Prozac so she feels good about what she’s doing but I am not convinced she understands the impact. Talking with a professional brings that home.

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  2. I’m with you all the way. Hope all works out for the best with your step-daughter. It’s possible that after the Prozac has done what it can, she may be amenable to some targeted therapy to help her work out what drives her choices and thereby diminish or lessen future missteps. Maybe some instructive stories from step-mom?

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  3. martha mendelsohn

    Medication and talk therapy can work very well together to repair the changes in brain chemistry caused by depression and anxiety.
    There are now different types of talk therapy–“cognitive behavioral therapy” is one. My son Nathaniel, who’s in his last year of a psychiatric residency, feels it works for some people. My husband, a retired shrink, feels it doesn’t.

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    • In the parts of her article I didn’t quote, Acocella acknowledges that medication may be necessary to bring certain patients into condition to benefit from talk therapy — either in conjunction with the medication or following it, as the case may dictate.

      Neither she nor I were referring to Freudian therapy when discussing “talk therapy,” and — being with a retired shrink myself — I certainly do know that talk therapy comes in many modalities, and also that there are strong differences of professional opinion as to the efficacy of one over the other. Not being a professional, but a mere blogger, I thought I could safely avoid putting a toe in those waters. Actually, I suspect almost everything will work for some people. The trick is to find out which thing and which people. 🙂

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  4. I have some strong opinions on the subject, which I wouldn’t voice, because though I’ve read a few books on the subject, I’ve never had the luxury of treatment. But isn’t what Kate said about friends, ‘sometimes their advice is skewed by their own experiences’, true of psychologists too? And is it absurd for me to think of psychologists and psychiatrists as ‘friends for hire’?

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    • I would never tell anyone that what they think is “absurd.” But I can assure you that therapists are not “friends.” (Although some have been known to slip and embark on affairs with their patients for which, if discovered, their license to practice will be taken away.) And the good ones never give advice. Moreover, friends have needs, whereas the good therapist has no needs at all within the fifty minutes of the therapy session. The less he lets you know about him (or her) the better. It is always all about you. You will never in life ever experience that anywhere else. Of course there are plenty of bad ones. From whom you should walk away.But with the help of the good therapist’s occasional question, you talk yourself sane. Or, to use a metaphor devised by “The Hungarian,” you gradually become able to play all the keys on your emotional piano.

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