Adam Blatner

Words and Images from the Mind of Adam Blatner

About Psychotherapy Research

Originally posted on February 17, 2018

There are (at least) two variables involved in psychotherapy research: One is diagnosis, the other is ego strength. High ego strength allows people to exhibit a symptom, but also to recover from it. With low ego strength, all the other coping mechanisms are shaky or non-functional. People are deeply handicapped. Although it’s not a diagnosis on the chart, what makes all the difference is not just the named disorder on the chart but rather the relative ability (or inability) to cope!

For example, this was brought to my attention by a letter from a colleague in response to the APA’s efforts to reduce the list of viable treatments for PTSD to a narrow range of manualized approaches that exclude creative arts therapies. What I noticed, though, was that major professionals submit slavishly to "evidence-based practice" and the small-g gods of objectivity. Some dare protest, and I agree with their protest! But let’s critique also the submission of the APA—psychologists and psychiatrists—the master organization both being the acronym APA— as if some medieval rebellion were to be suppressed not only by force but by (at that point in history) unquestioned assumptions about temporal and ecclesiastical authority.

So let’s just admit that most of the other therapies have not been adequately supported by evidence—but that’s because seeking such validation ignores the reality that diagnoses do not reflect underlying ego strength! There’s a world of difference between an anxiety disorder in an otherwise healthy (good ego strength) individual and one with poor ego strength. Diagnoses are very partial, and do not reflect the course of treatment. Therapy for whom ego strength is poor is much  more difficult (exponentially!) in relation to each drop in points (if there were such things) in ego strength!

So the whole approach of treatment includes both categories. Furthermore, people with good ego strength often don’t even come down with a diagnosable condition. So treatments are problematic because they don’t address the whole person, and, more, they lump together a great number of people who show symptoms in part because they don’t have good ego strength.

There was a historical antecedent to this. Smallpox was floating around Europe in the 14th century and lots of people caught tiny doses of it and developed immunity. That’s crucial, because when smallpox was introduced to Native American Indians the Indians died like flies! They had no resistance to this influx, to this infection. Europeans had some resistance and though epidemics did happen, they were less severe.

Health and illness do not belong on the same scale! You can be healthy and also a bit sick but it doesn’t wipe you out as much as people who are sick and unable to mount a resistance. Present statistics-dominated medical “science” that doesn’t recognize this is a pseudo-science!

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