Critical Articles

OUR TREATMENT BOOKS ARE BACKWARDS

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Psychotherapy has a beginning, a succession of therapeutic choices and interventions, and an eventual termination. Each patient passes along a unique therapeutic path that leads toward psychological improvement.
Nevertheless, there are commonalities to the paths that patients follow, and those common aspects of treatment can be outlined and shared, leaving it to the individual therapist to fill in unique details for each patient.
We should expect any literature that claims to instruct about treatment would either cover a small portion of the process, or find a way to represent all of it.
However, when treatment resources cover a small portion of the process, they tend not to discuss its place in the larger scheme of treatment, and we are left to apply it where we will. This means that we must remember it and use it sometime later, often with little or no guidance about applicability.
When the entire process is discussed, it often is in the form of a treatment manual that prescribes the same sequence for all patients with a given diagnosis or symptom. If therapists adapt the prescription to fit particular patients, the therapists are criticized for not doing it the right way.
When treatment books cover more general topics, they appear to be organized with a college course in mind: “Next week, read Chapter Eight, and we will discuss all the medications that can be used to treat anxiety.” At the end of the semester there is an examination on everything you have read.
Where is the patient? This is knowledge in the abstract, and it is backwards. It’s about principles, and conclusions, and groups, and averages. We won’t know how useful any of it is until the therapist attempts to use it in therapy, sometime later.
But that assumes that it will be needed, and if it is, that the therapist will recognize the need and apply the treatment appropriately. Meanwhile, the lecturers and authors can sleep easily, knowing that they have presented their material logically and clearly.
And the patients? We wish them well. If they don’t get better, blame their therapists.

Thad Harshbarger