Back in the days before Noah’s flood, a psychiatrist would take care of both the medical and the psychotherapeutic needs of a patient. Of course, we all knew that it took “a different kind of doctor.”  In the old days they said it had to be a Jewish doctor who was afraid of the sight of blood. I am not.  I mean, I used to be a surgeon so I put that one to sleep.

Read more on You’re the Boss…

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There was a man who came to me and told me that his therapist had comforted him on how to deal with his heart problem, and he was doing better now. Huh? Without telling him that I thought his psychotherapist was a lazy fool who enjoyed charging by the clock and seemed to believe that all he had to do was to keep his patient in the room and talking for the entire hour, I simply said I had probably spent more time studying the heart than his therapist had, so I could maybe be more help. Psychotherapy is subjective at best. Psychotherapists of any qualification known to me require “supervision,” or reporting of their cases to someone (presumably) older and more experienced who can “guide” them. The better of the psychotherapist supervisors will sometimes ask to see the patient, especially early on in supervision, to get at least a feeling for how the trainee is reporting the experience and the patient. Several trainees have approached me at various times in my career about supervision. I have supervised generations of psychiatric trainees and therapist trainees in university settings. I have even done a little in an insurance setting. Nobody has ever chosen me as a psychotherapy supervisor in a private setting. There are many reasons of this that I can figure out, judging upon what the potential trainees say.

1. I charge too much (more than doing the therapy myself, as I am giving people skills to use)

2. I actually expect people to work. I have been told I am too”results oriented” in many aspects of my life. Some people have even told me that my approach to psychotherapy is like an “ex-surgeon,” because I like to get the job done and get out. I think psychotherapy needs specific goals and objectives, a specific time frame, and specific ways that could actually achieve those goals and objectives.

3. I am “by the book,” although I have some flexibility as to which book. (This is a direct corollary of the above.) Although some people believe that psychotherapy comes from vague personal directives, and that the efficacy of therapies is impossible to measure, there is research done where therapists are given a “therapy manual” which they follow and document and there is good stuff. Sure, there is placebo effect, and that is hard to measure.

But there are ways to do real science here, not slumber into the poofie-cloud of feelings, which are soft, soft science in their stongest moments. If nobody wants to fund research in this direction, it is not my problem. I have tried to do things. An article like this one is courageous.

Now there are some things about psychotherapy which I know are true. Way back in the fifties, when the world was a bit more innocent, (and there was no internet) there were some nice, scientific articles in something called the “American Psychologist” Journal. It was shown, quite nicely, that the likelihood of someone to get better in therapy was a direct function of how much they wanted to get better, and of the degree of trust in the psychotherapist. The “type” of therapy used did not seem to matter much. Read more on What Are Therapists Up To?…

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