What’s the Best Form of Therapy?


The easiest method of doing something is not always the most effective; but it is the easiest, so that’s saying something for it. Easy is more effective than the most effective if the most effective is impossible for you to do.

When it comes to treatment for mental illness, if I were to rank the forms of therapy in order of effectiveness, meaning how thoroughly and reliably they can solve your problems, I would put it like this:

  1. Group psychotherapy
  2. Individual psychotherapy
  3. Medication
  4. Reading self-help books

But, if I were to rank them the easiest to hardest, it would go like this:

  1. Reading self-help books
  2. Medication
  3. Individual psychotherapy
  4. Group psychotherapy

Continue reading

Love: The Prisoner’s Dilemma

Old Posts

I can guess how this sounds, but love relationships remind me of the Prisoner’s Dilemma.

Two conspirators are arrested and brought into separate interview rooms. They are both given the opportunity to turn state’s witness against the other. The one that takes the deal goes free, and the other gets ten years. If both confess, each gets six years. If they both refuse, they both get six months.

If I was in this situation, my answer would depend on the nature of the alliance I had developed with my partner in crime. In every relationship there are multiple opportunities in which we choose to either cooperate with the other or go our own way. Most of these occasions don’t have the consequence of being sentenced to prison for ten years, but you get the sense of a person’s loyalty if they pick up the check at the diner when you plan the crime, bring their own burglary tools, and take off in the getaway car before you get in. You also get an idea of the cost of betrayal when you scarf up the tip he left, bend his best lock pick, and arrive late because you couldn’t decide on a color for a ski mask.

Every one of these tests is a miniature prisoner’s dilemma and every one of these tests is found almost continuously in every kind of relationship. Temptations abound, no matter where you are, especially in love. Do you steal the blanket? Put the seat down for her? Do you give her the first piece of toast in the morning? Do the dishes? Get up to answer the phone even when you know it’s for her? When she tells you about that dress she’s going to buy do you really pay attention, or just nod and smile? When she’s not listening do you talk about her with respect? Do you flirt when she’s not looking? Are you adult enough to admit there’s adultery afoot?

We form alliances because we get a better reward when we both cooperate, but it’s inevitable that every alliance is going to be violated in some way. It is impossible to go along with every little thing your partner wants. How are these inevitable violations handled? When you tug the blanket, does she tug back? Does she go all ape shit when you pee on the seat? When you put the seat down for her, does she put it up for you? Does she put the flirting in perspective, forgive the adultery? If she does, does it make her a patsy? If she doesn’t, is she just being a bitch?

Scientists have studied the prisoner’s dilemma by having players adopt certain strategies to see which win most often. Some will always cooperate, no matter how strong the temptation. Those players end up exploited. Their partners have no reason to play along since there is no penalty for failing. Others never work together with their partners, they give in to temptation every time. No one ends up trusting them. They say the winning strategy is called Tit-for-Tat: cooperate every time until your partner fails to, then punish him by withholding cooperation at the next opportunity. This will teach him a thing or two.

There’s one problem with that, though. We believe we are much better at detecting when we lose our partner’s engagement than we really are. The next time you are having a conversation with someone, watch her and you will see there are moments that she does not appear to pay attention, a minor violation in the alliance that could really piss you off. The thing is, she might actually be paying attention, or she might be the kind that can pay attention to two things at once. Ask her what you just said and you might be surprised that she can repeat it word for word.

There are times, though, that she can’t. You lost her; she tuned out, spaced out, went blank. It happens. If you taped it, hit the rewind, and play it back, you might discover something. You were boring. You went on and on and were inattentive to non-verbal cues that she wanted to participate in the conversation. Or you made your point in such a way that she couldn’t follow. Each of these errors is a violation of the alliance. You broke faith before she did.

We have built in, exquisite instruments that detect betrayal so sensitively calibrated that we are always chasing false alarms. What’s more, the instrument does not work on the operator. You don’t know when you are doing it. There’s a moral to the story. When you believe that your partner is violating your alliance, look to see if maybe you did so first.



Taming the Pumpkin


Old Posts

Introducing the Old Posts Series

If you’re subscribed to this blog, or a frequent visitor, you may have noticed I haven’t been posting twice a week as I had been. This doesn’t mean that I haven’t been writing, it only means that I’ve been rewriting.

For about two years, I’ve been working on the Road to Reconciliation series. When I couldn’t think of any more to say, the time finally came for me to look at this material and form it into a book.

Therefore, I need to slack off on the blog posts, so I can have time to do my final editing. Meanwhile, I’ll start an old posts series, bringing back some popular posts you may not have seen. Let’s begin with Taming the Pumpkin. Continue reading

The ACE Study

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It makes no sense, but one of the most remarkable and important findings in recent psychological research hasn’t gotten the attention it deserves and still has not had much impact on the practice of psychotherapy. I’m talking about the ACE Study.

In the 1990’s, the CDC and the health care giant, Kaiser Permanente, teamed up to recruit more than 17,000 adult research subjects, who filled out a short questionnaire, asking about their adverse childhood experiences. That’s what ACE stands for: adverse childhood experiences. They then compared their answers to a list of common ailments. They found a very strong correlation between the degree of adverse childhood experiences and a decline in both physical and mental health for the person later in life. Continue reading

Empathy and What It’s Like to be a Bat

workshop_6933-1_edited-1You could make a meal of a moth, hang upside down and sleep, flap your arms and try to fly, and close your eyes and navigate by sound; but you will never, never really know what it’s like to be a bat.

For starters, even if you were able to choke down a moth and fall asleep while hanging upside down, I don’t think you’ll succeed in flying, and; if you navigated by sound, it would be the sound of you crashing into things. But, even if you could, you still would not know what it’s like to be a bat. The best you could do is know what it’s like for a human to be a bat. That’s not even close to the same thing.

You might think you know something about flying if you’ve ever been in an airplane; but, in reality, you didn’t fly as a bat flies, you were shot through the air by a machine while sitting in a metal tube.

You might think you know something about navigating by sound if you’re a sonar operator; but, you’re not navigating by sound, a machine is doing it for you. That’s very different than being born with the capability and doing it naturally.

What it’s like to be a bat was the subject of an important essay by philosopher, Thomas Nagel. He was interested in refuting reductionism, the philosophical position that a complex system is nothing more than the sum of its parts. We find reductionism all the time, when people say that a thought or a feeling is nothing more than a bunch of nerves firing in the brain. To the neurologist, it may be; but to the person possessing the brain, the experience of, say, smelling a flower is far greater than can be expressed in a chemical equation or a chart of the regions of the brain that had been involved.

When I read Nagel’s essay, I wasn’t so interested in bats, or in reductionism. The essay got me to thinking about empathy. I was interested in knowing what it’s like to be my last client, who wasn’t a bat.

The client was a young woman, anxious about her new job, and worried that she’d never find anyone who would love her. This person’s experience is not entirely foreign to me.  I was young once, although I’m not young now. I know what it’s like to start a new job, and I’ve had my days when I thought I’d always be alone. However, I am not, nor have I ever been a woman; but I can imagine it. I’ve heard enough women talk about how things are for them, that I can put myself in their place and extrapolate what it would be like for me.

I could employ my mirror neurons while talking to this young woman. That might give me some insight into her experience. Employing mirror neurons works like this. You look at the expression on the face of the person you’re talking to and mold your own face to match that expression. Then your own face makes you feel what the other person is feeling. As strange as these operations sound, psychologists say we do it all the time, unconsciously, as a way of connecting with the emotions of others.

The term we have for all these procedures of understanding the experience of another is empathy. We counselors are instructed to use empathy in our counseling, but Nagel’s essay has got me wondering what empathy is, or if it’s even possible.

The Oxford English Dictionary defines empathy as the ability to understand and share the feelings of another. To the extent that I’m able to empathize with this young woman, it’s because I thumb through my files and pull out a version of myself that is young again, new to my job, and lonely. That’s not enough, though. I also have to construct a version of myself that is female, according to the specifications of femininity I have heard. Even that’s not enough, for this person is a millennial, while I’m of the boomer generation. Millennials differ from boomers to a small degree in ways we scarcely know. She has a whole history that is different from mine. We had different parents, read different books, have been to different places, etc. Strictly speaking, I can never know exactly what it’s like to be her; I can only know what it would be like for me to imagine I’m her.

With her, at least, I can check out my perceptions, which I can’t do with a bat. I can say, for instance, “You must be scared about the future.” That’s how I would feel if I were her. If she says, “Yes, I’m scared,” I might think I’ve got it right, but is my scared the same experience as her scared?

Let’s say I go ahead on the assumption that she’s scared in the same way I would be scared if I were her. I might set about to try to reassure her that everything is going to be OK because that’s what I would want to hear if I were her. Well, who am I treating here, me or her? I’m treating a fictionalized version of me that’s representing her. Not only could I be not giving her what she needs, but anything I say about her, really tells you more about me.

I’m convinced that these difficulties would be present even if this client was just like me. Even if he were a clone of me, the moment our two parts were created, our inner experiences would be different, and I would have no way of knowing whether I correctly understood his inner life.

To sum it all up: true, accurate empathy is impossible. There’s no way of knowing what it’s like to be another person, much less a bat. Still, it’s better when we try to be empathetic than when we don’t try. At least that brings us closer to getting it right.

You may feel very isolated, hearing that empathy is impossible, I wouldn’t know for sure. But, I think empathy being impossible is what makes your point of view so precious. No one has another point of view just like it. It’s the reason you are deserving of respect.

Narrative Therapy


If someone pointed a gun to my head and forced me to admit what my preferred counseling method was, I could not say I was a reflective eclectic. That would get me shot. It’s not really an answer. I would have to confess that I have a soft spot for narrative therapy. I might get shot anyway because few know what that is. Continue reading