Psychotherapy as a “Craft Tradition”

What will contribute to the growth of psychotherapy as a discipline?

Is psychotherapy a science? If it’s not a science then is it reliable? Psychotherapy is not a science, though some approach it from this perspective. They cite efficacy studies that suggest a specific treatment is more effective for a particular disorder. What gets lost in this equation is that these results are the product of quite artificial constraints and their conclusions are based on generalities. Many individuals do not fit within the generalities.

Psychotherapy is rooted in the humanities. It deals with subjective human experience and last time I heard that cannot be measured. Courtesy of Ken Pope: In the Journal of Trauma & Dissociation Judith Herman writes about the strengths and weaknesses of “craft tradition” among which she considers psychotherapy. Herman is a very respected researcher in the field of trauma. Her book Trauma and Recovery is a landmark text.

Some strengths of craft traditions:

They are strongly embedded in the practicalities of daily life and, as such, are constantly subjected to empirical (though unsystematic) tests of utility. They preserve a highly complex body of knowledge and skill, resisting reductive standardization. They are taught relationally, through a long apprenticeship that fosters discipline, high standards for performance, and an ethic of care. Within their disciplined forms, crafts permit wide scope for individual imagination and creativity.

Here are some of the weaknesses:

Craft traditions also have many weaknesses. Because crafts are highly complex and resistant to reductive standardization, successful practice depends on individual skill, which is highly variable. Training through long apprenticeship fosters the development of authoritarian personality cults, schools of master craftsmen and their disciples. These schools or sects can become secretive, stagnant, ritualized in their practice, and grandiose and dogmatic in their claims. Examples from psychology abound: One has only to mention the psychoanalytic, behavioral, family therapy, and expressive therapy schools and the manifold schisms and sects within them, each named for its ruling patriarch.

Finally, an enlightened path forward for psychotherapy:

Though the practice of psychotherapy is still a craft, this does not mean that we have to perpetuate the worst features of craft-guild behavior by clinging to sectarian allegiances and claims. In physics one does not find Maxwellian or Einsteinian schools; there is simply physics…. Though psychotherapy is not yet at the level of a science, we can foster an attitude of scientific inquiry based in respect for the clinician’s craft. We can encourage more naturalistic observation and open sharing of therapeutic work, using whatever methodology seems appropriate to the question being explored. Most of all, we can cultivate an attitude of humility, curiosity, and wonder at human resiliency, acknowledging that we are still far from understanding the active principles in recovery from psychological trauma.

Easier to Get than Beer: Teens and Prescription Drugs

Recreational use of prescription drugs among teenagers.

From a USA Today article by Janet Kornblum.

More teens now say it’s easier for them to acquire prescription drugs — usually powerful painkillers — than it is to buy beer, according to the 13th annual survey on attitudes about drug abuse, out today, from the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

What’s concerning about the trend is the use of very powerful antipsychotics recreationally. Today’s prescription drugs are nothing to laugh at. Furious Seasons writes about this regularly and with gusto. Here’s a does of Furious Seasons:

I continue to be fascinated by how psych meds–and particularly the atypical antipsychotic Seroquel–have wormed their ways into American culture and in how Seroquel has become a drug that, when snorted or shot, can get people low in a way they really seem to dig. As I’ve reported before, this drug seems to be replacing–or supplementing–OxyContin as a new hillbilly heroin.

And here’s a new example: dude gets busted in Massachusetts for, among other things, having hundreds of Seroquel pills that he didn’t have an Rx for. Clearly, he or his friends are slinging this drug and taking this drug (which simply staggers me given how gnarly this drug is when taken as intended) and, as I recently noted, some folks are so attracted (dependent? addicted?) to Seroquel that they will fake symptoms of schizophrenia in order to get a “legitimate” Rx.

So, what are your kids doing? (Back to USA Today)

Almost half (46%) of teens surveyed say they leave their homes on school nights to hang out with friends — and sometimes use drugs and alcohol. But only 14% of parents say their teens leave home to hang out with friends.

Teens still say it’s easiest to buy cigarettes and marijuana. But for the first time, they say prescription drugs not prescribed to them areeasier to get than beer, the survey says.

Multifactorial Depression

This from Ken Pope: Neurogenesis in the adult brain: The association with stress and depression Presented at the 21st Congress of the European College of Neuropsychopharmacology 2008, Barcelona, Spain.

The statement includes several interesting points about possible causes and remedies of depression. In the clinical implications section:

Experiments show that stress and depression inhibit the growth of new nerve cells as well as glial support cells, and that this inhibitory effect can be counteracted by antidepressive therapy.

Within the last two decades, the understanding of the mature brain has changed: Neuronal and glial cell networks in the brain are far from being fixed and immutable – a multitude of factors such as environmental stimulation, learning, growth factors, glucocorticoids, sexual hormones,
stress, aging, and several neurotransmitters regulate the generation of new neurons. Antidepressants stimulate the growth of neurons and glial cells again so the brain changes that occur as a consequence of stress and depression are generally reversible.

The idea that antidepressants stimulate the growth of neurons is news to me. The idea that depression is generally reversible is not news, but it is heartening. Also included are some of the statistics regarding the prevalence and cost of depression, not necessarily widely known. Here’s a compact summary of depression:

Depression is a chronic, recurring, multifactorial, and life-threatening disorder, which represents a collection of psychological, neuroendocrine, physiological and behavioural symptoms. Chronicity and frequency of these symptoms constitute the clinical condition.
Depressive disorders affect up to 20% of people at some time in their life. In primary care, an estimated 20% of patients suffer from depression, but often are not diagnosed correctly (Wittchen, 2000).

Depressive disorders are among the most prevalent illnesses worldwide, producing significant public health and socioeconomic problems (WHO, 2001). The immense costs of depression account for approximately 1% of the gross domestic product in Europe (approximately 100 billion Euro). Depression is affecting more than 120 million people globally, and is set to rise to become one of the leading causes of disability, second only to cardiovascular disease, by the year 2015.