Two books about the importance of the patient/therapist relationship

[Dr. Richard Grossman]

For many people, including those who maintain contact with family and friends, life is filled with aloneness.  Most important is that a person truly hears, understands and connects with you at your core so that you are valued and no longer alone.  Sadly, it is the rare person—and the rare therapist—who can actually do this.  If you would like to learn more about the importance of the relationship in therapy, see Dr. Richard Grossman’s memoir:  Voicelessness and Emotional Survival:  Notes from the Therapy Underground (https://www.amazon.com/Voicelessness-Emotional-Survival-underground-therapists/dp/1790164028/ref=sr_1_1?keywords=voicelessness+and+Emotional&qid=1691522756&sr=8-1), and also, The Mathematician and the Teddy Bear, (https://www.amazon.com/Mathematician-Teddy-Bear-struggle-someone/dp/1514215772/ref=sr_1_1?crid=FY9LPS748FIQ&keywords=The+Mathematician+and+the+Teddy+Bear&qid=1691522975&s=books&sprefix=the+mathematician+and+the+teddy+bear%2Cstripbooks%2C93&sr=1-1) a diary/book written about her therapy by Sara Field who had a severe, life-long, life-threatening attachment disorder and is now married, retired and traveling the world.  Since prior to beginning therapy at age 37 she had never attached to another human being, much can be learned about the nature of human attachment and the importance of the relationship in therapy from Field’s extraordinary and brave book.  Please note, most people will have to put aside their confirmation biases to appreciate these out-of-the-box books!

[Dr. Richard Grossman]

Hi everybody,

For those who have read the two books starting this thread, the following Medscape article/interview may be of interest:

The Medical Model Doesn't Work for Mental Health
Eric J. Topol, MD; Abraham Verghese, MD; Tom Insel, MD
March 25, 2022
https://www.medscape.com/viewarticle/969153#vp_2

The following quote from Tom Insel, MD, the former Director of the National Institute of Mental Health is particularly telling:

Insel: "In terms of psychological therapies, we spent 20-30 years developing "bespoke" therapies, all of which have acronyms: CBT (cognitive-behavioral therapy), DBT (dialectical behavioral therapy), IPT (interpersonal therapy) — there's a long list. But in the past 5 years or so, we have been asking whether there are some common features. I see increasing recognition that good outcomes depend not just on the therapy, but the therapist — people who are good listeners, naturally empathic, and able to build rapport and a sense of trust. Give them fundamental skills, such as motivational interviewing so they know how to help people talk about what's really bothering them, and tools, such as behavioral activation that can help people who are shut in or inactive, to become more engaged and involved. A limited number of those skills cross almost all therapies. In the hands of a person who has an empathic ability, these seem to be quite effective. It may not depend on whether this patient has a particular Current Procedural Terminology (CPT) code or lands on a certain page of the DSM, but some of these interventions are helpful across the diagnostic structure."

(The highlight above is mine!)  Looking back, this is what I discovered by myself 40 years ago, and, fortunately, the discovery totally changed my practice.  I could never have spent my career providing the relatively ineffective therapies that were taught then and are still being taught and "practiced" today. They were, in large part, built on therapist status/expertise and sometimes, altered data, and not on how much actual difference the therapist(s) made in a person's life.  As I wrote in my book, the best knowledge about how effective a therapy has been comes from the individual patient's side of the room--and sometimes (in my experience), years after the therapy has ended.

Richard

[Dr. Richard Grossman]

Hi everybody,

In my book, I try to illustrate my view that therapy is both a science and an art in form and argument.  That is why I start the book with a 10-minute play about therapy.

The desire/need/requirement to make therapy a science and the practitioners scientists did, in my view, more damage than good.  (Remember in the beginning of psychoanalysis, all practitioners were required to be MD’s!)

Compare the quote below from a "scientific" article in Psychiatry Advisor, Understanding Adult Attachment Disorders by Nicola Davies, PhD | August 3, 2020 https://www.psychiatryadvisor.com/home/topics/general-psychiatry/understanding-adult-attachment-disorders/#:~:text=Transference%2Dfocused%20psychotherapy%2C%20for%20example,attachment%20security%20and%20mentalizing%20capacity.&text=By%20projecting%20their%20feelings%20for,explore%20their%20emotions%20more%20deeply. to the therapy process for the severe/life-threatening attachment disorder in Sara Field’s book:

Dr. Toby Ingham:
"Instead, it may be useful to adopt more unique and focused forms of psychotherapy. Transference-focused psychotherapy, for example, has been found to improve attachment security and mentalizing capacity. By projecting their feelings for their caregivers onto the therapist, individuals are encouraged to express and explore their emotions more deeply."

The last thing Field needed in my view was a one-sided "scientific" attachment.  Instead, what she needed was the not only the real thing, but a powerful and meaningful 2-sided attachment with an understanding and empathic human being.  If you asked her, I am sure she would have said that she never would have attached to a person fitting the description of the therapist above.  Even worse, she would likely have lost hope that she could ever connect to another human being.  After all, if a therapist can’t do it, who can?  And yet, the above is what therapists are taught in school!

Thanks for reading!  More to come!

Richard

[Dr. Richard Grossman]

Hi everybody,

One of the key lessons that was reinforced over and over again in my life experience and that I wrote as part of the subtext of my book was the divergence of truth and status.  (One of my dear friends recently laughed knowingly when I said I would have been disappointed if I had written a popular book—he knows me well!)  We are in a period of history when we are being forced to observe this divergence over and over again. This is true not only in politics--in addition, we are learning that much of the “scientific” psychology data we relied on was altered in order to obtain positive results. The status genes in human beings, unfortunately, have been and will continue to be much more powerful–and important to human survival (in psychology—publish or perish)–than the truth genes.  For better or for worse, I inherited more truth genes than status genes from my mother.  For my patients, I know it was for better, but for my place in the broader world...   Luckily, my “place” with my patients is far more important to me than my “place” in the world. I feel so fortunate to have played a significant role in their lives.

Richard

[Dr. Richard Grossman]

Hi everybody,

Important research is finally beginning to emerge!  This research helps explain why grouping large psychiatric populations together and simply applying a "scientific" therapeutic technique only works for a relatively small percentage of people.

New Research Reveals That Lonely People Process the World Differently

  https://scitechdaily.com/new-research-reveals-that-lonely-people-process-the-world-differently/

The research was done by USC professor Elisa Baek, Ph.D. and her team.

Some quotes from the article:

"This finding is significant because it reveals that neural similarity, which refers to how similar the brain activity patterns of different individuals are, is linked to a shared understanding of the world. This shared understanding is important for establishing social connections. People who suffer from loneliness are not only less similar to society’s norm of processing the world, but each lonely person differs in unique ways, as well. That uniqueness may further impact the feelings of isolation and lacking social connections."

"Baek said, 'It was surprising to find that lonely people were even less similar to each other.” The fact that they don’t find commonality with lonely or nonlonely people makes achieving social connection even more difficult for them. The ‘Anna Karenina principle’ is a fitting description of lonely people, as they experience loneliness in an idiosyncratic way, not in a universally relatable way,'she added."  (Tolstoy's Anna Karenina principle: “Happy families are all alike; every unhappy family is unhappy in its own way.” )

"Comparing the brain imaging data between the two groups, the researchers discovered that lonelier individuals exhibited more dissimilar and idiosyncratic brain processing patterns than their non-lonely counterparts.

"This finding is significant because it reveals that neural similarity, which refers to how similar the brain activity patterns of different individuals are, is linked to a shared understanding of the world. This shared understanding is important for establishing social connections. People who suffer from loneliness are not only less similar to society’s norm of processing the world, but each lonely person differs in unique ways, as well. That uniqueness may further impact the feelings of isolation and lacking social connections."

"Baek said, 'It was surprising to find that lonely people were even less similar to each other.' The fact that they don’t find commonality with lonely or nonlonely people makes achieving social connection even more difficult for them."

“The ‘Anna Karenina principle’ is a fitting description of lonely people, as they experience loneliness in an idiosyncratic way, not in a universally relatable way,” she added.



This is why I had  to "connect" to each person in my practice in a different, unique way, including seeing one patient ("The Mathematician and the Teddy Bear" author, now happily married and traveling the world) 4 times per week.

Richard

P.S.  It is ironic, given my book, that it is Russian literature that is used/quoted!

[Hopalong]

Good Doc, I think you have a lot in common with poets.
Most of us long ago realized that we were forever flies on the wall, and most poets I know have made their peace with it. In our status and consuming-based culture, that realization is actually a relief.

I think the way you observe and engage people's inner worlds, poets do something similar with their own and others' inner and outer worlds, but still write out of hope. I do, anyway.

I've enjoyed re-reading all your posts above, and apologize for taking so long to acknowledge them. And I CAN'T BELIVE I NEGLECTED TO THANK YOU THIS THANKSGIVING!

With much gratitude for this beautiful board and all I've learned here.

love,
Hops

[Dr. Richard Grossman]

Hi Hops,

One of my dear friends, Bert Waters, who was the editor of my book, died three months ago. I was asked to deliver two of his long-term friends’ memorial addresses, one friend from his undergraduate years at Harvard, and another friend who worked with him in their 20’s.  Bert lived until 85—and both friends were unable to attend the memorial service at Harvard because of health conditions.  Their long talks were lovely, personal and reflected Bert’s wisdom and humor!  At the end I added: 

“And just a few words of my own:

One of the last things Bert said to me at the end of our final lunch was: 'We can’t change the world.'

We can’t.  But we can make a significant difference in individual people’s lives—and Bert certainly made a significant difference in mine."

My point is that, yes, we are flies on the wall, but we can make a significant difference in the lives of a few flies near us.  For me, that has been the meaning of life.

If all of this approaches poetry, I’m not surprised.  My mother was a wonderful poet who sat with Alan Ginsburg one day, having won a major poetry contest.  Sadly, like many famous writers would do, all he did was talk about himself.  But it was her very sensitive brain that I inherited, and not my electrical engineer/psychologist father's.  She wanted me to be a Classics professor, and if I had known how ineffective traditional psychotherapies were, perhaps I would have gone in that direction.  But luckily, I applied my poetry/10-minute-play brain to find significance and value in therapy, and as a result have made a major difference in some people’s lives. As such, I have no regrets!

Thank YOU, again, Hops for making such a difference on this board.  I don’t know what we would have done without YOU!

As always,

Richard