Shrinks are Partisan Morons: A Comment on the Treatment of Nightmares

There’s an article in a recent edition of the New York Times that discusses a relatively new approach to treating distressing, recurrent nightmares. You can read that piece here to learn more about this treatment technique. In short, it teaches patients to script their own healthy dreams while in a waking state, and when people engage in conscious imagery of anxiety-provoking visuals and resolve them in a positive manner, evidence suggests they are able to change the nightmares experienced during the sleep state.

As I pointed out here, the Shrink World can never accept something that benefits people if it doesn’t suit its personal agenda or mode of practice. The aforementioned techniques are promoted by those who are known as Cognitive-Behavioral Therapists, those who often practice with a “here and now,” pragmatic approach that is focused on symptom relief. Freudian therapists, on the other hand, are more interested in subconscious conflicts that drive neuroses. While they are not against the alleviation of symptoms, their goal is to delve into the psyche in hopes of greater personal understanding.

To that end, Freudian analysts are not in favor of “changing the image,” mainly based on Freud’s belief that dreams are the royal road to the unconscious. They assert that there is much to be learned from these dreams, regardless of the fear and anxiety produced, and that it’s imperative to understand these experiences, rather than simply altering them. This is not an unfair assertion – and the study doesn’t suggest that the program is successful with every person – although it is in sharp contrast to the Cognitive-Behavioral therapists who promote a more immediate improvement to mental health.

While these hard-core practitioners battle about this topic, let me pose to them one simple question: why not have the best of both worlds? If there is inherent value in each theory, then instead of taking a “my puristapproach is the best and therefore is always correct,” why not use both approaches. In other words, simply engage the patient in doing his/her best in understanding what these dreams are about, thenteach skills to help change what is troubling him/her?

A practitioner is not required to pick one approach or the other. This was my thesis when I bashed the “anti-medication” people. This is not a “one size fits all” field, no matter how badly some of my colleagues want it to be. That’s why you need to stab purists – as opposed to those who practice from an eclectic approach – in the chest with a wooden stake as if they were something seen on True Blood. They just don’t get the notion that no singular treatment modality can benefit everyone, and therefore end up forcing patients into a box of rigidity that doesn’t actually serve the patient, but rather the therapists’ personal need to follow through with what he/she perceives as correct in all situations. These practitioners counter my position with statements such as “but that isn’t congruent with my theory of personality,” and “that’s not how I work,” but ignoring useful data seen in the Times article isn’t only stupid, it’s negligent.

So as these two camps go war, insisting that everyone needs to think like they do, think about what other group this reminds you of. If you said “the bipartisan U.S. Congress,” you’d be right. And given that this government is basically BFF’s with everyone and overflowing with fans on Facebook for their superior ability to put their own agendas aside and come to reasonable agreements, maybe my colleagues might give this post a little thought. Or, more likely, simply continue to sit in their posh offices or ivory towers and keep telling themselves they are right, no matter what data comes their way. Either way, they’re fools, and feel free to say so at your next session.

Note: This post was written on my brand new, 21” IMac while I jammed to Led Zeppelin’s “The Song Remains the Same” on its killer speakers. I’m pretty sure this computer could tear apart an unabridged dictionary with its bare hands and score with dozens of lingerie models if it wanted to. It’s just that awesome.

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7 Responses to “Shrinks are Partisan Morons: A Comment on the Treatment of Nightmares”

  1. BL1Y says:

    We definitely live in a society that thinks of the symptom as the disease itself. If you have a headache, what do you do? You grab an aspirin. What you don’t do is try to figure out the underlying cause. Is it stress? Are you dehydrated? Do you have muscle tension problems because of your posture?

    The hybrid approach just seems so obvious. Use the symptom to identify the underlying problem, and then use whatever tools you have to provide more immediate relief.

    I assume the purists in either camp are intelligent, well educated people. How do they end up being so stupid? I can understand being committed to your camp and we tend to highly value our own ideas over equally legitimate ideas of others, but any idea how people get sucked into the extremist camp to begin with?

  2. Anna says:

    It’s interesting for me to read this as something a bit similar was said to me a long time ago, though about something very different. I paraphrase here as it was 10 years ago:

    When the client walks in he’ll walk in with a list of things he wants, this list is very likely to be ill-defined and vague. Your job is to sit the client down, talk to him, take your time and narrow down what the client wants, as well as what the client needs. There’s usually difference between these two things, at least initially. That you have to do this is something you already know. But here’s something the textbook won’t tell you that will make you a great deal more successful once you are working. What you need to look out for when trying to achieve what the client needs within the parameters of what the client wants is not to hinder the process with your own desires and your own preferences. The client is the priority, not your ego. Your expertise should help the client. It’s not there for you to select solutions based on what you want if your wants are in conflict with what solutions meet the client’s needs. Once you can separate your personal preferences from this assessment you’ll start to see a much greater success in your work.

    This was a little speech given not by a psychology professor but by one of my network solutions instructors – a man who was not a professional educator but brought in from a job in the field to give one course on dealing with the realities of working that kind of job. Even though I didn’t find myself in the networking field for very long much of what he said still stays with me as he tended to hold a very practical view of his work. While some of the professors would be married to certain architectures or brands* regardless of whether they were a good fit for the job they needed to do. I’ve found that when it comes to people (at the very least professionally) what he said does seem to hold true there as well.

    *I’m sure everyone has run into at least one Apple/PC/Linux/PS3/Xbox fanboy who recommends his brand of choice to everyone regardless of their needs.

    On a personal note I do find it a fascinating article, the idea of simply changing nightmares in such a seemingly simple fashion is quite interesting. While I can see why it would worry some people I do think knowing it’s possible to effect change like this is positive. It’s another option open to exploration, and I can think of situations where it could greatly improve a person’s quality of life.

    Also very glad to see you’re back up and running. Hope you didn’t lose too much work, and looking forward to the book. Grats on your new Mac as well 🙂 sounds like a good fit to you.

  3. Kristen says:

    I’m a psychology student and one of my professors is so obviously a CBT ‘purist’, and it bugs the hell out of me. He won’t even touch words that slightly resemble anything that could delve beyond the here-and-now without either sneering, saying it sarcastically, prefacing with some sort of caveat as to why he doesn’t like the word, or all the above. Ever seen Bob Newhart’s skit on MadTV? I can vividly imagine my professor yelling at his patients to stop it and halting any exploration into the past with, “We don’t go there.” Like hell I would ever want him to be my therapist.

    Anyway, it’s awesome reading this, especially because it’s something that I have been thinking a ton about lately. Thanks!

  4. Julene says:

    It’s hard not to think they take a look at the income generated from treating the symptom (which leads to repeated/steady visits with a patient) vs. the disease (which may mean a patient no longer needs them) and make the decision to “handle the small stuff first”. I just don’t trust a purist, regardless of what field of medicine they practice in.

  5. Dr J says:

    It’s hardly unique, this total belief in your own technique or ‘model’ as my therapist puts it (referring to my previous counsellor as “working from a different model”).

    Scientists all over the world argue and bicker between themselves over whose method works best. And even in Pure Maths (my field) where the results are absolutely concrete, unassailable once proven, there are always going to be disagreement about the best method to solve any particular problem.

    In my first proper seminar of my PhD work (on periodic systems), a very well-known/respected academic asked me why I didn’t simply use a transformation to turn the problem into one on manifolds (which is his field).

    I pointed out that if I knew more about manifolds than periodic systems I would have. But since I didn’t, I wouldn’t, though he was welcome to try.


  6. Antonio says:

    it may please you (or perhaps distress you) to hear this has defientely informed my perspective on psychology, just having come out of a personality theories class taught by a pretty hard line freudian. Your point was the point I made in all 3 of the essays I did for that class and I’ve done pretty well so far, so at least she appreciates being disagreed with.

  7. Jon says:

    The issue here appears to me to be akin to when you bashed the DSM; there are those who research psychology and those who practice it. Those who research psychology have to take, and argue with, one point of view else there are too many confounding variables. This is especially true for anyone whose religious beliefs may cause them to take one side or someone who has already published one side of the argument.

    Basically, for finding new ways to help people, taking one factor works best.
    For helping people in a clinical context, there is no reason not to take the blanket approach.

    Best example of this would probably be the study which showed brain scans for OCD paitents who either underwent CBT therapy or medicine; both showed alike results. Would have been nice to see freudian therapy included in the study.