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"Psychotherapy: How Can We Help?" (Smail, 2003) - critical analysis of psychotherapy

Discussion in 'Other Health News and Research' started by Dolphin, Mar 21, 2010.

  1. Dolphin

    Dolphin Senior Member

    Angela Kennedy mentioned "magical voluntarism" (and David Smail) elsewhere so, as I was not familiar with the term, I googled it and came across this article.

    I thought it was interesting.
    I have heard the odd person make this criticism before (e.g. Orla) - that psychotherapy can tend to put all the blame and responsibility on the individual (if they don't get better) when there can be external factors involved.

    One could of course extend "external factors" to not just a poor social security system, unsupportive family, etc but also a virus or other infection (for exampe) so expecting a patient to conquer an illness using nonpharmacological approaches would be unfair.
  2. BEG

    BEG Senior Member

    Southeast US
    Tomk, I felt like I was missing something when I read your post. So I read the article. This is a paragraph from the article which cleared things up for me.

    "Alongside technical assumptions in the history of psychotherapy – and indeed almost contradicting them – there has run a strong theme of individual responsibility. Patients, that is to say, are seen as somehow ultimately in charge of their own fate. They may be led by ‘insight’ to an accurate account of the reasons for their problem, but whether or not they do anything about it is up to them. If properly ‘motivated’, no doubt they will, but if ‘resistant’, maybe they won’t. Either way, this is not seen as anything much to do with the therapist. This is what I mean by magical voluntarism, for, even if not explicit, the idea that people can choose a way of being involves notions of ‘will power’, freedom and ‘responsibility’ that do not, in my opinion anyway, bear critical analysis in an even remotely scientific context. The fact that the clarifying element of therapy may expose in stark relief the reasons for someone’s distress in no way necessarily provides him or her with the means of putting them right, and in fact, in the vast majority of cases, the noxious influences giving rise to them will be well out of reach in time, space or both. Therapy frequently simply glosses over this difficulty with an implicit moralism that, ultimately, makes the person the author of his/her own predicament."

    According to the article, I took away the point that people may present themselves to a psychotherapist with problems (noxious influences) that are, frankly, unsolvable, which in no way reflects on the success/failure of patient/therapist. However, some patients will find their lives improved, while others will not even though the therapist applies the same techniques to each individual. The justification for making the statement that therapy is not based in science.

    Now, consulting a psychotherapist while having an organic illness as well presents another set of problems for both patient and therapist. The therapist needs to be keenly aware that all the talking in the world will not cure an organic illness. The therapist can only hope that the patient can learn better coping techniques while suffering with a physical chronic illness. With CFS, there is often comorbid depression. An antidepressant may quickly turn that around; then the patient can continue to learn coping techniques for the illness. Whether that is successful depends on so many variables as mentioned in the paragraph from the article.

    Scientific or not, talking therapy has a place for those suffering chronic illnesses, because psychological problems due to chronic disease are very common. I don't need to go into the psychological complaints that accompany CFS or the fact that suicide is the #2 killer of CFS patients. Comorbid depression, for example, is quite common for many chronic illnesses.

    No, the problem arises when certain individuals believe that psychotherapy is the cure for a physical illness not simply a coping mechanism, which I believe, you were referring to.
  3. Dolphin

    Dolphin Senior Member

    I suppose that would be my main point (or on of them). I agree learning coping mechanisms can be useful and that having the opportunity to talk through your situation could be useful.

    But I've also heard people make the point that social/external factors can be an issue in lots of situations.
    I've added: "(if they don't get better)" to clarify a bit: "that psychotherapy can tend to put all the blame and responsibility on the individual (if they don't get better) when there can be external factors involved."

    Could be an interesting discussion although I might not have much time/energy to contribute much myself.
  4. gracenote

    gracenote All shall be well . . .

    Santa Rosa, CA
    This is an excellent discussion. Thanks for posting this tomk. And thanks Brown-eyed Girl for your excellent thoughts.

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