I will concede that counseling, whether by a PhD Park Avenue shrink,
or by a Borneo witch doctor, will show some beneficial results. I
assert that these results do not vary measurably under different
theraputic methods, nor by the education level of the therapist.
I therefore argue that public and insurance money should only be
spent on the least expensive form of couseling that avoids severe
ethical abuses. Perhaps high school graduates with a few dozen hours
of ethical training.

---

In the past, these threads have died on sci.skeptic due to a lack
of defenders of traditional talk- or psycho- therapy. I'd play
devil's advocate, but I don't have the materials or training to
do a credible job of it. There has to be someone out there in
net land who believes in or practices traditional psychotherapy.

I believe the future of both psychotherapy and pharmacoptherapy lies
in identifying more specific biochemical derangements in the various
mental illnesses.  Clearly there are complex interactions in different
systems, but with functional MRI and pet and maybe MEG, it may be
possible to more clearly delineate these interactions.  When we
understand this better, more specific {*filter*} can be designed.  Perhaps
more intriguing is the possibility of more specific psychotherapy.
For the first time we will be able to design psychotherapy based on
its observable effect on the brain -- not based on a single
psychiatrist's theory of the mind some 100 years ago.

Greg Berns, PhD, MD-to-be
School of Med
Univ of Calif, San Diego

Most importantly, to validate itself as a viable therapy, talk therapy
would have to show its effects on the conditions being treated were
greater than less expensive therapies, such as $20/hour counselors
or $40/hour masseurs.

: "just as medicines can"? Do you mean "as much as," "as reliably as,"
: "experimentally indistinguishable from," or what? It's hardly suprising
: that *behavioral* therapy (or a good massage) would produce changes
: in neurotransmitters. But whether *talk* therapy can produce changes
: of the same magnitude as {*filter*} is another matter.

: Most importantly, to validate itself as a viable therapy, talk therapy
: would have to show its effects on the conditions being treated were
: greater than less expensive therapies, such as $20/hour counselors
: or $40/hour masseurs.

: >...
: >For the first time we will be able to design psychotherapy based on
: >its observable effect on the brain -- not based on a single
: >psychiatrist's theory of the mind some 100 years ago.

: Have at it! Just be sure your talk-therapy does better than much less
: expensive placebos.

I just finished reading "Listening to Prozac", a book which I highly
recommend to anyone interested in this subject.  The author mentions
a number of studies done on serotonin production in rhesus monkeys
and how it is affected by outside events.  He also talks about a
few studies where monkeys were given prozac and then the effect on
the {*filter*} hierarchy were observed.  

It does seem that stressful events alter serotonin levels and that
it may also be true that 'soothing' kinds of external events also
affect them.  Or else affect the levels of the re-uptake enzymes,
or the cell receptors or SOMETHING....

I am coming to view psychotherapy kind of like I do physical therapy
or speech therapy.  There are a few cases where each of the above
is indicated as primary treatment for an illness.  There are many
other cases where the above improve the outcome of treatment regimens
or that facilitate the re-integration into society of an ill person.

As an example of the above:  a person who has had schizophrenia or
years of severe depression often has much wreckage in their lives
that they need to deal with even if they respond well to a medication.
Studies may well prove that the combination of the two results in
much faster social re-adjustment than either one alone.

[mass deletia]

I suffer from disthymia (sp?) a less severe disorder than major depression.
I was first given Trazodone (sp?), which had little effect,  but about
3 weeks after switching to Prozac my moods underwent a dramatic improvement.
The change was rather like getting one's first pair of glasses; one
doesn't realize how fuzzy the world had become until one sees it clearly.

However, while the medication alone *did* improve my feelings tremendously,
I still had a number of problems just dealing with everyday life.  My
personal view of things is that years of depression get you into "habits
of thought" which then have to be broken.  I'm not entirely certain that
talking with a caring friend an hour each week wouldn't have had the
same effect, but the therapists I talked to were good at cutting through
to the things that were still upsetting me and causing me problems -
unlike the many caring friends I talked to.

So, I'm all in favor of medication, :), but "talk therapy" can, I think,
be a valuable addition, perhaps even well worth the admittedly high
fees charged by the therapists.  Mind you, I'm of the opinion that
I had good therapists, who helped me to learn to get mu *own* life
together.  So much so that I am now off both therapy and medication,
and doing (IMHO) fine.  However, when I read about certain therapists,
particularly those involved in this "Satanic Ritual Abuse" bullshit,
I recognize that "talk therapy" can also be incredible *bad* for
the patient.  Don't these guys have to have licenses or something?
Some of those guys shouldn't be let near a *healthy* person, let alone
an emotionally or mentally unstable one...

Yes, this is a "personal anecdote," and therefore not worth beans as
evidence; yes, I have not shown that the benefits of "talk therapy"
are not just due to the "placebo effect."  However, with that said,
I think there are still reasonable grounds for believing that a
trained counselor may be of great help to a mentally ill person,
and of more help than just "having someone to talk to."

--April