Is There a Science of Psychotherapy?

If we have to ask professionals, I guess not.  Here is what the president of the Society for Psychotherapy Research has to say:  “There is strong evidence for many…..approaches.”   Now what does that mean?  That many approaches are all valid?  That they are scientific?  How could that be?  You mean that there are many sciences in psychotherapy, all valid?  Are there many different sciences in physics, in biology?  There may be some difference of opinion but certainly not different sciences. I mean is there gravity or not?  Are there many ways to make electricity?

  Let me go back to my internship in a major Freudian clinic (Hacker Psychiatric Clinic).  There was no science in what we did. We all had different Freudian interpretations of patients….was he Id dominant?  Was his superego too strong?  Was there evidence of his childhood sexuality? And on and on.  No science, only guesswork and imagination.  And there was imagination at work as our staff spun incredible theories to explain the patient’s behavior.  There was certainly no science to guide us in how to proceed in psychotherapy.

   I think that there cannot be many valid approaches to psychotherapy; either there is a  scientific approach or there isn’t.    I now must offer our approach which I think is science at work.  We can predict what happens to patients  and what level of conscious  they are on.  We can predict the demarche of the therapy,  how it should proceed, and what steps we should take.  We understand immediately when a symptom such as high blood pressure or a migraine appears.    Above all, we know when a therapist makes a mistake.  Our staff can look at a tape, and we always tape patients, and know when something went wrong.  Why?  Because there is a precision to what we do that allows no margin to go off and do something else.

  Yes there is leeway in terms of the therapist and his perceptions but not in terms of what the patient needs.  It is never doing “what we feel comfortable with,” as I learned in my internship.   We have a clear understanding of anxiety and panic (see my piece in the World Congress of Psychiatry http://www.activitas.org/index.php/nervosa/article/view/146/183),  as well as what causes paranoia and what to do about it.   We don’t have to guess about what generates depression because we have a theory to guide us and decades of experience to tell us what works and why.

  So in those many approaches that they claim to be valid there may be ten different explanations of paranoia, not one, most of which do not concord with brain science.  Will it help to talk her out of her paranoia?  Not quite.  Since it is not an attitude; it is an imprint with a history and a biochemical foundation,  not just a cognitive misstep.  Without a comprehension of the levels of consciousness I cannot imagine how to construct a valid psychotherapy.  Because in the brain and its evolution there are distinct levels of consciousness with different identities and different symptoms.  For example, colitis has a specific origin and gets its start very early in evolution.  That symptom can tell us where in the brain it is located and originates, and what we can do to treat it.  When a patient needs drugs we know what to use (in conjunction with medical advice).   We know that serious mental symptoms require deep brain blockers because we understand that bizarre symptoms require deep access.   We also know that any scientific therapy must ultimately access deep brain engraved memories.

   We know that in gestation there are already imprints and repression that may be compounded into terrible depression later on.  We do not have to concoct hypotheses stemming from Freudian days about anger turned inward.  We learn from the unconscious of each patient, and from there, build a theory that helps explain it; we simply observe and listen.  It is all there, just waiting to be discovered.  It is not us that holds the truth; it is always the patient.

  So how can ten different therapies all be valid?  It can be affirmed precisely because there is no science that they follow.  Therefore anything can work.  If a neurosis is built on sequestered pain, how could we do anything else but access and address that pain?  We may disagree as to what to do about it but not of the pain itself, which we have seen thousands of times over forty seven years of Primal.
And of course we would not rely on medication as treatment when we do not want to push down the pain anymore, but rather to let it out; to express it at last.   Yes, if we do not admit to the stored pain and imprints then anything goes.

  Further, when we do acknowledge the existence of pain, we need to understand that we cannot travel deep too soon.  We know now that there is a valence to each pain; only so much that can be experienced at any time.  To deny that and over-reach the boundaries endangers the patient and her mental stability.  Yes there are times when the pain is hurtful but we understand that each little bit experienced is so much less pain driving us.  And that is why we see so much less stress hormones in our patients; as if to underline that feeling pain  relieves our neurotic burden.

  So to me, there cannot be any number of therapies all valid;   there can be many therapies all invalid, but they can claim validity if they change the criteria for improvement.   If they rely only on psychologic criteria, “ I  feel much better;” but no matter what she says, the biologic measurements tell another story.   So yes we can claim validity when we leave biology out of the equation.  But it is a pseudo state, and we don’t want to get pseudo well, do we?