A New Model?

Last time I wrote about how I can imagine that the way I do psychotherapy could change.  New insights, new technologies, or convincing  new evidence could, I hope, lead me towards a new way of doing things.  I'd like to think that I'm flexible enough to change.

Yes, I do believe that interpersonal interaction, especially between humans, is very powerful, and is one of the most basic components of our psychological existence.  But, that doesn't mean that the process can't be helped along.

There is a group of neuro-biologists on the west coast of the USA, the most prominent of them is a Dr. Christof Koch.  Working with Dr Fried, who treats epileptic patients, they implanted electrodes in their brains in order to help treat their seizures.  Slowly, they have been able to find  some exact spots in a brain that hold a specific thought.  And working with some talented computer programmers, they have found a way to have people's thoughts control which image appears on a screen just by thinking about what that image is.  For example, they had a woman who thought about Josh Brolin and about Marilyn Monroe.  They had electrodes placed on spots in her brain that represented their memories of each of those people.  When she thought about Josh, his picture would appear.  If she then began to think about Marilyn, Josh would fade and Marilyn would appear.

I feel that the implications of this technology for my work are tremendous.  What if a person harbors very ambivalent thoughts about themselves, or something they did, or someone they are close to.  If they could learn how to make one of those thoughts (and the feeling that goes with it)  become more dominant, they could have much better control of their lives and emotions.  The change process could go so much more quickly if someone was able to get immediate feedback, such as seeing a picture of what they want to see become clearer and clearer, the more they thought the good thoughts.

What about people who suffer with obsessive thoughts: is there a spot in their brain where these thoughts originate?  Could we tap into it and help them to learn to think about it less, while thinking about something else more?

Done correctly, this could become the opposite of brain washing, which is when someone else has a strong influence over what you think or believe.  People could be able to think and feel what they want, and learn to do so much more quickly than happens when they just talk about it.  I could see up there on the screen, how well they were doing.  How strong the thoughts and ideas are; how persistent is the idea we want to repress.

Of course, this implies a very reductionist philosophy, one that favors the stance that the brain controls the mind, more than the mind is controlling the brain.

But that raises the question of who (what?) controls the brain that controls the mind, if it is the person who is doing all the thinking for both the brain and the mind.

(I used to talk about this to my son.  He would leave the room screaming.)

But if we can change what we think and feel more easily, just by thinking about it.  That's what all this therapy stuff is about isn't it?

And what if there was an App for that?

We have a problem -- 1

We in the psychotherapy profession have a problem, and it is going to be getting worse in the near future. I am going to probably take a few of the next several entries here to spell it out for you. I know that the world has been waiting impatiently for me to do this so I will try to work on it here a few times so that I have a chance of making sense.

Part of the problem is that we are low-tech. The world has become very impressed with technology. I know I have. As soon as my eye heals and I can read the small font I am getting an iPhone. 85,000 apps! My God, there is nothing I will have to do any more -- except psychotherapy.

Look at the equipment we need -- chairs. And we don't even need them, although it is better than standing for almost an hour. Sometimes though, I have gone for a walk with a patient.

But that is only a small part of the problem, The big part is that, after a hundred years of trying somewhat scientifically to deal with psychological, emotional and behavioral problems, there is still not direct way into the mind. In fact, we really are still trying to find out what the "mind" is. Yes, we agree, it has a lot to do with the brain, but it is not the brain; it is different.

Yes, but then, what and where is the "mind?"

See, we have a problem, and already it is getting complex and confusing.

But, given all of the marvelous new technologies, people expect that there must be some way to get in there and make people better.

As I said a month or so ago, when they fixed my eye they went in, cut out the bad parts, threw them away and replaced them with good parts. My eye is healing and I expect that soon I will be able to see pretty well.

Now, even though we have marvelous fMRI machines to watch the brain, lots and lots of drugs to pour into people, and we are even learning about the genes that contribute to our talents and temperaments, we still can't get right at it. There are thousands, if not hundred of thousands of attempts, but none of them have really been that successful. We don't even really agree on what we are trying to get right at.

Now, the new US health plan (whatever it will be) is on the way. And the plan will expect that there will we empirically validated and specific treatments for whatever we do, if we are to get paid.

See, we have a problem.

the time it takes

I'm going back to work tomorrow. My eye, which gets tired when I read a lot, will be fine when I just sit and talk to people, even if parts of them look a little blurry.

First I go get the eye checked, and then I'm off to work. I am pleased at how well and quickly I am healing. It makes me wonder how awful it is for my patients. They come to see me and in the first hour we discuss a course of treatment, and what we hope will happen. But for most people, it will take months, if not years to make changes in their minds and lives.

I waited five months to have this surgery, and now I have to wait another three to six months before the swelling in my eye will go away, and I don't want to wait. I feel like they, those who do modern medicine, should be able to just pug in a new eye, and I should go on my way, seeing better than I ever have before. But nooooo, I have to wait until the swelling goes away.

At least my doctors operated directly on my eye. In my business we don't have direct access to the mind. We don't even know where to find it for Chissakes. Yes, it has something to do with the brain, but what? And we don't even have direct access to the brain; at least not for psychological stuff.

So how can any anyone really expect efficient treatment, given how indirect it all is?

I think we are lucky to be doing as well as we are doing.

When you find you mind, let me know where it is.