Edwin Harari 2104 Ghost Busting: Re-introducing psychotherapy for the psychiatrist
Objective: The purpose of this paper is to provide a clinically relevant historical and conceptual overview of psychotherapy as an introduction to a forthcoming series of papers on specific models of psychotherapy. The author offers a selective review of some key ideas in the history and practice of psychotherapy.
Conclusion: The principles of psychotherapy should inform all psychiatric practice, including the doctor– patient relationship, multidisciplinary teams caring for patients with complex or ‘treatment resistant’ problems, and patients who are non-compliant with psychotropic medication.
Keywords: psychotherapy, doctor–patient relationship, treatment resistance, psychotherapy and medication
Australasian Psychiatry 2014, Vol 22(5) 433–436 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav
Ghost Busting: re-introducing psychotherapy for the psychiatrist
Edwin Harari Consultant Psychiatrist, St. Vincent’s Hospital Area Mental Health Service, Fitzroy, VIC, Australia
Psychotherapy (‘healing the mind’) is a particular type of interpersonal influence, wherein one person, acknowledged by society as possessing relevant skills (the psychotherapist) seeks to change the thoughts, feelings, attitudes, behaviours, relationships or personality of a suffering other (the patient):
If one posits that the relation between doctor and patient has been critically wounded, how are we to understand whether, and on what basis, that relationship may be reasserted ? AI Tauber
The pedagogy for engaging hidden values and divided selves is the moral building of the clinician as a full developed human being. A Kleinman
I do not favour the way Descartes ontologically screwed up a reasonable search for mind-brain docking during the past four centuries yielding life-denying monstrosities like radical behaviourism and an emotionless information processing cognitivism… J Panksepp
The possibility of intersubjective knowledge offers a welcome relief from a forced choice between pure subjectivity (Descartes) and true objectivity (Kant). EM Hundert
The outcome of the game is to convert what would otherwise be a nameless trauma into a loss. J Lear
As a general rule throughout Asia, the more patriarchal the society, the more the Buddha looks like a woman: the more egalitarian the society, the more the Buddha looks like a man. L Shlain
Psychotherapists, especially, appreciate [that]… this painful ambivalence is as old as the ice-age, a hallmark of Cro-Magnon man, torn between his craving for consolation and his fear of revenge. J Cawte
Each of the above quotations may serve as a conceptual signpost or creative condensation of the argument each of the authors’ advances in their respective texts which bear on the nature, subject matter and practice of psychotherapy.
Tauber AI. Confessions of a medicine man: an essay in popular philosophy. Cambridge, MA: MIT Press, 2002, p.103.
Kleinman A. The divided self, hidden values and moral sensibility in medicine. Lancet 2011; 377: 804–805.
Panksepp J. The self and ‘its’ vicissitudes. Critique of commentaries. Neuropsychoanaly-sis 2002; 4: 50.
Hundert EM. Philosophy, psychiatry and neuroscience. Three approaches to the mind. Oxford: Clarendon Press, 1990, p.297.
Lear J. Happiness, death and the remainder of life. Cambridge, MA: Harvard University Press, 2000, p.92.
Shlain L. The alphabet versus the goddess. New York: Penguin, 1998, p.200.
Cawte J. Aboriginal healing: psychotherapy in ancient society. Aust J Psychother 1988; 7: 14.
Doidge N. The brain that changes itself. Melbourne: Scribe, 2007, p.216.
Wolff HH. The therapeutic and developmental functions of psychotherapy. Br J Med Psychol 1971; 44: 117–130.
Markowitz JC and Milrod BL. The importance of responding to negative affect in psycho-therapies. Am J Psychiatr 2011; 168: 124–128.
Frank JD and Frank JB. Persuasion and healing: a comparative study of psychotherapy (3rd edition). Baltimore: Johns Hopkins University Press, 1991.
Kernberg OF. Severe personality disorders: psychotherapeutic strategies. New Haven, CT: Yale University Press, 1984.
Gabbard G and Kay J. The fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist? Am J Psychiatr 2001; 158: 1956–1963.