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The Talking Cure

08/13/04 | by david2 [mail] | Categories: General
This has been brewing for some time: The Talking Cure is under assault . The Talking Cure? We all know what that is. It's what Tony Soprano got from Dr. Melfi, and what Billy Crystal gave to Robert DeNiro in that duo of bad gangster / shrink movies.

Classically, it takes the form of a psychiatrist sitting in a chair, with a patient lying down on a couch nearby, with the doctor out of sight. The patient talks to the psychiatrist, who allows the patient to engage in free association, with the objective of getting access to unconscious thoughts and emotions which, in theory, are at the root of most mental disorders.

The talking cure is credited to Freud, who published "The interpretation of Dreams" in 1899. Repressed thoughts and emotions, resident in the "id" were responsible for most ailments, and they could be exorcised via talking. Modern psychotherapy was born.

A Freudian psychiatrist (like my father) would see a patient for a "psychiatrist's hour", or 50 minutes, allowing the patient to talk freely. Notes would be taken. The cure would come when the patient managed to become conscious of the hidden thoughts and emotions at the root of the disorder

And therein lies the conflict: There isn't an awful lot of empirical evidence for the efficacy of the talking cure, so say a subset of psychotherapists who repudiate Freudian theories.

And also so say the insurance companies who are growing increasingly reluctant to pay for an hour of a doctor's time. "Show us the meat" they cry. We want to see studies proving that the talking cure truly works.

It's gotten to the point of a religious war, but the war remains central only to those who go to conventions: the talking cure is not and never was available to joe sixpack: it was always too expensive, even when it was in favor by all in the profession. And since the keepers of the money determine which treatments are in favor and which are not, the talking cure will remain where it is, a therapy of choice for those that can afford it.

Which also means that it's not going away any time soon. All of the Freudian psychiatrists I know tell me how business is booming, and expect it to continue to do so.

My father gradually found himself mixing the talking cure with pharmacological treatments: an hour of talk followed up with prescriptions for medications. His work at clinics abbreviated the psychiatrist's hour. Patients would come in, talk to my father for a short while, mostly to update my father with their condition. Then they would leave with their prescriptions.

I once asked my father what he thought about what he did: did he actually "cure" people? He thought about it, and said that there were some people who could be cured. Some had specific physiological ailments which could be treated successfully with medication.

Others were in need of a weekly "grounding". I'm reminded of the Roman Polansky movie "Repulsion" where Catherine Deneuve goes insane when she's left alone by her sister for an extended period of time. My father would act as the sister, coming in and reconnecting patients back with reality.

I have this image of patients being slightly lighter than air: over time they begin to lift off the floor, floating away. My father comes in, grabs them by their ankles, and pulls them back to the ground again.

So, while he called himself a Freudian, and had the works of Freud on his desktop, he became much more utilitarian than a classic psychotherapist. He was an expert in pharmacology and I believe relied more upon that than talking. Until the day he stopped practicing, however, he never gave up his own private practice of having patients come over for a 50 minute hour of the talking cure.
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Comment from: david [Visitor]
http://www.usyd.edu.au/hps/staff/hans/HPSC3010/3010.html

history of psychiatry
08/14/04 @ 13:03
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