Creativity in Psychotherapy
Posted by Dr. Vollmer on November 3, 2014
Cookbook therapies, as I call them, such as Cognitive Behavioral Therapy, theoretically speaking, are independent of practitioner, such that all providers give, more or less, the same service. Hmmm…sounds like a franchise. By contrast, psychodynamic psychotherapy lends itself to creativity, and hence there are no metrics, since there is no standardization. Standards in medical care, generally speaking, are positive. A person with chest pain in Omaha should get the same evaluation that he would get in Los Angeles, and yet, historically speaking, that was not true. Creating a centralized, replicable, mode of evaluating medical symptoms makes an enormous amount of sense, yet it has taken us many decades to get here. This change towards unification of health care will have an enormous benefit to millions of people and I salute this change.
Having said that, standardizing mental health care is not as meaningful, and is, in fact, harmful, both to patients and practitioners. From the provider’s point of view, the field has gone from creative to rote. The fun in providing rote care eludes me. From the patient’s point of view, the field has gone from inaccessible to most people, to more accessible, but with limited benefits. This shift towards limiting time spent in psychotherapy, limits clinician latitude. This latitude leads to uncertainty, not just in the patient, or the insurance company, but also in the clinician. Certainty and consistency are comforting, even if the tools are not deeply helpful. This is a large dilemma. Certainty and consistency provide relief, particularly with anxiety, but long-term gain comes with accepting uncertainty. Psychodynamic psychotherapy provides the consistency and reliability of appointments, without giving the patient the false notion of certainty that the psychotherapeutic tools are effective. Like panty hose, one size does not fit all, or even most, but rather individuality and uniqueness needs to be embraced for the good, the bad and the ugly inherent in the human condition. As I teach my students, we may not know how to help as many people as we would like, but unlike our behaviorally oriented colleagues, we have a better understanding of what the difficulties are.