Shirah Vollmer MD

The Musings of Dr. Vollmer

Critical Thinking: A Therapeutic Goal

Posted by Dr. Vollmer on February 26, 2018

 

 

 

Critical thinking — what the philosopher John Dewey called the ability “to maintain the state of doubt and to carry on systematic and protracted inquiry,” is the goal of reflection. To modify Dr. Dewey’s quote, psychotherapy/psychoanalysis aims to help the patient develop critical thinking about one’s own mind and about the minds of those that influenced them. “I am not interested in symptoms” I say, in a provocative manner, to my class, knowing that saying that contradicts all of their previous education in psychotherapy. “I am also not interested in symptom-relief,” I say, taking it one step further. “What I am interested in,” I say, “is how the patient is thinking about his life and why those symptoms are manifesting at the particular time, and in the particular way, in which they do. ”

Karen, sixty-two, comes to mind. She has what could be called Generalized Anxiety Disorder, and I prescribe her medication, so in that sense, I am interested in symptom-relief, but mostly I am curious why she has to worry. I am helping her be curious as to why her mind is preoccupied with worry. The key words are “has to”. As I understand anxiety, it is often a symptom of a deeper issue of insecurity and loneliness  and I would like to explore that with her. I want to explore that with her in a way that makes her curious about it in a way which generates a  “systematic and protracted inquiry” and which carries on both inside and outside my office. This is what I do, and this is what I teach. Sure, I tell patients with anxiety to try yoga, meditation, and dietary interventions, but that is merely the beginning, because as time progresses, the issue becomes, “so what is really go on here?” To that question, there are endless answers, requiring a “systematic and protracted inquiry.” Dr. Dewey, may he rest in peace, is my hero.

4 Responses to “Critical Thinking: A Therapeutic Goal”

  1. Jon said

    Let me offer friendly amendments to your statements, Shirah, one of which you have already caught. “I am not interested in symptoms” can be amended to “I am not interested in symptoms qua symptoms.” Likewise, “I am also not interested in symptom-relief,” can be amended to “I am also not interested in symptom-relief qua symptom-relief.” More succinctly, you are interested in getting to the root causes of the problems and solving those.

    Your hypothetical Karen anxiety is truly insecurity and loneliness. Working on those issues, both directly and indirectly, is the key to success. The surface approach of yoga, meditation, et al. may give the calmness of mind to address these issues. Coming to understand fundamental issues and solutions is not a simple path, and yes, critical thinking is necessary for that.

  2. Shelly said

    A worrywart is born and it is transmitted from one’s family of origin. Simple. It’s true to say that it also involves symptoms of insecurity and loneliness, but to diminish the importance of inheritance or epigenetics in the mix doesn’t help the issue. Yes, your patients can help themselves and need to develop critical thinking skills to try to overcome anxiety, but sometimes, they simply can’t help it. They were born that way.

    • Hmmm…not so sure I agree with you Shelly. I do agree that people are born with anxious temperaments which make them more vulnerable to anxiety, disorders but I do not agree that genetics answers the entire question. A systematic and protracted inquiry could still yield some important environmental contributions to the anxious state. in this inquiry, critical thinking can develop and as a result, anxiety can become more manageable. Thanks, as always for entering the discussion.

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