Critical Thinking: A Therapeutic Goal

 

 

 

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.

Understanding Subjectivity

 

Understanding subjectivity is the essence of good listening. Zoe and Berkeley illustrate this point well. https://shirahvollmermd.wordpress.com/2013/03/27/disappointing-siblings/

Many of my readers commented that Zoe was being “too sensitive”. This “too sensitive” remark often strikes me with the wish to respond “on what scale?” Who owns the sensitivity meter between nicely sensitive where one is sympathetic to others, to ‘too sensitive” where one is considered a “drama queen”? I often think of a dog who hears sounds that humans cannot detect. Are dogs “too sensitive”? Or, do they have powers of perception which exceed humans, and therefore we are baffled by their abilities? Sure, one could say that Zoe should not “make such a big deal” about Berkeley interrupting a yoga session, and that Zoe, clearly, to some, is either unforgiving in general, or specifically, with her sister Berkeley. On the other hand, Zoe’s reaction to Berkeley could be a detection of underlying hostility that Berkeley feels for Zoe, and as such, Zoe is wise to pay attention to her feelings, such that she understands the dynamics of her relationship with her sister. Suppose Zoe were to brush off the yoga experience, only for it to happen again, leading to more ‘sensitivity” and pain. This minimization of her feelings could lead her to a larger problem of repeated exposures to situations where she ultimately feels deeply devalued. Similarly, Zoe’s attention to her feelings could lead her to protect herself from people who do not appreciate her, thereby protecting her self-esteem. As Zoe’s therapist, it is my job to understand her subjective experience, and in so doing, help Zoe deepen her understanding of how she is feeling in the moment. I encourage her “sensitivity” such that she has a language for her emotional interior in which she can describe her  experience of a deeply wounding experience. This language of feelings can be scary to some ears, leading some listeners to want to dismiss her and say “get over it”. It does not matter whether the listener, in Zoe’s yoga experience, would have had the same reaction. What matters is that Zoe experienced hurt feelings, and like a person who takes a tumble, the friend asks  ‘how can I  help?’ and not ‘why are you moaning?’