under surveillance. Many families have made vast im-
provements from this work.
If your symptoms might improve by working directly
with others who have similar problems, your therapist
might also recommend group therapy as an additional
modality. Groups have the advantage of conquering the
shame that can so often affect people suffering from
anxiety. Around the world, twelve-step groups meet to
harness the power of the group as a tool to conquer
shame and mobilize recovery from all kinds of anxiety.
A landmark study by Dr. David Spiegel of Stanford
Medical School found that women with breast cancer
who received adjunctive group/psychosocial therapy
lived twice as long as those receiving no group therapy.1
Powerful connections are made in these groups, and
these connections relieve anxiety.
Selma s comments:
I have friends who see a variety of counselors, usually social
workers, for what they deem a small problem in their mar-
riage (generally stated as the other partner s inability to un-
derstand their needs). When I ask why not get treatment
with an analyst, they say they can handle this struggle
themselves, implying that analysis means changing into
other than what they are now. As a child, I had an essential
sense of myself. It was never articulated, but there was a
deep inner feeling that I knew was what I called, me. I ex-
pressed myself in things I liked and things I wanted. Some-
how, in my difficult home environment and with
subsequent anxieties especially around separations, like in
my stormy adolescence that sense of me disappeared. It no
longer existed, without even a memory of the girl I once was.
Some years into my analysis, I was walking on a beautiful
spring day, loving the beauty of the world. I realized that
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for an ephemeral few minutes, I looked at the scene and felt
it as I had felt it as a child. Rather than think this sense,
(like telling myself, I felt this way as a child ) this refound
feeling felt different. That feeling I had had long ago of
having my own private domain became mine again. Now I
am a mature, developed person, but the essential person I
was and that I knew to be me, articulated to no one, is
again intact. Analysis had in fact changed me. I again had
the freedom to be myself and to move away from all the de-
fenses I had built and used in order to cope with my anxiety.
I again laid claim to being true to myself. For me, it was
analysis that worked.
My treatment was hard work. No one does it except you, your-
self. My analyst became a trusted guide, and I suppose the
work provided tools to better handle life. But the commitment
to hang in there must remain, especially when you hate your
analyst, when you are so exhausted from the work that you
want only to sleep, and when it seems as if nothing is happen-
ing. And when things are happening, because they are hap-
pening and because you are changing, you might become very
anxious over just about everything. It is hard, slow work, and
the benefits are lifesaving and life-giving. Or so it was for me.
71. How does psychotherapy work?
Does it work?
If you read about any psychiatric medication, you will
learn that most are mechanisms of action unknown.
The same holds true for psychotherapy, making us
wrestle in detail with what also makes common sense.
Some excellent studies have been published, showing
the efficacy of a type of psychotherapy for a particular
disorder over a particular time frame, but this work still
cannot explain how healing takes place. Dr. Susan
Vaughan s The Talking Cure does a remarkable job of
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making the case for psychotherapy s actually changing
brain chemistry.2 She outlines a schema that, if true,
would offer one explanation behind a clinical truth that
many of us see daily: people get better when engaged in
psychotherapy with a therapist whom they feel under-
stands them. Drs. Jerome and Julia Franks Persuasion
and Healing takes a comprehensive look at the litera-
ture on outcome research and mechanisms of action in
psychotherapy.3 They conclude that in all of the work
that has been done, no one has ever been able to show
definitively that one form of therapy works better than
another. Psychotherapy is extraordinarily complicated,
with many interpersonal factors at play. This dynamic
of a situation makes it difficult to determine through
the scientific method how any given individual might
get better when the larger group is studied.
Many of us would say that it boils down to several key
ingredients. The first would be the relationship be-
tween you and your therapist. While any number of
providers might be a right enough fit for you, it is im-
portant that the fit be right enough. That fit is often [ Pobierz całość w formacie PDF ]