Canned Training

An executive coaching client asked my opinion on a certain brand of management training seminars. I replied:

I'm not familiar with these particular seminars. My attitude about canned training is that, in general, most of it doesn't apply to specific needs, but if you take an idea or two away from a seminar that you can plug into your work back at the ranch, that's probably pretty good. There can be a problem with being told to work in ways that actually won't work in your particular organizational milieu, market niche, or for your personality. So there's a sorting out responsibility that one has to do for oneself. Looking at the seminar descriptions, I found myself put off by what seem to me to be hyperbole in the titles and short descriptions, but then I became more interested when I looked into the details. I'm generally wary of hyperbole, and wonder how much of that will get into the presentations themselves, as a kind of hypnotic suggestion or propaganda wavelength. It's possible to leave training seminars feeling like one has been handed a jewel, but then find, afterward, that one's hand is really empty after all!

So, the bottom line is, yes, do go, bringing both your notebook and your skepticism with you, and be prepared to have to work, after the seminar is over, at sorting out what was potentially valuable from what wasn't. I'll look forward to hearing about it, and maybe that's where I'll be able to provide some value for you, in the sorting out process.

Stenhouse on Curriculum

As the new school year begins, I picked up my old copy of "An Introduction to Curriculum Research and Development," by the Scottish educational thinker and teacher Lawrence Stenhouse (1975), and found some good old thoughts about curriculum.

Stenhouse saw curriculum as both what a school (or teacher) intends to do, and what it actually does.  He takes it as given that there will always be a gap between intent and delivery, so understanding a given curriculum requires awareness of both what we're setting out to do and what we're actually doing. He thought teachers should be studying this, both on their own and together. 

Stenhouse saw curriculum as composed of three broad domains:
-- content (information to be learned, which you can pre-specify and test with a multiple choice test),
--skills (recognizing letters and words, writing a three-paragraph essay, solving mathematical problems, which you can also pre-specify),
--knowledge (using what you've learned to solve problems or meet challenges in some unexpected way that can't be fully prespecified; an essay question at it's best, a scientific, artistic or community project).

He thought that educational thinking and theory often fell short by confusing content and skills, which can be prespecified, with knowledge, which cannot. He saw the teacher as being at the center of education, contrary to the trend to see teachers as deliverers of pre-packaged curricula.

35 years after his "Introduction to Curriculum Research and Development," Stenhouse's thinking holds up very well indeed. The only substantial addition that I'd suggest is about the way teaching methods relate to the more recent knowledge about learning and the brain; for example, strategies designed to engage the left and right hemisphere, frontal lobes and attention, and the domain of social-emotional learning (individual and group strategies, etc.).

In these times, when education is so often about making sure that children can simply read and define words, do math, or pass pre-specified tests at such and such a level, Stenhouse can help us to remember that there are domains of education that connect with potentialities of human nature that lie far beyond these meager models of what learning and knowledge are about.

Latent Tension

"Dorothy" comments: "My dad came to visit and we had a pretty good time, but there was all this latent tension that he never noticed."

Dr. Einhorn comments: The implications that there is latent tension sometimes and not others, or that when there is latent tension we usually discuss it, are interesting, because they don't seem to reflect reality very well. It seems to me that there's always latent tension, or almost always, and we are always mostly ignoring it. Our lives and relationships are always moving, changing, bumping into one another, influencing each other. We are all--individuals, families, relationship networks of various kinds--part of this vast Darwinian humanity that is evolving, with huge fits and starts (wars, economic bubbles and crashes, dislocations of various kinds) into a planetary culture. Think of all the kinds of tension there are: status/authority, closeness/intimacy, economic, sexual, religious/spiritual (though I wonder if there can be real conflict once we are actually in the realm of the spiritual), etc. Not to mention the "latent tensions" within our own minds, between various impulses, urges, thoughts, feelings, values, allegiances, states, etc. These "latent tensions: are always going on; it's part of the environment that we live in. The questions that interest me are, which parts of the latent tensions going on at any particular time and in any particular relationships do we want to give attention to, and how do we want to do that. And, of course, that brings in the questions of how perceptive we are, how honest we are, and how much we are prepared to risk in being honest.

A lot of therapeutic work focuses on latent tension in the life of the client. It can also usefully focus on latent tensions in the relationship between client and therapist, if the therapist can use that skillfully and the client can enter into that level of dialog about their relationship.

A lot of art is about expressing the interaction between latent tensions in some way, especially (it seems to me) poetry and poetic musical lyrics, and storytelling in its various forms (novels, plays, etc.). Music itself is a way of creating harmony out of elements that are in a tension relationship, both in the music that is played and also in the instruments that make it. I remember the guitar being described as something that can hardly exist because all of its elements are in a state of tension with one another, the wood trying to collapse, the strings trying reduce their stretch tension. And of course that's what makes the beauty of the sound, when the tensions are just right and a harmony is created.

Rumi talks about the way that things apparently opposed can be working together, as in the handclap being created by the apparent "opposition" of the two hands, which we might see as the "tension between" them. The movement of the two hands through the air might seem "latent" in slo-mo, until they met one another and produced the clap.

It generally takes a lot of self-work to be able to talk about the latent tensions in any relationship, because the ability doesn't come naturally. You have to start the conversation, and then you have to stay in it, according to how the other person responds. Here, Dorothy doesn't say that she tried to raise any issues with her dad, although noticing them herself was a start. The implication is that he should have taken the initiative to raise issues with her, in which case I wonder if their pattern is that he's done that in the past, or perhaps that she wishes he had but he mostly hasn't. If she wants to take the risk of raising some issues involving latent tension with her dad, she'll have the opportunity to see what might come of that. It does take a certain amount of courage.

Songwriting and Psychotherapy

(This essay is in the Summer 2010 issue of The Illinois Psychologist, the newsletter of the Illinois Psychological Association)

I’m a singer-songwriter, and I subscribe to a folk music listserve on which a singer-songwriter posted this question: “How do you separate ‘songwriting’ from ‘performance’ when listening to a song that you wish to evaluate for it’s merit?” He continued: “There are some aspects of the performance of a song that you can think of as purely ‘writing’ (clever use of metaphor), and some that are purely ‘performance’ (great voice). But some of the finer points of a song include ‘phrasing,’ ‘dynamics,’ and ‘emotional connection.’ Are these related to writing or performance?”

This question sparked a lively discussion, capped by this comment from another singer-songwriter, just returned from a major folk festival: “Having just witnessed many outstanding singer/songwriters, I truly believe that you can’t separate the performance from the song.”

It seems to me that the question of the quality of a song compared to how it is performed is similar to the question of the quality of a therapy compared to how it is actually done.

Take Gestalt Therapy. Fritz Perls cleverly selected aspects of psychoanalytic theory and practice, Gestalt psychology, Zen meditation and philosophy, psychodrama, and existential humanism, and amalgamated them into a form of therapy which, when he did it, was often very powerful. People who’d been in other forms of therapy for years suddenly found themselves having insights and making breakthroughs. Perls thought he was creating a new form of therapy which would create a kind of revolution in therapeutic practice, but it hasn’t really caught on.

Why hasn’t it? Perhaps because its practitioners haven’t enjoyed the same success that Perls did. And why not? The answer seems to be that, in addition to the structure or form of Gestalt Therapy--the empty chair, the free-floating and focusing of attention, the role playing, and the view of human nature--there was Perls‘ own personality, his therapeutic skills honed over a lifetime of intensive questing and practice, including his fluency at catching and using patient imagery and transference. There was also the special mileau that evolved around him at Esalen, the growth center in California where he did much of the work which he is most famous for, which facilitated a self-organizing population of patients who were mostly well prepared to work with him.

I like Gestalt Therapy, and continue to find it useful with some patients at some times, but it has not become the presence in the therapeutic marketplace that Perls hoped for. There is the “songwriting” of Gestalt Therapy, and the “performance” of it, and no one “played” it like Perls.

The metaphor of the “song as written” and the “song as performed” applies across forms of psychotherapy. I recently read (and wrote a continuing education test on) “Cognitive Behavior Therapy and Eating Disorders,” by Christopher G. Fairburn, in which Fairburn discusses a form of therapy that he calls ““enhanced cognitive behavior therapy,” or “CBT-E.” Describing the steps of CBT-E, which is expected to resolve eating disorders in most patients within 20 weeks, Fairburn emphasizes that “Engaging the patient is the top priority.” To achieve engagement, he recommends that therapists “Be empathic and engaging in manner; Ask the patient what name he or she would like you to use and state your name; Be professional but not intimidating; Actively involve the patient in the assessment process; Instill hope; Avoid being controlling or paternalistic; Repeatedly...check back that the patient is ‘on board’...(and) “Enquire about any concerns that the patient might have.” Clearly, before even getting to the steps of CBT-E, Fairburn is focusing on therapist “performance” here. It is as if he were saying, “My song will work for you as well as it works for me if you sing it the same way I do.”

Psychologist Jonathan Shedler, giving the keynote address at the recent Division 39 (Psychoanalytic Psychology) conference in Chicago, referred to research indicating that most of the effectiveness of psychotherapy is due to the alliance between patient and therapist. Looking at the work of Perls and Fairburn, we see two therapists who are expert at establishing a relationship in which patients feel hopeful, encouraged and engaged with a person and a method that can help them transcend their emotional suffering and behavioral pitfalls and get on with their lives in a better way. Yet the therapies practiced by Perls and Fairburn could hardly be more different.

If we can’t really separate the “song” from the “performance,” the form of a therapy from how each therapist practices it, then every therapist is, in a way, co-creating, or at least modifying, the form of therapy, every time she or he does it, with every patient.

How about that!

Truth and Turf in the Psychotherapy Wars: Two Hands Clapping?

(This essay was originally published in the Winter, 2010, CAPPSTONE, the newsletter of the Chicago Assn. for Psychoanalytic Pychology, and subsequently in the Winter, 2010, PSYCHOLOGIST-PSYCHOANALYST, the newsletter of Division 39 of the American Psychological Assn., Psychoanalytic Psychology. Shedler's article was subsequently published in AMERICAN PSYCHOLOGIST)


The history of psychotherapy is, in part, the story of a long struggle among people and schools between searching for truth and staking out turf. Of course, that’s true of a lot of professions, but it might be more intense in psychotherapy, where the issues are about who owns the rights to understanding human nature and its treatment.

Jonathan Shedler, a psychologist at the University of Colorado-Denver, has written a monograph that advances accurate description of psychodynamic psychotherapy. “That Was Then, This is Now, Psychoanalytic Psychotherapy for the Rest of Us,” describes it in commonsense, non-jargon language that will be accessible to most readers. (http://www.psychsystems.net/shedler.html). Shedler avoids the morass of claiming turf, in the name of theory pronounced as received wisdom, that is so characteristic in the history of psychoanalysis. The psychodynamic method, practiced well, is more important and more powerful than the ability of any theory to explain it. Psychodynamic psychotherapy is better explained as a method, with the minimum of theorizing, and better understood, as much as possible, through models of neuroactivity, as Allan Schore is developing. This brings us closer to the truth about psychotherapy.

A new attack in the therapeutic turf wars was launched from Psychological Science in the Public Interest, the journal of the Association for Psychological Science, in the form of an article by Timothy Baker, Richard McFall, and Varda Shoham (from the University of Wisconsin-Madison, Indiana University, and University of Arizona, respectively), entitled, “Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care.” ( http://www.psychologicalscience.org/journals/index.cfm?journal=pspi&content=pspi/9_2 ) This is the article which, reported as truth in Newsweek, prompted so much discussion; including a flurry of comments on the Illinois Psychological Association listserve, and a rebuttal by Katherine Nordal, APA’s director for professional practice, as quoted in the November/December The National Psychologist (“Psychology gets slap in the face”). Its authors, implicitly defining randomized clinical trials (RCT) as science in psychology, explicitly define evidenced-based treatments as those which have been validated by RCT studies, and consign all other methods of therapy to the garbage pail of superstition and uninformed personal preference.

There’s a lot at stake here, including how clinical psychologists should be trained, how graduate schools should be accredited, and how third party payers should select treatments to recognize, all of which Baker, McFall and Shoham assert should be reserved for RCT-based programs and methods. The stakes were highlighted when I spoke with a psychologist who is an executive at a managed care company. “It’s all about the evidence,” he said, adding that psychodynamic therapy might enrich people’s lives but lacks evidence of efficacy as a treatment.

Of course, that raises the question of what the evidence is. Shedler, in an article entitled “The Efficacy of Psychodynamic Psychotherapy,” which has been accepted by American Psychologist (a draft is posted on his website), reviews an impressive list of studies showing efficacy for psychodynamic psychotherapy. I don’t know how our managed care executive colleague would react, although I expect that he would find a way to disregard it. Perhaps there’s some selectivity here about what evidence to include.

But the argument about which evidence is real evidence obscures the larger issues. I often tell couples whom I see in therapy that each one is probably the world’s best expert on the other’s shortcomings, and something like that situation applies in the opposition between the radical empiricist and psychodynamic traditions. The radical empiricists are right in characterizing much of what psychoanalytic therapists have believed about human nature and its treatment over the years as utterly without factual support. Much psychoanalytic theory is based on the Authoritative Pronouncement of some alpha analyst or other, a tradition begun by Freud and still rife in psychoanalytic culture. There is nothing scientific about it, and the claim of scientific validity for theoretical pronouncements given without a shred of evidence (even liberally defined) to support them is justly characterized by radical empiricists as ludicrous.

On the other hand, reducing human nature in order to fit it into the scientific method available at the time has ever been the problem of behaviorism’s search for scientific respectability in psychology. While the radical empiricists are right in asserting that merely claiming that what one is doing is scientific doesn’t make it so, this applies to their own position of defining science as equal to RCT as well; that’s a philosophy of science, not science itself. In fact, most of what we know about human nature, and particularly brain structure and function, has come about through autopsy studies of people with brain injuries, by neuropsychological and imaging studies of brain-injured people, by animal studies, and by imaging studies of normal people; not by RCT studies, although of course they have made a contribution. I expect that the most valuable research in therapy in future will be neuroimaging studies, once the technology improves enough to measure changes in volume and interconnectivity of parts of the brain. I expect those studies to show improvements in frontal lobe density (especially right frontal lobe), frontal-limbic interconnection, and interhemispheric connectivity, as a result of longer-term, conversational, reflective, relational therapy, when it is successful.

The truth is that, “Life,” as Chicago therapist and teacher Harold Balikov used to say, “is not user friendly,” and emotional pain and behavioral problems in living are part of being human and living life. DSM diagnosis is not the same as physical diagnosis, and therapy is often more like education--in which there are lots of different schools and methods of teaching, and students may have to find the ones that work best for them--than medical treatment, which at least aims for an expert consensus of recognized best practice for any disorder. Truth in marketing mental health treatment would be something like: ”If you need mental health treatment, you may find that therapy, medication, or a combination, may work best for you, and you may have to learn about the mental health treatment choices available, and search for awhile, before you identify the practitioners and the methods which are right for your needs at this time.” Instead, the marketing that we see takes a bit of truth and spins it into deception: ”If you’re depressed, take our clinically proven pill;” to which the radical empiricists would add, “our clinically proven treatment!”

The truth is that different methods and treatment relationships may work better for different people, or for the same person at different times. Twenty sessions of cognitive-behavioral therapy will work better for some people, five years of analytic therapy for others; or maybe both will work better for the same person, at different times in his or her life.

And the truth is that both psychoanalysis and radical empiricism have their roots in traditions in which the dedicated search for some kinds of truth and the dedicated gathering of turf evolved side-by-side. Both traditions offer keen insights into human nature and its treatment, both obfuscate the truth about it as well; most especially by claiming that their method is better than the other, when in fact it is better for some people at some times when practiced by some practitioners.

If this leads to problems about how to authorize and pay for therapy, how to monitor it’s effectiveness and how to do second opinions, then those are issues that psychotherapy, like any mature profession, must develop effective solutions for.

Meanwhile, I’m reminded of the reflection of the poet and teacher Jalaluddin Rumi, that things that appear to be opposed may really be working together; as when the “opposition” of two hands produces a handclap. Perhaps the opposition of the psychodynamic and radical empiricist traditions will produce an effect that will lead many therapists (and maybe even reporters, if they take the trouble to study up on it) to a more inclusive and commonsense mainstream understanding of what therapy is and how it works. Shedler moves in this direction when he acknowledges the overlap between cognitive-behavioral and psychodynamic therapy while respecting their differences. Maybe, even, the opposition between truth-seeking and turf-gathering, even when done by the same people, can help the rest of us, through observation, to learn to sort out the one from the other; leading to a more inclusive perspective that we can ground our work in, train students in, and communicate to the public. Wouldn’t that be a step forward for psychotherapy!

How Much Therapy is Needed?

An out-of-state Mom, whose son attends a local school, called to discuss the possibility of my working with him, which I appreciated. During our conversation, she identified several issues that he's struggling with, including relationships with a roommate and a girlfriend, and asked how much therapy might be needed to deal with those issues.

My reply was that the length of therapy is not so much about the issues that the person has as about the person having them. On reflection, I'd add, "and the people he's having issues with."

When it comes down to it, just about all therapy is about relationships, whether it takes one session or a thousand. There's an enormous variation in how much time and help people need; including, at the beginning of therapy, what they know and can learn, what they do and can change, and how quickly they can get to work on their perceptions, emotions and behaviors in order to make things better. And who the roommate and girlfriend are, in this case, could be as important as who the client is.

Which Divorce "Camp" Are You In?

“Becky” asks:

I am in the process of getting divorced, and I respect your opinion, experience and level head, so am hoping you will tackle a question I have. My husband decided to leave me, which apparently he’d been thinking about for a long time but not sharing with anyone, and it came as quite a shock. I have been reading copious amounts of studies, and opinions, on divorced families. Summarized briefly there seems to be an "If the parents are okay the kids will be okay" camp, and an "it doesn't matter what the parent's marriage was like (except in cases of violence), kids do better with their parents together" camp. Of course there are variations on this theme and a number of 'camps' in the middle. Do you have an opinion about this?

One aspect I am trying to work through is how to keep my kids’ lives as 'normal' as possible, especially my 14 year old son, who is beginning to show signs of 'feeling left,’ which of course I feel as well. He seems to “feel left” even by me, though I am here, because of course I am not 'here' the same way I was before. I guess I am looking for a validation of "if we are fine the kids will be fine", but I don't really believe it. What do you think? And what is your hourly rate for phone session, btw?

Dr. Einhorn replies:

Hi Becky,

Thanks for your compliments, and I hope my reply lives up to them!

Every situation and every person is different, so I'm not so sure that there is a rule of thumb about divorce.  Kids will tend to take their cues from their parents, but each child might be sensitive to different cues, and there's also the impact on each child's relationship with her or his parents, which can vary from child to child within the same family.  So I guess I'm not camping in any "camp."  I'm all about the particular people in their particular situations.  In your son's case, what matters is what happened to this child within this family.  

Keeping things “normal” is good, but the very definition of what’s normal is changing in your family. It used to be normal for the family to live together, now the parents live separately, and perhaps have relationships with other people who are now coming into their children’s lives. Even the definition of what used to be normal is changing, because it now has become obvious that one parent had private thoughts and feelings that culminated in a separation and divorce for quite some time.  

So, for those who “got left,” reinterpreting where you were may be part of being able to move ahead from where you are.  

It makes sense to suppose that, in at least some respects, your son probably did "get left," and in a somewhat different way by each parent; Dad left with little or no warning, and Mom was probably freaking out--however quietly and self-containedly and trying to keep the children protected. So if your son didn't feel “left” he'd be pretty oblivious, wouldn’t he?  

What he does with that feeling is another thing.  Of course, I'm a fan of therapy, because I think talking about stuff like that with someone who can listen and help us think it through is a very good thing for our brains and our lives.  Some kids are open to the idea, some not. Have you raised the possibility with him?     

Contact me privately for rates for telephone consults. Be aware that such consults are not diagnosis or psychotherapy and can’t be submitted for insurance reimbursement.

Best wishes to you and your family,
Dr. Einhorn