Reflections on “Reviving Plain Old Therapy” – a recent article featured in Psychiatric News

Today, psychotherapy researchers are hard pressed to demonstrate differences in effectiveness among various therapy brands.

“We are blessed with a spate of evidence-based therapies for specific psychiatric disorders and cursed with all their acronyms—CBT, DBT, TFP, ERP…to name a few,” says Jon G. Allen, Ph.D., senior staff psychologist at the Menninger Clinic and professor of psychiatry at the Baylor College of Medicine.

In a recent article written by Dr. Allen that appeared in Psychiatric News, titled, “Reviving Plain Old Therapy,” he proposes the idea of reviewing, “Plain Old Therapy” in protest of these ever-proliferating brands of psychotherapy.

He points out that 50 years ago noted psychiatrist Jerome Frank claimed therapies were more effective by virtue of what they had in common than their differences, the common factor being the therapeutic relationship.

Dr. Allen says the essence of that therapeutic relationship is promoting mentalizing (cultivating an awareness of mental states such as thoughts and feelings in ourselves and others) in the context of secure attachment, something he calls, “Plain Old Therapy.” Since mentalizing is intrinsic to psychotherapy, specialists must be competent practitioners of Plain Old Therapy with specific methodologies superimposed upon it.

As a practicing Child Psychiatrist for over 30 years now, I am in complete agreement with Dr. Allen.

At a time when clinicians are trained and encouraged to rigidly adhere to, “evidence-based specific treatments,” based on a fragmented conceptual, behaviorally specific diagnostic system that may have little resemblance to the complicated individual and family one is attempting to provide treatment for, “Plain Old Therapy” actually is the most novel approach I have heard in the past 15 years!

I was trained first as a Physician, then as a Surgeon and finally as a Child Psychiatrist. We did not use the word “mentalization” but the approach was very similar.

We were trained to treat the whole person, not simply the lab results, nor the psychological tests and certainly not to absolutely adhere to a limited categorical diagnostic system or to rigidly apply evidenced-based branded therapies.

We were asked to use ALL our professional skills and knowledge to help individuals and their families move successfully forward in a customized therapeutic approach that appropriately addressed each set of complexities presented by the individual and their family.

In an attempt to survive the challenges from the current financial and political atmosphere (and also because of our present limiting and fragmented conceptual models and training), many one-sided branded methodologies are, in my opinion, too fully embraced by institutions and clinicians.

These approaches may enhance financial stability for an institution and provide greater validity to coincide with statistically evidence-based treatment brands, but it certainly further limits many clinicians in their awareness and ability to utilize various treatment approaches that can address the complexity of individuals and their families.

For me, and for Dr. Allen it seems, the key to that healing element is the therapeutic relationship itself.

William Osler, a 19th century physician, once said:

“THE PRACTICE OF MEDICINE IS AN ART, NOT A TRADE; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

Dr. Allen points out that differences among therapists can outweigh differences in therapies, from which one may imply that the complexity of the individual therapist as a whole human being with a broad array of theoretical approaches and treatments is an essential element within the healing process. The process is more complex that simply following a procedural outline or workbook.

I believe the essence of the “therapeutic relationship” is the ability of the therapist to resonate with the heart of the individual and find a healing path created by the balance of heart and mind of both the therapist and individual. Heart, alone, is not enough, but “pure” detached mind is also insufficient. It is the balance that yields optimum therapeutic outcomes.

Kudos to Dr. Allen for having the courage to speak out and to Walt Menninger and family and the Menninger Clinic for maintaining a tradition of having an innovative, comprehensive treatment system delivered with integrity and commitment to the individual and family in this difficult and changing political and economic climate.

Here at the Optimum Performance Institute, we treat the WHOLE PERSON, not just the diagnosis, and we stay focused on providing individualized care, compassion and support for an environment that encourages balance, growth, opportunity and independence.

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