“There are, as we all know, no universal elephants, only individual elephants. But if a generality, a constant plurality, of elephants did not exist, a single individual elephant would be exceedingly improbable.” C.G. Jung
When I was working on my dissertation, I read quite a bit about the origins of psychiatry and the concepts of mind and madness in ancient Greece. Recently Daniel Carlat has been proposing that there be a kind of merger of clinical psychology and psychiatry which would lead to a return of psychotherapy to the practice of psychiatry. As I was cleaning out some files today, I ran across an interesting idea from Bennett Simon. In this passage, where he writes of psychiatry, I substitute psychotherapy.
"According to my definition, a [psychotherapist] is surprising even among that group who have graduated from [psychotherapy] training and are spending their time treating patients. This rarity reflects a situation quite different from that which obtains, for example, for graduates of violin training, of whom one might say Jascha Heifetzes are rare. Most of the people who claim to be fiddlers are at least playing the same instrument, even if not so well as Heifetz. It seems to me that for those who claim to be [psychotherapists], not only are they not all playing the same instrument, but some are playing instruments others disapprove of or disbelieve, or even in some cases, instruments whose very existence is unknown to others in the group." ( Bennett Simon, Mind and Madness in Ancient Greece).
It is a mistake to assume that psychotherapists are of a single mind, even within a given professional group. Not all of us play the same notes -- some focus on symptoms, others on goals, still others on childhood issues, and others on what we call depth psychological issues. That is part of the problem when we try to look at or research psychotherapy. As Bennett further says, therapists "could never form a symphony orchestra" (who could agree on the conductor?), but there is not complete cacophony. We do have a few themes in common.
My son recently completed his program in social work and will start his first job as a clinician later in the summer. He will be seeing patients who will likely be seen for 6-8 sessions, because that is the model the clinic employing him uses due to limitations imposed by insurance carriers and Medicaid. I understand that for some problems and some people, that approach works. But is it therapy or mental health first aid? Impassioned arguments can be found for both sides. And if the merger of disciplines that Carlat proposes occurred, what variety of therapy would be taught? And what of other professionals who provide therapy, like social workers, where would they fit?