yep, one does. I'm not a therapist (though a psychologist) and conventional wisdom in the field is that "flooding" is less effective than "systematic desensitization". Actually, not even that is done anymore, since it was a purely behavioural program and these days you add some cognitive therapy to the mix because -frankly- most people with anxiety disorders need it.
In summary, Barlow's method is certainly suitable for some people, though I'd guess fewer than half. Hence, research is needed to figure out the details.
Ah, ambiguity in the post: I just meant that the woman who "tried it at home" didn't require comment, not that the method was obviously right. Sorry about that.
If you say that you think it's suitable for about half of anxious people, do you accept the article's proposal that there's quite a bit of self-selection going on to account for his 85% success rate, or would you venture some other explanation?
first, IIRC, that 85% was his claim, so it might be inflated. Not necessarily though, since anxiety disorders are one of the few things where we know what to do and that it works, and so I'd expect healing rates for conventional methods to be at least in the same range.
Besides, you can easily have two programs with 85% success and both being suitable for 50 percent of people. There's no contradiction here, though you might increase success-rates for both programs if you improved your selection process. The optimal end-point being a whole host of treatments, and each patient being assigned to the one most suitable to him. In the real world the therapist is usually expected to provide that varying, individually tailored program.
Which brings me to the possibility that Barlow is just a damn good therapist. The ability to get in touch with, motivate and convince people is important, and some therapists have more of it than others (which is why you shouldn't see one who fails to give that to you). Besides, his motivation and conviction of his method certainly spill over to his patients (call it a Rosenthal/expectancy effect if you want) and your average therapist without a personal stake in the method will certainly be less effective (not much though, it's hard to fuck up basic behavioural therapy, unlike psychoanalysis).
More importantly IMO is that "self -selection" is an awfully broad term. It encompasses motivation, severity of disorder, personality of the patient (for instance talkative pseudo-philosophers (or bloggers) stand to gain more from psychoanalysis (which is otherwise crap) than down-to-earth straight-shooters) a host of situational and circumstantial factors and so on. And each of these may interact with a different aspect of the therapy. For instance, IIRC Barlow's therapy is done in groups and in weekend seminars, which makes it less suitable for generally insecure people or those who are well adapted to their disorder. For the latter group, the disorder almost certainly carries secondary benefits, like compassion and sympathy from others, the ability to avoid unpleasant experiences and so on. Pushing these people through a quick program may have adverse side-effects, possibly even pushing them towards a new disorder.
Those points make sense to me. (I will just note that I disagree with the tangential points that psychoanalysis is crap and that the talkative stand to gain more...but we don't need to get into that.)
I appreciate your point about the multifariousness of "self-selection." Teasing out the various factors and their interplay seems like just the kind of thing that makes good research.
to clarify, classical Freudian psychoanalysis is crap. Going through every detail of your past for over two years is helpful only to a tiny, tiny minority who (a) have no specific problem but are just generally a bit "fucked up" and (b) have the stomach for the intense navel-gazing required.*
The common type of problem centred (as opposed to the person centred first approach) psychoanalysis OTOH makes a good deal of sense and works well. Then again, this IMO is no longer proper psychoanalysis, especially since AFAIK cognitive and behavioural techniques are used here as well. (Which OTOH makes the approach far superior to a pure variant of either behavioural or cognitive therapy.)
Bottom line is, your parents/past/unconscious are not always relevant but should be considered. Trivially true, I know.
*A friend of mine, who is into the second approach and sympathetic to the former estimates that the former approach makes up about 2% of cases, the latter around 30-40%.
yep, one does. I'm not a therapist (though a psychologist) and conventional wisdom in the field is that "flooding" is less effective than "systematic desensitization". Actually, not even that is done anymore, since it was a purely behavioural program and these days you add some cognitive therapy to the mix because -frankly- most people with anxiety disorders need it.
In summary, Barlow's method is certainly suitable for some people, though I'd guess fewer than half. Hence, research is needed to figure out the details.
Posted by markus | Link to this comment | 10-31-03 7:49 PM
Ah, ambiguity in the post: I just meant that the woman who "tried it at home" didn't require comment, not that the method was obviously right. Sorry about that.
If you say that you think it's suitable for about half of anxious people, do you accept the article's proposal that there's quite a bit of self-selection going on to account for his 85% success rate, or would you venture some other explanation?
Posted by ogged | Link to this comment | 10-31-03 8:50 PM
first, IIRC, that 85% was his claim, so it might be inflated. Not necessarily though, since anxiety disorders are one of the few things where we know what to do and that it works, and so I'd expect healing rates for conventional methods to be at least in the same range.
Besides, you can easily have two programs with 85% success and both being suitable for 50 percent of people. There's no contradiction here, though you might increase success-rates for both programs if you improved your selection process. The optimal end-point being a whole host of treatments, and each patient being assigned to the one most suitable to him. In the real world the therapist is usually expected to provide that varying, individually tailored program.
Which brings me to the possibility that Barlow is just a damn good therapist. The ability to get in touch with, motivate and convince people is important, and some therapists have more of it than others (which is why you shouldn't see one who fails to give that to you). Besides, his motivation and conviction of his method certainly spill over to his patients (call it a Rosenthal/expectancy effect if you want) and your average therapist without a personal stake in the method will certainly be less effective (not much though, it's hard to fuck up basic behavioural therapy, unlike psychoanalysis).
More importantly IMO is that "self -selection" is an awfully broad term. It encompasses motivation, severity of disorder, personality of the patient (for instance talkative pseudo-philosophers (or bloggers) stand to gain more from psychoanalysis (which is otherwise crap) than down-to-earth straight-shooters) a host of situational and circumstantial factors and so on. And each of these may interact with a different aspect of the therapy. For instance, IIRC Barlow's therapy is done in groups and in weekend seminars, which makes it less suitable for generally insecure people or those who are well adapted to their disorder. For the latter group, the disorder almost certainly carries secondary benefits, like compassion and sympathy from others, the ability to avoid unpleasant experiences and so on. Pushing these people through a quick program may have adverse side-effects, possibly even pushing them towards a new disorder.
Posted by markus | Link to this comment | 11- 1-03 8:07 AM
Those points make sense to me. (I will just note that I disagree with the tangential points that psychoanalysis is crap and that the talkative stand to gain more...but we don't need to get into that.)
I appreciate your point about the multifariousness of "self-selection." Teasing out the various factors and their interplay seems like just the kind of thing that makes good research.
Posted by ogged | Link to this comment | 11- 1-03 8:56 AM
to clarify, classical Freudian psychoanalysis is crap. Going through every detail of your past for over two years is helpful only to a tiny, tiny minority who (a) have no specific problem but are just generally a bit "fucked up" and (b) have the stomach for the intense navel-gazing required.*
The common type of problem centred (as opposed to the person centred first approach) psychoanalysis OTOH makes a good deal of sense and works well. Then again, this IMO is no longer proper psychoanalysis, especially since AFAIK cognitive and behavioural techniques are used here as well. (Which OTOH makes the approach far superior to a pure variant of either behavioural or cognitive therapy.)
Bottom line is, your parents/past/unconscious are not always relevant but should be considered. Trivially true, I know.
*A friend of mine, who is into the second approach and sympathetic to the former estimates that the former approach makes up about 2% of cases, the latter around 30-40%.
Posted by markus | Link to this comment | 11- 1-03 9:28 AM