Are there things that clients need to say in therapy, but are not-yet-said? Peter Rober launched a generative discussion on this topic by asking us why some things are said and other things that might need to be said are not.  He wanted to know if there is anything we can do to facilitate people saying what needs to be said?  The discussion went off along several different lines of thought.

One line of discussion said, "yes", there are things that are not-yet-said, and suggested we could get to the not-yet-said by looking at the physical aspects of what was happening. Katherine Levine, for example, suggested the physical as one of the relevant dimensions.  Tony Michael Roberts seemed to agree.  He suggested we consider the physical reality of state-dependent learning.  That is, perhaps the not-yet-said hasn't found expression because people were in different states at the time they learned something than they are when they try to remember it.  You might get the not-yet-said, therefore, by helping them recall a previous state of mind.

Another line of discussion was developed by Judy Weintraub, Craig Smith and myself (Tom Strong). We thought about the "not-yet-said" within the Collaborative Language Systems model rather than within a more traditional and modernist model.  In fact, Weintraub suggested that the modernist "knowing approach" may actually make it more difficult to have the kind of conversation in which people can say what is not-yet-said. I added that if we think of therapy as a form of modernist catharsis, then we will think of ourselves as having not-yet-said emotional deposits awaiting expression.  Bringing us back to a more Collaborative Language Systems model, Craig Smith suggested we turn to what is  actually happening in the dialogue, rather than focus on speculation about what may exist in an unsaid form. 

A third line of discussion had to do with where people can say the things that are not-yet-said.   Peter Rober told us, "when something is not-yet-said, that's because there's been no conversation in which it makes sense to say it.   Things are not said when the conversational context doesn't invite them to be said." That makes a kind of sense.  People can say things in some contexts that they cannot say in others.  Reflecting on Peter's observation, I responded by suggesting that there were many possible explanations for the not-yet-said.  Therapy, in my judgment, often plays a surrogate role for those conversations.  That is, sometimes we can say things in one context but not in another. (Perhaps therapy is a kind of rehearsal for what is not not-yet-said in other contexts?)   I notice, now, how this ties back to Tony Roberts point in the first line of discussion,   that what is said in one context might not be remembered in another.  The not-yet-said may be best thought of as what is not-yet-said in a particular context.

Then, jolting us out of our self-focus on the not-yet-said, Gonzalo Bacigalupe threw us a bomb of a politically big-picture by reminding us that while we are here talking about these subtle matters many people in the world are "not even close to listening to us."  He was referring to people who could not afford therapy conversations or computers or who lived in cultures without these tools for conversation.  This reminded me of a comment by a friend the other night that eighty percent of the word's population is still unable to use a telephone.

So, what do we do?  Both Nick Drury and Lynn Hoffman suggested that perhaps we would do well to shift our focus on the not-yet-said to a focus on generous listening so that we can create a paralogical community in which new things to be said can emerge from our discussions.

So, that's where we are.  As with most good conversations, there are more questions than when we began.    However,  I notice that many traditional approaches organized themselves around the task of helping people say what was not-yet-said.  (Think of traditional psychoanalytic approaches. ) To me these approaches are knowing and modernist.  Still, it is legitimate to ask if there is anything about these approaches that is still useful?  And so I ask you: Is there any way to translate these old concerns to postmodern therapies?  If so, is one of the ways suggested here appropriate?  Or is it something that is not-yet-said?
 
 

Can therapists decide what therapy to give depending on the DSM diagnosis people receive? 

In PMTH there seems to be remarkable consensus that this would be a terrible idea.  First, we seem to agree that DSM disorders are far less valid than the institutions imply.  Second, we also agree that there is no evidence to suggest which therapies should go with which disorders.  So, we pretty much agree that requiring therapists to perform specific therapies for specific patients would be not only silly, but something close to disaster.

Our conversation about this matter started a couple of weeks ago when I ran across a provocative observation by the US Secretary of Health and Human Services, Donna Shalala .  Talking about psychiatry's diagnostic manual, the DSM IV, Shalala said 
 

How can that be?  I remember in my graduate school days (when we were working out of a DSM II rather than a DSM IV), we used a flimsy little spiral bound document with no real attempt at precision, at least by today's standards.  But since DSM III at least, the attempt has been to weave these vague cobweb-like concepts into precisely defined objects fit for rigorous scientific research. 

But, please, complexity and lengthiness of the definition does not imply adequacy.  Just as a long and wordy document isn't necessarily any better than a brief one, so the DSM isn't necessarily getting better through the years just because it is getting longer. 

My friends here in PMTH tend to agree.  Lynn Hoffman seemed to sum it all up with her statement, 
 
 

Argh!  I agree!  And it's so terrible!  Why are the helping professions trapped in this kind of thinking?

Don't let us tell you what to think, but please do keep an open mind.  Just a few minutes ago, Lois Holzman posted a list of relevant books and articles.  I then invited others to join.  We really do need to put a long list of these books and articles in a specific place so that those of you reading this newsletter have something solid to look at.  But there are many, many books and articles questioning the traditional diagnostic category -- but, neverthless, the practice of putting people in these pigeon holes just continues on and on.

Until we get this list together let me suggest you look at two of Tom Strong's articles on this topic, 
 
 

But back to the initial problem.  The rumor has it that the American Psychiatric Association is trying to tie specific therapies to specific diagnostic disorders.  Lots of people here have either heard this independently or actually looked at texts that testify that it is so. Riet Samuels said she had heard this, as did Katherine Levine, David Haddad, and Leonard Bohanan.  I guess I have had my head in the sand.

Just imagine it!  There is no research suggesting that any therapy works any better with any diagnosed illness, and there is no research indicating that we can diagnose mental illness with any precise agreement.

What is the world coming to?

I know there are counterarguments to this apparent PMTH consensus, and I feel compelled to tell you about them.  That is part of what PMTH is about, recognizing the counterargument.  But what is it?

Well, a guest at my house last week put it like this:  It feels good to her to have a diagnostic label for her problems. 

Okay.  I grant many readers may feel the same way.  In fact, how could we sell people on their disorders if it didn't feel a little good to have a diagnosis?  Without diagnoses, the counter argument goes,  we would just go back to blaming people for their depressions and anxieties.  Good point.  It might be true.

But, even if that's so, surely someone needs to remember that the research and the manuals on diagnosis are based on a house of cards.  We don't have the research, folks, for establishing the validity of the diagnoses much less decent research on the appropriateness of treatment for the different diagnoses. 

And, doesn't that count for something?
 
 

Frankly, sitting here in California, I had never heard of the Wizard of New Zealand until PMTHer, Nick Drury, began to talk about him.  But according to Drury, he is wellknown in Kiwi land (that is, New Zealand) where he presents a dramatic presence that serves, apparently, to satirize war, that is to make fun of it.

I wonder, can someone like the Wizard actually diminish the likelihood that the rest of us will engage in lethal war?  Maiming and killing each other? 

At any rate, I invited Drury to contribute his account of the wizard to the PMTH site.  Link here if you want to study the wizard and his tactics  a bit more.
 

Do you ever read PMTH NEWS and wonder what the conversationalists here would have to say about your response to our conversation?  Well, no guarantees, but if you click here and send me your point, or your question,  I will forward it to PMTH and someone might send you an answer.
 
 
 
 
 
 
 

The author of today's quote is Donald Spence.  Spence is a mover/shaker in the psychoanalytic world.  This quote is from his book, The Freudian Metaphor, a book that tirelessly deconstructs the reified psychoanalytic notion of an unconscious and challenges the whole tradition of the analyst as a psychological Sherlock Holmes. 

Still, I think I notice that he sometimes speaks as though the right metaphors will come if we are sufficiently patient.  Can you see that in his writng below?  To my ear, in the beginning of this quote he implies that when the right metaphor comes reification will be okay.  Yet the last sentence seems to change the story.  See if you see what I do:
 

Passages like this convince me that in spite of himself Spence is still looking for the right metaphor, the one that we can reify.  But I'm not sure. 

At any, I (Lois Shawver) am more inclined to think that what we need is a continuous looseness with our metaphors.  Metaphors are never correct in a final sense, although some may work better for some purposes than others.

At least, that's how I think.  What do you think?  Do you think there is such a thing as a metaphor that is so good that we can adopt it and never turn to others? Before you dismiss the possibility and agree with me too quickly, reflect back on the article today by Tom Strong, summarizing the PMTH discussion on the not-yet-said.  Isn't the not-yet-said another metaphor?  It seems to me it is.  The not-yet-said doesn't exist in time and space.  Or does it?  And if it is just metaphor, is it good enough to reify and pretend that it exists in time and space? 
 

Is a political ideology a meta-narrative? Should we expect post-moderns to be as incredulous of the grand narratives of the "left" and the "right" as they are of other big, broad stories which claim to explain everything? Is there a politics uniquely associated with post-modern thinking? And how can you have an incredulous politics?

    According to Stanley Fish, the answer is either "yes" or "no" depending on how you look at it. The answer is "no" in that the postmodern turn will leave everyone's bread buttered about where it was before. There is no reason to believe that simply going post-modern would alter any vested interest or personal preference which had determined a given citizen's political choices before going post-modern. 

    Learning incredulity toward the grand narratives of politics will not change what a person wants and what a person stands to lose. A unanimous turn to post-modern thinking would leave each player in the political game wanting the same things he or she had always wanted and feeling the need to protect the same personal turf of privilege as before. Learning incredulity to the grand narrative of "Free Enterprise" would still leave Steve Forbes, for example, with the same set of preferences rooted in the same position of economic privilege. A post-modern Steve Forbes would seek rewards from his involvement in politics which differ not at all from the goals we see Forbes seeking today. 

    But, if the whole political world had turned post-modern right along with Forbes, he, along with every other player in the newly post-modernized political game, would need to learn new ways to pursue those goals. The persuasive power of a big part of what passes for political rhetoric today, arguments for the superiority of one particular political grand narrative over all others, would be lost by a general turn to incredulity. This change is the "yes" involved in saying that the answer to the question of how post-modern politics will be different from what we are used to is both "yes" and "no". Yes in the sense that a turn to incredulity would end the war of political grand narratives (Marxism Vs Free Enterprise, etc.) which characterized the modern era. No in the sense that the interests and preferences which marched under those flags will still be the driving motive forces behind politics even after we are all post-modern. 

    This is all offered as background to our on-going discussion of the Reform Party. Jerry Shaffer has asked any number of excellent questions about the Reform Party. All of them derived from his own inability to see how "a community of those with nothing in common" (in terms of core political issues) can possibly function as a political party. Lois Holzman, George Spears, Judy Weintraub and myself (Tony Roberts)  among others tried to answer Jerry's concern by explaining the motives behind our involvement in or support for the Reform Party. 

    Jerry's specific question was how those of us who are either liberal or libertarian in our own views could support an arch- conservative like Pat Buchanan. Several of those who responded did so out of a long and committed association with the reform party. A common thread uniting their responses was a questioning of the idea that politics is exclusively about outcomes. 

    Lois Holzman was kind enough to post articles by herself and by Fred Newman eloquently putting forth the idea that political action is a developmental process with a value per se over and above the outcome achieved. Post-modern politics could only mean a form of political action not regulated by any grand narrative describing either a broad status quo to be either challenged or maintained or the vision of a future to be achieved. The process oriented developmental politics being practiced by Newman, Holzman and their allies is arguably the first politics of this description to be put into practice on a significant scale in this country. This makes the reform party an important experiment testing what political action can mean under conditions of post-modernity regardless of the outcomes finally achieved. 

That's that way I and lots of other PMTHers think, but it is understandable that Shafer and other postmoderns would find it disconcerting to hear any acceptance of Buchanan as a candidate.  Buchanan has said some pretty alarming things in his career --  however, postmodern incredulity sometimes means we can join with those who believe things we do not believe in order to make space for more opinions.
 

Now, that I have joined the New Therapist list of contributing editors, along with PMTHer Tom Strong, I am especially keen on interesting you in the fledgling magazine -- this is especially so since the March issue is slated to include an interview of me complete with a photograph of me squinting into the California sun.  This should be the next issue.  Being a little less egocentric, let me add that same issue should include a review of the book, Performing Psychology.  This is  Lois Holzman's new edited collection discussing the controversial "social therapy" approach of Fred Newman.

Yesterday the latest issue of the New Therapist arrived in my mailbox and I wish you had a copy, too.  To get your copy every other month, as I do, send a credit card number to: 
 

But, for now, I'll give you a glimpse into the magazine through my eyes.  On the front, there is a bigger than life picture of a woman's face with a tear running down her cheek.  In the lower right corner, in red, is the phrase "Facing Trauma".  Then, browsing through to page 10 I  see a group of book reviews, and the first one is by Tom Strong.  You know Strong.  He writes for PMTH NEWS, and you can see his articles in today's edition.  Or do a search on his name in the search box of PMTH NEWS up in the upper left.  You'll see how much this author gets around.  Well, here he is again in the New Therapist where he reviews Jack Martin and Jeff Sugarman's new book, The Psychology of Human Possibility and Constraint.  In this review, he tells us that Martin and Sugarman build on the notion that "our ways of talking...have something to do with creating what is possible and constraining for us."  That means, so Strong points out, that this book is highly relevant to the practice of therapy.  (There are other reviews in this issue of New Therapist, too, one on a new Milton Erickson book and another on a new book on therapist burnout.) 

There is also an account of people who put together family histories, reconstructing these histories from the accounts of existing relatives and putting them in bound volumes.  Wouldn't that be interesting?  To have someone interview you and put together a book on your family story?  An interesting way to make a living, too, it seems to me. 

And there's an article, which I quite liked on some of the ways that psychological assessments in schools can be damaging.  We psychologists try to be helpful and if we are to achieve that status, it is incumbent on us to notice ways in which our work can also be damaging. 

Ah, and here's the article on psychological treatment of trauma victims.That's explains the cover and the tear running down the woman's cheek.

If you are interested in the things we talk about in PMTH, you'll probably be interested in this new South African magazine.  It is edited by John Soderland, and he is reachable by clicking here.