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The Talking CureReview - The Talking Cure
The Science Behind Psychotherapy
by Susan C. Vaughan, MD
Henry Holt, 1997
Review by CP
Apr 25th 1999 (Volume 3, Issue 17)

The Talking Cure is a light book. With less than 200 pages, a low density of words on the page, and a very skimpy bibliography, Vaughan waves at many theories without weighing the reader down with too many difficult details. The main idea is that talk therapy can affect the chemistry and "wiring" of the brain. Vaughan, like so many authors of popular psychology, seems to feel that the way to make this digestible for the reader is to sugarcoat the bitter pill of science with stories and vignettes about her patients. When done well, by Oliver Sacks, for example, this can lead to a sublime integration of scientific theory and personal detail. But in the hands of Vaughan it is a crude device that leads to an awkward juxtaposition of styles. Each chapter starts off with a description of a dream (the royal road to the unconscious for Freud). After a few details about the patient, Vaughan launches off into some tangentially relevant scientific research, and then returns at the end of the chapter to her patient, wrapping up with a little self-congratulation about how insightful she is.

To be honest, I suspect the reason I am being snippy about her style is that I don’t like the assumptions behind this book. Of course, at one level, there can be nothing wrong with explaining some recent scientific research in psychology and neurophysiology, and then speculating how this may be linked to what goes on in psychotherapy. The chapters are set out in a logical order, and there is a semblance of progression in the ideas explained through each of the eight chapters. But Vaughan never really comes clean about how immensely speculative her musings are: the subtitle of the book, "The Science Behind Psychotherapy," is misleading. More accurate would be, "Some scientific psychology possibly associated with psychotherapy."

Vaughan herself is one of an increasingly rare breed of psychotherapist: a psychoanalyst. She says very little about psychoanalytic theory, although that she does say that she sees many of her clients four or five times per week. (I don’t know of any HMO plans which cover that amount of psychotherapy any more!) But she is not a traditional psychoanalyst. Indeed, many of her beliefs would have been heresy in the Church of Freud only a few years ago. For instance, she is quite comfortable in prescribing psychotropic medication to her patients when she believes it necessary.

Of course, Freud himself was very interested in neurophysiology and early on in his work he foresaw a time when our understanding of talk therapy would be in terms of what goes on in the brain. Today, no one with an interest in clinical psychology can afford to ignore the information that is coming out of brain science. What is objectionable about The Talking Cure is that Vaughan assumes that really the only way to validate talk therapy is by looking to brain science.

Anyone who has thought about the mind/body relationship in any depth realizes that changes in the mind must be paralleled by changes in the brain. Science may eventually tell us what exactly those changes are, but we don’t need new research to tell us that there must be something happening in the brain when we have an experience or interact with each other. For the most part, psychotherapists have to do their job in complete ignorance of what is going on at the chemical level. But is this a problem for them? No. While psychotherapy can very occasionally make use of some of the new information from brain science, basically it operates in a different realm from neurophysiology. Therapeutic technique, interpreting dreams, and finding out how best to help others are skills that are learned in a one-on-one interaction. So far no single systematic theory has managed to capture all the insights that good therapists learn and pass on to trainees. Freud himself abandoned his immediate goal of reducing psychology to brain chemistry, and instead brought together a bewildering variety of approaches to his work in one of the great interdisciplinary projects of this century. (For one of the best discussions of this, see Patricia Kitcher’s excellent book Freud's Dream: A Complete Interdisciplinary Science of Mind.)

The Talking Cure provides a competent and interesting summary of some recent scientific psychology, and it could be useful to someone looking for a simple explanation of difficult ideas. But the real science behind psychotherapy is the study of what makes a good therapist, and Vaughan never even mentions that kind of investigation. So her book misses what is important and interesting about the scientific evaluation and explanation of psychotherapy.


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