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Lots of thoughts bubbling around in my head from Monday's session. Looking forward to continuing discussion of pharmacotherapy, but glad we had the juxtaposition we had on Monday.

It would, it seems to me, be a huge step forward to get wide-spread agreement that "nobody should be allowed to just dispense drugs in order to solve mental problems." The point here is partly a simple clinical one, easily made within the "medical model" framework, and relates to observations summarized in several of the background quotes Sophie and Ryan offered us. The response to psychoactive agents is so variable from individual to individual and so context dependent that it seems to me irresponsible on the face of it for doctors to be prescribing such drugs without frequent and active monitoring of their effects in individual cases.

But there is a deeper issue here, one to which the highly variable responses to psychoactive agents is also relevant. My guess is that yes, the "story teller" is involved in "depression, bipolar, etc.", indeed in all "mental illness," that the variablity of drug response reflects this, and hence that some form of "talk therapy," some engagement with the story telling process itself, is an essential component of all good mental health work.

I'm less comfortable with the idea of a "faulty story teller that is far from reality and leads to bad thoughts." Stories are ways to summarize observations, not to describe "reality." And are "real" to people who have them, not "correctable" by appeals to "reality." What makes more sense to me is to presume that what is at issue is not a "faulty" story teller nor "bad" thoughts but rather an interaction between the unconscious and the story teller that is getting in the way of the ongoing critique and revision of stories ("unresolveable ("destructive," "unconstructive?") conflict"). The goal of mental health treatment, pharmacological and otherwise, should be to enhance story telling and revising ability (using whatever thoughts are present and result).

Maybe this perspective can be useful in thinking about various forms of therapy, drugs and others? Severe pain/discomfort, among other things, can get in the way of story tellling, and so should be alleviated as quickly as possible. This, though, should always be regarded as an interim symptomatic treatment, not as a goal in its own right. And such treatment should never be used to try and eliminate the underlying conflict without knowing exactly what that conflict is and being sure its elimination has greater benefits than costs. Pharmacotherapy is not only unpredictable but "at best a very coarse tool" for the critical issues beyond symptomatic alleviation, and will always be.

And that, of course, brings us to "talk therapy", of various kinds. Yes, there are issues here of "legitimate use of community resources," but those arise in connection with other health matters too (chronic treatment for diabetes, vision problems, etc) and so don't seem to me to get to the heart of a reluctance to embrace one or another forum of talk therapy, either institutionally or individually.

Perhaps closer is the notion that talk therapy "can and should be found among friends and family." And perhaps in a more ideal world it would be. But we live in a world in which the integrity and stability of an individual's story is often of great importance to that person's "friends and family," and so they are perhaps the last people who are willing to encourage an individual to explore alternate stories of themselves, whether they possess the skill to do so or not. To put it differently, interpersonal interactions may sometimes facilitate story telling and story revision, but they may also in some cases inhibit it. A good mental health worker should have not only the skills but the inclination to faciliate story revision. That may sometimes require a certain "professional" distance, a willingness to lay aside one's own stories and allow another person's to story evolve in whatever ways it does. And/or a certain transactional empathy that encourages story revision?

My guess is that a delicate balancing act between inhibiting and enhancing story revision is inherent in all forms of talk therapy. And Sarah's experiential therapy exercise helped me to see that more clearly. I have a lot of experience with individualized talk therapy and a lot of confidence in its potential to facilitate story revision. I'm more skeptical about group therapy, but also have less experience with it. What struck me after the session is that there is some inconsistency between my skepticism about group therapy and my sense from experience that group conversation is valuable in an educational context (like our course), that the spontaneous sharing of diverse stories can be quite productive in encouraging revision of individual ones.

That conflict, as well as several conversations after our session, has made me think more why I have been skeptical about group therapy and about the several paths of interpersonal exchange, with the upshot that my story about group therapy may undergo some changes. I suspect my skepticism about group theory in general, and experiential therapy in particular, has to do with an unconscious understanding that interpersonal interactions in groups, and associated non-verbal exchange, tend to stabilize stories rather than to encourage their revision. And that unconscious understanding must have to do with a different set of observations/experiences than those I've had in the classroom.

I need to, and will, mull this more, but the upshot of this (and some other recent experiences) is to lead me to suspect that group and non-verbal interactions have the potential to play a more positive role in story revision than I have been inclined in the past to think. And to wonder exactly what the circumstances are that would achieve that. My guess is that it depends on a context in which people in the group share a common interest in and commitment to an ongoing process of both individual and group story revision, as well as some significant level of confidence in the ability of both themselves and others to contribute to that process.

Is that achievable in a group context? I suspect so, but it depends (as it does in a more traditional talk therapy context) on an atmosphere of interpersonal trust that all involved have a meaningful role to play in the process. And that all involved will value differences among people as contributions to the process rather than use them as ways to validate one's own existing story by attacking others.

Maybe that's a key to thinking not only about group therapy but also about talk therapy in general? "when put in groups ... I go blank," perhaps because of an unconscious feeling that one will be judged rather than valued? And perhaps that one will hear things from others that will cause one to be critical not only of others but oneself as well?

Maybe talk therapy is less accepted than in might/ought to be not because it isn't effective but rather because it is? Because it brings out into the open things that our story tellers would prefer not to have to try and make sense of? Because as individuals and a culture we're suspicious of interpersonal interaction, rather than seeing it as a useful route to continuing story revision? Maybe we all need more experience with the potentials and benefits of experiential reciprocity?