Lauren Slater's op-ed piece in the New York Times (Sunday, November 2, Section 6, Page 34) questionning the value of Barlow's exposure therapy has been raising hackles on practitioners across APA listservs in recent weeks. To quote Slater:

"Barlow's method for treating anxiety disorders is surprisingly simple, although its philosophical and clinical implications are anything but. He aims to reduce anxiety not by teaching customary relaxation techniques involving calming mantras or soothing imagery, but by doing just the opposite: forcing the patient to repeatedly face his most dreaded situation, so that, eventually, he becomes accustomed to the sensation of terror. Barlow claims he can rid some people of their symptoms in as little as five to eight days. His treatment promises to be psychotherapy's ultimate fast track, but while many clinicians praise its well-documented results, others take a dimmer view of what one clinician calls 'torture, plain and simple.'"

As a critic of Psychology's academic and professional communities and as a person with a specific phobia, I appreciate Slater's criticisms and would like to add some of my own thoughts to this issue. Exposure therapy is emblematic of the one-size-fits-all bureaucratization and homogenization of Psychology within academic and professional communities. Denizens of the psychology world aim to standardize and manualize everything, to plug its own members into a massive framework of common expectations, to strip individual researchers of their wits and free thinking, individual research participants of their individuality, and psychological phenomena of their integrity and diversity. Fears are no exception. For proponents of manualized exposure therapy, there is nothing unique or complicated about the relationship between the fearful individual and a feared object. Proponents of exposure therapy treat all feared objects as generic cues for a faceless physiological distress. There is no attempt to discern the psychological function of the fear, no attempt to penetrate the meaning of the feared object, no attempt to elucidate the role of the feared object in a self-regulating system known as "personality" or "experience." This is a factory-style approach by people who do not understand the nature of fear or creation, only coercion, and they seek to bully their clients into getting over irrational fears that disrupt their vaunted harmony with the environment. I for one find it particularly productive and meaningful to fear exposure therapy; as a chip off the old block, exposure therapy represents a broader culture within Psychology, and by forcing me to confront my revulsion of ET, Lauren Slater helped me to resolve a broader opposition to psychology's treatment of the human condition.

Exposure therapy is also emblematic of Psychology's technical and utilitarian approach to psychological phenomena. Too many contemporary therapists approach the problem of fear as it is presented by the client, in isolation and at face value. A client cites a phobia as a source of distress, and the therapist targets the phobia. For some clients and some fears, this may work. I for one know that neither exposure nor systematic desensitization could help me make any gains in overcoming my phobia. My phobia is an all-or-none reaction, a rogue instinct of sorts; there is no incremental mitigation of my fear. And I suspect this is true for many clients. My point is that not all fears are the same. With the exception of the rather arbitrary and vapid distinction between generalized anxiety, social phobia, and specific phobia, DSM fundamentalists treat all fear as one thing with many theoretically uninteresting manifestations. They rob the fear and the client of its meaning and dignity.

Exposure therapy is also emblematic of Psychology's outer-directedness. The scholarly attitude and motive of the therapist is to deploy professional training and technique (i.e., therapists are remarkably dependent on external sources of guidance and validation) to help the client increase his or her adjsutment to (and harmony with) the requirements of the external world. Given third party (i.e., managed care companies) requirements for reimbursement, this therapeutic goal and method make for one "idiot machine." I suspect the proponents of exposure therapy are seeking a psychological (i.e., behavioral) equivalent of pills. In fact, researchers at the helm of these efficacy studies are obsessed with validating therapies by comparing them to pharmacologic treatment. I could not think of a more fitting comparison. Now I have to give some psychologists credit for broadening the purpose of therapy (and the concept of adjustment) from "fear reduction" (i.e., harmony with external object) to the "ability to live with a fear" (i.e., harmony with lifestyle). There are signs of life in the psychological community. The ability to live with a fear is a higher purpose available to clients, both to those who reduce their fear and those who do not. However, exposure therapy is not the means to get there. Good case conceptualization is the only means to get there, some method in which the therapist has both his feet on the ground (phenomenology of client) and his head in the clouds (theory or informal thinking). We need not get lost in the wilderness that is the approaches to talk therapy. Psychodynamic, object-relations, or humanistic-existential therapies are all relatively open and flexible frameworks that allow the therapist with good case conceptualization skills to customize a method of helping a client formulate productive meanings and relationships with his or her psyche. I always fall back on the word psyche for lack of a better term, because psyche is not biased with respect to internal or external factors (and indeed a therapist's customization must account for the individual's [introverted or extraverted] orientation). A therapist must also be bright enough to recognize a healthy and potentially productive state of disequilibrium, during which a person susceptible to change can be helped to mature as well as adjust. In addition to mediocre intelligence, contemporary therapists are hampered by assumptions, values, and objectives that prevent them from expanding the pie that is the person. They do not know how to help the client to make meaning of short-term pains and sacrifices as investments in long-term growth and development. The use of the term 'investment' here is not accidental, as psychologists fall short because they fail to understand the psyche as an economy of value and energy. Having abandoned the big picture puzzle (i.e., the pursuit of truth about the human condition or personality system), psychologists have consigned themselves to the fate of bandaging and beautifying individual puzzle pieces.

But I admit this is a lot to ask of a psychologist. I am not asking that he or she possess the knowledge and skills to achieve these ends routinely and effectively with clients. Currently, we all lack this knowledge and wisdom and so therapists are simply making do with their limited tools in the interests of helping the client. What I do revile however is the attitudes of therapists and researchers alike that trap our science of human nature in the confines of its institutional shell. See ADHD Science. I can not justify picking on exposure therapy when it is one specific manifestation of Psychology's penchant for brutally hammering human nature into the shape of a nail. The contemporary method of psychological inquiry is less real science than it is therapy for professors medicating their own vanity and insecurity with community, expediency, and bureaucracy. Is exposure therapy cruel and tortuous? Perhaps. But what do you expect when you hit a client with an instrument as blunt as Psychology?

fireflySun.com Report List

16 Points Memo: Wyatt Ehrenfels

Authors, Scholars Unite to Support Wyatt Ehrenfels: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Dream Researcher Gail Bixler: Wyatt Ehrenfels

Wyatt Ehrenfels Exposes Our Fear of Exposure Therapy: Wyatt Ehrenfels

Wyatt Ehrenfels Interviews with Internal Correspondent: Wyatt Ehrenfels

Wyatt Ehrenfels Says Psychology Professors Suffer from Professional Analogue of Borderline Personality Disorder: Wyatt Ehrenfels

Student Defies Psychology Professor's Warning Not to Correspond with Wyatt Ehrenfels: Wyatt Ehrenfels

Wyatt Ehrenfels Chides Daniel Dennett for Evangelical Atheism in Psychology: Wyatt Ehrenfels

Wyatt Ehrenfels Argues Psychology Graduate Education Not Worth the Money: Wyatt Ehrenfels

Psychology Professors Acknowledge Student Complaints about Curriculum: Wyatt Ehrenfels

Wyatt Ehrenfels Answers Critics, Campaign of Diversionary Tactics: Wyatt Ehrenfels

American Psychological Association Denies Listserv Members Access to Wyatt Ehrenfels OKTV Broadcast Report: Wyatt Ehrenfels

Wyatt Ehrenfels Talks about the Dissertation Experience: Wyatt Ehrenfels

Wyatt Ehrenfels Discusses a Methodology for Dream Research: Wyatt Ehrenfels

Wyatt Ehrenfels Defends Dreaming from Psychologist Negative Thinking: Wyatt Ehrenfels

Urban E-Zine Entelechy Publishes Wyatt Ehrenfels Essay: Wyatt Ehrenfels

Wyatt Ehrenfels Defends Dream Research against Vaunted Psychology News Group Moderator: Wyatt Ehrenfels

Wyatt Ehrenfels Customizes Probe to Explore Dreaming-Waking Interface: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Kindred Critic Dennis Fox: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Psychotherapist Elio Frattaroli: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Political Scientist John Freie: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Biologist John Hewitt: Wyatt Ehrenfels

Wyatt Ehrenfels Shows Support for Embattled Psychology Graduate Student: Wyatt Ehrenfels

Wyatt Ehrenfels Counsels Students on True Callings: Wyatt Ehrenfels

Wyatt Ehrenfels Amuses with Proposal of Psychology Graduate Program Insurance: Wyatt Ehrenfels

Wyatt Ehrenfels Says Corrective Statistical Procedure Emblematic of Psychology's Flaws: Wyatt Ehrenfels

Brad Jesness Target of Malicious Psychologists on Usenet: Brad Jesness

Wyatt Ehrenfels Teams with Medal-Winning Author M.J. John: Wyatt Ehrenfels

Wyatt Ehrenfels Critical of Vaunted Cornell Research Claiming Opposites Do NOT Attract: Wyatt Ehrenfels

Wyatt Ehrenfels Criticizes Berkeley Psychology Professors for Left Wing Bias: Wyatt Ehrenfels

Wyatt Ehrenfels Offers Links to Education and Appropriations Subcommittees: Wyatt Ehrenfels

Wyatt Ehrenfels Thunders Away at Psychology's Load-Bearing Premises: Wyatt Ehrenfels

Wyatt Ehrenfels Counsels High School Students on Choice of College Major: Wyatt Ehrenfels

APPIC Match Service Helps Veterans Hospital Psychologists Discriminate against Applicants w/ Disabilities: Wyatt Ehrenfels

Psychology Professional Development at Odds with Adult Maturation: Wyatt Ehrenfels

Wyatt Ehrenfels Republishes Work of College Curriculum Critic and FOX News Writer Wendy McElroy: Wendy McElroy

Wyatt Ehrenfels Likens Psychological Research to Premature Ejaculation: Wyatt Ehrenfels

According to Social Psychologist Wyatt Ehrenfels, Diversity Is Skin Deep, Black-and-White at University of Michigan: Wyatt Ehrenfels

Wyatt Ehrenfels Dismantles Psychology's Standard Defenses against Criticism: Wyatt Ehrenfels

Wyatt Ehrenfels Points to Hypocrisy in Terror Management Research: Wyatt Ehrenfels

Wyatt Ehrenfels Releases Revitalized Pocket Memo: Wyatt Ehrenfels

Wyatt Ehrenfels Publishes Critique in Revolution Issue of New Therapist Magazine: Wyatt Ehrenfels

Is Psychology at Odds with Itself?: Wyatt Ehrenfels

Wyatt Ehrenfels Says Campaign Not Intend to Offend Psychology Majors: Wyatt Ehrenfels

Why Community Access Television Is Coming Around to Wyatt Ehrenfels: Wyatt Ehrenfels

Overview of Wyatt Ehrenfels's Fireflies in the Shadow of the Sun: Wyatt Ehrenfels

Are Psychology Professors Prejudiced against Psyche: Wyatt Ehrenfels

Psychology's Science of Dreams Fails Science and Dreams: Wyatt Ehrenfels

Psychology Graduate Schools Blasted for Culture of Student Character Assassination: Wyatt Ehrenfels

Ode to Psychology Students: Are You Making A Major out of a Molehill: Wyatt Ehrenfels

Multicultural Fetish of Psychology Professors Belie Suppression of Individual Freedom, Ideas in Psychology: Wyatt Ehrenfels

Games without Frontiers: Ehrenfels Depicts Science of Psychology as ADHD: Wyatt Ehrenfels

Wyatt Ehrenfels Uses Evolutionary Theory, Natural Selection to Impugn D-Volving Psychology: Wyatt Ehrenfels

Wyatt Ehrenfels Reveals American Psychological Association as Lobbying Tour de Force: Wyatt Ehrenfels

Wyatt Ehrenfels Shares Bizarre Tale of Application for University Position: Wyatt Ehrenfels

Dreams & Dreaming Frequently Asked Questions: Wyatt Ehrenfels

Wyatt Ehrenfels Discusses Predictive Power of Tornado Dreams: Wyatt Ehrenfels

Wyatt Ehrenfels Releases Preface to Fireflies in the Shadow of the Sun: Wyatt Ehrenfels

In a Drugged States, New Mexico Legislators Give Psychologists Prescriptive Authority: Wyatt Ehrenfels

Fireflies in the Shadow of the Sun Press Release: Katheryn Moyer

Brad Jesness Exposes Malicious Stalking by Psychologists on Usenet: Brad Jesness

Psychology Majors Respond to Wyatt Ehrenfels fireflySun.com: Wyatt Ehrenfels

Wyatt Ehrenfels Offers Personality Taxonomy: Wyatt Ehrenfels

Wyatt Ehrenfels Offers Blueprint for Blighted Psychology: Wyatt Ehrenfels

From Position of Ignorance, APA Official Diverts Attention from/Urges Skepticism for, Wyatt Ehrenfels APPIC Discrimination Report: Wyatt Ehrenfels

Wyatt Ehrenfels Comes to Terms with Roiled Psychology Graduate Student and News Group Moderator: Wyatt Ehrenfels

Responses to Wyatt Ehrenfels Campaign to Reform Psychology: Wyatt Ehrenfels

Independent Publisher Offers Glowing Review of Fireflies in the Shadow of the Sun: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Psychotherapist Robert Roerich: Wyatt Ehrenfels

Wyatt Ehrenfels Says Psychology Professors Play Games with Rules: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Physicist Jeff Schmidt: Wyatt Ehrenfels

Malicious Stalking by Psychologists Abusing Psychotherapy News Group: Wyatt Ehrenfels

Wyatt Ehrenfels Reveals Groupthink, Abuse in Psychology Faculty Evaluation of Graduate Students: Wyatt Ehrenfels

Wyatt Ehrenfels Begins Sequel to Fireflies in the Shadow of the Sun: Wyatt Ehrenfels

Wyatt Ehrenfels Exposes Counseling Center Hiring Preference for Gays, Lesbians: Wyatt Ehrenfels

Wyatt Ehrenfels Diagnoses the Diagnosticians with the Shadow DSM: Wyatt Ehrenfels

Prominent UC-Davis Dream Researcher Dodges Wyatt Ehrenfels Draft of Reformers: Wyatt Ehrenfels

Wyatt Ehrenfels Teams with Management Consulting Maven R. Mallory Starr: Wyatt Ehrenfels

Overview of Wyatt Ehrenfels Dream Research with Cancer Patients: Wyatt Ehrenfels

Wyatt Ehrenfels Comments on the Short Falls of Teaching in Psychology: Wyatt Ehrenfels

Popular Psychotherapy All about Controlling Chaos: Wyatt Ehrenfels

Washington National Cathedral Site of Synchronicity in Novel by Social Psychologist: Wyatt Ehrenfels

Wyatt Ehrenfels Comments on the Value of a Degree in Psychology: Wyatt Ehrenfels

Wyatt Ehrenfels Offers Strategy for Self-Science of Dreams: Wyatt Ehrenfels

Wyatt Ehrenfels Attacks Psychology on Two Fronts: Wyatt Ehrenfels

Connie Vaughn Teams with Wyatt Ehrenfels to Explain Why She Is Not a Psychology: Connie Vaughn

Benjamin Willard Elected President of Wyatt Ehrenfels Fan Club: Benjamin Willard

Wyatt Ehrenfels Identifies Flaws in U.S. News Report of Psychology Employment Prospects: Wyatt Ehrenfels