Through high expectations, a therapist can gently guide a patient


Unfortunately, your advice of Nike Therapy works with very few people. For most, the symptoms they bring to therapy are not within the conscious control that you would have us believe. Your advice is sadly reminiscent of Bob Newhart’s comedy sketch where he simply and repeatedly yells “Stop it” at his patients (www.youtube.com/watch?v=Ow0lr63y4Mw). People should expect more from therapy than tacit moral judgment.

— M.W., Las Vegas

Thanks for the Bob Newhart link. It’s a classic. In high school, I lived for Saturday night: Mary Tyler Moore followed by Bob Newhart as perhaps the worst but funniest therapist ever.

Now, to your criticisms: Let me begin by reiterating the real thrust of the column ...

First, psychoanalytic insight is, often enough to notice, a bill of goods. “Because/therefore” explanations allegedly discovered in therapy are the softest of soft science. So soft, in fact, that it can hardly be called science. It is, in many cases, the purest speculation. I’m regularly suspicious of its usefulness. I remember a patient who, in her 40s, lamented her sexual promiscuity in college. “I think it was because I didn’t get my ‘touch needs’ met as a child,” she said, completely sage and serious. I didn’t buy in. She noticed my underwhelming response to her insight and asked me what I thought. I told her I didn’t know how we could ever know that we know if or whether the way a mother and father touch or don’t touch a child could necessarily shape a human psyche in such a way that said psyche sought and desired a glut of casual sex in postadolescence.

“Then, what else could explain it?” she asked. I shrugged my shoulders and said, “Uh, the simplest answer is that you really, really enjoy sex and were at that time undiscerning and impulsive in a form fairly typical of that stage of psychodevelopment.”

Here’s my prejudice about that story: My view argues for radical responsibility. Her view is, at best, an indulgent naval-gazing. At worst, a sloughing of responsibility. An intellectualizing. A dodge. The Freudian Mystique has become a Freudian Culture. Patients don’t even wait for therapists to conjure psychoanalytic explanations for behavior. They show up with the explanations! Because they are certain that is the way human behavior works.

Secondly, modern patients, steeped in Freudian Culture, expect therapists to participate in this presumptive worldview. I don’t. I won’t. Not merely because it’s bad science. Not merely because I think there are more respectful, not to mention helpful, ways to treat patients. But mostly because I don’t need any more temptation to aggrandize myself. For the sake of my patients and myself, I resist Guru-dom at all costs.

You say that Nike Therapy works with very few people. Your observation misapprehends the question and misrepresents what I said. Of course there’s no such thing as Nike Therapy. This was just my tongue-in-cheek way of describing a particular intervention indicated by a particular kind of patient presenting in a particular way. I would no more say “Stop it” to compulsions than I would walk into an AA meeting and suggest they could all abandon these meetings if they would just stop drinking.

Nope. What you’ll find in constructivist theory is a kind of “raising the bar.” The best thing I do for my patients is have high expectations of them. Specifically, I believe there is almost always overlooked initiative, gumption, chutzpah, intention, motivation and assorted other energies for change in most of us, most of the time.

Tacit moral judgment? You’re dead wrong. The patient in the column had already explicitly – not the least tacitly – judged himself. He was already heartsick about his own behavior.

But, mystified by his own dereliction, he started to float away into the Freudian Mystique. I thought it was more strategically advantageous, not to mention quicker, to suggest that he first try harnessing the power of his own authentic remorse. Not to mention that I know of no research suggesting (let alone proving) that certain traumatic childhood experiences are statistically linked with causing men to use vile gender slurs with their wives.

That’s ridiculous. I respected this man more than that.

Tacit moral judgment? Do you mean judicare (“to render an opinion”)? Or krino (“to distinguish, to separate”)? You should run away screaming from any therapist who professes comprehensive moral neutrality. That is, who pretends not to possess values-based opinions.

Tacit? Oh, make no mistake: I think it’s a really ugly, destructive and despicable thing to call your wife a (expletive). Nothing tacit about that opinion. I think you should expect alienation in your marriage if you do that.

Expect me to call the police if I know you’re beating your children, too. My opinions about such things aren’t tacit. They are explicit.

What you should expect is that a therapist will know his own value system. That, in knowing, it will be less likely to be negatively projected as counter-transference. A patient should expect not to be condemned and criticized, yes. But, conversely, a patient should expect credible boundaries. Or, as my own therapist once said to me, in response to my own shoddy behavior: “Steven, I will always support you … even if I don’t support your choices.”

People should expect more from therapy than the vacuous pretense of a moral vacuum.

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). His columns also appear on Sundays in the Las Vegas Review-Journal. Contact him at 702-227-4165 or skalas@reviewjournal.com.