🚀 go-pugleaf

Julie Wetherell wrote:
>
For someone (like me) from a cognitive
> behavioral perspective, symptoms have "meaning" in that they are not seen
> as random, but rather that they arise from and are maintained by a variety
> of contingent reinforcers, both internal and external.

The concept of reinforcement is logically circular, and strictly
(scientifically) speaking has no explanatory or predictive value on the
level of individual behavior, only statistically and in artificial
environments. Things are called reinforcers only after one _infers_ that
these stimuli are what "causes" the individual to increase/decrease a
behavior. Replication (thus prediction) requires, by definition, same
circumstances. But environmental contingencies are messy and the
learning history of the free-ranging organism is not knowable (unless
you rely on self-report, which no self-respecting
"scientist-practitioner" would). So contingency in therapy is an
inferential as much as data-driven process, don't you agree? The mantle
of science is not so easily carried into the therapy room, attitude to
the contrary. In any case, stating things so technically doesn't really
make the cognitive-behavioral process much different from the
psychodynamic process. Psychoanalysts' responses are "stimuli" and the
feeling of being connected with is a "reinforcer," and by extension,
this relationship can "reinforce different behaviors" by changing the
salience of cues in the client's world outside of sessions; but I don't
see how this any more useful a way of using language. In fact, I think
that making things so clinical, objective-sounding, and detached is very
much a punishing stimulus for others' "loving-behaviors" and attempts to
practice joining on a human level. Your pragmatism actually reminds me
of the detached "neutral" style of a Freudian analyst than the way
someone like Ellis or Meichenbaum does therapy (of course the way they
write sounds like they're more detached and more technical than how they
actually are interpersonally in sessions)

You said:
> Whether medication is prescribed is a pragmatic decision, not a
> philosophical issue, and may vary by the symptoms or the patient.

I see _your view_ as a philosophical position, in the same way that "not
being political" is a political position; or as Rush (the band,not the
fat guy) said, "If you choose not to decide, you still have made a
choice." Ah, junior high school!
Marriage can be a pragmatic decision too. Does this person meet the
requirements of my checklist? Can they help provide financially? What
are the genetic risks? Do they like the country or the city? Do they
want two kids or 4? Obviously for me, there's something missing in the
pragmatic, technical world--i.e., love, passion, integrity to an ideal,
human connection and felt compassion. I recommend the Argentinian film,
"Man facing southeast" for all you pragmatists out there. Never mind.


> Hope that provides one answer as to how a therapist could be in favor of
> simultaneous medication and therapy.

Yes, it does. Sorry to sound so un-pluralistic. I certainly don't think
that any of us have any right to try to limit how others practice or see
things. There's a need for all of our different ways of seeing things. I
think it's also important that we critique and challenge the foundations
of what we do also, and ask intensely personal ethical, moral, and
philosophical questions if we are really going to be effective and
well-grounded clinicians and researchers. I appreciate that we can
question each other's philosophical stances and positions through this
forum. Thanks for your response to my initial posting!