Talk Is Not Enough, Part I

THE OPEN MIND
Host: Richard D. Heffner
Guest: Willard Gaylin, M.D.
Title: “Talk Is Not Enough”, Part I
VTR: 4/14/00

I’m Richard Heffner, your host on The Open Mind. And once again today as he has been so many times over the past quarter century, my guest is Dr. Willard Gaylin, Clinical Professor of Psychiatry at Columbia’s College of Physicians and Surgeons and Co-Founder of the Hastings Center, the pre-eminent institute for the study of ethical issues in the life sciences.

Now most frequently it’s been a provocatively titled new Gaylin book that has brought my guest here to THE OPEN MIND, as his “Caring, Feelings, Our Vital Signs,” “The Perversion of Autonomy,” “The Proper Uses of Cohersion and Restraints in a Liberal Society,” “ The Rage With in: Anger in Modern Life” and so on, Today is no different in that regard. Though there is something rather overarching, uniquely comprehensive about his new Little Brown volume, “Talk Is Not Enough: How Psychotherapy Really Works”. For it rather much goes back to the very first principles, giving us something of a bird’s eye view of what his, and his psychoanalytic professions’ vantage point has been all these years.

Now my guest’s eminent colleague, Dr. Robert Michels, may have put it best about “Talk Is Not Enough” and its author. “Gaylin”, Michels writes, “thinks like a philosopher, writes like a novelist and guides us like a master psychotherapist. A must read for a patient or a therapist, or anyone who wants to know what psychotherapy has taught us about the human conditions.”

Well, first things first, then, though Dr. Gaylin writes it at the end of his new book, I want him to begin today by elaborating upon his statement that “in the end we psychotherapists, independent of our varying views of human nature and humankind are totally dependent on the patient’s willingness to screw his courage to the sticking point and act”. What did you mean by that, Dr. Gaylin?

GAYLIN: Well, I guess that’s a fundamental concept of the whole book. There had been for years, years, going back into the nineteenth century the assumption that somehow or other psychotherapy involved talking, talking within the therapeutic session and then “something swell” would happen, don’t ask me what that was … magical … and it … the patient would be cured of all his ills. The classic stories. If you think of the movies you can think of that grand psychiatrist, Ingrid Bergman, in Spellbound I think it was called. Or you can think of a more current one, Judd Hirsch in Ordinary People. Inevitably the idea was that if you just talked, in the therapeutic situation, you would discover some horrible thing from your past … the thought that you had been responsible for killing a sibling or something of that … that was the favorite one, something like that. And when it came to the surface, when you abreacted it, when all the emotion came out, tears would come to your eyes and the therapist would choke back a few tears of his own. You’d hug each other and then magically you’d be cured. Now I’ve been waiting for thirty years for that …

HEFFNER: [Laughter]

GAYLIN: … patient to walk into my office, and he has never come there. And the fact is that talk is essential, insight is essential, catharsis is essential, all of those things are good stuff and are necessary. But you must take all of the learning out of a therapeutic situation and have the courage to apply it into the life situation. Change occurs not in the analysts office or the therapists office, but in the real world out there because that’s where the problems exist. They may have started inside of you, with internal dynamics and conflicts. But they must be resolved in the real world, in your relationships.

HEFFNER: Does that make the psychotherapist an active participant in the process.

GAYLIN: Well, it should. And part of the problem is that many therapists were caught up in that nineteenth century model of passivity, non-intervention, just let the process happen. In the old days they did really believe this. But you’re going back now to a second century … you’re going back … Freud wasn’t even 20th century … he began and most of the creative insights were in the nineteenth century. Many therapists, unfortunately, are themselves passive individuals. Also, the idea of not intruding too much stemmed from this concept of a value free science, we mustn’t have values, we mustn’t get in the way of our patient. We mustn’t influence them too strongly. That was also a very nineteenth century idea. In the 20th century, particularly with the biological revolution, we know that all science is shot through with values. I have values and my patient must know that. And I must make sure that he subscribes to my values … if he doesn’t he shouldn’t be with me. Fortunately, the values that I have are broad. And they are those that are probably part of our culture. But I do have those values. I believe in activity versus passivity; I believe in a fuller life rather than a narrow life. I believe in engagement rather than isolation, even though there’s a place for hermits in our society, or monks in our society. Those are some of the values that I have to assume my patient shares with me. So that I believe in activity in terms of work rather than indolence. Even if you’ve got more money than you know what to do with … and some patients do because some people do, there’s a sense that work is an important part of the defining features of being human. So, yes, I think the therapist has to intervene … not completely. He doesn’t take over, he doesn’t tell you “listen, you’re foolish to be a supporter of Bill Clinton, you should be voting this way or that …” those are nonsense, that kind of value, of course, would be outrageous to intrude on a patient. But in the broader scheme of things you must get the patient to move into real life and it’s hard.
Because what happens first is that the patient takes a lifetime of experience … let’s take a simple case … “you can’t trust a man in authority, if you do he’s going to hurt you, he’s going to damage you, you’ve got to be wary, you’ve got to be protective. A mildly paranoid thing coming … you can name any scenario from a father who is alcoholic, abandoned the family, whatever. He starts with me, assuming that I’m going to betray him. And I simply am not going to and he’s going to be sometimes provocative, and sometimes outrageous, and sometimes insulting, telling me I’m stupid, or he didn’t hear this. And I’m not going to take the bait. That’s the passive mode that allows him to express all of this. Eventually, and I’m making it very simple-minded now, that with other things begins to challenge this perception of the world that he has carried over from his childhood that, “hey, all men can’t be betrayers, all men can’t be exploiters because this man isn’t”. And that’s what we call the transference. Now having done that many therapists are just thrilled and happy about it. You can’t be, it doesn’t do any good if you are healthy in your relationship with me. I’m going to kick you out of treatment sooner or later. I want you to get on with your life. I’m going to get older, I have other patients waiting to come on. The next step, which has been a neglected step often is that you have to take that insight about me, that knowledge that “hey, the world isn’t quite the way it looks”, go into the outside world and apply it to all of the critical relationships that you have.

HEFFNER: Will, you say “neglected” that next step has been frequently neglected. How could it have been? How could success or failure be measured?

GAYLIN: You have to understand that the insights of Freud at the nineteenth century were so phenomenal, the idea that talk … talk would cure an illness? Or that dreams were important? Dreams were the stuff of charlatans, dreams didn’t do anything. The awareness that if you stopped talking, sat quietly, were patient … the truth would reveal itself out of the patient’s rambling thoughts. In the old days, you did questions, and you know what a history is … “How old are you? How tall are you? How often do you have sex? Do you have any diabetes in your family?”, this and that. Freud discovered that the truth emerges when you stop asking questions and the patient is forced to go into his own unconscious out of the anxiety of that tense situation. Well that presupposes and requires a kind of passive therapist, who’s laid back. And I am, like most therapists waiting. I don’t ask a whole bunch of questions, I just say “Hi” and wait for my patient to get started. So that leads to the free association that’s enormously helpful. So you are inclined and taught to be passive early. To let this stuff come out, to not be too directive, or certainly not manipulative. In addition, early theory didn’t focus on the emotions and the feelings. Early theory focused on the conflict, the story … ”there’s something wrong with the story”. And the idea that somehow or other, if you got those old unconscious conflicts out to the surface, it would automatically, like lancing an abscess brings you instant relief. Or if you’ve ever had one of those things in your fingernail … and they press down … ohhhh. That’s what they thought would happen. As I quoted from the movies, even twenty years ago or ten years ago they were thinking these ideas happened. Well, it doesn’t work that way and if Freud had lived another hundred years … he was a smart guy … he always learned by his mistakes … he didn’t like other people to tell him where he was making mistakes, but he learned by his mistakes and revised his theory. What emerged was an orthodoxy. An orthodoxy that said “This is the way you do it. Don’t change things. Don’t intervene”. And what they were trying to do was to set up a model, a psychoanalytic model and I’m now talking about psychotherapy in general. But psychotherapy in general has borrowed greatly from psychoanalysis. That was different from “counseling”, from coaching, from hectoring. So they wanted to say “Hey, we’re not going to do what those other guys do, here’s how we’re …”. So all of that encouraged a kind of passivity. Now if you want to throw this into the pot and I don’t mean to be provocative, but what kind of a person earns his living all day long by sitting in one chair, never moving out of it …

HEFFNER: I …

GAYLIN: … for seven, eight hours …

HEFFNER: I’ve often wondered about that, Will.

GAYLIN: For the most part it tends to attract passive people. So that the very nature of the filtering of who goes into psychoanalysis. Active, tough football players become orthopedic surgeons. They want the hammer in their hands, they want to … it’s very true. Introspective, artistic, sensitive and somewhat passive people are attracted to psychoanalysis. So that the theory became a rationalization for doing what came naturally anyway. And this is a kind of plea, after 30, 40 years of practice, therapists to say, “it just isn’t going to work”. A passive therapist with a passive patient, in a procedure that induces more passivity, is a kind of leisurely journey of two people into nowhere.

HEFFNER: Now, Dr. Gaylin, I need to ask whether that point of view, that perspective which is set forth so well in “Talk Is Not Enough”, whether that is what will find today, if one goes into psychiatry, psychotherapy, psychoanalytic practice or not. Your revision?

GAYLIN: I think while I have a certain spin on it, if you remember, my point of view is that intelligent people can have different story lines about human nature and disease that are entirely different and get very good results. So I, I won’t say I’m the only person, I’m certainly not. I think there has been a change, but in order to get to that change, we had to take a hell of a detour. People began to get fed up, the intellectuals particularly, with psychoanalysis … it was oversold. It was pretentious and portentous. People would talk about “my analyst … oh, your analyst and my analyst”. And then we got into the Woody Allen kind of … no disrespect for him … kind of thing where everybody was in analysis for forty years and kept going on. They got fed up with it. And they wanted something quicker. And it happened to come at a time when the whole society was going for the “quick fix”. You know longer built relationships, you just met someone and went right to bed with them. You wanted the “quick fix”, the quick answer. So we went into a kind of detour where people spent a weekend hugging trees, and that solved everything. You’d have your toes manipulated, whatever that’s called … reflexology … and somehow or other that would tinkle and twinkle your, your brain so that you were functioning better. People were looking for a quick fix. This caused many therapists to begin to question and to begin … and also it was a time when we began to see there was such a thing as intervention in drugs where you couldn’t fool around much … you had to get to them. There was the drug therapy itself which was a kind of quick fix and a wonderful one … one for which I’m enormously grateful. On the other hand it still leaves room for a therapist. So there were a lot of movements going on in the sixties, seventies, eighties that made for change. Also, most people were going to lie around four or five times a week for a hour or 45 minutes and be psychoanalyzed. Who could afford it? Who could afford the money and the time? So all of that began to make people think something has to go on to make this more directive and patients wanted it. They didn’t have the patience. But I think some of us were earlier in getting more active, more involved with the patient and being life-oriented. There was that big change, too .. I hate to use technical terms, but there’s two ways of approaching therapy … I go into it in the book, but it’s … reluctantly … because I hate getting theoretical, I’d much rather … but there was something called “Id analysis” that meant if you only went into the unconscious of the person … that was the old fashioned. And there was the emergence of “ego analysis” across the board in a lot of difference schools, the Jungians, the Rogerians … all of them, began to deal with how you adapt in real life. How do you related. Certainly the interpersonal things. Harry Stack Sullivan, enormous impetus … my teacher Rado, all these schools were much more involved with adaptation, how are you maneuvering during your day? What are you doing? Forget about what’s causing it … something there is burning or driving in some direction, but how is it influencing your behavior? So it became much more behavioral oriented and it go you out of the internal struggle and into real life.

HEFFNER: And that now has resulted in what? If one were to start again, Will Gaylin begins again, Will Gaylin is who he is, he has the personality he has, he has the orientation he has. What will you find in training? Will you find the old fashioned and the new? Or will …

GAYLIN: You find both. I think more people … you’re not going to find the true old fashioned in some … except in some little yeshivas of orthodoxy where this is still practiced. And you do find it, I’m afraid, more than I would like to think … the patients won’t stand for it. They just don’t have the time or energy, we live in a different time. So you will find it much more eclectic and a much more behavior oriented and a much more relationship oriented, generally speaking. One of the change is that the idea … never mind what you think about your therapist … it’s wrong, he’s qualified. You don’t have to like him. I felt from the beginning that was nonsense. Whenever someone came tome for referral, I’d say, “Look, we have to be sure of three things … and I promise you this, it’s going to be a smart person, it’s going to be a person with character and integrity, and it’s going to be a person that’s well trained. So don’t worry about that, I’m going to send you to that guy. Having said that, you are perfectly free, indeed, it’s almost demanded of you, if you don’t like the person to whom I send you, come back to me and tell me that you don’t and tell me why. Because it is a little bit like fixing up your cousin with your wife’s cousin, and oh, they’re both attractive, charming people and they’re both witty and entertaining, they’re going to love each other … and then you get a phone call and your wife get a phone call, “What were you thinking of? Are you crazy? That person for me? No”. Because there’s a magic to it, it’s a relationship. And I have always said that I want my patients to have a positive response, now I say to them it may not come the first session …got to give it a couple of sessions … and if someone tells me after the fifth referral … then I say, “hey, wait a second, this is not … “

HEFFNER: Something going on here.

GAYLIN: There’s something going on over here. Now that, that idea that the persona of the therapist was important was strongly resisted in psychotherapy. There was a time … we always selected … we candidates, our own therapist. Then there was a time that you were assigned a therapist … I felt that was an outrage. I don’t know if I’d have the guts … I like to think I would have, but I wouldn’t have stood for it when I was a student … I think. Who knows, I might have made the compromise, but it wouldn’t have been a happy compromise.

HEFFNER: Now, what does that lead to in terms of the power of the therapist? You are directive rather than non-directive, if you participate rather than just sit back. If you are not exactly the orthopedic surgeon type, the football player, but are more active, what does that do to the patient in terms of her or his ability … should I say to withstand … the moral guidance of the therapist.

GAYLIN: Don’t forget … a distortion is introduced in my talking about this because I don’t start from the mid-point, I start from an extreme and I’ve moved us this way. We still do the very same things. We still respect the non-direct … the power of the non-directive interview. I don’t know if you remember that interview that I had in here, where a young man came and he wanted to impress me, he was applying to psychoanalytic school [laughter] …

HEFFNER: Right.

GAYLIN: … how much he knew. And I didn’t want to hear how much he knew and I just said, “what do you do for fun” and he … most of the time these young analytic candidates don’t do anything for fun they’re so overwhelmed with their residency, earning a living … and I led to a very … I would get led off, I just laid back and listened to it and a power interview emerges, you remember, and it was very touching … he got furious with me … and I loved that he got furious with me. And he was sure I was going to refuse him. Of course I accepted him because what I wanted to see was his emotionality, his capacity to stand up to a threat from an authority.

HEFFNER: But that’s different, Will, from the role that you will play. I mean
I think of your founding role and the dominant role you played in the Hastings Institute all these many, many years … just concerned with ethical matters. Now in your private practice, you’re a person concerned with ethics, and you must by definition be imposing your ethical judgments upon your patients. Is that unfair?

GAYLIN: I think in the broadest sense, but don’t forget we go through five or six years of training. And what do you think the most important part of the training is? To learn to control yourself. Not to learn psychoanalytic theory. It is crucial that a therapist not be allowed, or not allow himself to get angry with his patient. That’s easy because there’s a natural sympathy for the patient when you know his whole story. But you also can’t get weary of his problems, that’s not so easy. You can’t get bored. And worst … the hardest thing is you can’t get maternal. Because most of us …

HEFFNER: Maternal?

GAYLIN: Maternal.

HEFFNER: Not paternal, but maternal.

GAYLIN: No. Paternal is no problem, that authoritarian stuff, we can all keep … pretty much … there are a few, I’m speaking generalities. The hardest thing for me to control, and I think for most therapists is the desire to take care of and to help my patients and to be maternal. So you have to be laid back. Most of my training is directed to that and also to keep my own life out of it. Look, I … my mother could have died … indeed did, and I heard about it after therapy and quickly made arrangements. The next three patients I had to see and give my attention to them and not tell … I didn’t say, “Oh, my mother died, I have to leave”. They knew nothing unless they had some kind of insight. So there is still a role, and an important role for being capable of laying back and not stepping in at the moment and allowing the patient to extend them self. What I’m talking about is the recognition that that is not enough. It doesn’t mean that that non-directive approach and that talk isn’t, in itself important. It’s not enough. Talk is not enough. Insight is not enough. Now with the values …I specifically go into this because I don’t’ want trouble here and it could be trouble. If I had someone who was anti-Semitic … I think I use that example in the book … mildly anti-Semitic … a Connecticut businessman, he wife is mildly anti-Semitic, most of the friends he’s with are mildly anti-Semitic … he would be horrified if a swastika were put in … he would be leading the civic effort to find who were the vandals who did this. But he would used words like “don’t Jew him down”, or something like that. And he would be little more comfortable at his club where no one is Jewish, etc. Do I analyze that … I don’t like the anti-Semitic … no, I don’t. He comes to me because he’s got a marital problem. His wife shares the same values, his whole community shares the same values. If it had a paranoid edge and if it was a consuming part of his life. Well, that’s different, that’s a neurosis. But this is a mild cultural …

HEFFNER: In other words you take him on when he has some consuming anti-Semitic …

GAYLIN: Yeah. But here he’s in for a different problem. That’s my … and I might say, “Oh, god, I don’t like anti-Semitic people”, or I don’t like anti-Blacks, or I don’t like homophobic. I don’t get into that unless if you were a counselor, then for sure I have to get into it,. If you were a therapist to be, you have to analyze it because he is going to … there is no way he’s not going to allow that contaminate his therapeutic process. So there’s certain things … I don’t care if they’re Republican … they pro- … one of things it taught me, you said, “Well didn’t your work at the Hastings Center get you all into these ethics things?”. But remember my work from the Hastings Center also taught me that people of good will can come down on opposite sides of crucial questions. There are decent people who are pro-life and there are decent people who are pro-choice. The same thing is true for all of the major things … capital punishment … experimentation with animals … all of these things … decent people can occupy the territory on both sides. I wish more people who are hysterical in their own persuasion there, recognize that. So it’s not hard for me to stay out of these things.

HEFFNER: Will, we have a minute and a half left. Why did you become a therapist … a psychotherapist?

GAYLIN: For all the wrong reasons. This is kind of funny … this is one of things that disturbs me. I came out of … I was not myself … experienced Depression, but my parents … and no one can quite understand that who are younger, what that great Depression meant in the Untied States, in the Midwest particularly, in the rust belt where I come from, from Ohio. I don’t know. We were poor, you had to have security, so that meant you couldn’t just decide to go off somewhere … you had to become a doctor or a lawyer or an engineer or a dentist or something like that. I thought of a doctor, but then it seemed to me the human mind was the most intricate and complicated and wonderful of things. And in those days I hadn’t read any psychotherapeutic literature, so … no had a I ever met a psychoanalysts. Had I, I wonder if I’d have gone into the field.

HEFFNER: [Laughter]

GAYLIN: But it just seemed exciting. It seemed analytic and provocative. And when I say the “wrong reasons”, I’m still delighted that I went into it. Psychoanalysis … psychotherapy doesn’t require a keenly analytic mind philosophy. It requires patients, kindness, self-control. But it was the kind of analytic thing that I thought. Nonetheless I’m happy I ended off there.

HEFFNER: I’m happy, too. And so much so that I want you to stay where you are.. We’ve come to the end of our program, Dr. Gaylin, but I’d like to follow through.

GAYLIN: Great.

HEFFNER: Okay. Thank you so much for joining me this time, however, on
THE OPEN MIND.

GAYLIN: Thank you.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. If you would like a transcript of today’s program, please send four dollars in check or money order to: The Open Mind, P. O. Box 7977, F.D.R. Station, New York, New York 10150

Meanwhile, as an old friend used to say, “Good night and good luck”.

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.