Treating Affect Phobia is a
sequel to an earlier work by the first author, Changing Character: Short
Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and
Attachment. The authors believe that much psychopathology is rooted in Affect
Phobia, a fear of feelings than can be addressed by recasting the concepts
of psychodynamic conflict into the language of learning theory and behavioral
therapy while retaining the ideological underpinnings of Freudian analysis.
Psychodynamically, Affect Phobias are viewed as a triangular constellation of
defenses and inhibitory affects that block adaptive feelings; defensive
behaviors  that allow the patient to avoid the conscious experience to
maladaptively avoid the conscious experience of conflict between an adaptive
affect; and, it€™s corresponding inhibitory affect. The goal is to assist the
person, within approximately 50 sessions (hence, STDP) to change their
character structure to experience more adaptive affects while keeping
inhibitory affects at a manageable level. As with most of the psychodynamic
theoretical models, much of the action within the person takes place beyond the
scope of the individual€™s awareness- within the unconscious.

Organizationally, the manual is broken down into
four parts. Part I focuses upon the theoretical underpinnings of the approach:
how affects are developed and defined, an over-emphasis of behavioral and
psychodynamic approaches to cognitions and intellectual insight rather than
experiencing affect; and, how systematic desensitization may be extended to
treat phobic avoidance of internal states of being. Parts II and III are
devoted to the treatment of Affect Phobia through three primary treatment
objectives: Defensive Restructuring, Affect Restructuring; and Self- and Other-Restructuring.
The final Part discusses the application of STDP with specific DSM-IV diagnoses
and the process of termination.

The manual provides numerous
examples of patient-therapist dialogues which are intended to guide the
clinician to become adept at identifying the core conflicts and defenses
presented by the patient; and, to incorporate the techniques into their
day-to-day clinical interactions.

Thomas Kuhn, in his seminal work The
Structure of Scientific Revolutions, clearly articulates that paradigm
shifts occur when the preponderance of evidence overwhelms the parsimony of the
explanatory models used. Treating Affect Phobia is a clear example of an
explanatory over-extension and over-borrowing of concepts, rather than a
revision of the paradigm proper.

Fundamentally, the flaws in logic,
organization, and treatment throughout the manual lead this reviewer to have
serious concerns regarding the application of this approach to any patient that
seeks treatment.

Some individuals may prefer to have
practically every paragraph bulleted with a description of what is addressed;
however, this reviewer finds it particularly distracting, confusing and
redundant. Equally so are the frequent references throughout Treating Affect
Phobia to the previous volume by the first author.

The authors posit, based upon a
cursory review of the work of LeDoux (1996) concerning the neurobiology of
affective and cognitive responses to environmental events, that parents
classically condition their infants and children to become affectively phobic
by excessive inhibition of the child€™s affective responses. The limbic-mediated
affect of the infant prior to the development of cortically based language is
viewed as having dramatically negative effects upon the overall development of
the individual. The extent that other individuals and social circumstances have
an effect upon the individual throughout the life cycle is minimized; and, is
seen as an effect of early development, rather than a system of adaptive
responses a/k/a social learning theory.

In a similar vein, the authors
indicate their graded exposure model of systematic desensitization is
significantly different from earlier €œanxiety-provoking€ models using flooding,
which is markedly different from what actually occurs in most clinical
practices of clinicians who ascribe to a cognitive-behavioral approach. As a
therapist trained in the use of Rational Emotive Behavior Therapy, an essential
element is to address the central irrational thoughts (cognitions) that lead to
non-productive emotional states, both inhibitory and excitatory.

Because of the power of the
treatment modality that is being taught, clinicians are warned that the
application of the technique is clinically contra-indicated with persons with a
Global Assessment of Functioning (GAF) scale less than 50, thereby
necessitating an entire chapter to the DSM-IV and assessment of the GAF. Given
that the targeted audience are clinicians in practice, it is questionable
whether a clinician who needs to be tutored in the either the derivation of a
GAF or the structure of the DSM-IV should be practicing at all on an
independent basis, without supervision.

Finally, there are a number of treatment
excepts and examples that would cause this reviewer, as a Supervising Psychologist,
to seriously seek legal advise from a malpractice standpoint. Take, for
example, the following advice regarding €œMistaking Maladaptive for Adaptive
Affects€ (page 45), in which €œhelpless weepiness was mistaken for sadness€:

THERAPIST: My patient howled and sobbed
for weeks. I thought we were really getting somewhere, but after a while, when
she felt no relief and nothing changed, I realized that this was a regressive
form of the feeling and wasn€™t letting her function more effectively in her
life. She was really feeling helpless, hopeless, powerless, and frustrated.€

The advice given in Treating
Affect Phobia was €œWhen such affects emerge, it is important to note them,
explore them in a contained way, and help the patient bear them, so that the
patient can come to understand the underlying meanings and the more adaptive
feelings that need to be accessed.€  Reframed within a cognitive approach, the
individual clearly meets the criterion of a clinical depression based upon the
depressive triad (negative evaluation of current life circumstances, negative
evaluation of own capacity to effect change, negative expectation for the
future). For this reviewer, allowing the patient to €œhowl and sob for weeks€
without mention of an antidepressant because it may be addressed by a fuller
understanding of her misery; or, attempting to undermine the depressive triad
borders on a potential lawsuit if the individual truly is a Cluster C
personality that the authors indicate as a beneficiary of this treatment
modality.

Rather than re-mold psychodynamic
therapy, it is suggested that the reader interested in the concepts of Treating
Affect Phobia receive training in Social Learning Theory, Cognitive Therapy
and Behavior Therapy. Switching paradigms to scientifically-validated models
rather than attempting to morph continually non-substantiated, but
aesthetically pleasing, paradigms is the suggested mode of professional
behavior expected of clinician-scientists.

©
2004 Lou Gallagher

Lou Gallagher, Ph.D. has a B.A. in Psychology from Hofstra
University, M.S. Ed. (with Distinction) in Vocational Rehabilitation
Counseling from Hofstra University, a M.A. in School-Community Psychology from Hofstra
University, and Ph.D. in Clinical and School-Community Psychology from Hofstra
University. Fellow, American College of Forensic Examiners. He is a NYS
Certified School Psychologist and Licensed Psychologist, with training at the
Institute for Rational Emotive Therapy in the early 1980€™s. He has taught
Psychology at Hofstra University, Long Island University and other institutions
in the past. He has served for eighteen years as a Supervising Psychologist
with the Suffolk County Division of Community Mental Hygiene Services where he
currently supervises a number of community-based programs to divert persons
with serious and persistent mental illness (SPMI) from the criminal justice
systems; provide services to SPMI individuals being released from and within
correctional facilities; and, coordinates disaster mental health services and
the Mental Health Response Team, in addition to serving as the inoculated
mental health responder for the Suffolk County Smallpox Response Team. He has
been in private practice as a consulting and clinical Psychologist for
twenty-one years, with an emphasis upon anxiety disorders, depressive
disorders, developmental disabilities and Asperger Syndrome and forensic
issues.

Categories: MentalHealth, Anxiety