Rhetorical questions get right up my nose. [Just for fun, notice how many RQs I sneak into this post, and how annoying they are.] This famous RQ is from the Old Testament prophet Jeramiah [13:23], who prefaces his animal metaphor with what these days would be called a racial slur: “Can the Ethiopian change his skin?” In both cases, one might be moved to reply, “Why would he even want to [change]?” [Jeramiah’s answer would be, to avoid the destruction of Solomon’s temple, silly! Go read his whole sarcastic, “Now you’ve gone and done it, and you’re gonna get it!” rant for yourself, if this isn’t ringing any distant bells from your Judeo-Christian-Islamic upbringing.]
Ever since I was assigned my first patient in 1971, the leopard-spot-changing question has dogged me. [Remember this variation on the theme of an old joke? Q:”How many psychotherapists does it take to change a lightbulb?” A:”Just one; but the lightbulb has to really want to change.”] Apparently, I’m not the only one who feels a little bit defensive about the efficacy of The Talking Cure. In this month’s issue of The California Psychologist, there’s an article with the subheading, “Psychotherapy is Effective!” Here’s what various cited outcome studies have “shown” it can do: “provide symptom relief and personality change, prevent future symptomatic episodes, enhance quality of life, promote adaptive functioning in work/school and relationships, [and/or] increase the likelihood of making healthy and satisfying life choices.” Not to mention buying a little time, when your colleagues, constituents & the media are baying for your blood. Nar’mean?
How do you suppose most of these studies determine whether the desired outcome has been achieved? Why, by self-report questionnaires, mostly. “After 10 sessions, I can definitely see my spots fading!” Got any methodological problems with that? Remember the principle of Cognitive Dissonance? [The more Therbligs/money/effort you invest in achieving a goal, the more likely you are to believe that you achieved it.] That’s why, explained our grad school profs, “no-cost” psychotherapy hardly ever “works.” “Charge ’em at least fifty cents, if you want ’em to change,” they advised. [The APA Ethics Committee is constantly chasing its tail, as to whether barter is a therapeutic form payment. “Taking it out in trade” (as the lewd British euphemism has it), is definitely not, and is punishable by loss of license to practice.]
But, even if a paying leopard really wants to change its spots, can it? How much of brain function is “hard-wired” [as neuro-scientists used to like to say], and how much is “plastic” [as they like to say, these days]? Turns out, the more the patient and the therapist believe in the plasticity of brain function, “the more positive change is observed.” Even if they insist on calling it “rewiring.”
These days, I regard “a good therapeutic outcome” as “changing a leopard into a snow leopard.”
And I hate RQs because they are at best intrusive [a big waste of time, since they promise an answer which they don’t deliver], and at worst humiliating [since, like Jeramiah, they imply, “Schmuck, you should know this already!”].