Moving from clouds, and through clouds, to psychotherapy research

I have still not really managed to digest my brief trip to Tirana, or is it too that I am still digesting my return to the UK, if I think about the challenge more evenly?  Anyway, that’s still work in progress, so one or more posts that seem to be brewing in my head out of that trip and my return must wait another few days (sorry Blerta!)  I’m sprinkling this post with some ‘photos, spread over some years, of Mont Blanc “calving” clouds.

However, that extraordinary and wonderful cloud I saw in Tirana took me back to something that’s been with me for some years now since I read a fascinating book: Hamblyn, Richard. The Invention of Clouds: How an Amateur Meteorologist Forged the Language of the Skies. 1st ed. New York: Farrar, Straus and Giroux, 2001.  The book is about Luke Howard (1772-1864).  Howard was a hard working Quaker and pharmacist from East London who invented the core of the naming system for cloud formations that is still in use today, first describing it publicly in 1802.  There’s a typically useful Wikipedia page about him and an Amazon page about the book here.  Howard invented the names cumulus, stratus and cirrhus and combined names, e.g. cirrostratus, for their intermediate forms.  He got this sufficiently right for it to have survived as a system for over 200 years despite there being very little then known about how and why clouds form, or even about meteorology.  He did it entirely through observational data, much of it simply qualitative descriptive data in the form of sketches and narratives.

I liked the book which seemed itself to have been carefully done and well written.  I admit that I have a weakness for biographies of brave eccentrics, particularly of the many who pretty much developed modern science and for works about and by the many who still do push forward the “hard sciences”.  However, what grabbed me on reading the book was not just the human story and the emerging science of clouds but also a metaphorical message: that this was probably a better model for where psychotherapy research needs to be than the models we currently worship.

Howard could conduct no formal experiments, no randomised controlled trials, he didn’t even have any real chance to take temperature and humidity readings or to collect water droplets or ice crystals from clouds.  He understood that one could have powerful reactions to clouds and he had a correspondence wtih Goethe and they admired each other’s work and Goethe wrote a short celebratory verse in honour of Howard.  However, he could put his feelings aside except perhaps for how much they helped him keep working.  He could put them aside because metereorlogy has the huge advantage over psychotherapy research that we can ignore our emotional reactions as meteorological observers. Our feelings and reactions are not cloud shaping forces.  In radical contrast, when there are two or more people in a room communicating (even if only non-verbally), then they always affect one another and this does shape the interactions that take place. That means that only “computer delivered psychotherapy” and “bibliotherapy” (reading therapeutically intended books) can ignore observer impacts on the process.

I am not saying that psychotherapy research just needs us to watch and describe.  I’m clear that we do need tools, measures and reductive, quantitative ways to describe things and I do believe the neuroscience has a bit to tell us about psychotherapies. (Though I suspect that it’s currently oversold and part of the “neurodolatry” afflicting late 20th and 21st century attempts to understand the mind).  However, the psychotherapies are, like cloud formation and weather, in formal mathematical terms, probably both chaotic and complex system phenomena. Despite their phenomena being chaotic and complex, the meteorologists who came after Howard could not only ignore their own rections but could also assume that regular laws of physics (and a bit of chemistry) will determine the processes that create clouds.  As we understand more about the mind it seems increasingly unlikely that any such linear or regular laws drive human minds in communication.  That shouldn’t stop us seeking simplifications, measurements and explanations, even guides as to how we might make psychotherapies more helpful*.

However, too much psychotherapy research wastes time and money applying tools that are fine where their logic applies but which have no epistemological coherence applied to psychotherapies.  The paradigm example is the randomised controlled trial (RCT). The RCT is brilliant and completely appropriate in the shape of the double blind randomised controlled trial in pharmacology but it becomes the at best single blinded, or frankly unblindable, RCTs of psychotherapies.  We know from much empirical work in pharmacology that even the prescriber knowing whether the trial participant is getting a supposedly active drug or a placebo, even when the participant doesn’t know this, makes a difference to outcomes. We know that on balance it makes the outcomes better (though almost certainly also creating some “nocebo” negative effects**).  We even know that this appears to have effects not just on how people feel but on their mortality.

All that tells us that psychotherapy in its simplest form works: the client sensing that that the therapist knows or believes something might help, is, on balance, better than doing nothing.  We can never separate that effect from “true psychotherapy” as we can never double blind the delivery of psychotherapies.  Sadly, at least in the UK and North America, and I think mainland Europe, psychotherapy research funding is overwhelmingly directed at RCTs.  Can we shake off this mad pursuit of pseudo certainties and trappings of “true science” and recognise that many “true sciences” came from, continue to come from, purely descriptive work and theory building?  Is Luke Howard’s story of what one dedicated person managed to do by observation and quiet persistence an inspirational story for us?  I think so!

Footnotes!

*  Where helping is a legitimate aim: arguably some therapies, say full psychoanalysis, or some other analyses (Dasein analysis, Jungian analyses) and some humanistic psychotherapies, rightly avoid any commitment to help and only offer to make self exploration possible and more thorough.

** Etymology and a little communicative recursion: “placebo” is Latin for “I will please”, I think “nocebo” is Latin for “I will harm”.  A little Latin or Greek goes a long way to make things sound erudite and impressive, particularly usefully for medicine.  Latinate terms are linguistic placebo ingredients.  And sometimes irritating nocebo ones too of course.