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Imagine, if you will, that after a certain period of therapy that might range all the way from psychoanalysis to psychotherapy to cognitive-behavioral therapy on to psychopharmacologic treatment, we were able to determine fairly exactly that some particular neuron-al connections in the brain were significantly altered. Based upon these alterations, we could further determine just how effective this or that particular therapy had been. In truth, as of now, there can be seen certain brain changes by way of PET scans after both psychotherapy and antidepressant drug therapy in patients treated with these modalities. Alas, it is only after talking to these patients to determine if they themselves claim improvement that we can make much of anything of these brain changes.
As eagerly as we long for some sure way of knowing if what we are doing is working, we have to fall back on merely asking. And even then, we cannot be sure. Some patients say they are better in order to please us. Some say they are not in order to hurt us. Sometimes we insist that patients are better in spite of contrary evidence. And sometimes we ourselves refuse to recognize improvement. So somewhere between those telltale brain connections and our own personal sense of certainty come the authors of this volume.
Rather than discussing each contribution individually, I should like to see the collection as representative of a long-standing problem