Freud and Psychotherapy

A collection of Sigmund Freud's drawings is scheduled for exhibition at the New York Academy of Medicine, according to a story in the New York Times. The drawings reflect Freud's progression from a neuroanatomist to psychoanalyst. As is obligatory in articles about psychoanalysis, the comment is made, "Freud's methods have fallen from favor in recent decades, but science historians say that his investigation of the unconscious more than a century ago stands as a revolutionary achievement that still informs many therapists' understanding of memory, trauma and behavior."

When I was in graduate school, the conventional wisdom was that Freud's greatest contribution was his concept of transference. In traditional psychoanalytic thought, transference refers to a client's tendency to think of his or her analyst as a parent. The client's behavior toward the analyst was then used as evidence of early relationships and interpreted back to the client.

Today, the term, transference, is out of style. Nevertheless, a good clinician uses behavior in the office as the primary data for treatment. How a client responds to me tells me much about how the client behaves outside of therapy. For example, I usually teach angry clients relaxation exercises, so they can calm themselves when angry. If a client tells me that relaxation exercises seem silly to him, it tells me a lot about how he behaves outside of the session. He may behave judgmentally toward his bosses, coworkers, or family members. Then, I can show him how he angers himself, by saying, "This is silly. I shouldn't have to do this." From there, it's a simple step to restructuring the thoughts by substituting, "It can't hurt to try it and see if it helps."

I certainly don't think of myself as a psychoanalyst, although I respect Freud's genius in uncovering the healing nature of a relationship. Freud did something else, which therapists should never forget. He let his patients teach him about healing.

Psychotherapy for Compulsive Gambling

Slot machines are coming to Pennsylvania. Like most psychologists who don't work near a casino, I don't see many gamblers. When the slot machine law was initially enacted, I took some continuing education credits to brush up. It taught me how little we really know about gambling.

Mostly, psychologists see gamblers when their luck has run out and their lives are in a shambles. We'll be seeing more of those people as casinos become more common. I just reviewed an on-line book on gambling , [Sorry, this link is dead--F. O. 8/27/2009] dated 1999. It's a little old, but not much has changed since it's publication. It's also a little thin on treatment, but it does have some good data. For those that are into diagnostics, they have a copy of the diagnostic criteria for pathological gambling.

The current issue of the APA Monitor has an article entitled, Gamble at Your Own Risk , which discusses some research on controlling compulsive gambling. The article reports on two studies. In the first, they found that even people well-versed in the probabilities of gambling, will still do it. In one study, students in an introductory statistics class got intensive education in the probabilities of winning at gambling. They still gambled at the same rate as students in a control group.

In the second study, a casino was set up, using a computerized roulette game. Warnings, such as, "If you bet more to make up your losses, you're likely to lose more money" and "If you continue to gamble, you'll eventually lose money," were flashed on the screen. Not surprisingly, students receiving the warnings did gamble less money. But come on, do you think you'll ever see warnings in a casino?

Generally, treatment for pathological gambling follows the addictions model. The goal is not to "recover," but instead to stay in recovery for the rest of one's life. To assist in this process, the clinician must address at least four areas:

1. The negative effects of gambling on the client. The goal is to help the client see that gambling is the cause of all their major problems. Once they are convinced that not gambling will improve their life, they can be engaged in therapy. I always begin by taking a history from my clients. For problems like gambling, the client may find it very traumatic to recount their gambling behavior. Having the client write an autobiography, linking major events in their life to gambling may be a very emotional experience, too.

2. Education about pathological gambling. There are two issues here: First, gamblers need to understand gambling itself, and see that the odds are generally stacked against them. Their unrealistic beliefs about gambling, such as the belief that they can make up for their losses, need to be challenged.

Second, they need to understand their own addictive behavior. For me, the best explanation of gambling comes from basic learning theory. People do what they are reinforced (rewarded) for. There are two rewards for gambling. First, there is a "high" to gambling; a thrill that people report when they are about to pull the lever, lay their money on the table, or watch the outcome of a game or race. That high is very rewarding for the gambler. Second, the behavior is intermittently reinforced. That is, they are rewarded by winning just often enough to keep people playing in the face of their losses. Combining the immediate reinforcement of the high with the intermittent reinforcement of winning makes the gambling behavior very resistant to treatment.

3. Repairing the damage. Pathological gambling does tremendous damage to people's lives. The client needs a great deal of supportive therapy to deal with the financial or legal fallout from the gambling. It's not unusual for a person to have repeatedly run up tens of thousands of dollars in debts, leaving the family struggling to get by. Often, the gambler has embezzled money from their employer, also and may be up on charges as well. In addition to individual therapy, family or marital therapy is necessary to heal the anger that loved ones feel over the client's behavior. The clinician must be careful to support the client, help him or her over the difficulties, but not to minimize or excuse the behavior.
4. Support for abstinence. It might be possible for some gamblers to return to controlled gambling, but I think the risk is too great. The client needs to go to Gambler's Anonymous on a regular basis. Family members should go to Gam-Anon , too.

As the gambler abstains from gambling, they will experience cravings, just like an addict. These cravings are a vital part of recovery. In therapy, they can be used to help the client understand the role of gambling in their lives. Abstinence reveals how gambling filled the holes in the gambler's life. Filling those holes with healthy behavior is a vital part of recovery.
Working with addiction is always frustrating. In some ways, gambling is the worst of the addictions. Substance abusers can avoid their drug of choice fairly effectively. However, with the proliferation of lotteries, casinos, and Internet gambling, the recovering gambler is never far from the scene. Relapses are common with gambling, and are much more catastrophic than with substances. A drunk can go on a bender and then climb back on the wagon. A gambler can relapse and lose $10,000, in a weekend, literally erasing all the good work he had done.

In conclusion, therapy is a mix of educational, supportive, and confrontational treatments. Knowing when to implement them is challenging, to say the least. Gamblers often do enter and maintain their recoveries, although it can be a difficult road there.

Links Between Drug Companies and Psychiatry

Diagnosis in mental health is detailed in the fourth Diagnostic and Statistical Manual (DSM-IV), published by the American Psychiatric Association. The New York Times today published a report of a study claiming to show links between the authors of DSM-IV and pharmaceutical companies. The report stated,

The researchers found that 95 — or 56 percent — of 170 experts who worked on the
1994 edition of the manual, called the Diagnostic and Statistical Manual, or
D.S.M, had at least one monetary relationship with a drug maker in the years from 1989 to 2004. The most frequent tie involved money for research, according to the study, an analysis of financial records and conflict-of-interest statements.

Honestly, I'm not surprised or upset by the relationship. DSM-IV is published by psychiatrists for use by psychiatrists. It reflects a medical model of mental illness, and most of the experts who work on it are researchers in the biological side of treatment. Most of psychiatry is conducted drug treatment. Psychiatrists prescribe medication. Psychologists, social workers, psychotherapists and counselors conduct psychotherapy. A few psychiatrists still dabble in psychotherapy, but they are a dying breed.

Not surprisingly, then, DSM-IV works fine for medical management of mental illness. It stinks as a diagnostic tool for psychotherapy. Let me show you how it works. A person is diagnosed along five "axes:"

I. Clinical disorders
II. Personality disorders or mental retardation
III. General medical conditions
IV. Psychosocial stressors
V. Global Assessment of Functioning

Axis I disorders correspond to depression, anxiety, and other problems that we normally treat (and are advertised on TV). Axis II refers to personality problems that are long-standing. (Why personality disorders and mental retardation are linked is beyond me.) Axis III details medical status. It's important to know this, as many medical illnesses may manifest the same symptoms as depression or anxiety. Axis IV describes psychosocial stressors in very general terms. Axis V describes a person's level of functioning with a 0 to 100 scale.

So, for example, a person might have the following diagnoses:

I. Major depressive disorder, moderate, recurrent
II. Borderline personality disorder
III. No diagnosis
IV. Problems with the primary support group
V. Current GAF 57

There are myriad problems with this scheme. First, the use of the term "axis" implies that each axis is independent from the others. Nothing could be further from the truth. People with personality disorders, for example, are more likely to have anxiety and depressive disorders than others without personalty disorders.

Second, we don't really know what a "disorder" is. In most cases, there is evidence of both psychosocial and biological causes for a client's complaints. Both psychological and biological treatments are effective for the same "disorders." So, what are we really treating?

Third, this scheme doesn't describe the quality of the client's life very effectively, and that's what we really deal with in psychotherapy. Axis IV, where this should be placed, is very general, and poorly delineated. "Problems with the Primary Support Group," covers a lot of ground, from arguing with your wife to repeated sexual abuse of a child.

Fourth, assessment of these disorders remains rooted in the clinical interview. We've known since the 1950's, with a book by Paul Meehl that clinical interviewing is not very reliable. Unfortunately, psychologists, who are the true experts in assessment, have dropped the ball entirely. We have not generated the kind of data necessary to add psycosocial assessment to the diagnostic manual.

So, why do we need diagnosis at all? We need it to describe what we're treating. We need it to organized our research into better treatment methods. So as a result, we limp along with the diagnostic manuals as written. Hopefully, the next one will be better.

New Orleans Evacuees Suffering from Lack of Health Insurance

Today the New York Times published a story on the mental and physical health of New Orleans evacuees. According to the story:

The study, conducted by the Mailman School of Public Health at
Columbia University and the Children's Health Fund, is the first to
examine the health issues of those living in housing provided by the Federal
Emergency Management Agency. Based on face-to-face interviews with more than 650 families living in trailers or hotels, it provides a grim portrait of the
hurricane's effects on some of the poorest victims, showing gaps in the tattered
safety net pieced together from government and private efforts.

I haven't been able to find the source on line, so I can't comment on the specifics. However, the overall picture is not surprising. One observation they made caught my eye:

Forty-four percent (of adult evacuees) said they had no health insurance, many because they lost their jobs after the storm, and nearly half were managing at least one chronic condition like diabetes, high blood pressure or cancer.

Our reliance on employer-based insurance coverage continues to fail all of us, but especially the poor. It is infuriating to me that we continue to insist this is the only way, while Western Europe, Australia, and Japan have been able to provide universal coverage to their citizens. The only reason we can't is that we cater to large insurance corporations who like the current system. Remember how they reacted when Clinton proposed changing it?

The current system is completely anticompetitive. Employers negotiate with a few insurers, who are only interested if the employees are a good risk. The employers are interested in insurance that is the least expensive for them. The employees themselves, who will actually use the services are not consulted on what they want.

Once the insurance goes into effect, the only competition that goes on occurs between the provider offices and the insurance company. Basically, the system is this: the physician office employs at least one person to make sure all claims are paid. The insurance company employs people whose job it is to assure that as few claims as possible are paid. They fight it out with each other, raising costs, and slowing down service delivery. It's no wonder we have an incredibly expensive system that nobody likes.

I'm glad that Massachusetts is trying to provide insurance to all, but I'm pessimistic about the plan. State governments don't have the resources to manage a plan like this. Ultimately, as New Orleans is showing us, the solution has to be with the Federal Government.

Professional Ethics and the Clinical Psychologist

Ethical issues are always a concern for most psychologists. As the profession has grown, the ethics code has grown from a brief statement to a whole field of study. Professional ethics create tremendous anxiety for clinicians. Let me scratch the surface by citing an article posted by Ken Pope on his web site.

Pope reports the results of a recent survey of American Psychological Association members on ethical dilemmas. The abstract notes:

A random sample of 1,319 members of the American Psychological Association (APA) were asked to describe incidents that they found ethically challenging or troubling. Responses from 679 psychologists described 703 incidents in 23 categories.

As always, the response rate (just under 50%) raises questions about how representative the results are for American clinical psychologists. But the data does show some interesting trends. First, of the 679 responses, 134 reported experiencing no direct experience of ethical dilemmas. Of the remaining responses, 49% fell into three categories: (a) confidentiality, (b) blurred, dual or conflictual relationships, or (c) payment sources, plans, settings, and methods. Let me give you an idea of what psychologists deal with on a regular basis by just touching on pieces of these three areas.

a. Confidentiality. A clinician cannot reveal any information about a client without the client's consent. There are only three exceptions. First, a judge may order a clinician to reveal information over the client's objects. This rarely happens. It may happen when the client is accused of criminal activity and might have disclosed it to the clinician.

Second, the clinician must reveal information to protect a client who is likely to harm the client or others. This happens more frequently. A depressed client calls a clinician and indicates he is suicidal. If the client refuses to go to the hospital voluntarily, the clinician can initiate involuntary commitment procedures.

Finally, clinicians are required to reveal ongoing or recent information to the authorities concerning sexual or physical abuse of minors (and in some cases, the elderly). There is always real concern about balancing the interests of an abusing client against protection of an abused child. While in some cases it's a no-brainer to report, there are other cases where the abuse is suspected or probable, and the clinician must make a judgment call as to whether or not to report. Remember, when you report your client to the authorities, you may be ending your relationship with the client. If you made the wrong call, and the client isn't abusing a child, all you've done is hurt the client. That client will never go back to another therapist after having the police show up at their door.

Confidentiality issues become more complicated when you are treating children from a divorced couple and there is a noncustodial parent, custodial stepparent, and a noncustodial stepparent. Who gets to hear what, and what do I do to protect my client from a parent who might use that information against the other parent? This is one reason why many clinicians have stopped seeing children. There's too much to sort out and too much extra-therapy time required to deal with all those relationships.

b. Dual relationships. If I am seeing a client for therapy, it is my obligation to avoid any other relationship with the client. So, for example, if my client fixes furnaces, I don't hire him to fix mine. Think of how therapy would go if the client does a bad job for me.

The worst example of dual relationships involves clinicians who have sexual relationships with their clients. It's a felony in Pennsylvania, yet it still happens remarkably often. Hollywood seems to think there's nothing wrong with it, which is really bizarre, given the amount of therapy taking place there. There were some recent jokes on TV about it, which really offended me.

Even dating a client years after you have terminated therapy is a terrible idea, although in some instances, it's considered ethical. Personally, I don't see how you can have a relationship with a former client that is truly egalitarian. There would always be some remnant of the old theraputic relationship there.

For those of us in small communities, simple decisions can raise problems with dual relationships. For example, say I want to buy an Accura. The only dealer in town is a client of mine. Do I go to the client's dealership (in which case, he can look at my credit history—another can of worms), or do I go out of town? How do I explain that to my friends, without revealing my relationship to the client, or implying there's something wrong with the dealer? Imagine if that gets back to the client.

c. Payment for services. When clients lose their health insurance or if their benefits run out, the clinician is left in a quandry. Referring long-term clients away to a county agency can be traumatic for the client, evoking old fears of abandonment. When I was in private practice, I might decide to see someone pro bono. That's a lot harder to do when you work for a large corporation with specific ideas about the bottom line.

The flip side of payment issues is productivity. Most employers today expect psychologists to produce a quota of charges for the week. The quota has been rising over the years. A long time ago, the American Psychological Association defined a full time caseload as 20 clients a week. As costs have risen and reimbursement has lagged, caseloads have risen.

Currently, it is expected that you see somewhere in the vicinity of 28 or 30 clients per week. That means that you are seeing at least 6 people per day in a 40 hour week. That is certainly doable, but it's very tiring. The last client of the day may not get the best services. At what point does the large caseload become an ethical issue?

Professional ethics are, by their very nature, a minefield. A middle aged psychologist once remarked to me that her only ambition was to make it through to retirement without getting sued. That's a pretty low level of ambition, particularly because the odds of being sued are pretty low, despite the minefield we have to negotiate every day.

When I started into private practice, malpractice insurance cost $150 a year. Today, it's 10 times that amount. Still, that's not a bad expense, compared to many other professions. Part of the reason, I believe, is that American psychologists have taken ethics seriously. While the APA doesn't have much teeth to it's ethics committee, the state boards of psychology do.

State boards are run by state governments. Most of them have written the APA ethics code into their professional licensure laws. The boards have teeth and they do bite on a regular basis. Most boards can issue reprimands, fine psychologists, limit or even revoke their licenses, depending on the severity of the infraction. I hear a lot of complaints about them from other psychologists, but the Boards keep us on our toes. They've made us more responsive to our clients' needs. Last year, in Pennsylvania, according to the Board of Psychology newsletter, only 11 people were disciplined, so in this state, that's not much of a risk.

State boards are only one kind of landmine. The other is the malpractice suit. This, fortunately, is very rare. I believe (I could be wrong here) that the probability of a clinical psychologist being sued in the course of a lifetime is about 2%. Those are pretty good odds. However, I hear from others who have been sued that it is a terrible experience, as it is when you're disciplined by the board.

Ultimately, ethics are about good practice. Keeping up with the latest literature, maintaining confidences, consulting other clinicians when in doubt, are all ways of providing good treatment and keeping yourself safe from malpractice. You can't be 100% certain of avoiding a suit, but you can keep yourself reasonably safe.

Happy Passover

I took a few days off from blogging to celebrate Passover. Passover is a holiday observed entirely in the home. Jews who don't keep kosher, who don't observe the Sabbath, who may only go to synagogue twice a year, still celebrate Passover enthusiastically. It's a wonderful holiday. We have a sumptuous meal, and re-tell the story of the exodus from Egypt, praising God for helping us escape from Egypt. Since we drink four cups of wine in it, there is usually great merriment associated with it.

Passover lasts for eight days. It's traditional to have two seders on the first two nights of Passover. Mostly, people hold their own on one day, and visit someone else's seder on the other day. For all eight days, we are prohibited from eating anything that is leavened. There are also other restrictions, based on where your family comes from. Ashkenazic Jews (from eastern Europe) don't eat rice, while Sephardic Jews (from the Mediterranean) do eat rice.

So, we eat a lot of matzah, which is basically a cracker. It's absolutely tasteless, and we all love it. Every time we bite into a matzah, we recall all the joy of Passover. It's a testament to the power of classical conditioning.

Psychology and Homosexuality

A rant against the American Psychological Association cropped up here. I'm not sure who wrote it, but it turned up on the PsyUSA mailing list. Now, I'm not an APA member, so I don't care what happens to them, or what people say about them. But I do care about my profession and some of the nonsense that this rant is spewing.

For the record, I dropped my membership a few years after they turned up the screws on clinical psychologists, requiring a surcharge on our dues. I found myself paying much more money than APA was worth, and watching APA ignore the real threats against psychology. As far as I was concerned then (and now), the real threat wasn't managed care, it was the depressed fees we were being paid. Most practitioners in private practice would agree with me now.

Anyway, this rant screamed, "American Psychological Association has gotten out of control in its politicization of psychology." Apparently, according to the paranoid who wrote this:

Psychologists, it seems, soon may not be allowed to administer mental therapy for persons experiencing homosexual tendencies and wanting to change their behavior, without getting their license from the American Psychological Association revoked.

And mental therapy is....?

The ranter is referring to reparative therapy, i.e., efforts to make gay people straight. Back in the 60's and 70's, I recall some gruesome behavior therapy attempts, using electric shocks (no, not electroshock therapy; that's something else). It didn't work. No procedure has been documented to change sexual orientation. Certainly not the modern fundamentalist efforts. None of the groups who allegedly can change sexual orientation have provided any good data to back their claims.

I'm sorry to inform the author that the APA is not a licensing body. In the USA, licensing of psychologists is done at the state level. The APA does write the ethics code adopted by most state boards, but the APA's ability to manage their own members' ethics is minimal. All they can do is to either censor someone or expell them from the APA. Big deal. I'm not a member and I don't care.

Another piece of misinformation gets added:

the funny thing is that 30 years ago, the APA had homosexuality classified as a mental disorder.

The American Psychological Association never classified homosexuality as a mental disorder. It was the American Psychiatric Association, and entirely different body, and one that has been quite hostile to organized psychology.

This person goes on, even more ridiculously,

Shannon Love, also a blogger, 20 years ago was "denounced as a [crypto-fascist] for asserting that [she] thought that a lot of homosexuality had a physiological basis."

Back then, she claims, liberals believed that there were no biological roots to such things as homosexuality, because saying that was reminiscent of the biological engineering programs of the Nazis.

But in the '90s, defending homosexuality as something as unchangeable as the color of your skin became more "politically expedient," said Love.

I have no idea who Shannon Love is. If she was "denounced as a [crypto-fascist] 20 years ago, I'm sorry. To charge that liberals are being politically expedient to accept homosexuality is silly. Just check the results of the last election, when gay marriage wound up on several state ballots.

The thinking on the origins of homosexuality has certainly changed over 20 years, but the reason it's changed is that there is more data available.

Apparently, the ranter doesn't think so:

The human "sexual orientation gene," if there is one, has not been found.

According to gene-watch.org, the only attempt to do so, by Dean Hamer, was controversial and is now under investigation by the federal Office of Research Integrity.

I checked this gene-watch.org web site, and I didn't find the charge against Hamer. But I did find some nonsense. They also say:

The claim that genes account for the transmission within families of schizophrenia, bipolar manic depression, and alcoholism have all been contested, and most such reports have eventually been withdrawn.

Maybe on their planet. Here on earth, it is recognized that genetics play a critical role (but not 100% role) in all of those illnesses.

But what both this ranter and gene-watch.org do is set up a straw horse. I don't think anybody believes that there is one gene controlling homosexuality. Instead, our sexuality is controlled by a complex interaction of genes, with potential interplay from both pre- and post-natal influences.

Of course, when we're all done, the ranter has to add:

Regardless of the true nature of the causes of homosexuality, the anecdotes described above show what can happen when emotions and agendas get in the way of calm, rational debate.

A clear case of the pot calling the kettle black.

There is plenty of good data about homosexuality and other sexual minorities available here. Wikipedia has an unfinished section on biology and sexual orientation, which has some good references.

The Scientist as entrepreneur

The Ewing Marion Kauffman Foundation released a study today, entitled, The Knowledge Filter and Economic Growth: The Role of Scientist Entrepreneurship. It indicates that that basic research does pay off for future economic growth. Businesses are frequently started by the researchers to exploit their findings. The press release summarizes the main conclusion of the study by saying:

"The study by Indiana University researchers reveals that cancer scientists,
in addition to commercializing their research through licensing, are starting
new businesses, which largely go unrecorded by existing innovation
commercialization tracking systems. In fact, more than one in four patenting
National Cancer Institute (NCI) scientists within the researchersÂ’ dataset has
started a new firm. These scientist-launched start-ups are the sleeping giant of
university commercialization."

This doesn't surprise me that much. Basic research is always what it says it is. Basic. Our imaginations are the only limitation of how much we can build on it. But, there is something that is missing, and that worries me very much.

Not alltherapeuticss are patentable. Psychotherapy, speech therapy, and physical therapy, are all examples of therapies that cannot be patented. If we focus our research on patentable therapies, other, often less expensive, treatments go undeveloped. For example, it is widely accepted that psychotherapy reduces risk of relapse in adults with either depression or anxiety. Consequently, the preferred treatment is combined pharmacotherapy and psychotherapy. Yet, cognitive-behavior therapy, a well-researched treatment for depression and anxiety, has remained largely unchanged since it was originally proposed by Albert Ellis in the 1950's. Both Meichenbaum and Mahoney laid out the basic research in the 1970's. Beck's classic Cognitive Therapy of Depression was published in 1979.

Since then, federal support for research in behavioral health has eroded and there's been little progress. The money has been in drug research because that is profitable. If we continue to focus on what is easily commercialized, we will continue to see the erosion of non-drug therapies. Ultimately, we need more support for basic research in areas that are not commercial.

Humor in Psychotherapy

I like to use humor in therapy. I use a lot of cognitive techniques, and therefore challenge my clients' beliefs about the world. Often, humor is the best way to get people to reevaluate their beliefs. This is one joke I love, but will never tell a client:

A young psychologist obtained his license, and opened a private practice in a building where an older, well-established psychologist practiced. Over time, they got to know each other, and fell into a pattern of coming and going from the office at the same times, often chatting for a few minutes in the morning and the evening.

One day, the young psychologist noticed another pattern. Every day, they both walked into the building with a spring in their step and lots of energy to start the day. By the end of the day, the young psychologist was exhausted. His shirt tail was out; his tie was down, and was absolutely exhausted. The older psychologist still had a spring in his step and was still full of energy.

Finally, the young psychologist asked about it. "How do you do it?" he asked. "I spend all day listening to people's problems, and it just wears me out. I'm exhausted at the end of the day, but it doesn't seem to bother you at all."

The older psychologist looked at the younger psychologist and asked, "You listen?"

Oops. Microsoft strikes again

I noticed today that my posts have been hidden by the footer when viewed in Internet Explorer. It worked fine in Firefox. I reloaded and tweaked the template and it seems to be working now.

Physics and Psychophysics

Over at Uncertain Principles, I got a few chuckles over the description of the activities of bored graduate students. University labs are the same all over. It was also neat to see that a student in his lab had reinvented the psychophysical experiments that gave me the name of this blog. Seems that the jnd for color perception is quite small.

Prayer and Psychology

Much of the shouting has died down since the release of Benson's much heralded study of the effects of prayer on the recovery of people going through heart surgery. Over at Science Blogs, there was much conversation over whether or not it was worth the trouble to perform a study where the outcome was obvious. PZ Meyers was especially critical.

The New York Times published several letters about the study today. Some contained the predictable rationalizations; other pointed out that prayer is beneficial to the one who prays, not to the object of the prayer.

Although, as I said in a previous post, negative results are never the final word, it is still true that the evidence that God answers prayers of petition is pretty weak. I don't think most people are surprised by this result. I believe in God, I pray, and I wasn't in the least bit surprised.

I never thought that prayers to God directly brought changes to this world. I live near a bunch of Civil War battlefields. Both Federal and Confederate armies prayed fervently for God's support. If prayer "worked," the slaughter on those battlefields never would have happened. Besides, if both sides pray for their side to win, what does God do then?

More facetiously, if God answered prayers of petition, how many 15 year old male virgins would there be?

I'm Jewish, and I attend a Reconstructionist synagogue. Reconstructionism is an offshoot of the Conservative movement, and falls somewhere to the liberal side of the Conservative movement. (Or, the traditional side of the Reform movement.) Although I have differences with Reconstructionism, I'm more comfortable with this approach than any other. It balances rationalism with tradition.

In the traditional service, there is a prayer said for the sick during the morning service, known as mi sheberach. It is a petition for God's intersession. The Reconstructionists added in a line praying for the physician to have "wisdom and sound judgment," but the prayer for intersession is still there.

So, what should I do? Should I demand that the prayer be omitted? No, and here is why:

First of all, our prayer book is an historical record, which links me to a very long history. Part of that history is the belief that prayers to God are answered. I may no longer believe it, but it's still part of me. It links me to my community.

Second, when I pray, I am reminded of my values. For many Jews, a central part of our belief system is that we must be partners with God in creation. That means that we have an imperfect world, and have to work things out for ourselves. God is not going to stop war or heal the sick. We have to do it ourselves.

So, when I say--or listen to--mi sheberach I am reminded that healing will make the world a better place. As I pray--sometimes--I sense God's presence, and am reminded there is more to this world than getting through the day. I am inspired to commit myself to my community and to work to heal others.