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Constructionism, Hermeneutics, and Phenomenology in Qualitative Psychotherapy Research – SEPI Lisbon Pre-Conference Discussion. Edited byTullio Carere-Comes
An intense and passionate on-line discussion has taken place from June 2, to July 2, 2007, among Michael Basseches, Daniel Fishman, and me, in preparation for our Symposium on “Understanding Commonalities and Differences in Psychotherapy: The Role of Qualitative Research”—SEPI Lisbon Conference, Sunday July 8, 2007. The Symposium will be preceded by a presentation by Michael Basseches and Michael Mascolo on Saturday morning on “Developmental Analysis of Psychotherapy Process (DAPP): Case Illustration of Methodological Advances in a Common Factors Developmental Approach to the Study of Psychotherapy Effectiveness, Similarities, and Differences”.
PART ONE
Tullio, 2 June 2007 Hi Dan, thank you for sending us your paper, which I found engaging and thoughtful as you kindly found mine. As I read it, I was reminded of the most interesting exchange you had with Barbara Held on your journal Pragmatic Case Studies in Psychotherapy, and felt the impulse to start a discussion here between the three of us in the same vein, friendly yet frank and straightforward. Although I wouldn't locate myself in the "mainstream scientific perspective" as Held (I rather feel at home in a broadly phenomenological perspective), I agree with her in most of her objections to your pragmatic constructionism. Basically, I agree with her that the refusal of any ontological reference for our theories (however founded, either deductively or inductively), dooms them inevitably to (post-modern) cultural relativism, which is hardly compatible with the very idea of science. In your last response to her, you underscore that your "concept of a knowledge system was explicitly set forth as a way to separate the internal assumptions and logic of a particular paradigm, culture, or language from the attitudes and beliefs of any particular individual or group of individuals". In other words, you claim that pragmatic constructionism can offer some sort of objectivity (therefore being entitled to be called scientific), to the extent that it does not depend on the beliefs of a group of individuals, but on the internal logic of a particular knowledge system. My first objection to this is that any knowledge system is grounded either on some ontological reference, or on the beliefs of a group of individuals. In the latter option, which is yours, the distinction you make between the beliefs of a group and the internal logic of the knowledge based on those beliefs is somewhat blurred, because any organized group tends to produce a theoretical system endowed with inner coherence. This leads to my second objection. You seem to endorse the currently prevailing view according to which any observation is theory-laden, and there cannot exist an observation endowed with some degree of theory freedom. This view seems bound to lead to theoretic-cultural relativism, since how can an observation insuperably conditioned by the theory of the observer work as judge on the validity of the theories of different observers? The researcher cannot help but organize the observation or the experiment or the case study according to their theoretic expectations. If experience is denied the role of external judge of the theories, the researcher is authorized to invent all sort of strategies to save a theory even in presence of conflicts with the data of observation or experiment. This basic fallacy is confirmed by the fact that it is virtually impossible to detect any difference among the outcomes of different psychotherapies, once they are corrected for the researcher's allegiance (it is the "Dodo verdict": Luborsky et al., 2002). Once the ontological reference is ruled out, I don't see how the Pragmatic Case Study Method could avoid the same Dodo verdict blind alley of the outcome studies based on Randomized Controlled Trials. It seems to me that the crucial point of research is not induction vs deduction (on this, I would agree again with Held that any scientific endeavor implies a convenient mixture of inductive and deductive procedures). The crucial point, as I see it, is the exploration of the middle way between dogmatism (which believes in the possibility of absolute, decontextualized truths), and relativism (in which any ontological reference disappears). Dan, I hope you will appreciate my challenge as you did with Held's. I look forward to your and Mike's comments to my comments.
Mike, 5 June 2007 Thank you, Tullio and Dan, for getting this fascinating discussion launched. I would like, in the following way, to structure my thoughts about where we seem to be as a panel, as well as my hopes about what I, reporting on the work of my colleagues working with the Developmental Analysis of Psychotherapy Process (DAPP) approach, might hope to contribute. First I would like to affirm what stands out as a strong common concern among the three of us, and then to note some of the areas of difference or controversy that stand out as we try to address this common concern. The common concern I see is that we are all strongly motivated to accomplish what Tullio states in his introduction: We seem to share the goal of bridging the "researcher/practitioner" gap. The work of the DAPP group has been guided by particular versions of this gap-bridging goal that I would state as follows: First, among practitioners, we are particularly interested in those practitioners who are motivated to reflect critically on their work with clients. For them we hope to provide a useful framework for evaluating their success in their work with individual clients -- useful in that it helps them to see the choices they make in the context of possible alternatives, and to reflect on which potentials of the therapeutic dialogue are being realized and which may be being overlooked or blocked. Second, among researchers, we are particularly interested in those who are concerned with "ecological validity or relevance" of their research to psychotherapy as it is commonly practiced, (as opposed to those whose wish is to eliminate much of current psychotherapeutic practice and to replace with an alternative, supposedly "scientifically based" form of practice, the foundation of which is "empirically supported treatments.") I hope the DAPP approach can provide those researchers with a transtheoretical framework that allows the idiosyncratic nature of successful work with individual clients to be recognized and documented, and allows common processes of successful psychotherapy and common obstacles to successful therapy to be recognized. And our hope is do this using a shared language that transcends the limited and highly theory laden language of specific schools of therapy, but nevertheless remains a language describing development of the person, unlike typical “outcome research” which documents symptom reduction or consumer satisfaction. It seems to me that there are differences between your approaches that are both epistemological and methodological. From where I sit, my approach in some ways seems like a middle position on these issues between yours (I don't dare claim it's a synthesis), but maybe from where you sit it just looks like another view. Regarding methodology, I think I agree with Dan that the focus on individual case analysis (including group/couple/family tx) is absolutely crucial. Like Tullio, in his acknowledgement of the work of the Boston change process study group, however I would value "especially the study of transcripts from videotaped sessions to see what really happens in a session". It is our experience even within relatively small bits of psychotherapy process that are captured on tape, it is possible to track (a) microdevelopmental transformations of meaning and action that are occurring, (b) the forms of developmental resources that the therapist is offering to the process, and c) the presence or absence of processes of mutual adaptation between clients and therapists. (Of course, in segments of therapy that participants identify as ones where something "very important" happened, these microdevelopmental movements are more likely to lead to developmental change of greater significance). Note that this can be done for various sizes "slices of therapeutic life" without the need for the type of flowcharts that Tullio and Dan (from Peterson) have offered. While I think these flow charts do represent valuable contributions to relatively generalizable maps of common macroprocesses that often occur within therapy, to me their limitation is that they seem imbued with ways of thinking about how therapy works that reflect particular traditions in the field -- Peterson with the "Assessment-Formulation-Action" model; Tullio with the idea that the starting point for therapy is the observation of irrational or incongruous behavior. When Tullio warns (below), that "The researcher cannot help but organize the observation or the experiment or the case study according to their theoretic expectations," I agree with his concern that the risks of Dan's PCS method is that even further embues the maps used to locate the data with limiting theoretical assumptions. Now of course, the DAPP method of analysis is not "theory-free", but the theory it is imbued with is not a "theory of psychotherapy" but rather an extremely general model of the nature of developmental movement and how it occurs in relational contexts, brought to bear on observations of what the interactions that occur across all forms of psychotherapeutic practice, regardless of the therapist's theoretical formulations. While we agree that the therapist's meaning making influences his or her choices, it is the developmental impact (or lack thereof) of those choices that we study, not the way the therapist understands what is going on. Now moving from methodology to related questions of epistemology, it appears that Tullio has suggested that Dan's view adopts a more relativistic epistemology, while Tullio wants to give his "mountain" an ontological status that will rescue this form of "science" (that we are all trying to articulate) from being subject to the life and beliefs of communities of therapists. Dan wants to integrate the work of traditional research by incorporating the findings of empirical study into the making meaning of cases that is the essential work of PCS. I think Tullio wants to integrate the value of traditional research on objectivity. However Tullio tries to clarify how this is best accomplished in psychotherapy research by focusing on "discovering the objective" and attempting to separate phenomenology/observation from theory, rather than by "verification/falsification-oriented" research, in which data-gathering is structured by theory rather than separated from it. Tullio writes: "But again, if every school, every group has its own science, it is like having no science at all. Because science means objectivity, and there can be no objectivity, if the subjectivity of the schools reigns unrestrictedly, and science is just a means used by all to gain respectability. We can have a science only to the extent that we agree that there exists one mountain—i.e., a common ground—of which the schools have explored each a different sector or, quite often, the same sector with different tools. We can make use of the contributions of the different schools to design a general map of the territory, but for this we need an approach as experience-near and theory-free as possible....The construction of a general map in the form of a series of interconnected flowcharts is the job of heuristic, not empirical research (either experimental or correlational). Heuristic comes from the Greek verb heuriskein, which means to discover. Heuristic means therefore discovery-oriented, as opposed to empirical, which refers to a research oriented to the verification or falsification of hypotheses." Do you both agree with my formulation of your differing epistemological assumptions, and differing ways of relating the new science we are striving for with the extant, or am I misinterpreting something here? If I'm understanding the issue correctly, I would definitely like to adopt a middle position, which I will try to articulate in my talk. On the core issue here, my view is that the cure to the problem of "every group having its own science", and thus both psychotherapy practice and psychotherapy research being limited by the shared assumptions of various communities of discourse comprising researchers and or practitioners, is the expansion of intersubjectivity to the point of its becoming (ideally) fully inclusive, not objectivity. My views on epistemology, scientific methodologies, and their relationship to the human condition are built upon those of the philosopher Jurgen Habermas. As we continue this discussion, I will be eager to hear your advice regarding how much exposition of Habermas would be feasible and useful to integrate into my talk. But with respect to this issue, Habermas’ perspective entails the view (agreement with Tullio?) that the acceptance of relativism as insurmountable is incompatible with the telos of science. And at the same time (agreement with Dan's emphasis on case-analysis as a context for cross-community dialogue?) it leads to the view that the limits of subjectivity and the intersubjectivity of limited human communities must be transcended through processes of dialogue across these communities. (And when interests other than in fully intersubjective knowledge--e.g, the interests of a community or members of a community in maintaining power vis-a-vis others-- distort the nature of dialogue, the effort to transcend of intersubjectivity can no longer be separated from effort to resist and reverse these inequities of power). So two final points for now, that I hope to emphasize in my presentation -- with more to come I'm sure as our discussion continues. 1. At the level of epistemology, I would like to focus on the distinction between sciences relying on hermeneutic method -- which have as their telos the expansion of intersubjective understanding (of meaning and value of events) both within and across communities of practice/discourse, and sciences relying on empirical-analytic methods, which presume the prior existence of intersubjective understanding of the meaning and value of events, and have the telos of predicting and controlling which events occur. (Habermas' third form of sciences (probably beyond the scope of our panel), those relying on critical method, have the telos of revealing distortions in intersubjective understandings that result from the role of those understandings in maintaining the power of the privileged). Personally, I think that for psychotherapy research, these distinctions among methods are more useful than the distinction between the "logic of proof" and the "logic of discovery". There are certain situations where it is appropriate for psychotherapy research to ask questions about prediction and control, and to use empirical analytic methods to answer them. There are also situations in which it is appropriate for psychotherapy research to ask questions about whose interests in power and monetary gain lead to shared distorted understandings of the nature of psychotherapy practice, and for psychotherapy research to use the more political methods of "critical science" to address them. But the fractionization of the field of psychotherapy, as well as the researcher-practitioner gap, to me seems like mainly a problem of lack of intersubjective understanding. I see as an appropriate solution to create frames of understanding that transcend the boundaries of communities, and allow a) for the translation and exchange of theoretical and practical contributions across these boundaries and b) for critical reflection of cases of psychotherapeutic practice across these boundaries Thus, it is trans-community hermeneutic methods of inquiry that our science most needs. 2. At the level of methodological offering, as I said in my abstract, the DAPP method is conceptualized as a hermeneutic one in that the analysis that is ultimately presented is itself an interpretation of the unique movement that is occurring within any instance of psychotherapy and of the processes by which that movement is occurring (and/or how such processes may be obstructed in therapies that are “stuck”). Thus the power of the DAPP interpretive framework lies in its measurable capacity to create dialogue and shared understanding (“psychotherapy integration”) among different sub-communities of therapists who may currently understand their work using theoretical, conceptual, or technical languages local to their sub-communities. Such shared understanding in turn facilitates comparisons and recognitions of differences across different cases and different approaches to psychotherapy. Now there is one other bridge with traditional research paradigms, that I think I suggested to Tullio for the panel description, but I wonder whether you think it is worth discussing given these other salient issues that have emerged across our presentations. Repeating what I said above, as I see it, the design of empirical analytic studies presumes shared understanding of the meaning and value of events. Within these frameworks, "inter-rater reliability" is often assessed, and it serves as a kind of check on that presumption. Reliability assessments ask how confident can we be that when one of us calls something an instance of "x category", that we would all agree that that's what it is. In hermeneutic inquiry, and I'll take DAPP analysis as an example, the description of the developmental movement occurring within a therapeutic session is offered as an interpretation, and the key hermeneutic question is "when I offer you, my reader, the interpretation along with the data, can you see the movement that I see?" And then, next step, when I put this side-by-side with an interpretation taken from a different region of "psychotherapy mountain", can you see the similarities and the differences in the way in which this developmental movement occurred. Or do you see something different from what I see, and is there a way of interpreting what happened that integrates our interpretations? It is through this process that intersubjective understanding is established. Now as a means to both developing and presenting our analysis/interpretation of a "slice of psychotherapy" we code the utterances using such categrories as "thesis statement", "antithesis statement (to x thesis)", "conflict statement (of x thesis and y antithesis)", "synthesis statement (of x thesis and y antithesis)”, as well as categories of (therapist offers/client uses) "attentional support", "interpretation", "enactment opportunity". Within the context of hermeneutic inquiry, when we check reliability of our coding (prior to presenting our analyses to readers), we are assessing to what extent are we ascribing meaning consistently to events amongst ourselves as a group of coders. This seems like a very reasonable step, and it illustrates an example in which quantitative methods are appropriately being used in the context of hermeneutic inquiry. To me, this reinforces that to frame the issue as one of "quantitative vs. qualitative" research, as it is most often framed in discussions of methodology in our field, is sadly inadequate. It is much more helpful to ask the question what are the appropriate roles of quantitative data and qualitative data in the context of hermeneutic research, in contrast with empirical-analytic research, and what kind of research is currently most needed by both researchers and practitioners of psychotherapy? In closing, let me reiterate what I see as additional important ways in which I hope to reinforce the very important points that both of you have made. Like Dan, I also believe that there is a need for psychotherapy research to focus on the individual case, because cases are unique and different enough that attempting to proceed by categorizing the client by dx or other characteristics, then seeking guidance from research on clients with similar characteristics, is going to distract the practitioner from the whole person and lead to a distorted view of the person as an exemplar of a type. For the researcher, it leads to missing or treating as error variance a lot of what is at the core of therapeutic practice, thus exacerbating the practitioner researcher gap. On the mountain, each therapy case is a unique journey, crossing territory shaped by both what individual clients and individual therapists bring, and ending, when successful with unique constructions that represent developments in the clients (and therapists) selves-in-relationship. But like Tullio, in looking at cases, I want to move beyond the language of narrow therapist communities for conceptualizing their practices and understanding their successes, and to allow us to look together at the whole mountain. Tullio and Dan, please accept my apologies for both the lateness and the less formal way in which I have joined this wonderful conversation. Since I find myself developing my thoughts for my presentation very much in the context in part of responding to the very clear and articulate papers that you have both written and shared, would it be ok with both of you if I went third when we present in Lisbon? I look forward to hearing your responses and to sharing my thoughts further. Tullio, 10 June 2007Dear Mike, here are some reflections on your most challenging post. 1. I did acknowledge the work of the Boston change process study group, but I did so "because it corroborates my view, as the more empirically oriented colleagues like the results of neuroscientific researches that fit in with their. We are all human, we are very happy when we can say that our opinions are scientifically validated or supported. But… I wouldn't say that this has much to do with the science we really need." 2. My idea is not that the starting point for therapy is the observation of irrational or incongruous behavior. This is one of the possible starting points, dialectically connected with the opposite: the empathic listening of the experience of the patient (this will be made clear in another flowchart). The aim of my research is to draw a map including the most common pathways ( i.e., interactive patterns) in psychotherapy and counseling. The knowledge of these patterns is in my view what more than anything else deserves the name of science in psychotherapy. The knowledge of the map facilitates the practitioner in the choice moment by moment of which path to take—or no path at all, if an unmapped journey is what the process seems to require at that moment. The knowledge of the territory is the science, as the capacity of using it freely and creatively is the art. 3. You say that the analysis of transcripts "allows common processes of successful psychotherapy and common obstacles to successful therapy to be recognized". But the Boston change process study group has shown, analyzing the transcripts, that real therapy is a most unpredictable and floppy process. Why? Because in real therapy science and art are inextricably intermingled, with a plain dominance of improvisation and floppiness. There is compelling evidence that success in therapy is much more a function of the relational skills ( i.e., the art) of the therapist, than of their technical-theoretical competence (the science). I am sure that the study of transcripts would be of great usefulness for learning tasks; I am not equally sure that it could produce a significant advance in the science of psychotherapy. In fact, success in therapy is basically a function of the therapist saying or doing the right thing at the right moment—which is the art, not the science, of psychotherapy. 4. The DAPP method is not theory-free, to the extent that it builds upon a general model of the nature of human development. The PIP (Psychotherapy Invariances Project) method is theory-free, to the extent that the aim of the cartographer is to draw a map that is as faithful as possible to the territory. To this aim, the cartographer is eager to receive feed-backs that point up any possible unfaithfulness or incompleteness of the map, in order to improve it endlessly to include newly opened or previously not recorded paths, or to correct any sort of biases or mistakes. 5. You say that "the cure to the problem of 'every group having its own science'… is the expansion of intersubjectivity to the point of its becoming (ideally) fully inclusive, not objectivity ", and you add that "the limits of subjectivity and the intersubjectivity of limited human communities must be transcended through processes of dialogue across these communities ". I am not sure to understand what you mean by this "transcendence", but to me the limits of subjectivity and intersubjectivity are transcended to the extent that one is willing to suspend (bracket off, put at stake) one's own persuasions for the sake of truth, i.e. for the sake of understanding how things really are, beyond one's subjective view (episteme beyond doxa). This does not mean that I believe in an observation from nowhere. I go round the mountain and observe it from different viewpoints, not from nowhere. But then, I don't aim at a negotiation or a gentlemen's agreement among the different views, but at a knowledge as objective as possible of the mountain, because real people walk there and I want them not to go astray and I want them to be able to find the way that is more convenient to them. In a similar vein, I don't know how dialogue works in your perspective, but in mine true dialogue happens only to the extent that people are willing to suspend or bracket off their opinions for the logos of the subject matter to reveal itself in the space opened between (dia) the dialoguing persons. The trouble with radical constructionism, as I see it, is that it forgets the mountain (the ontological reference), and if the real thing is forgotten, words like truth and logos lose their meaning. Yet if there is no truth but just a negotiation among individual or collective subjects, how can a true science exist? And if there is no logos, how can a genuine dialogue happen? 6. It is not clear to me, in this regard, why you see yourself in the middle position between Dan and me. Rather, it seems to me that your position is similar to Dan's, inasmuch as you both share a constructionist perspective that replaces objectivity with intersubjectivity. (Anyway, Mike, if you find it useful to go third at the panel, to me it is fine). 7. You say: "At the level of epistemology, I would like to focus on the distinction between sciences relying on hermeneutic method -- which have as their telos the expansion of intersubjective understanding (of meaning and value of events) both within and across communities of practice/discourse, and sciences relying on empirical-analytic methods, which presume the prior existence of intersubjective understanding of the meaning and value of events, and have the telos of predicting and controlling which events occur ." This dichotomy is too narrow to me. As I said before, I am among those who don't understand how a science could rely only on the hermeneutic method. Maybe you and Dan are aware of the same difficulty, and this may be the reason why you both add quantitative measurements from the empirical methods to your basically hermeneutic approaches. I agree that empirical methods are appropriate when the telos is that of predicting and controlling events—a telos which has some legitimacy in psychotherapy. But I, for one, don't share this telos. Psychotherapy, as I understand and practice it, is mainly a developmental and philosophical process, in which I hardly feel the need of controlling and predicting events. What I do need, is a knowledge that "may assist people to anticipate events, by sensitizing them to possibilities… this kind of anticipation occurs with an appreciation that the field may include will and choice" (McLeod, Qualitative research in counseling and psychotherapy, 2001). According to McLeod—and to myself—this approach (anticipating possibilities, not predicting and controlling events) is common to both hermeneutics and phenomenology. But hermeneutics, per se, cannot transcend subjectivity—therefore it cannot found a science. Phenomenology, on the other hand, focused as it is on grasping the essence of things, does not take enough into account that we are interpreting (meaning-making) beings and live in an interpreted world. Therefore, in McLeod's opinion and mine, the hermeneutic and phenomenological approach must be integrated: "The roots of all qualitative research lies in hermeneutics and phenomenology". But you and Dan have rooted your qualitative research only in hermeneutics, seemingly to the complete exclusion of phenomenology. As a consequence, your qualitative research cannot stand alone, and you have been compelled to look for the support of quantitative research in order to give a more scientific status to your research. 8. Dear Dan and Mike, I have dared address this extraordinarily interesting discussion in the style of the discussion that Dan (and Ronald Miller) had with Barbara Held on the journal Pragmatic Case Studies in Psychotherapy. I hope you will pay me back with the same ruthlessness, exposing the naïf realist in me, or whatever. Mike, 10 June 2007Hi Tullio, thank you for your response. It gives me a lot to chew on and will give it more thought and respond more. But I have two off the top of my head responses that stand out. 1) Maybe there is something I have never been able to "get" about phenomenology, and if anyone can help me with this, it's probably you, because I trust that we think about things in such similar ways. But it seems to me if one tries to understand a set of phenomena with a framework of understanding, it is like using a filter where you catch some things and not others. Someone approaching things with a different framework/filter will catch other things. If the two people compare what they caught, they will have a richer appreciation of what's "out there", and perhaps they can even redesign a filter to catch the important things that both previous filters caught. But if the idea of phenomenology is to approach a phenomenon with no theory, so structures with which to assimilate what one finds, no filters, isn't that like sticking a fishing net in a river with no netting, just the ring, insuring that one won't catch anything at all. What am I not understanding here? 2) Reifying the distinction between the "art of psychotherapy" and the "science of psychotherapy" deeply worries me. I would hope that all psychotherapists aspire to do the "right thing at the right time", and this is certainly in part a matter of trial and error (conducting little experiments and examining the results), i.e. science, broadly speaking. The more conceptual tools we have that help us generate options for how to respond, that help us to make the tough choices among these options, and that help us then reflect on the results of our experiments to determine the extent we have been successful or unsuccessful, and/or should continue to make similar choices or try something quite different, the better therapists we will be. While anyone can be a good therapist for some clients, I would much more trust a therapist with a "scientific attitude" (i.e. being ready to learn from experience), and with conceptual frameworks that facilitate such learning. I guess that's why I'm interested in addressing both practitioners and researchers who are truly open to learning from experience -- the scientists rather than the dogmatists. I suspect that would you call art and what you call science are both involved in the former, with what you call "science" being a bit more formalized, and in it's formalization being vulnerable to becoming dogma (as in manualized treatment!). Dan, 11 June 2007Hi Tullio and Mike, Your exchange was very helpful to me in better understanding your respective points of view. I want to mention that based on the last exchange, I agree with Tullio that my position is very close to Mike's. There was nothing Mike said in this last exchange with which I disagreed, and there was much that he said that expressed my point of view particularly well. In any event, you both did a great job in grappling with and clarifying the relevant issues. Dan, 14 June 2007Hi Tullio and Mike, I have found some time to think some more about SEPI presentation in light of your abstracts and what I have learned so far from our very interesting and informative email discussion. Tullio, I see the goal of what you propose as the discovery/isolation-and-articulation -- through an open-minded, "phenomenological" observation of actual therapy processes -- of general therapy processes across theoretical orientations. I'm assuming the end result of this process is illustrated by the two "Pattern" figures you sent us in your full paper. Mike, I would like to see a parallel concrete example illustrating the goal of what you are seeking in your DAPP system of analysis.For example, 1) Do youuse quantitative analysis along with qualitative analysis in your coding? and 2) Do you search for generalizations at the level of Tullio, or do you search for patterns of common processes as they are embodied in particular cases? In my own pragmatic psychology model, my goal is to create a database of published therapy case studies that are systematic and methodologically rigorous, and that generally (although not necessarily) follow Peterson's Disciplined Inquiry model in their overall structure, to facilitate cross-case comparisons. In my model, the way to generalization is inductive, from groups of case studies using similar approaches with similar clients. Examples of what I am seeking are the published case studies on the PCSP web site (http://pcsp.libraries.rutgers.edu ). E.g., see Vol. 1, Module 3 for a psychodynamic case, and Vol. 3, Module 2, for a cognitive-behavioral case. My model is trans-theoretical, in that it accommodates multiple theoretical orientations; however, it does require the practitioner to systematically set out whatever theoretical model he or she was using, not to focus on common processes per se. The first level of generalization, as I mentioned above, is within a particular theoretical model dealing with a particular type of client. However, at a later stage, these "first-level" generalizations could be inductively analyzed for generalizations about common processes across multiple theoretical orientations. In any event, a crucial aspect of any generalization in pragmatic psychology is that since the generalizations emerge inductively from specific cases, the generalizations are embodied/grounded in those cases. The logic of the system always allows the reader to trace back from the generalization to the specific cases and case examples that created these generalizations. I believe that the similarities and differences among our approaches is clarified and concretized by laying out the specific "products" that each of us are trying to create. At this point, it sees to me that Tullio and I are rather different, in that I am focusing more on collecting concrete, contextualized, thickly described case study examples, while Tullio is looking to go much more directly to identifying broad, general processes and patterns. Tullio, 15 June 2007Thank you Dan for the material on Rorty. I myself am a pragmatist, if it means a person to whom knowledge counts to the extent that it helps solve problems of, or give meaning to, everyday life, not that it looks for eternal truths. But I certainly disagree with Rorty when he maintains that "truth is not out there, separate from our own beliefs and language" (from the NYT obituary, highlighted by you). The horse-ness is out there, thanks to it every child knows how to distinguish a horse from a donkey, independently of belief and language. Human growth needs specific growth factors that are out there -- nothing to do with beliefs and language. We need some essential aminoacids, vitamins, minerals in our diet, however you call them and whatever you believe. There are also psychological factors that are essential, e.g. unconditional acceptance and confrontation. You can vary your diet, or the way you raise your children, in many ways, according to your tastes, preferences and beliefs. But you must introduce in your diet and your educational style (and your therapy) some essential, indispensable factors, if you don't want you and your sons (and your patients) to get (or remain) sick. These are not eternal truths, just essential truths inasmuch as they belong to the essence of the human species in the current phase of its evolution. And yes, you correctly synthesize my position "as the discovery/isolation-and-articulation -- through an open-minded, 'phenomenological' observation of actual therapy processes -- of general therapy processes across theoretical orientations." And I also agree on the way you define our difference: you are "focusing more on collecting concrete, contextualized, thickly described case study examples, while Tullio is looking to go much more directly to identifying broad, general processes/patterns." In fact, my approach is not inductive as yours. I rely mainly on processes of abstraction and identification of the inner logic of the different patterns. It is the same process applied in zoology or botany: you don't need many horses to describe the structure of the horse. Just a couple of exemplars will do. Thank you. --------------------------- Hi Mike, I have something to add to my previous post. Your worry helped me to better clarify my concept of science along two lines: general and local. 1. The general science of psychotherapy is in my view neither a collection of empirically validated procedures, nor a cultural construction. Rather it is the accurate and systematic, experientially (not empirically) based and supported, description of (a) the basic therapeutic factors (the 'common factors' of psychotherapy), and (b) the basic patterns of the therapeutic interaction. You know what I mean for (a), because you were so kind as to cite my 4-vertex model at the final session of the SEPI Conference in Amsterdam, 2004. As for (b), I sent you the first two of a (in my project) long series of patterns of the Psychotherapy Invariances Project, my next challenge. This general science (basic therapeutic factors plus basic interactive patterns) offers the therapists a map that help them orient themselves in the field of the therapy. But then what step to take, with the help of such a map, at a given moment in a given relationship, is much more a matter of art ( i.e., the ability of doing or saying the right thing at the right moment) than of science. It is like a painter who knows the basics of painting, perspective, etc, and decides in the making of a given painting which laws of painting to apply, and what to invent outside any law, in their individual interpretation of the subject they are representing on the canvas. 2. The second level is local, the therapist as local scientist (Stricker & Trierweiler). The therapist is an artist, to the extent that they interpret creatively the general science of psychotherapy to apply it to the individual case. But then they are again a scientist, to the extent that they monitor all the time the effects of whatever they say or do in the therapeutic relationship, and correct in real time their movements as a function of the feed-backs they receive. The therapeutic setting, beside being an atelier or scene where various scripts are represented and varied according to different interpretations, also is a scientific laboratory, where all sorts of hypotheses are formulated and put to test in the therapeutic relationship and everyday life, and even experiments are undertaken, in order to make discoveries or test hypotheses. The art of therapy is dialectically connected to the science of therapy at both levels, local and general. Dan, 15 June 2007 Hi Tullio, Your statement is very helpful in the process of our continuing to clarify our differences and similarities. Thanks Dan Mike, 18 June 2007see a couple of questions in bold below, then I'll try to move on to the rest of both of your contributions, responding as best I can, though selectively, in bold. (From Tullio, June 12) Hi Mike, Thank you for your observations. Here are my replies: 1. Consider the horse-ness, the essence of the horse. Every child knows how to tell a horse from a dog or a donkey, without using frameworks or filters. Would you not see the schemes and structures that Piaget and/or Vygotsky describe as "filters?" Both describe how the differentiations among different animals develop over time. If they used filters, every child, every community, every epoch would have their idiosyncratic horseness. Not according to either Piaget or Vygotsky.It is not so. The Chinese and the Italian child, today or one thousand years ago, know perfectly how to distinguish a horse from a donkey. The horse in my mind can be white and the horse in yours can be black, but this does not alter the horseness that we perceive, totally independent of our mental constructions, frameworks or filters. I guess I definitely view perceiving "horseness" as a developmental accomplishment based on the construction, with the help of experience, language and culture, of appropriate cognitive structures. While this accomplishment surely comes earlier than the constructions of structures that enable us to perceive what we call “psychotherapy”, both depend on experience language and culture. On the other hand, Heidegger pointed out that the 'natural attitude' that Husserl claimed to bracket off is in fact the 'fore-understanding', i.e. the interpretive horizon through which the world is understood. Heidegger disappointed his master Husserl, because he showed that phenomenology must be integrated with hermeneutics. Heidegger's fore-understanding is what you call 'filters'. You are right, filters are often necessary for a preliminary understanding of things. But if there are always filters between you and the world, you never get to the 'things themselves'. Even Kant said this, before Hegel tried to allow for development through dialectic. You use your filters as a net to catch things, but you yourself are caught in your net. You never get out of your net. At the most, you can modify your net, adding pieces of other nets. In the constructionist perspective there is nothing like an objective knowledge because in this view what we know is necessarily a function of our interests and needs. What I like about Habermas is that he articulates transcendental "human interests" that are constitutive of knowledge and that go beyond the "interests" of particular individuals or communities. Habermas, like Kant, uses transcendental arguments, that appeal to what makes knowledge possible (other than direct non-mediated access to the objective, which seems to be what you long for, Tullio. But do you really believe this is possible?) We only know what we are interested to know. The corrective to this, as Rorty (thank you Dan for the obituary) taught, can be dialogue. But what is dialogue in this perspective? Something like: let me use your filter, if I see something that is useful to me I will adopt it or build a new filter that integrates both. Nothing to object, save that what you integrate in this way is not the real thing, but different interests that generate different outlooks on the thing. Yes, indeed, what develops in development of knowledge, in my view, is always a more integrated and equilibrated relationship between human knowers and the “known” (e.g., the material world, but including critical reflection on our ways of interacting with it, e.g., psychotherapy). The question is then: is the hermeneutic approach the only way to knowledge? My answer is that it is not. The alternative is phenomenology. You don't throw away your filters; you just put them aside for a while. You try to empty your mind, to create a 'clearing' in which the true nature (the essence) of things could be seen. The crucial difference is that in the hermeneutic approach your try to grasp something, to catch something with your interpretive nets; whereas in the phenomenological approach you don't try to catch or capture anything, you just try to be as calm and silent and open as possible, so that something can reveal itself, can manifest itself to you (phenomenon means what appears, what is manifested). Two examples from our field. Kleinian psychoanalysts who go on hammering their interpretation into their patients' heads work in a pure constructionist way: they try to have their patient replace their non adaptive filters with the analyst's more adaptive filters (most behavior therapist work in the same way). By contrast, Rogerian therapists who never interpret but listen empathetical, try to create a space in which new insights can happen spontaneously: this is a phenomenological way of working. I am not saying that the one is better than the other. Both work. But the really good thing is when you have both arrows in your quiver, and use them alternatively or in combination in response to your patient's needs. A central distinction in the DAPP framework is between Interpretation and Attentional Support, and I think this is a useful way of distinguishing these two ways of working. But both foster the development of insights, not into things in themselves, but the client's experience of things.
2. I think that the distinction between art and science of psychotherapy is a very important one. Why do you think that I want to 'reify' it? Art and science are the two poles of a continuum. Science means knowledge (a knowledge as much as possible supported by experience or experiment), art means intuition and inspiration. In the floppy and unpredictable movement of a session, the therapist has to decide moment to moment what to say or do. Doing or saying the right thing at the right moment is much more a question of intuition than of knowledge, in my view. But intuition is much helped by the knowledge of the ground upon which one is moving. Let me cite from my Lisbon paper: "In my view therapy is the product of the creative and largely unforeseeable co-construction [and co-discovery] by both patient and therapist, not the administration of scientific procedures, empirically or even heuristically supported. On the other hand, it also stands to reason that the more knowledgeable the therapist is about the basic patterns of the field, the more effective his work will be. And by knowledge I mean not just declarative, but above all procedural knowledge, that is the know-how of a pattern: the capacity of working according to a pattern, not just knowing that it exists. An ideal therapist should be familiar with all the main procedural patterns of the field, and be able to apply them when indicated in the most flexible and customized way—as they should be able to set aside any pattern and work creatively to respond to the demands of the unique encounter with their patients." I guess more discussion of this is necessary; I suppose that if you believe that the "objective" is knowable, a distinction between the "knowledge base' that is applied and it's creative application to a new situation makes sense, but for Piaget all knowledge grows by a continuous series of creative encounters of ones schemes with new situations, and this process entails both assimilation and accommodation. What I meant saying that I am not sure that the study of transcripts could produce a significant advance in the science of psychotherapy, is that a successful session is above a function of the capacity of the therapist of working flexibly, fluidly and creatively. Sure enough, there must be much knowledge behind this capacity, but you don't see much of this knowledge in the transcript. I am saying approximately the same thing that you say here: " The more conceptual tools we have that help us generate options for how to respond, that help us to make the tough choices among these options, and that help us then reflect on the results of our experiments to determine the extent we have been successful or unsuccessful, and/or should continue to make similar choices or try something quite different, the better therapists we will be." I had a training analyst who used to say: forget all about theory when you enter the session--just work 'without memory and desire'. It is good to have much knowledge, many conceptual tools, but it is also good to forget all about that in the session, in order to be spontaneous and attuned to the relationship moment by moment. This is why I say that in a transcript you can see much more the art than the science of a therapist--unless the therapist is one who works by the book: that is a bad therapist. Tullio, 18 June 2007Hi Mike, thank you for your observations. I admit that my previous description of the relationship between interpreting and seeing can sound a little like naïf objectivism. Therefore, I will restate my position quoting firstly a passage from a paper of mine (http://cyberpsych.org/sepi/logic.htm ), and commenting on it. The dialectic of interpretation and neutralization has been described, albeit in different words (assimilation and accommodation), by Piaget. In the course of normal development the child firstly tries to assimilate all new data to her available cognitive schemata, ie she interprets them in the light of preexisting models, myths or theories. Piagetian assimilation substantially corresponds to hermeneutic interpretance, an ongoing, structural attitude of the human being. However, the healthy child does more than assimilation. Facing contradiction, she does not insist on trying to force reality into her schemata, but she finally suspends those schemata, stepping back and letting the new data enter into her horizon. In so doing, the child does not interpret, but sees something new, thanks to the suspension of the assimilative attitude. Instead of assimilating the data to her schemata, she accommodates her perceptive apparatus to the reality in front of her. The child's accommodation is the first embryo of phenomenology's epoché, in which the bracketing of expectations and preconceptions permits her to receive what appears in that opening. And it is only for this systematic neutralization that her schemata are modified and enriched. As you see, Mike, my position is as dialectical as yours. Yet my dialectics, being basically rooted in the ontological reference of perception, does not have a constructionist outcome. I agree that perceiving "horseness" [is] a developmental accomplishment, but the development I have in mind is one in which the child continuously corrects her schemes to adjust them to what she sees. So, in the final analysis, horseness is basically the same for every (healthy) child, every child can distinguish a horse from a donkey, independently of language and belief, because the process of seeing that happens in accommodation results in the objective perception of the essence of the thing (I am obviously speaking of the phenomenal thing, the thing that appears to the consciousness, not of the noumenal thing, the thing-in-itself, which is unknowable). When I wrote that "Every child knows how to tell a horse from a dog or a donkey, without using frameworks or filters", I was referring to idiosyncratic or cultural frameworks or filters, i.e. schemes in which a subjective (individual or cultural) bias is constitutive of perception -- as it seems to me to be the case in constructionism. But when I have caught the essentials of the horse, what permits me to distinguish it from all other animals, I have an essential image of the horse in my mind, an image that includes all that is typical of the horse. This is the essence of the horse that reflects well enough what is out there, independently of my language and my system of beliefs. I would not call this a 'filter', but surely the set of characteristics of the horse that make up its essence organizes in my mind as a framework or structure, and the construction of this structure in my mind is obviously a developmental accomplishment. I have no problem in admitting that we construct in our mind the images of things, to the extent that my constructions mirror what is out there, the ontological reference. Yet constructionism, as I understand it, denies the mirroring capacity of the mind (Dan does it explicitly, do you deny it too, Mike?). Construction is a basic and obvious activity of our perceptive apparatus, constructionism (as I see it) is a theoretical position that gives subjective (individual or cultural) construction a privileged status, to the detriment of the possibility of objective knowledge. Do I see it correctly? Maybe a way out of this conundrum is in Habermas' conception of "human interests" that are constitutive of knowledge and that go beyond the "interests" of particular individuals or communities. I don't know what precisely Habermas means by human interests. But if they are to go beyond the interests of particular individuals or communities, it means that the human being has the capacity to transcend all particular interests, or to suspend or bracket them off: this is exactly the function of the transcendental ego in phenomenology. You may not like the word 'phenomenology', but it seems to me that either you admit that the human being has the capacity to go beyond or transcend all particular interests, or you don't. What remains of 'constructionism', if you do? Finally, I see your central distinction ... between Interpretation and Attentional Support very much similar to the polarity assimilation/accommodation, or hermeneutic/phenomenology. And when you say that both foster the development of insights, not into things in themselves, but the client's experience of things, I agree to the extent that to me too the things in themselves (noumena) are unknowable: we don't have the things in themselves, just our experience of things. The crucial point, as we have seen, is whether this experience is rooted or not in our transcendental capacity of going beyond all particular interests. I suspect that the gap between our ways of conceiving of knowledge and therapy might be much narrower than it may appear at first glance. Thank you for helping me to clarify more and more my understanding of my and your position. |
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