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Editor's Note In preparation for the 2nd
Sepi- Italy Conference, held in Florence from 24 to
26 March 2006, Tullio Carere asked the speakers of
the Conference and the members of the Sepi listserv
to participate in an on-line debate. In his e-mail
dated 22 January 2006, Carere proposed a series of
questions which have been the starting point for a
rich and passionate discussion among 16 participants
(listed in the order in which they intervened) :
Tullio Carere, Paul Wachtel, John Norcross, George
Stricker, Allan Zuckoff, Hilde Rapp, Tyler
Carpenter
Tullio
Carere, 2 February 2006
Thank you
dear Hilde for your rich response, which reflects
your vision of psychotherapy as art and science -
which is also my vision. Medicine too is art and
science, but psychotherapy is such in a very special
way, given its kinship with natural sciences on one
side and human sciences on the other. Our field has
not yet been able to find a viable integration
between these two sides. You acknowledge that there
are "different traditions which are linked to
different practices", one "diagnostically driven",
and the other of "more humanistic type". But the
difference you underscore is between two opposite
thrusts, one adaptive/normalizing, and the other
actualizing/self-realizing. If this were the point,
your observation that "most good, and most
integrative psychotherapist would see a positive
value in both these endeavors" would solve the
problem, and the integration between the two
traditions would already have been happily realized.
In my view this unfortunately is not the case.
As a
matter of fact, there is a big rift between the two
sub-fields. Here is how I describe the relevant
difference: Those "diagnostically driven", as you
fittingly name them, apply the simple principle of
diagnosing a disorder, a problem, a need, or a
phase, and prescribing the (empirically supported)
procedures to fix the disorder or the problem, or to
meet the need or the phase. This frame of mind is
commonly called "medical model", because it
corresponds to the medical treatment as it is
conceptualized in our time. On the other side, the
adherents to the adversarial perspective, often
called "contextual model", maintain "that
psychotherapy is incompatible with the medical model
and that conceptualizing psychotherapy in this way
distorts the nature of this effort" (Wampold, 2001).
They propose as an alternative a holistic/contextual
approach, in which common factors are emphasized to
the detriment of procedures (which are reduced to
mere placebo). Both sides support their views with
enormous amounts of empirical research; both sides
maintain that the approach of their side is the one
that best meets the needs of the clients; and both
sides dismiss the other as simply wrong if not
harmful. As Westen put it, "the intensity of the
acrimony, the distaste, has never been so high."
If we want to come to terms
with this split, we might start with a few things.
To begin with, we should not deny its existence. A
way both sides have to dismiss the other is to
simply deny their existence as a partner of a
dialogue or a negotiation. If the other does not
exist, why should we waste our time with dichotomies
or polarities? It is pointless. Secondly, we should
get rid of the myth of scientific neutrality. If X
and the opposite of X are both empirically
supported, we cannot ask empirical research to solve
the problem (I am not saying that empirical research
is useless, but only that it cannot solve this
problem). Thirdly, it is clear that no
reconciliation is possible between the medical and
the contextual model. But do we really need them?
They are both abstractions far from everyday
practice. In the "common
sense" model every therapist makes use of some
procedures which they deem useful - therefore
they are not contextualist. But nobody applies them
in a protocol mode: they use heuristic,
rule-of-thumb procedures, and adapts them to the
present circumstances - and every patient
responds to their therapist's procedures according
to the way they understand them and the way they
need them. Everything happens out of a great deal of
improvisation and "sloppyness". Therapy works when
there is a good enough working alliance, which is
not the result of protocols, but of ongoing
negotiations. In the common sense perspective there
is room for both procedures and context: at this
level integration is possible, whereas what we get
from the protocol-driven and the contextual
perspective is the split of the field.
In the
common sense perspective it is not so important to
separate the procedures from the context. What is
crucial instead is to correlate process and outcome,
i.e. to understand what transpires in the clinical
(not the experimental) setting that explains the
progress, or the lack of progress. It seems to me
that empirical research is much more useful when it
tries to illuminate this matter, than when it claims
to prove or disprove the efficacy of procedures
independently of the context. This is my response to
my own questions.
Hilde Rapp,
6 February 2006
Tullio wrote:
<< You acknowledge that there are
"different traditions which are linked to different
practices", one "diagnostically driven", and the
other of "more humanistic type". But the difference
you underscore is between two opposite thrusts, one
adaptive/normalizing, and the other
actualizing/self-realizing. If this were the point,
your observation that "most good, and most
integrative psychotherapist would see a positive
value in both these endeavors" would solve the
problem, and the integration between the two
traditions would already have been happily realized.
In my view this unfortunately is not the
case.
As a matter of fact, there is a
big rift between the two sub-fields. Here is how I
describe the relevant difference: Those
"diagnostically driven", as you fittingly name them,
apply the simple principle of diagnosing a disorder,
a problem, a need, or a phase, and prescribing the
(empirically supported) procedures to fix the
disorder or the problem, or to meet the need or the
phase. This frame of mind is commonly called
"medical model", because it corresponds to the
medical treatment as it is conceptualized in our
time. On the other side, the adherents to the
adversarial perspective, often called "contextual
model", maintain "that psychotherapy is incompatible
with the medical model and that conceptualizing
psychotherapy in this way distorts the nature of
this effort" (Wampold, 2001). They propose as an
alternative a holistic/contextual approach, in which
common factors are emphasized to the detriment of
procedures (which are reduced to mere placebo). Both
sides support their views with enormous amounts of
empirical research; both sides maintain that the
approach of their side is the one that best meets
the needs of the clients; and both sides dismiss the
other as simply wrong if not harmful. As Westen put
it, "the intensity of the acrimony, the distaste,
has never been so high."
>>
I
entirely agree with you, Tullio, that the field at
this present moment is divided and that
debates are acrimonious. However, I would want
to argue that it is precisely because of this
situation that integrative psychotherapy- where the
emphasis is on the syllable –ative- ie an ongoing
process- is necessary , and that this was,
indeed, the stimulus for the origination of the
‘movement’ for exploring the integration of
psychotherapies. We have had four recognized
waves, the last being accommodative- assimilative
integration.
I
am, however not describing the status quo, but
rather I am actively and passionately pleading
for a fifth wave- as I believe are you- which
advocates for meta- integration. Meta-
integration can accommodate the historically
existing differences because increasingly
integrative therapists set store by and are skilled
in ‘negative capability’- ie the capacity to
tolerate paradox, uncertainty, contingencies and
ambiguity as inevitable properties of complex living
systems.
With this
comes the recognition that any integrative
‘solutions’ will be local and specific and are
likely to relate to single lines of conflict.
There are echoes here of Bion’s dream that there
could be a grid that would allow us to specify a
problem quite precisely- that we might be able to
formulate a coherent question by means of
which to interrogate reality. But there is also the
recognition that in fact we really proceed in a much
more random fashion, making use of
unexpected windows of opportunity, leaps
of the imagination, the availability of new
descriptive and analytic tools as information
technology improves, victims of the vagaries of
intellectual fashion and the vicissitudes of
everyday life as it presents populations with new
anxieties, new challenges and both news
defenses ( beliefs in panaceas, distractions
etc) and new solutions, real or imagined.
The new skill is not so
much the capacity to deliver sweeping answers which
unify a universe of discourse- this would be my
‘quarrel’ with Ken Wilber’s ‘integral psychology’ as
an attempt at a new ‘theory of everything’. The new
skill would be to have a methodology for
transforming conflicts between assertions and
positions by focusing on common needs and goals-
perhaps also common factors- but more strongly on
common functions: What is the function of the
client’s defenses or resistances? How do they
aim to meet the client’s needs- and which ones?- and
what are their priorities in terms of the client’s
assumptive world and value system? Is it bread or
honor ? As it were. Echoes of Maslow would figure
here and the contemporary expansion of his model
into a more differentiated hierarchy of needs
in Spiral Dynamics. It is an enterprise that is both
modest and bold.
Tullio wrote:
<<If we want to come to terms
with this split, we might start with a few things.
To begin with, we should not deny its
existence>>.
Agreed. We need to bear
the pain of its existence and accept splitting
and polarization as a part of the human condition
and hence also the professional landscape, and we
need to endeavor to understand the
psychological pressures which maintain these splits
and conflicts.
Tullio wrote:
<< A way both sides have to
dismiss the other is to simply deny their existence
as a partner of a dialogue or a negotiation. If the
other does not exist, why should we waste our time
with dichotomies or polarities? It is pointless.
Secondly, we should get rid of the myth of
scientific neutrality. If X and the opposite of X
are both empirically supported, we cannot ask
empirical research to solve the problem (I am not
saying that empirical research is useless, but only
that it cannot solve this problem). Thirdly, it is
clear that no reconciliation is possible between the
medical and the contextual model. But do we really
need them? They are both abstractions far from
everyday practice>>.
I am reading
this as description of the arguments advanced in the
split field rather than as statements of your
position- I am right in this? As you can see
from the previous response, I entirely agree
that the problems arises and is maintained by
the fact that both positions are ‘abstractions from
practice’.
Tullio wrote:
<<In the "common sense" model every
therapist makes use of some procedures which they
deem useful - therefore they are not
contextualist. But nobody applies them in a protocol
mode: they use heuristic, rule-of-thumb procedures,
and adapts them to the present circumstances -
and every patient responds to their
therapist's procedures according to the way they
understand them and the way they need them.
Everything happens out of a great deal of
improvisation and "sloppyness". Therapy works when
there is a good enough working alliance, which is
not the result of protocols, but of ongoing
negotiations. In the common sense perspective there
is room for both procedures and context: at this
level integration is possible>>
Hhmm… Yes I
agree that at the pragmatic level, as confirmed by
Lisa Najavits’ research, senior and/or
successful practitioners tend to be responsive to
clients needs and hence use whatever heuristic
approach moves the client on with respect to
insight and desired change. Experienced
therapists from widely different orientations
are therefore more similar to each other with
respect to their practice and their ‘theory in use’,
what ever their ‘espoused theory’, than they are, by
and large, to their more junior
colleagues from the same theoretical
orientation. It seems much more important to ask in
the first instance : what do you do? What does
your praxis look like? What are you aiming to
achieve, what are your goals? and only then to
ask for theory informed explanations of these praxis
choices…
Tullio wrote:
<< whereas what we get from the
protocol-driven and the contextual perspective is
the split of the field>>
I raise this in my
chapter about research- the protocol driven
perspective tends to have its home in the
research community, in that it is – for many- a
favored vehicle for formulating and testing
researchable questions in a reliable and consistent
way. We need ask population focused questions:
Does this approach work at all and if so how does it
compare to its competitors? Does this intervention
really work? For whom does it work? Does the change
last? Obviously, unless there is as much
standardization as possible there is no possibility
to compare what therapist A does with client A
to what therapist B does with client B. I
don’t believe there is a serious expectation that
therapy in natural environments should be carried
out in such formalised ways.
Once there is evidence that a
particular protocol does seem to deliver the desired
clinical change reliably, it would seem foolish, in
a cash strapped service, not to offer such
treatments. The issue then becomes what to do
with clients or types of clients who do not seem to
respond to generally effective approaches
designed to target the kinds of problems
these clients bring. Most researchers
and clinicians are modest enough to recognize
that such clients exist and that other forms
alternative help may be needed. Even
though advocates for a particular approach may not
see it as part of their brief to find out what
needs to be done, the extraordinary changes in
which cognitive behaviour therapy is now
conceptualized and delivered, including both
relationship and mindfulness focused approaches,
testifies to the openness of researchers and
practitioners to exploring new ways of working in
order to reach clients” that other beers don’t
reach”.
Once
there is evidence that something does work in
principle, we want to ask process questions
concerning how ( perhaps even
why?) it might do so. Within ‘hard science’
approaches this is done through experimental methods
which focus on observable and measurable
variables.
So called
‘contextual’ approaches do not ( or should I
say should not?) make any claims that the
‘soft’ science variables which underlie their
practice are ( with some exceptions) researchable by
certain ‘hard science’ means and they should
not be expected to produce equivalent outcomes.
This is not to say that they should be exempt
from the public health related question as to
whether their approach is capable of
producing reliable clinical change, ie
works in principle and works for particular
populations, and whether it works as well as
its competitors, or whether it has a competitive
advantage in relation to specific populations, and
should therefore be publicly funded.
Historically, contextual
approaches have struggling with descriptive
case histories and analytical formulations which
address how or why certain kinds of therapist
behaviours might successfully address certain kind
of client behaviours, such as defenses, thought
/feeling/behaviour patterns
(schemas) and how unconscious pressures and
relationships might play a role in both. They have
largely done so anecdotally, but in a way which is
recognized as a sizable body of expert clinical
opinion capable of guiding practice. There are good
reasons for these differences in epistemology and
methodology which I will come back to below.
Tullio wrote:
<<In the common sense perspective
it is not so important to separate the procedures
from the context. What is crucial instead is to
correlate process and outcome, i.e. to understand
what transpires in the clinical (not the
experimental) setting that explains the progress, or
the lack of progress. It seems to me that empirical
research is much more useful when it tries to
illuminate this matter, than when it claims to prove
or disprove the efficacy of procedures independently
of the context. This is my response to my own
questions>>.
I suppose the ‘common sense’
perspective is actually still an ‘uncommon
sense’ perspective. I agree, see above, that
it is a ‘both-and’ scenario, where the real
challenge for my proposed meta-integrative
approach is one of humility and cooperation in the
face of the complexity of the human condition and
the marvelous achievements of the moral
imagination we are capable of on a good day and the
awesome depths of depravity we seem to be able to
sink to on a fearsome day. We need
people who will examine the outer landscape of how
human beings negotiate their conflicting needs
through social contracts of one sort or another, and
for this behaviour focused ‘ normalizing’
approaches are extremely useful.
We equally need people who
plumb the inner landscape of how we attribute
meaning to our passions, dreams and fears. The
kinds of measurement that are fit for
calibrating a psychic plumb line that reaches
into the depths of meaning making are not the same
as those fit for regulating socially
adaptive behaviour by means of guidelines that
map our social skills.
However, social skills
without the attribution of meaning are empty,
mechanical and soulless, and
efforts after meaning without the social
skills to share them with others, leave people
isolated, without role or relationships on the
margins of the social world.
Only by each bringing to the
table the best we can offer by way of tools
for enquiry, ways of reaching out to lonely,
frightened, lost, confused and deeply troubled
fellow human beings, and ways of satisfying our
social institutions that taxpayers money is invested
ethically and effectively, can we move forward : in
other words only by integrating the fragments of
what we know and know how to do well, can we serve
humanity as psychotherapists and mental health
professionals…
This
means loosing our fear both of healthy competition
and of accountable co-operation…
Ken
Benau, 7 February 2006
Hilde
wrote:
<<However, social skills without
the attribution of meaning are empty, mechanical
and soulless, and efforts after
meaning without the social skills to share them with
others, leave people isolated, without role or
relationships on the margins of the social
world>>.
I simply
want to say, bravo! Having worked with many
developmentally challenged children and adults who
have deficits in social skills, but usually lack an
appreciation for the reason, i.e. one that gives
them meaning/purpose, to apply said taught skills in
the first place. The "depth" folks and the
"behavioral skills" folks have much to teach each
other, if we can only listen.
As a
serendipitous aside: an Asperger adult client
of mine recently ended a session telling me why he
believes there is a link (in Asperger's/high
functioning Autism) between deficits in mirror
neuron functioning and executive functions... I
don't know his theory yet, but he's obviously been
doing his reading and I am very curious... So I
should add, if we can listen to our clients,
too.
Hilde Rapp, 7 February 2006
Dear
Ken,
Thank you
for your feedback. I also have some experience
of working with people suffering from neurological
or developmental deficits and learning difficulties.
I am struck by the level of insight some
people do have into their difficulties and how
imaginatively they talk about them by making
use of metaphors where they lack access to – or the
capacity to understand- relevant scientific
research. We can often help by
amplifying their ‘naïve theory’ with research, where
we ourselves know any. This seems to help
clients make sense of their difficulty better. It
helps them to normalize and accept it and it
encourages them to co-develop and practice relevant
coping mechanisms with the therapist.
From a
practical perspective even a ‘superstitional’ pseudo
theory can function like this because any
explanation that makes subjective sense to the
client will lessen anxiety and hence lower the
threshold for responding to therapeutic
help…
I tend
to translate into appropriate language that a client
can understand something to the effect of “
Given what is going on in your brain/ nervous
system/endocrine system…etc it is to be
expected that you should have this difficulty. It is
a normal consequence of your impairment. Let
us look in detail at how this makes your life
difficult and let us work out together what
you might do to make it easier to
function despite your impairment…
This
can be learning to breathe, speak in a particular
rhythm to overcome dysarthria and speech problems
which seriously get in the way of communication. Or
it can mean helping a client learn to
understand the anxiety reducing effect of gaze
avoidance in intimate situations ( Michael Argyle
studied this in Oxford in the seventies), and
to help a client to use gaze avoidance with
awareness by learning to say to an
interlocutor: I am sorry I have difficulty
looking you in the eye while I talk to
you because it makes me loose my
thread…. And so forth…
All
this develops out of the therapist’s
deep respect for the client’s wish and need to make
meaning of their difficulties through listening
‘deeply’ as Rogers once put it. Our task is to
accept, amplify, clarify, and transform
what the client knows about themselves and then to
add, as necessary, new skills and understanding
which enrich the client’s repertoire.
It helps enormously if we
understand enough about normal and abnormal human
development and physiology and the effect of adverse
events and environments on both. To know
something about 1) normal responses to abnormal
circumstances or 2) normal sequelae of
abnormal development, or conversely, 3)
abnormal ( neurotic or psychotic) responses to
normal environments, and of course, 4)
developmentally normal responses to normal
situations is very helpful. It empowers the
therapist to convey to clients that their experience
is understandable and expected in the light of
research. This provides a sound basis
for helping people to drop developmentally
superseded defenses and to develop more age
appropriate ones, to overcome abnormal
defenses to’ objectively’ non threatening stimuli ,
and or to explore ways of using the
plasticity of the brain to bypass a current
loss or distortion of function.
Here it is
the ‘contextualists’, especially within
psychoanalysis and constructivism have rekindled the
passionate interest Freud had in understanding the
links between the physiological ( phi) and the
psychic ( psy) as he explored this and theorized
this in his project for a scientific psychology
by participating in neuroscientific research.
In addition, especially analysts, have been
revisiting and working collaboratively with
academic experimental cognitive and social
developmental psychology, while cognitive behaviour
therapists have from the outset been
grounded in academic research that
focuses on the connections between beliefs,
attitudes, emotions and behaviour. The difference
seems to be largely one of language, what is
impulsivity in one quarter becomes lack of
mentalisation in an other and what might be time out
and thought stopping in one tradition might become
reflective functioning in another…
It is
all out there for the taking if we are
not too frightened to leave our silos…
Tullio Carere, 9 February
2006
Tyler
Carpenter wrote:
<< To me to be therapeutic is
simply to say I got the mix right this time with
this person.
........
To split such things into
meaning-medicine-technique, except for the purposes
of teaching or
discussion, is to miss a
complete understanding of the entire phenomenon at
hand.>>
I agree, Tyler. It seems to me
that you apply a common sense model (like most
of us?). The problem with this model is that the mix
that looks right to you might look wrong or
arbitrary to others. If we don't rely on
empirically supported procedures (possibly because
our faith in the external validity of ESP is
too weak), how do we know that our mix is
right? If the validity of our work is not
guaranteed by the strict adherence to some e.s.
protocols (a guarantee widely accepted these
days), do we have any alternative to
producing objective material, like post-session
questionnaires or session recordings, to
monitor and document our work?
Tyler Carpenter, 9 February
2006
I suspect
that we all share more than a little "horse sense"
in our work, Tullio, though I greatly admire
the clarity and particularity that you
and Hilde bring to your explanations of what
you do.
For me
in the prison, where I work and play, there was a
period not a little like an initiation where
one is tested and left on one's own a lot. With
so much at stake you are watched carefully for
your ability to manage what comes your way and
to others. A gradual accretion of successful
public experiences gives you credibility and
things get easier and you're trusted and called
on for the tough stuff. In other words, one can
believe whatever one wants about what one does
(and others can think what they like
about you), but how things turn out is what
makes the difference. Perhaps that is the
prison version of EST. There are a lot of terms for
pseudo courage and ability in this sub-culture.
The issue is not what you call it or where
you said it came from, but what you can do. I
have to say that I thought I was pretty good
before I went to prison. Now I know, and so do
others, what I can and can't do. The best
complement I ever got was in a Super Max when
the Captain, who had heard others refer to me
as "Doc", asked me if I was one. I told him I
was one and he reacted with vehement disbelief for a
few weeks until I showed him my license. I
asked him why he didn't believe I was one and
he said simply "You don't talk like one." In these
places it boils down to the
basics. I once watched while a consultant
(chosen by some experts new to prison work) who
spoke all the right behavioral stuff came to help
out a stalemate in maximum segregation. I have
an M.A. in general-experimental psychology and
understand what operational analysis supposed to
accomplish. The consultant used models that
came from the literature that completely
failed to take into account factors that drove
the behavior and undergirded the system. The
result went nowhere. Whatever you call it and
wherever it comes from, it won't work if you
don't know how to apply it. This is the
great lesson of places like prisons. People
come from outside to apply what works one place
without understanding the context. John Gall's
"Systemantics" is a marvelous example of the
importance of thinking about context and what
goes in it and how that might change what
happens in strange and chaotic ways. Part
of the problem is to go beyond articulating the
divisions and take the leap into talking about
how meaning is simultaneously diagnostic
and biological and dynamic and contextualized
in systems. The only SEPI presenter I ever
talked with who would directly talk about the
more molecular levels of system and their
interaction with things like meds was Bernie
Beitman. When he talked about how people needed to
want to change for meds to work I was floored.
Now after working with dangerous and
psychotic character disorders for years at a
stretch, I see how the seams to the work can be
brought by the therapist's models and that when
transmuting experience in the dyad with a
treatment team and multiple models and multiple
staffs reduces symptoms and brings satisfaction,
that 's the kind of result that goes beyond
models and arguments. Our team had a
marvelous time talking about a stalker whose
vulnerabilities were ego syntonic.
How
do you talk and think about target for meds
when there is critical disagreement on meaning
between patient and team and context is variable,
but necessary to get therapeutic leverage?!
I'd
love to have a fraction of the protected time I had
as a junior PI at Harvard now as a clinician in
the trenches, but am too busy putting out
the fires that are brought my way.
Tullio Carere, 20 February 2006
Hilde wrote (on
February 6):
<<The new skill is not so much
the capacity to deliver sweeping answers which unify
a universe of discourse- this would be my ‘quarrel’
with Ken Wilber’s ‘integral psychology’ as an
attempt at a new ‘theory of everything’. The new
skill would be to have a methodology for
transforming conflicts between assertions and
positions by focusing on common needs and goals-
perhaps also common factors- but more strongly on
common functions: What is the function of the
client’s defenses or resistances? How do they aim to
meet the client’s needs- and which ones? - and what
are their priorities in terms of the client’s
assumptive world and value system? Is it bread or
honor? as it were. Echoes of Maslow would figure
here and the contemporary expansion of his model
into a more differentiated hierarchy of needs in
Spiral Dynamics. It is an enterprise that is both
modest and bold.>>
I
agree, Hilde. Every theory of everything is bound to
clash with other theories of everything, as
religions have always done and still do. An
"integral psychology" has more to do with
integralism than with integration, in my view. And I
strongly endorse your idea that in order to
transform conflicts between theories we should focus
on common needs, goals and functions. My own
formulation of the same idea is that in order to
transform theoretical conflicts we are bound to move
to a non theoretical ground - and this ground is the
common ground where we find all common needs, goals
and functions. This implies that we don't need a
theory of the common ground - if I put forth a
theory of it, somebody else will put forth another
theory that will be no less empirically supported
than mine, and there we are again. This is where the
common sense comes in.
You write:
<<I suppose the ‘common sense’
perspective is actually still an ‘uncommon sense’
perspective>>.
Yes, common sense is still
quite uncommon. But we can try to make it a little
more common, if we understand how badly we need it.
Many believe today that psychotherapy integration
can only happen on the ground of empirical
(especially experimental) research. I believe that
this belief is the main reason of the big rift in
our field. Besides, it encourages all schools to
empirically support their theories, and in the end
the Dodo bird is the one who wins. The faith in
empirical research, as applied to psychotherapy,
does not seem to have any integrative effect on our
field. To the contrary. If we hope to be able to
communicate among us, shouldn't we return to the
commonalities (to the things themselves, as Husserl
put it), i.e. to the basics of experience? And how
do we get to these commonalities, if not on the
ground of common sense, that is the sense that is
common to everybody who is willing to use it? We all
can use our abilities of intuition and argumentation
(nous kai dianoia, as the Greek knew well), but the
correct use of these requires a disciplined mind, a
mind that disciplines itself by means of epoché, or
suspension of memory and desire, or similar ways. Of
course this is quite unzeitgemaessig for our
undisciplined Zeitgeist. Yet, controlled clinical
trials and statistic processing of data are poor
substitutes for disciplined minds. Maybe a growing
number of therapists and researchers will realize
that. If this happens, common sense will be a little
less uncommon in our field.
Hilde Rapp, 20 February 2006
Dear
Tullio,
Thank you
and a general reply in haste with apologies: John
Norcross was quoted in the UK guardian this
week ( have you seen it John?) with a sort of reply
by Andrew Samuels, a prominent Jungian- in a piece
which argued, as you have done, Tullio, that there
is practically a war on between lets say the
psychoanalytic and person centered imagination and
the empirically researched approaches to
treatment. Although probably not meant to be
inflammatory, Andrew argued that some people need a
more sophisticated, ‘nuanced’, as he called it,
approach.
I
think this is unfortunate because its draws false
distinctions, to which Paul Salkovkis would
justifiable rise with passion. Both sides are
sophisticated and nuanced, both sides set store by
‘epoche’ ( I do too, and strongly- although I also
humbly think we are relatively bad at suspending
preconceptions as a biological species – at least we
should aim for it!) both sides are well
schooled in philosophy of mind and science- and both
sides are passionately committed to bettering
the lot of suffering people.
That
is the common ground position.
So why
the near war?
In the
seventies there was a fierce Methodenstreit- a
battle of methods between the ‘human sciences (
Geisteswissenschaften) grounded in hermeneutics ,
lead by the Frankfurt School ( TW Adorno) on one
side and Karl Popper as the representative of the
positivist camp on the
other
( contributions were collected by Erst Topitsch
in German)…We should really get round to recognizing
that we do precisely neither have a theory of
everything nor a corresponding epistemology for
everything that is coherent and systematic. We
can understand facets in detail and we can
understand the relationship between these
facets in general, ie we can have a metatheory
which helps us to locate and relate facets of
understanding to one another.
It is
surely positive that we can and do have vigorous,
passionate, and on occasion, even rigorous debates
about which shoe fits which foot and which glass
slipper does not.
My only
regret is that we do, all too often get
carried away by our passions to the extent that we
forget to be respectful. Then we argue ad
hominem instead of ad argumentum or factum
- and we forget that not everyone speaks Latin
or statistics or Latino-Greek nosology and
psychiatric classification or post modern
contextualist jargon – or dare I say it- English!.
So we should be polite and
translate.
We
need to humanize our dialogue without loosing our
commitment to the original Platonic purpose of
dialogue- namely to arrive at approximations to the
truth(s).
We
also need to humanise the dialogue in the sense of
remembering that much of the quarrels are not about
truth(s) or facts, but about values.
Values, by
definition are not strictly speaking , based on
rational decision making or indeed empirical
validation- as both researchers and modelers know
only too well. They are about life choices, about
preferences, about ethics and aesthetics.
These
preferences will never be unified- and in that sense
Andrew Samuels in right- our tastes will
always be nuanced and there will always be people
who prefer one style of therapeutic interaction to
another.
There is – in my view-
however far too little serious dialogue about
the basis on which decisions are made about
funding psychological services and what
epistemologies and models , methodologies and
methods can be agreed to be
mutually acceptable to demonstrate that
services deliver the outcomes they are set up
to bring about ( Health Technology Assessment,
in the UK) . Here we get into health
promotion, social inclusion, ethics, health
economics and models of needs assessment and
so forth : what the public may demand/want may not
actually meet their assessed need ( I have early
lung cancer \and I want a fag, may meet a
psychological need but contravene a medical
one) and what services want to supply may meet
demand, but not need ( I want to sell cigarettes
because I have a pile of them, but people actually
need food). This no longer has much to do with
theories of psychotherapy- although it does have
something to do with models of (wo)man, philosophy
of science, and the mind and morals…and it also has
to do with research by medical anthropologists ,
sociologists and social psychologists…
Paul Wachtel, 20 February 2006
Hi Tullio
and Hilde,
Looking
forward to seeing you both soon. Tullio, I
think we will find, when we get into the in-person
discussions, that, as we might expect, there are
both agreements and disagreements (which is, of
course, what makes the whole thing
interesting). I think one of my biggest
disagreements is that you have, in my view, much too
much faith in the "disciplined" mind. As I
think I stated in a previous exchange on the sepi
listserve on Bion, "without memory or desires" seems
to me like with
self-deception. But apart from the
specifically Bionian version, I simply don't think
we can be nearly as
disciplined as you give us credit for. I think
the entire scientific enterprise dovetails exactly
with Freud's main message (even if Freud himself --
perhaps illustrating the very point -- didn't always
heed this) -- that our capacity for self-deception,
for seeing what it is convenient to see, is utterly
enormous. The controls of systematic empirical
research are not a perfect solution, not a
panacea, and it is certainly true that if we take
the findings of any particular study (or even line
of study) as gospel, this is just another form of
self-deception. But I still think that the
controls of systematic empirical research are very substantially better
than the "discipline” the lone clinician can
muster. So, although I myself have not been
primarily an empirical researcher (and hence, as you
might imagine, I don't believe that is the only path
to knowledge) I do
believe that disciplined and serious critical and
integrative thought (which, I guess, is what my own
contributions largely consist of -- when I'm doing
well) cannot be very useful unless it pays very serious and careful
attention to systematic empirical
research. Reversing your sentence, I would say
that "disciplined minds" can be poor substitutes for
controlled clinical trials and statistical
processing of data -- although I don't think
controlled clinical trials are always the best way
to investigate particular questions and indeed, are
often used (and set up) in highly tendentious and
misleading ways. Critical thought is always
needed. I'm certainly not advocating giving up
our minds for our statistical programs. But I
think you are too cavalier and dismissive toward
empirical data. The dodo verdict either
reflects a real phenomenon (in which case we need to
take it seriously in our thinking) or poorly
conceived and biased studies (in which case we need
to examine the sources of potential bias and do
better studies), but it is not a reflection of the
inadequacy of empirical research per se.
I'm all for common
sense. But unaided
it often doesn't get us very far. Common
sense tells us the world is flat, the sun revolves
around the earth, etc. Quantum theory,
relativity theory go against "common sense."
Sometimes, it is the non-intuitive, the idea or
finding that challenges
our intuitive sense of things that is what we need
to be open to.
If you're
saying that we need to be wary of the arrogance of
the "empirical" or "scientific" finding (also to be put in
quotes) I am 100 percent with you. But if we
substitute for that the arrogance of our clinical
observations, or intuition, or common sense, then we
have gained very little.
But enough.
It's hard to do this at a distance (I'm not of the
generation of instant messaging) and it always
sounds more adversarial when put this way.
When we see each other in a few weeks, and can talk
about it over a cappuccino, then we will make progress
in the conversation.
Paul Wachtel, 20 February 2006
Just read Hilde's
contribution after sending the reply to
Tullio. I think in many ways Hilde is making
similar points to the ones I made. So when the
three of us (and John,
and whomever else) have that cappuccino, my guess is
that (a) we will have a very interesting
conversation [actually, that one's a no-brainer --
because the people
aren't); [b) that we may well find that our
particular points of agreement or disagreement are
different than they seem on the email
exchange. I say this because I assume (I think correctly, that
however the conversation has been tilting in
response to previous tilts [ad infinitum?] , we all
in fact agree that there is no single path to truth
and that multiple perspectives are essential.
So what will get really interesting is when we try
to go past that bland generality (which also, of
course, happens to be at the same time a profound
truth) and see just where and why we do depart.
David Allen, 21
February 2006
Tullio, Hilde,
Paul:
Don't we all agree
that we need both empirical research to reduce the
biases of clinical observations AND clinical
observations to reduce the inherent limitations of
our ability to measure psychological constructs in
empirical research? Not only scientists but
patients responding to psychological measurement can
deceive themselves as well as others. The two
methods of discovery compliment one another to my
mind; another example of "both-and" thinking rather
than "either-or" thinking. In the same
dialectical vein, of
course every "theory of everything" generates a
competing theory of everything. The two of
them are then reconciled, generating yet another
thesis-antithesis-synthesis. This is how
knowledge grows as we get closer and closer to
truth. I think this is an argument in
favour of the genesis of metatheories, not
against it.
Andre Marquis, 22 February 2006
Dear Paul, Tullio,
Hilde, David, and everyone else:
To begin, I’d like
to briefly introduce myself to the SEPI members and
express my heartfelt thanks for a community that
seems so genuinely devoted to non-parochial
dialogue, in contrast to acrimonious debate. I join
this discussion as assistant professor of counseling
and human development at the University of
Rochester, a mental health counselor fortunate to
have been mentored under Michael Mahoney, a founding
member of Integral Institute, and one of my primary
interests is exploring various avenues of
psychotherapy integration.
I have been reading the
discussions on the SEPI listserv for the past four
months, wondering when I might chime in; when Hilde
mentioned Wilber’s Integral theory, I recognized my
cue, which is also pertinent to the current dialogue
on the role of empiricism and evidence-based
practice. It does seem clear that the vast majority
of SEPIites are deeply sympathetic to the current
emphasis on accountability and recognize the need to
ground our practice in evidence. It is necessary
then, even if elementary, to delineate what forms of
inquiry and evidence constitutes legitimate forms of
data. As Gerald Davidson recently wrote http://www.apa.org/divisions/div12/homepage.html <http://www.apa.org/divisions/div12/homepage.html> , let’s bear in
mind that “empiricism” derives from “based upon
experience.” To limit our evidence to strictly
controlled randomized clinical trials seems limiting
indeed. I am certainly not opposed across-the-boards
to the EST research protocols, but the stringent
exclusion criteria, lack of clarity regarding
reporting therapist characteristics, problems with
strict adherence to manual-driven therapy, and
less-than-optimal follow-up reporting (to name a few
criticisms; EST critiques abound: Andrews, 2000;
Carroll & Nuro, 2002; Messer, 2001; Miller,
1998; Persons, 1991; Seligman, 1995; Slife, 2004;
Slife & Gannt, 1999; Weisz et al., 2000; Westen
et al. 2004; Westen & Morrison, 2001) suggest
that a plurality of complementary methodologies
would more comprehensively inform our clinical work.
And here is one of the many
controversies where I view the AQAL model
(All-Quadrant, All-Levels, all-lines, all-types,
all-states) of integral theory being particularly
informative. Wilber’s quadratic model (I’ll confine
myself here to quadratic issues) represents the
interior and exterior of any occasion, individual,
event, etc. That occasion, individual, event etc.
can also be viewed as an isolated occasion or
contextualized within larger systems. So, the inside
and outside of both an individual/occasion and the
larger systems/collectives in which that
individual/occasion emerges yields 4 distinct
perspectives from which to view and conceptualize
any phenomenon. Reminiscent of the parable of the
blind men arguing about what the elephant
actually was, it seems to me that systematically
integrating methodologies from at least those 4
perspectives would mutually-inform each perspective
and generally enrich the communicative exchange
between researchers and clinicians. A simplified
example of methodologies from each of the 4
quadrants appears below: (I just realized that a
figure loses its formatting via email so it's more
of a list; imagine the intersection of two axes:
interior/exterior and individual/system)
The
Four Quadrants and Methodologies Appropriate to
Psychotherapy
Individual
from Interior: (Subjectivity):
Phenomenological analysis of
clients’
experiences of therapy (Rogers, Bugental, May)
Individual
from Exterior: (Objectivity): Empirical
investigations –
from
EST/RCT methodologies to other “objective”
approaches such as
neuroscience
(Damasio, Siegel, LeDoux)
System
from Interior: (Interobjectivity): Systemic
analyses (including
videotaped
sessions) ala Greenberg’s (1999) intensive
observation,
measurement,
and analyses of concrete-change performances; as
well how
client
and therapist engagement evolves
(social-autopoetically); any
other
external analyses of systems such as of
environmental consequences
that
impact client outcomes
System
from Exterior: (Intersubjectivity):
Interpretive inquiry in
general
(Riouer, Gadamer, Giorgi) including hermeneutic
investigations
of the
intersubjectivity/in-betweeness/fit of client and
therapist
(Stolorow
et al)
An integral approach to
psychotherapy research calls for an integration of
research methodologies – honoring the values and
limits of each approach – and anticipates that a
coherently organized pluralism of inquiries (an
“integral methodological pluralism”) will help
advance our understanding of psychotherapy process
and outcome far more than one narrowly-defined form
of empiricism will. Although Hilde Rapp’s writings
are among my very favorite on the SEPI listserv, I
don’t understand the nature of her “quarrel” with
Wilber. As someone deeply familiar with his work, I
don’t consider it accurate to say his project is to
“unify a universe of discourse” so much as it is to
provide a conceptual scaffolding (AQAL) with which
many of the parochial and acrimonious debates can be
transformed into mutually-enriching dialogues,
hopefully facilitating both humility in each camp’s
claims to total knowledge and a heightened curiosity
about how other perspectives can enrich their own.
For example, Wilber’s quadratic model nicely
assimilates Hilde’s “four simple distinctions to map
the field – each of which connects into a particular
tradition of enquiry” (see below). In a similar
manner, many approaches that appear irreconcilable
(medical and contextual) are, from the
meta-perspective of integral theory, not only
reconcilable, but mutually enriching.
The
Four Quadrants and Hilde Rapp’s “four simple
distinctions to map the
field –
each of which connects into a particular tradition
of enquiry”
Individual
from Interior: “I. exploring subjective
experience”
Individual
from Exterior: “ III. Examining and measuring
bio-social
determinants”
System
from Interior: “II. Exploring
cultural patterns of meaning
making”
System
from Exterior: “IV. Investigating the
effects of
social-political-environmental-economic
regulation of society”
Hopefully the "figures" of the
four quadrants reveal that an integral approach (and
there is not just one approach to integral; it is a
broad framework capable of assimilating and
accommodating tremendous diversity) transcend
dichotomous positions. No one perspective or
methodology is inherently privileged over others in
all cases. Yes, one approach may be more appropriate
than another based upon developmental issues or a
host of other factors (quadrants, lines, states,
types, etc.), but no “pure-form” approach or
methodology hegemonically dominates within the
integral metatheory.
I also do not think that all
meta-theories necessarily clash with or contradict
other meta-theories. Wilber’s integral metatheory
(2000a; 2000b) and Mahoney’s constructive metatheory
(2004) are illustrative of this. Both Wilber and
Mahoney are not only sympathetic to each other’s
work, but Mahoney and I (2002) have written together
on “Integral Constructivism”, though that article
was far from a genuine integration of those two
metatheories. Also fundamentally commensurable with
those two metatheoretical approaches is the
Transtheoretical approach (Prochaska,
DiClemente, Norcross) which is something akin to
another metatheoretical approach.
To address very briefly
Tullio’s initial question regarding why
psychotherapists are so much divided, I want to
suggest that the very boundaries that separate and
divide therapists also connect them simultaneously.
Strict empirical methods will never disclose the
qualities of lived-experience or what makes a life
worth living, just as phenomenology will never
reveal the neurobiological underpinnings of our
experience. Am I naïve, or isn’t it becoming
increasingly clear that our understanding of human
nature, psychopathology, and change processes will
be increased by a metatheorical scaffolding that
honors the validity of different epistemologies,
recognizes the limits of each, and provides a
systematic way to organize them such that the
different approaches synergistically complement,
rather contradict, one another? I believe that
Wilber’s integral theory is capable of lending a bit
more room for, and order amongst, the many
differences we find in the field of psychotherapy.
Simply consider the differences between radical
behaviorism and classical psychoanalysis. Their
conclusions were virtually opposite, but what else
would you expect when Skinner posited that the only
data worth studying are externally observable
behaviors and environmental contingencies and Freud
was primarily concerned not only with internal
experience, but largely unconscious determinants of
experience. Skinner privileged looking from the
outside; Freud privileged “looking” from within.
It’s not that one of them was right and the other
wrong. They were both partially correct and both
partially limited because they didn’t look at the
subject matter from more than one perspective.
An article I wrote with Wilber
for the issue of Journal of Psychotherapy
Integration devoted to unification briefly touches
upon some of these issues, though we were asked to
keep the article to 5-10 pages, which was quite a
challenge. I am beginning to work on a much longer,
more detailed article on Integral Psychotherapy and
its meta-theoretical approach to psychotherapy
integration that I will submit to JPI.
Paul Wachtel, 22 February 2006
Dear Andre,
Welcome to the dialogue and
thank you for your stimulating contribution. One
question about which I am unclear – what makes the
first set of examples of system from interior
"interior" and systemic from exterior "exterior"? If
anything, I would at least initially think of
watching the video tape as "exterior" and
interpretive, intersubjective thinking as more
"interior. Was there a typo, or am I missing
something basic?
I am clearer about exploring
cultural patterns of meaning making as in a sense
"interior" and investigating the effects of
social-political-environmental-economic regulation
of society as "exterior."
But finally, as one more
difference among us that probably also needs to be
taken into account (and, of course, eventually
integrated, or at least the attempt made to bridge the
dichotomies), I am aware that, although I feel
largely in agreement with much of what you are
saying, and find some of it extremely perceptive, I
am also, by inclination, somewhat suspicious (this
is not quite the right word– sounds too hostile;
maybe "disinclined toward" or something like that)
of schemes that are too abstract. Your illustrations
help to concretize. But there is something in the
overall scheme that feels like it looks too much at
the world from outer space, denoting that, as we
mortals clash and bump into each other, we are
missing that there is north, south, east, and west
(even though, to be strict about it, those axes are
more earth-bound than universal in a literal sense).
I am deeply committed to theorizing, but I guess a
bit more skeptical about "meta" theorizing. It has
the danger to me of being a little too up in the
air.
But again, that is a matter of
taste and style, not a critique. I mention it to
alert us to still another way in which we can sail
by each other, blithely unaware of other
possibilities because they are not coded to appear
on our radar screens.
Andre Marquis, 22 February
2006
Dear Paul,
Thanks
for your prompt reply. You are correct that I made a
typo regarding systems from the interior and
exterior (I accidentally reversed them; I apologize
for that and appreciate your attending to details).
It should have looked as you suspected:
System
from Exterior: (Interobjectivity):
Systemic analyses (including
videotaped sessions)
ala Greenberg's (1999) intensive observation,
measurement,
and analyses of concrete-change performances; as
well how client and
therapist
engagement evolves (social-autopoetically); any
other external analyses of
systems
such as of environmental consequences that impact
client outcomes
System
from Interior: (Intersubjectivity): Interpretive
inquiry in
general
(Riouer, Gadamer, Giorgi) including hermeneutic
investigations of the
intersubjectivity/in-betweeness/fit
of client and therapist (Stolorow et al)
I also appreciate your wariness
of overly abstract schemes. Although it may not have
been clear in my previous reply, I am committed to
theorizing only to the extent that it translates
into more effective practice. Of course, there is
the matter of how to evaluate if any theory actually
improves clinical practice, and that is part of the
dialogue that has been taking place throughout the
last week on this listserv. That will also be part
of my career-long research agenda. There is also the
issue of the different ways that theories can
facilitate more effective practice (for instance, by
changing the therapist, in contrast to changing the
specific interventions used).
As I
mentioned, many, many of the details of an integral
approach to psychotherapy integration (PI) remain to
be worked out. And there won’t be just one working
out of it. Whether from journal publications that
receive critical responses, dialogues on this
listserv, my own clinical experiences, or more
controlled experimental research, disconfirming
details will hasten my accommodating integral theory
to “fit with the facts” or “down-to-earth”
practicalities of clinical practice. Thus, much of
my challenge will involve a delicate balance of what
integral theory’s AQAL model can assimilate and how
the AQAL model will need to accommodate itself to
“fit the facts.”
As I have begun to formulate my
ideas on an integral approach to PI, I have become
aware that a large part of how integral theory can
influence the practice of psychotherapy is by
changing how one conceptualizes the human condition,
the multitude of factors influencing psychopathology
and suffering, and comprehensive treatment. Of
course, I see other valuable aspects of the integral
model being significantly helpful; for example, its
encouraging/urging clinicians to deeply train their
attention, awareness, presence, and compassion so
that their capacity to be with and bear witness to
clients’ suffering is enhanced. Which is not to say
humanistic encounters are all that is needed; I am a
firm believer that compassion and care must be
complemented with technical expertise and honed
clinical judgement.
Tullio Carere, 23 February 2006
Hi Paul,
I look forward to discussing
the following points over a cappuccino, or a glass
of Chianti:
1. You think that "the controls
of systematic empirical research are very substantially better
than the 'discipline' the lone clinician can
muster." Better for what? If I had to choose between
a therapist with a disciplined mind and one who is
perfectly knowledgeable about all systematic
empirical research on earth, I would have no doubt
and choose the former – wouldn't you do the same?
Besides, a man of discipline looks for the company
of other men of discipline, just as a man of
empirical research prefers the company of other
empirical researchers. Discipline of mind is not a
matter of lone clinicians, it is an intersubjective
enterprise like empirical research.
2. You think that I am
"too cavalier and dismissive toward empirical
data". In my self-perception I am only dismissive
toward the claim of hegemony of empirical data
over our field. I believe that it is dangerously
reductive to think of psychotherapy as a primarily
scientific enterprise (which leads to the dangerous
idea that the medical model -- empirically supported
manualized procedures to treat specific disorders or
meet specific needs -- is a superior form of
treatment). In my view psychotherapy is a primarily ethical
discipline, inasmuch as both patient and
therapist are engaged in a relationship in which
they decide at any single step what to do in a
relationship involving meanings and values. In an
ethical perspective (pre-conventional –conventional
–post conventional), empirical science and even
randomized clinical trials have their own place. A
manual is better than arbitrariness, as the capacity
and the responsibility to choose the right thing to
do in the unique circumstances of a
psychotherapeutic encounter is better than any
manual.
3. In an ethical perspective --
in which manualized and truncated treatments can be
the right choice for inexperienced therapists and
low-budget public services, as well as for the
conventional side of all of us -- the aim is to
progress from a conventional (school based, theory
and protocol driven) to a post-conventional, genuine
therapy, in which the interaction between patient
and therapist is less and less ruled by theories and
protocols, and more and more guided by dialogue and
moment by moment assessment of whatever the process
requires of both members of the therapeutic couple.
Technical procedures have their place here too, but
in a heuristic, not a stereotyped mode ("the
experience of the community to which I belong and my
own tell me that a given procedure could be useful
in similar cases: let us see what happens if I try
it here, how it will be experienced be my patient
and myself in this specific circumstance").
4. In genuine, predominantly
post-conventional, dialogical therapy a scientific
approach is essential, but not in the form of the
application to the interaction here and now of some
guidelines that some empirical researchers have
concocted there and then. The dialogic therapist is
primarily a local
scientist (in dialectical tension with the local artist - the dialogic
therapist being in fact a dialogic-dialectical
therapist). It means that the therapeutic
relationship becomes the laboratory where all sort
of hypotheses relevant to the present case are
formulated, discussed, and tested in a variety of
ways by a couple of local scientists (the patient is
co-opted as an assistant). Besides, the two
scientists produce documents (particularly in the
form of recordings of the session or post-session
questionnaires) for monitoring the process and
correlating process and outcome. At the level of
dialogical, post-conventional therapy the aim of
empirical research is not to demonstrate the
efficacy of some manualized procedures for specific
disorders (the aim of empirical research at the
conventional level), but to correlate process and
outcome. The process develops in its own,
unforeseeable way, what we need to know is to which
extent the outcome has been affected by the process.
As in the study of all historical process, research
is documental, not experimental. And the
scientific historian interprets the documents,
does not make statistics with them.
Tullio
Carere, 24 February 2006
I wrote: "If I had to choose
between a therapist with a disciplined mind..".
Sorry: I did not mean "a therapist who has fully
disciplined his or her mind", nor "one who has
approximated that goal to any significant degree",
but just "a man of discipline", i.e. a man who has
prioritized the discipline of the mind (in the form
of epoché, of the noetic/dianoetic dialectic, or
else) over the learning of any empirically supported
procedure.
Paolo
Migone, 24 February 2006
Dear Tullio,
I have the feeling that to rely
on ethics is quite useless, especially today when we
are in a multi-cultural, multi-ethnic and
pluri-religious age. Everybody knows that a given
cultural population may have ethical principles that
are considered unethical by others. And everybody
knows, as well, that often the therapists who do big
technical "errors" o behave unethically (according
to other therapists) say that they did the right
thing and/or "rationalize" their behaviour.
I think we need to find other
ways to deal with the problems you are discussing
about.
Tullio
Carere, 26 February 2006
David Allen
wrote:
<<Don't we all agree that we need
both empirical research to reduce the biases of
clinical observations AND clinical observations to
reduce the inherent limitations of our ability to
measure psychological constructs in empirical
research? Not only scientists but patients
responding to psychological measurement can deceive
themselves as well as others. The two methods of
discovery compliment one another to my mind; another
example of "both-and" thinking rather than
"either-or" thinking. In the same dialectical
vein, of course every "theory of everything"
generates a competing theory of everything.
The two of them are then reconciled,
generating yet another thesis-antithesis-synthesis.
This is how knowledge grows as we get closer
and closer to truth. I think this is an
argument in favor of the genesis of metatheories,
not against it.>>
David,
You
point to a contradiction of mine. I have been
praising a dialectical approach, but then I seem to
be non dialectical when I suggest that we could or
should move from the ground of endlessly conflicting
theories to the non theoretical ground of
common/uncommon sense. Let me try to explain. I
wrote in a previous posting:
<<In my view nothing is
wrong with dichotomies, mostly. To the contrary,
dichotomies are there to correct therapists' and
theorists' one-sidedness. Behavior therapy was born
to expose psychoanalysis' one-sidedness. Insight vs.
action therapies is a useful dichotomy, because it
exposes the one-sidedness of both. It is good, but
not good enough. The really good thing is when
someone transforms the dichotomy into a polarity.
That is, when someone understands that insight and
action are not two definitively and insuperably
different things, but the two terms of a "cyclical
dynamics", as Paul called it in his pioneering work.
This is how dialectics works: the apparent
separateness and one-sidedness of the two terms of a
contradiction is transcended (aufgehoben) when the
relation connecting the two is seen and
implemented>>.
How is a synthesis or
integration between psychoanalysis and behavior
therapy ever possible? Is it a case of "theoretical
integration"? No way. How could such incompatible
and incommensurable theories be "integrated"? It is
impossible. A synthesis is
possible, but not on a
theoretical ground. You have to look at what
happens in practice. A
patient came to me a month ago, asking for an
antidepressant medicine for his obsessive disorder
(he had read of this indication). I replied that I
am a psychiatrist, but prescribe medicines only in
the context of a psychotherapeutic relationship. He
accepted four sessions, to begin with. I gave him a
low dose of citalopram. At the third weekly session
he came and said that the obsessive disorder had
greatly improved, but now he had a painful feeling
of loneliness and of being abandoned. He saw that
the obsessive disorder was a defense against the
underlying painful feeling, which had surfaced
thanks to the medicine. He was now willing to work
through his feelings, and accepted a three-month
contract of psychotherapy.
What has happened? Have I
integrated psychopharmacology and psychoanalysis?
Yes, I have, and successfully. Have I integrated
psychopharmacological and psychoanalytical theories?
Not at all. The dialectic of acting (not only
behaviorally, even pharmacologically) and
understanding does not happen on a theoretical, but
on a practical ground. The ground of common sense,
in fact. The common ground of the basics of
experience, where you find common needs, factors,
goals, as Hilde put it. Theories usually just clash,
very seldom produce dialectical conflicts conducive
to some sort of synthesis. Theoretical clash is
useful, as I said and repeat. But in order to
reconcile conflicts you usually have to move to a
different ground.
Hilde Rapp, 26 February 2006
Dear
Andre,
Thank you
very much for your contribution. I have just come
back from working abroad and I apologize that
I don’t have time right now to respond in the way
you deserve.
I just
want to say that I too am broadly sympathetic to Ken
Wilber’s work, and indeed I have been in touch
with Mike Mahoney over some years. I am also
in touch with Don Beck and Chris
Cowan who are spearheading the successor to
the Gravesian project in social psychology,
Spiral Dynamics ( SD). As you know, this model
is extending Maslow’s hierarchy of needs
and specifies needs in terms of values
on the one hand and life conditions on the other. A
few years ago, Don has linked up with Ken Wilber to
formulate SDI, the All Quadrant All Levels
integration ( AQAL) you have referred us to .
I became interested in these approaches precisely
because they offer meta models
rather than models, and they do so in very
useful ways that ‘chime’ with what I have been
grappling with since my Frankfurt School days in the
sixties and they also provide a helpful way of
mapping the bio-psycho-social
model as it is current in medical anthropology
and in the health sciences in general in the UK.
Any four quadrant approach, including my
own, is , wittingly, or unwittingly
rooted in the ancient fourfold mandalas and
coordinate systems which we find in all
cultures across geographies and times…
My
‘quarrel’ is only ever about the degree to which a
broad approach becomes a ‘school’ and looses
some its openness because language becomes
standardised to a certain extent and the model
attracts a ‘following’, even though it was
originally designed to be a shared ground map
for leadership project. This is often an
un-intented consequence of its usefulness and
success: not wished for – usually- by the person who
has offered this particular way of
thinking to start with.
I am
merely passionately advocating for staying open to
the future, remaining respectful of
complexity and being staunchly modest in the
face of what is unknown and perhaps
unknowable. I am wary of being too systematic-
precisely because certainty it is alluring and
tempts us to wish for the possibility of a
comprehensive model, theory or approach – I am
in the words of the poet John Keats,
adviocating for ‘negative capability’ willing
to bear the anxiety of doubts and uncertainty,
paradox and complexity…
Hence
my insistence on integrat-ive- rather than integ-ral, ad-verb rather than ad-jective… construct- ivist rather than
construct- ionist… as
they say, in the beginning was the verb, not the
noun!
In other
words, Marx was not a Marxist and Freud was
not a Freudian- but both were cutting edge thinkers
who changed their mind and outlook frequently as new
discoveries were made and new ways of thinking about
then became either necessary or attractive – and
this is also true of Ken, Don and Mike…, but not
always true of how their work is used in the
field…
That having
being said, I too am happy to be an ally, and
I am genuine appreciative of the ‘integral’
project insofar as I have become
familiar with it…
I hope I
will find time to respond to your points in a more
detailed and specific way…
Allan Zuckoff, 26
February 2006
Tullio
wrote:
<<How is a synthesis or
integration between psychoanalysis and behavior
therapy ever possible? Is it a case of "theoretical
integration"? No way. How could such incompatible
and incommensurable theories be "integrated"? It is
impossible. A synthesis is possible, but not on a
theoretical ground. You have to look at what happens
in practice>>.
I believe
that in this statement, Tullio has captured
precisely the problem with the kind of "meta-theory"
described by Andre. Because of the differences in
their foundational assumptions (what they take to be
axiomatic), there is no common ground on which the
theory of psychoanalysis and the theory of
behaviorism can meet—much less the theory of
behaviorism (which asserts that human behavior is
strictly determined by external contingencies) and
the theory of humanistic and existential
psychotherapy (which asserts not only that human
beings are purposeful—of course there have been
many efforts, however flawed, to reconcile
purposefulness and behaviorism—but that we are
capable of freely choosing our actions, in ways that
are not subject to causal determinism and thus that
render behavior in principle inevitably
unpredictable).
As Tullio
argues, what calls for integration in psychotherapy
are the various strategies and techniques of
intervention/healing—a pragmatic integration. The
theories, in contrast, because they are not only
incomplete but also false, call not for integration
but replacement via rethinking and
reconceptualization. The theory of evolution
does not represent any kind of “integration” of the
previously existing theory of divine
creation.
Yet, this
still does not mean that "common sense" is an
adequate ground for practice. For thousands of
years, human healers stumbled upon various remedies
that actually did heal—yet the theories
(explanations) of why
they healed were completely wrong, and thus healing
remained very much a hit-or-miss proposition. It's
taken until the modern era for theories (e.g.,
the microbe theory of contagious illness) to be
developed that capture the truth well enough to lead
to reliable intervention.
Unfortunately, when it comes to
theories of psychotherapy, I suspect we are still in
the equivalent of the pre-modern era. For example,
the theories of behaviorism and psychoanalysis,
different as they are, both rest on a foundation of
Cartesian mind/body dualism. Without going on
insufferably, suffice it to say that my intellectual
wager is that this dualism is (bluntly put) wrong,
and thus that any theory upon which it is founded
must be overcome—discarded or, at best (in Tullio’s
framework), sublated.
Praxes are
integrated; theories are found wanting, discarded,
and replaced. It seems to me that both of these
tasks are vital to the continued development of
psychotherapeutic healing.
George Sticker, 26 February
2006
My
preference is for an assimilative approach to
integration, in which a preferred theory is
maintained and techniques from other approaches are
assimilated. However, the challenge after successful
assimilation is accommodation - changing the home
theory so that it can accommodate a technique that
originally would not have been suggested by it. Is
accommodation possible or must the theory be
discarded in favor of a synthesis? I don't know, and
that is the challenge we face.
Hilde Rapp, 27 February 2006
Alan wrote :
<<As Tullio argues, what
calls for integration in psychotherapy are the
various strategies and techniques of
intervention/healing—a pragmatic
integration>>.
I agree. For
me the question here becomes: what outcome do we
seek to achieve? For the sake of argument, the
psychoanalyst might say that the aim of the
therapy- the outcome it drives towards, is that the
client should complete the developmental task of
emotionally separating from his/her mother in
order to become a viable adult. The cognitive
behaviour therapist might reformulate this as
the client needs to learn certain cognitive
behavioural skills which involve the false belief
that they cannot function without their mother, the
emotional skill of managing their own
emotions, social skill of learning to ring up
friends when miserable, practice managing their
anxieties when decision making etc etc…The analyst
might agree that this is the way forward, but might
choose to express the means in theoretically driven
different language… and this story could be told
with respect to most approaches current in
psychotherapy…
Past
Sepi conferences have demonstrated how good our
colleagues are in this sort of exercise in
translation, transposition and reformulation.
Alan went on
to say:
<<The theories, in
contrast, because they are not only incomplete but
also false, call not for integration but replacement
via rethinking and reconceptualization.
The theory of evolution does not represent any
kind of “integration” of the previously existing
theory of divine creation>>
If we go
back to the original meaning of “theory”
( theorein) in Greek, it means “a way
of seeing” , rather than a an body of laws or
relationships which organize a set of systematic
observations. It seems to me that most of our
psychotherapeutic ” theories” function more
like values which
organize our preferred ways of seeing- or
understanding the observations, presumed
facts, and our relationship to what we know and do
in the complex world around us. The
African philosopher John Mbiti once observed that
theories are stories that help us to cope with
our fear of the unknown…
I therefore
agree that we are working in a proto-
theoretical space, and I submit that the value of
the kind of meta-theoretical
framework I am proposing is that it can act
as a shared ground map which allows us to organize
such ‘stories’ in terms of
the underlying values and facts that
particular individuals and professional ‘schools’ see as
particularly helpful for our practice.
Working integrat- ively then
becomes not the endeavour to
seek a synthesis or resolution of differences, but
rather, an effort after seeking an
understanding of how different positions are
articulated, what conflicts arise between them and
when, where , why and in what context this matters.
As
Andre pointed out, this is also the
arena where Spiral Dynamics and Integral
Theory are making a contribution, not
necessarily specifically to psychotherapy, but
to our general understanding of the dynamic
evolution and articulation of value systems with
proto-theoretical content and how to work with
conflicts between them.
After such a
‘diagnosis’ of
the actors and positions in a given conflict,
such a meta-framework also allows us to
collect and organize best practice
examples of how to transform these
conflicts in a particular practical situation
where colleagues are at loggerheads about the
‘treatment’ of a particular client or patient.
The journal
of Psychotherapy Integration is full of such
best praxis examples- and George has
contributed many – and indeed our SEPI conferences
are always an exercise in conflict
transformation in action. Of course there are
entrenched conflicts for which we have not found
a process, or perhaps we haven’t tried
yet…
Allan
Zuckoff, 27 February 2006
George
wrote:
<<My preference is for an
assimilative approach to integration, in which a
preferred theory is maintained and techniques from
other approaches are assimilated. However, the
challenge after successful assimilation is
accommodation - changing the home theory so that it
can accommodate a technique that originally would
not have been suggested by it. Is accommodation
possible or must the theory be discarded in favor of
a synthesis? I don't know, and that is the challenge
we face>>.
I think this
model, drawn as it is from Piaget’s model of
individual learning, provides an appealing account
of the process of the (ideal) individual
practitioner. For anyone who is plying his/her trade
as a psychotherapist, challenges will arise that
cannot be neatly fit into one’s existing
sense-making structure; whereas the rigid therapist
rejects the apparent anomaly and insists upon
forcing the new challenge into his/her procrustean
theoretical bed, the open therapist acknowledges the
poorness of fit and adapts to the novel
circumstance.
But, how
much do practitioners’ “theories” change, as opposed
to their praxes? If I am a client-centered therapist
and I notice that whatever client speech I empathize
with occurs more frequently, how likely is it that I
will conclude that my empathy is merely (and
mechanically) reinforcing the client for certain
verbal behaviors? I think it’s more likely that I
will conclude that I am empathizing accurately,
inviting the client to explore more thoroughly that
area of his/her experience, and perhaps incorporate
the idea that I can guide my sessions towards deeper
exploration by empathizing more actively. Because
client-centered and behaviorist theories offer not
just different, but mutually exclusive accounts of
why people act the way they do—and once I buy into
the theory of reinforcement, I’m forced to admit
that I’m not eliminating conditions of worth but
merely changing them into more benign versions.
Thus I’m not
sure the assimilative model does the job from the
standpoint of the theoretical development of the
discipline. This is essentially a model of “normal
science” in Kuhn’s sense: when a widely-accepted
theory provides the foundation for a great deal of
new knowledge discovery, it is maintained via small
accommodations. But if our field is still
pre-paradigmatic—driven by incompossible
theories—then I think what is needed may be more
“philosophizing with a hammer.”
Allan Zuckoff, 27 February 2006
Dear Hilde,
I find
much of what you propose helpful to my own thinking
about these matters.
The
statement that <<most
of our psychotherapeutic ” theories” function
more like values
which organize our preferred ways of
seeing- or understanding the observations, presumed
facts, and our relationship to what we know and do
in the complex world around us>>
captures something important for me, going
directly to my sense of a disconnect between what we
normally mean by the term “theory” and the way that
“theories” seem to function in the work of
practitioners.
Yet I also
wonder whether the theories
themselves—psychoanalysis versus behaviorism,
say—are so readily integrated as your example
suggests. The behaviorist may admit that the source
of a dysfunction lies in the early history of an
individual—presumably the occasion of the “false
belief that they cannot function without their
mother”—but will also insist that the belief was
established via reinforcement patterns that have
presumably continued to obtain. The psychoanalytic
claim that, say, the “belief” is grounded in
fixation of cathexes will presumably be given short
shrift. So I believe that what you have successfully
re-languaged remains at the level of praxis, rather
than of theory.
I also
remain uncertain about the value of “meta-theory” in
the sense you are describing. In the beginning of The Order of Things,
Foucault quotes a story by Borges, in which a
certain ancient taxonomy goes something like this (I
paraphrase broadly, and with apologies): a) Solid
things b) heavy things c) things that belong to the
emperor d) things that from a distance look like a
chicken…
Foucault’s
point, of course, was that the conceptual space
within which such a taxonomy could be comprehended
no longer exists, and is so foreign to our own as to
render those letter labels [a), b), c)] absurd to
us. However, unlike Foucault, I would want to argue
that this taxonomy is not merely the product of a different “episteme,” but
an inferior one. Because
if knowledge does not progress, but merely changes,
then we are all
absurd.
My concern
about the “metatheoretical space” defined by Andre
is that it is uncomfortably like Borges’ taxonomy,
and I’m not sure what is gained by placing
conflicting constructs in a defined order, or within
a single plane. While I see the value in trying to
draw out commonalities among competing theories,
once again at the level of praxis, I don’t think we
will achieve maturity as a discipline until we are
precisely able to achieve, at the level of theory,
“a synthesis or resolution of differences.”
David Allen, 27 February 2006
I completely
disagree that there is no common grounds on which
the theories of psychoanalysis, psychopharmacology,
behavior therapy, cognitive therapy, humanistic
therapy and family systems theories can meet.
In my opinion, it only appears that way if one
views these theories as monolithic wholes that must
be accepted or rejected in their entirety, and
conceptualize the various theories based on the
arguments of each theory's most extreme,
reductionistic adherents. Each
theory is in fact a collections of ideas with
common threads that are then applied to various
observed phenomena in an attempt to understand
them. Some of the conclusions based on
theory may be right while others completely wrong.
No
behaviorist I know thinks that human behavior is
ONLY determined by external contingencies.
They just choose to intervene there. Social
learning theorists even look at the interpersonal
environment, although they do so in an un
system-atic way (if you'll pardon the pun).
Likewise, you don't have to believe that OCD is
caused by harsh toilet training (an empirically
disproved idea from analytic theory) to believe in
the general validity of the concept of defense
mechanisms (even if you call them mental schemas or
automatic thoughts).
Tullio, you
could in fact approach what happened with your
obsessive patient using a theoretical integration of
pharmacology and psychotherapy, such as a
stress-diathesis model.
Hilde Rapp, 27
February
2006
Dear Allan,
Thank you.
I agree with most of what you say, which suggests to
me that I have – as I do from time to time-
left out parts of the argument because they are
too familiar to me by now.
Yes,
I agree that the potential accommodation
between the caricatured analyst and
behaviour therapist positions is entirely pragmatic- they would
agree on what needed to be done,
but they would go about it by different methods/techniques and
they would justify what they
do differently- ie take recourse to
different as well as- usually- incompatible theories.
The proposed common ground is purely functional.
In a
previous mail to Andre I voiced similar concerns to
those advanced by you, although less eloquently and
explicitly. Tongue in cheek: fuzzy semantics are
useful to a degree, but beyond that they become woolly ! Even in a
scenario where we could ever work in an
“integral” manner,
sufficiency would
increasingly work against transparency and one
would need an international mainframe
collaboration to work out a therapeutic algorithm!
In any case, temperamentally, I
would probably always have an aversion to any
approach that is potentially totalizing- Bob
Niemeyer made a very good case about this some years
ago, reminding us of an attempt by Goebbels’ cousin
to create an integrat-ed psychotherapy in
Nazi Germany…
So, my
integrative framework should
perhaps be simply called a meta-framework rather
than a meta-theoretical framework? It transcends
theories in so far as it does not aim to
integrate them but merely to organize them.
Its purpose is to give us a shared ground map
which allows us to map or locate theories with
respect to their central focus: does the
theory focus most strongly on subjective
experience ( Q1) , does it focus on culturally
situated inter-subjective dialogue ( Q2) , does it
aim to organize on neuroscientific and
cognitive-emotional- developmental research findings
into new understandings of the human mind/psyche? (
Q3) , or does it focus on the
socio-economic, environmental and political
determinants of mental ill health (
Q4) or, to be more specific, does it
look at sociological factors from a
hermeneutic position ( say Foucault,
then it would be Q2 &Q4) or more from a
positivist position ( empirically grounded, drawing
more on quantitative studies, say evolutionary
theory) then it would be located across
Q3&Q4…
The purpose
of such a mapping would be to explore along
which axes of enquiry the major conflicts lie
with a view to learning something from each
other without giving up our positions if the
approaches look like they are too incompatible. This
would be to advance academic enquiry and practical
skill and knowledge building and
CP/E/D.
Or more
practically still, we might want/ need to
transform a conflict between colleagues with shared
responsibility for a shared patient or client-
Tyler’s issue, for example – this would be
leadership and conflict transformation
work.
What
we tend to learn by using a meta framework
approach and we can tolerate, nay,
embrace difference and healthy competition, is
usually a new technique which borrow and
assimilatively integrate into our own
approach.
What
we are invited to let go off is our fear of
difference, our competitive desire to win, and our
discomfort in the face of not knowing and our
anxieties about not being in control…
Tullio Carere, 28 February 2006
Paolo Migone wrote:
<< Dear
Tullio, I have the feeling that to rely on ethics is
quite useless, especially today when we are in a
multi-cultural, multi-ethnic and pluri-religious
age. Everybody knows that a given cultural
population may have ethical principles that are
considered unethical by others. And everybody knows,
as well, that often the therapists who do big
technical "errors" o behave unethically (according
to other therapists) say that they did the right
thing and/or "rationalize" their behaviour.
I think we need to find other
ways to deal with the problems you are discussing
about >>.
Dear Paolo,
Do you really believe that we
can leave ethics out of the door? Ethics is the
study of how we decide that a choice is good or bad,
right or wrong. Psychotherapy is ethics, from
start to end. In an era dominated by the myth
of science many people believe that science is
neutral, i.e. not grounded on ethical and
metaphysical choices. Modern epistemology has
dismantled this myth (even Popper had to
grudgingly admit it, in the end). For instance,
the evidence based psychotherapy is based on
the belief that you can extract a procedure from
the relationship in which it is embedded, and
administer it to a patient in the same way as
you administer a drug. You choose to believe
that psychotherapy works like medicine, and you
produce empirical data to support your belief.
You can produce empirical data to support
almost any belief (even the belief in miracles:
at the Vatican they have a scientific faculty
for that).
In ethics you have
three levels. At the ground level
(preconventional) you are the lawmaker: you
decide what is right or wrong, you don't care
what other people think. At the second floor
(conventional) you submit to some conventional
law: you are the follower of some school or
theory, you behave according to the principles of
your convention - for instance, you
administer protocol driven procedures. At the
third floor you suspend as much as you can all
your presuppositions and expectations; you try
to understand what every individual
situation requires, and behave accordingly; in
the awareness that your perceptions and
evaluations are limited and fallible, you
constantly look for feed-back, dialogue and
confrontation. All three levels are present in
different proportions in most of us. Genuine
dialogue happens at the third floor. Faith in
dialogue (dia-logos) is the belief that you can
move in life (and in therapy) beyond
all conventions, guided by the inherent logic
of any process (the logos) that manifests
itself in the relationship between (dia) people
willing to let go of any preconceptions and
expectations to open up to it.
Hilde Rapp, 28 February 2006
Dear Tullio, dear
Paulo,
In haste:
perhaps it would help to distinguish between
ethics and morality on the one hand and
religion and spirituality on the other.
Crudely, by rule of
thumb: ethics relates to
principles of natural or distributive justice, while morality relates to
conforming to the rules and codes
of conduct that are the norm ( conventional) in a
given cultural reference group.
In a similar vein, spirituality
relates to principles that help us
to establish a relationship to the Sacred
( Divine to some) as such and in
ourselves and in our fellow living beings ( by
whatever name or none), while religion ties us into
sets
of beliefs and rituals which constitute a
particular theology and faith based
practice…
While morality is grounded in
ethics and religion is rooted in spirituality,
a person can act ethically and yet contravene
prevailing moral dictates ( a white person
having relations with a black person in Apartheid
South Africa, which would have been illegal to
boot!), just as a spiritual person may be burnt at
the stake for heresy…
Having said that I agree with
you Tullio, that psychotherapy is a profoundly
ethical practice, and- if I read you
correctly- I agree with you Paulo, that morality has no place in
it- other than as information about what the
client believes or what she might be up
against!
Allan Zuckoff, 28 February 2006
Dear
Hilde,
Thank you
for taking the time to lay out your argument more
explicitly; it seemed very clear, even in pre-edited
form. I do think that we agree on many things,
although I’m not at all daunted by the prospect of a
“totalizing” theory of psychotherapy—in fact, I
think that should be our goal (just as a “unified
theory” is the goal of physics), but I’m certain
that the approach to such a theory (for such finite
creatures as ourselves) will be asymptotic.
Your
“meta-framework” sounds like it is organized to lead
to the overcoming of conflicts among theories via
higher-order syntheses, though without demanding
that adherents give up their individual theories
until they are ready to do so. More than anything,
this seems like a skillful therapeutic intervention
for academics: invite them to relax their defenses
enough to consider other perspectives, but avoid
generating resistance by not trying to strip those
defenses away?
Allan Zuckoff, 28 February 2006
David,
I certainly
agree that, in practice, adherents of competing
theoretical schools borrow from other schools and
reject aspects of their own. But I disagree with
your definition of theories as “collections of ideas with
common threads that are then applied to various
observed phenomena in an attempt to understand
them.” I understand theories as well-organized
explanatory frameworks, which can be applied to a
range of phenomena and which are capable of
generating either hypotheses that can be tested
empirically or truth-claims that can be evaluated
rationally. While certain peripheral aspects of a
given theory (e.g., accounting for OCD via anal
eroticism) can be rejected without having to abandon
the theory altogether, challenges to the theory’s
fundamental assumptions (e.g., psychosexual
development or unconscious process) can render them
useless.
You may well
be right that there are no behaviorists left who
believe that behavior is determined only by external
contingencies; I hope that’s true. But the very
construct of “external contingencies” is
not theory-neutral; rather, the claim that human
beings react in lawful ways to “stimuli” (another
theory-specific construct: there is purported to be
a meaningless physical environment “outside” the
person) is, for example, rejected by
phenomenological and Gestalt theories of what is,
and where human beings fit in what is. At this
level, both theories cannot be correct—and the
implications of which is true (or, at least, truer)
are profound with regard to how we view the people
we seek to help.
Stephan
Tobin, 28 February 2006
Allan,
That idea of an external
reality from which the individual is separate and
"stimulated by" is a good example of the
individualist paradigm, i.e., that the self exists
prior to interaction with the environment, rather
than seeing the person/environment as part of a
phenomenological, intersubjective field.
I'm pleased that you mention Gestalt here.
Even though Perls was a prime example of the
individualist paradigm in his behavior, the Gestalt
theory has always stressed a more intersubjective
paradigm.
David Allen, 28 February 2006
Psychosexual
development and unconscious processes are examples
of what I was trying to talk about - they seem
to me to be very different ideas tied together
with some common assumptions. Even within
a given construct, however, is it not possible that
the various analytic ideas about, say,
psychosexual development are partly correct
and partly wrong? The different
subschools of psychoanalysis can't even agree
among themselves about all the particulars -
Kohut had to invent a whole new psychic agency
(the self) just to get his ideas across in order to
remain "in the club." I believe even
fundamental assumptions within a theoretical
construct can be modified with new
evidence without having to throw the baby out with
the bathwater.
I agree
that the construct of "external contingencies "
is not theory neutral - strict constructivists don't
even believe that such an external reality
exists. If one believes that solipsism is the
totality of the universe, I guess they could never
even talk about external conditions. But that
is the type of radical, reductionistic type of
stance that is more like religion than
science. Perls wasn't like that -
he wrote extensively about disturbances at
the interface between individuals and their social
world. The word interface inherently refers to
two of something.
Allan Zuckoff, 28 February
2006
Stephan Tobin wrote:
<<Even though Perls was a prime
example of the individualist paradigm in his
behavior, the Gestalt theory has always stressed a
more intersubjective
paradigm>>.
David Allen wrote:<< Perls wasn't like that -
he wrote extensively about disturbances at
the interface between individuals and their social
world>>.
American though I am, my
training in philosophy was Continental; when I use
the term Gestalt, I intended to refer not to the
“gestalt therapy” of Perls, but to the Gestalt
psychology of Lewin, Kohler, und so weiter… Thus we all
agree (I think): there is fundamental disjunction
between atomistic and holistic models. And perhaps
that disjunction is consequential?
David wrote:
<<Psychosexual
development and unconscious processes are examples
of what I was trying to talk about - they seem
to me to be very different ideas tied together
with some common assumptions. Even within a
given construct, however, is it not possible that
the various analytic ideas about, say, psychosexual
development are partly correct and partly wrong?...
I believe even fundamental assumptions within a
theoretical construct can be modified with new
evidence without having to throw the baby out with
the bathwater>>.
Your point
is well-taken: it is clearly possible to jettison
the sub-theory of psychosexual developmental stages
and still maintain the validity of the construct of,
say, the active unconscious. Although then, one is
no longer a Freudian analyst, but perhaps a
psychodynamic psychotherapist. But what happens if
one jettisons the construct of the active
unconscious? Can one still claim to hold the theory
of psychoanalysis as valid? It’s hard for me to
imagine what would be left—and I suspect at that
point one would have to say that the theory of
psychoanalysis no longer offers enough explanatory
power to be worth retaining.
David wrote:
<<[S]trict
constructivists don't even believe that such an
external reality exists. If one believes that
solipsism is the totality of the universe, I guess
they could never even talk about external
conditions. But that is the type of radical,
reductionistic type of stance that is more like
religion than science>>.
I am not a
constructivist myself—I find that approach to be a
variation on philosophical idealism, with all its
problems (the risk of solipsism being one;
relativism and ultimately nihilism being others).
But rejecting realism does not require one to veer
all the way to the other pole. Existential
phenomenology (specifically, that of Merleau-Ponty)
starts from the premise that “internal” and
“external” are, like all such dualisms (e.g., “mind”
and “body,” the “immanent” and the “transcendent,”
the “ideal” and the “real”) derivative constructs of
an inherently unitary world of phenomena of which
human beings are constituents (in the Gestalt sense
of mutually constitutive parts of a whole,
inseparable from each other without losing their
essence). This is a remarkably hard thought to think
(I’ve been working on it, on and off, for 25 years
or so), but possibly the thought that leads to the
aufhebung of many
destructive dichotomies. Science? Probably not.
Reductive or Religious? Definitely not
David Allen , 28 February 2006
Sorry about
the confusion of "Gestalts."
What
you call "the Gestalt sense of mutually constitutive
parts of a whole, inseparable from each other
without losing their essence" is an idea to which I
wholeheartedly subscribe, so I guess we actually
agree more than disagree. That idea is at the
heart of a dialectical variety of family systems
thinking about which my own metatheory
revolves. Definitely not reductive or
religious! The nice thing about it is that one
doesn't have to give up the ideas of environmental
contingencies OR unconscious processes in order to
subscribe to it.
If a
theorist believes that there are no unconscious
mental processes, that theorist clearly has
forgotten the experience we all have had of driving
down a familiar highway lost in thoughts unrelated
to the drive, only to suddenly realize that one
remembers absolutely nothing about actually
having driven the previous few miles. One can
argue, however, about whether any given
thought, impulse or emotion is truly unconscious in
the Freudian sense or is merely pre-conscious
or actively ignored.
Continue to read the listserv
discussion during March, Part I
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