One or Many
Integrations
(SEPI
Forum, May 2000)
(Editor's
Note) The 2000 Washington
SEPI Conference was followed by a number of messages on the SEPI discussion
list ranging from unbridled enthusiasm to sadness for having missed
it. A properly theoretical debate began with Diana Fosha's intervention,
on May 10th, 2000. Her statement that "there are two types of integration"
was challenged by others, who put forth their own ideas of what integration
is or should be. The discussion that ensued is worth reading firstly
because it is a state-of-the-art collection of points of view on psychotherapy
integration. Secondly, because it is a noticeable example of the way
integrative therapists discuss issues among themselves. How much are
the participants capable or willing to accommodate to their interlocutors'
views, beyond just trying to assimilate them to their own? Is a real
dialogue unfolding, or, in other words, can we discern an integrative
process taking place among integrationists? And in that case: Which
is the meaning, the essence, or the aim of such process? One should
not expect to find exhaustive answers to such questions in a brief
debate. But if this is seen as the first of a series, one could keep
such questions in mind as the series unfolds.
Diana
Fosha, 10 May 2000
First of all, deep thanks for
what is an unfolding affirmation in responses to the conference -
it had been my goal, my wish to facilitate precisely what is happening
for people -- in parallel process to what happens in therapy -- to
facilitate deep learning which would integrate knowledge and experience
through exposure, teaching and evocation. And that this deep learning
would rejuvenate and energize and provide a fresh perspective to one's
world, which would thus be transformed, maybe just a little bit or
maybe even more than just a little bit.
As is often the case, slips (in
this case a slip of the fingers) get to the heart of the matter because
they partake of two worlds (let's call them the amygdala-based and
cortex-based ways of knowing, to bring in Les Greenberg's latest distinction
for the dichotomy): I find the distinction between knowledge and self-knowledge,
between experiential and formal learning not useful. Each without
the other is deeply problematic (though in different ways). For example,
Diana Wais writes:
"The second part seems to be knowing
how to walk, which to me means saying or doing the optimal thing on
a moment to moment basis within a session.... Having empathy seems
to be an important part in that, but probably not enough. For example,
I can really feel the pain of my patients to the point where I sometimes
cry with them, but I still do not know what to say when, and when
to not say something. I guess that is the art part."
Diana, that isn't the "art part".
Knowing what to say and when and why, and having been effective, is
the result of extremely hard work, conceptual and technical, repetitious
and mortifying. One of the reasons why I was so gung-ho about having
a lot of videotape at a conference on affect is because of how important
it (i.e., videotape) it has been in my development as a clinician.
Having watched thousands of hours of sessions on tape, my own and
those of my colleagues and trainees, micro-analyzing the process,
seeing what works and what doesn't, coming to understand what "working"
and "not working" mean, how (a) clarity of conceptualization, (b)
mastery of technique(s), and (c) authenticity, empathy, honesty, contact,
caring, all need to be there simultaneously informing the process
-- all that has informed a way of working with a patient that, when
it flows, makes it seem like art. Which it is and it isn't, with art
and science being another one of those distinctions that collapse
upon close examination. The hard work, the learning of techniques,
the watching and micro-analyzing of thousands of hours of videotape,
the mortification of the videotape revealing one's blind spots or
vulnerabilities or areas of cowardice, the bearing of that sufficiently
to have the joy of the videotape also documenting transformation,
all that is the behind-the-scenes, years-and-years that informs that
transcendent moment-to-moment stuff that happens and is captured on
tape when therapy "works." What Yo-Yo Ma does is art, but it's an
art informed by twenty years of work on technique. Strong technique
is what allows true spontaneity to flourish.
Similarly, science is pushed forward
by the "aha" experience, by Kekule's dreams, by middle of the night
explosive revelations, which can only come to those who have toiled
with the problems day in, day out.
To my mind, SEPI, like affect,
is about transcending the facile distinctions. It is about finding
those distinctions ready-woven. There are two types of integration:
the integration that says I am A, and you are B, and let's work on
developing the realm of AB; or integration is something that is already
seamlessly present. The beauty of "affect" is that it can be approached
as neurobiology or as communication, as experience or as information-processing,
as the product of aeons of evolution or as the reflection of quintessential
individual idiosyncrasy of experience. Like an individual, it is a
phenomenon so complex that it can be apprehended through any number
of windows, that each opens to reveal some essential aspect of it.
One of the aesthetic pleasures
as an organizer of a SEPI conference is that for at least two of the
three plenary speakers, and actually I think for all three -- Francine
Shapiro, Don Nathanson, Les Greenberg-- integration is not the driving
force of their work. Their work is the driving force of their work,
and in the process of staying faithful to it, they all three revealed
a beautiful and organic and "spontaneous" integration, not as the
result of effort but as a result of letting phenomena guide our understanding.
Tullio Carere, 11 May 2000
Diana Fosha wrote: "There are
two types of integration: the integration that says I am A, and you
are B, and let's work on developing the realm of AB; or integration
is something that is already seamlessly present." In Washington the
integration we talked and experienced about was the one Diana points
up in the plenary speakers Francine Shapiro, Don Nathanson, and Les
Greenberg, for whom "integration is not the driving force of their
work. Their work is the driving force of their work, and in the process
of staying faithful to it, they all three revealed a beautiful and
organic and 'spontaneous' integration, not as the result of effort
but as a result of letting phenomena guide our understanding."
This is the kind of integration
that Stan Messer would probably call "assimilative", which looks so
"organic" and "seamless" when it is well done (in a sense, we are
all "assimilative integrationists", more or less accomplished). But
there is another kind of integration (one that I would call "accommodative"),
which is not exactly about "developing the realm of AB", as rather
about looking for what A,B,C...N have in common, and then trying to
connect all those common factors in a comprehensive structure, that
is in a general theory of the field. I do not think of this kind of
integration as alternative to the first one, as both of them are necessary,
each in its own right. I rather think of giving to each side of the
coin the space and attention it deserves, so that a proper dialectics
can develop.
One is struck by the disproportion
between the amount of eclectic or integrative practitioners (approximately
half of all psychotherapists all over the world), and the comparatively
small number of them who feel attracted by an association like SEPI.
Could it be possible that at least in part the relatively low appeal
of SEPI (at least as we in Europe see it) be connected to an insufficient
development of the above sketched dialectics (too much pluralism,
too weak a group identity)?
George Stricker, 12 May 2000
Tullio has raised a very important
point, and that is the dual necessity for assimilation and accommodation.
Jerry Gold and I, when writing about our model of assimilative integration,
often have pointed to the corresponding need of the home theory to
accommodate the techniques that are incorporated, thereby expanding
the scope of the original theory. Whether this leads to a Grand Unified
Theory remains to be seen, but it certainly can expand the reach of
the theory with which we start.
Michael Basseches, 12 May 2000
I want to address the dialogue
which Tullio started, to which George responded, to which Arthur is
in the midst of responding, and to which much of my personal experience
at the conference felt relevant.
I agree entirely with Tullio's
points both about the strengths of the Washington conference and about
the opportunities to address the limits of pluralism and the search
for integration within more comprehensive structure at some point
in the future, (perhaps in Santiago). From a dialectical perspective,
it is important to acknowledge that by "more comprehensive structure",
I certainly don't mean anything like an "ultimately comprehensive
structure" or a "complete comprehensive structure." I would expect
that even the process of attempting to organize a more integrative
understanding of a process as evolving and dynamic as psychotherapy
would bring attention to (a) what that structure leaves out, and (b)
the tensions between theses (the articulated) and antitheses (the
emergent "left out") that have often been brought to focus in discussions
on this list (e.g., when Tully would articulate his common factors
theory and Arthur would wrestle to name what is was that felt left
out, after which further efforts at integration would ensue.)
George's response alluded to "our
(with Jerry Gold's) model of assimilative integration", (saying that
they) often have pointed to the "corresponding need of the home theory
to accommodate the techniques that are incorporated, thereby expanding
the scope of the original theory." This reference to "the home theory"
brought to mind something that was my experience throughout the conference,
and especially in response to Jerry Gold's presentation to the session
on psychotherapy training in which he talked about the differing "home
theories of center fielders" to which New York Giants', Brooklyn Dodgers'
and New York Yankees' baseball fans in the 1950's maintained allegiance.
If this reference makes those of you are not New Yorkers (or who are
the wrong age) feel left out, it perhaps will help you to experientially
understand something of what I understood more clearly at the conference.
On the one hand, thanks to the spirit of integration, I feel more
comfortable among SEPIites than within any other professional organization
of psychotherapists with whom I have met. Yet I felt different from
many of you in that I had no "home theory" of psychotherapy. I was
trained as a developmental psychologist long before I became a psychotherapist,
so developmental psychology became my "first language", psychologically
speaking. To help me grasp each theory, practice, technique and experience
of psychotherapy which I encountered later in my training and practice,
I guess I assimilatively integrated it into my understanding of how
human development occurs. Not surprisingly, although it probably makes
my beginning psychotherapy students more anxious and insecure, I invite
them to explore more broadly their theories and practices of human
development first, and we begin to discuss all approaches to psychotherapy
in that context, rather than train them in a home theory of psychotherapy.
I look forward to our continued
efforts to explore psychotherapy integration, through searches for
"common factors" (in my mind common developmental processes), and
integrative frameworks as well as through assimilative integration.
But when George writes " Whether this leads to a Grand Unified Theory
remains to be seen, but it certainly can expand the reach of the theory
with which we Start", I want to say 1) we don't all start with one
psychotherapy theory and 2) I think Grand Unified theorizing will
have to be an ongoing process to which I hope SEPI remains committed.
George Stricker, 13 May 2000
Mike questioned my use of the
phrase "home theory," feeling left out because of his original training
in developmental psychology and his absence of a theory of psychotherapy.
Leaving aside my astonishment that somebody isn't familiar with Willie,
Mickey, and the Duke (for all too many of you, the center fielders
Jerry was referring to), Mike was not saying anything at odds with
what I meant. Each of us has a basic understanding of what makes people
think, whether it is psychoanalytic, behavioral, developmental, or
whatever. To that theoretical understanding, we assimilate techniques
that arise from other understandings, and with luck and thought, might
accommodate our understanding to include the effectiveness of the
new techniques. The allusion to Grand Unified Theory refers to a quest
that physics hasn't reached yet, and I don't have much hope that we
will either, but much will come from the effort.
Hilde Rapp, 14 May 2000
Kit Bollas talks about 'a first
aesthetic', Gianni Liotti and Paolo Migone might talk about expectancies,
Otto Rank about Birth trauma, the ethologists about imprinting, the
attachment theorists about attachment patterns, cognitivists about
interpersonal schemata... and so on... The common theme is that there
is a belief that our models of the world, and of how people relate
have something to do with what we have learnt in our first formation
with our caretakers. This in combination with our temperament, is
thought to form some kind of template, set of organizing principles,
a pattern that connects,..., which influences how we assimilate other
experiences and what sort of theories and what sort of practices we
lean towards.
And then there is the spanner
in the works- socialization- identification with role models who bring
quite different patterns into the field... and then there is therapy
and the chance of a second socialization, internalization of yet more
and different patterns... and then there is life beyond therapy...-
unless we subscribe to the tragic vision and forgo all free will and
view ourselves as bound to rota fortunis and the compulsion to repeat
the patterns of our first formation...
Even if we were to limit ourselves
to say five types of vision- tragic, comic, romantic, heroic and ironic
we have ipso facto forgone the chance of one predominant approach
to understanding the human condition...
However, at the matt level, each
vision does the same job: it reduces anxiety and increases certainly-
we do or we don't have free will, can or can't rewrite our script...
we know where we're at- inextricably bound into the Oedipal triangle
forever acting out primal material, or cast upon the uncertain slopes
of the human heart negotiating our fate from a position of negative
capability...
Within the limitations of my own
ability to resonate with these different visions, I am greatly enjoying
the challenge of stretching my imagination to the limit in order to
explore the many ways of being human...
This message has, like analysis
interminable, no 'natural' end. I simply stop here.
It feels there is either much
picking up on shared experience from Washington or quite a bit of
back channel traffic- because I can't find the beginning of many of
these conversations on the list-- I suppose this is a good simulacrum
of therapy...
Arthur Egendorf, 16 May 2000
Tully, Diana F, Diana W, George,
Michael, Hilde and others have initiated a new round of wrangling
with our version of "the many and the one" issue, and in particular,
whether (as Tully rightly wonders) we would do well to balance our
pluralism with some clearer identity.
-- In response, I suggest that:
(1) while I can't hope to say anything here in a way that will fit
precisely for most of you, nevertheless, if you give me a generous
reading, I might somehow convey that (2) we are already carrying on
together in ways that are what Tully calls "accommodative" and could
lend themselves to further explication so as to voice more clearly
a SEPI "identity," and as a rough draft, (3) I offer the following
term and sub-terms in hopes of furthering those efforts (of teasing
out how we are already carrying on that many of us find valuable,
distinctive, and worth communicating more widely).
-- "INTEGRAL-PLURALISM" -- the
"SEPI" spirit:
SEPI consists not only of formal
presentations at conferences, along with the published works in our
journal and books (all of which may tend, at least on the surface,
to be "assimilative"). SEPI also consists of the many ways in which
we, or many of us, conduct ourselves with each other -- informally,
in serious dialogues, and light hearted banter and friendship, in
the often unstated but powerful solidarity of kindred souls, and in
the unstated but no less detectable style (approach, underlying attitude,
implicit philosophy, etc) in which formal presentations are made when
members can readily recognize a "good" contribution "in the SEPI spirit."
-- The SEPI spirit, like all such
rarefied phenomena, lends itself to being laid out in gradations:
--We begin by TOLERATING differences.
For, like it or not, you don't do things my way, and we'll get along
much better not only if I accept that fact, but also if you accept
as well that I don't do things your way either.
-- Things get more interesting
when we move onto RESPECTING our differences. For if I take the trouble
to look more closely, I am likely to find that you have managed to
discover and create ways of doing good work that I never imagined.
My goodness! There are many ways that can lead home!
-- If I let myself go even further,
from interest at a distance to an even more detailed APPRECIATING
(enhancing the value of) of your way, I may end up letting you provide
me with an occasion to change, develop, acquire new knowledge, and
function in ways I couldn't before. Heck, I might even become a bit
more genuine and human in the process.
-- In these (and many, many other
ways) we may come together as ONE community, to the point of even
CELEBRATING our differences, even as each of us and our respective
ways keep changing through mutual tolerance, respect and appreciation.
Now, I could go on (as any of
you who've read my posts before surely know). But out of restraint,
a lesson I am struggling to learn from George Striker's admirable
example, I stop here, leaving to you and your ways whether & how
to go further with the above.
George Stricker, 16 May 2000
I was all set to write a lengthy
response until Arthur reminded me to exercise restraint. Let me simply
say that his post approaches SEPI identity more from a personal than
a professional view (in the unlikely case that we can separate the
two), and probably will not satisfy those who want a statement of
our position (I kept myself from writing about a final solution).
However, he captured very well the spirit of our conferences and,
I hope, of our organization, and I always preferred looking at process
rather than some endpoint that would last a few minutes and then be
absorbed in an ongoing process.
Zoltan Gross, 17 May 2000
I, too, left the Washington Convention
aglow with the assimilative and accommodative spirit of SEPI. And
I also left it feeling that just as there is a large community of
selves existing within us to accommodate the variety of interpersonal
and social conditions with which we engage, so too there is a large
community of psychotherapies existing in our society trying to accommodate
a large variety of social needs. At the Convention I realized that
George Sticker's psychodynamic psychotherapy had a different psychotherapeutic
task than Les Greenberg's emotional/gestalt psychotherapy. It seemed
to me that George's psychodynamic psychotherapy was oriented toward
character analysis and Les's emotional therapy was oriented toward
the treatment of depression. This observation also exists with other
therapies. These differences can inform the different therapies, but
I think that it would be helpful to recognize that the therapies have
different task systems which affects the nature of the therapeutic
relationship. One obvious difference is the relationships have different
durations. Character oriented therapies take longer than affect oriented
therapies. I also believe that a recognition of the different therapies
has relevance to the theme of the Santiago Convention which asks what
makes therapy work. Different relationships could make a difference
in creating effectiveness in different therapies.
Arthur Egendorf, 17 May 2000
Ah yes, as Zoltan writes: " the
therapies have different task systems which affects the nature of
the therapeutic relationship "
And so, of course, it is not enough
simply to pass from tolerating and respecting to appreciating and
then celebrating our differences! Somewhere in there we can benefit
greatly from recognizing and specifying those differences, not so
much as an analyst characterizing a cognitive behaviorist, but in
the SEPI spirit of one fellow tolerating-respectful-appreciative-celebrator
suggesting A way to recognize/specify our differences so as to add
to a (likely ever expanding) catalogue of such recognizable specifications.
Allen Kalpin, 17 May 2000
Zoltan,
You make some points that are
interesting to consider and discuss. I agree that some therapies have
been developed to try to correct specific problems. Beck's cognitive
therapy was originally for depression. However, it has by now expanded
its scope to include anxiety disorders, personality disorders, and
just about anything else that is treated with psychotherapy.
Although Les Greenberg has done
outcome research one his experiential therapy for the treatment of
depression, I do not think that depression is the only condition that
he treats. Also, although dynamic therapy may certainly be aimed at
character change, short-term dynamic therapy may be focused on symptom
relief.
I seems to me that any of the
major psychotherapeutic approaches can potentially be used to treat
a large range of problems, although one could certainly have a specific
sub-category of one of these approaches that is modified to target
a specific problem.
Alan Javel, 18 May 2000
A statement of the SEPI identity
may indeed be useful; I certainly can get behind the ideas of tolerance
and appreciation and celebration of others' ideas. I would like to
say that ultimately the goal is one of psychotherapy integration,
meaning a useful synthesis of all ideas in psychotherapy, moving towards
a unifying whole (who knows when). There may indeed be no end point,
the entire thing being a process. Nonetheless, a statement of SEPI
identity would have to acknowledge this goal, however unattainable
it may be.
Tullio Carere, 18 May 2000
Arthur poignantly describes the
SEPI spirit: it is the one that tolerates, respects, appreciates and
celebrates the differences. SEPI spirit is the spirit of the difference.
George confirms: " he captured very well the spirit of our conferences
and, I hope, of our organization". I am happy to join them and sing
the same song: vive la difference!
But then, Arthur admits that "it
is not enough simply to pass from tolerating and respecting to appreciating
and then celebrating our differences". What more is needed? I would
endorse Alan F. Javel's words that resonate to Mike's:
" From a dialectical perspective,
it is important to acknowledge that by "more comprehensive structure",
I certainly don't mean anything like an "ultimately comprehensive
structure" or a "complete comprehensive structure." I would expect
that even the process of attempting to organize a more integrative
understanding of a process as evolving and dynamic as psychotherapy
would bring attention to (a) what that structure leaves out, and (b)
the tensions between theses(the articulated) and antitheses (the emergent
"left out") that have often been brought to focus in discussions on
this list (e.g., when Tully would articulate his common factors theory
and Arthur would wrestle to name what it was that felt left out, after
which further efforts at integration would ensue.)"
Just to give an idea of the direction
of the process, please consider the Internet panel that the SPI (society
Psicoanalitica Italiana) has recently announced on "Psychoanalysis
and the parental functions". Though for the psychoanalyst to take
a parental role is very much at odds with the classical neutral stance,
they don't refuse the challenge posed by the question: is a psychoanalyst
supposed to include any form of parenting (and why, and when) in his/her
relation to the patient? (This question makes sense if one admits
that a thing named psychoanalysis does exist, which I would not take
for granted).
Let us imagine to propose a similar
question on our list server: is a psychotherapist supposed to include
any form of parenting (and when, and how) in his/her work? This question
too makes sense if we admit that a thing named psychotherapy does
exist. But to admit this (we cannot take it for granted either), we
must go beyond the celebration of differences. We have to make up
our minds. Either we decide that only specific, regional, assimilative
methods exist (in which case the above question is meaningless); or
we decide that a unified field does exist, one of which the individual
methods are regional variants (in which case we might feel obliged
to define its coordinates, as far as we have been able to discover
them up to now).
George Stricker, 20 May 2000
I agree with Allen in his preference
for psychotherapy integration as a process rather than as a likely
goal. Any goal, once achieved, then becomes another school, and I
always felt that the point was to choose among schools according to
a coherent theory that will expand our ability to be helpful. However,
I also want to respond to a question that Tullio raised:
"Let us imagine to propose a similar
question on our list server: is a psychotherapist supposed to include
any form of parenting (and when, and how) in his/her work? This question
too makes sense if we admit that a thing named psychotherapy does
exist. But to admit this (we cannot take it for granted either), we
must go beyond the celebration of differences. We have to make up
our minds. Either we decide that only specific, regional, assimilative
methods exist (in which case the above question is meaningless); or
we decide that a unified field does exist, one of which the individual
methods are regional variants (in which case we might feel obliged
to define its coordinates, as far as we have been able to discover
them up to now)."
In some ways, this depends on
what is being treated. For many symptoms, a more educational (not
didactic) approach is indicated. However, for character problems (and
Allen correctly noted that I prefer to deal with those), I do think
that we have a parenting role to play - I prefer the term re-parenting,
as that acknowledges that the patient already has had a parenting
experience, and that may even serve as an obstacle to our success.
This re-parenting often takes the form of a corrective emotional experience,
which I see often as being at the heart of good treatment.
Diana Fosha, 21 May
I was starting to shape a response
to the ongoing discussion on the list, but it is still somewhat inchoate,
so take what follows as musings rather than position statements. The
recent communications from Tullio, George, Arthur, Hilde, etc. focus
more on overarching theoretical integrations (pros and cons of). Allen
Kalpin's pithy contribution --that if a grand unified integrationist
model came to be, many SEPIites would rapidly run to form another
organization that eschewed issues of model loyalties-- elicited an
affective resonance response. My own inclinations are toward urging
us (the SEPI membership) to focus on sharing a phenomenological data
base, an endeavor to which videotapes of actual clinicians doing actual
clinical work with actual clients is crucial. The more we share access
to what actually happens (however construed), to what the moments
of change consist of (even when we are not in agreement), then we
can continue to evolve a shared consciousness, and a shared phenomenological
history. Which then each of us might interpret or express with a different
lexicon, through the lenses of different models, etc. What made the
Washington conference buzz -- both in my experience of it and in what
many people have said -- is that it led to relatively jargon-free
non-denominational discussions, led to lots of personal responses
which could be shared, stirred people up, and there was a lot of talking
which unfolded in lots of directions, but not so much meta-talking.
Whatever happened in the organized events became integrated and shared
with others at a more personal level rather than at a more primarily
theoretical level. Which proved to be energizing and thus inspiring.
So, gender aside, this is a plea for a greater measure of phenomena.
Tullio Carere, 21 May 2000
Allen,
Why do you think that SEPI members
should quit SEPI and form another organization to explore how that
whole integrates with other wholes? Why couldn't they do that inside
SEPI? This would be exactly the dialectical process Mike (and I) were
talking about. There is no definitive whole to arrive at, only provisional
syntheses that would inevitably give rise to new antitheses (other
wholes, in your terms).
But a provisional synthesis would
be better than no synthesis at all, in my view. Isn't it the case
of all scientific theory, after all? Isn't any scientific theory a
provisional synthesis?
George,
I like very much what you say,
as I take it as a response to my plea for a coordinate system. If
I am not misunderstanding you, you say: when our patient has some
character problem, we have to offer him/her some re-parenting experience
(I call it "remaking", but it is exactly the same). Then you say:
"For many symptoms, a more educational (not didactic) approach is
indicated." It seems that "education" is for you not what parents
do, but what other people (teachers, priests) do outside the family.
In other words: if parents and educational figures had done their
job well, we would be jobless. As it is rarely the case, there is
plenty of work for us. Which we do playing in some cases as parental
figures, in other cases as educational ones (I would say: cultural,
philosophical -- but again it is the same).
I see then two possibilities.
(a) Therapist-centered therapy: The client is treated according to
the theory of the therapist (if the client is lucky enough, there
is a good fit between his/her needs and his/her therapist's theory).
(b) Client-centered therapy: The client is treated according to his/her
needs. The therapist makes use of a coordinate system (like George's
or mine) to locate his/her client's needs. Then he/she uses his/her
approach as far as it fits his/her client' needs, refers the client
to another therapist if the fit is poor, or sees the case as a challenge
the client offers him/her to transcend the limits of his/her current
theoretical position.
Diana,
Eschewing model loyalties elicits
an affective resonance response in me too (I have always been fond
of heresies). Model loyalty is parochial, and the fear of parochialism
can get one to refuse any superordinate model. As I see SEPI as a
place really free of any parochialism (just a little biased for postmodern
pluralism), it seems to me that we can afford to build models without
running the risk of believing in them. I see another dialectical polarity
between what you urge (sharing a phenomenological data base, relatively
theory-free and jargon-free) and a phenomenological description, and
theoretical organization, of the factors that are common to any psychotherapeutic
enterprise: the theory-free data collection furthers the emergence
of a whole picture, as the latter furthers the collection of data
(some of which could be disregarded without a holistic frame of mind).
George Stricker, 21 May 2000
Tullio, you interpreted what I
said exactly right, and I really like this distinction. Years ago
I remember describing an exchange between a patient, who says "I hope
you treat what I have" and a therapist who says "I hope you have what
I treat." Marv Goldfried made a very nice cartoon capturing this exchange.
Your distinction, in less facetious language, says the same thing,
and clearly I think everyone is better served by what you call (not
in the Rogerian sense) client-centered therapy.
Gerald Davison, 21 May 2000
George et al.,
I haven't been following this
interesting thread, so forgive me if I repeat what has already been
said. I see a third possibility -- therapists transform their patient's
suffering into something that they can treat with the techniques and
strategies at their disposal. This is not tantamount to therapists
ignoring what is bothering their patients. It reflects, rather, a
constructionist approach to assessment and problem formulation. I
think it's very SEPI-ish.
Hilde Rapp, 22 May 2000
I hope I mean what I say and that
I can say what I mean (in fairness to the mad hatter's admonition
to Alice...)
To my mind, this new turn in the
dialogue, currently between Tullio and George (and both of you know
how much I respect you and your views), is a reframe of the tension
between assimilative and accommodative integration: the challenge
is for therapist and client to mutually negotiate meaning as part
of their encounter with the unknown, in the context of testing what
is safe and unsafe to share, and how to tread the fine line between
desire acknowledged and desire acted out...
I think Jerry Davidson put what
I am trying to say below much more succinctly- but as you will see-
He speaks more from the place of the scientist-therapist than I- and
therefore constructs meaning live within the encounter between therapist
and client and he talks about what we do: Jerry, if this is an unwarranted
caricature I will apologize fulsomely - I know that you can talk most
eruditely about what follows- I just note that you have chosen not
to do so in this instance!
I
am in a someway poetic - philosophical way struggling with how on
earth we talk about talking about talking about meaning... I talk
about what we say and what we mean...
The asymmetry in the power relationship
mandates that the therapist should be just that much more aware of
these issues and just that much more skilled in negotiating them than
the client. Knowing when to refer on because this negotiation of meaning
is not, or no longer, sustainable is part of the basic competence
of a therapist: theoretical abuse is a form of incompetence.
At the same time the client is
usually a client precisely because they are not able to fully articulate
the repertoire of their human needs and they therefore may fail to
ask for things they need or demand things they shouldn't have because
they don't actually meet their needs. This is a politically explosive
territory, because a formulation such as this suggests that therapists
know better what a client needs than the client themselves.
It is the therapist's job to know
at least as much about human need as the client, and it is the therapists
responsibility to help the client understand more about what it is
they don't, or don't dare, to know or do. It is the therapist's job
to have the skill and knowledge which will help the client identify
what this is, to find the words to say how this affects them and what
help they want in learning how to do whatever it is differently.
What then is it we know? Our trainings
specify that we should know something about the human condition, about
human development and about processes of change–they also require
us to be guided by principles which refer to what is just, fair, ethical,
dignified, and in keeping with human rights.
Human needs could then be defined
as the other side of the same coin on which we inscribe human rights....and
clients are individuals (couples or Ro families) whose human needs
are not met properly and who don't have the psychological resources
at present to do something effective about it.
This is our dilemma: how do we
own up to and take self responsibility for our power to help someone
to come into their power in turn? How do we do this without abusing
our power more than we can help, given our human fallibility?
This question 'how do we use our
power without abusing it?' is answered very differently by different
therapists, but it must be, and it is, answered by all therapists,
because it is a fundamental condition of practicing ethically that
we should be able to answer it.
In fact, we don't so much answer
it, as that we get better at asking it in a more precise and more
helpful way.
It is for this fellowship of people
with a sincere commitment to ask this question and all that follows
from it, that I belong to SEPI.
The diversity of answers reflects
the diversity and complexity of ways of being human.
It is not a grand theory I seek,
but a way of becoming more human in the company of others who also
strive to walk that same road where the only certainty is that we
can and will discover more about what is still hidden.
The 'how' also defines different
ways of knowing that of the scientist, that of the poet, that of the
philosopher, that of the administrator–and all these ways of
knowing ourselves and each other are necessary and as therapists we
are always in dialogue with authority, moral and administrative...
Which focus we set determines our style and the range of activities
we engage in which aim to challenge and support clients in this process
of themselves owning up to a fuller repertoire of being human, of
living more fully, more in touch with their human potential to work,
love, and play - to assimilate and to accommodate...
This is an endless path (analysis
interminable) and I will stop just here. As a scientist, I would have
stopped long before–as there are many things that can't be said
clearly enough to be sure what they might mean.
As a poet I have carried on, hoping
to show or convey some glimpses of what lies behind the veil...
As a therapist I would have taken
the cue from the other as to whether they still feel that I am with
them, interested enough, and interesting enough...
Michael Basseches, 22 May 2000
As a constructivist, I appreciate
Jerry's introduction of a third possibility. But I am concerned by
the one-sidedness of the account. Yes, there is an ongoing co-construction
by therapist and client of the nature, focus, and meaning of their
work together. Negotiation is an inevitable part of this process (and,
as I've argued in my papers on psychotherapy process and expertise,
this process of negotiation may itself be a central therapeutic process).
But if therapists see themselves as transforming "their patient's
suffering into something that they can treat with the techniques and
strategies at their disposal" without allowing their own techniques
and strategies to be transformed by their patient's suffering (including
the particular way patients suffer when they feel that therapy is
not helping), they are especially vulnerable to being perpetrators
of "theoretical abuse." Perhaps both "therapist-centered" and "client-centered"
are too simplistic terms to characterize the complex power dynamics
involved in any human relational process of making shared meaning.
But Tullio's drawing our attention to these power dynamics seems of
crucial importance.
The prior discussion on this thread
of integration versus pluralism seems to me to mirror the tension
between a dialectical voice and a relativistic voice that I see in
within the constructivist therapy movement (though the relativists
seem more likely to call themselves "constructionists" as Jerry does).
The spectre now raised (probably more in my reaction than in Jerry's
intent) of a constructionist assessment that is based on imposition
of the therapist's professional identity on the client's suffering
suggests that we must be careful of a more imperialistic form of constructivism
as well.
I'd love to say more here but
have to leave my computer now. Let's leave it at "let's appreciate
Jerry's point that effective therapy is better conceived as a matter
of transformation than as a matter of 'fit', but let's be careful
not to ignore the power dynamics that influence what is transformed
and how". I'm hoping to write a review dealing with constructivism
in psychotherapy this summer and would appreciate hearing anyone's
thoughts and or references about imperialistic, relativistic, and
dialectical voices within the constructivist/constructionist movement.
Gerald Davison, 22 May 2000
Mike,
Good points, and thanks for your
graciousness. But I am willing to bite the bullet on the "imperialism"
issue by making clear that you understand me completely. I believe
there is an inevitable power imbalance in therapy, and it makes the
enterprise even more daunting than many believe it to be. It goes
beyond the empirical and technical to the ethical and the political.
I developed this argument back in 1974 when I proposed that therapists
stop offering sexual reorientation treatment to homosexuals, even
when they ask for it. It made a lot of colleagues (most, probably)
very uncomfortable. Some of them were quite angry. Many felt (and
feel) that I was disrespecting gays and lesbians, denying them their
free choice of a treatment goal. I don't see it that way at all. If
anyone is interested in a reprint of the latest incarnation of the
position, extending the argument to assessment and goal-setting in
all domains, drop me a line backchannel.
Allen Kalpin, 22 May 2000
Tullio Carere wrote: But a provisional
synthesis would be better than no synthesis at all, in my view. Isn't
it the case of all scientific theory, after all? Isn't any scientific
theory a provisional synthesis?
Now I need to think about and
state more clearly what I meant by my previous remark.
I note that this is the Society
for the EXPLORATION of Psychotherapy Integration. I think it is good
and inevitable that members and groups of members will come up with
syntheses and that these can be debated and discussed. However, I
do not think that the organization needs to reach toward some synthesis,
even if provisional. Rather, SEPI can remain a place where exploration
can take place.
Michael Basseches, 24 May 2000
Thank you, Jerry, for your response
and your "biting the bullet" clarification. I will try to carry the
discussion forward below:
Gerald Davison wrote: "Mike, Good
points, and thanks for your graciousness. But I am willing to bite
the bullet on the "imperialism" issue by making clear that you understand
me completely. I believe there is an inevitable power imbalance in
therapy, and it makes the enterprise even more daunting than many
believe it to be. It goes beyond the empirical and technical to the
ethical and the political.".
I agree with you on both of the
above points. Would you agree with me on the following points? Therapists
of all persuasions may make use of their own meaning-making structures
to make sense of and respond to clients' presenting concerns, and
as we know, assimilation, whether by use of the digestive system or
by the use of the mind entails transformation. Often, these assimilations
facilitate successful engagement of the client in therapeutic processes
(which as integrationists we are working to conceptualize). Less often,
yet still all too frequently, these efforts to assimilate may fail
due to inevitable limitations of the conceptual frameworks on which
each therapist relies. This is where the experience of conflict between
the client's desire "that you treat what I have (you hear my experience/accept
who I am)" and the therapist's wish that "you have what I treat" (or
"I can transform what you have into something that I treat") can become
most intense (and potentially traumatic). Two factors (which I view
as aspects of psychotherapeutic expertise) can mitigate the potential
negative effects of such conflicts and ultimately increase a therapist's
"success rate".
1. "Epistemological preparation"
on the part of the therapist. To me, this entails the recognition
that therapy is not merely a technical enterprise of applying psychological
knowledge (validated by someone else), but also a scientific enterprise
in which in some cases knowledge may be further validated, and in
other cases encounters with anomalous data should be welcomed as opportunities
for transformation of the therapist's personal and practical knowledge
and the field's shared knowledge.
2. The ability and effort on the
part of the therapist to create a more optimal interpersonal, dialogical
context for collaboration between client and therapist in this effort.
While fundamental inequalities in the relationship may exist, and
while such inequalities may inevitably distort processes of inquiry
(see Habermas on "systematically distorted communication") there is
much that a therapist can do to both safeguard and foster the process
of dialogue. For example, the therapist can listen carefully for and
acknowledge the client's experience of the therapeutic relationship,
especially disappointing aspects of it. The therapist can communicate
appreciation for any efforts on the client's part to communicate such
feelings. The therapist can propose interpretations, formulations,
etc. with sufficient tentativeness that the client's crucial roles
as a confirmer, disconfirmer, co-creator, and modifier of all efforts
to make sense of the client's experience of life and both parties'
experience of the therapeutic relationship is clear to the client.
Finally, the therapist can communicate his or her own readiness to
respond, learn, grow and change in the service of the client.
Gerald Davison: "I developed this
argument back in 1974 when I proposed that therapists stop offering
sexual reorientation treatment to homosexuals, even when they ask
for it. It made a lot of colleagues (most, probably) very uncomfortable.
Some of them were quite angry. Many felt (and feel) that I was disrespecting
gays and lesbians, denying them their free choice of a treatment goal.
I don't see it that way at all. If anyone is interested in a reprint
of the latest incarnation of the position, extending the argument
to assessment and goal-setting in all domains, drop me a line backchannel."
I would very much like to see
a reprint. While a successful therapeutic alliance clearly depends
on a process of negotiation, I would support the view that neither
therapist nor client should be expected to negotiate beyond the boundaries
of what he or she considers to be the line between maintaining a sense
of personal moral integrity and violating that sense. But yes, this
also position requires seeing therapy as more than a technical process.
Tullio Carere, 28 May 2000
Michael Basseches wrote: "The
prior discussion on this thread of integration versus pluralism seems
to me to mirror the tension between a dialectical voice and a relativistic
voice that I see in within the constructivist therapy movement (though
the relativists seem more likely to call themselves "constructionists"
as Jerry does). The specter now raised (probably more in my reaction
than in Jerry's intent) of a constructionist assessment that is based
on imposition of the therapist's professional identity on the client's
suffering suggests that we must be careful of a more imperialistic
form of constructivism as well."
There is luckily a dialectical
voice within the constructivist therapy movement. But there is a further
dialectic beyond the constructivist therapy movement: one in which
constructivism is one side, and phenomenology is the other side. In
the first (constructivist) dialectic both client and therapist build
each his/her own world, and a negotiation begins when each one gives
up the attempt to impose his/her view on the other. If I understand
the constructivist vision rightly, dialectic means here basically
negotiation. But if negotiation were the only dialectic we have, who
could object if client and therapist agreed through a regular negotiation
that, say, sexual intercourse between them is a valid therapeutic
practice? Science (and ethics) cannot content themselves with negotiation.
They want some degree of truth. That is, they cannot content themselves
with *the meaning we make*, they also want *the meaning we find*:
the meaning that is already there for us to uncover. As you further
say (24-05-2000):
"1. "Epistemological preparation"
on the part of the therapist. To me, this entails the recognition
that therapy is not merely a technical enterprise of applying psychological
knowledge (validated by someone else), but also a scientific enterprise
in which in some cases knowledge may be further validated, and in
other cases encounters with anomalous data should be welcomed as opportunities
for transformation of the therapist's personal and practical knowledge
and the field's shared knowledge."
In the constructivist view we
are meaning-maker, in the phenomenological view we are meaning-finder.
I do not want to equate science with phenomenology (Newton tried it,
when he said 'hypotheses non fingo', but he himself had to compromise).
Science is both meaning-making and meaning-finding: the scientist
is free to invent (construct) all the conjectures he likes, but he
is then bound to return to experience, to find there the data he needs
to support his hypotheses. How could we ever verify the value of our
theories, without the resort to a non-theoretical ground? Science
could not exist if we were not able to bracket out all our theoretical
or emotional preconceptions: that is if we were not able to practice
the phenomenological epochŽ.
In sum, there is to me a first
dialectical level, in which therapist and client negotiate their respective
constructions–this dialectic remains inside a constructivist
view. There is then a second dialectical level, in which the term
of comparison and contradiction is no longer the construction of the
other, but the truth that is beyond the constructions of both. If
we see this truth as the ineffable and unknowable Ding an sich, the
noumenon of all phenomena, as Bion's "O" (the source of all healing
and inspiration), we point to a still further level, in which the
therapist is a shaman, a mystic or an artist (which every therapist
sometimes is called to be). But if we want to remain at the level
where knowledge is produced, that is if we are interested in a *science
of psychotherapy* (as far as psychotherapy can be a science), the
truth we deal with here is more modestly *taxonomy*. We need a taxonomy
of the psychotherapy field, that is a classification of its basic,
essential, cardinal elements organized in a comprehensive whole. Where
should such taxonomy ever be explored and tentatively built, if not
in a Society for the Exploration of Psychotherapy Integration? (Or
do we prefer to think that a science of psychotherapy cannot, or even
must not exist?)
