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?)