Of Cats and Elephants, or Why Assimilation is Not Enough

Tullio Carere-Comes

The psychotherapeutic field

I start with this definition: the psychotherapeutic field is the relational space generated by the inner logic of the therapeutic process, not by the therapist’s or the patient’s personal and ideological preferences. It is implied, by this definition, that a therapeutic field will not be generated as long as the patient or the therapist succeeds in imposing their personal or ideological preferences upon the process. For instance, at the beginning of the treatment both patient and therapist may be persuaded that they know what is to be done. The patient may want to be freed of his symptom without any significant change in his lifestyle. The therapist may want him to explore and work through his Oedipus complex as a precondition for any lasting change. But if the symptom happens to be the by-product of a wrong attitude or belief that has nothing to do with the Oedipus complex, both patient and therapist will have to change their minds for any useful work to be done.

The precondition for a truly therapeutic process to develop, therefore, cannot be the therapist’s theory, any more than the patient’s expectation, but the capacity to neutralize both, to explore the nature of the presented problem and its possible solutions. This defines the first vertex of the therapeutic field: a working alliance where patient and therapist agree to bracket out all theoretical or emotional pretence, and devote their efforts to understanding whatever is pertinent to the process (if at the beginning of the treatment the patient’s capacity of neutralization is not yet developed enough, the therapist‘s capacity must be strong enough for both).

The question that arises is then: how can psychotherapy be a scientific enterprise, if the therapist is asked to put aside the theoretical apparatus that gives him a scientist’s status? The answer is that to neutralize does not mean to cancel, but to balance a theoretical approach with one open to listening to whatever is not foreseen by a theory. In order to grasp the nature of a correct working relation, we can resort to the Piagetian idea of knowledge proceeding through phases of assimilation and accommodation (Piaget, 1959). When faced with a new experience, the healthy child tries to interpret the new data according to her pre-existing schemata (assimilation), and if she does not succeed in it, she modifies her schemata to adapt them to the new reality (accommodation). In the assimilative phase the child is like a scientist who interprets the world in the light of her own theories; in the accommodative phase the child is like a phenomenologist who brackets out her expectations and preconceptions to open up to whatever can show itself through that opening.

Science deals with objects, phenomenology deals with phenomena. The split between objects and phenomena is akin to the Diltheyan distinction between explanation and understanding, and between natural sciences and human sciences. The arbitrariness of such a split has been shown (Holt, 1962; Fornaro, 1998) particularly in the psychotherapeutic field. But learning itself, at its core, is a dialectical process. The suspension of a pre-existing schema creates an opening through which a new aspect of reality is disclosed; this in turn is coded in a new schema on which the following assimilations will be based, and which will be suspended for new accommodations. No new learning can ever happen if one sticks too rigidly (or too loosely) to his theory; every original scientist must be a phenomenologist when he applies the necessary epoché which enables him to see whatever was concealed by his theory, as every rigorous phenomenologist must turn into a scientist when it comes to organizing phenomena in new patterns and to verifying their correspondence to available data.

Wachtel (1981) has proposed to substitute the Piagetian schema for the Freudian distinction, epistemologically naive, between "accurate" and "distorted" perceptions, on which respectively "real relationships" and "transference relations" would rest. What Wachtel suggests to be still referred to as transference, is that part of the experience of relation in which assimilation is strongly predominant (since pure assimilation can never occur, no "transference" experience is totally arbitrary, as Gill, 1984, has pointed out). In other words, it would make sense to continue to call transference the relational experience in which a person holds firmly to his schemata and does not know how or does not want to suspend them in order to open up to the experience of whatever contradicts them. It goes without saying that equally pathological is the therapist who sticks to her own theories or beliefs and does not know how or does not want to have them challenged.

"Ideally, one might expect to see a fairly even balance between assimilation and accommodation, with neither predominating to any great extent" (Wachtel, 1981). A fairly even balance is desirable because too much assimilation prevents dialogue and learning, while too much accommodation is conducive to incoherence, fragmentation, or confusing eclecticism. But the balance at issue here is not just a quantitative matter. Let us consider, for instance, the case of two spouses who over several decades adapt more and more to each other, modifying themselves according to what each one expects from the other. Such adaptation can be not maturational or evolutionary at all, and will end in nothing but a big false self à deux. The same could be said of the process of reciprocal adaptation between a charismatic leader and the crowd, or between analyst and analysand after years of analysis. In all of these cases each one adapts to the "knowing" of the other, conscious or unconscious (theories, models, schemata, fantasies). How can we tell this pseudo-adaptation – in fact a reciprocal collusive manipulation – from a true adaptation to reality? True accommodation, unlike pseudo-accommodation, is not a negotiation between knowings, but the correction of a preexisting schema that follows the suspension of every knowing: that jump into the void that Bion (1970) has pointed to with the formula "Faith in O", which means entrusting oneself to the unknowable origin of every knowledge.

Again and again, in discussions with colleagues, I am faced with the same objection: "how can anything unknown be the foundation of anything known?". The necessity of the noumenon – of the unknowable Ding an sich – can be perceived if one realizes that no creative problem solving can happen out of what is already known, that the search for the truth is not a negotiation, that any original thinking requires an opening to the origin of thought. This relates to the first meaning of truth in the Western culture, aletheia (unveiling) in Greek. Truth, in its original sense, is nothing that we can possess, manipulate or construct. It is the being that unveils itself, that suddenly and unexpectedly reveals itself to one who is ready to receive this most precious gift.

In the current psychotherapeutic language the word that comes closest to aletheia is probably insight. Insight is not the result of an interpretation. One or many interpretations can pave the way to it (or equally well obliterate it), but it can also be the effect of an action (Wachtel, 1977), or just of empathic listening (Rogers, 1961). In any case it is one of the most powerful and decisive experiences in therapy, one in which a person sees with irrefutable evidence how things are. This is the truth that frees, immediately and directly. This is not to say that in the insight we know the unknowable noumenon. We can see only what appears to us, that is a phenomenon. But this does not imply that a phenomenon is just an "appearance", either. The whole phenomenology is the development of the intuition that an "essential truth" unveils itself in the phenomenon, that is in what appears to the consciousness that practices the epoché. This essential truth is not the noumenon, but what of the noumenon can "pass" into the phenomenon, what of the Ding an sich can reveal itself to the consciousness that opens up to it. In Bion’s terms, it is a transformation of O in K.

It is of utmost importance that the two horns of the cognitive enterprise are caught together. On its passive, receptive side, we see what appears to us in a non selective, non discriminating way, and the more complete is the suspension of all our interests and motivations, the more essential and near to the "things in themselves" is our vision (as this suspension can never be really complete, the phenomenon can never be coincident with the noumenon). But then we must shift to the active, constructive side of knowledge, as we cannot, as beings living on this planet, leave our interests suspended for too long. That is, we must select our material according to what we want to know. In so doing, we try to confirm as much as possible our pre-existing schemata, assimilating to them any new data, or we build up those new schemata that allow for the most satisfactory adaptation that we can possibly find to the present circumstances.

If the active, constructive side of the enterprise becomes predominant to the detriment of the other, we may cling too firmly to our theories or beliefs and become dogmatists, or we may be all too open to compromise and become conformists. In both cases we lose touch with the truth and we are unfaithful to the whole process. If, on the other side, the passive, receptive attitude becomes prevalent – if we become too open-minded – we run the risk of being overwhelmed by a mass of information that we will not be able to process. The result could be a developmental disorder characterized by the omnipotent pretence to know or to be open to everything, or by a weak, fragmented, and confused personality.

If we, however, know how to create a right balance between these two poles, we learn to temper our constructivism (which left to itself is bound to drift towards dogmatism or relativism) with our epoché, and our open-mindedness with a healthy and non dogmatic assertion of our standpoint.

It may be clear, at this point, that knowledge is not enough in itself: we need to be reminded all the time of its vital counterpart, the unknown and unknowable being. Failing this, knowledge falls all too easily into its typical disorders: dogmatism, relativism and conformism. This essential connection could be graphically represented as the vertical line of the therapeutic field: the uncovering axis, uniting the K (Knowledge) and the O (Being) poles (I borrow these letters from Bion). The latter is there to temper the hegemonic pretences of knowledge, in the first place: to prevent therapy from falling into cognitivism, that is into one-sided emphasis on cognition. The therapist shifts to the O vertex of the field whenever she feels that what the process requires is not that she produces knowledge, but that she allows the process to inspire and guide her: a situation in which rather than a scientist, an artist is needed.

There are therapists who feel more at ease in the K vertex and others who feel better in the opposite pole: there are, and surely there always will be, therapists of the scientist-type, and therapists of the artist-type. There is no need for one to force his or her basic temperament. But it is certainly advisable that, when in one pole, one does not lose sight of the other.

A scientist and an artist is all many patients need to find in a therapeutic relation. But to many others this is obviously not enough. Science and art are higher-order cultural operations, which require well enough integrated selves to be implemented. This is not always the case in therapy. When the patient’s self is more or less defective as a consequence of a disturbed maturational process, which in turn depends on inadequate administration of psychological growth factors, what was lacking in the past must be as much as possible compensated for in a new corrective emotional experience. This means that the therapist must take on some basic parental competencies. If we put a maternal and a paternal pole at opposite ends of a horizontal line, we get the remaking axis of the therapeutic field.

The movement on this line has been precisely described by Marsha Linehan (1993, p. 19): "The most fundamental dialectic is the necessity of accepting patients just as they are within a context of trying to teach to change... it requires moment-to-moment changes in the use of supportive acceptance versus confrontation and change strategies". In an ideal case, a patient with a fully developed self would need neither acceptance nor confrontation, as he or she would be fully capable and motivated to work on the uncovering axis of the field, no matter how hard and painful it might be. In a real case, a patient needs a variable measure of maternal-accepting and paternal-confronting support, both to be able to cope with the difficulty of the work on the uncovering line, and to build up the basic patterns of the psychological self.

For an extensive discussion on this axis, see Carere-Comes (in press). The only evidence I want to point out here is that the development of the patterns of secure attachment and responsible cooperation, which are basic to any healthy psychological self, happens normally in the family environment, if good enough maternal and paternal growth factors are available there. If instead the psychological self emerges more or less defective from the family environment, repair is still possible, provided that the lacking growth factors can be found in a new environment, like the psychotherapeutic relation.

A two-axis and four-pole system can be compared to the partition of the earthly horizon. As the North and the South poles define the axis around which the Earth rotates, and the East and the West stand for the sunrise and the sunset, they are not conventional, but natural reference points to any Earth traveller. Any other direction can be defined in relation to these four cardinal points. Similarly, in human existence one can detect two quite distinct lines. First, man is an animal among animals as a being endowed with an anima, or psyche: the place of all representations, connected to pleasant and unpleasant affects, which animals make of the world and themselves, where strategies of satisfaction of needs and desires, aimed at survival and reproduction, are elaborated, tested and carried out. The animal or psychological dimension is the one in which man, like any other animal, must fight his or her way between the security of the womb (or the egg) and the deadly menace of a hostile environment.

Secondly, man is the only animal to raise its backbone from the horizontal to the vertical. This reorientation in space, signalling the conquest of a relative freedom from the earthly gravitation, is the bodily premise of the spiritual dimension. All psychological beings know (that is, have an implicit or procedural knowledge), only the spiritual beings know that they do not know: that is, they know how to neutralize all pretences to know that are rooted in their soul, and in the soul of those surrounding them. Overcoming the ignorance of ordinary knowledge, conditioned by specific interests and standpoints and by sanctioned values, the spiritual being is in search of what is right and true in itself, beyond what is useful for the attainment of vital aims. In this line the researcher moves between the pole of knowing and that of being: in the first place the aim is to know things as much as possible as they are in themselves (scientifically and phenomenologically), thanks to the ongoing neutralization of all interfering interests and presuppositions; in the second the very need to know is suspended, as the subject opens up and surrenders to the whole process of which he or she is part (as in the Stoic philosophy: when all is said and done, one leaves the things in the hands of the gods).

On the horizontal line the problem is defect, or psychological immaturity. It is treated through corrective emotional experiences, that is through the administration of the lacking psychological growth factors, inside and outside the therapeutic relation. On the vertical line the problem is ignorance, or spiritual immaturity. It is treated through the theoretical and practical investigation of all programs, fantasies or identifications, either conscious or unconscious, in which the self has remained trapped (K vertex), and the development of a transtheoretical, transpersonal grounding of one’s existence (O vertex).

The generative grammar

The above four-vertex map can allow a new orientation in the field of psychotherapeutic integration. A field which is not integrated in itself, as there are "three generally accepted ways [common factors approach, technical eclecticism, theoretical integration] in which the methods and concepts of two or more schools of psychotherapy may be combined or synthesized" (Stricker and Gold, 1998). To begin with, the three can be boiled down to two if we consider that on closer examination "technical eclecticism is not a pure combination of heterogeneous techniques, but always a way of treating in which a particular view of pathogenesis and therapy incorporates techniques of different provenance, reinterpreting them on its own terms and making them consistent with its own aim", as Alberti (1997) concluded in a survey of cases of supposed technical (atheoretical) eclecticism. There seems to be no substantial difference between technical eclecticism and theoretical integration, as in both one starts with an idiosyncratic view and proceeds in an assimilative way. But this is what we all do. There is no other way to be a therapist than to start somewhere with any model or theory and go on building on it for one’s whole professional life.

We are all assimilative integrationists, after all. Then why bother? Because assimilation is necessary but not sufficient. It is obviously impossible to work without a theoretical-technical base of reference. Nothing is wrong with it, as long as it is a reference, and not a foundation. It is a reference when it is used as a tool, which is precious as it may be, yet nothing more than a tool: one uses it as long as it is useful, and puts it aside and looks for a better one when it is no more so. But it becomes a foundation when the identity of the therapist hangs on it; the allegiance to it is in this case mandatory, because without such ground the therapist no longer knows who he is or where he is going.

It should be clear that the theoretical-technical base must be a reference, and not a foundation, because when it becomes a foundation (I am a psychoanalyst, I am a behaviorist), the therapist can no longer be neutral as to her own theory. When a therapist looses her neutrality, she looses the very thing that makes her a therapist. When the neutrality is lost, the therapy is lost too. What remains is manipulation or indoctrination.

But when the therapist is no longer identified with his theory, what happens to his identity? The quest of psychotherapeutic integration crosses the quest of the self. A true or healthy self has been likened (Messer and Warren, in press) to a wheel: the parts of the self are like the spokes held in place by the center of the wheel, as their anchoring point. Only the presence of a firm center can grant a sound dialectic between the one and the many, the unity and the multiplicity of the self. Failing this, the self is bound to get harder and stiffer, in order not to fall to pieces (modern self), or to drift towards fragmentation (postmodern self). But what do we find at the center of the self?

"You can unite thirty spokes to a hub, but the utility of the vehicle depends on what is not there" (Tao Te Ching, 11). The comparison between the self and the wheel has been made since olden times. As the hub must be void for the wheel to be a true wheel, so it is for the self. If in the core of the self you put a theory, what you get is a false self: a self that has remained stuck to an object, and has therefore objectified itself. In the K vertex the therapist makes use of all sorts of theories and techniques: the more spokes she has in her wheel, the better. But all these spokes cannot work properly if they are not connected to the hub of the O vertex, the empty center of the self, the ineffable Ding an sich, or the fathomless source of all creative and healing powers.

For the sake of completeness, let us remember that the wheel is a symbol for the human spirit (no animal has ever invented one), but besides the wheels a carriage needs a horse to move. A horse stands for the animal part of the whole, the anima or psyche. The dialectic between remaking and uncovering, which is basic to any psycho-spiritual-therapy, corresponds to the dialectic between the psychological and the philosophical axes, which is basic to any human growth process.

We are now at our last step. We have reduced the three commonly accepted ways of psychotherapeutic integration to two. From the "common factors approach" we have derived a model that includes the basic therapeutic strategies or roles that are common to all methods, but is not just the usual list of factors, inasmuch as it integrates them in a coherent, observable structure. Then we have reunited the "technical eclecticism" and the "theoretical integration" in one group, as we have found no substantial difference between the two, which operate both with a progressive assimilation of new theoretical-technical elements on a given base. What remains for us to do is to integrate the two perspectives we are left with; that is, we have to see their reciprocal implication, or the fact that, so to say, they need each other.

For this last step I will resort to Walter Benjamin’s concept of translation. The very aim of translation, as Benjamin (1923) pointed out, is not to make understandable in one language what is written or said in another, but to look for the common ground that is beyond both. In fact no translation would ever be possible, if such common ground did not exist. This common ground is the truth or the reality of which all languages speak, each in its particular way: once again, it is the noumenal Ding an sich. The different tongues can be translated into one another only because they speak all of the one reality in which we all live, though each of us in his or her particular way.

As no language can be perfectly translated in any other, any translation will miss something of the original, and will add something else that in the original was missing. But this difference, in Benjamin’s view, is not to be seen as an imperfection, on the contrary: the translation reveals more fully the complementarity of the languages. Through the act of translating, therefore, we come nearer to the essence of things, though we never get to possess them entirely. The aim here is not a universal perfect language to replace all historical, regional tongues, as the reality as a whole can be grasped only in the partial and incomplete ways represented by the individual tongues. But through the effort of translation we transcend the limits of any single tongue and move towards, or open up to, the truth or reality in itself. This opening to a wider perspective does not lead to a universal language, but permits one to discern a universal grammar that is common to all languages. It is obvious that the rules of such grammar, which are generative of any language, are implicitly known to every human being: otherwise how could any child learn so easily such an extremely complicated thing as is any natural language (Chomsky, 1965)?

What is true for the natural languages, can be said in a similar fashion for those special languages that are the psychotherapies. The effort of translation, or the comparative study of all methods, does not bring us to one best psychotherapy, but helps transcend the onesidedness that is the inevitable companion of any approach. This transcendence means pluralism and dialogue, to say the least. But beyond that, it begins to shed light on the universal grammar of psycho-spiritual-therapy, that is on the basic rules of any relational therapeutic enterprise.

A universal grammar is not to be confused with the tongues it generates: each of them will continue to exist in its own right, and new ones, or variants of the old ones, will constantly be generated. But knowledge of the universal grammar allows for both a better translation from any language to any other and for a better use of any individual language.

One best psychotherapy does not seem to be more desirable than one best mammal. As the replacement of cats and elephants by big cats with a trunk could hardly be seen as an improvement of the mammalian world, so would be the replacement of the great variety of therapeutic schools and practices with just one standardized method. As George Stricker said: "The main difference is whether we are seeking the one best way, which I have trouble thinking we will find, or a general process that may work for all people, even though it will look different according to the needs of different patients and the preferences of different therapists".

Nobody needs the best mammal, or tongue, or therapy. It is good that we have many species and varieties of all of them. What we need, instead, is a key – a generative grammar – for every class of living phenomena, which enables us to better understand their essence and, as a consequence, to better relate to them. As for the therapy, the knowledge of the general rules – or roles – that are basic to any therapeutic enterprise, inasmuch as they are responses to the basic psychological and spiritual needs of the human being, would be of great help in making the best match between "the needs of different patients and the preferences of different therapists".

In sum, the final dialectic every therapist should consider is between her idiosyncratic method and a map or model of the general rules or roles of any relational therapy. The constant reference to the latter would help her not to lose sight of the needs of her patient (and not to become too idiosyncratic), to work on her blind spots, to develop the underdeveloped areas of her own approach, and to refer her patient to another therapist when the match is poor. On the other hand, the deeper familiarity every therapist has of a limited sector of the field, if brought back to bear on the general map, can improve it and enrich it with finer details. Every therapist should be in this sense a researcher, giving her unique contribution to the general knowledge of the field, as in turn the study of the field as a whole should help every therapist work better in the limited sector of it that she has chosen.