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Hilde
Rapp, 1 March 2006
Allan
wrote:
<<I
understand theories as
well-organized
explanatory
frameworks, which can
be applied to a range
of phenomena and which
are capable of
generating either
hypotheses that can be
tested empirically or
truth-claims that can
be evaluated
rationally>>.
I
agree entirely, a theory
needs to be able to
organize observations,
generate lawful or at
least orderly relations
between them,
predict what novel
observations would be
expected to fall under
the scope of the theory,
be testable empirically,
or capable of rational
justification via
logical argument.
It
was precisely this
understanding of the
role and nature of
theory which led to the
evolution of the
assimilative(-
accommodative)
integration (
pre?)paradigm.
T he
debate was/is (see
Messer et al 2000/2001?
the JPI assimilative
integration issue) about
what transforms or
re-descriptions of a
borrowed technique, or
what
reformulations
of a theoretical
term, might be
possible so as to
allow it to be
integrated into
the theory
which informs our
practice without
distorting either
theory or praxis in any
serious way…
There
are clear exclusion
criteria at
stake which have been
variously articulated in
our literature and
which
constrain
the principled (
here Tullio’s term is
very apt) transposition
and inclusion of new
thinking and ways
of working, whatever
their origin, into
an espoused
theory
if this is
to retain any meaningful
family resemblance
to the theory
in use by a
practitioner.
Hilde Rapp, 1 March
2006
Allan
wrote:
<<
Existential
phenomenology
(specifically, that of
Merleau-Ponty) starts
from the premise that
“internal” and
“external” are, like
all such dualisms
(e.g., “mind” and
“body,” the “immanent”
and the
“transcendent,” the
“ideal” and the
“real”) derivative
constructs of an
inherently unitary
world of phenomena of
which human beings are
constituents (in the
Gestalt sense of
mutually constitutive
parts of a whole,
inseparable from each
other without losing
their essence). This
is a remarkably hard
thought to think (I’ve
been working on it, on
and off, for 25 years
or so), but possibly
the thought that leads
to the aufhebung of
many destructive
dichotomies. Science?
Probably not.
Reductive or
Religious? Definitely
not.>>
To
think of our being in
the word and of the
world in which we are
and do as “mutually
constitutive parts of a
whole, inseparable from
each other without
losing their essence” is
indeed “a remarkably
hard thought to think”.
This also
exercised Freud more
than somewhat – and
indeed, Bion. I
have (reluctantly) come
to the conclusion that
we can, in certain
meditative states which
include the
psychoanalytic art of ‘free
association’, and
‘mindfulness’
in cognitive
behaviour therapy , experience
wholeness and unity.
I
do, however, not know
how to convey this
experience of unity
in the form
of narrative discourse,
nor, in the strict sense
of the word, do I know
how to think
such a thought-
my mind seems to be too
small for that. I
therefore contend myself
( reluctantly)
with recognizing
and respecting
that different disciplines
and their different epistemic
foundations and methods
of enquiry have
come about in
order to addressed this
task in piecemeal
fashion so as to make
thoughts smaller and
thus thinkable
in a coherent way .
The
ground map for my four
quadrant meta- framework
therefore sets out four
different starting
points for a
collaborative and
integrative endeavour at
understanding ourselves
and our world in ways
useful for the practice
of psychotherapy.
I suggest that we draw
on the wealth of
historic traditions
which define different
universes of discourse,
bodies of
knowledge, wisdom,
experience, practices,
and peer derived
conventions that
give shape and
content to each of
these ( notionally) four
families of logic of
inquiry into :
1.
subjective experience
( phenomenological)
2.
collective meaning
making ( hermeneutic)
3.
human development
(evolutionary/ human
sciences)
4.
understanding society
and environment
(complexity/ living
systems approaches ).
Each
epistemological
enterprise addresses a
particular area of
enquiry particularly
well and looses its
force and scope in
relation to another.
As
integrative therapists
we need to be clear an
honest about which of
the following two
kinds of
endeavours we are
engaged in. the making
meaning of our
experience or
searching for
knowledge and
explanations. We
need both to
practice. We may be
temperamentally inclined
to wards one or the
other. We pick clients
who benefit more form
our intuitive wisdom and
skill, or clients who
need more direction and
systematic support. All
the same our art,
craft and science relies
on both scientific
research and
emotional intelligence…
1.
Sharing Experience and
Making Meaning
for the Sake of
the Client’s Wellbeing
( largely
informed by
1 phenomenological,
and 2 hermeneutic
endeavours: reflection,
contemplation, intuitive
understanding and
interpretation)
Seeking
a means for
pointing to an
experience so that we
can share something
about it that makes us
more compassionate, more
sensitive and observant,
more humble and yet more
daring when we grapple
with dark forces,
lies at the
centre of our praxis.
We are working
with our capacity for
violence, our capacity
for deception, but also
our passion for what is
beautiful and erotic and
our hopes and fears and
our search for truth.
This
is the crux of
psychotherapy –
something happens in the
consulting room between
the client and the
therapist which is
actually ineffable
because we cannot unpick
it from the context of
the living and lived
experience without it
loosing much of its
meaning and its
significance for change.
We
may call it transference,
projective
identification and
so on if we are
analysts, empathy,
mirroring if we
are person centred,
modeling if
we are behaviour
therapists, parallel
process if we come
from Gestalt, shaping
if we are learning
based, resonance
, following and
leading in
NLP, experiencing,
if we are experiential ,
therapist and client
factors in the
common factors approach,
and the relationship,
if we are
cautious about
avoiding what may
sound like jargon and so
on.
We
work with these
phenomena and we know
that they are essential
to therapeutic outcomes.
Although
he abandoned this
position later,
Wittgenstein once said
something like “there
are things that can be said,
and things that can only
be shown-
and about that of which
we cannot speak we
should remain silent…”
but then he was a
philosopher. We as
therapists ( must?) dare
to speak ( clumsily)
about those ineffable
things because we are
practitioners and not
logicians…We need to
achieve what Jerry
Bruner calls joint
deixis, that
is a line of gaze
that points us to the
therapeutic experience
we want to share,
collaboratively seek to
understand so that we
may find ways of
working more effectively
for the sake of the
client’s wellbeing.
The
best we can do is to
circumscribe what
it is about the whole
that we can experience
but not speak about
Adorno
recommended an
essayistic
circumlocution of
the ungraspable object
of our enquiry. Like the
poet , we might
encircle what we
are after enough to
narrow down where we
should look- with inner
and outer eyes: out
quarry is in that
symbolic thicket over
there! Merleau
Ponty or Husserl
language this
enterprise
differently, but I think
they are after the same
thing. Long live epoche,
the
inevitable
adhesions of
preconceptions not
withstanding, and
may the cloud of
unknowing shield
us all from hybris…
Perhaps
we need to bear our
relative smallness and
ignorance and accept
that these ineffable
experiences at the
heart of the therapeutic
encounter cannot be
theorized
in the sense
of making the sort
of “ truth-statements”
that should be
foundational to a “proper”
scientific theory.
Perhaps they
can only be “theorized” in
the original Greek sense
of the word which
refers to a way of
seeing linked to an
exercise in aesthetics
and ethics
rather than to
an effort after
explanation in a natural
science sense. Here
we are after an
activity, a verb, to find
ways of seeing and
interpreting reasons
and justifications,
rather than
that construct a
systematic edifice which
accommodates the relations
between causes and
effects?
We
can speak about
things, but not of
them, but we
can show phenomena
( appearances)…
2.
Picking out and
languaging an aspect
of our experience to
generate knowledge(
largely informed by
3.
evolutionary/human
sciences and 4. living
systems approaches:
observation,
description,
explanation, treatment
and prevention)
We
endeavour to generate knowledge
by become more
competent at picking
out
an aspect of
that whole and
to language
it in such a way
that we
come to
know
something new and
specific about this
experience which does not
depend for its
understandability on the
unmediated access of
an embodied
experience or the
context in which it
appears . The
experience is mediated,
abstracted and
symbolically
expressed (Hegel’s Vermitteltheit).
Although we loose a lot in
the transmission, what we
can say still makes enough
sense to be useful and informative
to others who work in the
same area- and if we are
lucky it makes sense to
people at large, at which
point it may
approximate to knowledge.
Observation
and Description:
We seek to
describe in relatively
unambiguous language any
observable effects of
these clinical phenomena
such as resonance,
f critical moments, or
change events.
We
want to
specifically
exclude what
we may know through our
imaginative
participation in the
privileged experience in
the actual therapy
situation. We want
to objectify and
decontextualise that
which we wish to study.
Such objectivising
approaches are
nonetheless not
‘theory free’.
There
are no ‘data’ ( givens)
, everything is
interpreted, but the
theory in this
context is a sort
of contamination.
We
aspire to
translate
natural language
terms with all their
semantic fuzziness into
formal language terms –
we deliberately
set out to create
jargon that is
stripped of ambiguity
because the word is not
normally used outside
the scientific arena for
which it has been
formulated and so does
not acquire
contextualised
meanings.
We
admit that we
cannot wholly
succeeded- we are
self reflective- but we
continue to try to make
something like DSM3R or
DSM4 or ICD 10 as clean
and descriptive as we
can./ We do our best to
categorise and
classify the observable
effects/ symptoms of
ineffable psychic
and relational
processes in a
descriptive way. We aim
to set signposts that
reliably point us
to roughly the same
place in the forest of
symbols. ,
Observation
and Explanation:
We want to be able to
identify the
object of our inquiry as
accurately as possible.
We want to be able
to compare
one client with another
on the basis of clear
selection criteria . We
want to map
comparable
patterns in client
behaviour. We want to
examine their
relationship to the
clients life conditions.
We want to see whether
certain effects are
reliably associated with
certain causes. What
makes people vulnerable
or ill? . What is the
natural history of
a disorder?
Treatment
and Prevention
We want to know what the
therapist and client
do
together to see who
works well with whom and
who does not, and
what works and what does
not, and what sort of
therapist behaviours
work with what
sort of client
difficulties.
We
endeavour to
specify
therapeutic
procedures in the
form of treatment
manuals so we can
test certain hypotheses
about what
facilitates or hinders
the occurrence of
experiential and
relational
phenomena
which we believe
to be associated with
change. We need to
be able select
clients who are
well described by a
particular label in a
common classificatory
system. We need to
ascertain whether
therapist A and
therapist Z are
both performing
the action specified by
their espoused
theory as
effective and we need to
be sure that this
is significantly
different from what
therapist B and O are
doing who espouse
different theory. We
want to know which
method is more
effective.
We
also want to study
what factors
can to prevent
distress or disease, so
that we can help
to ameliorate it
better and faster.
Processes
We are curious
to identify behavioural
markers for psychic
events and processes
which we cannot
directly access, but
which we know from our
own experience as
practitioners, take
place. There- that
look- that inclination
of the head- that
silence- that breath-
seems to correlate with
a critical event- does
it? The use of
imagery, metaphor,
laughter precedes
a shift – is this
a pattern. ?
Here
comes the rub –( or
is it an invitation
to integration and
learning ?) :
We
can only
meaningfully pick
out an aspect of
therapeutic experience
for this kind of objectivising
scrutiny because, (
provided we are
practicing therapists),
we
already have
direct–
presentational-
( see also
Shannon’sexcellent
arguments for this
) experience
of
the whole from
which we are now picking
out a part for our
special attention.
We are in
the same business.
Although our experiences
are not exactly
the same, they are
often similar enough for
us to be able to
recognize our own
experience in someone
else’s account,
description or analysis
of what occurred in a
session or treatment.
This is how we
learn from other
people’s experience and
how we come to enrich
our own. We have
the Aha-experience of
yes ! this
is what happened
in my session,
yes: this is
a useful interpretation
of something I have been
struggling to
understand, oh good she
also thinks that this is
a good technique…
This prior
orientation allows us to
understand where a
given
linguistically or
symbolically
mediated
re-presentational
(and
probably logically
incomplete)
sentence or
description is
pointing.We
may recognize our client
in a particular DSM
description and we may
find that a clinical
guideline for
how to work with
such a client
illuminates for us
what to do better
tomorrow.
The guideline
may give us a road map
for
setting
up the
facilitating conditions
to give space to and
bring about a particular
therapeutic experience
which replicates the
kind of experience the
clients who were part of
the sample that was used
to construct the
guideline may have had
that may have
helped them to
change.
The map
is not the territory
: description is no
substitute for
experience
The writer
of a
cookbook
or a therapy
manual doesn’t claim
that it makes you an
inspired or competent
cook or therapist ,it
doesn’t create an
intimate atmosphere, it
doesn’t equip you with
the sense of smell that
tells you that
something stinks,
it doesn’t regulate your
flame or prevents you
from burning the meal.
It just describes,
how you might use
certain ingredients to
create a
constituent of the
whole experience – the
meal- not the encounter
within which the meal
plays a part, nor whom
to invite. Nor does it
forbid you to alter the
recipe. It merely
describes...
Whether it helps
our praxis to use a
guideline or to copy
another colleagues
technique is
partly a function of
whether we are a ‘good
cook’, whether this is
the right time, the
right chemistry and
whether we have the
right ingredients for a
therapeutic experience
to arise and
whether we have to wit
to recognize a change
event for what it
is when it does occur.
I have not
really met anyone within
SEPI who
confuses the map (
symptom checklists of
whatever kind – or the
recipe, ie
descriptions of
observable relationship
events, or behavioural
markers of
features of an
emotional
landscape) with that
territory where Virgil
dares to walk with the
leopard!
I also I
think we do, on the
whole, know the
difference between this
leopard and a paper
tiger quite well- thank
you to all within
SEPI!
Both
the effort after meaning
and the effort after
knowledge are paths to
understanding
within a
civilizing
endeavour- to bring out
the best in us as
individuals by way of
self realisation and
self definition on
the one hand and
to socialize us to be
fit for building
relationships as
global citizens through
attunement, self
restraint and
co-regulation in the
service of joint action…
on the other.
Experience without
science is dumb (
speechless) and science
without experience is
dead (lifeless ).
I apologise that I
needed so many words to
mutter this. We
can, as Allan wrote,
only ever “
asymptotically”approximate
to the truth.
Tyler Carpenter, 1
March 2006
I
agree with your general
slant on things, Tullio.
Sorry I can't join
you for a Chianti or
cappuccino in the near
future, but when I'm in
the neighborhood
I'll bring a home brewed
beer (I just finished
making a Belgian Tripel
and will bottle a Barley
Wine April 1st).-
More
particularly:
Sometimes group process is
muddled with paradigm
clashes. I would add to
the concept of a
disciplined mind, the zen
concept of no mind.
Sometimes even disciplined
minds run into subtle
distinctions that are
obstacles in the path to a
larger understanding of
the topic at hand. The
late Chogyam Trungpa
Rinpoche's concept of
"spiritual materialism" is
related to the idea that
individuals, even bright
ones, can fetishize
concepts (especially
ideals) and then get
caught up in the
detritis of certain
distinctions and emotional
reactions.
As a former academic -
medical school research
team member, I have a
great appreciation for the
role that disciplined
study can bring to any
orientation that one
chooses, as long as the
data and context are
clearly understood. Here I
suspect I think similarly
to Tullio. ESTs can also
simultaneously be great
tools for the apprentice
and journeyman and patient
on an individual path of
change, or if tweaked by
the expert, an adjunct to
systems interventions or
psychotherapy broadly
conceptualized. I would
add to the concept of
treatment as ethically
based, that of
evolutionary and adaptive
biology. If the applied
values didn't have
survival value for the
individual and the group,
there would be little or
no purpose or effect in
applying them. When you
add
biology-chemistry-neuroscience
to the pot, things begin
to bubble and savory
smells emerge.
Hilde,
I would
add, that
particularly when we begin
to drop the need to define
all in one framework,
different levels of
systems often provide
their own vocabulary and
framework that complements
other levels. When each
participant (or group)
deals with the issue as
they see it and it (their
conceptualization) is
perhaps tweaked a bit to
function both for them and
in doing so for the
systems, then the whole
may lumber on adaptively
without the impediments
that separate conflicting
vantage points can often
bring to what is
essentially a unitary
process, regardless of our
attempts to name it and
its constituent elements.
What I am struck by again
and again is the
lack of understanding
different groups have of
each other and how often
just providing common
ground, without exchanging
worldviews, is all that is
needed for good enough
adaptations to become
emergent.
Dear
Paolo,
On ethics
I'm not sure that relying
on ethics is anymore or
less useful than relying
on theories of therapy
(especially given their
partial correlation with
one another). Ethics are
often based on precisely
what you suggest makes
them unworkable as a
foundation for treatment,
namely the different
schools of reasoning that
govern the ways in which
one may integrate the
various common principles
that one may invoke when
addressing a common
problem. The approach is
both nomothetic and
idiographic and this dual
nature is built into the
body of the discipline.
Tullio
Carere, 2 March 2006
George
Stricker wrote:
<<My preference
is for an assimilative
approach to integration,
in which a preferred
theory is maintained and
techniques from other
approaches are
assimilated. However,
the challenge after
successful assimilation
is accommodation -
changing the home theory
so that it can
accommodate a technique
that originally would
not have been suggested
by it. Is accommodation
possible or must the
theory be discarded in
favor of a synthesis? I
don't know, and that is
the challenge we
face.>>
George,
it is wise to prefer the
inevitable. In my view
we are all assimilative
integrationists,
inasmuch as we all start
with a theoretical base
that we form in the
years of our training,
and go on building on
that base through our
entire professional
life. When we assimilate
something, we have to
change more or less our
home theory to
accommodate the new
thing, as you point out.
As a result, in the
course of time the
building grows into a
mixture of the original
theory unmodified (which
already is an
idiosyncratic
collection/selection of
the original inputs),
the original theory
modified to accommodate
the assimilated foreign
bodies, foreign bodies
not really assimilated
but hanging around in a
more or less eclectic
way. The bottom line is
that we have hundreds of
schools, thousands of
subgroups, and virtually
as many
psychotherapeutic
theories as there are
psychotherapists in the
room. The paradoxical
outcome of assimilative
integration is that the
individual
psychotherapists become
more integrated, to the
extent that they
integrate into their
original approach modes
that originate
elsewhere, while at the
same time the
psychotherapy field
becomes more and more
dis-integrated.
We are all very happy
with our idiosyncratic
assimilative
integrations, as we also
are more or less
painfully aware of the
resulting disintegration
of the field, and
struggle towards some
form of integration --
this is why SEPI came to
existence, I believe. I
am not as optimistic as
David about the
feasibility of a
theoretical integration
between, say, two
incompatible but
reasonably coherent
theories like
psychopharmacology and
psychoanalysis (if
psychoanalysis were a
coherent theory, which
is not). But it should
be clear that the very
idea of integrating
hundreds or thousands of
incompatible and
incommensurable (and
incoherent) theories is
absurd. This is why I
say that the only
possible integration of
the field happens on the
pragmatical ground, i.e.
the common ground where
we find a number of
common factors, and
where a communication
among us, independent of
our theories, is
possible.
Sure enough, research
has been done, and more
research must be done on
common factors. But I
dare say that empirical
research as it is
commonly meant (on the
blueprint of medical
research) is not very
fit for investigating
common factors. For the
simple reason that
common factors are not
"ingredients", or
"procedures" which one
can "manualize" (what
can an empirical
researcher do without
manuals, or at least
precise enough
guidelines?). They
are not behaviors of
the therapist
(observable,
recordable) --
they are
experiences of the
patient. For
instance, we know that
every therapist, of
whatever school, must
respond properly to the
basic need of secure
base virtually present
in all patients. But
there is no way to know
in advance what will be
reassuring for a given
patient in a given
session. One will feel
at ease in a rigid
setting experienced as
persecutory by another
who will feel secure in
a flexible setting.
Experiences cannot be
observed from the
outside, yet they can be
investigated not just
in-session (which is
obvious), but with
post-session
questionnaires,
integrated with written
notes by both patient
and therapist. This
material permits to
monitor and document the
process, and to
correlate process and
outcome. If the object
of research is not
behavior, but
experience, the research
should not be
experimental, but documental.
We diverge among us
inasmuch as we integrate
in the assimilative
mode, we converge in the
common factors approach,
which could also be
properly called accommodative
integration. We
can observe common needs
and common therapeutic
factors, and facilitate
their emergence,
expression and
development, to the
extent that we know how
to bracket out our
theories and get tuned
in the process that
develops in its own
right. Too much
assimilative integration
makes the therapist self
centered and insensitive
to the process, too much
accommodative
integration is
detrimental to the
therapist's coherence.
"Ideally, one might
expect to see a fairly
even balance between
assimilation and
accommodation, with
neither predominating to
any great extent". Paul
wrote this sentence with
reference to individual
treatment, but it also
applies to the field as
a whole.
Barry Wolfe, 2 March
2006
Hello All,
I would like to weigh in
with a vote for working
toward a unifying
conception of
psychotherapy, even
though this may strike
us now as an
unrealisable goal.
There are two reasons
for this: 1) there is a
lot of theoretical
redundancy in our
various theories of
psychotherapy and in the
disorders they treat and
2) some theoretical
propositions within each
theory are just plain
wrong. For
example, in my recent
review of the various
extant theories of
anxiety disorder and
their treatment (Wolfe,
2005)*, I found that
psychodynamic,
cognitive-behavioral,
and
humanistic/experiential
theories all argue that
we are ultimately
attempting to bring
about change in tacit
internalized psychic
structures regardless of
the theoretically-based
terms we give them (i.e.
unconscious character
traits,
cognitive schemata or
tacit emotion
schemes).
Secondly, psychodynamic
theories need to
"accommodate" the fact
that exposure therapies
can effect symptomatic
improvement in virtually
all of the anxiety
disorders, while
behavioral theories need
to accommodate the fact
that there are tacit
dimensions to anxiety
disorders (even phobias)
that are responsible for
both the development and
maintenance of these
disorders.
These are just single
examples of what I
believe is a fairly
wide-spread need for
trimming theoretical
redundancy and engaging
in a significant amount
of theoretical
accommodation.
George
Stricker, 3 March 2006
My response
incorporates a response
to an early post from
Allan as well as yours
Tullio. I agree that my
approach is within the
realm of normal science,
to use Kuhn's term, and
also that psychology
(not just psychotherapy)
is still
pre-paradigmatic. My
preference for normal
science rather than
Allan's Nietzschean
solutions (theorizing
with a hammer) is based
on my pessimism about
the approach that so
many others are
favoring. Physics, which
is far in advance of us,
and is paradigmatic, has
been searching for a
Grand Unified Theory in
vain, at least to date,
and that does not
encourage me as to the
prospects for
psychotherapy achieving
success at a GUT. In the
meantime, we still have
to serve our patients,
and the best avenue, in
my mind, is through
assimilative efforts and
a search for common
factors, probably
located in a region at a
level lower than
theoretical. By the way,
Tullio, I wish we all
were assimilative
integrationists, but I
think many people
function as eclectics,
free from theory,
although I've never been
enamored of that
approach.
Zoltan
Gross, 5 March 2006
How
does one convince others
that the earth rotates on
its axis while traversing
its orbit around the sun,
when it is important for
them to know the sun rises
in the East and sets in
the West?
I agree with George
Stricker that both
psychotherapy and research
psychology are in a
pre-paradigmatic stage of
theoretical
development.
However, with the
introduction of
information from
neuroscience, I am more
hopeful than he is about
the prospects for the
creation of theory of
personality that is both
researchable and
clinically useful.
At present, theorizing
about personality is an
outside-in way of looking
at it. We observe
the behavior and the
reported experience of
people with common sense
cognition that is linearly
and sensorially
formatted. This
information is then passed
through lens of Western
cultural tradition and
belief. As a result
we are greeted with
descriptions of
personality spoken in
different "languages"
(paradigms) using the same
words but which have
different meanings. There
are no consensually agreed
upon definitions about
such words as personality,
person, self, emotion, or
cognition. Furthermore,
none of these terms have
theoretically elaborated
relationships with one
another. In effect,
I believe we
have been
anthropomorphizing
cerebral operations based
on commonsense cultural
biases. I find it
difficult to believe that
"meaningful" assimilation
can readily occur when
this epistemological
barrier exists.
Early on in my practice I
realized that common sense
contributed more to my
confusion than to
psychotherapeutic
growth. When people
returned their "repressed"
to me I found that they
were "returning" what I
had asked them to
return. Nothing much
happened with that
exchange. The
operation of the Pleasure
Principle was rarely seen
except when it came to ice
cream cones. Plato's
and Freud's hoped for
sovereignty of reason over
passion didn't
exist. Reason was
always swept away when the
storms of passion,
anxiety, depression, or
pain passed over the
landscape of the
individual's
personality. As I
came to see how congruent
the dualities of
personality operations
were to the doubly dual
structure of the brain, I
abandoned "common sense"
as a guide to my
work. I found my
self engaging in some of
the wisdom of the Theater
of the Absurd and the Sufi
and Zen mystical
traditions. The
differences in information
processing of the left
(linear) and right
(nonlinear) hemispheres
and anterior ("executive"
and emotional -
nonsensory) and posterior
(sensory) lobes helped me
to better understand the
relationship I was having
with the people with whom
I was working Since
personality operations are
largely relational and are
nonsensory it is extremely
difficult to describe them
in common sense
formats. Instead,
applying Averill's idea
about functional analysis
to cerebral operations (an
inside-out way of looking
at personality) it is
possible to create a
theoretical paradigm that
can accommodate the
nonlinear (relational) and
nonsensory (selves and
emotion) dynamics of
personality that is both
researchable and
clinically useful.
We are now on the
threshold of the creation
of a new psychological
paradigm. The
achievement of Freud's
Scientific Project is now
possible. With it,
we can escape the
limitations of "folk"
psychology upon which we
currently rely. It
is not enough to know that
the sun rises in the east
and sets in the
west. This belief
could lead us to believe
that we are at the center
of the universe. We
have a richer and less
limiting understanding of
where we are in it, when
we know about the dynamics
of our orbital
relationship to the sun.
The wish I have just
outlined hasn't happened
yet, but I believe that it
can.
Allan Zuckoff, 6 March
2006
Tullio
wrote:
<<
For instance, we know
that every therapist,
of whatever school,
must respond properly
to the basic need of
secure base virtually
present in all
patients. But there is
no way to know in
advance what will be
reassuring for a given
patient in a given
session. One will feel
at ease in a rigid
setting experienced as
persecutory by another
who will feel secure
in a flexible
setting>>.
Tullio,
Each
of the three statements
above is a)
theory-specific, and b)
empirically testable.
Manuals are much less
limiting (and limited)
than you suggest, and it
would not be that
difficult to do a study
in which one group gets
therapy that is attuned
to these polarities and
adjusts accordingly,
while the other gets a
one-size-fits-all
approach. And the
results of the study
would allow us to go
from assertion to
research-supported
positions on these
critical questions.
Hilde
Rapp, 6 March 2006
Dear
Allan, dear Tullio,
Such
research exists-
especially within
Shapiro paradigm
of altering the sequence
in which
conversational-
relationship focused
interventions and
cognitive behavioural
interventions are
delivered –
Members of the
Society for
Psychotherapy Research
in the UK can help
pinpoint where
particular studies may
be found…
Allan
Zuckoff, 6 March 2006
Hilde
wrote:
<<The
ground map for my four
quadrant
meta-framework
therefore sets out
four different
starting points for a
collaborative and
integrative endeavour
at understanding
ourselves and our
world in ways useful
for the practice of
psychotherapy…>>
Dear
Hilde,
Your
post was challenging and
complex, and I found
much to admire in your
views as well as in the
humanity that spoke so
clearly through them. I
must, however, have
another go at
challenging the
epistemological
assumptions of your
meta-framework.
Much
of your post centered
around the dichotomy of
the “subjective” and the
“objective,” understood
through a traditional
philosophy of science.
In this model, there is
a “subjective” realm of
immediate experience
that cannot be directly
accessed by others, and
an “objective” realm of
mediated knowledge that
can. Of course, these
categories also
correspond to the
traditional ideas of
“mind” (that which is
private) and “body”
(that which is public).
I
would like to propose
that this model,
universally accepted
since Descartes, is
precisely what has led
to all kinds of
conceptual trouble and
needs to be jettisoned.
That is to say: because
we are “incarnate
consciousness” or
“animated bodies” (the
two terms mean exactly
the same thing), mind
and body, subjective and
objective, can never by
separated without doing
violence to reality.
(And the trouble has not
only been conceptual;
once we dichotomize mind
and body, we prepare the
way for the demonization
of the erotic body that
has plagued the West for
the past couple of
millennia). Our
experience is always
mediated and accessible
to others: not, as the
poststructuralists and
anglo-analytic
philosophers after the
linguistic turn would
have it, because we are
born into and formed by
language (though we are,
in part), but because we
are flesh, and
we recognize ourselves
in the flesh of others
(Merleau-Ponty called
this the chiasm,
or intertwining), and
the meanings we perceive
are not merely “imposed”
by us (because, then,
how would we ever know
whether we are imposing
the correct meanings?),
but inherent in reality.
What is, is
autochthonously
organized; we are part
of what is; and we
perceive that
organization because it
is there, and because
our perception is a
constituent of its
coming-to-be.
So,
one might reasonably
wonder, what are the
implications of all this
wooly philosophizing for
psychological and
psychotherapy research?
Well, one major
implication is: we need
to stop using the term
“phenomenological” as a
synonym for
“subjective.”
Empirical-phenomenological
research is not merely
the elaborate
description of
subjective experience.
It is a (human)
scientific method for
accessing the real
essences of things, the
meanings that inhere in
phenomena (which is all
there is). It provides
analyses of descriptive
data that allows us to
“come to know something
new and specific
about this
experience which does
not depend for its
understandability on the
unmediated access of an
embodied experiencer or
the context in which it
appears.” It does not,
of course, provide us
with “objective”
knowledge—but only
because the very idea of
“objectivity” would
require that we could
view the world from a
God’s-eye view, and
because, once we
“decontextualize that
which we wish to study”
it is no longer what
we wish to study. (What
is, is organized as
figure/ground,
theme/horizon; the theme
does not exist without
the horizon, nor the
“object” outside its
context.) It does,
however, provide us with
knowledge that can be
replicated (or
falsified), and allows
us to test hypotheses
and make
truth-statements.
It
does not, it is true,
allow us to speak of
“cause” and
“effect”—and, as
problematic as those
constructs are within a
phenomenological
framework (and within a
quantum physics
framework, for that
matter), we clearly do
wish to be able to make
such statements—we need
to conceptualize the
world in these terms (at
least for now). So
research along the lines
of our traditional
understanding of science
is needed, as well.
RCT’s tell us part of
what we want to
know—does doing therapy
one way bring better
outcomes than doing
therapy another
way?—and, pace Tullio,
it is not hard to
separate studies done
from a standpoint of
openness to any outcome
from studies (like those
of the Vatican
“scientists” Tullio
invokes) whose outcomes
are predetermined. (All
“empirical” research is
not created equal.) It’s
just important, I think,
that we recognize that
this is not the only
path to genuine
knowledge—and that the
knowledge we gain via
methodologically sound
empirical-phenomenological
analyses may ultimately
tell us at least as much
about what we most want
to know.
Tyler
Carpenter, 6 March
2006
I
suspect that the
phenomenon that Tullio is
referring to is more
subtle than the research
solution you are
proposing, Allan. Evidence
of such security is highly
idiographic and relative
to not only the specific
relationship, but such
factors as timing, nature
of issues being addressed,
etc. Security itself is
dimensional, as well as
being both state and
trait-like. Are we talking
Ronnie Laing's
"ontological insecurity" -
his philosophical labeling
of the phenomenological
state of biomedically
based psychoses, the
individual's willingness
to risk insecurity because
of their faith in the
security of the
relationship, etc.?!
What constitutes a
multi-dimensional
dependent measurement
which both reflects the
levels of system in the
individual, but also
allows for comparisons
across and within
groups? I'm not being a
nihilist here, and I
certainly appreciate good
research, but we don't
need more studies looking
at changes in verbal
behavior linked to theory
and interventions. I
remember years ago reading
Walter Mischel's (I think)
conclusion that one of the
flaws of analytic research
was that in order to
examine concepts with real
construct validity, one
was forced to stay close
to the surface so to
speak.
Although I suspect that
high-speed computers and
chaotic models used for
weather and economic
forecasting would be one
entry into more
sophisticated research, we
would not be mired in the
lose-lose discussion about
ESTs vs. dynamic models if
we had something better
and transtheoretical to
examine. This stuff is
hard to think and talk
about, let alone study
reliably and validly.
Tyler Carpenter, 6 March
2006
I'm not
sure that many would argue
your points regarding the
limitations of an
epistemology derived from
those terms as you have
done, Allan. The issue is
not whether reality is as
complex as you describe,
but how do we chose
constructs that by their
very definition violate
the integrity of the
whole, but allow for a
more dynamic examination
of their operation in the
context of therapeutic
relationships? Said a
different way, I don't
think that one needs to
toss out the terms
objective and subjective,
so much as to study their
relationship within the
epistemology you suggest.
Whatever terms you use to
describe the component
parts, the success of the
design is going to rise or
fall on your ability to
establish meaningful
construct validity and
then demonstrate
replicable results between
the manipulated variables.
Part of the problem with
the EST stuff I've read is
that it is such a weak
approximation of the
reality of the therapeutic
relationship (let alone
complex formulations of
real psychopathology) that
it is hard for results to
establish much more than
we already know or to say
something more about a
limited number of
dimensions in a
multi-dimensional
phenomenon.
Hilde Rapp, 6 March 2006
Dear
Allan,
Thank
you again for
taking the trouble to
point out
that, as
expressed so far in this
discussion, my meta-
model has been
presented in a way that
leaves too much room for
misunderstanding.
Yes,
of course there is no
such thing as a monadic
subjective mind- we
understand ourselves and
we think
about ourselves through
language- I am with
Benjamin Lee Whorff and
Lev Vigotsky on this,
and significantly also
with Bakhtin: our
imagination is
inappellably dialogic.
And
of course there is no
such thing as an
objective, or natural,
science in which
our observations are
free from
subjective as well
as collective
distortions by way
of observer effects,
perceptual set effects
and context effects, let
alone expectancy,
interpretation,
‘ideological’ bias
etc ( the
first thing I
learnt in my
course on measurement,
decision and control,
looking at the
psychology of
perception and
cognition, when
measuring reaction times
to stimuli of a
certain luminance!).
My
meta- framework is
purely heuristic-
it does not
aim to set out an
epistemic
position: it
merely takes
account of the fact that
there are bodies of
‘knowledge’ ‘out there’
which subscribe to
certain epistemic
assumptions, such
as ‘direct access
to the contents of our
minds’, ‘unmediated’
experience ( for
instance within
Buddhist inspired
mindfulness based
cognitive therapies – we
can’t actually prove
that our sense of having
a direct experience of
unity is not an illusion
related to a particular
biochemical-
bio-physical brain
state…), or a
position which
prefers to remain
entirely silent about
anything we cannot
directly observe and
measure as in
radical
behaviourism
whether informed
by Occam’s razor
or modesty, making
no positive
assertion that what we
can’t see doesn’t
exist… .
My
meta-framework is
an ordering
device, it
aims to map
what is out there for
a particular purpose
relevant to your
current therapeutic
task: if you
want to find reports,
studies, information,
theories etc
relevant to
certain aspects of
your work, - I
invite you to look
through the lens of this
or that quadrant and you
may find relevant
material.
Each
person who chooses to
use this framework
is invited to look at
their client work from
all four aspects, even
if , ostensibly, the
‘problem’ which
necessitates some
research or enquiry
seems to be clearly
located in one quadrant:
the clients social
skills are appalling,
say, and we are looking
at this in relation to
developmental ‘deficits’
ie from a Q3
biological
basis of behaviour and
social developmental
patterns of attachment,
affect regulation,
failures in
‘mentalisation’ and
schema based
relationship formation
perspective …
It
may help to also look,
even if only in passing,
at what beliefs,
attitudes, phantasies
and existential torments
might inhabit the
client’s mind- and
indeed our own (Q1), and
to do so with an
eye on philosophies past
and present, be that the
Buddha or Descartes,
psychologies past
and present
be that William
James , Sigmund Freud,
Lacan, Perls or Ellis,
Wachtel, Carere
and Zuckoff etc…
as it were…
Something
may be learnt from
understanding more
about how this mind is
embedded in a society in
which certain coercive
processes may have
shaped the client’s
parents to push
the client into
particular roles, to
adopt a certain way of
symbolizing his or her
experience which did, it
would seem, do violence
to their own meaning
system, and where
dialogical forms
…( Q2) were
replaced by ‘acting out’
or ‘enacting’
conflicts
behaviourally, ( Q3) The
studies which
might ‘show up’ in Q3
may well address
very similar issues, but
usually from within a
different tradition and
using a different
vocabulary for
instance in the field
of substance
misuse or domestic
violence and there
may not be much
cross referencing
between the work of
Carlo Di Clemente
and Ronnie
Laing even though they
both accurately diagnose
what is wrong and
prescribe what may help.
(There are more
psychotherapies,
Horatio, than you have
ever dreamt of…)
The
study of institutions
and their effect on
what we consider normal
and desirable, the extent
to which power
structures are
designed to include or
exclude and how this
impacts on our clients
experience and
reality will usually
make a difference to
whether we see certain
behaviours as defenses
against oppression,
racism, homophobia or
whatever, or as the
paranoid phantasies of
someone on the verge of a
psychotic breakdown, or
indeed, a mixture of both!
(Q4) or a drug induced
temporary state ( Q3) .
DSM IV etc
may
effectively screen
for general life
conditions, an
understanding of the
health care system will
help us locate appropriate
pathways to care, health
policy will address the
politics of how to tackle
inequalities etc,
all of which
connects with
structure grams and
statistics and
sociological enquiry into
public health
related factors (
Q4) but we need to
look to Q2 for
theory driven
critiques of how we do
describe and research such
issues
informed
by people such as Weber,
Foucault or Habermas
etc… and to rule out
biochemical imbalances
(Q3).
My
personal experience has
been that I have found
extremely useful
pointers to
information I
needed to better
understand my
clients in studies
whose underlying
assumptions I do not
share at all, and whose
methodology I
found in some way
questionable. A
‘re-analysis’,
re-ordering- rethinking
of ‘data’
presented in
certain studies would on
occasion point me to an
interpretation of
findings quite different
from those
elaborated by the
authors in their
discussion. This would
usually put me on the
trail of looking for
other work where,
with luck, I might find
studies or inquiries
that were closer to my
own preferences
regarding assumptions
and favoured
methodologies,
providing me
with some evidential
basis for my
intuitive take on
the client’s issues –
that is provided I also
took full account
of any
countervailing evidence
that would cast doubt on
my currently favoured
hypothesis…
The
four quadrants are
really pointers to
living webs of ever
changing knowledge,
skill, information,
hypotheses, data,
assumptions, hypotheses,
etc that have
their centre of gravity
on one tradition rather
than another, quote a
certain body of
literature that has a
certain coherence,
rather than another.
I
ask that integrative
therapists should
endeavour to consider-
not cover- as that would
be impossible- all four
bases. Most
integrative therapists
will have a
preferred home
base which brings
with it in depth
familiarity with a
particular discipline,
domain, universe of
discourse, set of models
and practices etc. All I
ask is integrative
therapist be aware
that this is so, and to
respectfully look next
door with a degree
of curiosity, and on
occasion in genuine
search of help ‘from
outside’.
The
meta- framework
differs from many
existing
bio-psycho-social
models in
that it does not in
itself offer a
particular blend of
psychological
biological,
socio-cultural
bodies of
knowledge and practice
that could be set down
in a textbook. It
is a tool for
acquiring such
knowledge ( if a
student) or for applying
such knowledge ( for
seasoned
practitioners) .
Anyone
who uses it would of
course use it to organize
their own
core menu of
questions asked about
decision making
procedures which take
into account
philosophical inquiry
and
scientific
methodology and that
operate upon a core
curriculum of findings
about human
psychology and
development
through the life span,
dialogical processes
explored
through ethics,
aesthetics and
anthropology, and
an understanding of the
workings of living
systems comprised
of institutions,
organisations and the
natural world…
Once
we have acquired
and organized our
own bases of findings,
understandings and
practices we ally
for new journeys into
unknown territory.
What we may ‘know’
today’ will always need
to be live, constructed
out of different facets,
useful for a particular
line of inquiry
relevant to a
particular client, but
there will be some
family resemblance
between what
integration we
achieve today
regarding client x and
what we put
together yesterday
regarding client y
and what we may
construct tomorrow
regarding client z.
There will be a
family resemblance
between
what we do over time, we
all have a signature
tune, but if we are
truly integrative we are
forever composing new
pieces and forever
innovating, yet
without
loosing our
personal and
professional
shape. We
will be subject to the
usual pressures of
competing personal and
professional
responsibilities, bad
hair days and other
factors likely to impair
our judgment- but the
aspiration to do a
reasonable job is always
there…
The
purpose of the meta-
framework is to
help us to research
and inquire in an
integrative fashion.
What we need to know in
order to practice
in an informed
way, responsibly
,effectively,
efficiently, and above
all wisely.
The
onus is on each of
us to examine whatever
we find with
careful regard to the underlying
assumptions, both
the assumptions of
the authors whose work
we draw on, and our own.
This means being
open about the
inevitable fact that
each of us has
preferences, a default
standpoint and certain
historic allegiances.
Conflict
is healthy
as long as it is not
adversarial and ad
hominem ( feminam) ,
but rather it is
the motor which
drives forward a form of
collaborative
enquiry
where we openly compete
with one another to find
the clearest questions
and the most well
formulated answers to issues
of common concern.
We
are openly and honestly
advocating for our own
synthesis, integration,
analysis, truthfulness,
accuracy of observation,
ethical practice .
This
is called dialogue and
it keeps the inquiry
open to the future, ie,
dynamic and with a
living growing
edge…
I
am spelling many these
issues out in more
detail in a book which
is ninety percent
complete – you are
welcome to have a
preview – and I will
illustrate this way of
working at the Florence
conference with a
practical case example
Allan
Zuckoff, 6 March 2006
Hilde,
Do
you remember the rubric
quoted by Foucault from
Borges that I used
previously as an
illustration? I had the
same sense of
disorientation when I
read your line,
<<psychologies
past and present be
that William James ,
Sigmund Freud, Lacan,
Perls or Ellis,
Wachtel, Carere
and Zuckoff etc… as it
were…>>
Thank
goodness for that “as it
were”—otherwise I might
have been permanently
shifted into some
unfathomable episteme
within which such a
sentence could be deemed
comprehensible.
With
this notable exception,
I believe I finally
understand the nature
and purpose your
meta-framework, and all
I can say is: it’s a
fascinating model. Thank
you for taking the time
and effort to lay it out
so clearly that even I
can grasp it. I look
forward to paying for
and enjoying your book
when it becomes
available.
Tullio
Carere, 6 March 2006
Allan,
Hilde, Tyler, Zoltan
Hundreds or thousands of
things happen in a
session, all of which are
idiosyncratically
interpreted and responded
to by both patient and
therapist. Real therapy,
as any genuine
inter-subjective exchange,
and as is clear to common
sense and to Stern's
Boston research group, is
basically floppy
(unpredictable), whatever
the therapist's theoretic
allegiance. Of course,
from this intricacy one
can extract all sorts of
testable hypotheses, put
them to test, produce
procedures supported by
those tests, and apply
such procedures to the
intricacy in the sincere
conviction that this will
improve the efficacy of real
therapy. This is the scientific
approach to
psychotherapy, and I have
nothing to object to those
(therapists or patients)
who feel more at ease in
this sort of relational
environment.
I, among others, feel more
at ease in the common
sense approach to
psychotherapy,
corresponding to the assimilative-accommodative
integration. In this
approach the therapists
assimilate whatever theory
or technique suits their
taste or temperament, and
bracket out as much as
they can all their
theories in order to
accommodate as much as
possible moment by moment
the demands of the
process. In the common
sense approach protocol
driven procedures are
sheer non sense; but the
common sense therapist
feels compelled to produce
objective material (mainly
post session
questionnaires and written
notes by both patient and
therapist), whenever
needed, to monitor and
document the process and
to correlate process and
outcome.
Ps. Tyler, thank you for
saying <<I
suspect that the
phenomenon that Tullio
is referring to is more
subtle than the research
solution you are
proposing, Allan", and
"one of the flaws of
analytic research was
that in order to examine
concepts with real
construct validity, one
was forced to stay close
to the surface>>
Tyler Carpenter, 7 March
2006
Not
sure I see the two
positions as that
dichotomous, Tullio. I
think it may be the
hypothesized mutual
exclusivity and reducing
the dialectic to anchor
points that kills the
discussion and the
science. I think it fair
to say that I can easily
understand what I do in
your framework. However,
much research such as you
describe is both the
source of information on
which I might base a
medication referral or is
the basis of a treatment
protocol or ideology that
my client is compelled to
work with and which I can
integrate if I broaden my
understanding. Said a
different way, I can
practice as you say you
do, but would lose much
synergy for my patients if
I neglected the
contextualizing milieu or
access to mood and thought
modulators. Sometimes what
I do is work with what
others are doing or
calling something and help
my patient process the
material therapeutically.
In this respect perhaps I
am more Taoist than
Confucianist in my
therapeutic sensibilities
and pragmatism.
Allan
Zuckoff, 7 March 2006
Tyler,
I
agree that there are
subtleties that would be
difficult if not
impossible to capture in
controlled research.
Hilde’s post suggests
that there may
nonetheless be ways of
capturing at least some
of the variance via
traditional research
methods. And this is
precisely where
systematic qualitative
research may capture
even more.
A
method I have used (in
brief): record a therapy
session of interest,
break the tape into
smaller parts, then
invite the client to be
interviewed about the
experience of the
session; offer
instructions, play a
tape segment, ask the
client to describe
his/her experience in
the moment. Record the
interview and have it
transcribed, so you have
the session segments and
the interview segments
linked. Do this with
multiple clients, then
use a disciplined
methodology to first
analyze each of the
subjects’ experiences
individually, then
synthesize a general
structure of the
experience. This general
structure is potentially
replicable (or
falsifiable), both
through obtaining
analyses of the same
data by other
researchers, and through
repeating the analysis
with data from other
sessions/ other clients.
What
matters most, I think,
is not the specific
method we use; it is our
willingness to subject
our intuitions and
fondly held beliefs to a
test in which they can
be shown to be wrong. It
is simply too easy,
otherwise, to believe
what we wish to be true,
because we wish it so.
Tyler
Carpenter, 7 March 2006
Fascinating
methodology, Allan, and I
agree that Hilde's
framework has much to
offer.
For me these days it is
the non-verbal emotional
resonances and dissonances
(e.g., vocal tone, facial
expression, posture,
verbal-nonverbal
discordances, etc.) that I
find both crucial to
effective work and
fascinating to process.
When I reviewed the extant
models of brief therapy at
a Mass General Hospital
seminars about 12 years
ago I found that they were
quite limited in
applicability to severely
disturbed populations
(except for Leopold
Bellack's model which was
not covered and which I
learned in a seminar with
Bellack in the early 70s).
I later saw Si Budman
present on his character
focused model (about 20
sessions I think). When
adapting to working in
prison I found that not
only did I need to become
aware of multiple
comorbidities in
diagnostic formulations,
the nature of the "average
expectable environment",
the adjunctive use of
medications, but broaden
my conception of what
Martha Stark refers to as
the principal modes of
therapeutic action, e.g.,
interpretation,
experience, and
relationship. In such
interpretation,
re-education, support,
exploration, behavior,
modulation of
drive/affects, etc., take
on fine nuances and it is
the sound and fury that
signify what is important
to attend to, as well as
what it is important to
interpret and how to frame
it. I absolutely agree
with you about the
importance of submitting
everything to careful
scrutiny. I couldn't have
unpacked some of the
concepts if I didn't do
so. If I wasn't up to my
neck in clinical work I
could look closer at the
process than current time
and resources allow.
Tullio
Carere, 8 March 2006
As the
Florence Conference
approaches, it is time
to draw up a first
balance. The
pre-conference
discussion has taken
place so far parallely
on this listserv and on
the Italian SEPI-list. On the latter
Giovanni Liotti made a
lucid point. Psychotherapy
integration, he said,
happens only on the
ground of empirical
research. On this ground
psychotherapy is on its
way of becoming a normal
science, like biology or
medicine. But the field
is split: on the other
side of the split there
are those who refuse
this integration. There
is no other integration
happening on that side,
though: on the side of
science integration is
in progress, on the
other side one finds
only differentiation
into myriads of school,
group, or individual
theories.
At this point of the
debate I think that
Giovanni is right. On
the side of those
unwilling to accept
empirical science as the
foundation of
psychotherapy, the field
is fragmented or
pulverized by the joint
effect of assimilative
integration and
eclecticism. As I
pointed out earlier,
assimilative integration
is inevitable, inasmuch
as we all go on
assimilating pieces of
other theories into our
home theory through our
all professional life.
This paradoxical process
is integrative at the
individual level, but
disintegrative at the
field level. (As George
remarked, an alternative
to assimilative
integration is
eclecticism, which is
disintegrative at both
individual and field
levels). The joint
effect of assimilative
integration and
eclecticism is that
there are almost as many
psychotherapeutic
theories as there are
therapists in the room.
The differentiation of
the field happening on
the non-empirical side
of the split would not
be a trouble, were it
balanced by the presence
of a common ground,
where common needs
and goals were matched
by common factors
and strategies, and
therapists could communicate
among them on the ground
of a shared common
sense. On the
ground of common sense,
therapists could bracket
out their pet theories
and be able to dialogue
with colleagues of
different persuasions,
and thanks to this
dialogical space could
change their minds and accommodate
elements of different
perspectives
incompatible with their
frame of mind. The
integration would then
be really assimilative-accommodative,
not just assimilative
with as little
accommodation as
possible.
Common sense, in which
sound intuition and
reason are balanced, is
common to every human
being, i.e. is available
to anybody willing to
conquer it; but on the
other hand it is very uncommon,
inasmuch as in order to
conquer it one has to
submit to a hard and
permanent discipline
like phenomenological epoché,
Bion's freedom from
memory and desire,
or Gemma Corradi
Fiumara's philosophy
of listening. All
these disciplines
require the suspension
of all preconceptions
and expectations, which
is experienced by the
ego as a psychological
catastrophe. As a
consequence, none of
these disciplines is
very popular, almost no
therapist puts one of
them at the core of
their dialogical
approach and clinical
practice. As common
sense remains most
uncommon and unpopular,
common ground among
therapists remains the
bizarre utopia of
'common grounders', and
the only integration
really happening on the
real ground is the one
grounded on empirical
research.
George
Stricker, 9 March 2006
How about
an integration that does
not occur on one or the
other side of the
divide, but between the
two poles, representing
a real seeking of a
synthesis?
Tullio Carere, 9 March
2006
George,
in a dialectical
perspective no real
synthesis is possible
between a strong thesis
and a very weak
antithesis. The
antithesis must grow,
for a synthesis to be
possible. The
antithesis, to me, would
be a full-fledged
assimilative-accommodative
integration. But how
many would agree? Not
many, I guess.
George
Stricker, 9 March 2006
A
full-fledged
assimilative-accommodative
integration would be my
preference for an
antithesis (and I agree
that a strong one does
not exist and is needed
for a synthesis to
occur). However, it is
not the only option, and
any one that might
provide an antithesis
would start the process
off, and might even be
the impetus for further
development of
antitheses.
Tullio
Carere, 10 March 2006
George,
as a full-fledged
assimilative-accommodative
integration is the
preference of both of us
for an antithesis to
empirically supported
psychotherapy, and as we
also agree that a strong
one does not yet exist
but is needed for a
synthesis to occur,
could we elaborate a
little more on it, just
to make it a little
stronger?
Firstly, the
assimilative side is
precious inasmuch as it
lets us tailor our
theory on our tastes and
preferences. My theory
is an idiosyncratic
summa of my history,
personality and choices,
nothing to do with
manuals. I am free to
choose the theories that
best suit me, as the
patient is free to
choose the therapist
that best suits him or
her. In this
perspective, the crucial
therapeutic factor is
the person of
the therapist, not a
technician who
administers
protocol-driven
techniques. "As many
theories as there are
therapists in the room"
is no longer a mark of
weakness, but a sign of
freedom and pluralism.
Secondly, the
accommodative side makes
me bracket out my theory
all the time in order to
get tuned with the
demands of the process.
It is the reciprocal of
the request I make to my
patient to suspend his
or her convictions to
have our dialogue
progress. It means that
the focus of therapy is
dialogue, not a
disorder to diagnose and
treat by means of
empirically supported
procedures. Genuine
dialogue happens when
and to the extent that
both interlocutors let
go of their respective
convictions -- personal,
ideological,
metaphysical,
theoretical, whatever --
and rely on nothing else
than common sense.
In sum,
assimilative-accommodative
integration means that
the focus of therapy is
on interpersonal
relationship and
dialogue, not on
scientific proceedings
(though science has some
room in it, especially
in the form of the local
scientist -- as of
course in ESP there is
some room for dialogue,
but the focus is not
there). I see
assimilative-accomodative
therapy and ESP as two
different and
incompatible things, one
basically dialogical and
heuristic, the other
basically
epistemological and
protocol driven. The
great divide reflects a
real difference. It
seems to me that before
trying to make any
synthesis between the
two, it would be
necessary to firmly
establish the autonomy
and independence of one
another as two distinct
disciplines. It is too
soon for conciliation.
Reciprocal
acknowledgment and
respect come first, in
my view..
George
Stricker, 10 March 2006
Tullio,
I hope that it is not
too soon for
reconciliation, and
perhaps the key is in
your statements about
ESPs. Generally, I agree
with you, and feel that
they are limited and
limiting. However, I do
not equate science or
scientific contribution
with ESPs. There are
many other
epistemological
approaches to research,
such as practice
networks, effectiveness
research, systematic
case studies and N=1
approaches, and so on.
If we expand our notion
of research, we also can
expand the possibilities
of a synthesis (or at
least I hope so).
Zoltan
Gross, 10 March 2006
Dear Tullio
and George,
Underlying your theories
of both dialectics and
basing psychotherapy on
empirical science is the
assumption that we are
all examining the same
"elephant" of
psychotherapy and that
we are all speaking to
one another in the same
"language" about our
discoveries of the parts
of the elephant we are
exploring. I don't
believe there is a
single psychotherapy,
which is the implicit
assumption of the
discussion. While it
might be true that a
cognitive behaviorist
and an analytic
therapist might both be
successful in
alleviating the anxiety
of the person with whom
they are working, I
seriously doubt that
personalities of the
persons being treated
wind up in the same
place. The cognitive
behaviorist's work has
little to do with
character
structure. On the
other hand, analytic
work, relational or
transferential, does
alter the emotional
structures of the people
with whom they work. I
believe there are
different
psychotherapies serving
different personal
goals. The Dodo
bird awards are only
given to the
experiential end results
of therapeutic
work. Prizes are
not awarded for
personality
change. Which
brings me to my second
point, so far empirical
research does not have a
common language with
psychotherapy about the
definition of
personality, emotion,
self, cognition, or
consciousness. The
words used by both
systems are the same but
they speak different
languages. The words
don't mean the same
things in the different
systems. As a matter of
fact, in a recent
article by the president
of APS declares that
research in personality
and psychotherapy are so
different that they will
never meet. He
ended his comments
expressing his belief
that this was the way it
should be.
Unfortunately, not only
are we blind in our
examination of the
elephant of
psychotherapy, but when
we communicate our
findings we don't speak
the same language. While
assimilative integration
is an agreeable hope, I
believe it is very
unlikely until we get
past the
pre-paradigmatic stage
of knowing that George
recognized
George
Stricker, 10 March 2006
I think
that Zoltan's metaphor
about the elephant is
well taken, and agree
that the issue of
therapeutic goals is
often overlooked when
comparing therapeutic
outcomes. It makes as
much sense to speak of
"psychotherapy" as it
does to speak of
"medication" or
"surgery."
Tullio
Carere, 11 March 2006
George,
Zoltan,
I see a variety of
animals, not just
elephants. But in this
variety I believe to
perceive a sort of
order. Some animals are
elephant-like, or strive
to look like elephants,
the most powerful
animals of all.
Others are cat-like,
much less powerful but
proud of their cat-ness,
and not willing at all
to look like elephants.
Then there are of course
all sorts of
intermediate forms. Sure
enough, they are all
mammals. But for the
time being to
concentrate on the
general mammalian
structure risks to make
us lose sight of the
substantial difference
of at least two main
species, as I see them:
the species of
those who are fascinated
by science (all sort of
scientific research, not
just RCT), and believe
that science has the
last word in deciding
what is valid and what
is not in their
practice; and the
species of those who
have a moderate interest
in science, but are much
more interested in
interpersonal
interaction governed by
genuine dialogue (which
requires the sacrifice
of all preconceptions
and myths, the myth of
science included). It
seems to me that cats
are an endangered
species today, at risk
of being crushed by the
elephants' stampede. We
should protect poor
cats.
Tyler
Carpenter, 11 March
2006
Perhaps
a first step for such
an integration to
begin to occur, George and
Tullio, is to set up some
tentative conditions and
parameters: Many
discussions on such topics
are so wide ranging that
although they discuss the
broad issues, there is
much time spent on
discussing the fine points
of mutually accepted
dynamics, e.g., the
acceptance of a need for
research & clinical
thinking/experience, the
idiographic and the
nomothetic. By
finding a limited
consensus on a topic and
some sufficiently
representative
participants to discuss
it, you have both a goal
to be refined and a
constituency to address
the question.
Tyler
Carpenter 11 March 2006
Zoltan
Gross wrote :
<<Dear
Tullio and George,
Underlying your theories
of both dialectics and
basing psychotherapy on
empirical science is the
assumption that we are all
examining the same
"elephant" of
psychotherapy and that we
are all speaking to one
another in the same
"language" about our
discoveries of the parts
of the elephant we are
exploring. I don't
believe there is a single
psychotherapy, which is
the implicit assumption of
the discussion. While it
might be true that a
cognitive behaviorist and
an analytic therapist
might both be successful
in alleviating the anxiety
of the person with whom
they are working, I
seriously doubt that
personalities of the
persons being treated wind
up in the same place. The
cognitive behaviorist's
work has little to do with
character structure.
On the other hand,
analytic work, relational
or transferential, does
alter the emotional
structures of the people
with whom they work. I
believe there are
different psychotherapies
serving different personal
goals. The Dodo bird
awards are only given to
the experiential end
results of therapeutic
work>>
I
suspect the issue is not
so much whether we are
using the same language,
Zoltan, because it seems
as though we are. The
language is English.
However, we do at times
move fluidly between
professional vocabularies
and our understanding of
them and this tendency to
do so makes the discussion
both more personal and in
ways perhaps more
undermining of an attempt
to develop a common
assimilative- accomodative
framework that both
accrues certain agreed
upon and shared structures
(nomothetic) and terms,
while also allowing for
individual divergencies
(idiographic) in
structures and meaning.
There may be no single
psychotherapy in the
narrowly defined sense,
but there are ample
examples of common
practices or ways of being
therapeutic that are
clearly supported by
empirical literature or
easily discerned by
translating terms and
structures and processes
from one framework to
another. This last point
leads to my next one:
I think to draw the
distinctions you do about
cognitive vs. analytic
approaches to anxiety and
character is to make the
approaches more separate
than they actually are in
practice and to talk about
how a process may be
described rather than how
it may in fact occur in
terms of both frameworks.
To take the example of
addressing anxiety using
both frameworks, there is
nothing that would suggest
to me that either
framework neglects the
role of personality
and its relationship to
anxiety. And broadly
construed there is nothing
that suggests to me
intervening cognitively
has any less or more to do
with character and symptom
in one framework as
opposed to the other. Both
disciplines utilize
interventions of a
cognitive nature aimed at
changing the relationship
of understanding of
symptom to personality
context and while the
vocabularies and timing
may differ, with an
understandable difference
(perhaps minimal)
difference in change in
the individuals involved,
this is as likely to be
something found within a
group of analysts or a
group of cognitive
behaviorists talking about
how they do what they do.
I
think it was Roy Schafer
who attempted to deal with
a similar cacophony and
chaos in the analytic
community by writing a
book on changing the
language used to describe
therapeutic change(perhaps
more accurately
professional terminology)
that focused on what is
actually done rather than
spending time sorting out
specialized terms and
constructs that become a
source of contention among
groups trying to discuss
(at least on one level)
what they are trying to do
in their work. Said a
different way, both
analysis and cognitive
therapies agree that
distortions in perception
are anomalies in ideal
adaptations to the world
and focus on these
anomalies is central to
the process of restoring a
relative functional
adjustment with respect to
cognitive-affective and
interpersonal function.
One group calls such
anomalies cognitive
distortions and the other
calls them defenses.
Useful dialogue may
proceed from laying out
and discussing how these
terms
differ in assumptions they
imply as well as in how
their role may be
addressed both in theory
and practice of restoring
function in patients. When
this happens it becomes
quite clear that there are
often differences within
professional groups that
are as profound as between
groups with respect to how
the individual
practitioner makes use of
the structures to address
the problems at hand in
the treatment.
Tyler
Carpenter, 11 March 2006
However,
Tullio, such a distinction
seems to be as much about
how you choose to use the
terms and bound the
discussion (see Lewis
Carroll's quotation from
"Through the
Looking-Glass." on how and
what words mean and are
chosen to mean), as it
does about the data and
processes involved. The
results of the research
that undergirds ESPs is as
likely to be
heuristic and provisional
and reflective of common
sense, and hence to be
assimilated and
accomodated by the
local-scientist, as are
the results of a common
sense focus on the person
of the therapist in the
therapeutic dialectic For
example, see how
Ebbinghaus' personal
observation of his memory
has stood the test of
time. We are talking in
large part about
preferences in the
qualitative
characteristics of
methodology and not
necessarily about what
each method produces for
assimilation and
accomodation by whoever
and whatever we choose to
call the common model
(which I submit is not a
bad way to describe it and
avoids the superfluities
and pitfalls of
double-think - call one
thing by another set of
terms). To be a little
subversive, I suspect that
if we were not to discuss
where we got the data we
are submitting to the
process, it would be
damned difficult to
determine whether it was
from ESP research or
self-other clinical
observation. Perhaps that
is a better way to proceed
and thus dispense with the
question of determining
first whether something
had a previously
determined authenticity
and then second whether
and how it could be
assimilated and
accomodated in a larger
and agreed upon framework.
Tullio
Carere, 11 March 2006
Tyler, I am
not sure that I
understand what you say.
What I say is that there
are two basic attitudes
among therapists: one is
theory-centered, the
other is
dialogue-centered. The
theory-centered depends
on empirical testing,
the dialogue-centered
depends on the training
of the capacity of
genuine listening. The
first discipline is much
more popular these days.
I have tried hard, years
long, to reconcile these
two attitudes (the first
SEPI-Italy conference,
2002, was the highest
point of my efforts in
this direction). Now I
have given up, I don't
think any longer that
these two attitudes can
be reconciled. Not in
this phase of
development of
psychotherapy. Not until
the dialogue-centered
becomes a strong enough
antithesis to the
theory-centered.
Tyler
Carpenter, 11 March 2006
I would
both make myself clearer
and amend your position as
follows, Tullio: Two of
the basic attitudes that
therapists consider are
theory centered and
dialogue-centered. Theory
and dialogue can both be
empirically tested
(formally as in a
"scientific" study) or
individually tested as in
careful and thoughtful
observation of dialogue.
Both approaches are
characterised by careful
listening and attention to
the variables involved.
The zeitgeist is
predominated by the former
methodology.
Sometimes people resist
being put in a box and
having data systematically
excluded from discussion
and integration. I
couldn't survive and
thrive in prison if I
engaged in drawing overly
exclusive distinctions.
That, and not punitive
ideology and maladjusted
personalities, are the
primary reasons psychology
and psychiatry haven't
historically flourished in
these environments. Sorry
I can't be in Florence. I
hope we get to meet in
person some day. If you
enjoy a thoughtful beer
(not just the discussion
accompanying the drinking,
but the way the beer
is crafted), I suspect
you'd enjoy sharing one of
my homebrewed beers. "St.
Feullion's", the Belgian
Tripel I just finished is
great! The development of
psychotherapy, by history
and nature, has always
been non-linear and
proceeded on multiple
fronts.
Tullio
Carere, 11 March 2006
Thank you
Tyler for clarity and
amendment. I understand
that people don't like
being put in a box. Yet
concepts are boxes,
aren't they? Can we do
without concepts if we
want to reason? But let
us try to use our boxes
judiciously. Both the
theory-centered and the
dialogue-centered
therapist have their own
theories, but the
difference is that the
former is highly
motivated to apply
rigorously their theory
(from which their
professional identity
usually depends: I am a
"Gestalt therapist", or
a "Kleinian
psychoanalyst" inasmuch
as I am true to the
theory of my school or
group): whereas the
latter is much more
motivated to bracket out
their theory (from which
their identity depends
much less) for
accommodating whatever
in the relationship with
their patients resists
being assimilated by
them.
Even if the
theory-centered
therapist is not a
school therapist, but a
conscientious therapist
willing to apply
empirically supported
theories and techniques,
she knows that she
cannot empirically test
her theory inside the
session: she has just to
hand her material over
to professional
researchers, who will
give her in exchange the
last empirically
supported theories or
techniques to apply.
Quite another story for
the dialogue-centered
therapist: she is a
researcher and a local
scientist in her own
right, she uses moment
by moment the feed-backs
she gets in the
relationship for
adjusting her theory.
Finally, both the
theory-centered and the
dialogue-centered
therapist are interested
in the external
validation of their
work. But the methods
are quite different,
whether or not one
chooses to call them
"empirical". The theory
must be transformed in a
protocol and studied in
an experimental setting.
The dialogical therapist
must produce objective
material, like
recordings, post session
questionnaires or
written notes by both
patient and therapist to
document their work. We
have nothing to gain, I
believe, if we mist and
blur these basic
differences for fear
that someone feels being
put in a box.
Tyler
Carpenter, 11 March 2006
You're
welcome, Tullio.
For me, box in this
context is a rhetorical
device. Concept is
neutral
language/vocabulary. If
I think outside the box
or come out of the box
(both of which metaphors
are good descriptors of
my behavior that are
highly congruent with
how others would
describe me and how I
behave) those describe
how I respond to being
restricted in my thought
and behavior. I see your
point about identity or
self. This concept comes
in various kinds and
sizes and neither
implies narrowness or
excessive (or any)
reliance on empirical
proof. In fact in the
narrow sense excessive
boundedness by parochial
or personal definitions
might be seen by some as
on a continuum or a
dimension with a more
open and inclusive sense
of who one is .So as we
play with the concepts
things don't appear to
be so exclusive and the
opportunities for
dialogue and
understanding and
integration can expand.
Whether one practices in
one setting or another,
the issue remains
methodologica
l and there
is no corresponding
theoretical mandate to
surrender control of
ones evaluative
processes, though others
may choose to see us
differently (and there
Einstein's thinking may
have much to offer our
discipline about the
nature of relativity).
As for external
validation, different
folks require different
kinds. In the prison,
most everyone demands
that the individual who
talks the talk walks the
walk. Whether you get
there by introspection
or journal reading,
results everyone can see
and live with is the
only real measuring
stick accepted by all,
whatever they call
themselves and whatever
role they fill. I think
the concept of fuzzy
boundaries is not only a
pragmatic approach, but
a part of the conceptual
tools of modern
mathematicians, but then
I'm way over my head
when it comes to that
particular application.
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