Psychology and Psychotherapy (Psychology Revivals)

Current Trends and Issues

David Pilgrim, David Pilgrim

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317511656
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Originally published in 1983, fifteen well-known psychologists and psychotherapists write about their personal interests to give the reader a vivid picture of the complexities of psychotherapy in Britain at the time. They explore aspects of the interaction and intersection of the psychological and psychotherapeutic worlds, paying particular attention to the practical and theoretical controversies involved in this overlap.

The first half of the book concerns itself with problems of theory and practice in psychology and psychotherapy, while the second half deals with professional conflicts and political issues impinging upon the practice of psychotherapy by psychologists. Areas of concern and controversy that are scrutinised include the problematic relationship between academic psychology and psychotherapy; doubts and certainties in psychotherapy; the psychology of helping; the relevance of the psychodynamic tradition; inter-professional disputes; women and psychotherapy; and social class issues in psychotherapy.

Part one
Theory and Practice

Chapter 1
Psychotherapy and Psychology

David Smail

Telling somebody about your troubles in order to find some relief from them is neither an unfamiliar nor a new experience for most people: it happens every day, in families, between friends, in bars and barbers' shops, vicarages and doctors' surgeries, and has been happening, in one form or another, for a very long time.

As far as psychotherapy involves this kind of activity, then, it would not seem to need much in the way of justification. But, of course, there is much more to psychotherapy than this. Psychotherapists are, or are supposed to be, especially expert in the nature of human psychological ills, have degrees and qualifications, professional organizations, and expect to be paid for whatever comfort they dispense. And so it seems reasonable to expect them to have something more to offer than just a sympathetic ear or a piece of friendly advice. When professional claims are made, expectations established among clients, and money changes hands (even if only indirectly, as in the British National Health Service), it becomes important to establish a solid justification for psychotherapy as a discipline.

Because, perhaps, of the uncritical faith which we tend to invest in our established institutions, it is hard for the layman to doubt that such justification must exist. Psychotherpists are, after all, like other professional experts, specially educated, trained, and accredited; they are, in some cases at least, supported by academic and medical authority; their services may be sought through the official channels of the National Health Service. Such a person could scarcely be thought to exist in such a setting were he or she offering nothing more than what could be obtained from a spouse, mother, best friend or barmaid.

It is not my intention to suggest that no psychotherapist has more to offer than this, but I do wish to argue that the kind of justification for our activities commonly stated, or at least implied, cannot be substantiated in any convincing way. In particular, those of us whose involvement in the psychological therapies stems from a background in psychology, often like to think, I suspect, that our therapeutic practice is guided by the psychological discoveries which have been made in academic laboratories - that we are, in other words, applied psychologists who can, in defence of our professional activities, appeal to established scientific laws and principles. Tor reasons which will, I hope, become apparent, I do not believe that this is a tenable position, and if we try much longer to hold onto it we shall find ourselves, from a theoretical point of view, less rather than more credible than the sympathetic layman. This is not to say that I see credibility, pure and simple, as an end in itself; it is more my hope that by achieving an adequate theoretical understanding of the process of psychotherapy we may in the long run make it easier for effective psychological help to be available to people without recourse to any particular groups of experts.

Ever since the beginnings of psychoanalysis, psychotherapists have been desperately anxious to establish the validity of their credentials - both in order to earn the respect of psychological and medical colleagues and, no doubt, to justify their professional (fee-taking) status. To be rather more charitable, they have also been concerned to establish the degree to which their undertaking works. During the past century, of course, the way to justify an activity of this kind has been scientifically - it is the scientific community which has to be satisfied that therapeutic treatments are reputable and claims supported by satisfactory evidence. However, as an object of scientific study, psychotherapy has not stood great in repute. From the -moment that Freud put pen to paper, experimental psychologists, as well as many medical specialists, have looked with mistrust at the activities and theories of those calling themselves psychotherapists, largely because of the difficulties encountered in framing these activities and theories in a sufficiently disciplined and well defined form to allow them to be scientifically tested and validated. As far as it goes, the 'scientific evidence' supports such a mistrustful attitude. Libraries full of published research aimed at establishing the effectiveness of or clarifying the processes involved in a wide range of psychotherapies still give no really clear indication of what the important ingredients are or what is the nature of their operation. Despite this being the case, however, and despite the almost universal importance attached to scientific justification of his or her activities, no psychotherapist of any of the myriad schools of psychotherapy which exist has as far as I know given up practising on the grounds of lack of adequate evidence. There may be a number of reasons for this. It may be, for instance, that psychotherapists are by and large a collection of charlatans who are making too much money to allow their scientific scruples to interfere with their interests. They may be misguided, stupid, or mistaken. They may be pinning their faith on potential rather than actual scientific support for their position. Often, however, they may be being guided by a kind of evidence which, while not 'scientific' in the orthodox sense, seems to have a kind of validity which they are reluctant to discount.

I do not myself believe that this state of affairs has arisen because psychology is a young science which cannot yet reasonably be expected to deliver the goods. Rather, I suspect, it is because the conception of psychological science most widely adopted both in and outside academic institutions is one which, because of the assumptions it makes and the aspirations it embraces, is doomed to failure when applied to psychotherapy. One must of course acknowledge that such assumptions and aspirations have not remained unchallenged in recent years, even from within the institutions where they tend to hold sway; nevertheless, they survive as those conventionally accepted among the vast majority of those who conduct research into psychotherapy as well as by therapists who are conscious of a need to pay lip service to the demands of 'science'.

The assumptions and aspirations which I mean may perhaps best be illustrated by reference to the definition of psychotherapy (taken from Meltzoff and Kornreich, 1970) which has found most favour with the British Psychological Society recently. This sees psychotherapy as an:

informed and planful application of techniques derived from established psychological principles by persons qualified through training and experience to understand these principles and to apply these techniques with the intention of assisting individuals to modify those personal characteristics as feelings, values, attitudes and behaviors ... as are judged to be maladaptive or maladjusted.

Despite its surface plausibility, this definition seems to me to beg just about every factual and moral question which can be asked about psychotherapy. For example, it assumes (a) that there are techniques which can be applied to individuals; (b) that the application can be planful; (c) that there are established psychological principles on which they can be based; (d) that qualificiation and experience will reveal what the techniques and principles are, and (e) that judgements about what is maladaptive and maladjusted can be made relatively unproblematically.

My objection to these assumptions is not that they are not in principle attractive or reasonable or what I should like to be the case. It is that in my experience they simply do not seem to be valid, and I could believe in their validity only if I suspended belief in my own experience of psychotherapy. For example, I have never found that I can say or suggest things to one patient on the grounds that either my own of other people's patients have in the past been helped by the identical utterances or procedure: in other words, I have not found that I can rely on techniques, as such. Instead, I have to take account of how the patient understands, what he makes of what I say and suggest: I have to negotiate with him or her the meaning of what we are talking about. Over and over again I have to abandon preconceived notions because of the influence the patient has on me. As for 'planfulness', I almost never find that I can predict the way a therapeutic interview is going to go, but can only formulate ideas about what has taken place after the event. Again, I know of no 'established psychological principles' in the formal academic sense: the psychological literature seems rather to attest to the fact that any attempt to establish a psychological principle has been met with a more vigorous attempt to establish a range of opposing 'principles', with the result that in no sphere of research have stable paradigms emerged.

The implicit claim in the above definition of psychotherapy that training and experience qualify one to understand and apply techniques blithely ignores the fact that psychotherapists are split into a wide range of different schools, with fundamentally different and often mutually exclusive theoretical ideas. It would be truer to say that qualification reflects more often an allegiance to a prejudice than privileged access to established knowledge. Finally, the making of judgements about what is maladaptive or maladjusted has, as surely nobody remotely connected with the field of mental disorder could be unaware, been the centre of a violent and unresolved controversy for at least the past twenty years.

The assumptions embodied in this definition of psychotherapy, then, reflect wish rather than reality; they are the creation of a scientific mythology which in fact takes almost no account of our actual experience of psychotherapy.

Academic psychology seems to breed in its adherents an unhealthy obsession concerning how far they are or are not 'scientific'. Indeed, what seems to have happened is that what it is to be scientific has in psychology become a question of dogma, which is itself centred upon an appraisal of the methods which natural scientists appear fairly consistently to have used to pursue their enquiries. What inspires this dogmatic approach to scientific thinking seems to be a tacit faith that, by following a prescribed methodological path, scientific authority can be rendered absolute and impersonal; can, in guiding human activity and human intervention, exclude the frailty of human judgement by appealing to such principles as objectivity, lawfulness, quantifiability, generality, stability, determinism (prediction and control), and so on. It is possible that principles such as these are helpful in understanding and manipulating the inanimate and mechanical aspects of our world, and perhaps also the behaviour of organisms 'lower' than man, though even in these spheres of scientific achievement and relatively stable scientific paradigms orthodox methodological dogma has been questioned by a number of eminent natural scientists (the reader is likely by now to be familiar with most of these arguments - if not, I can do no better than recommend Polanyi, 1958). But whatever is the case with the natural sciences it seems to me now beyond question that the view of scientific method conventionally accepted in psychology has not helped us in our attempts to understand psychotherapy. Confronted with this, we have, presumably, at least two choices: we may conclude, as some certainly seem prepared to do, that scientific psychology must concern itself only with those phenomena which will leave its methodological purity uncontaminated, relegating psychotherapy to the realm of the 'healing arts', or, alternatively, we may begin to wonder whether our traditional scientific concepts need revising in order to cope with phenomena to which they should, if we are to remain psychologists rather than physiologists or biochemists, be applicable.

In considering the question of the applicability of a scientific psychology to the field of psychotherapy, it is of course important to distinguish the practice of psychotherapy from the theoretical understanding of it. Szasz (1979) has argued, in my view convincingly, that psychotherapy cannot in itself be seen as a scientific undertaking, but rather as a moral enterprise. That, however, is not to say that the processes of psychotherapy are not mediated by psychological phenomena which can be studied scientifically. That such study does not seem to be facilitated by the impersonal set of dogmas we have taken to represent science does not release us from an obligation to get properly to grips with the intellectual (as distinct from the moral) problems presented in the experience of psychotherapy. What alternatives could there be to a scientific understanding, apart from believing in magic, or being ready to accept that something is the case just because somebody says so?

Science, freed from a dogmatic interpretation, has its own special appeal not because it guarantees an impersonal route to objective truth, but because it embodies a particular set of values. Most centrally, what is, or in my view ought to be valued is an understanding, elaboration and, where possible, explanation of our experience of the world which is, precisely, not based on dogma or arbitrary authority. Ideally, science is thus a means whereby we convince or persuade ourselves and others of the adequacy of our understanding by appealing to experience which we and they cannot in good faith deny. The fact that science may have developed methods which have proved useful in this undertaking, particularly perhaps in spheres unrelated to psychology, does not mean that such methods are sacrosanct - if at any point they prove inadequate for our purposes, they can be jettisoned without a qualm. What conventional psychological science has failed consistently to do is to take, our experience seriously, and yet that is exactly what should have been its task.

It is not even on the whole considered necessary to a scientific psychological understanding to have any experience of the phenomena under consideration. For example, some academic psychologists seem to feel quite at liberty to give 'scientific' opinions about or to conduct research in psychotherapy without having any first hand knowledge of it. This presumably stems from a misguided belief that 'objectivity', in the sense of approaching a problem uncontaminated by any familiarity with it, somehow guarantees a more accurate appraisal of its nature. And yet, surely, the very first thing a scientist should do is make himself thoroughly acquainted with the phenomena whose nature he wishes to understand. I find it completely mystifying to see how anyone can know, except in a completely empty and abstract sense, anything with which he or she has not been in intimate physical relation. One can only know the taste of oranges by having had one in one's mouth, and nobody could learn to play the piano by reading a treatise about it. The structure of orthodox, dogmatic psychology is such that it permits people to pronounce with apparent authority upon whole ranges of psychological phenomena about which they know nothing simply because the methodology it espouses is applicable to any set of data, no matter how meaningless, and as long as methodology is seen as the criterion of scientific excellence, we shall continue to be subjected to an apparently endless stream of meaningless research. One cannot know anything about psychotherapy unless one has been in some way bodily involved in it. Those who have been so involved often do know a lot about psychotherapy, but they are on the whole unable to elaborate their knowledge because the structure of official scientific psychology is uninterested in their experience and unwilling to alter its methods and assumptions in order to take account of it. Almost inevitably, to say something truthful about psychotherapy is to violate the dogmas of conventional academic psychology; to be an accurate student of psychotherapy is to be a psychological heretic.

There are many instances of this kind of difficulty in the literature on research into psychotherapy, where often only those 'findings' are taken seriously which conform to current standards of methodological purity. Sloane et al. (1975), for example, in their well known study of psychotherapy versus behaviour therapy, obtain objective measures of personal characteristics of therapists as well as seeking directly the views of patients on the same characteristics of their therapists. Because there is some conflict between the two sets of evidence, the authors are persuaded to pay more attention to the objective measures, though the logical grounds for doing so are far from clear, solely because this is more in accordance with methodological dogma. Again, Jerome Frank (1973), having soberly and dispassionately taken stock of many of the important phenomena of psychotherapy (thereby, one would have thought, advancing the cause of science), then despairingly witholds the possibility of scientific study from psychotherapy on the gounds that the processes involved cannot be reduced to physiological or biochemical events. What seems to be happening in these and other cases is that our assumptions are blinding us to the significance of what is in front of our noses.

If our theoretical structures turn out to be such that our experience cannot be fitted into them without doing it violence, then our theoretical structures will have to be revised. Galileo (see Drake, 1980) complained that the professors of philosophy of his day 'would have us altogether abandon reason and the evidence of our senses in favour of some biblical passage...'. If one substitutes 'methodological dogma' for 'biblical passage', and professors of psychology for professors of philosophy, we find ourselves faced by similar dogmatic constraints. If we took a leaf from Galileo's book, and characterized science simply as the conjunction of practical experience and reason, we might find ourselves free to think about, for example, the phenomena of psychotherapy with results far more fruitful than those we have come to expect from orthodox research. Laying our scientistic prejudices on one side, the first thing we should do is to take our experience of psychotherapy absolutely seriously, and only then use our powers of reasoning to construct a theoretical framework which can do it justice. If in the process we find ourselves in need of conventional philosophical concepts, that is no immediate cause for alarm and despondency.

Any statement which purports to be scientific in the end stands or falls on the evidence presented in subjective experience, not on its conformity to established dogma. Where our subjective experience overlaps, we are presented with the possibility of debating, persuading, and negotiating with each other the significance of the phenomena experienced. Objectivity thus becomes, not a magic methodology for guaranteeing truth in an impersonal world of ideas, but rather what emerges from a consensus of subjectivities.

If one approaches the psychotherapy literature with the intention of learning from those who have gained experience in psychotherapy, it is my impression that there are sufficient areas of commonality, enough recurring foci of interest, to suggest at least embryonic forms and questions with which a science of psychotherapy might concern itself.

For example, Freud, when not lost in the intricacies of theory-building or carried away by his own mystique, develops undeniable insights into the way neurotic symptoms and defences can disguise painful and distressing dilemmas. Jung, long before Rogers, is clarity itself when discussing the nature of the therapist-patient relationship. Sullivan expounds brilliantly the importance and influence of interpersonal relations in the formation of personality and psychopathology, foreshadowing in many respects the later contributions of Laing as well as of Kelly. Horney develops very helpfully a framework in which to view the kinds of neurotic problems and strategies familiar to all...

Table of contents

• Cover
• Title
• Copyright
• Original Title
• Original Copyright
• Contents
• EDITOR'S ACKNOWLEDGMENTS
• NOTES ON CONTRIBUTORS
• EDITOR'S INTRODUCTION
• Part one THEORY AND PRACTICE
• Part two POLITICS
• INDEX