:: Conceptual Boundaries in Psychotherapy (part 1)

( part 1 | part 2 | part 3 )

This entry is was stimulated by a post to an Internet discussion list in which I participate (see note 4, below). It will be in three parts, due to its length. I encourage you to read the whole piece.

INTRODUCTION

This is addressed to my professional peers. I realize that non-professionals may also read this, so some things are explained at levels which aren’t necessary for professionals.

Basically, I make a plea here for us think about our work with more care and awareness of consequences. Too many psychotherapists appear to have entered into unnecessarily confused thinking, through a failure to grasp the historical and intellectual context of psychotherapy as a discipline and a profession. Our profession has both liberal and conservative aspects, and for good reason. We are a diverse lot, but do not and cannot allow indescriminant thought.

What we do as psychotherapists matters – to us, to our clients. As you consider what I write here, I ask that you recognize that my concern is always ideas, and not the individuals who express them. People who personalize can’t have adult conversations about serious topics. Let’s have an adult conversation.

If, when reading what I have written here, you believe I have strayed into error, offer your constructive comments below. Talking among ourselves is important – that’s why I wrote this.

Anyone who is easily confused about authority should be advised: I live in a rural area, and our utilities are not as good as in other parts of the world. My direct line to God has yet to be set up, so I can offer here only my own thinking (see note 1, below). I speak freely here. You can too, in your comments.

PSYCHOTHERAPY – WHAT IT IS

It’s distinct from counseling. Let us begin by distinguishing counseling from psychotherapy. “Counseling” has a fairly indefinite connotation. People buying stock can obtain counseling prior to purchase (and may need it afterwards as well!). Lawyers, in the USA, are sometimes addressed as “Counselor….”. And, yes, there is also psychological counseling – and some individuals who do that also do psychotherapy.

At the risk of being overly simplistic, counseling is advice-giving. If the advice is from someone with considerable knowledge and experience, it may well be worth a great deal. But…it’s not psychotherapy.

Psychotherapy is about healing mind, employing principles which may be validated. Strictly speaking, psychotherapy is about healing (therapy) for the self (psyche). But there is a further connotation, which separates psychotherapy from all other sorts of good, healing counsel: it is the practice of healing the “self” of a person, utilizing the best knowledge we have of such things. It’s a “profession”. It practitioners received formal education, training, and certification, after which what they have to offer to others may legally be described with a vocabulary which may not be used by any other individuals. The purpose of all this control is to protect the consumer of services, and to protect the investment an individual has made in becoming such a professional.

Making psychotherapy a profession means that some things are NOT psychotherapy. For example, these are not: shamanism, conjuring, messages from some alleged “other” world, angelic intervention, spirit involvement, and a great many things. Oh, such things – if they are real – may indeed facilitate psychotherapeutic healing. I don’t take that up here. They just aren’t properly a formal part of psychotherapy, for reasons I hope I make clear, below.

What moves me to write at this moment is that all this apparently is not obvious to all my professional peers, and I think it should be (see note 2, below).

HEALING PRINCIPLES IN PSYCHOTHERAPY ARE SPECIAL

The practice of healing a person’s mind using the best principles of psychology – the science of the person, of the Self, of the mind, of the brain – science as in physics, chemistry, astronomy, geology, etc., shares a distinguishing feature with these other fields: its key assertions are arrived at in a specific and formally describable way.

It may help if, for a moment, we think of psychotherapy as a kind of product. There are laws in my country (USA), and many others, describing what may and may not be called “chocolate”, “cheese”, “wine”, and a great many other things. There are laws which also describe who may describe themselves to others as a “medical doctor”, or a “realtor”, etc. Again, these controls protect both consumer and producer or practitioner.

Psychotherapy’s product is its practices and principles. Psychotherapy is properly based on knowledge derived from the application of inductive reasoning (see note 3, below) – the production of generalizations from a set of premises (data) which invariably is a sample from a larger population of interest. While in practice this ideal not always achieved, it nevertheless the standard. Therefore, it is simply bad form to represent a principle or practice as known or validated when it is only supposed or assumed to be effective.

Knowing, potential knowing, and all else. I think we should make careful distinctions between what we know, what we could know, and what we can’t know. For example…

• We can know that when a creature with a non-trivial brain experiences something pleasant after a particular course of action, the chances of that action’s being repeated will generally increase. Ample empirical study has validated this concept.
• We could know that some new way of conducting an intake assessment leads to subsequent greater, or lessor client compliance with treatment – IF someone were to examine the matter in a careful empirical study.
• We can’t know whether the presence of angels in our consulting room facilitates psychotherapeutic healing. Angels cannot reliably be introduced into any experiment or study, and appear unlikely ever to be.

If you can’t disprove it, you can’t prove it. Karl Popper formalized this idea in his proposition that some ideas are fasifiable and some are not, and that only the former belong to the realm of science. It’s a crucial notion. It proposes that if you cannot get an idea “grounded” in a research proposal, you cannot take it for a flight.

Angels-as-therapeutic-adjuncts appears not to be a falsifiable hypothesis – we cannot realistically propose how we might show that this idea is wrong. We therefore must not bring angels and their ilk into our formal psychotherapeutic models, at least not so long as “angels” are taken as supposedly real entities. (I don’t have anything against angels – they’re just a convenient surrogate for all manner of hypothesized yet unreachable entities, influences, factors, etc. Besides, they are reputed to have feathers, and I like things with feathers.)

Having a license doesn’t give one license. I am troubled when psychotherapists allow into their formal toolkit various concepts, hypotheses, and assumptions which are not knowledge – and which aren’t even knowable – but which come to be treated as such. Worse than that, too often some of my peers seem to prefer such weak notions to others which are far stronger, are available for use, and yet somehow are mysteriously passed over. This just doesn’t make sense, and as professionals we do not have justification for doing this. Belief is never to be preferred to knowledge.

VARIABILITY – DEVIANCE – IS A GOOD AND NECESSARY THING

If you are at all informed about the known dynamics of both (a) sexual reproduction, in all plant and animal populations which reproduce in this way, and (b) its larger manifestation – organic evolution, you know that variability is an essential part of long term survival. Populations whose individuals do not differ from each other die out eventually – it’s that simple. Tomorrow’s successes are often recruited from today’s deviants.

We are all the children of non-conformists – biologically and culturally, because the same system dynamics which drive biological evolution and persistence drive cultural evolution and persistence. (I have to trust you understand this to some degree, as I haven’t the space to explain it here.)

Biologically, much deviance is useless, and even fatal. I would assert that the same is true of cultural deviance. In the real world, progress often has a high price. The lesson seems clear: deviant things are necessary, and most of them are worthless. But not all.

My concern is about deviant – read unusual or non-status-quo – thinking in psychotherapy which is not discarded – but which should be, because it makes no useful contribution, and in fact degrades the quality of our reputation and product.

LIONS AND TIGERS AND BEARS…AND ANGELS? – TWO QUESTIONS

A tale for our times. Suppose Client X comes to a psychotherapist for help, and with multiple complaints (they tend to do that). This client is engaging, interesting, thoughtful, and humanly appealing. A good alliance is established between client and therapist, and it is soon discovered that this client’s issues are not simple. As the client tells his tale, a variety of references are made to such things as angels, energy fields, psychic work, and past lives.

The therapist, in recounting this in a peer consultation group, appears to take the client’s story at face value, essentially as it was reported, and just as if the client had been talking about a lack of motivation, a thyroid condition, an alcoholic father, and a recent change of medication. I have seen just this sort of report, from a number of my peers, and it sets off all kinds of alarms in my mind.

Clients do present us with non-mainstream ideas we ourselves don’t possess. Alternatively, we may find ourselves serving a population who generally accepted beliefs deviate considerably from our own. That’s diversity in the flesh, and we see more of it now than a generation ago. As my colleague Natalie Zigel says,

The “new age” generation of self help has opened many doors to people searching for answers, and that’s good. Personally it’s been positive for me, particularly in dark times, to explore myself in a larger context than just my ego self. But it also provides exits and flights into deeper pathology for others…no matter how intelligent or organized…

Inquiring minds want to know. It appears to me that at least two questions arise from these sorts of situations:

1. What do we, as therapists, do with such references to concepts and entities, whether or not we accept them as valid?
2. How do such references relate to the psychotherapy process, if at all?

[ continued, next post ]

NOTES

1. I say this because too many people have, in the past, become threatened by the confidence with which I sometimes speak. They say goofy things like, “Well, you know, that’s only your opinion.” I’m sometimes grateful to receive such clarifications – about them, not me. When I’m dealing with an easily confused person, I appreciate some indication of this, and such mindless, unsolicited clarifications give me just the indication I need!

2. A little personal disclosure: I do not come to this topic without bias. My first graduate degree was in cultural anthropology, the study of which brings one into contact with people who believe all sorts of things. In addition, there certainly are a broad range of beliefs about many things, and considerable dissent about these beliefs, in my own culture, to wit:

• God exists / God is delusion
• the universe was created / the universe evolved
• the US government is concealing evidence of alien visits to our planet / yeah, sure (!)
• we had good reason to go to Iraq and bash Saddham / …if we are Republican!
• …and so on.

I certainly don’t necessarily reject beliefs not personally endorsed by me. BUT, I don’t like points of view entering into my own professional field which appear to violate the core assertions of its professional culture. More than once, in recent discussions with my professional peers, I have seen this happen. I have been largely silent about the matter, until now.

In addressing this topic, I am concerned not to cause shame or distress to anyone. I cannot help it if you find it difficult to encounter someone who disputes your beliefs, but I do hope to lay out MY dispute in a reasonably gentle and fair manner. I do believe that adults can (and should) disagree about important things. This process engenders the diversity which confers upon us adaptive potential.

One more personal disclosure: Very early in my adult life I developed a love of philosophy, and especially for that branch of it concerned with the problem of knowing – epistemology. In our own time, this concern had focused on the problem of induction – of producing a state of knowing when one doesn’t have all the information needed to be certain. Since the age of 17, I have read, studied, written, and done research ever mindful of my deep fascination for this topic. What I have to say here reflects this. I make no apologies, but give warning simply because in my experience not many in my profession have much background in epistemology or induction or even formal research theory and methods. We all take a few required courses (and some of us take much more), but many seem then to run far, far away. I didn’t. I love this stuff. Sometimes I feel a little lonely, though.

3. Let’s be precise: Only in deductive reasoning can we be sure of the outcome – IF our premises are in order, AND we employ correct logical method. Essentially all interesting real-world generalizations involve inductive reasoning, however. With induction, conclusions are NOT certain, but probabilistic, stochastic, and heuristic. Great words all, but the point is that inductive reasoning is not about certainty, but about the best we can do for now. It’s all about practical life in the real world.

The core of the problem is simply this: we don’t have all the data. In inductive reasoning about real world matters, data take the place of the premises one sees in deductive reasoning. Because the questions we seek to answer are about domains which we never can examine exhaustively, we must settle for a sample of the domain. Settling for that, we give up any hope of being certain of the outcome. In most cases, however, our likelihood of erroneous conclusions can be calculated.

Inductive generalizations are not guesses, but are calculated likelihoods. This makes some people edgy, but one just has to get used to this reality. It’s just the way things are, and it’s the reason why science continues to advance.

4. This is not a response to the discussion list post, in any way. The post merely got me to thinking, and that lead to this statement.