SOME CRITICAL THOUGHTS ON THERAPY CULTURE
I recently read the description of a presentation by Scott Miller "Over the last 40 years, thousands of research studies and how-to books on psychotherapy have been published. Presently, hundreds of treatment approaches exist, each claiming to contain ingredients essential to therapeutic success. Despite the steady parade of the 'new and improved,' the overall effectiveness of psychotherapy has not changed a single percentage point. Not one point—no improvement in effectiveness, whatsoever. Meanwhile, practitioners are facing an economic environment never before seen in history. The cost of training is up, incomes are down, and fewer people are seeking psychotherapy as a remedy to their problems. What’s more, the majority of people who could benefit, choose never set foot in a therapist’s office. How did this happen? How did psychotherapy lose its ability to attract and enchant? More importantly, what can therapists do to get it back? In this workshop, therapists will be pushed to move beyond the narrow narratives characterizing modern clinical practice, reconnecting psychotherapy with practical strategies from its deepest roots in magic, healing, and religion."
I think that the questions raised here are well worthy of extensive debate. We seem to have reached a point in our culture at which nothing is deemed acceptable unless it has the imprimatur of science upon it. This means that the label "scientific" and the use of scientific sounding terminology is now extensively used as a form of advertising, however shaky the supposedly scientific validation might actually be. However, this trend according to which science tries to conquer every aspect of life is not good for science itself nor for the things that then have to pretend to be scientific in order to be acceptable. It can introduce substantial bias and distortion. This is true in the field of psychotherapy where nowadays therapies increasingly rewrite their principles so as to make them seem scientific, often, in the process, betraying the heart and soul that are their actual raison-d'etre. The fact that a therapy is associated with a large number of "scientific studies" does not actually prove anything about its superiority. If psychotherapy were amenable to scientific study then we should have made great progress by leaps and bounds, but it simply does not happen.
My hunch is that basically psychotherapy is a process of influence and how good it is turns on how good is the person who influences you far more than upon any technique or protocol. The idea that the effective agent lies in a replicable procedure is false. However, without replicable procedures you cannot count as scientific. So we establish things that don't work, simply because they are easier to research. The remarkable thing is not that psychotherapy effectiveness has not inched forward - the really remarkable thing is that it has not slipped back.
Also, psychotherapy is a community held together by values and to enter that community one has to be socialised into those values, yet by no means all psychotherapy values are obviously virtuous. Not all the directions that popular psychotherapy is likely to influence one towards are self-evidently good or beneficial. Psychotherapy can make a person more self-obsessed and even more selfish. It can lead to building up rationales for dysfunctional behaviours. It can instil a philosophy of life that is stronger on rationalisation than on character. It can also inculcate stereotypes and suffer from a subtle judgementalism. Mostly the people who spread these influences are completely unaware of the bias and often have never considered the possibility that their value system is open to question.
Over the years I have moved in various circles within the psychotherapy world and in all of them one finds some excellent people. One feels that they would be great healers even if they had never read a psychology book, but that whatever therapy theory they associate with serves them as a language and a structure. They use it rather than being used by it. But then one also meet people who have passed the exams, got the piece of paper, who one has serious doubts about. This is not an issue about tighter regulation - some of the worst abuse cases have been at the hands of the most qualified and validated people. It is not about needing higher academic standards - there is no (or possibly even an inverse) relationship between knowing how to pass therapy theory exams and ability to be a good therapist.
I am not arguing that all research should be abandoned, just that we should have a much more modest estimate of what it is capable of finding out, but I am arguing that the present fetish for awarding status to therapy methods on the basis of supposed scientificness is damaging and misleading nonsense. And going back to Scott Miller's original observations, I think it will be very difficult for the real effectiveness of psychotherapy to increase while the current culture and ethos of the profession, coupled to its associated education and validation systems persists. However, the days of the great pioneers are over. Freud, Moreno, Rogers - how would they fare today?
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