Critical Issues in Psychotherapy: Translating New Ideas into Practice

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Edited by: Brent D. Slife, Richard N. Williams & Sally H. Barlow

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    Acknowledgements

    The editors express their appreciation to Clayne Pope, Dean of the College of Family Home and Social Sciences at Brigham Young University, for his moral and financial support of the conference that led to this volume.

    Brent D.Slife, Richard N.Williams, Sally H.Barlow

    Introduction

    Brent D.SlifeBrigham Young University

    The hallmark of any science is investigation. Nothing should go uninvestigated, particularly if it bears directly on the phenomena being studied. Unfortunately, this hallmark is often taken to mean that science investigates only empirical questions. That is, science only deals with questions that can be conceptualized in terms of its methods (e.g., observable variables, operationalized factors). Questions that cannot be understood in these terms—questions that are not necessarily empirical—are frequently thought to be “unscientific” and outside the realm of science.

    The contributors to this book do not share this narrow view of science. Although empirical issues are obviously important to any scientific discipline, there are many vital issues that cannot be investigated by empirical means alone. Particularly in the realm of psychotherapy, there are pivotal nonempirical questions—“critical issues,” as the title of this book indicates—that have escaped careful consideration. The purpose of this book is to pursue such careful consideration. At the dawning of a new millennium, it seems appropriate that we investigate these issues in ways that help not only the frontline psychotherapist but also the therapist in training.

    The Significance of the Nonempirical

    Many scholars have noted over the years that it is the nonempirical, rather than the empirical, that lies at the heart of therapy's most pressing problems (Koch, 1959, 1992; Miller, 1992; Robinson, 1985; Rychlak, 1981, 1988; Sass, 1992; Slife & Gantt, 1999; Slife & Williams, 1995). For example, the heart of the controversy over prescription privileges is the mind-body issue. If the mind is merely a byproduct or an aspect of the body—completely controlled by the neurological system of the brain—then psychopharmacology (or surgery) is the only real intervention. Traditional therapy models are merely stopgap approaches until the biological basis for all human behavior is fully established. From this perspective, the traditional discipline of psychotherapy itself is in peril. Its peril depends, however, on whether mind is merely brain, an issue that cannot be settled by purely empirical means alone (see Williams, this volume).

    The problem is that very few therapists have been trained to deal with such critical issues. Most have been trained to be practitioners or scientist-practitioners; they can conduct either therapy or research (or some combination of the two). Their training does not assist them in recognizing, let alone investigating, the nonempirical issues that pervade and tacitly influence their therapy and research. This lack of training does not mean that these therapists avoid making decisions about nonempirical issues. It only means that these therapists cannot make explicit, informed decisions about such issues.

    For example, the position taken (above) on the mind-body issue is not the only one that is available or justifiable. This position is a variant on “eliminative materialism,” as it is sometimes labeled, and is, to say the least, controversial (Churchland, 1986; Fisher, 1997; Muse, 1997). Nevertheless, many therapists apparently hold this position on the prescription privilege issue, often without knowing they do. Does this “philosophical” and sometimes unrecognized position influence the everyday treatment decisions of these therapists? As we will show in this book, such positions are not just philosophical or professional; they influence the moment-by-moment decisions that affect the therapy session itself. For instance, eliminative materialists probably have little faith in traditional psychological interventions. They view such interventions as providing little genuine resolution of the fundamental causes of pathology, and thus use them grudgingly, if at all.

    Of course, nonempirical issues are not just involved in disciplinary problems; they are also involved in disciplinary opportunities. Some of the greatest advances in science have occurred through the consideration of nonempirical issues. Einstein's work is probably the most famous example, questioning as he did the nonempirical assumptions of his discipline. To be sure, Einstein's “gedanken experiments”—his nonempirical inquiries—ultimately led to many testable, empirical questions, but they began with what could only be viewed as “philosophical” questions (e.g., What is the nature of time?).

    In the same sense, the authors of this book welcome the many empirical investigations that may follow from or lead to this exploration of nonempirical issues. They do not, however, require that testable implications be the primary reason for their gedanken experiments. More important for this book is the significance of the issues for the field. That is, critical issues do not have to result in empirical hypotheses. An issue could have important disciplinary consequences, and thus significance, without necessarily leading to a program of scientific research.

    Karl Popper's (1959) pivotal work in the philosophy of science illustrates this point. His work eventually influenced the important notion of falsifiability, which many in psychology consider to be crucial in distinguishing science from pseudoscience (e.g., Radner & Radner, 1982). Yet his examination of scientific method and the philosophy that underlies this method could hardly be considered empirical in nature. Indeed, he could not, in principle, use empirical methods to examine the fundamental character of empirical methods; this would be tautological. His inquiries were instead philosophical in nature, leading to no testable hypotheses per se. But these inquiries have great significance for science in general and the entire enterprise of statistical analysis (e.g., denying or falsifying the null hypothesis).

    The upshot is that examining the nonempirical—the critical issues of a discipline— has the potential not only to resolve disciplinary problems but also to create disciplinary opportunities, opportunities for new understandings and new approaches. The contributors to this book do not consider themselves to be in the company of such thinkers as Einstein and Popper. Still, each has embarked on a similar quest: illuminating overlooked problems that cannot ultimately be decided by empirical criteria alone. Each trusts in the significance of investigating the “sacred cows” of the discipline as well as rethinking its familiar and seemingly settled elements.

    The Context and Impetus for the Book

    What are the sacred cows of the discipline, as well as its important settled and unsettled nonempirical elements? The editors of this volume created a list of such issues, much like any therapist's list of important issues in the field: empirically supported treatment, assessment, pharmacology, spirituality, culture, managed care, individualism, the scientist-practitioner model, determinism, eclecticism, postmodernism, multiculturalism, diagnosis, and feminism. We then asked a distinguished panel of contributors to address one or more of the overlooked, nonempirical elements of these topics and begin a conversation about them. Part of this conversation took place in a conference (held at Brigham Young University in 1999) that allowed this distinguished panel to discuss these issues with practicing psychotherapists.

    None of the contributors was asked to tackle an overly broad or abstract issue, such as “What is the nature of therapy?” or “What is the nature of abnormality?” Nor was anyone asked to resolve a particular issue in a definitive fashion, assuming this were even possible. The main thrust of each chapter of this book, then, is to describe a relatively ignored problem and begin to find the language— in therapist's rather than philosopher's language—to raise our consciousness about it. Some authors attempt to solve the problems raised; others attempt to show new ways of dealing with these aspects of the therapy enterprise. In all the chapters, however, the emphasis is on illuminating pivotal nonempirical issues, so that the reader can join the conversation about them and ultimately deal with them more effectively in practice.

    To reinforce this emphasis on practical conversation, the editors also asked practicing psychotherapists (who also attended the 1999 BYU conference) to comment on each of the chapters. These commentators were given relatively free rein, addressing such questions as, what did they think about the issues raised? Were the chapters helpful? Did they illuminate a previously overlooked perspective? How might they, the commentators, extend or elaborate the points made? Were there other implications of these ideas for practice? Unfortunately, space constraints limited these helpful contributions considerably. Still, they prompted the chapter authors to move away from their sometimes obscure language to talk directly to the commentator, and thus the practicing psychotherapist.

    The Critical Issues of Psychotherapy

    What are the nonempirical aspects of the issues addressed? Stanley Messer of Rutgers University begins the book by tackling important aspects of the issue of empirically supported treatments. He discusses some of the relevant philosophy of science considerations, showing how frequently the unacknowledged assumptions of science play a role in what seems to be “empirically supported.” Is it possible that these nonempirical factors bias empirical “support” toward some therapies and away from others? Are there therapies that would never be empirically supported, given current methods, despite their effectiveness?

    What about conventional approaches to psychological assessment? Is the potential of today's assessment instruments generally actualized in practice? How much does the usual sterile and mechanical style of assessment prevent the richness of clients from coming through? Is there another framework for assessment that provides more useful information, allows the humanness of the client to be communicated, and yet is scientific and valid? Constance Fischer of Duquesne University addresses these questions with numerous case examples. She describes some of the problems with the traditional approach to assessment and advocates an alternative that may overcome these problems.

    One of the clear trends of psychotherapy is the movement toward biological conceptions. From the increasing popularity of prescription privileges to a heavier reliance on medications, there seems to be an increasing biologization of the discipline. Some professionals would consider this an unqualified good, whereas others are much more wary. In either case, Richard Williams of Brigham Young University explicates the nonempirical issues frequently overlooked. Have we overestimated what biological interventions can offer? Can such a biologization take away the meaning of our client's behaviors? Is there an alternative approach that allows us to value the body but not assume that it is all there is?

    What about the other side of the ontological coin? What role should spirituality play in psychotherapy, if any? Traditionally, therapists have assumed that anything that smacked of religion was off limits, including spirituality. Moreover, spirituality was considered to be outside the domain of the sciences associated with psychotherapy. Increasingly, however, both assumptions are being challenged. As Sally Barlow and Allen Bergin of Brigham Young University show, it is difficult to deal with whole persons in therapy without encountering their spirituality. Bergin is also noted for his rigorous program of spiritual research, indicating how spiritual interventions can facilitate client care.

    The therapeutic influence of culture has also been relatively ignored until recently. In the not too distant past, personality theorists assumed a type of universality that transcended culture—human nature was human nature, regardless of its context. Cultural issues were “add-ons”—incidental aspects of more basic personality structures. More recently, however, therapists such as Lisa Hoshmand of Lesley College have considered culture to be more than incidental. Indeed, Hoshmand shows that traditional theorists themselves were functioning within particular cultures when they formulated their explanations. Are conceptions of abnormality and treatment also bound to culture? What would a truly sophisticated approach to culture be like for a psychotherapist?

    The bane of every therapist's existence is managed care, or so it would seem. Many therapists do their best to manage their associations with managed care and keep its influence to a minimum. Nevertheless, there is no denying the huge impact that this system has had on the psychotherapy enterprise, from the types of therapies now considered to be appropriate (e.g., short term) to the assessment instruments now being developed (e.g., the Outcome Questionnaire). What is behind the managed care regime? What impact is it having and why? Where is it going, and how will it affect client care? Don Polkinghorne of the University of Southern California attempts to address these questions.

    Many psychotherapists take it for granted that people should be treated and assessed, if possible, as individuals. However, this assumption is not one that has been rigorously tested. Rather, it originates from certain cultural biases, including the North American notion of a “rugged individualist.” How has this individualism affected the therapist's understanding of therapy? Is our standard focus on individual autonomy, self-esteem, and personal freedom a reflection of this bias? What alternatives are there, and what ramifications would these have for therapy? Frank Richardson and Timothy Zeddies of the University of Texas—Austin address these provocative issues.

    Another sacred cow in the training of psychotherapists, especially in psychology, is the scientist-practitioner model. This model assumes that teaching the practice of psychotherapy (and how to consume research) is insufficient. Practitioners should also be taught to produce research; practitioners should be taught to be scientists. Ideally, the two roles—scientist and practitioner—are combined to produce a down-to-earth but rigorous therapist. Yet how effective is this model? How necessary are the two main facets of this model, and how effectively are they combined? Hendrika Vande Kemp of Fuller Theological Seminary addresses these questions through a dramatic portrayal of her own physical and emotional problems.

    Joseph Rychlak of Loyola University of Chicago next shares his travails with the prevalent, but frequently unacknowledged, notion of determinism. As he defines it, theories of therapy are hard pressed to avoid this notion, because they describe “what's responsible for” a particular behavior or problem. What influence does this type of theorizing have on the therapist? Does it necessarily presume that clients are not responsible for themselves? Could the therapist assume that the client has a type of self-responsibility? Rychlak explores all these questions and outlines—through the treatment of a particular client—a self-deterministic style of therapy.

    Another undeniable trend in the field is the popular movement toward eclecticism. What is behind this trend? Are traditional single theories failing to measure up to modern standards? Is eclecticism a type of miscellaneous category for homegrown (and thus relatively unevaluated) theories? Or are therapists bothered about the biases of traditional theories and thus wish to escape these theoretical “chains”? Brent Slife and Jeffrey Reber of Brigham Young University first analyze the many mansions and motives of eclectic psychotherapists. This analysis, however, leads them to question whether eclecticism will really satisfy most eclectic therapists. They propose an alternative that they believe better meets the needs of eclectics, and they illustrate it with a therapy case.

    One of the most recent developments of the academy has finally made its way into the practice of psychotherapy—postmodernism. Barbara Held of Bowdoin College evaluates this development. She asks the important questions: What is this seemingly ineffable philosophy? and, How is it currently affecting psychotherapy? Is there anything really different and useful for the practicing therapist? Dr. Held surveys prominent postmodernists and finds their proposals wanting. She then turns to an alternative that seems to address the concerns of the postmodernists, but without postmodernism's dangerous side effects.

    Multiculturalists can be congratulated for generally raising most therapists' awareness of the cultural identities of their clients. Greater stress than ever has been placed on properly dealing with ethnicity in the training and evaluation of competent therapists. Still, is there a “dark” side to this training? Is there a problematic framework that underlies some of the seemingly innocuous rhetoric of multiculturalism? Blaine Fowers of the University of Miami believes that there can be. Multiculturalism can too easily evolve into a penicious relativism, if psychotherapists are not careful. Is there some other way to value the cultural context of clients without falling into these conceptual and practical traps?

    No book of critical issues could be complete without considering the problem of diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994)—in all its revisions—has been one of the most used and yet maligned elements of the therapeutic enterprise. The advent of managed care has given it even more prominence. Many of its supporters view it as a relatively value-free and objective (though imperfect) set of descriptors for the major disorders, much like the functional analysis that has worked so well for medicine. Robert Woolfolk of Princeton University reveals the controversies over such an analysis, even in medicine. He shows how this affiliation with medicine does not save diagnosis from its value-laden nature. What implications, then, do these values have for diagnosis and treatment?

    Surely no modern social movement can claim greater visibility than feminism. For some time now, the theories that have underlain this movement have made their inimitable presence known in psychotherapy. Has this presence been good? Is feminism an all-or-none affair, or is there feminist “wheat” that can be separated from feminist “chaff”? What is the status of this movement at this juncture? Jeanne Marecek of Swarthmore College brings her considerable evaluative powers to bear on these questions. She presents a sympathetic picture of feminism, but also puts it in proper perspective.

    Daniel Robinson of Georgetown University concludes the book. Though not a psychotherapist himself, there is no more astute observer of the nonempirical issues of the social sciences, including the intellectual and practical concerns of psychotherapists. Robinson first draws attention to some of the prominent themes of this panel of authors and commentators, and later adds his own incisive observations about an issue that undergirds all genuinely therapeutic efforts—the “good life.”

    References
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (
    4th ed
    .). Washington, DC: Author.
    Churchland, P. S. (1986). Neurophilosophy: Toward a unified science of the mind-brain. Cambridge: MIT Press.
    Fisher, A. (1997). Modern manifestations of materialism: A legacy of the Enlightenment discourse. Journal of Theoretical and Philosophical Psychology, 17, 45–55. http://dx.doi.org/10.1037/h0091161
    Koch, S. (1959). Psychology: A study of science (Vols. 1–3). New York: McGraw-Hill.
    Koch, S. (1992). Psychology's Bridgman vs. Bridgman's Bridgman: An essay in reconstruction. Theory and Psychology, 2, 261–290. http://dx.doi.org/10.1177/0959354392023002
    Miller, R. B. (Ed.). (1992). The restoration of dialogue: Readings in the philosophy of clinical psychology. Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/10112-000
    Muse, M. (1997). The implicit dualism in eliminative materialism: What the Churchlands aren't telling you. Journal of Theoretical and Philosophical Psychology, 17, 56–66. http://dx.doi.org/10.1037/h0091162
    Polkinghorne, D. E. (1983). Methodology for the human sciences. Albany: State University of New York Press.
    Popper, K. (1959). The logic of scientific discovery. New York: Basic Books.
    Radner, D., & Radner, M. (1982). Science & unreason. Belmont, CA: Wadsworth.
    Robinson, D. N. (1985). Philosophy of psychology. New York: Columbia University Press.
    Rychlak, J. F. (1981). Introduction to personality and psychotherapy: A theory-construction approach (
    2nd ed
    .). Boston: Houghton Mifflin.
    Rychlak, J. F. (1988). The psychology of rigorous humanism (
    2nd ed
    .). New York: New York University Press.
    Sass, L. (1992). Madness and modernism. New York: Basic Books.
    Slife, B. D., & Gantt, E. (1999). Methodological pluralism: A framework for psychotherapy research. Journal of Clinical Psychology, 55 (12), 1–13. http://dx.doi.org/10.1002/%28SICI%291097-4679%28199912%2955:12%3C1453::AID-JCLP4%3E3.0.CO;2-C
    Slife, B. D., & Williams, R. N. (1995). What's behind the research? Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: Sage.
  • Conclusion: The Values of Psychotherapy

    Daniel N.RobinsonGeorgetown & Brigham Young Universities

    The excellent discussion in this volume has been clear and cogent and certainly could not benefit from any summary I might presume to offer. The chapters stand on their own. I found them informative, if only because my own contact with issues in clinical psychology has been limited. Accordingly, I will confine my remarks to what I would hope might be of some interest to those likely to read this volume, and this alone must incline me toward a number of quite general observations. It is my hope that specialists will find something worth abstracting from these generalities in ways that will be of benefit to other professionals.

    The truism according to which psychology is a “hybrid” discipline is nowhere more obvious than in the practices and perspectives that define clinical practice. Here we find not ambiguous values, but well-defined values that just happen to be in conflict. At the most general level, the conflict is between what for the sake of brevity I will call humanistic and scientific values. The former ground all considerations of caring, “therapy,” empathy—all considerations that enter into the sincere desire to understand a life other than one's own and to bring something of value to it. As the textbooks insist, though usually without much by way of critical reflection, the core value of science is something called “objectivity,” which is what is supposed to be left over when we have stripped our efforts of every trace of empathy, caring, hopefulness, altruism, and kindred sentiments.

    At a somewhat more specific level, this very conflict then generates kindred conflicts in choosing the right model of explanation. Science, at least since the time of Hume, has confined its aspirations to the identification of efficient causal modalities. To explain an event on this account (made famous for psychologists by Carl Hempel) is to subsume it under a general law. Wherever we find reliable regularities, we are able to predict, and wherever we are able to predict we have more or less “explained” the event in question. For example, if 88% of those judged to be free of treatable mental disorders see an ambiguous pattern as a butterfly, we must be on the way toward a reassuring Hempelian explanation. It is notable at this point that such a conception of science renders the explanation of singular events problematic, the very events that are now at the center of the most advanced thinking in the most advanced science. That is, it is not clear what a Hempelian explanation of the big bang would look like. I mention this by way of drawing attention to the fact that the tension between so-called idiographic and so-called nomothetic explanations is not confined to psychology.

    When we set out to explain, or in other words to understand, just what it is that has this patient or client incapable of entering into satisfying relationships, however, we begin to search for factors that lack the properties of efficient causes. Indeed, we generally abandon the causal model of explanation and undertake instead a search for what are sometimes called “reasons explanations.” Both common sense and broad experience in the world reassure thoughtful adults, even those with doctoral degrees, that Smith's inability to form and maintain friendships of worth is not likely to be covered by the deductive-nomological model of explanation. If it were, then Smith's problem would be a species of mechanical or chemical malfunction calling for the services of specialists in biochemistry and even neurosurgery. No, we understand that to explain Smith's problem is more akin to explaining Napoleon's failure at Waterloo than to explaining the descent of balls perched at the apex of an inclined plane.

    To the extent that humanistic and scientific values are not isomorphic, and to the extent that one consequence of this is a distinctive difference in what counts as “explanation” in the value domain of each, there would seem to be little room for a credible rapprochement or pax philosophica. And this makes me wonder why so much visible passion seems to be expended by those who criticize the clinicians for their “unscientific” labors and by those clinicians who defend themselves by producing arid statistical summaries of outcomes that describe not a patient, but only a collection of data.

    This very matter of idiographic and nomothetic modes of inquiry and explanation was well understood, if in different terms, by Aristotle, who actually came before Allport. As Aristotle calmly notes in his Physics, there are two different explanations of, for example, “anger,” available to us depending on whether we are interested in a physical or philosophical understanding. Radical changes in the temperature of the blood may be common to all instances of anger, whereas the belief that one has been wrongly slighted by another may be unique to this person's anger.

    But there is much confusion surrounding this distinction. It has been suggested that attention to idiographic approaches carries with it what some have called the “danger of N=1.” Now, just what is this alleged danger? Probably the most scientifically grounded branch of all of experimental psychology is the field of psychophysics, where N=1 is entirely serviceable. Physics itself would not have got very far had physicists believed that the best approach to science is to roll many balls down inclined planes, compute averages and standard deviations, and then offer values of p as the best predictor of just what might happen next. It is surely suggestive, even if not portentous, that none of the developed sciences has ever found much use for “analysis of variance.” There are exceptions, I am sure; I think some work in x ray diffraction might have benefited from such an analysis. But the truer mark of developed science is measurement, which is different from estimates of probability or reassurances as to how “confident” we are allowed to be.

    On the matter of balls and inclined planes, if a study is conducted properly and in a framework that already includes a developed theory, one ball will do! This has long been understood in research fields as different as clinical medicine and classical mechanics. Once one has a developed theory of physiological function, the laws of physiology will be evident in every single specimen and, by the same token, the violation of said laws will instantly qualify the deviant as “ill.” I often illustrate this point with the example of an epidemiologist summoned to a village to determine whether there has been an outbreak of disease. Imagine the following report being turned in:

    I've examined all 1,000 residents and am pleased to say that 997 of them have temperatures of 104 degrees, with only three falling to 98.6. I think we can contain the disorder by isolating these three.

    To make the case all too briefly, whether or not a discipline or science has or will have general laws with which to explain instances cannot be settled in advance on the basis of sample size. Typically it is the daring and integrative theory that dictates just the sort of findings that will tell for or against it. Absent a developed and defensible theoretical framework, the enterprise collapses into a vapid and tedious ritual of fact gathering.

    What would seem to be needed, then, is a defensible theory of what seems on the record to be the nature of human nature itself, as this expresses itself under the most favorable conditions. Presumably conditions are favorable when human beings are spared an early death, debilitating or incapacitating diseases, political regimes that preclude the development of powers of moral and civic judgment, and modes of instruction or indoctrination that foreclose whole realms of thought and inquiry. We are, of course, a wonderfully adaptable species, in large measure because we are especially good at getting the physical world to adapt to our own needs and desires. Lacking feathers, we invent aerodynamics. Lacking flawless memories, we invent books and libraries. Lacking herculean strength, we invent devices that increase our mechanical advantage.

    Owing to this very versatility, these very powers of invention, there seems to be neither a ceiling nor a fence circumscribing our possibilities, and this insensibly gives rise to the notion that no generality regarding our best interests is defensible. That is, we confuse virtually limitless potentiality with the very different notion of unlimited options for the good life, as if the power to make a mountain of chocolate constituted an argument against self-restraint. But the record of history is not silent on these subjects. Every recorded age turns up persons worthy of profound respect and attempts at emulation, as well as lives that must have been horrors to those living them. The text here is not filled with numbers; it is filled with judgments, and like it or not the former cannot be substituted for the latter.

    Not only is the history of our brief epoch on earth fairly well documented, but we even have a number of sages who have tested the record for its larger implications. My own candidate for the most systematic and discerning of these teachers is Aristotle, but the choices here are many and the conclusions are not radically different among those who have undertaken a systematic study. Most seem convinced that there is a difference between a merely scripted life and one that is authentically lived. Aristotle notes the difference between the hand of a statue of a physician and that of a physician; the former is a hand in name only, for it does not engage in the activity that constitutes the healing arts. So too with any feigned form of activity.

    It is widely assumed by those we have reason to listen to that a life is authentic to the extent that its most defining features are chosen rather than imposed, where the choice itself is valid as a choice. It is a choice among well-understood alternatives. This is not to say that elements of stress or even social pressure are absent; only that such elements incline but do not determine, for if they are determinative, then the action is in fact a reaction and it is not authentically the actor's own. We see then that the notion of “autonomy” is really quite empty unless we have good reason to believe that those who are “law unto themselves” are not traipsing about sleepwalking or in the thrall of controlling addictions or stupefied by a chronic ignorance of what life could be like. If autonomy is a value—nothing less than a “therapeutic” value—then it too is to flourish and not merely exist. We might guess it would be small comfort to Goya's “Giant” to learn he was “autonomous.”

    If choices are to be potentiating rather than paralyzing, a form of moral order is presupposed. Just in case we have convinced ourselves that there is no way of establishing the moral worthiness of one set of choices over another, it is not at all clear just what “psychotherapy” is treating. After all, who says contentment is to be preferred to misery, or clarity to confusion, or decency to self-degradation? Therapists claiming to be “morally neutral” or to be guided by that will-o'-the-wisp “value neutrality” are engaged in a form of self-deception no less injurious for being ridiculous.

    Does all this constitute a rehearsal of the conflict between scientific and humanistic values? Does it not call for the abandonment of “objectivity”? I should like to consider this notion of “objectivity,” for the manner in which it is understood is, in my view, at the bottom of many confusions.

    In her recent Josiah Berlin lectures at Oxford, Lorraine Daston has closely examined the history of the concept of objectivity and has shown it to be a variegated one. A single illustration will, I think, be eye-opening for some. When diligent botanists of the 17th century committed themselves to drawing to the most exacting standards a given specimen, they judged their efforts to be only preliminary. Once a single specimen was accurately depicted, it became necessary to present the “truth” of the thing, which then called for skilled artists to locate the specimen in a painted garden, which is to say, in the true and real context in which such specimens are found. Note, then, the difference between the “objective” rendering of the specimen and the scientific presentation of the thing as it is actually found. Let us be clear, then, that accuracy is no guarantor of truth—a point Wolfgang K$oUhler (1938) made so trenchantly in The Place of Value in a World of Facts.

    There is still another reservation to be recorded on this matter of objectivity. When one claims to be “objective” in research or inquiries of one or another sort, what quality or state or attribute is the reference of the term? I believe the most defensible answer to the question is that objectivity is a moral term. It refers finally to a disciplined disposition in the matter of evidence and argument. It refers to the suspension of purely personal desires or motives and their replacement by an utterly depersonalized attitude. Were we morally neutral up and down the line, one of the first casualties would be objectivity itself, for even if our neutrality did not lead to out-and-out fraud it would surely disregard mere, if not gross, exaggeration and concealment.

    Finally, I would hope to fortify the humanistic resources and perspectives in psychotherapy by reminding clinicians of the central part they have taken in keeping the discipline of psychology alive and defined. It is always the clinic that puts simplistic and confident theory on notice. It is the unpredicted successes and failures taking place in the real world that both demand and test assistance coming from the scientific quarter. It is then one of the “values” of psychotherapy to settle for a vexing reality if the only alternative is a consoling fiction. I would hope, in their pursuit of reliable measures and methods, their attention to developments in the basic sciences, their attachment to what is perhaps the less refined thinking in science itself, that psychotherapists would not lose their allegiance to the core values of psychotherapy, values that are, and must be at bottom, moral, civic, humanistic, and realistic. There are baser values!

    Reference
    Kohler, W. (1938). The place of value in a world of facts. New York: Liveright.

    Name Index

    About the Editors and Contributors

    Sally H. Barlow is Professor in the Clinical Psychology Graduate Program at Brigham Young University in Provo, Utah, where her duties include individual and group supervision, psychodynamic psychotherapy, and diversity issues. She has been teaching and researching in the area of psychotherapy for the past two decades. She has presented at national and international conferences on such topics as group psychotherapy, violence and aggression, and spirituality. She holds diplomas from the American Board of Professional Psychology in both clinical and group psychology.

    Lorna Smith Benjamin, PhD, for many years was Professor of Psychiatry, University of Wisconsin–Madison. There, in addition to teaching psychopathology and psychotherapy to psychiatry residents, she had a large clinical practice. Now in the Department of Psychology at the University of Utah, she is using her Structural Analysis of Social Behavior (SASB) for research in object relations. She is the author of Interpersonal Diagnosis and Treatment of Personality Disorders.

    Lynne A. Bennion has a PhD in clinical psychology from Purdue University. She is an Associate Clinical Professor at the Brigham Young University Counseling and Career Center, where she provides psychotherapy to BYU students, supervises predoctoral psychology interns and other trainees, and teaches university courses. Her areas of professional interest include mood disorders, eating disorders, posttraumatic stress disorder, and supervision.

    Allen E. Bergin is Professor Emeritus at Brigham Young University in the Department of Psychology in Provo, Utah. Winner of numerous national and international awards, he is most noted for his pioneering work in psychotherapy reasearch and spiritual interventions.

    Marian S. Bergin is a licensed clinical social worker in private practice in American Fork, Utah. Using a cognitive-psychodynamic approach, she treats a varied clientele while specializing in personality disordered clients. She has been an adjunct faculty member in psychology at Brigham Young University, supervising clinical psychology graduate students in psychotherapy practica. She has also worked as an acute care psychiatric unit therapist and an emergency room crisis worker in a large general hospital in Provo, Utah. Additionally, in the hospital she was program director of Adult Psychiatry, program director of the Depression Center, and clinical coordinator of the Eating Disorders unit. She has written, published, and lectured on a variety of mental health subjects.

    Constance T. Fischer is Professor of Psychology, and Director of the Psychology Clinic at Duquesne University. She also conducts a part-time practice of clinical psychology (psychotherapy, consultation, psychological assessment). She has authored Individualizing Psychological Assessment and coedited Volume 2 of Duquesne Studies in Phenomenological Psychology (with A. Giorgi and E. Murray) and Client Participation in Human Services: The Prometheus Principle (with S. Brodsky) and is editing Qualitative Research Methods for Psychology: Case Demonstrations. She is a consulting editor for The Journal of Humanistic Psychology, The Humanistic Psychologist, and Methods: A Journal for Human Science. Current pursuits include promoting use of qualitative research and of collaborative psychological assessment practices and conducting her own research on the phenomenon of becoming angry.

    Blaine J. Fowers is Associate Professor of Counseling Psychology at the University of Miami. He received his PhD from the University of Texas at Austin in 1987. He is an approved supervisor in the American Association for Marital and Family Therapists and a licensed psychologist. His primary scholarly commitment is to developing a better understanding of the moral and ethical dimension of psychology, both in research and practice. His empirical work is devoted to clarifying the role of cultural values in marriage and the family and he is currently investigating the prevalence of cultural values in research on marriage. He is the author of Beyond the Myth of Marital Happiness (2000) and a coauthor of Re-Envisioning Psychology (1999). He has published numerous articles on culture and psychology, including “Why Is Multiculturalism Good?” published in American Psychologist. He has also published widely on the philosophy of social science and the pervasive individualism in our research and therapy.

    James M. Harper, PhD, is Professor of Marriage and Family Therapy and Director of the School of Family Life at Brigham Young University. A licensed psychologist and marriage and family therapist, he has a private clinical practice and supervises other therapists. He is an approved Supervisor and Fellow with the American Association for Marriage and Family Therapy.

    Barbara S. Held, PhD, is the Barry N. Wish Professor of Psychology and Social Studies at Bowdoin College in Brunswick, Maine. She is the author of many scholarly articles, among them “Constructivism in Psychotherapy: Truth and Consequences,” in The Flight from Science and Reason (edited by Paul R. Gross, Norman Levitt, and Martin W. Lewis), Annals of the New York Academy of Sciences (Volume 775, 1996). She is also the author of Back to Reality: A Critique of Postmodern Theory in Psychotherapy (1995), in which she provides theoretical and philosophical analysis of the postmodern/linguistic turn in psychotherapy. A licensed clinical psychologist, she has practiced psychotherapy for many years in Maine.

    Lisa Tsoi Hoshmand, PhD, is Professor and Division Director of the Division of Counseling and Psychology at Lesley University in Cambridge, Massachusetts. She is the author and editor of three books, including Creativity and Moral Vision in Psychology: Narratives on Identity and Commitment in a Postmodern Age (1998). A clinical psychologist and counselor educator, she has written on topics related to professional education, research praxis, critical inquiry, and cultural and moral perspectives in psychology and adult development. She has served one term as the associate editor of the Journal of Theoretical and Philosophical Psychology and as a member of the editorial board of the Journal of Counseling Psychology, The Counseling Psychologist, Journal of Community Psychology, and Journal of Constructivist Psychology. She was previously Professor of Counseling at the California State University, Fullerton, and Professor and Director of Clinical Training at the American School of Professional Psychology, Hawaii campus.

    Lynn D. Johnson received his PhD from the University of Utah in counseling psychology. He has worked in mental health centers and in private practice, and in 1984 formed The Brief Therapy Center of Utah, located in Salt Lake City. From 1986 to 1995, he was a consultant to Aetna Insurance in helping the company develop its managed care programs. His interests are in improving therapy processes and outcomes. He and his wife raise four children in their spare time.

    Daniel K. Judd is Associate Professor of Ancient Scripture at Brigham Young University in Provo, Utah. He holds a PhD in counseling psychology and an MS in family studies. In addition to his teaching; administrative duties; and counseling practice with individuals, couples, and families, he has specialized in both quantitative and qualitative research concerning the-relationship of mental health and religion. His most recent publication is “Religion, Mental Health, and the Latter-day Saints.” He is presently engaged in a major research project looking at the relationship between marriage and religion.

    Jeanne Marecek is Professor of Psychology and a member of the Women's Studies Program at Swarthmore College in Pennsylvania, where she teaches courses on clinical psychology, women and gender, qualitative research, and feminist theory. She earned her PhD from Yale University, with specialties in clinical and social psychology. She is coauthor, with Rachel Hare-Mustin, of Making a Difference: Psychology and the Construction of Gender (1990). She has written numerous chapters and journal articles on gender, qualitative inquiry, and clinical psychology. Her present research focuses on feminist therapists and uses discursive approaches to study the varied identities, therapeutic stances, and meanings of feminism that they embrace. She has also worked in Sri Lanka for over a decade. Her research there focuses on suicide, a social problem that has recently reached epidemic proportions. Her research concerns the circumstances, meanings, and consequences of suicidal acts in rural contexts, as well as the development of intervention programs. She serves on the board of directors of the Women's Therapy Center in Philadelphia and on the Executive Committee of the American Institute for Sri Lankan Studies. She is also Vice Patron of Nest, a rural psychosocial outreach program in Sri Lanka.

    Stanley B. Messer is Professor and Chairperson in the Department of Clinical Psychology at the Graduate School of Applied and Professional Psychology at Rutgers University at New Brunswick, New Jersey. He received a BSc in honors psychology from McGill University and MA and PhD degrees in clinical psychology from Harvard University, and completed a psychotherapy fellowship program at Hillside Hospital in Glen Oaks, New York. He is coauthor of Models of Brief Psychodynamic Therapy: A Comparative Approach (with C. S. Warren, 1995), associate editor of History of Psychotherapy: A Century of Change (with D. K. Freedheim et al., 1992), coeditor of Essential Psychotherapies: Theory and Practice (with A. S. Gurman, 1995), Hermeneutics and Psychological Theory (with R. L. Woolfolk and L. A. Sass, 1988), and Psychoanalytic Therapy and Behavior Therapy: Is Integration Possible? (with H. Arkowitz, 1984), among other works. He has written extensively on topics such as psychotherapy integration, brief psychotherapy, and case formulation in relation to psychotherapy, and he has conducted empirical research on the process of psychotherapy. He was an associate editor of American Psychologist and is on the editorial board of several other journals. He maintains a clinical practice in Highland Park, New Jersey.

    Louis A. Moench, MD, practices general and forensic psychiatry in Salt Lake City, Utah, where in this “decade of the brain” he still talks and listens to patients in a large, multispecialty medical clinic. A medical graduate and now clinical Professor of Psychiatry at the University of Utah, he completed his psychiatry residency at the University of Pennsylvania, learning psychotherapy from Aaron Beck (cognitive), Lester Luborsky (psychodynamic), Paul Brady (behavioral), and Sal Menuchin (structural), all under more or less the same roof. He is an examiner of candidates for the American Board of Psychiatry and Neurology and is active in the governance of the American Psychiatric Association, serving on the Assembly Executive Committee and the committees producing the Diagnostic and Statistical Manual of Mental Disorders (DSM), the APA Practice Guidelines, and the guidelines for electroconvulsive therapy, as well as the committee operating the Practice Research Network.

    Stevan Lars Nielsen is Associate Clinical Professor at the Brigham Young University (BYU) Counseling and Career Center in Provo, Utah, where his duties include assessment and treatment of college students and teaching as an adjunct professor with BYU's Department of Psychology. He also maintains a private practice, which includes therapy, assessment, and consulting. He earned his doctorate in clinical psychology from the University of Washington in 1984. He served as a psychologist in the United States Army for seven years, where he provided psychological services in diverse settings (tents in German forests, hospitals in Frankfurt, Germany, and San Francisco) and with diverse clients (soldiers, retired soldiers, and their families). His research interests include studying the effectiveness of psychological services actually provided in real world settings. (The parameters of everyday practice probably bear scant resemblance to the worlds where psychological treatments and assessments are studied). His most recent publications deal with assessment and treatment of religious clients, including a forthcoming book written with W. Brad Johnson and Albert Ellis on treatment of religious clients with Rational Emotive Behavior Therapy.

    Judy Norman, DSW, LCSW, is Associate Professor, School of Social Work, at Brigham Young University in Provo, Utah. She maintains clinical affiliation with LDS Hospital, Psych Resources, Salt Lake City, Utah. She primarily teaches graduate clinical courses and clinically supervises small groups of graduate students. She is a longtime board member, including past Vice President, of the National Association of Social Workers/Utah chapter. Her research interests include mood disorders in adults and children, women and mental health, and multicultural as well as socioeconomic framework for assessment and intervention.

    Kay Packard is Clinical Associate Professor in the Department of Educational Psychology at the University of Utah. She has an MSW from the University of Utah and a PhD in Marriage and Family Therapy from Brigham Young University. She is a licensed clinical social worker and has worked in various agency settings, as an independent practitioner, and most recently as a staff member at the University of Utah Counseling Center. She is the coauthor of Multidimensional Psychotherapy.

    Ted Packard is Professor in the Department of Educational Psychology and a former Director of the Counseling Center at the University of Utah. He has worked with clients and supervised students for over 30 years. His PhD is in counseling psychology from the University of Minnesota. He writes regularly on topics associated with both the statutory and voluntary regulation of professional psychology and is President of the American Board of Professional Psychology during 2000–2001.

    Agnes M. Plenk is Adjunct Professor in the Department of Educational Psychology at the University of Utah and in the Department of Clinical Psychology at Brigham Young University in Provo, Utah. She was born in Hungry and received her early professional education at the University of Vienna. She continued her training at Northwestern University, receiving a BS and an MA and working toward a PhD in clinical psychology and a minor in anthropology. She worked at the Chicago Psychoanalytic Institute and the Institute for Juvenile Research before completing her PhD at the University of Utah in the department of Educational Psychology. She is the founder of The Children's Center, a day treatment center for preschool children with behavioral problems, and was its chief psychologist and executive director until 1986. Currently, she supervises interns and residents at The Children's Center and acts as consultant to a genetic research project. She is a child advocate and active in mental health organizations and a licensed psychologist (former president of the Utah Psychological Association, [UPA]), a member of the UPA and the American Psychological Association, and a Fellow of the American Orthopsychiatric Association. She is the originator of “The Plenk Storytelling Test” and the author of Helping Young Children at Risk—A Psycho-Educational Approach, as well as a number of papers in her field.

    Donald E. Polkinghorne is Professor in the Division of Counseling Psychology at the University of Southern California, where he holds the Attallah Chair in Humanistic Psychology. He is a fellow in the American Psychological Association's Division of Counseling Psychology and a fellow and past president in the Division of Theoretical and Philosophical Psychology. His educational background includes an undergraduate degree in religious studies from Washington University in St. Louis, Missouri, and graduate degrees from Yale University, Hartford Seminary Foundation, and the Union Graduate Institute. His PhD is in psychology.

    His scholarly publications have focused on the epistemological foundations of qualitative research and the implications of Continental philosophy for psychological theory and research. His publications include four books: An Existential-Phenomenological Approach to Education, Methodology for the Human Science, Narrative Knowing and the Human Sciences, and Human Science and Praxis. In addition to his scholarly work, Polkinghorne is a licensed psychotherapist. He received his clinical training at the Norwich, Connecticut and the Waterbury, Vermont state hospitals. He maintains a part-time psychotherapy practice and serves as an oral examiner for the California Psychology Licensing Board.

    Marybeth Raynes is a marriage and family therapist and clinical social social worker who maintains a private psychotherapy practice in Salt Lake City, Utah. She is a clinical member of the American Association of Marriage and Family Therapists as well as a clinical diplomate, National Association of Social Workers. She holds an MS in Marriage and Family Relationships and an MSW. Over the course of her career, she has taught clinical social work courses as well as relationship development and dynamics courses at the university level and has published numerous articles and chapters in books, addressing mental health topics, women's issues, and spirituality. She is the coeditor of Peculiar People: Mormons and Same-Sex Attraction. She also speaks regularly to public and professional groups on these topics and has been actively involved in women's groups and feminist issues for 30 years.

    Jeffrey S. Reber is Assistant Professor of Psychology at State University of West Georgia. He recently received his PhD in psychology from Brigham Young University and he has published papers regarding theoretical and philosophical implications of eclectic psychotherapy, the nature and importance of truth in psychotherapy, and the possibility and meaning of altruism. He has also produced work concerning the assumptions and implications of evolutionary psychology and women's experience with and perceptions of sexual harassment.

    Frank C. Richardson is Professor of Educational Psychology at the University of Texas at Austin. His empirical research has focused on cognitive-behavioral approaches to the treatment of anxiety and stress. His writing includes a number of articles that have appeared in American Psychologist and other leading journals, as well as chapters in several books, examining the cultural and moral value underpinnings of modern psychology and psychotherapy. He is coauthor of Stress, Sanity, and Survival (with Robert Woolfolk) and of Re-Envisioning Psychology (with Blaine Fowers and Charles Guignon). He has practiced individual therapy, marital therapy, and group therapy part-time for many years. Currently, his scholarly interests center on the philosophy of social science, topics in philosophical psychology, and topics in religion and psychology.

    Daniel N. Robinson is Distinguished Research Professor and Professor of Psychology at Georgetown University in Washington, D. C., and Faculty Fellow at Oxford University. He is past president of the Division 24 and Division 26 of the American Psychological Association.

    Joseph F. Rychlak is Professor Emeritus at Loyola University of Chicago. In addition to teaching for over 40 years at five different universities, he has distinguished himself as a psychotherapist, author, theorist, and researcher. He is a Fellow of both the American Psychological Association and the American Psychological Society and served twice as President of the APA Division of Theoretical and Philosophical Psychology. He is known as a rigorous humanist who submits his nonmechanistic theoretical claims to traditional scientific tests.

    Brent D. Slife is currently Professor in the Department of Psychology at Brigham Young University in Provo, Utah, where he holds a joint appointment on the clinical and theoretical faculties. A previous Director of Clinical Training at Baylor University, he continues to manage a private practice in family and group psychotherapy. He was recently the President of the APA Division for Theoretical and Philosophical Psychology. He has over 100 published articles on the theoretical underpinnings of psychotherapy. His recent books include Time and Psychological Explanation, What's Behind the Research: Discovering Hidden Assumptions in the Behavioral Sciences, Taking Sides: Clashing Views on Controversial Psychological Issues, and Managing Values in Psychotherapy.

    Amy Fisher Smith is Assistant Professor in the Department of Psychology and Special Education at Texas A&M University-Commerce. After formal training in clinical psychology, she completed a clinical internship at the South Texas Veterans Health Care System in San Antonio. Currently, she contributes to the training of both doctoral and master's level counseling and school psychology students. Her research interests include the relationship between psychotherapy, ethics, and the role of therapist values. Her most recent publications focus on the theory and practical implications of values in practice.

    Diane L. Spangler received her PhD in clinical psychology from the University of Oregon. She received a National Research Service Award from the National Institute of Mental Health for her doctoral research and went on to a research fellowship in the Department of Psychiatry at the Stanford School of Medicine, where she investigated cognitive-behavioral theory and therapy. She has published a number of articles and book chapters on the theory, practice, and mechanisms of action of cognitive-behavioral therapy and has received awards from the American Psychological Association, National Institute of Mental Health, International Association of Cognitive Psychotherapy, and the Association for the Advancement of Behavior Therapy for this work. Currently, she is a member of the psychology faculty at Brigham Young University and maintains a private practice specializing in the treatment of mood, anxiety, and eating disorders.

    Hendrika Vande Kemp is Professor of Psychology at Fuller Theological Seminary, where she teaches clinical courses on family psychology, family therapy, dreams in psychotherapy, interpersonal assessment and psychotherapy, and physical disabilities. She completed her clinical training at the University of Massachusetts in Amherst (PhD, 1977) and Topeka State Hospital. She has published clinically focused articles in Family Therapy, Family Process, Journal of Marital and Family Therapy, The Psychotherapy Patient, Teaching of Psychology, and Journal of Psychology and Christianity. She is the editor of Family Therapy: Christian Perspectives (1991). As a historical and theoretical psychologist, she has authored many book chapters and published articles in encyclopedias, dictionaries, and journals such as Journal of the History of the Behavioral Sciences, Journal of Psychology and Theology, American Psychologist, International Journal for the Psychology of Religion, and Journal of Individual Psychology. She is the author of Psychology and Theology 1672–1965: A Historical and Annotated Bibliography (1984).

    Richard N. Williams is Professor of Psychology at Brigham Young University in Provo, Utah. His interests include the conceptual foundations of psychological theories and the relationship between traditional and postmodern perspectives. He is coauthor of What's Behind the Research: Discovering Hidden Assumptions in the Behavioral Sciences (with Brent D. Slife) and has published in the area of human agency and the ethical foundations of human being.

    Robert L. Woolfolk is currently Visiting Professor of Psychology at Princeton University. He has contributed to both the empirical psychology and the philosophical literatures. His most recent book is The Cure of Souls.

    Timothy J. Zeddies, PhD, is an Associate Clinical Psychologist, Camino Real Community Mental Health and Mental Retardation Center. He is on the editorial board of Psychoanalytic Psychology; is Chair of the Film Studies Group; is on the Education and Training Committee, both for the San Antonio Society for Psychoanalytic Studies; and is outgoing National Cochair of the Graduate Student Committee for the Division of Psychoanalysis (39) of the American-Psychological Association. He has published numerous articles related to comparative psychoanalysis, unconscious mental processes, clinical training, and the ethical and moral aims of psychoanalytic treatment. His forthcoming book, coauthored with Frank C. Richardson, is titled Analytic Authority and the Good Life in Relational Psychoanalysis.


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