By Dan Williams – Integrative Psychotherapist
Neuroscience validates psychotherapists’ collective intuition but new insight threateningly promises to put us out of the job. I think much of psychotherapy theory is well intended confabulation in which much is repeated and rebranded while falsely claiming originality exactly because of clinicians’ fear of having their water wings torn off by some tsunami of new understanding makes them cling to old ideas. Controversial? Maybe but this article does not intend to dismiss or disrespect psychotherapeutic theory or its authors, only to explore the personal challenges we face as clinicians in a time of rapidly changing clinical theory.
The difficulties with psychotherapy theory
I doubt that until just over a century ago when this psychotherapy fad emerged, Homo Sapiens either didn’t get sad and traumatized or just stumbled along in the emotional dark and did the best they could. We are thought to have existed in our present neurological form for around two hundred millennia which is a long time to wait for psychotherapy to be invented if you have PTSD. I think the idea offered in Gilbert & Orlan’s (2005) ‘Integrative Therapy | 100 Key points and techniques’ that talking therapies have existed in various forms throughout the human ages is most likely.
Intuition is the manifestation our brain’s heuristics engine and though it makes things feel like they fit, it is not always accurate; it’s possible to ‘just know’ (to ‘just feel!’) we are right and not be. Science validates many aspects of clinicians’ collective intuition about talking therapy and has disproved or challenged others for example conversion therapy (disproved), Freud’s Oedipal / Electra complexes (widely rejected), NLP and primal therapy (widely rejected as pseudo-science).
Until science offered insight into how talking therapy works(or doesn’t), a lot of psychotherapy theory existed in the form of hypothesized models retrofitted to observed clinical phenomena like Freud’s id, it, ego model, Assigioli’s psychosynthesis ideas, TA’s ego states inter alia. Models like these are useful in practice but I think over time, particularly as their authors die and the body of ‘theory about someone else’s theory’ grows, such legacy begins to drag progress down.
The disunity of theory mirrored in practice
For me the current state of psychotherapy seems like the herd of technical oddities (Palm pilots, WAP-capable phones, various organizer devices with primitive infrared interfaces) that emerged and disappeared in the late 1990s and early 2000s before the world converged on smart phones with two (and a bit) competing standards. Similarly, different flavors of talking therapy – around 500 according to Warren Tryon (2014) in Cognitive Neuroscience and Psychotherapy: Network Principles for a Unified Theory (p. 79) – have sprouted like mushrooms underpinned by slightly different variations on the same theoretical themes which are often presented as new and different with real original research being quite rare. Opposing theories attempt to explain the same phenomenon making it hard to know what theory to trust.
I think a key element of this disunity is the personal uncertainty changing understanding sews in clinicians. Livelihoods, statuses and I think, loss of personal meaning are staked on clinicians’ theories being ‘right’. Too many people have too much to lose to progress.
So how can we work in these conditions?
To illustrate how change can feed fear and how we might sit with the fear and learn to welcome the change I describe my short personal journey of reaction, resistance, self-soothing and integration to this (2017) article.
I reacted negatively to this article because of the mode of expression (making uninhibited sounds) encouraged in the treatment and the shamanistic inspiration of the Comprehensive Resource Model (CRM) described. To illustrate my process around this, firstly, though my self-acceptance has a been a fantastic journey, the vestiges of a once pernicious self-consciousness remain so I am still a bit uncomfortable with unbridled expression. How could I possibly learn a treatment that involved doing something that made me uncomfortable! No! Better to stay safely in my therapist chair and speak calmly.
Secondly, faith-wise, I have thrown in my lot with Science. Central to my faith is that all phenomena can be explained empirically even if the complexity is now or forever beyond us (humans). Practically that means to me, if a treatment works, there is a scientific explanation for its workings even if it continues to elude us. That means when I see words like ‘animal guides’ and ‘personal connection to nature’ (from subsequent reading about CRM), I get jumpy. What is the (my!) world coming to if this woo-woo is finding its way into the NHS! I won’t have it!
But exercising a vestigial clinical diligence of self-reflection I was fortunately able to call these things to mind and acknowledge them as the sources of my angst so recovering from my attack of bias. Then I could read the article with a calm and open mind. Then I saw that while it coined things in terms I am uncomfortable with, it also embraces the established understanding that resident trauma needs somehow to be reintegrated in the psyche; after all this is still new ground, things have to be called something so why not use the names the inspiration already supplies – ‘animal guides’, ‘connection to nature’ etc.
From there it is just (well, ‘just’…) a case of evaluating and integrating the new knowledge as is appropriate to my circumstances: Do I like the sound of the approach? Am I interested in working a lot with PTSD? Would I like to train in CRM? And so on.
Of course, there might be a treatment that revolutionizes me out of the job, just as many jobs in many industries have been made obsolete by science and technology. Embracing change is no guarantee of employment but it’s the best shot we’ve got.
For us to practice calmly in the current storm of change I would recommend keeping in mind we aren’t doing anything that original but we are only now beginning to understand what it is we are doing. Rooting out our unconscious fears (as in my personal example above) on which any manifesting kneejerk resistance is based is the first step to keeping an open mind and welcoming changes in understanding as they arise.
© Dan Williams 2019
Born in New Zealand and living in the UK for the last 20 years, Dan is an integratively trained psychotherapist and supervisor with a previous career in information technology. He works in full time private practice with a wide range of clients and his professional interests are gender and attachment differences across cultures, perceptions of disability, the evolution of marriage, questions of monogamy and polyamory and exploration of nature vs nurture in general. He also enjoys writing fiction and reflective pieces.