Tuesday, August 14, 2007

Carl Rogers Pumps his Fist

Interesting article in the New York Times Magazine this past Sunday by Laurie Abraham: Can This Marriage be Saved? Abraham followed a couples therapy group for one year, and provides an insider view on both the interactions between the participants, and the therapist's thought process. I liked the thoughts and personality of the therapist very much -- she's well-educated, but at her best when she lets her instincts guide her and her quirky personality shine through. I find the same approach works for me, but I haven't had her years of experience to prove that it's safe (and more effective) to go that way. Reading about experienced clinicians at work is often helpful.

There are a few interesting segu├ęs in the article, and I wanted to call out one regarding what the literature has to say on the nature of an effective therapeutic relationship:
Investigators have repeatedly tried to single out specific "therapeutic factors" that can distinguish good therapy from bad, and the only unequivocal winner is what's termed a "positive therapeutic alliance," meaning the client feels that the therapist exhibits qualities like empathy and support.

Jay Efran, a psychologist and emeritus professor at Temple University who surveyed the last 25 years worth of trends in therapy in an ambitious recent article (...) has another idea about what makes for an estimable therapist. He suggests that therapy boils down to a facility for conversation and therefore is a creative and contingent act that does not lend itself to formulas. "The profession has gotten itself into a bind," he told me recently, "because it wants to be seen as a science and it wants to collect money and it has made this category mistake of thinking it provides treatments for diseases and not just conversation or community or human contact or offering new slants on life."
In school, I've had the point in the first paragraph drilled into me so many times I can't count. It's one of the foundations of the humanistic approach that Carl Rogers, a founding father of modern psychology, first defined. And it feels right on to me. (Note that there is a silly, 40-year-old myth related to this which holds that therapists are simply trained to either a) say back to you what you've said to them, or b) gush vague, unexamined supportive statements. Neither is true of a good therapist, regardless of his or her theoretical background.)

The second point seems to me simply to take point number one a giant step further. It may be stated just a little too loosely for my taste, but the gist, again, feels right to me. And while I can hear my more scientifically-oriented friends in the field (and the HMOs, and their panels of well-paid MDs) groaning loudly in the background as I type this, there is a boat-load of truth in this quote.

Thinkulous readers know that I'm a big fan of what science can tell us about our minds, emotions, and behavioral patterns. Neurological breakthroughs in the last 20 years have taken our understanding giant steps forward. Social scientists blaze wide swaths of fascinating new information, cutting through the vast forest of ignorance about our inner workings. I adore reading this stuff, and I try to integrate it into how I approach the field.

At the same time, I've always believed that science, art and mystery are not only highly compatible (in this and any field) but are actually three parts of one whole. What I know, and what I've yet to know that I know, flow together indistinguishably and create my unique approach to clients and clinical situations -- the art. Heck, they create me. And while I adore what science can add to that picture, there isn't an argument in the universe that will convince me that science is any more important than mystery, intuition and subjectivity. We're talking about the mind, about emotions, about self-hood. If it isn't subjective, we are, by definition, off track. How could we possibly quantify why certain people are healing to be around?

One well-recognized marker of mental health is flexible thinking. Practitioners spend a lot of time fostering in our clients a balance of healthy empiricism and risk-tolerant acceptance of the unknown. If the field of psychology doesn't admit pretty soon that the dynamics of pscyhological healing are at least somewhat unquantifiable -- while also unmistakable -- are we then practicing what we preach?

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