INDIVIDUAL THERAPYSSIT3112015LECTURER: GARETH MITCHELL

THEORY IS A GOOD THING?

Chapter 1

Individual Therapy IIISSIT3112015

INTRODUCTION

A fundamental aspect of psychotherapeutic practice is the use of theory to inform the manner in which the therapist works with the client.

Are psychological theories objective “truths” or tools for understanding?

This raises the debate between a objectivist/positivist standpoint versus social constructionist viewpoint of theory.

Objectivism proposes that theories reflect ultimate truths about the way in which the world operates. So for Freud, the unconscious is an objective truth. And for the behaviourists, learning through reinforcement is an objective truth.

For those practitioners who subscribe to a social constructionist viewpoint, theory is a set of conceptual tools that allow the theory user to make connections between different observations, gain understanding and insight, communicate with others and plan actions.

Social constructionism is not interested in whether a particular theory is true or not, but rather whether the theory works in a particular context, or not.

The distinction between a positivist approach to theory and a social constructionist approach is important to acknowledge as it has everything to do with the kind(s) of theories you might be drawn to.

WHAT IS A THEORY?

Theory as a Structured Set of Ideas  A theory is a set of ideas or concepts used to make sense of

some dimension of reality.

It is different from everyday, common-sense ideas:

Stated formally

Clearly defined terms

Tested/critically evaluated

Consistent with other scientific ideas 

Theory as a set of Social Practices  Theories are created within and are sustained by members of a

particular community / society seeking to understand a particular behaviour.

Therefore in order to understand a particular theory, one needs to immerse oneself in the community within which the theory developed.

It is now recognised that even the physical sciences, and not only the social sciences, are influenced by social factors. In other words scientific theories are created by scientific communities.

Thus, by subscribing to a particular psychotherapeutic theory, you are also becoming a member of the psychotherapeutic community that sustains that theory.

The process of sustaining a particular theory is carried out by the use of:

Specific institutions, e.g. International Psycho-Analytic Association,

Association for Behavioural and Cognitive Therapies or the British Association for the Person Centred Approach.

Specific oral tradition – teaching and training psychotherapists within a particular theoretical approach is undertaken through a process of passing down knowledge from supervisors to supervisees or a therapist experiencing therapy themselves.

Specific language (jargon).

Theories can be used as tools of power and oppression – e.g. if the dominant theory regarding normal psychosexual development pathologises homosexuality, this then marginalises and silences those individuals who are homosexual.

The purpose of theory: Explanation versus Understanding

Explanation:

Theory is used within the positivist / scientific tradition to explain events or behaviours.

It does this by specifying a single set of causal

factors responsible for the event and then predicting the outcome of future events.

This refers to an automatic / mechanistic process, with no allowance for human will or choice.

Understanding:

Theory is used within the social sciences as a means of understanding events or behaviour.

A theoretical understanding provides a nuanced appreciation of the multiple elements that could feasibly have contributed to the event.

It can never provide certain predictions, but does allow for anticipation of possibilities.

Theory-as-understanding opens out the possible reasons why something might have happened.

Trying to understand the reasons for why something happened the way it did allows for human intentionality and purpose.

WHY DO WE NEED THEORY?

Provides order in the face of chaos:

Client’s often provide the therapist with incoherent and contradictory ideas, perceptions, identities, information, etc.

At times of feeling lost, stuck or hopeless, a theoretical framework can be used as a means to begin to structure and understand what is happening.

At difficult moments, theory gives a psychotherapist a basis for reflecting on experience, and a language for sharing that experience with others (e.g. colleagues or a supervisor) and thus gaining support and guidance.

Offers client a way of making sense:

Modern theories of psychotherapy have begun to suggest the value of teaching or educating clients about theory as a means of allowing them to make sense of their own difficulties.

Transactional Analysis (TA) and Cognitive-Behavioural Therapy (CBT) are two such therapeutic theories.

Both these therapeutic approaches have produced many self-help books which teach lay people theory.

Many CBT therapists claim that the best evidence of whether a client has benefited from therapy is whether they can quote theory back to the therapist and explain how they apply it in their everyday life.

 

Secures professional status:

One of the characteristics of professions such as Law or Medicine (as opposed to less formally established occupations) is that they can claim privileged access to a specialist body of theory and knowledge.

Assists in case formulation:

One of the early tasks for all psychotherapists when they first start working with a client is to arrive at an overall formulation of the case.

A formulation usually comprises a set of hypotheses that make potential connections between:

the immediate problems of the client the underlying factors and processes responsible for

the problems (and help to maintain it) the factors in the client’s life that might facilitate or

impede the therapy the psychotherapeutic interventions that might be

used in working to resolve the client’s problems.

A useful formulation is one which employs theory as a means of making these links – a case formulation that does not incorporate a theoretical understanding ends up being no more than a list of presenting problems.

Helps create knowledge communities:

Theory plays an invaluable role in enabling psychotherapists to communicate with each other.

It is through a web of language and concepts that psychotherapists remain in contact with a collective community of practice.

It is through belonging to such a community that the work of individual practitioners can be sustained and supported.

THE MOVE TOWARDS THEORETICAL INTEGRATION

Since 1980’s there has been a rapid move towards theoretical integration and /or eclecticism.

Across several studies it was shown that 30 - 50% of therapists describe their approach to working with clients as either eclectic or integrative.

Eclecticism

Selection of techniques from different approaches in interests of client.

Eclecticism is a highly pragmatic approach to therapy, which concentrates on ‘what works’ in practice rather than bothering to any great extent about the underlying images of the person or systems of theoretical constructs.

Integrationism

Combine different theories into new theory

The underlying unity of theories

Since the birth of psychotherapy many theorists have pointed out the significant similarities across various theories of psychotherapy as opposed to their many differences.

Frank (1973; 1993) has been one of the most influential writers in the field of the underlying unity of psychotherapeutic theories.

Frank argued that the effectiveness of therapy is not primarily due to the employment of specific therapeutic strategies (such as free association or systematic desensitization), but rather is attributable to the operation of a number of general or “non-specific” factors.

The key non-specific factors of psychotherapeutic effectiveness:

The creation of a supportive relationship

Provision of a rationale for making sense of problems

Instillation of hope

The expression of emotion

Participation of both client and patient in healing rituals

Frank suggested that although these non-specific factors are delivered in different ways by different psychotherapeutic approaches, they all function as a means of increasing the client’s sense of mastery over the inner and outer forces causing their problems.

This is achieved through labeling these forces and problems and placing them within a theoretical framework, as well as providing experiences in which the client overcomes these problems.

Evidence for the non-specific factors hypothesis:

Outcome research – research of differing psychotherapeutic models have reported similar success rates.

Non-professional counsellors (who have not received the same level and depth of training as professional psychotherapists) have been shown to be as effective in assisting clients.

In studies of what client’s find most helpful about psychotherapy, the client’s always rate non-specific factors more highly than the techniques specific to the therapeutic model they were treated within.

CHOOSING A THEORY

Pick and choose – eclectic?

Select specific theory according to the therapist’s or the client’s needs?

Integrate?  “There are many ways and means of practicing

psychotherapy. All that lead to recovery are good”Sigmund Freud

Questions to consider:

Therapist fit – personality, values, social / historical context, exposure to theory.

Client fit – well-being of the patient.

Is suffering alleviated?

How quickly, how completely and how enduringly?

Any negative consequences?

Secondary criteria – time, effort, cost.