In following up on the previous post I wrote about research based diagnostic and therapeutic tools and its “One size fits all” pitfall, I will like to further elaborate on what I think is a scientific approach to psychotherapy that is not solely Research based. I capitalized the first letter in Research because I am using it in the term often associated and defined by how it is used in mainstream academia. However, I do believe that every psychotherapist is a researcher on a micro level when working one-to-one with the client. Clinical assessment is really an investigative tool and research into the client’s psychosocial and developmental history, symptomatology, etiology of the mental health issues or disorders, motivation for change and resiliency or personal strengths. Herein lies what I perceive as the true science and art of psychotherapy.
Here is the definition of science I found on Dictionary.com:
There is science in applied psychotherapy. But before I begin to explore this concept, let me explain my seemingly redundant usage of words “applied psychotherapy”. Psychotherapy is a practice so it is implicit that it is an application. However, I do this redudancy to differentiate between the psychotherapeutic practices and theories that are formulated and conducted by practitioners versus those that are conceptualized and prescribed by academic researchers, which I would consider somewhat “laboratory” or “academic” psychotherapy. This is not to say theories and research is not important. It is quite the contrary. A good psychotherapist has a strong basis in understanding client’s problems through systemically conceptualized theories. Otherwise, there will be much unreliability or invalidity in formulating the framework for problem-solving of the client’s issues.
Where the science is in applied psychotherapy is that it has been observed, investigated, studied, analyzed for accuracy and relevancy for each client against an established body of knowledge, and then experimented to validate the concepts within the therapeutic context with the client in question. Of course, all this is also done in Research based studies of diagnosis and psychotherapeutic techniques. But as I mentioned in my previous post, Research has often been limited and simplified, and thus not reflecting the true quality of the nature of mental health issues and the complexity of the person’s reality. Also, much of the Research subjects are biased against or toward certain demographics, thus cannot be fully universal. Yet often such Research is taken as universal and applied to a more complex context than initially researched upon, and then used as a standard with unique individuals who will not fit perfectly into the generalized sterile observations of Research studies. Hence, its usability has to be critically scrutinized before we can be certain that it would be accurate for each individual person that walks into the therapy room. This leaves the practicing psychotherapist to become his or her own researcher in the room.
The therapist will, through assessments and interventions, analyze the information reported by the client, and use the theories and Research available in the field, as well as the therapist’s own observations, studies, and investigations, to hypothesize the nature of the client’s problems and his or her realities. From this hypothesis, the therapist then can carefully and sensitively experiment with different therapeutic techniques to further validate or disprove the hypothesis, and in the process, facilitate change with the client.
The therapist has to be an active listener to receive feedback, whether explicit or not, by the client to review and revise the working hypothesis and its associated interventions. This requires the therapist to listen attentively, and to see and understand the client as a whole and real person. It also means the therapist has to be humble and be open to change his or her conceptualizations accordingly, instead of holding on to a theory or technique as the ultimate authority. It is the client that has the authority to inform the therapist the course of the therapy, not some abstract ideas that might or might not apply to the individual in the room with the therapist. The tools, such as theories, diagnostic categories, and techniques, should be used as what they are – just tools. It is good for a therapist to be well-versed in as many tools as possible, and have access to as many tools as possible, so that the most suitable one can be applied with the client when appropriate. This is client-centered approach in its essence.
One more tool, which I believe is inherent in all of this, is the psychotherapist him or herself. It is, after all, the therapist who will be the scientist observing, investigating with the senses and experiential knowledge, and integrating the other bodies of knowledge, to conceptualize and assist the client with finding new ways to move through the difficulties the client is facing. It is the therapist who empathizes with the client, using his or her heart and compassion. The therapist as a tool has to be properly trained and appropriately accommodated for the client’s well being. It is a creative joint endeavor between therapist and client to transform pain into resiliency and growth. How all this is done is truly an art form as it is a refinement of skills and sensibilities, with a foundation in the science of applied psychotherapy.