My Perspective on Psychotherapy Integration: An Outsider Who's Out of It

My rejoinder is a response to two commentaries on my SEPI keynote in 1997: commentaries written by Goldfried and Cullari. Instead of grappling with the ideas I presented, both respondents were distracted by my satirical beginning. In my talk I proposed a method for studying psychotherapy integration. I am not pessimistic about the potential for integration, nor am I pessimistic about psychotherapy. But I am a skeptic, and science is driven—and indeed advance—by skepticism. In fact, psychotherapy integration requires that its advocates be skeptics. I still do not know what psychotherapy integration is, and remain confused. I can only conclude that I am not only an outsider, but out of it.     

Believing in Make-Believe: Looking at Theater as a Metaphor for Psychotherapy

In this essay, I explore the theatrical dimensions of psychotherapy. I argue that many of the historical, practice-related, and conceptual connections between theater and therapy often are only alluded to in the literature, but rarely made explicit. In doing so, however, it seems apparent that, as a metaphor for psychotherapy, theater perhaps offers a more appropriate fit than those narrative and conversational metaphors that have been employed so far. Proposing that theater is, in fact, the metaphor on which psychotherapy bases itself, I briefly examine some of its implications for how therapy might be conceptualized and performed. I conclude by inviting other therapists to consider — by openly acknowledging theater as a metaphor for psychotherapy — if they might then become more engaging, creative, and imaginative in their work.     

Is the Impact of Psychotherapy Processes on Outcomes Already Quacking and Waddling? Comment “A Primer on Psychotherapy Process Research (Pfeifer & Strunk, 2015)”

The article by Pfeifer and Strunk on psychotherapy process research offers a highly thoughtful review on the state of psychotherapy process research in cognitive therapy for depression, and the inherent challenges in establishing causal relationships between process and outcomes. In this commentary, I argue that the goal of internal validity in psychotherapy process research may be unattainable, and possibly unnecessary. Finally, I suggest that psychotherapy process research should shift from “does it affect change?” to “how does it affect change?”, “when does it affect change?”, and “for whom does it affect change?”     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

How My Theory and Practice of Psychotherapy Has Influenced and Changed Other Psychotherapies

In this article I address three main questions: (a) how psychotherapy has changed the modern world of psychology, (b) how it has changed the modern world in general, and (c) how my special form of psychotherapy, rational emotive behavior therapy, and its derivative, cognitive behavior therapy, have changed the recent theory and practice of psychotherapy.     

Research and the organization of knowledge: where do psychotherapy and counselling fit in?

In order to clarify the place of research in psychotherapy and counselling, I look at the interrelationship of two ‘organizations of knowledge’. Organization can represent a process or an institution. My thesis is that there are particular characteristics of psychotherapy and counselling, considered as an intellectual discipline, that mean it organizes knowledge in peculiar ways that are reflected in the difficulty of reconciling them within the organization of the modern university. I shall propose that a different conception of research, based upon a third ‘organization of knowledge’, is necessary to resolve these tensions. Once psychotherapy/counselling finds more cohesion as a discipline, it is more likely to establish an independent niche within the university.     

Relationality and Existence: Hermeneutic and Deconstructive Approaches Emerging From Heidegger's Philosophy

In this article I discuss the concept of relationality from a philosophical perspective. I focus, in particular, on the philosophy of Martin Heidegger, exploring how his relational concepts of worldhood, being-with, solicitude, and Befindlichkeit were central to his early philosophy, before he extended his ideas and related them to psychotherapy in his later work. I then proceed to focus on the work of other philosophers, influenced by Heidegger, who developed and extended his relational ideas further. In particular, I discuss Hans Georg Gadamer's notions of Horizon and Dialogue, Paul Ricouer's notion of Dialectics with Otherness, and the writings of Emmanuel Levinas and Jacques Derrida concerning Otherness, Difference, and Ethics. I develop this philosophical discussion as a foundation for further consideration of the relevance of relational ideas in philosophy to the domains of developmental psychopathology and clinical approaches in the field of psychotherapy.     

Can Psychotherapy Research Serve as a Guide for Research About Executive Coaching? An Agenda for the Next Decade

Although there are important differences between psychotherapy and executive coaching, both seek to bring about behavior change and both involve a relationship between a professional (e.g., therapist, coach) and a client (e.g., patient, executive). Numerous meta-analyses conducted over the past 30 years have established the efficacy of psychotherapy, but research on the efficacy of executive coaching is scarce at best. Based on a review of meta-analyses of psychotherapy, I present eight questions to guide research concerning executive coaching. For each question, I present the results of psychotherapy meta-analyses and discuss the implications for executive coaching research and practice. The voluminous history of psychotherapy research points to important questions and methodological issues that should guide future research about the impact and practice of executive coaching.     

Psychotherapy with compulsively striving professional women 2: Clinical issues

In a previous paper I described the common characteristics of seventeen women between the ages of 22 and 42 with whom I had worked over the past few years in private psychotherapy practice, and who, I suggest, constitute a specific patient group, which I call ‘compulsively striving professional women’. I went on to explore the developmental, theoretical, cultural and systemic context of this group. In this paper I consider the challenging clinical issues raised in working with them.     

How can psychotherapists influence psychiatry?

Summary

This paper is based on an invited contribution to the first APP conference on psychoanalytic psychotherapy services in Europe. I was asked to address the question “How can psychotherapists influence psychiatry?” within the overall title for the half-day session of “Psychiatry and Psychodynamics: Towards integration or splitting”. As a background to later discussion I began with a historical sketch of how we had arrived at the current situation in the UK with a specialty of psychotherapy, both separate from and yet still within psychiatry. I argued the need for a separate specialty to protect the space needed for psychotherapy in the face of the inevitable polarisations that occur within psychiatry. Some of the tensions between the different points of view are likened to those between masculine and feminine roles. This specialty might eventually emerge into or foster a new profession of psychotherapy but will still need to negotiate its position in relation to psychiatry.     

The place of once-weekly treatment in the work of an analytically trained child psychotherapist

In this paper, I explore how we might link ideas about clinical facts to current issues in child psychotherapy research. I consider what our understanding of clinical facts might contribute to our research methods and how our research methods might better represent the clinical facts. The paper introduces a selection of psychoanalytic writers' formulations of the concept and describes some of the debates about the shortcomings of the traditional style of case reporting. The importance of keeping emotional experience central in our research is discussed. I describe a research method that I believe has the potential to capture and describe some of the complicated processes of change in psychotherapy. This is the concept of the ‘turning point’ session. Introducing the paradigm of complexity theory, I briefly explore how we might think about and understand the relationship between processes revealed through detailed analysis of a single session and change over a longer period of therapy.     

Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.     

Data Analytic Advances That Bridge the Scientist-Practitioner Gap

In this commentary, I advance the view that the scientist-practitioner gap is partly due to the research designs commonly used in psychotherapy research. Specifically, I believe that randomized controlled trials, which are important for establishing treatment efficacy and as leverage when making the case for the value of psychotherapy in relation to various stakeholders, are limited for further development of clinical theories. Instead, I find recent advances in cross-lagged panel modeling to be both clinically intuitive and stronger for causal inference than most other nonexperimental designs. In addition to discussing causal inference and clinical interpretation of cross-lagged panel models, I discuss the potential of improving mediation analysis, personalization of research, and studying issues of clinical timing. Finally, I briefly discuss some limitations of cross-lagged panel models. It is my belief that the use of these data analytic advances can make empirical research better live up to the innovations in Beck’s work.     

Reflection on My 32 Years with Albert Ellis

In this article, I reflect on what I believe are Albert Ellis’ important contributions to the field of psychotherapy. Having worked closely with Albert Ellis for 32 years, I offer my opinions on some misconceptions of Albert Ellis.     

Rorschach assessment of changes following psychotherapy: a meta-analytic review

I examined Rorschach assessment of personality changes following psychotherapy. I conducted a comprehensive literature search to find all studies using the Rorschach method at least twice for the same participant in connection with psychotherapy. I conducted meta-analyses for 38 samples, and I performed regression analyses to identify moderating factors. Across all Rorschach scores, the total weighted sample effect size was r = .26, and nearly half the variables obtained effect sizes higher than .30. Several moderating factors were found. Most important, effect sizes increased with longer and more intensive therapy. More concern for interscorer reliability was associated with larger effect sizes, whereas a higher degree of scorer blinding was associated with smaller effect size magnitudes. Predicted levels of change based on the regression models indicated substantial increases in effect size with longer therapies. The data indicate that many elements in the Rorschach are valid indicators of change despite the poor reputation the method has acquired within psychotherapy research.     

REBT: Past,Present and Future

In this article, I reflect on what I believe are Albert Ellis’ important contributions to the field of psychotherapy. Having worked closely with Albert Ellis for 32 years, I offer my opinions on some misconceptions of Albert Ellis.     

The barbarism of reflection: A Vichian perspective on the nuclear arms race

Abstract

This article explores how the I—Thou relation described by Martin Buber can be important in the therapeutic effect of psychotherapy relationships. It also discusses the characteristics that Buber viewed as essential to interhuman encounter, both as helpful aspects of a psychotherapy relationship in themselves and as guidelines for increasing the likelihood of the occurrence of I—Thou relations.