“Back to the Future”: Historical, Cross-Cultural, and

Contemporary Issues.Lecture #1 – 9/24/07

Tyler Carpenter/Charles Ducey

Definitions

• Theory: • archaic – “imaginative contemplation of reality”

(Merriam-Webster)• “A …procedure proposed or followed as the

basis of action.”• “The body of generalizations and principles

developed in association with practice in a field or activity and forming its content as an intellectual discipline: pure as distinguished from applied art or science.”

Definitions con’d.

• “Psychotherapy is…the informed and planful application of techniques derived from established psychological principles, by persons qualified through training and experience to understand these principles and to apply these techniques with the intention of assisting individuals to modify such personal characteristics as feelings, values, attitudes and behaviors which are judged (by the therapist) to be maladaptive or maladjusted. (p.4)”

• - from Meltzoff and Kornreich (1970) in Ch. 1 of Gurman and Messer (2003) (p. 4)

Definitions con’d.

• “Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principals for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.”

- Prochaska and Norcross (2007) p. 25

Questions

• What does a theory do? - Structures experience (+ makes sense, brings

coherence and order, when to do what; - may foreclose or derail, obscure what may otherwise reveal itself);

- Allows for transmission of learning (+ manuals and skills; - manuals and instrumental skills);

- Is heuristic (generates hypotheses and the opportunity for evaluation and improvement);

- Provides a basis for integrating related fields of knowledge (biopsychosocialenvironmental model)

History: Procedure, and Process

• “Those who cannot remember the past are doomed to repeat it.”

• “Sanity is a madness put to good use.”• “Science is nothing but developed

perception, interpreted intent, common sense rounded out and minutely articulated.”- George Santayana (Spanish Philosopher, Harvard Class of 1886)

History con’d.

• “What occurs during a scientific revolution is not fully reducible to a reinterpretation of individual and stable data.”

- Thomas S. Kuhn (author of “The Structure of Scientific Revolutions.”,1970)

History con’d. – “Roots”

• How did/do humans see and understand their relationship to themselves, others, and the universe?

• How is suffering and unusual behavior understood in the context of the tribal group and during the evolution of an increasingly differentiated society over time?

• Given a culturally embedded model of cause and effect, who mediates and puts into practice sanctioned rituals/techniques of healing the ruptures in individual and group behavior?

• How does this process change over time?

History/Roots con’d.

• Culture is a dynamic context in which knowledge interacts with individual and group behavior to produce bodies of knowledge, values/mores, increasingly differentiated social roles, and concomitant institutions that mediate individual and social behavior.

• The science, art, and practice of psychotherapy reflects the interaction of these variables in recursive feedback/feed forward loops over time.

• The form that psychotherapy takes is mediated by the evolving and interacting forces of religion, medicine, economics, and the need for social coherence and meaningful adaptive functioning by a society and its constituent members.

History/”Roots” con’d.

• Consciousness evolved from the breakdown of the bicameral mind, in which a human being experienced him/herself as directed and influenced by spirits and forces outside their control, to one in which there was a gradual understanding of personal boundaries and forces both within and outside of oneself.

- from Julian Jaynes (1976) “The Origin of Consciousness in the Breakdown of the Bicameral Mind.”

History/”Roots” con’d.: Pre-modern

• Examples: Eastern• Buddhism and the 4 Noble Truths: The source of

suffering is attachment and release from the cycle is found in the 8-Fold Path.

• Confucius: The role of duty and correct behavior in developing moral citizens and maintaining a virtuous social structure and society.

• Taoism: The chaotic harmony and indissoluble unity of Nature.

History/”Roots” con’d. Pre-modern

• Examples: The Evolution of Suggestion (Western) – C. Ducey (1988)

• Defined as, ”…the process of inducing thought or action without resorting to techniques of persuasion or giving rise to reflection in such a way as to produce uncritical response.” Urdang (1968) p. 1314 in Ducey (1988).

• Ubiquitous and has evolutionary value (biological basis)• General – supply what is missing • Freudian – unexamined and accepted as arising

spontaneously

Theories of Suggestion• Prior to 19th Century: Little distinction between interpersonal influence and other forms

of influence (Note: part of the nature of knowledge growth toward more informed complexity);

• Mesmer and “animal magnetism”: A process by which it was thought that a “…universal and invisible magnetic fluid flow(ed) from the magnetizer to the subject so as to revitalize the subject’s nerves.”

- Mesmer invoked rapport as a factor and a 1774 Royal Commission noted an erotic component.

- roots of concepts of transference and symbiosis.* Psychological concepts of attention, concentration, personality traits, desire,

imagination, and “double consciousness” invoked by Bertrand and Braid.• Conflict between the Nancy School (Liebeault and Bernheim) who suggested that

suggestibility was a normal dimensional trait that was the natural outgrowth of the ability to transform thoughts into actions and to inhibit them through self observation. VS. Charcot who distinguished between normal and pathological (symptomatic) suggestibility.

• Wundt suggested (downgrading role of rapport) that associationist theory suggested that there was a complementary relationship between the brain’s capacity increase sensitivity to some stimuli and decrease sensitivity to other stimuli.

Suggestion con’d.• Janet (augmented by Prince and Sidis): We have multiple

subconscious selves and that suggestibility varies as a function of the disaggregation (pathological) vs. the unification of consciousness as mediated by therapeutic suggestion.

• Psychoanalytic Theory: Freud translated Bernheim’s books and extended the therapeutic application of hypnosis. His understanding of the role of suggestion was more complex and integrated than his predecessors or followers.

- Patient’s confidence and affection for healer (interpersonal) and activation of attention, affect and volition in patient’s experience (intra-subjective) integrated the previously separated notions of physical and social variables in earlier theories of suggestibility and hypnosis.

- Freud added that it was the erotic (Eros) element that binds together individuals in groups and provides the template which is imposed on the reality of relationships.

Suggestion con’d.

• Modern Psychological Research: - Social Learning: Selective reinforcement of subject(s) behavior

(performance); reinforcers can be subtle. - Cognitive Theories: The operator can supply information that alters

meaning and structure of subject(s) experience and thus affect his/her affective and motivational state; knowledge of subject history enhances the ability of the operator to accomplish this outcome.

- Therapist thus gains power to the extent to which they can bring clarity and direction to amorphous and disagreeable states of being.

- Social-Psychological research on “Persuader” attributes (rhetorical questions, repetition, one vs. two-sided questions given based on persuadibility of the subject) increase the potency of the message; “Characteristics of the communication” ( moderate affective arousal) and extent to which the subject improvises or resists (complementary – strengthens effect) mediate the strength of the process; Recipient(s) characteristics (evaluation apprehension and locus of control – anxious resist and external comply.

An Outline for Comparing Psychotherapeutic Systems

• Gurman and Messer (2003)• Historical Background: What is the historical context of

an approach? - Major influences (constituent elements such as books,

people, research, theory, conferences); and, Zeitgeist (spirit of the age)/sociohistorical forces that shaped the emergence and development of the approach.

- Therapeutic forerunners; - Types of patients; - Early theoretical speculations and therapy techniques.

Outline for Comparisons con’d.

• The Concept of Personality: Describe the concept of the person within the therapeutic framework.

- Is there a meaningful concept of “personality” or is there an aggregation of constituent psychological and/or physical units?

- “What are the basic psychological concepts used to understand the patient?”

- How is the concept of the person thought to develop?

Outline for Comparisons con’d.

• Psychological Health and Pathology: How is this dimensional continuum understood within the therapeutic framework?

Outline for Comparisons con’d.

• The Process of Clinical Assessment: How is the individual’s pattern of adaptive and maladaptive symptoms and interactions assessed?

Outline for Comparisons con’d.

• The Practice of the Therapy: How is the goal of treatment actualized in the structure, strategies, and process of the therapeutic approach?

Outline for Comparisons con’d.

• The Therapeutic Relationship and the Stance of the Therapist: How does the therapist relate to the patient and what is the role of this relationship in providing a context for change?

Outline for Comparisons con’d.

• Curative Factors or Mechanisms of Change: What are the factors/change mechanisms and the data for their empirical basis?

Outline for Comparisons con’d.

• Treatment Applicability and Ethical Considerations: What is the patient population for whom the approach is most efficacious and are there special ethical issues that are relevant?

Outline for Comparisons con’d.

• Research Support:

Outline for Comparisons con’d.

• Case Illustrations:

Outline for Comparisons con’d.

• Current and Future Trends:

Common Factors: The Core of Psychotherapy (P&N)

• The ‘Dodo Bird verdict’ from “Alice in Wonderland”, mentioned by Rosenzweig in 1936 and reprised in Luborsky’s famous paper,”Everyone has won and all must have prizes.”:

• Positive Expectations;• Therapeutic Relationship;• Hawthorne Effect;• Other Common Factors – - Jerome Frank (1961); Frank & Frank (1991): All methods are

elaborations on age-old therapeutic procedures that are aimed at the restoration of morale (e.g., an emotionally charged and confidential relationship, a healing setting, a conceptual scheme, a ritual) and include an official healer with a nurturing personality, opportunity for emotional expression, learning new behaviors and exploring one’s inner world, suggestion and interpersonal learning. Note, Garfield lists a similar set of factors.

Specific Factors

• Unique to the Different Therapies

Processes of Change (P&N-5Cs)

• Consciousness Raising

• Catharsis

• Choosing

• Conditional Stimuli

• Contingency Control

Initial Integration and Therapeutic Content (P&N)

• Intrapersonal

• Interpersonal

• Individuo-social Conflicts

• Beyond Conflict to Fulfillment

Study Questions

• In Dr. Ducey’s article on the history of suggestion, he traces the evolution of the understanding of this core psychotherapeutic concept over time and through historical epochs.

- What does this tell us about the forces and processes that give rise to psychotherapeutic systems?

- Give several important changes in the evolution of the understanding of the concept of suggestion and how these understandings were embedded in the context and forces of their times.

Study Questions con’d.

• Give Gurman and Messer’s Outline for Comparing Theories of Psychotherapy and Explain It’s Utility.

• How does Norcross and Prochaska’s Concepts of Core Common Factors and a Trans-theoretical Framework differ from and complement Gurman and Messer’s Outline?

The Prison as a Model Paradigm for Comparisons

• Purposes:

• Clients:

• Contributing Forces:

• Concrete Realization:

• Concept in Process Over Time:

• Feedback Loop