Psychotherapy as a Human Science

Clinical Postscript

284 Clinical Postscript Contemporary psychotherapy is often portrayed as an empirically based treatment technique practiced by professionals in a medical setting . According to this account, the patient has a discrete form of psychopathology , while the therapist is an expert with the requisite knowledge and skills to remove the patient’s symptoms as quickly and painlessly as possible. Yet the push toward “evidence-based” and standardized , highly scripted treatment protocols often obscures the fact that psychotherapy is not principally a matter of technique, but a special relationship between two unique human beings — one whose outcome is inherently unpredictable. Unfortunately, the medical model of psychotherapy overlooks human science therapies such as existential analysis, revisionist forms of psychoanalysis, and depth psychology, which are not easily quantified. The human science perspective rests on a philosophical foundation that enables practitioners to grasp, or at any rate to glimpse, what it means to be fully human, and to relate the concrete specificity of the patient’s complaints to a more comprehensive and encompassing view of human existence. Our reflections on psychotherapy as a human science have sought to provide the experienced practitioner, trainee, and interested reader with a theoretical foundation that is too often absent in today’s clinical milieu. We are not interested in displacing empirical forms of psychotherapy or psychopharmacology, both of which have made significant advances in the treatment of specific symptoms. Rather, we wish to demonstrate that the mastery of a particular technique or treatment approach is only half the story, and that a balanced approach to therapy needs theory as much as technique. Many clinicians practice today Clinical Postscript 285 without fully understanding the theoretical underpinnings of clinical practice, or the important theoretical controversies that affect their everyday work. Our aim has been to provide a history of the ideas that make up the human science perspective and to explain current controversies about clinical practice that are grounded in these complex and compelling theoretical differences. PART I:THE HUMAN SCIENCE PERSPECTIVE IN CLINICAL PRACTICE In this section, we will review some of the clinical implications raised by our exploration of philosophy and psychoanalysis. This overview will describe the main themes and controversies that encompass the field, but without providing detailed technical guidance.1 In our experience, having taught a wide spectrum of trainees and experienced therapists — from undergraduates and doctoral candidates in psychology to psychiatric residents and candidates in psychoanalysis — we have found that students actively seek knowledge beyond the boundaries of natural science. Although many of our students were trained within a medical model, and some have little or no prior exposure to the humanities in general or to philosophy in particular, there is often a desire to learn more about fields outside of medicine and empirical psychology. This intellectual curiosity has much to do with 1. There are a number of useful texts, only some of which we can describe here, that elaborate the dynamics at work in psychotherapy from a human science perspective . See, for example, Yalom 2002; Curtis and Hirsch 2003, 69–106 (this book contains a number of other useful chapters as well), Schneider 2003; and Ehrenberg 1992. Each of these sources provides clinical examples along with theoretical discussion. While there are many texts that explain specific therapeutic techniques , none can take the place of expert supervision. In our view, the practice of psychotherapy is best learned through intensive supervision and is aided by a personal “training” therapy so that therapists can understand the role of their individual psychology and the way it impacts their work. A personal therapy can also enable therapists to empathize with their patients about what it is like to experience therapy. In addition, useful theoretical guides to clinical practice from a human science perspective include Fiscalini (2005), Benjamin (1988), and Chodorow (1999). 286 Psychotherapy as a Human Science how the practice of psychotherapy is experienced by the clinician. Even if we view therapy in terms of manualized practice regimes, in which the various stages of the therapy are laid out with step-by-step instructions, nothing prepares the trainee or the experienced therapist for the vagaries of human interaction or their own reactions to the therapeutic experience. Therapists want to make sense of what they do, to find out what works, what does not, and, above all, why. They want to understand their patients’ experiences and to find out how to relate to...