The Writings of Ivor Browne: Steps along the road-the evolution of a slow learner

15. How Does Psychotherapy Work? Part I. The New Science Paradigm for Psychotherapy Theory

15. How Does Psychotherapy Work? Part I.The New Science Paradigm for Psychotherapy Theory IVOR W. BROWNE AND VINCENT KENNY 173 Vincent Kenny and I were asked by Dr Frederik F. Flach, MD, to write two papers on the way psychotherapy works for his ongoing Professional Development programme in New York entitled ‘Directions in Psychiatry’. The following two papers were published in the journal Directions in Psychiatry (vol. 5, lesson 3) in December 1984. Flach later included these two papers in a book he edited on the subject of psychotherapy. Editor’s Note IN this chapter and the following, the authors explore the question that recurrently haunts even the most experienced clinician: does psychotherapy really work? Do the hours, weeks and years we spend carrying out this modality really have a healing influence? The approach they take is not, however, statistical. Rather, they emphasize that many of the traditional methods in research may be simply inadequate to the task for confirming – or denying – the importance of psychotherapy. They divide scientific endeavour into past – dominated by Newtonian concepts that deal in measurable forces of cause and effect – and contemporary (and future), which began with Sadi Carnot’s formulation of the second law of thermodynamics , to the effect that any isolated physical system will proceed spontaneously in the direction of ever-increasing disorder. Darwin, de Chardin and Einstein continued the evolution of vision and thought that moved away from the idea of the material world being a comfortably ticking clock to be repaired when out of order to an indeterminate interweaving of interdependent interrelationships. Studies of psychotherapy following the Newtonian model have been singularly inconclusive. Some, such as those of Eysenck, suggest psychotherapy is totally ineffectual; others give the The Writings of Ivor Browne 174 appearance of proving the efficacy of one psychotherapeutic approach over all others; some suggest that every form of psychotherapy is equally effective. The authors offer a fresh, challenging view of psychotherapy and redefine the nature of psychotherapy as a way to help patients who are in psychological distress because their personal theory of reality has failed to reconstruct their view of the world and consequently help them reorganize themselves in a new and different way. The concept of open systems suggests an active principle emerging in matter characterized by change, instability and continual fluctuation; at bifurcation points fluctuations destabilize the current organization of the system, which may then disintegrate into chaos or suddenly reorganize itself into a higher level of organization. The purpose of psychotherapy is to facilitate a constructive outcome for such an event when the individual cannot do so on his own. Introduction To find the answer to the question ‘How does psychotherapy work?’ we must first ask another question: ‘Why, after more than half a century, do we not have an answer to the question ‘How does psychotherapy work?’ The answer to this question probably lies in the inappropriate application of Newtonian science to the area of human experience. Part I of this chapter explores the tacit assumptions and problems inherent in the old science and outlines the essential ingredients of the new science paradigm. Part II outlines the application of the new science outlook to psychotherapeutic practice and attempts to illustrate how psychotherapy works within this framework. We will begin with a brief historical review of the major conceptual landmarks on the way from Newtonian to systemic theory. Galileo (1564–1642) The scientific revolution began with Nicholas Copernicus, who first proposed that the earth was no longer the centre of the universe but merely one of a number of planets circling a star. This theory was published in 1543, the year of his death. The real change in scientific thinking, however, was ushered in by Galileo. He not only confirmed the work of Copernicus but for the first time combined scientific experimentation with the language of mathematics. Galileo stated How Does Psychotherapy Work? Part I 175 that science should restrict itself to studying the essential properties of material bodies: shapes, numbers and movement; i.e. that which can be measured and quantified. In doing this he was very aware that this did not represent all of reality and that the science he suggested did not deal with other aspects such as experience, quality or values. Nevertheless, the views he put forward represented the dominant features of science throughout the seventeenth century and...