Adam Blatner

Words and Images from the Mind of Adam Blatner

Perhaps Psychotherapy Cannot Be Evaluated Scientifically

Originally posted on March 30, 2014

Some aspects of psychotherapy might well be able to be scientifically assessed or validated, but many other aspects transcend this kind of assessment because these aspects are not specific, replicable techniques. Rather, they prepare the stage for clients possibly making some new synthesis, creative breakthrough, or other type of progress. If one approach doesn’t work, the therapist tries another. It may be the therapist’s own flexibility and willingness to grope that allows the client’s unconscious to find the courage to work out compromises.

Approaching it another way, speaking theoretically, while some knowledge works with systems at simpler levels where mechanical responses may apply, other types of far more complex systems (i.e., mind) require a far more subtle type of knowledge. This applies to the art, not the science, of psychotherapy. It develops cybernetic and contextual responses rather than specific techniques. In turn, these "therapeutic maneuvers" work in a far less obvious, less determined fashion. They make use of the unconscious mind’s inclinations, just like vaccines make use of the body’s tendencies to manufacture antibodies.

What I’m saying is that minds cannot be "made" to do didlly-squat. Minds don’t change that way, and thus no therapy always works to effect a certain change. In the simpler realm of physics, a force x in a certain direction y will move a box weighing z in a certain direction by such a distance. Mind is entirely different and more complex. We know that on the whole certain circumstances tend to help, but the operative word here is "tend" and it doesn’t work as planned every time. That’s because there are scores of intangible and un-measurable variables, such as what is important to a person now, which might be different from what was important five minutes ago.

My paradigm is what most parents have discovered. When medium-young children squabble, no outside judgment really works. Even if parents send the kids to their rooms to cool off, no real negotiations get worked out by the kids. They need to re-engage, the parts of them that want to get along and have a playmate on average overbalancing whatever they may have wanted when the squabble broke out and indeed, they may have forgotten what that was. They offer to sacrifice some trifle to them that the other might want more, and haggle a bit, and find a common meeting just like what happens in politics.

The point is that what they offer first, and concede second, cannot be anticipated by the wisest outside "judge." In therapy, this also applies. Some therapist judgment is required, but most often clients work it out. Unconsciously, they sacrifice what is less core to get what is more core, and this is negotiated and experienced in the mind, in the moment. It’s as if parts of the mind-soul are negotiating. No outside psychiatrist or judge, however wise, could anticipate exactly what those concessions might involve! Nor could any outside figure weigh accurately which concession is "ripe" to give a way. Indeed, even the people themselves couldn’t tell at the outset of the negotiation what they will want more and hold on to less. These operations unfold in time, in the course of interaction.

In psychotherapy, part of the creative process is this approach-avoidance keep-give-away process on a micro-level: One gets used to a distasteful idea this way, with many micro-adjustments. One becomes ready to take a risk, the forces of courage negotiating unconsciously with the forces of fear, the forces of wanting something new negotiating with wanting to stay with the familiar.

Examining these micro-negotiations, they in turn involve so many subtle shifts in valuing that it must be recognized that this all is an unconscious process, at least to a considerable extent; the process consists of many variables sorting themselves out; and the point is that no outside conscious judge could anticipate how this process will proceed. The very general term "creativity" may well be suffused with such ambiguities. For many, it’s a bit of a mystery. It feels at times as inspiration that is, as if a spirit comes in and through, that it’s not born of the ego. My point here is that without yet claiming to explain it, I am willing to say that creativity is quite complex and subtle, and perhaps has many micro-components.

So if psychotherapy releases creativity or draws upon creativity, I don’t claim to know what all that’s about. It’s a general category that remains somewhat mysterious. What we can do, though, is to generate the circumstances wherein creativity thrives, and it’s becoming clear that we do now know certain circumstances that work better than others: Create a context not suffused with fear, and offer enough richness and/or variety so that people can kindle and then follow their natural instincts towards attaining competence, deepening interests, showing off a bit, and so forth. Extend this "Montessori" type educational model to a more multi-modal type of embodied learning and healing, a mode that is utilized in the creative arts therapies in general.

In other words, give  ‘em enough to work with, encouragement, occasional guidance in a general way, a context of safety, a bit of play, be a bit of a cheerleader, a fitness trainer, a bit of a pathfinder, one who has tried some options and hit dead ends, and beyond that someone who seems older and wiser and who is liked, what one wants to become like—all these role components serve as a catalyst.

Note, though, that this is far from objective science. We don’t know what precise recipe, what exact combination of elements will work for anyone not even ourselves! We sort of muddle along, and this is indeed necessary. We recognize now more than ever than circumstances themselves are changing, and adaptations to a fixed reality become creative adaptations to a changing reality.

All this is by way of renouncing the possibility of ever formulating a guaranteed therapy method for anyone who is not a machine, a robot. People have minds and minds are another level or two more complex and subtle than anything that can be prescribed in a manual.

Science, therefore, empirical science, generates observations and rules that can be replicated. It speaks to a vast range of phenomena, but however complex they may be, they pale in light of another level of complexity of socio-emotional-cognitive-psychological processes, processes that operate at a level of complexity that are vastly greater than the ordinary realm that science can assess.  Thoughts?

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