CAUTION: This email originated from outside of JMU. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Fascinating thread, Everyone. Gregg, we agree. It’s all made up;-)
Warmly, always,Tyler
James Tyler Carpenter, PhD, FAACP
From: theory of knowledge society discussion <[log in to unmask]> on behalf of Henriques, Gregg - henriqgx <[log in to unmask]>
Sent: Thursday, April 14, 2022 12:50:00 PM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: TOK RE: Common Core of Psychotherapy/Entrenched Maladaptive Patterns########################################################Stephen,
I DO NOT think that we should consider Western psychotherapy to be currently scientific in a paradigmatic or ontological sense. And thus I agree that a better frame to understand its totality is constructionist. And so there is much that you and I agree on.
At the same time, this is precisely what UTOK is about. The basic issue from a UTOK perspective is that we have not solved the ontology of the mental or of human persons. And that we now can. And that is a game changer going forward. And the argument is not empirical, but grounded in logos.
I support many facets of your vision and your argument and believe it is a wakeup call that SEPI should listen to. But I also think that the fact that the problem of psychology could not be solved but now can be solved ontologically is a game changer. And so, clearly, that is where I am going to be placing my efforts. But I do believe yours is an important voice that should be wrestled with. But I did decide to orient SEPI for my Presidency in a different direction.
May be we should have a special UTOK conversation about this?
Best,
Gregg
From: theory of knowledge society discussion <[log in to unmask]> On Behalf Of Stephen Bacon
Sent: Thursday, April 14, 2022 11:16 AM
To: [log in to unmask]
Subject: Re: TOK RE: Common Core of Psychotherapy/Entrenched Maladaptive Patterns
CAUTION: This email originated from outside of JMU. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Hi Greg,
I appreciated your response and understand how your other priorities forced its brevity. However, given the imminence of the SEPI conference, I thought it appropriate to continue our dialog.
One of the key points in your response is that we need to be careful not to draw too many conclusions from the research findings about techniques lacking inherent power and our privileged knowledge failing to enhance outcomes. If these findings were actually isolated and standing on their own, I would agree that we should take care not to stretch them too far, but in actuality they are reinforcing factors tightly woven into an overarching theory—a theory that points in a significantly different direction than the theories pursued by psychotherapy in general or SEPI in particular.
In my first posting, I refer to Berger and Luckmann’s cross-cultural analysis of mental heath practices and note that they see western psychotherapy as one practice among many and believe that all of these practices are constructed. Western psychologists by and large agree with this analysis with one exception: they believe that other culture’s models are constructed but argue that our western one is not given that it is based on science. And certainly, small parts of our mental health model are scientific and based in fundamental reality; for example, clients with low thyroid get depressed and the depression can be ameliorated with thyroid supplements.
But psychotherapy is a different matter. And given this presupposition about science, it is incumbent on western psychologists to refute the Berger/Luckmann social constructionism hypothesis by advancing compelling arguments showing that western psychotherapy is indeed different. Instead, we get instance after instance supporting the constructionist perspective. For example, the dodo bird hypothesis, showing that systems with radically different underlying theories and interventions still get equivalent, positive results is a huge argument for constructionism and the importance of expectancies and beliefs. The fact that something as absurd as eye-movements has a prominent place in the treatment for PTSD certainly suggests that we have little superiority to shamanic interventions with crystals and chanting. And what about Donald Spense and his argument that clients improve equivalently whether they are resolving false memories or accurate memories. Finally, Scott Miller has documented that there have been no evolutionary improvements in the effectiveness of psychotherapy over the past 40 years; the effect sizes from psychotherapy are equal at the beginning and end of that period. I could go on and on with other examples that demonstrate that the kind of evolution we expect to see from a science-based professional discipline simply isn’t happening with psychotherapy.
And, yes, the biggest argument that our mental health model is as constructed as the ones from other cultures comes from the fact that we have been unable to develop techniques with inherent power and our privileged knowledge fails to correlate with outcomes. These are glaring findings. They don’t stand on their own. What they do is endorse the social constructionist theory of psychotherapy. Human suffering is real but our symptoms, explanations, and interventions are constructed.
What this means for SEPI is that the path to psychotherapy integration must begin with the concept that our approach to mental health is as constructed as other cultures. Indeed, it is the possibility that we have the capacity to become self-aware of this constructionist factor that should allow us to improve our extant outcomes and the outcomes of other cultures Every other culture, including ours, is absolutely fixated on validating our own particular constructs; however, we have a good shot at evolving because part of our intellectual world is working hard to develop the ability to deconstruct our assumptions. The way forward is to focus on the power underlying therapeutic explanations and rituals: beliefs, expectancies and the charisma of the therapist.
The most common response I’ve received for these arguments goes something like, “I can’t refute what you’re saying logically but, since I know that it doesn’t feel true, I’m going to ignore your points.” That would be the exact same counter argument one would get trying to convince exorcists that the spirits are constructs. We should be better than this… I believe, however, that our culture of open dialog—and all the work we’ve done on constructionism and Kuhn’s paradigm shifts—puts us in a position where at least a significant minority of us might move in another direction.
I’m going to close with a striking story from hundreds of years ago which illustrates all of the points made in this response. Constructionism didn’t begin in the west in the 20th century but had its origins in the east, particularly with Vedanta and certain Buddhist thought. In the following story, the teacher points out that when the disciple understands that techniques have no inherent power, then they will be on the right path. This story is attributed to Dogen Zenji.
When asked why he practiced zen, the student said, “Because I intend to become a Buddha.”
His teacher picked up a brick and started polishing it. The student asked “What are you doing?” The teacher replied, “I am trying to make a mirror.”
“How can you make a mirror by polishing a brick?”
“How can you become Buddha by doing zazen? If you understand sitting Zen, you will know that Zen is not about sitting or lying down. If you want to learn sitting Buddha, know that sitting Buddha is without any fixed form. Do not use discrimination in the non-abiding dharma. If you practice sitting as Buddha, you must kill Buddha. If you are attached to the sitting form, you are not yet mastering the essential principle.”
The student heard this admonition and felt as if he had tasted sweet nectar.best wishes,
Stephen Bacon, Ph.D.
351 S. Hitchcock Way #B110
Santa Barbara, CA 93105
website: drstephenbacon.com
(805) 563-2820
On Mon, Apr 11, 2022 at 4:28 AM Henriques, Gregg - henriqgx <[log in to unmask]> wrote:
Many thanks for this interesting argument, Stephen.
It warrants significant thought and a careful reply. I unfortunately do not have the time at this point to give it the attention it deserves. Indeed, I need to go back and respond to some commentaries on Dissociative Identity Disorder. Unfortunately, my life has placed a number of demands on me and limited my time.
Briefly, my response is: Yes, the lack of the correlation of expertise and outcomes is an important finding that must be wrestled with. However, I do not draw the same conclusion regarding its meaning. Indeed, the argument from that finding to the argument that entrenched maladaptive patterns is not what psychotherapy treats is too great a stretch. Here is a possible explanation for the findings. It is a fact that the ontology of psychology and psychotherapy is lame. The schools of thought have partial truths. You can enter into the common ground through them. And there are some expert/guru/charismatic figures who find a school and get good results (as you know there are master-class clinicians who do have qualitatively better outcomes). And then people form a school and train. However, because the school only had a partial truth, the followers of the school actually double down on an incomplete picture, such that their expertise is weak tea. And trying to become an expert in a specific school of thought does not help you much.
My point is this. I can’t draw much ontological insight from this finding. I do acknowledge substantial existential anxiety from it. Indeed, part of my decision to give up my license last year can be justified by the finding. But I don’t think it makes much sense to build a theory of human functioning from it.
Best,
Gregg
From: theory of knowledge society discussion <[log in to unmask]> On Behalf Of Stephen Bacon
Sent: Saturday, April 9, 2022 9:37 PM
To: [log in to unmask]
Subject: Common Core of Psychotherapy/Entrenched Maladaptive Patterns
CAUTION: This email originated from outside of JMU. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Hi Greg,
As you know, I’m a big TOK fan and really appreciate all you have been doing to put psychology into a larger context and to address some of the fundamental questions in our field. That said, I do have some disagreements with where you, Goldfried and Smith have been going on the common core of psychotherapy.
To keep this relatively brief, I’d like to focus solely on one of your initial principles: “The core problems of psychotherapy involve entrenched maladaptive patterns.” While this sentence appears fairly self-evident, I believe that it leads us in an unproductive direction.
While I know that you are familiar with my work, let me review it briefly for other readers. I am also concerned with developing the common core of psychology. My work is founded on an extensive literature review designed to ascertain whether psychotherapeutic techniques have inherent power. My basic argument in this area is simple: if psychotherapeutic techniques have inherent power, then experienced therapists should best the inexperienced given that they know more techniques and have practiced them more assiduously. Moreover, trained therapists should best the untrained because they know relatively more techniques.
I have conducted extensive literature reviews (Bacon, 2020, 2022) that document that therapist experience and therapist training do not correlate with improved outcomes. This leads to the conclusion that clients are not changing secondary to the inherent power of our interventions; rather, following Jerome Frank, they are changing because they believe in our explanations and expect that going through our prescribed cures will create healing. In sum, we are using therapeutic rituals not techniques with inherent power.
Even more provocative and alarming, the lack of experience and training effects mean that all of psychotherapy’s privileged knowledge—diagnoses, clients characteristics, psychological systems, research studies, etc.—also fail to contribute to enhanced outcomes. Certainly, psychotherapy works--approximately 55% of our clients get better pretty much no matter what we do (Bacon, 2022)—but when our privileged knowledge is of little use it’s pretty clear we have no real idea why.
Returning to the statement that psychotherapy treats entrenched maladaptive patterns: unfortunately, this concept runs directly into the two research findings about techniques lacking inherent power and privileged knowledge not enhancing outcomes. More specifically, treating maladaptive patterns implies that good psychotherapy replaces those dysfunctional strategies with more effective ones; in other words, you’ve been doing it the wrong way and I’m going to work with you so that you can do it the right way. If psychotherapy works like that, then our techniques must have inherent power. If I’ve been skiing the wrong way and falling down, and you know and teach me a better way to ski, that’s the definition of a technique with inherent power.
If mentally ill clients don’t know the right way to live and we psychotherapists do, then we have a technique with inherent power. That means that therapists who have practiced telling more people how to live right would be better than beginners and trained therapists—who have privileged information about how people should live—would best the untrained. It also implies that therapists should be quite a bit more effective at living well than the average person and simply saying that statement out loud is kind of embarrassing…..
The other argument, that therapists aren’t specially gifted at knowing the right way to live but are gifted at helping clients figure out their own right way to live fails in a similar fashion. If we really know how to do that especially well, then that ability is a technique with inherent power and experienced therapists should do it better than the inexperienced and the trained should best the untrained. In sum, logical as it may seem, we are not in the business of remediating entrenched maladaptive patterns and that is not the beginning point to develop a common core for psychotherapy.
There is an entirely different but highly useful additional perspective on “entrenched maladaptive patterns” that comes from the latest behavioral genetics research. Robert Plomin, in his 2018 book, Blueprint, proposes the radical idea that there are no lasting, sustained positive effects from the nurture side of the nature/nurture spectrum. More specifically, he states that the positive attempts made by healthy families and excellent schools to instill high functioning life strategies in children is ineffective.
Parents obviously matter tremendously in their children's lives. They provide the essential physical and psychological ingredients for children's development. But if genetics provides most of the systematic variance and environmental effects are unsystematic and unstable, this implies that parents don't make much of a difference in their children's outcomes beyond the genes they provide at conception. (p. 82) …. In essence, the most important thing that parents give to their child is their genes. Many parents will find this hard to accept. As a parent, you feel deep down that you can make a difference in how your children develop. You can help children with their reading and arithmetic. You can help a shy child overcome shyness. Also it seems as if you must be able to make a difference because you are bombarded with child - rearing books and the media telling you how to do it right and making you anxious about doing it wrong. (p.83)….. The shocking and profound revelation for parenting from these genetic findings is that parents have little systematic effect on their children's outcomes, beyond the blueprint that their genes provide (p. 85)
To understand how Plomin arrived at this shocking conclusion, it’s useful to examine a simplified example: the effects of environment on weight. Imagine adopted children who are being raised in a household with normal weight parents and very healthy eating strategies. While in the household, these healthy strategies have a positive influence and help the children have normal weight. After becoming adults, however, their weight has a correlation of 0 with the adoptive parents’ weight and a high correlation with the genetic parents’ weight. The healthy strategies learned in their adoptive household did not have a sustained influence once they are out in the world. Similarly, good strategies practiced by families and schools have a positive effect while one is there but the attempts to teach and instill life-long, healthy strategies fail.
Plomin sees human suffering and mental illness as an interaction between genetic vulnerabilities and environmental stress. He does not believe that mental illness comes from entrenched maladaptive strategies; if it did, then the adoptive children in homes with poor eating strategies would have a correlation with their adoptive parents’ weight. Our clients aren’t suffering from bad strategies and they won’t be fixed by teaching good strategies.
That said, one of the major confusing factors in terms of sorting out this area is how well psychotherapy works. Given that approximately 55% of our clients get better no matter what we do, it is tempting to view this client success as an endorsement of the extant explanations and the underlying assumptions. More specifically, the key assumptions receiving endorsement are that mental illness works like medical illness—i.e., diagnosis plus evidence-based intervention equals cure—and that mental illness operates in fundamental reality and follows a rational, rule-based order.
But a moment of reflection reveals that the research results radically challenge these assumptions. If the medical model is a functional representation, and if psychotherapy occurs in fundamental reality where science is the dominant paradigm, then we should have already been successful at developing techniques with inherent power and our privileged knowledge should correlate with enhanced outcomes.
We know psychotherapy works. The secret to developing the core is to figure out “why” the research documents such abysmal training and experience effects. “Entrenched maladaptive patterns” requires us to continue to use the paradigm that has been proven to be unproductive. It would be far better to explore psychotherapy’s core by following the implications of these provocative and unsettling research results regardless of where they might lead.
There is a famous Sherlock Holmes story about the significant clue in a murder is that the “dog didn’t bark in the night” (the lack of barking implied the dog knew the intruder). Similarly, we have an enormous clue that we have been reticent to pursue: how come the hundreds of thousands of books, articles, and research studies fail to enhance outcomes and how could the work of so many gifted and hard-working psychologists amount to so little? Our research doesn’t “bark in the night” and very few psychologists appear to care……
Fortunately, Berger and Luckmann, back in 1967, offer a compelling explanation. They examined mental health models cross-culturally and argued that human suffering is inevitable and, hence, every culture is required to develop a mental health paradigm and a class of healers dedicated to applying the paradigm. In addition, they pointed out that the cultural members will have symptoms congruent with the constructed model and achieve healing via the culturally-sanctioned technology. As most of us are aware, Berger and Luckmann concluded that the suffering was real but the explanations for the suffering and the technology for its relief were constructed.
If, therefore, we compare our mental health model with an “exorcism of malevolent spirits” mental health model, it becomes clear why our psychotherapy techniques lack inherent power. The secret is that for the 55% of clients that generally respond well to psychotherapy, they will get better no matter what model is offered—CBT, psychodynamic, EMDR, or primal scream—as long as they find the model credible. Our clients are just like the exorcists’ clients; they get better no matter what kind of spirit is diagnosed and no matter what kind of ritual is prescribed. The exorcism clients get better but no one would argue that the rituals have inherent power. The techniques have no inherent power; rather their power is derived from beliefs and expectancies.
In the exorcism culture, a great deal of effort is expended on determining exactly what type of spirit is possessing the person and which ritual will specifically eliminate that spirit. We, of course, see those efforts as a waste of energy because we recognize that the real healing factors are rituals, beliefs and expectancies. Thinking that “entrenched maladaptive patterns” is the first step in exploring the core of psychotherapy is equivalent to arguing that the first step is to determine what kind of spirit is present. It implicitly pushes us towards the next step—a continuing search for techniques with inherent power—which can redress the bad strategies. This, of course, will result in further additions to our privileged knowledge—additions which will be just as ineffective as the hundreds of thousands of preexisting concepts.
In your article you discuss the importance of moving beyond common factors: “we were able to lay out the argument that we can move beyond common factors and clarify the common ground of psychotherapy with much greater levels of specificity and utility.” This, of course, is what anyone who is interested in developing the core of psychotherapy must accomplish. While there is no time in this short note to explore the implications of how to move past common factors, there are intriguing clues inherent in our exorcism example. Suppose we were operating in a culture that required exorcisms to cure mental illness but we were in the small group of exorcists that knew that the spirits were a construct. What kind of edge would that give us over the standard exorcists who believe in the spirits? Exploring the implications of that question begins to take us beyond common factors; moreover, it suggests a different direction for developing the core of psychotherapy.
References
Bacon, Stephen. (2020). A Constructionist Extension of the Contextual Model: Ritual, Charisma, and Client Fit. Journal of Psychotherapy Integration, 30(4), 506–521. https://doi.org/10.1037/int0000188
Bacon, Stephen. (2022). Deconstructing the great psychotherapy myth: Therapists and clients are confused about how therapy works [Video]. YouTube. https://www.youtube.com/watch?v=L_54PhNY6vk&list=PLuSjXeuKpouUoV9vN4O9hZw-4oqTX6y29
Berger, P. L., & Luckmann, T. (1967). The social construction of reality. Anchor Books.
Plomin, R. (2018). Blueprint: How DNA Makes Us Who We Are. United Kingdom: Penguin Books Limited.
Stephen Bacon, Ph.D.
351 S. Hitchcock Way #B110
Santa Barbara, CA 93105
website: drstephenbacon.com
(805) 563-2820
############################
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
############################
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
############################
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1
To unsubscribe from the TOK-SOCIETY-L list: write to: mailto:[log in to unmask] or click the following link: http://listserv.jmu.edu/cgi-bin/wa?SUBED1=TOK-SOCIETY-L&A=1