Controversies in Psychotherapy Research: Epistemic Differences in Assumptions about Human Psychology

Abstract

It is the thesis of this paper that differences in philosophical assumptions about the subject matter and treatment methods of psychotherapy have contributed to disagreements about the external validity of empirically supported therapies (ESTs). These differences are evident in the theories that are the basis for both the design and interpretation of recent psychotherapy efficacy studies. The natural science model, as applied to psychotherapy outcome research, transforms the constitutive features of the study subject in a reciprocal manner so that problems, treatments, and indicators of effectiveness are limited to what can be directly observed. Meaning-based approaches to therapy emphasize processes and changes that do not lend themselves to experimental study. Hermeneutic philosophy provides a supplemental model to establishing validity in those instances where outcome indicators do not lend themselves to direct observation and measurement and require "deep" interpretation. Hermeneutics allows for a broadening of psychological study that allows one to establish a form of validity that is applicable when constructs do not refer to things that literally "exist" in nature. From a hermeneutic perspective the changes that occur in meaning-based therapies must be understood and evaluated on the manner in which they are applied to new situations, the logical ordering and harmony of the parts with the theoretical whole, and the capability of convincing experts and patients that the interpretation can stand up against other ways of understanding. Adoption of this approach often is necessary to competently evaluate the effectiveness of meaning-based therapies.

The Promise and Challenge (and Reality) of Defining Therapist Expertise

“…We know good therapists build good relationships, but we rely on clinical wisdom to understand how that happens for any individual therapist-research in the aggregate has failed to distill the essential attributes, skills, or behaviors. A question remains whether we can know and verify such things within a positivist science paradigm; one's response lies within one's epistemic stance regarding psychotherapy (Shean, 2013). Hill et al express hope that, in the spirit of Dr. Harlow, an empirical approach can catch up with our clinical wisdom.…”

Psikoterapi Araştırmalarında Konuşma Çözümlemesi: Yöntemsel Bir Gözden Geçirme

“…Psikoterapi araştırmalarının gelişimi psikoterapinin tarih boyunca nasıl bir gelişim, değişim ve çeşitlenme gösterdiğiyle yakından ilişkili olmuştur. Shean (2013) Braakmann (2015) psikoterapi kavramının 1700'lü yıllara dayandığını hatırlatsa da araştırmaların doğumu olarak 1900'lü yılların başını işaret edip, bu dönemde özel uygulamalar ve vaka çalışmalarının baskın rolünden bahsetmektedir. Perakyla, Antaki, Vehvilainen ve Leudar (2008) ile Kuş (2007), Breuer ve Freud'un (1957) histeri çalışmaları gibi vaka raporlarının anlam temelli ve nitel psikoterapi çalışmalarının öncü örnekleri olduğu fikrini desteklemektedirler.…”

The need for temporality in theoretical psychology: A commentary on Manoussakis’s The Ethics of Time.

“…Many psychotherapy strategies are derived from this tradition, yet these theories are presented as one atemporal and universal proposition after another. As a result, most practicing clinicians report that these theories are quite thin and even impersonal (Levine, Sandeen, & Murphy, 1992; Shean, 2013; Weisz, Krumholz, Santucci, Thomassin, & Ng, 2015), because the temporal context that Manoussakis describes is not provided. Here, especially, the abstractionism of the natural attitude has not served psychology well.…”