Why not mix psychotherapy theories and techniques?

mixed pyschotherapy


In the 21st Century, it is time to ask why not rather than why. The reason is that at least half of practicing therapists are already mixing techniques from different traditions and theories. The four main objections have their roots in 19th century science and it’s time for a change in thinking. Here they are:

First, psychoanalytically oriented therapists (I am still more one of these than anything else.) learn early in their careers that they should hold back their feelings and reactions. This often makes them feel ashamed of engaging with patients and reluctant to use more active techniques. In the nineteenth century, scientists thought that if the therapist was a “blank screen,” that would prevent influence on the patient and what they observed would be purely “objective.” Physicists were the first to see that the observer can’t help but influence the observed. Now psychodynamic therapists see, too, that a disengaged therapist has just as much effect on a patient as an engaged one, but the old ideas have a lot of power, especially backed by shame.

Cognitive-behavioral therapists are no less immune to nineteenth century science. In the hope of being completely objective, John Watson, the founder of behaviorism, proclaimed that information gathered from  introspection (looking inside yourself) was subjective, therefore invalid. Similarly, speculation about the past was too subjective to be taken into account. To this day, young behaviorists are taught not to think too much about why, but just to look at behavior. Now there is recognition that humans don’t just react to stimuli like animals, but react to the meanings they give to the stimuli. Attending to individual meanings is much more respectable but again the old prejudices have staying power at the expense of a lot of very useful “subjective” data that other traditions know how to gather and use.

Not to be outdone, psychodynamic training still teaches that you shouldn’t tell people what to do because it will “infantilize” them.  We all know that there are times when your child should tie his or her own shoes, and times when it is right to help out. Therapists are quite able to make the same judgment call. Helping people when it undercuts their own efforts does send the wrong message, but there are many more times when people need all the guidance they can get. Especially now, when so many problems center on compulsive, destructive behaviors, changing those is critical to success. For that, a passive therapist isn’t very effective.

Finally, behaviorally oriented therapists are taught to measure everything. Once I took a tour of the Mississippi Bayou with a swamp guide. He didn’t measure much of anything, but he knew a great deal. Research is useful but experience is, too. Therapy is not research and doesn’t have to be cluttered with protocols and questionnaires for people to change.

So, if it makes sense to you that pure objectivity is a myth of the past, then it might be OK for a therapist to be helpful, human and use good judgment to avoid the pitfalls. Therapists and patients can pool observations, experience, knowledge and intuition from all sources. I have come to think of therapy as a set of emotional tasks for which there are different tools. In the 21st Century, we can focus on finding the best tool for the job whatever tradition it comes from.  Why not?

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