All in the family? On therapeutic commonalities.

Abstract

John C. NorcrossUniversity of Rhode IslandIn a provocative article, Goldfried(November 1980) echoed the call ofmany clinicians clamoring for a rap-prochement across various theoreticalorientations, for an integration oftherapeutic rationales, and for a de-lineation of principles of therapeuticchange. The proliferation of thera-peutic eclecticism, the growingdiscontent among psychotherapistswithin each orientation, and the re-sulting openness to contributions fromother theoretical persuasions attestwell to such a movement. However,it seems to me that Goldfried's rec-ommendations dismiss too lightly thecontributions of the therapist's phil-osophical presuppositions and per-sonal characteristics, as well as the sit-uational variables unique to eachtherapeutic relationship, in determin-ing therapeutic activities and beliefs.As such, the concentrated study ofcommonalities across theoretical ori-entations may be premature in ourinfant stage of knowledge in psycho-therapy.Goldfried admits that is unlikelythat we can ever hope to reach com-mon ground at either the theoreticalor philosophical (p. 994) andcontends that the search for common-alities across approaches in the realmof specific techniques would probablynot reveal much more than trivialpoints of similarity. Instead, Goldfriedsuggests that . . the possibility offinding meaningful consensus existsat a level of abstraction somewherebetween theory and technique which,for want of a better term, we mightcall clinical strategies. Were thosestrategies to have a clear empiricalfoundation, it might be more appro-priate to call these principles ofchange (p. 994).In essence, I believe that this newlevel of abstraction between tech-nique and theory must be created todiscover commonalities because avail-able research has failed to substantiateconsistent similarities among psycho-therapists on either the technical orthe theoretical level, and second, be-cause certain philosophical positionsadvocated by theoretical orientationsare simply incompatible and incapa-ble of consolidation with philosophi-ca l positions of other theoretica ori-entations.To take the first of these arguments,clinical investigators (see review bySundland, 1977) have repeatedly en-countered numerous and predictabledifferences in both the activities andbeliefs of therapists of differing the-oretical orientations. In short, rela-tively few commonalities of specifictherapeutic techniques or interven-tions have been found. Such differ-ences among the activities of thera-pists are not solely due to thetheoretical orientation of the thera-pists. The psychotherapist's personaland clinical characteristics also havea profound impact on his or her ther-apeutic practice, and may well affectthe process and outcome of psycho-therapy. Such characteristics includethe therapist's sex, race, personality,age, experience, mental health, hav-ing had personal psychotherapy, andthe like (Auerbach & Johnson, 1977;Parloff, Waskow, & Wolfe, 1978; Sat-• tier, . 1977; Sundland, 1977). Whereasa rapprochement of theoretical ori-entations might someday be concep-tually possible, consolidation and in-tegration of therapists' sex, experience,race, personality, values, and mentalhealth hardly seems possible.Similarly, diametrically opposedphilosophical principles espoused bytherapist s with different conceptionof the nature of humanity and realityare difficult, if not impossible, to re-solve within the clinical context. Forinstance, there have been persistentattempts to link psychoanalytic andbehavior therapy on conceptual andclinical levels. According to Messerand Winokur (1980), these attemptsat integration suffer, if not fail, be-cause of contrasting perspectives onreality, which in various ways focuseither on the inner world of experi-ence or on the outer world of consen-sual validation. Psychoanalytic andbehavior therapy embody alternatevisions of life with different basic pos-sibilities of human existence andgrowth. In contrast to the behaviorist'soperation within the extraspective,objective, and realistic perspective,psychoanalytic therapy utilizes the in-trospective, subjective, and idealisticperspective. The limits to the integra-tion of varying theoretical orienta-tions are to be found, ultimately, inthe contrasting visions of humanityand reality (Messer & Winokur, 1980).Likewise, the similarities and pros-pects for a fruitful integration be-tween humanistic and behaviorallyoriented approaches certainly do ex-ist. However, the possibility of rap-prochement is seriously confoundedby the ancient polemics of freedom/determination and idiographic/nomo-thetic approaches. Add to this Rych-lak's (1968) list of topics that lendthemselves to historical bifurcation(e.g., artist vs. scientist, behavior asactive-stimulating vs. behavior as pas-sive—responding, teleology within manvs. within science), and one has someof the major controversies in the fieldof psychotherapy—as James called it,the tenderminded versus the tough-