Empirical psychotherapeutic methods.

Abstract

Psychotherapy comprises all forms of psychological treatment. Four aims can be distinguished in various psychotherapeutic procedures – to provide a rewarding experience, to increase self-knowledge, to allow confession, or to effect a lasting change in behaviour. During psychotherapy, the therapist uses his behaviour to change that of his patient. Prediction of therapeutic events requires more knowledge of the periodic table of therapeutic elements than we now possess. Low-order empirical hypotheses are currently possible but unitary theories are too far removed from the data to be of predictive value. ‘Empirical’ implies reliance on observation and experiment, and empirical psychotherapeutic methods start with observation of patients’ behaviour outside and inside therapy. From such observation, ideas are formed about operative variables, and these ideas are tested in larger controlled situations. These in turn, suggest further ideas for pilot study. The dialectic between pilot and larger scale study revolves around clinical observation of patient behaviour in response to events outside and inside treatment. Therapist behaviour flexibly follows inferences about variables maintaining patient behaviour in the short- and the long-term. What the therapist actually <i>does</i> may have little relevance to the theory he espouses. Similar psychotherapeutic procedures can be described in many theoretical languages, and a rose by any other name smells just as sweet. When an existentialist logotherapist shows an obsessive-compulsive patient how to approach contaminated material and requests him to follow suit, he is doing the same as self-styled behaviourists who model with flooding in vivo and response prevention. More important than the global theory is the procedure actually employed. Of course, active therapeutic ingredients of most treatment techniques still have to be dissected. Effective psychotherapeutic methods are valuable tools of experimental psychopathology which advance understanding and efficacy simultaneously. Potent treatment changes certain behaviour and so enables the therapist to detect which pathologies are interlocking and which are independent. This is rather like an ablation experiment in neurophysiology. No one aspect of behaviour can be regarded as primary, and confidence can only be placed in psychotherapeutic results which are consistent across different facets of behaviour. ‘Behaviour’ here denotes any or all aspects of a sequence from its initiation in internal imagery and feelings, to its final execution as overt behaviour, together with its physiological concomitants. An empirical psychotherapeutic approach implies multifactorial mechanisms for aetiology and treatment. It allows active ingredients of treatment to be isolated, and delineation of relationships amongst different psychopathologies. In time, higher-order theories will become possible with greater predictive power than at present.