The psychological theories that are usually used “trim a life to fit the frame,” according to J. Hillman. Here is a good story about how we perceive things through such frames, our theoretical lenses.
“A behavior psychologist was sitting on the bench in the park observing the relation between a blind man and his dog, who were coming toward him. When they got very close to him, he coughed a couple of times to signal them, but the dog came to him, sniffed him, and lifted his leg and peed on the man’s foot. The behaviorist kept observing without too much protest because it was obvious that the blind man understood what happened and apologetically blushed. But then the blind man pulled a dog biscuit from his pocket and offered it to the dog. That was the last straw. The behaviorist said indignantly, ‘Hell, don’t you think you are positively reinforcing an undesirable behavior?’ The blind man said, ‘No, I am trying to find out where his head is so that I can kick his ass!' ”
H. Kohut talks about experience-near theory, but no theory is truly experience near, since it is impossible to approach data without some preconceptions. Given that limitation, the marrow of the work in psychotherapy can be defined in three overlapping bases: first, psychotherapy’s primary goal, that of remedying deficits and resolving conflicts; second, the nature of the patient-therapist relationship, which encompasses the empathic presence of the therapist, the working alliance, and transferential relations between the therapist and the patient; and third, the primary technique, which is to establish and maintain their interpersonal relationship. It has been said that the human relationship per se is never sufficient, and that the technique alone is not feasible. But in fact, technique and relationship are inextricable; or stated otherwise, one’s technique is always embedded in one’s relational predisposition. One’s secondary techniques could be almost anything. That is why there are more schools of therapies than brands of breakfast cereal.
As the practice of psychotherapy is based on theoretical paradigms ― admittedly an overused concept (Richard Darman, mocking the idea, says, “Brother can you paradigm!”) ― we need a paradigm that can combine or transcend diverse perspectives of psychopathology and treatment. Examples are the integration of drive, ego, object relations, and self psychology approaches, and/or the synthesis of conflict and deficit models. (This doesn’t mean that this very assertion itself will be exempt from some form of fallacy, or be immune from inherently self-limiting conjecture).
Of course, there are those rare masters; one is Milton Erickson, who has been described as a psychotherapeutic Peter Pan, someone who could operate without any paradigmatic constraint, and would do anything including cornering and conning the patient into changing. J. Haley describes one of his teachings in his book of tribute, Uncommon Therapy:
Interviewer: Suppose someone called you and said there was a kid, nineteen or twenty years old, who has been a very good boy, but all of a sudden this week he started walking around the neighborhood carrying a large cross. The neighbors are upset and the family’s upset, and would you do something about it. How would you think about that as a problem?
Erickson: Well, if the kid came in to see me, the first thing I would do would be to want to examine the cross. And I would want to improve it in a very minor way. As soon as I got the slightest minor change in it, the way would be open for a larger change. And pretty soon I could deal with the advantages of a different cross ― he ought to have at least two. He ought to have at least three so he would make a choice each day of which one. It’s pretty hard to express a psychotic pattern of behavior over an ever increasing number of crosses.
Such an unusual encounter cannot be fitted to any theory or paradigm ― it is just Erickson genuinely being himself. One cannot decipher a blueprint of a generic technique in this encounter. The marrow, the bones, and the meat of Erickson’s work, or for that matter, anyone’s, emanates from the person’s unarticulatable, undissectable essence of himself. [One cannot articulate the whole into pieces without damage to the whole, says R.D. Cumming in contrasting the philosophies of Hesserl vs. Heidegger.
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T. Byram Karasu, M.D. is the author of The Psychotherapist as Healer