Communicating with many scientists from different fields of science (most often natural), I encountered their rejection of modern psychology and, in particular, psychotherapy as a practical activity. Almost all of its directions, except, perhaps, the «academically approved» cognitive-behavioral, were called into question and suspicions of charlatanism were expressed. Where is the scientific justification? Where is the effectiveness?.. The text below is an attempt to reflect in search of an answer to the question: “where is the scientific character in psychotherapy?”.
I began my path to non-drug psychotherapy through academic psychology. I had no special illusions about the holistic concept of the psyche and consciousness. On the other hand, the study of psychological experiments, especially in the field of social psychology, made it possible to understand the essence of research activities in psychology.
The work on the dissertation enriched the experience of relations with mathematical statistics, without which modern scientific psychology is nowhere. Correlations, t-criterion, factor and cluster analysis, regression and other concepts dear to the scientist’s heart that turn chaos from a set of data into an ordered structure. A person in these structures is only a particular element, a set of numerical data related to one or another operationalized concept. Personal, subjective phenomenology, a private inner world — all this was dissolved in orderly numerical rows following the ordinal numbers denoting the subjects.
Psychotherapy from this beautiful, shining with sterile objective purity of the world, looked (and looks) like some kind of nightmare: one theory on another, different approaches, conflicts, contradictions … At the same time, the topics that were raised in the psychotherapeutic materials that I read, me worried much more than objective scientific truth, which, as it turned out, in psychology still does not want to be established once and for all.
Trying to understand myself, and not in abstract people, I gradually plunged into the world of practical psychology, where the ground under my feet is rather shaky, and classical scientific methodology, let’s say, is not always welcome. In this regard, the perception of psychoanalysis is noteworthy.
Academic psychology has rejected and rejects psychoanalysis with a passion that deserves greater application in other areas [1]. Moreover, Z. Freud was often attacked personally (for example, by R. Webster in Why Was Freud Wrong?), as if psychoanalysis itself had stood still since the time of its founding father, and personality criticism was the best way to criticize its theory. And in the ranks of «psychologists-fighters against pseudoscience and pseudopsychotherapy», the word «psychoanalysis» has become almost abusive, and the slogan «Freud is a swindler» has become an axiom. Not all, of course, were so radical: neurophysiologist E. Kandel, Nobel laureate, speaks with respect about Z. Freud and the development of psychoanalysis.
But, according to T. Wilson, “many psychologists refrain from using the term “unconscious”, otherwise their colleagues will decide that they have gone nuts” [cit. by 6, p. 29]. D. Barg, a Yale psychologist, recalled that he once, in the late 1970s, shared information with a fellow scientist that there were facts indicating that people do things for which they are not aware of the motives. “Wishing to refute the results of such studies, Barg’s relative cited his own experience as an example: he can’t remember anything in his actions that he did, not realizing the motives … Barg wrote: “We are all very dear to the idea that we are rulers own souls that we are at the helm, and the opposite is very scary. In fact, this is what psychosis is — a feeling of detachment from reality, loss of control, and this will scare anyone. by 6, p. thirty].
However, modern scientific psychology, armed with the latest technologies, has returned to this Freudian concept, filling it, however, with a different content. So, it was all the same this brilliant insight of Freud? And now E. Kandel talks about supplementing psychoanalysis/psychotherapy with biology (without rejecting this “profound quackery” from the threshold) [5], V. Ramachandran compares the psychoanalytic description of the defenses and phenomena he observes in his patients [7, p. 318-320], and N. Doidge writes about psychoanalysis as a «method of neuroplastic therapy» [4, p.352-393]. Of course, this is not a complete rehabilitation of psychoanalysis in the eyes of the academic community, but much more like a fruitful dialogue.
In the same way, I went from a scientific inquisitor, who burns out anti-scientific or non-scientific sedition with a red-hot iron, to a much more moderate supporter of a combination of objective (scientific-analytical) and subjective (phenomenological) approaches to understanding human consciousness.
I consider it fundamentally wrong to renounce the scientific foundation — science allows you to rely on those fragments of reality that it discovers in its search. Logic, experiments (from socio-psychological to using fMRI) and mathematical methods of data processing are excellent tools for studying the general patterns of our psyche, its basic rules for its functioning.
Therefore, I am rather skeptical about all sorts of mystical ideas in psychology and psychotherapy (for example, Jung’s «synchronism» or the idea that such clients come to a psychologist who are «consonant» with the problems of the psychologist himself), and to the use of various kinds of «magic means» , like tarot cards — even if with the best of intentions. As well as to psychotherapeutic conferences, which are called «scientific-practical», but the speculative constructions of the speakers are taken for science in them.
However, wonderful scientific research does not allow me to understand the concrete, individual consciousness of a person who is sitting right in front of me in the office. Here the objective language of science becomes what makes contact difficult.
But what about scientifically posed thinking? What about cognitive psychotherapy, the most «scientifically based» and rational of all? I am reading «The Complete Guide to Cognitive Psychotherapy» by D. Beck, and I find:
“While the cognitive therapist’s main toolkit is cognitive strategies… techniques borrowed from other areas of psychotherapy (especially behavioral therapy and gestalt therapy) are also widely used” [3, p. thirteen].
What? Gestalt? This hotbed of emotionality and unscientific irrationalism (according to some of my opponents)?!
Why did I, a fairly rational and scientifically oriented psychologist, enter non-drug psychotherapy through gestalt? There are many reasons, but there is one important circumstance that I came to understand relatively recently.
Turning to Gestalt therapy allowed me not to dry up, but to support and develop my own emotionality — something that began to suffer for the sake of my love for analytical constructions. Gestalt, by the way, is not alien to the mind at all (some Gestalt therapists may be alien to it), but it was the appeal to emotional experiences that turned out to be more important for me personally than cognitive conceptualizations and the identification of automatic thoughts. The coexistence of such different psychotherapies as cognitive-behavioral and gestalt is not a problem for me.
But why? In academic science, there are two major questions addressed to psychotherapy: how scientific it is (corresponds to scientific data) and how effective it is. Can such different psychotherapies coexist? Something should be at least more efficient? In a serious and long article, “Why Ineffective Psychotherapies Appear to Work: A Taxonomy of Causes of Spurious Therapeutic Effectiveness” [12], the researchers provided an almost exhaustive list of 26 reasons for the apparent effectiveness of psychotherapy psychotherapy (PCEP).
Category 1: In the absence of improvement in the client’s condition, the psychotherapist and / or client believe that there is improvement (15 SCEP) — palliative benefit, distortion, playing along with the therapist, etc.
Category 2: Improvements in the condition are not due to psychotherapy, but to external factors (8 SCEPs) — spontaneous remission, the cyclic nature of disorders, etc.
Category 3: Non-specific treatment factors (3 PPEC) — placebo effect, novelty effect, justification effect.
In general, anyone claiming that their psychotherapy is effective should rule out all 26 SCEPs as plausible explanations for «effectiveness». At the same time, it follows from this work that neither the psychologist / psychotherapist, nor the client / patient themselves can judge what has improved and what has not, in principle, they have no “authority” to do so. But why can’t a psychologist’s client judge for himself whether a visit to a psychologist helped him or not? The answer is simple: in medicine, the subjective feelings of a patient or a doctor cannot be a criterion for declaring a person recovered.
It is at this point that I come to the point that is not taken into account by the fighters against «ineffective and unscientific psychotherapy.» Modern psychotherapy has long gone beyond the medical framework. And academic psychology sees it through medical glasses, where there are specific diagnoses and specific medicines. A huge number of people who are not sick in the medical-psychiatric sense turn to psychologists / psychoanalysts / psychotherapists to improve the quality of their lives, and not to treat their illness. Can a person who comes with a request that «I’m bored with life» and who does not have depression judge for himself whether life is «happier» as a result of work or not (even taking into account the very likely change in the original request)? Or a married couple who turned to a family therapist — can she herself judge whether the relationship has improved or not? From the point of view of the advocates of objective science, no, they cannot. This, apparently, should be done by the fMRI machine. However, such people — not sick — are not taken into account in principle. It seems that the ideal of a psychotherapist in the «scientific paradigm» is a mechanic, like a doctor-application to high-tech devices.
A patient/client of a psychotherapist is an object of influence that does not have the right to his own assessment of how his life changes as a result of working with a psychotherapist. More precisely, he has the right to think anything about his own life, but subjective assessments must be brushed aside — there are too many “wrong” factors and distortions.
Another point, well described by S. Hawking and L. Mlodinov, is not taken into account.
“Strict realists often argue that the proof that scientific theories reflect reality lies in their successful application. But other theories can just as successfully describe such phenomena through completely different conceptual schemes … In fact, many scientific theories that were considered successful were then replaced by other equally successful theories based on completely different conceptions of reality … It makes no sense to ask whether it is real or not model of the world, one thing is important: whether it corresponds to observations. If each of the two models corresponds to observations, then it cannot be said that one of them is more real than the other … It is impossible to exclude the observer — ourselves — from our perception of the world, which is created with the help of our feelings and by thinking and reasoning. Our perception (and therefore the observations on which our theories are based) is not immediate, but is formed by a kind of lens — the human ability to interpret. [11, pp. 51-53].
It seems to me that these lines describing the situation in science describe what is happening in psychotherapy with amazing accuracy and turn us to the central problem related to the scientific/unscientific nature of psychotherapy — the problem of consciousness, because it is consciousness that is the lens in which our perception is refracted.
And here objective science flies into a serious alteration. In the traditional natural science approach, a person is often considered as a being isolated from the world, and the psyche as a product of the activity of a separate brain. The analytical approach, ignoring the fact that the psyche of living organisms cannot exist in isolation from the environment, gave rise to the strange idea that it is possible to understand the human soul with the help of exclusively analytical reduction, ultimately reducing the person and his «I» to the brain. The study of the human psyche focuses on the functioning of the brain and the humoral system, and the subjective experience of a person, his phenomenological consciousness, are discarded as insignificant epiphenomena (“appendages” of the phenomenon that do not affect anything side effects) of the nervous system.
However, when serious scientists attempt to tackle the problem of consciousness, an interesting twist can sometimes be observed. N. Humphrey, emeritus professor of psychology at the London School of Economics, who bases his research on consciousness on neuroscience and evolutionary theory, suddenly calls his work on consciousness published at Princeton University very poetic: “Pollen of the soul. The Magic of Awareness» (in the Russian edition: «Consciousness. Pollen of the Soul»). You expect a much more rigorous presentation from an academic professor. But he does not let up, and in the introduction you read such lines, very far from dry academicism: “The material world has given a person a magical soul. The human soul paid the same, casting a magical spell on the world around» [see. ten]. Soul, enchantment, magic? But Humphrey is not alone in this lyricism, when he begins to talk not about perception, memory, speech and other mental processes, but about consciousness as a phenomenon. He is joined by a major domestic psychologist V.M. Allahverdov, who named his book on consciousness is also very lyrical: «A methodological journey through the ocean of the unconscious to the mysterious island of consciousness» [10].
And even V. Ramachandran, who confidently stands on the solid ground of cognitive neuropsychology, when speaking about self-consciousness, suddenly hits the lyrics:
“Self-awareness is a trait that not only makes us human, but paradoxically makes us more than just human. Science tells us that we are just animals, but we feel differently. We feel like angels hidden in the bodies of animals, forever striving to overcome our boundaries. In general, this is the main problem of man. [7, p. thirteen].
The phenomenon of consciousness turns out to be extremely difficult to describe without referring to subjective images. Explain to me how you can objectively, without resorting to subjective experience (to the subjective experience of consciousness!), measure «the degree of meaningfulness of life.» How can fMRI check “my life has become more meaningful”, “I began to get more joy from everyday life”?
I am reading a wonderful book about archaeology. The authors, professional archaeologists, describe in detail and with a large number of examples modern archaeological science, which now belongs more to the natural sciences than to the humanities: a lot of geologists, physics, chemistry … Reliance on the facts obtained, a clear fixation of what is, the desire to tie all interpretations to facts and not to break too far in their reconstructions from the obtained factual material (there is something in common with phenomenology in psychotherapy!). Classical scientific procedures… And suddenly the eye stumbles over the lines:
«Some of the best minds in archeology struggle with scientific methodology in the study of the human mind, especially religion and beliefs» [8, p. thirteen].
Chapter «Archaeology of the Spiritual», paragraph «Cognitive Archeology»… Trying to study the content of the consciousness of people of the past, archaeologists suddenly realize the insufficiency of classical scientific methodology, or even try to find their own way.
M. Jacoboni, talking about his own and others’ studies of mirror neurons, eventually proceeds to reasoning about phenomenology, recalling E. Husserl, and to the concept of «existential neuroscience», because «the themes raised by mirror neuron research strongly resonate with themes recurring in existential phenomenology» [12, p. 318]. Why does this «rollover» occur? Because in the matter of understanding another person, «the lion’s share of mirror-neuronal activity, apparently, is associated with experiential, pre-reflexive and automatic penetration into other people’s internal states» [12, p. 316], and not with a conscious mental effort.
«Pre-reflexive, automatic penetration into other people’s internal states» can and should be studied scientifically, but in practice it is often carried out in the process of psychotherapy. In the office of a psychologist / psychotherapist, a situation is created in which the typical (objectively measured) and the unique (subjectively significant) merge, and therefore psychotherapy, based on science, cannot be reduced to it and measured only with the help of objective methods.
K. Frith, one of the champions of objective neuropsychology, also speaks of a similar thing:
“Our brains are finely tuned to interact with other people. Concepts such as will, responsibility, and even meaning depend on these interactions. Each of us predicts what the other will say and adjusts our predictions until we both agree. As a result, the meaning on which both converge in the end will depend on both, which means it may differ slightly depending on who we are talking to. Meaning is born from the interaction of consciousnesses” [9, p.283-284]. And with the scientific study of the interaction of consciousnesses there are great difficulties. “If we want to understand the neural basis of these interactions, we cannot study one single brain. We need to explore the two brains in the process of their interaction. Work in this direction is just beginning. So far, we don’t even know how to compare the measurements obtained for the brains of two different people.” [9, p. thirteen].
And even if we understand the neural basis of the interaction, we will not penetrate into the subjective experience of it by a person, it is not accessible to direct observation, and I still cannot even imagine if it will ever be available. This aspect, as I have already said, takes psychotherapy beyond the scope of purely science, and brings it closer to art and craft. We can study in detail the chemical composition of the paint with which the artist painted his picture, but the meaning of the picture may elude us — in order to comprehend it, we need either our own past experience, or emotional involvement, or even a direct conversation with the artist about what he had in mind . Psychotherapy deals with the content of the consciousness of specific people, while the science of psychology deals with the “material carriers” and products of the activity of this consciousness.
In general, the search for a scientific foundation for psychotherapy is an important matter. But the foundation cannot replace the whole building, and psychotherapy cannot take place exclusively in the objective-scientific part. It has a lot of subjective, not amenable to measuring instruments. And that’s what I’m trying to convey to my fellow scientists.
Literature
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