Today, we live in an age when
practicing psychotherapists are faced with increasing economic and
administrative pressure to conform to the status quo. Managed care, for good or
ill, has forced psychotherapists to find very quick and efficient means to
handle more and more complicated cases. With innovations in biological
psychology and psychiatric medication, there is an increasing tendency for
psychology as much as psychiatry to explain psychological meanings by reducing
them to biological mechanisms. At the same time, psychotherapists are faced
with contrary forces that demand attention to individual and cultural diversity
among their clientele. As a way to manage the immense responsibility of their
tasks in a shrinking job market with smaller and smaller pay, and in the face
of the ambiguities encountered on a daily basis, some psychotherapists more
rigidly adhere to manualized approaches to treatment while others succumb to a
wishy-washy eclecticism for fear of making any commitment to a particular
point-of-view.

In the face of the pressures
outlined above, it is understandable how many psychotherapists have found
little time to ponder what appear to be esoteric philosophical issues. Yet the
re-examination of the basic assumptions undergirding psychotherapy practice is
precisely a way for psychotherapists to re-imagine their craft so that it can
survive and flourish in the face of difficult, ambiguous times. In this light,
the edited volume Critical Issues in Psychotherapy is a welcome and much
needed addition to the psychotherapy literature.

The editors of this volume are Drs.
Brent D. Slife, Richard N. Williams, and Sally H. Barlow. All three are
psychologists in the department of psychology at Brigham Young University.
Slife and Barlow are both clinical psychologists who practice in the field.
Slife and Williams have previously worked together as authors of the excellent
text, What’s Behind the Research: Discovering Hidden Assumptions in the
Behavioral Sciences, which to my mind still stands as one of the few
quality texts introducing psychologists to the non-empirical theoretical and
philosophical issues confronting psychology today. Slife, a past President of
the APA Division for Theoretical and Philosophical Psychology, has also written
three other texts, Time and Psychological Explanation, Taking Sides:
Clashing Views on Controversial Psychological Issues, and Managing
Values in Psychotherapy, that are exemplary of the kind of theoretical
analysis that has direct, practical value for applied psychology. Likewise,
Williams’ edited volume Rediscovering Psychological is an important
contribution to the field of theoretical and philosophical psychological. With Critical
Issues in Psychotherapy, these scholars continue their groundbreaking task
of carving a niche for philosophical psychology in the field of psychotherapy research
and practice.

The text is organized around
fourteen themes: Empirically supported treatments, assessment, the
biologization of psychotherapy, spirituality, culture, managed care,
individualism, the scientist-practitioner model, free will/determinism,
eclecticism, postmodernism, multiculturalism, diagnosis, and feminism. These
topics were initially addressed at a 1999 conference held at Brigham Young
University, and the format of the text follows the format of the conference.
Each theme is first addressed by a scholar-researcher in the field who brings
his or her expertise to the subject matter of the philosophical issue. The
essay is followed by a commentary issued by a practicing psychotherapist in the
field.

I am impressed by the manner in
which the authors in this volume manage to apply difficult philosophical
concepts to concrete issues in psychotherapy practice. Further, he great
majority of the essays are quite accessible to an audience who is unfamiliar
with the philosophical discourses from which these insights are derived. This
text would not be out of place in an upper-level undergraduate course in
clinical psychology; in fact, I would recommend it. And, given the gravity of
the issues raised, I think it would be negligible if, at some point in their
academic careers, clinical graduate students were not exposed to such meaty
topics of concern. I can hardly imagine a clinical psychology text more likely
to generate stimulating and passionate discussion.

Stanley’s Messer essay presents a
hard-hitting critique of the notion of “empirically supported treatments.”
Constance Fischer’s essay on her technique of individualizing psychological
assessment introduces her humanistic approach to a whole new generation of
scholars. And Richard N. Williams’ treatment of the biologization of
psychotherapy introduces the reader to the complexities and problems related to
the biological reductionism that is today sweeping psychology and medicine.

Sally H. Barlow and Allen E. Bergin
address the issue of spirituality in secular forms of therapy. While the topic
is engaging and the thesis raises important questions, the essay unfortunately
lacks rigor and focus. Nevertheless, similar issues are masterfully engaged by
scholars such as Lisa Tsoi Hoshmand and Blaine J. Fowers who address the
culturally situated nature of psychotherapy. Likewise, Joseph Rychlak explores
how the notion of agency (free will) makes a difference for psychotherapy. If
given two equally plausible theories of therapeutic outcome, he argues, the
theory that supports the notion of free over that of determinism should be the
theory of choice. Why? Because, even in the extreme case that we asserted a
deterministic approach, we would still act as if we were free beings.

Donald Polkinghorne’s essay on
managed care is a gracious and even-handed treatment of a delicate issue. By
situating the issue of managed care in a historical context, he manages to
point out the problems with our current predicament even while demonstrating
how its arrival on the scene follows from ethically-questionable behavior on
the part of working psychotherapists. Frank C. Richardson and Timothy Zeddies
point out the assumptions of individualism in modern approaches to
psychotherapy. Barbara Held critically evaluates the “postmodern turn” for
psychotherapy, and Jeanne Marecek outlines feminist approaches to therapy.
Finally, Robert L. Woolfolk’s exploration of “objectivity” in diagnosis
presents an uneven but engaging argument for the problem of applying the
evolutionary concept of “malfunction” to diagnosis and treatment.

All told, Critical Issues in
Psychotherapy runs the gamut of philosophical issues that arise for
psychotherapists. My one criticism is that the diversity of issues is not
matched by a diversity of perspectives. The respondent clinicians,
unfortunately, tend to affirm the theoreticians more than challenge them.
Perhaps the volume could have benefited less from the input of working
clinicians and more from commentaries of other theoreticians who are opposed to
the arguments presented. At least then the readers would have a more
even-handed treatment of these heated controversies and would less likely be
lulled into the false impression that they are easily resolved. Then again, I
realize I am playing Monday morning quarterback. Certainly, the initial idea to
include the opinion of clinicians is ultimately benevolent and worthy of the
highest praise.

©
2002 Brent Dean Robbins

Brent Dean Robbins, Ph.D. (cand.)
is a clinical psychologist who is Visiting Assistant Professor of Psychology at
Allegheny College. He is planning to defend his dissertation this Fall at
Duquesne University. His research interests include emotion, philosophical and
theoretical psychology, psychopathology, psychotherapy research, and the psychology
of religion. He is a co-editor of the interdisciplinary journal Janus
Head and a partner of Trivium Publications.

Categories: Psychotherapy