More invested in what is important than what is new, and protesting the proliferation of new therapies with their accompanying slew of acronyms (e.g., CBT, DBT, IPT, MBT, etc.), I have declared myself a practitioner of POT: Plain Old Therapy. In response to this declaration, my colleague, Tom Ellis, responded, “Who says there’s nothing new happening in the world of psychotherapy?”
Dr. Ellis has not persuaded me to give up POT. But his counterpoint to my blog post leads me to introduce a caveat: while respecting the essential ingredients, we must strive continually to improve the quality, effectiveness—indeed, potency—of POT. In advocating POT, I do not mean to imply that we learned long ago how to conduct psychotherapy in the most effective way and that there is no need to question, modify or improve our practice. We have much to learn from research on psychotherapy and, indeed, the quality of research on psychotherapy is improving. Dr. Ellis’s critique made me aware of the extent to which I am continually striving to learn more and improve the quality of my practice.
Perhaps being hooked on POT will allow me to speak out of both sides of my mouth without concern for self-contradiction. On the one hand, I believe that some essentials of psychotherapy are venerable and cannot be improved upon. These essentials boil down to the quality of the human relationship the therapist is able to establish with the patient.
In this sense, therapy is an art.
Therapists vary from one another in their capacity to form a therapeutic relationship, and their capacity to do so also will vary from patient to patient. I think this therapeutic capacity is fundamental to the therapist’s humanity. We all share a common core of humanity, but I believe that we differ from one another in being more or less skilled in being human. I find myself admiring some individuals who seem to me to be gifted at being human.
I also find psychological theory and research helpful in understanding what goes into this skill at being therapeutically human: the capacity to mentalize (i.e., to be emotionally attuned to mental states in self and others) and the thoroughly intertwined capacity to form secure attachment relationships. This core of our humanity develops—more or less completely—in the context of attachment relationships. What makes for a good parent or romantic partner makes for a good psychotherapist. Of course, as effective psychotherapy demonstrates, we can always improve our individual humanity, that is, become more skillful at being human. Perhaps it makes sense that psychotherapy is a common part of the training (or development) of psychotherapists—maybe the most essential part for many.
The conduct of psychotherapy is a rather messy amalgam of the therapist’s humanity and expert knowledge, art and science. Thus, on the other hand: in addition to developing increasingly refined evidence-based treatments for specific disorders, we can continue to refine our understanding of the “common factors” that cut across different brands of psychotherapy (i.e., cognitive-behavioral, interpersonal, psychodynamic).
Whether we call it “talk therapy,” “generic psychotherapy” or “plain old therapy,” we can clarify what we are aspiring to do and do it more effectively. From this perspective, we have most to learn from research on “mechanisms of change,” that is, the psychological processes catalyzed by psychotherapy that facilitate amelioration of psychiatric disorders along with improved functioning and quality of life. Attachment security and mentalizing capacity are examples of potential mechanisms of change, but research on these factors in psychotherapy is in its infancy.
Dr. Ellis has made me aware of the hope that the POT of tomorrow will not be the POT of today. In writing this post, I was reminded of the 2008 address our esteemed colleague, Irv Rosen, gave to graduates of the Menninger training programs. Among many other distinctions, Dr. Rosen was the first graduate of the Menninger postdoctoral training program in clinical psychology. I conclude with a quotation from his inspiring address, which applies to psychotherapy as well as psychiatric treatment as a whole:
The techniques that characterize a clinic or hospital at any given time are ephemeral, provisional, to be inevitably replaced by newer and better methodologies. What forms the core of a place of healing are its values…. I am confident that those values of hope, transmitted through a caring relationship and sustained by a spirit of ever-present inquiry, will continue to inspire your work….
To the good fortune of a great many, Dr. Rosen, a master therapist, served for many years as the director of the psychotherapy service at The Menninger Clinic when it was located in Topeka, Kansas. As I hope this brief quotation illustrates, he is an exemplar of a person who is gifted at being human.