Methods for training therapists customarily are directed to developing cognitive abilities. Using Milton Erickson as a model, an alternate, experiential approach is offered. The "evoking style" of the therapist determines the outcome of the treatment more than the theoretical and clinical methods to which the therapist ascribes.
The evolution of psychotherapeutic methods over the past 200 years from Mesmer through the psychoanalytic schools, behaviorism and current cognitive psychology tells a fascinating tale of our evolving understanding of human nature. In this address we will trace the development of fundamental techniques such as suggestion, free association, active imagination, gestalt dialogue, focusing, Erickson's indirect approaches and what I now call "The Basic Accessing Question."
Cognitive therapy was originally developed for the treatment of Depression and Anxiety. Since its early beginnings various clinicians and investigators have extended its use to a wide variety of disorders and populations. Systematic outcome studies have demonstrated its efficacy not only in the garden variety of disorders such as Depression, Anxiety and Panic but also in medical disorders such a low back pain, diabetes, chronic fatigue syndrome and chronic hypertension.
Anyone can perform brief or short-term therapy, but unless pivotal issues are addressed, the treatment will, at best, be too narrow and restricted. It is essential to employ empirically established methods whenever possible, but also to have a framework and rationale for on-the-spot inventiveness. This Invited Address will explain how to be precise and targeted while also ensuring that interactive healing processes are put into effect.
The author traces the evolution of psychodynamic theory over the past fifty years and demonstrates how various individuals and schools of thought have contributed to increasing conceptual clarity despite significant continuing differences. Along with these theoretical advances, there have been important changes in analytically-oriented therapeutic techniques.
In the early decades of the 20th century Freud's mastery of the craft of presenting a case enthroned a belief that anxiety disorders were caused by repressed emotional complexes and that recovery required the restitution of repressed ideas. This belief dominated psychotherapeutic practice, and even though little was to be seen in the way of success, any alternative was treated with scorn. Mid-century studies of experimental neuroses showed that these disturbances were the consequence of the learning of maladaptive anxiety and could be overcome by systematic counteraction by other emotions.
The major emphasis in contemporary psychoanalytic psychotherapy is on the early and consistent interpretation of the transference. A growing attention to countertransference analysis, to the risk of "indoctrinating" patients, to character analysis, to the analysis of unconscious meanings in the "here and now" also are dominant trends. Significant controversies continue regarding the importance of the "real" relationship, the therapeutic versus the resistant aspects of regression, the role of empathy, and the relation of historical to narrative truth.
For the past half-century there has been a remarkable and continual evolution in the theory and practice of psychotherapy. Now that evolution shows signs of becoming a revolution. Many elements of these changes are, as yet, only scantily represented in the literature, but they are the stuff of bull sessions, the more liberated case conferences and solitary, sometimes fearful, experimentations. This transition comes about from a variety of influences, among which three are particularly worthy of examination for what they suggest about what is likely to emerge a half-century from now.
The traditional assumption that only insight into the causes in the past can bring about a change in the present makes us blind for what Alexander & French called "the corrective emotional experience," i.e., chance events in the present that may lead to almost immediate solutions. A great number of Erickson's surprising results could be considered the outcome of "planned chance events," often in the form of behavior prescriptions similar to interventions in hypnotherapy (e.g., "speaking the clients's language," prescribing resistance, the use of reframing, paradoxical interventions, etc.).
Supervision and therapy are isomorphic processes. What supervision teaches is the process of creating change in people, and the very teaching of this process is itself an attempt to create change in the supervisee. Like families, therapists tend to confine themselves to selected segments of their possible repertory. Thus a major goal of supervision can be the expansion of the therapist's use of self.