Editor's
Note
After
reading Paul Wachtel's superb last book (Relational Theory
and the Practice of Psychotherapy, 2008) I sent Paul a comment
(October 19, 2008) in which I listed the main strengths of
his book, as I saw them: the observation of how much the classic
or orthodox position still conditions the real practice of
many relational analysts, me included; the attention to the
vicious relational circles in the present that makes his approach
stand out among the relational perspectives; and a masterful
description of the evolution of psychoanalysis, from the fundamental
Freud's 1926 revision to the relationship-centered psychoanalysis.
I went on discussing the points that in my view were more
problematic: an overemphasis on acceptance to the detriment
of confrontation, and one on the inevitable pervasiveness
of the observer's subjectivity vs. the possibility of its
neutralization. Paul kindly replied (October 29, 2008) that
I had "gotten" what he was saying in many ways, and addressed
my objections. Firstly he pointed out that what I (and there
he too) were calling the mothering or nurturing side is not
devoid of the "hard" confrontation with the truth and with
what has been avoided. Those elements have always been central
to his thinking, which is why he emphasizes exposure so much. Secondly,
he is skeptical about any possibility of neutralization, bracketing,
and similar operations. We cannot take off our theoretical
lenses. What we can and must do, is strive to create appropriate
controls to whatever degree is possible. We should be wary
of our clinical judgments, especially when the data on which
they are based are solely things we "remember" rather than
transactions that have been tape recorded. There followed
a rejoinder of mine (January 25, 2009) and a final comment
by Paul (September 16, 2009).
At
the end of this exchange-the last of the many we had on these
matters in ten years- it is clearer to me where we converge
and where we diverge. We converge on the persuasion that science
is more than anything else an effort to counter the extraordinary
capacity of our species to deceive ourselves. We diverge on
the way to achieve this result in the specific field of psychotherapy.
We converge on the view that the insistence that nothing can
be regarded as a valid knowledge unless it has been tested
in a randomized controlled clinical trial is "more like
an obsessive-compulsive symptom than the creative and disciplined
application of human intellect" ¯ (Wachtel, 2006). We
diverge on the alternative we suggest to the gold standard"
¯ of empirical research: of the various ways of trying to
correct at least in part for our biases, bracketing¯ seems
to Paul one of the weakest, to me one of the strongest. We
converge on the distrust in manualized therapy and research.
We diverge on what we most appreciate instead: tape recorded
sessions for Paul, meta-theoretical (i.e. as theory-free and
experience-near as possible) observation for me. We converge
on the necessity of intersubjective validation of our observations.
We diverge in that Paul views it in the form of inter-rater
reliability, I in the form of trans-theoretical dialogue.
Finally, we converge, in Paul words, on "continuing this
conversation in Florence, where, as last time, we can have
espresso and direct contact instead of words passed along
by electrons"
Reference
Paul
Wachtel (2006). Psychoanalysis, Science, and Hermeneutics:
The Vicious Circles of Adversarial Discourse. Journal
of European Psychoanalysis, 22 - 1. Internet edition:
http://www.psychomedia.it/jep/number22/vachtel.htm
(This paper originated
as an invited address to the Italian chapter of the Society
for the Exploration of Psychotherapy Integration, Florence
2006).
Tullio
Carere, October 19, 2008
Dear Paul,
The experience of reading your last book (Relational Theory
and the Practice of Psychotherapy, 2008) has been one of most
intense participation and learning, very much like the one
I had thirty years ago with your Psychoanalysis and Behavior
Therapy. I admire and feel grateful to you for being able
to capture my attention and interest in such a way after decades.
I will now list the main strengths of your book, as I see
them, before discussing the points that in my view are more
problematic. Firstly, you often point out the gap existing
in most or all of us between our theoretical persuasions and
the way we actually work, which may be influenced by ideas
and principles that we no longer consciously accept. You specifically
refer to the "default position" (the classic or orthodox position)
that conditions the real practice of many relational analysts.
Many times, comparing my mode of working with the clinical
examples presented in your book, I had to realize that my
way of relating to my patients was not always as relational
as I wanted or imagined it to be. Therefore, the immersion
in the reading of your book has been a really "corrective
experience" for me, as I think it could be for many a reader.
Secondly, I agree with you that all too often relational analysts
are relational only insofar as their own relationship with
their patients is concerned, or the relationship of their
patients with significant figures of the past. What all too
often does not receive adequate attention are the vicious
relational circles that maintain the self-defeating patterns
in the present, and the ways to break them. The focus on these
vicious mechanisms makes your approach stand out among the
relational perspectives.
Thirdly, the description of the evolution of psychoanalysis,
from the fundamental Freud's 1926 revision of Inhibitions,
Symptoms and Anxiety to the relationship-centered psychoanalysis,
and to the integration with non-analytic approaches (which
you have pioneered) is in itself a masterful history of our
discipline that I would recommend reading to therapists in
training as well as to expert analysts.
Coming to the (in my view) more problematic areas, I feel
very much in agreement with the approach that you describe,
grounded in unconditional acceptance of the patient's experience,
as the fundamental way of overcoming anxiety that is at the
basis of his self-denial and self-dissociation. I was only
surprised by your presentation of this approach as a conquest
of relational psychoanalysis, with just one small and fleeting
quotation of Carl Rogers--whom I see instead as the true author
of that something-more-than-interpretation approach,
and maybe the most revolutionary thinker in our field after
Freud. By the same token, I was a little surprised by your
presentation of a revised conception of the unconscious that
bears so many aspects of resemblance with Jung's, again with
an even less significant quotation of him in a footnote. I
personally am not a fan of either, but I miss a proper consideration
of these two authors in an otherwise excellent history of
our discipline.
Considering what you have done to open the analytic ears to
non-interpretive approaches, it would be ungenerous to claim
that you did for Rogers and Jung what you have done for behavior
and family therapies. Besides, if it were just a matter of
acknowledgement of the forerunners, its lack would amount
to a really small thing. But there is more to it. Rogers'
was a real revolution at his time, the early Forties of last
century. The psychoanalytic/ psychotherapeutic world was then
under the unquestionable dominance of the "default position",
characterized by an adversarial, challenging and confronting
stance against the resistance to treatment. Rogers had the
guts to question to unquestionable, and say that the king
was naked. In so doing, he probably overdid, but I would say
that it was perfectly understandable at that time and place.
He substituted a thoroughly accepting, reassuring, validating
stance for the default position: Where a stern father was,
a tender mother shall be. At that time, it was a great revolution,
and an extremely brave one (the psychoanalytic establishment
attacked and derided him for that).
A few decades have passed since Rogers' revolution. A father-centered
culture has been replaced by and large by a mother-centered
one (the revolution of which Rogers was an avant-garde has
reached its peak in the meantime: l'imagination au pauvoir,
it is forbidden to forbid, flower children and so on). It
seems to me that the pendulum has swung far enough on the
maternal side, and the time may be ripe for a more balanced
position. However, the provision of a secure base, where the
patient can feel unconditionally accepted, reassured, and
validated, and where he can risk exposure to whatever he is
afraid of and explore all his potentialities, seems to be
throughout your book the only key to improvement and healing--besides,
of course, the recognition of the vicious circles that keep
him stuck and their breaking. Nowhere in the book is a more
"paternal" position, challenging and confronting, taken into
consideration as a possible choice for a given patient at
a given moment. Challenge and confrontation of resistances
and renunciation of illusions seem to be anathema to you.
It seems to me that the strong maternal bias that characterizes
today a great part of the relational field furthers the view
of the patient as a small child who basically needs huge doses
of acceptance and reassurance and little else, whereas the
other child, the Freudian one, who clings to all sorts of
illusions thriving on the ground of infantile omnipotence,
seems to have completely disappeared from the horizon.
You seem to believe that all attitude of confrontation, all
request of renunciation stem from a position of unwarranted
suspicion and criticism. My objection is that this might be,
but it is not necessarily so. In my experience and in that
of many other therapists, a "paternal", confronting vertex
belongs to the field of psychotherapy no less legitimately
than a "maternal", accepting vertex. A proper dialectic between
these two poles is essential for a balanced management of
therapy, if the two basic attitudes are seen as the therapist's
responses to the two corresponding basic developmental needs,
one of finding acceptance and reassurance, and the other of
learning to face reality. Both acceptance and confrontation
belong to the logic or the essence of any care giving, to
the extent that on one side we all need to find secure bases
"from the cradle to the grave", and on the other we all need
to learn to face the real, cruel world that is not there to
protect, support, and validate us in the first place. If a
ruthless, unforgiving world is out there, shouldn't we begin
to train to cope with it in the protected environment of the
parental or the therapeutic relationship?
You will probably disagree with my statement that there is
an intrinsic logic or essence to the care of the self. You
would say that I have an essentialist vision, and a developmental
one on top of it, both of which you take issue with. In your
contextualist view there is nothing like an essence of man,
and the very idea that the patient has to "grow up" is another
anathema of yours. Yes, I am both contextualist and essentialist.
And I am persuaded that at least in the process-oriented type
of psychotherapy the patient has to grow up, as has the therapist
along with him. The clarification of these points brings us
to a second area of difference between us. What follows is
an excerpt of a paper in preparation.
*****
The
very possibility of objective observation is aggressively
challenged by the post-modern Zeitgeist. Quoting Nietzsche's
dismissal”where the presumed objective observation is sarcastically
compared to "immaculate perception"constructionist authors
point out the plainness that the observer cannot divorce from
their own role and standpoint in the observational process.
"The impact of the observer is so pervasive, continuous, and
inevitable"so intrinsic a part of the field of observation"that
the attempt to eliminate that impact is not only to engage
in self-deception, but actually to generate a less accurate
or reliable picture", writes Wachtel (2008, p.17). So, all
attempts to "keep out of the way", or "bracket out" one's
subjectivity not only miss the aim of producing objective
knowledge, but the result is even worse, to the extent that
the contribution of our subjectivity is ignored.
For
compelling that these arguments may sound, they may be faulty
in more than one sense. Firstly, "bracketing out", or "keeping
out of the way" does not mean "ignoring". Let us refer to
the famous Bion's formula of "freedom from memory and desire",
blamed by Wachtel as "utterly and quintessentially a one-person
conception"(p. 125), i.e. one which disregards the essentially
interactive nature of any observation. "It is thus surprising
and disappointing that so many relational writers discuss
Bion's conceptualizations so positively and uncritically",
adds Wachtel. However, the injunction to eschew memory, desire,
and understanding is not a call to suppress the flow of memories,
wishes, images and thoughts that spontaneously present themselves
to the mind of the analyst, as Bion made it clear when he
realized that he had been misunderstood (Bion, 1967, p. 383).
It is not desirable to suppress desires, as it is not conceivable
to suppress concepts. Yet it is both desirable and conceivable
to be free, i.e. not conditioned, by desires and concepts,
expectations and theories. Bracketing out or suspending is
not suppressing, it is just distancing oneself from whatever
prevents one from being here and now. It is freedom from thought,
in favor of thinking. Thanks to this freedom, or to the extent
of this freedom, the analyst can observe both what belongs
to the patient alone, and what belongs to the interaction
between patient and analyst (beside, we should add, what belongs
to the analyst alone)"and be able to sort out what belongs
to whom. Without this freedom, how could the therapist distinguish
the reality of their interaction from their subjectivity?
More in general, how could the observer say anything about
how things essentially are? If we were completely incapable
of objective observation, we could only speak of the way we
subjectively transform things even as we observe them, and
say nothing at all of their essence.
Ironically,
I think that Paul's last book is a great book just because
he says many convincing things of how things essentially are.
One can read the words in essence, essentially, even quintessentially,
almost on every page of the first part of his book, accompanying
his accurate and astute observations. His observations are
not empirically supported, because empirical research has
nothing to say on the essence of things: all it can say is
about the quantitative, measurable properties of things. Galileo,
almost four hundred years ago, deliberately renounced to "try
the essences", in favor of the quantitative, measurable aspects
of things, and the modern science was born. This choice has
brought about immense advantages, at the cost of the loss
of something essential, the very essence of things. Therefore,
I don't mean at all that empirical science has nothing to
contribute to the field of psychotherapy"I only say that
it cannot be the only science for psychotherapy. It must be
complemented by a descriptive, qualitative science, based
on accurate, faithful observations of the essence of things.
And Paul is a great descriptive scientist, not an empirical
one. His cyclical-contextual model is thoroughly based on
good observations, not on Randomized Controlled Trials or
things like that.
Why
does Paul believe that "the pervasive influence of others
in our lives" is something real and indisputable? Because
it "is something that can be observed" (p. 86, italic in the
text). It is not a matter of taste, "It is about whether the
formulation is adequate to account for the clinical data.
Those data "like the data that derive from more controlled
experiments" are always to some degree theory-infused,
difficult to disentangle fully from the preconceptions we
bring to bear in the process of making observations. But they
are not reducible to those preconceptions" (ibid, italic in
the text). That's right. We do have preconceptions, but we
are capable of disentangling the objectivity of our observation
from them. Not fully, for sure "we must content ourselves
of a good enough objectivity. But in principle up to a certain
extent, never fully, we can free our attention"our transcendental
subjectivity" from our memory and desire, preconceptions
and expectations" our empirical subjectivity. Yet this
freedom does not come by itself, it cannot be taken for granted.
It requires discipline of attention and genuine dialogue,
as said before. Therefore, in the discussion of this case
I would call Paul as a witness against his own surprising
conviction that we cannot have a good enough capacity of knowing
things objectively"unless he is fighting the claim of
a perfect, absolute objectivity: but who would be so fool
as to put forward such a claim?
The
whole point, as far as the clinicians/researchers gap is concerned,
is to make very clear that descriptive and empirical research
are independent of one another"although they can surely
complement each other. If it were not so, all Paul's observations
would be worthless unless or until they are empirically validated,
which means that they would be definitely worthless, because
empirical research cannot validate the essentiality of anything.
The logic of the two kinds of research is completely different
from one another, I would say opposite. Paul gets to something
essential inasmuch as he disentangles it from all theoretical
preconceptions that infuse his observational data. It is only
thanks to the neutralization of all theoretical preconceptions
that Paul can arrive to "more general principles that underlie
all good clinical work" and highlight "convergences that have
been obscured by political and linguistic divisions" (p. 14,
italic in the text). This is the very purpose of a general
science of psychotherapy: to describe the general principles
and patterns that are operating in the practice of all therapists,
independent of, or rather obscured by, their theoretical,
political and linguistic persuasions and allegiances. Descriptive
research is meta- or trans-theoretical. Instead, hypothetic-deductive
research works on the premise that our observations are insuperably
theory-laden, i.e. we always look at the world through our
theoretical lenses. It takes the theoretical infusion of all
our observations as a fact that it does not challenge at all"it
rather makes its basic premise of this undisputed fact. We
cannot see anything without theoretical lenses, says the ideology
of empirical research; but we can find out which lenses work
better on our nose. Empirical research is thoroughly pragmatic,
it is completely unconcerned with matters of essence or truth.
It cannot verify anything, but it can falsify wrong theories.
Paul
Wachtel, October 29, 2008
Hi
Tullio,
Some thoughts about your comments on the book. First
of all, thank you for all the nice things you say. I really
appreciated those comments, especially because it was clear
that you had "gotten" what I was saying in so many ways.
I also appreciated very much your comments regarding Rogers
and Jung. I have never done much reading of Jung, so I can't
comment much on what you said other than to acknowledge that
indeed I do not cite him and haven't been very aware of where
there are overlaps. With regard to Rogers, whose ideas I am
much more familiar with (I have only an amateur's understanding
of Jung, not the subtleties), I think you are absolutely right.
I think I actually became more aware of the convergences with
Rogers after I finished the book. Partly it derived from being
asked to write a commentary article on Rogers's classic "necessary
and sufficient conditions" paper, which led me to immerse
myself in his work. Partly it came from thinking more explicitly
about the "fourth" leg of my integrative approach "that
is, after first addressing psychoanalysis and behavior therapy,
then extending the integration to family systems thinking,
I have increasingly been interested in the "experiential"
approaches as a fourth dimension to be integrated, and in
so doing I have been thinking more about Rogers. I've
also noted, in observing my own comments as a therapist, both
for a new book based on a video of my work and some transcripts,
and in watching over my own shoulder in my sessions, that
a lot of what I do sounds sort of like Rogers, in the sense
of restating what the patient has just said. Of course,
my aim is more "directive" than his, to promote exposure,
lead the patient toward important new patterns of behavior,
etc. I disagree with his faith in the "spontaneous growth"
hypothesis, because I see things as more complicated than
that. But I do find that I have renewed respect for
his work, deriving from both the theme of rooting exploration
in being supportive and facilitative rather than "suspicious"
and simply from watching what I actually do.
Where I think you and I diverge most (and I think we have
differed in this way before) centers on the mother-father
distinction. In part, I am not as struck that "A father-centered
culture has been replaced by and large by a mother-centered
one." I understand what you are pointing to, and
they are important changes. But sitting here in NY,
with the mean-spirited authoritarian George Bush still president
(even if deservedly very unpopular), and with anxiety that,
although Obama is ahead (and, my rational self tells me, probably
will win), McCain's "trust the warrior father" message and
deriding of Obama's "socialism" for wanting anything other
than let the strong and aggressive take all they can "“ that
all this even has a chance at winning, even after four years
of Bush, does not speak so loudly to me of a mother/nurturance
culture. (And then you've got this guy Berlusconi over
there, also not quite Mother Teresa).
I do understand the kind of balance you are asking for.
In part, my answer is that sometimes I do do what you are
requesting, though certainly the book highlights another side.
It highlights it (a) because I believe that the proper "balance"
is not fifty-fifty, and that it can seem that way when it
isn't because there are flaws in the mother-father metaphor,
which seems to imply there is one of each so an equal dose
of each. But there are certainly times when some kind
of effort to push for change is needed. Rather than
think in terms of the mother-father metaphor, I am more taken
by the dialectic between acceptance and pushing for/promoting
change. For me that captures better the need to not
just accept.
But my divergence from the balance you would like also reflects
a different assessment of where the field is. Just as
we are still in the Bush/Berlusconi era, we are also, in psychoanalysis,
still characterized by a good deal more accusatory/suspicious
stances than I think is acknowledged. Were the field bending
over the other way, I might well be making the kinds of arguments
you are (though still, I think, with a belief that the nurturant
side is more useful more of the time for most patients "“
definitely not all).
Also, and important, what you (and here I too) are calling
the mothering or nurturant side is not devoid of the "hard"
confrontation with the truth and with what has been avoided.
Those elements have always been central to my thinking, which
is why I emphasize exposure so much. It is exposure
to the "hard stuff" that is needed.
As to Bion, as well as the possibility of objectivity, bracketing,
etc., we've already had some discussions of these, and we
haven't agreed yet. But I think it is good to keep talking
about these issues, and it is one of many reasons I am looking
forward to the meeting in Florence in 2010.
In any event, I am by no means a fanatic about randomized
controlled trials, and have critiqued their inappropriate
use as a criterion myself. But I do think that we need to
strive to create appropriate controls to whatever degree is
possible without killing/losing the phenomena of interest
in doing so. And I think we all need to be very skeptical
about our clinical judgments, especially when the data on
which they are based are solely things we "remember" rather
than transactions that have been tape recorded, say.
The confusions - and ambiguities about where we agree or disagree
- come with phrases like "the neutralization of all theoretical
preconceptions" or "we are capable of disentangling
the objectivity of our observation from them," followed by
"not fully, for sure" and "good enough." I am not a
constructivist fanatic any more than a rct fanatic.
I do think that somehow we muddle through enough to see something
useful, that it is certainly not just arbitrary or just "made
up." But I think you are more sanguine about how much
we can do that, and about how seriously we should take what
are often pronouncements by clinicians rather than real reports
of observations that we can look at independently and draw
our own conclusions from (as, again, with tape recordings
- which of course are also imperfect but often "good enough").
This is another part of my lack of enthusiasm for Bion, who
strikes me as a "pronouncement maker" par excellence.
I'm not sure exactly what it means to make "descriptive and
empirical research independent of one another," but my guess
is that if I understood fully I would find it too dichotomous
a formulation, and a way of sneaking in a warrant for "theory-less,
just 'real' observing", about which you know I am skeptical.
Related, when you say "Descriptive research is meta- or trans-theoretical.
Instead, empirical research works on the premise that our
observations are insuperably theory-laden, i.e. we always
look at the world through our theoretical lenses." I feel
that you almost have it backward. Unless you are acknowledging
that "empirical" research acknowledges that our theories (as
well as our personal predilections) shape our perceptions,
and that therefore we must devise ways to at least somewhat
correct for or minimize this whereas "descriptive" research
denies this inevitability and posits a kind of immaculate
perception. To me, being aware of the danger enables
you to get at least halfway there. Thinking we have
somehow transcended this keeps us not only deluded about our
objectivity but unable even to address that (inevitable) overvaluation
of our own perceptions. How do we decide when Bion,
out of his presumed direct contact with reality, with the
"essence" of things, uninfluenced by any context that might
constrain the universality of his claims, says something different
from another psychoanalytic guru, who claims that same objectivity.
Therein lie cults it seems to me.
Anyhow, that is surely enough for now. Again, I really
appreciate the serious attention you have given to my thinking,
and I look forward to our continuing this conversation in
Florence, where, as last time, we can have espresso and direct
contact instead of words passed along by electrons.
Tullio
Carere, January 25, 2009
Dear Paul,
emerging from a period of intense work, I would like to briefly
comment on your October 29 comment on my comment on your last
book. We shall surely talk on these matters next year in Florence,
because they are specially relevant to the theme of the conference.
I would only like to prepare our live conversation with some
electronic words.
Two points. First, the maternal-paternal polarity. I agree
with you that this metaphor might be misleading. In fact,
in my general map of the therapeutic field I have long replaced
it with the dialectic Acceptance - Confrontation. The meaning
is the same, but it avoids some problems generated by the
parental metaphor. Let me compare it with your dialectic between
acceptance and pushing for/promoting change. We agree on the
first term acceptance, very good. Let us consider the second.
Promoting change hardly stands to me in a real dialectic polarity
with acceptance, because acceptance itself is change promoting.
Pushing for is indeed contrary to acceptance, but I prefer
confrontation because it seems to me as a more dialogical
term. I push somebody for change if I am somehow convinced
that he is in a wrong position and must change. Instead, if
I confront someone with my opinion, I do not imply that my
opinion is right and his is wrong. I simply ask him to confront
his opinion with mine which is different, which implies that
a contradiction must be faced. As a result, he can change
his opinion, as I can change mine, or both can change ours.
Confrontation only means that a contradiction or a conflict
must be faced. Pushing for change sounds to me a little too
behavioral, or "paternal" in the old, authoritarian meaning.
I would see Bush as pushing, and Obama as confronting. By
the way, congratulations for being able, you Americans, to
produce a president like Obama. There is sadly nobody like
him on our grim horizon. No hope to get rid of our champ in
a short or even reasonable time.
Second point, theoretical vs. trans-theoretical (descriptive,
phenomenological) research. Why should the latter be based
on "immaculate perception"? Of course perception, or intuition,
is never immaculate. Both theoretical and descriptive science
have the same aim: to correct as much as possible all subjective
biases in order to get a knowledge as objective as possible.
But the fields of application, and the methods of research,
are different for the two types of science. For instance,
if you are a botanist and discover a new plant, you don't
make up a theory to demonstrate its existence. You just describe
it, including the place where it grows, so that anybody can
go there and see it with their own eyes. Just one or two specimens
of the plant may be enough, you don't have to have many and
elaborate statistically on the data you collect. Of course
your description can be flawed in some respect. But you don't
devise experiments, nor you start number crunching, in order
to cope with the possible flaws. What you do is different,
if you want to stick by a descriptive approach. You send your
description to one or a few colleagues, possibly of different
theoretical persuasions, asking if they have observed the
same phenomenon, and if they would describe it as you do,
or differently. But such a dialogic comparison can take place
only to the extent that those taking part in the dialogue
are willing to temporarily suspend their theoretical persuasions,
in order to observe the phenomenon at hand from one as much
theory-free standpoint as possible.
For instance, take the "acceptance versus X" phenomenon that
we have been discussing. This is not a matter of theory, but
of accurate observation. We already are at a good enough point,
because we agree on the acceptance pole "“ who could not
agree on the hard fact that acceptance is fundamental in any
psychotherapeutic endeavor? Similarly, who could disagree
on the equally hard fact that acceptance must be balanced
with at least a minimal request for responsibility, a request
that can be more vigorous, the more developed is the self-structure
of the patient? Now, what do you do to request responsibility
to your patients? You might answer that you can do myriads
of things, from an almost imperceptible raise of your eyebrows,
to a formal request not to slam the door when they enter your
office. Is there a single, non judgemental word to describe
the fact that you disagree with what the patient is thinking
or doing? It seems to me there is one: you confront the patient,
in one out of a myriad of ways, with the hard fact that you
don't think that the way he thinks or behaves is the best
way to get what he wants or needs. Maybe sometimes you want
to push him to change his thought or behavior, but probably
this is not a thing that you do on a regular basis, whereas
confrontation much more probably is such a thing.
How do we get to a shared description of a phenomenon? Maybe
we never get there, for instance if for some unknown reason
you hate the word confrontation. But the progress of science,
of this kind of science, does not need that everybody completely
agrees on a corpus of phenomena. A "good enough" inter-subjective
agreement is enough. We have been discussing the maternal-paternal
thing for a decade or so now, and it seems to me that a good
enough inter-subjective agreement is not much ahead now. Can
the dialectic acceptance-confrontation, as I have been briefly
describing it here, be counted in your view as a robust phenomenon
of our field, or would you describe the essence of this phenomenon
in some other way, or would you reject altogether the idea
of robust phenomena as relevant to our field?
I hope I have made it clear enough that there is a science
that puts hypotheses to empirical test, and there is another
science that discovers and describes robust phenomena. The
two scientific approaches can obviously and fruitfully collaborate,
provided that one doesn't fall into the unfortunate misunderstanding
of thinking that descriptive science is no science at all,
but just a way of producing hypotheses to be empirically (i.e.
through measurements and statistic elaboration) tested "“
science being only what results from empirical testing of
hypotheses, a most widespread myth of our time. Only to the
extent that we are free from that myth, and acknowledge descriptive
science as a science in its own right, not just a preliminary
survey of a field aimed at producing hypotheses for the real
scientists to work on, can we pass to the next question: is
empirical or descriptive science more appropriate to the study
of the peculiar subject matter of our field? I anticipate
my answer to this crucial question: it depends. If science
is meant to reply to questions like what works with whom and
why, empirical science clearly is the science of choice. If
instead science is meant as an exploratory enterprise whose
main task is to discover and describe the fundamental regularities
or formulate the basic laws of the field, in order to design
maps of a territory in which every single therapeutic couple
will draw the path that is unique to that patient and that
couple, then descriptive science is likely to produce much
more meaningful data.
Surely next year in Florence, Paul, but hopefully before on
this electronic medium, I will be happy do discuss with you
and anybody interested my conviction that in the post-Dodo
bird-verdict psychotherapy the prescription (what to do with
whom) is less and less relevant, whereas what is really important
is the description of the field, which can be compared to
a mountain crossed by many paths. In other words, we hardly
need manuals, what we mostly need are maps of the territory,
as tools for the orientation in a course that is highly context-dependent
and unpredictable. In this perspective, the descriptive, trans-theoretical
research is bound to come forth as the science of choice.
Paul Wachtel, September 16, 2009
Hi Tullio,
You have invited me to have "the
last word"¯ (at least for now) in this discussion.
I thank you for that, but I will also try to keep it short.
There are ways in which these conversations can feel like
flypaper. As soon as we get unstuck from one misunderstanding
(the misunderstandings, of course, being judged differently
by each of us) we are right in the thick of another.
Clearly we will not resolve the matter in this exchange.
I think, as my final comments, I
will stick to just a few themes or issues. The first
is the distinction you make between descriptive and empirical.
To me, descriptive is empirical. There is formal,
controlled empirical/descriptive work and there is empirical/descriptive
work that is not - or cannot yet be - controlled in this way.
I am a big fan of Polanyi, who argues for the importance of
trying to articulate "tacit"¯ observations, things
that you sense but cannot yet state in a more formal way.
But Polanyi does not have any illusions about grasping"essences"
or about getting directly to the reality of things by bracketing
presuppositions. We inevitably see through our
presuppositions (including, I would say in your case, the
presupposition that one can eliminate - or even significantly
"bracket"¯ presuppositions). These presuppositions
are, so to speak, filters. They are not blindfolds.
That is, they do not prevent us totally from seeing things
as they are. I am not a "my-head-would-go-easily-through-this-wall-if-that-happened-to-be-my-social-construction-so-I-will-hit-it-hard-against-the-wall"¯
type postmodernist. I think that there is a there there,
that there is a reality of some sort in many respects.
But I also think that it is damned easy to see that reality
through our particular filter, and that when one does, everything
"looks like"¯ it confirms that filter. So I am wary
of the filter, respectful of the scientific methods that aim
to provide some correction for it (though without any
illusion that it can be eliminated completely to get to a
purely "objective"¯ truth or reality).
So, to return to descriptive and empirical,
to me the distinction is not between these two but between
various ways of attempting to control for one' own biases.
There are various stages of observation and various modes
of observation that have value throughout the continuing process
of formulating and refining one' understanding, and there
are various stages and modes of checking on one'
observations. Leaping immediately to, or only paying
attention to, controlled experiments would impoverish our
understanding enormously and, indeed, short-circuit the conduct
of science itself. But romanticizing the "descriptive"¯
part of the continuum as somehow directly in touch with "essences"¯
or as not needing the same skeptical caution that other observations
do seems to me problematic. Of the various ways of trying
to correct at least in part for our filters, "bracketing"¯
seems to me one of the weakest. This is probably where
we differ most. I wish I could "disentangle
my observations from all theoretical preconceptions that infuse
my observational data,"¯ but I think you give me too much
credit in this regard. Alas, I am a human, not a god, and
I don't believe we humans can do that.
Regarding the issue of "confrontation,"¯
it seems to me that in part we read (through each of our different
"filters"¯) different connotations into that particular
word, and so to some degree keep meaning different things
by the same word. I certainly do agree that not everything
the patient does or believes is in his own best interests,
and that doing something that enables him to consider
or to see that is a part of the process we engage in.
I do offer my own input or point of view in various ways as
a counterpoint to the way the patient has seen things.
If you want to call that confrontation, then that is your
preferred vocabulary. But even with our using different
terminology -- and in your terminology, you say Bush pushes
and Obama confronts-- I am sure that you certainly don't think
my approach to people is more like Bush than Obama.
So in this regard at least, we probably disagree less in substance
than in what words we use to describe the substance.
But to really know if that is the case, or to know whether,
in the room with the patient, we actually go about it in a
similar way, we would have to look a lot at each other's sessions
to know that, and you are against taping sessions so I don't
know how I could look at yours.
Finally, to stay with the theme of
Bush and Obama, let us celebrate the fact that sometimes a
measure of enlightenment can appear in human affairs
at times. When I wrote my first response to you in this
exchange, George W. Bush was president. Today, it is
Barack Obama. That is cause for great celebration. But
in recent months, the same primitive, rageful, reality-denying
(yes, as I said above, there is a reality) mindset
that Bush represented is back with a vengeance, attacking
Obama with lies and almost psychotic delusions. If only
those people could "bracket!"¯
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