Psychologists as psychotherapists: the problem of reconciling Laurel and Hardy
Psychologists who work as psychotherapists are faced with the task of relating their two roles. Some shirk the task of integrating completely and wear their psychologist hat and their psychotherapist hat alternately, as unrelated types of headgear. They speak with forked tongue. It depends which act you hire them for, what kind of performance you get. They can switch from being your kindly, common-sense, play it by ear, friendly, neighbourhood counsellor to being your hard-headed, correct to the third decimal place scientist and never the twain shall meet.
A common way of failing to interweave the languages of psychology and psychotherapy is to let one become a faint echo of the other. Many psychotherapists practice a curiously unimaginative kind of psycho-therapy which overspecifies the problem of the client and mechanises the contribution of the therapist because they feel that thereby they will not jeopardise their membership of the Science Club. Equally, some espouse a cloudiness that would foredoom psychology as a discipline never to advance beyond the wisdom of the personal chat because they feel that in this way they are remaining true to the values of psychotherapy.
At best a related concern with psychology and psychotherapy can clearly enrich both. Consider three central themes in psychotherapy which might, to good ends, become our concerns in psychology.
If you undertake psychotherapy you will realise that clients put themselves at serious risk by confiding their problems to you and by heeding the ways in which you respond. This confidence of the client is only bearable if you are reasonably convinced that your contribution is as important and as valid as you can make it. Your belief in the significance of your contribution is primary - only in relation to that do you feel it appropriate to solicit the approval of colleagues. It can be argued that in formal psychology we have come to regard the approval of our colleagues as our primary concern - our personal conviction or lack of it is not closely examined. The importance we attach to publication and our very style of publication suggests that it would be scientifically ill-mannered to ask a colleague whether he or she personally thought their contribution trivial or significant. Yet clients in psychotherapy are implicitly asking this question. The experience of psychotherapy might be of value in encouraging us, as psychologists, to evaluate personally what we declare publicly.
The second dominating characteristic of a psychotherapist's experience is that issues of concern are formulated by the client. This is in stark contrast to the situation in experimental psychology where the subject is truly an object and issues of concern are formulated by the psychologist. We might do better as psychologists to find ways of exploring the language, invention and focus of people rather than using them as often bewildered illustrators of what we have determined are matters of importance.
Thirdly, in psychotherapy the client will continually remind you - if you are inclined to forget - that he or she lives within a context, that what is factual and what is problematic for them, is so within a human situation of which they are part creators and part prisoners. In psychology as a formal discipline we most often try to strip away the personal situation of our subjects and substitute for it the denatured and featureless landscape of the laboratory. We might gain in scientific understanding if we were to accept that to understand persons we must endeavour to understand the context with which they are engaged.
Equally there are aspects of psychotherapy which can be profoundly changed because the practitioner approaches them as a psychologist rather than as social worker, psychiatrist, priest or purely on the basis of his or her personal wisdom.
Struggle as we may, psychotherapy, like the word itself, is still enmeshed in the medical model and we tend to pathologise our clients, to see them as patients with illnesses rather than as persons with problems. We do this not least because clients often prefer to view themselves as suffering from ailments rather than as having made mistakes. Psychology has no historical allegiance to a medical model and insofar as it deals with human experience and behaviour as integral then the psychologist-psychotherapist will be that much less likely to divorce the complaint from the situation and purposes of the client.
Again, because the client is suffering pain and demands relief from it psychotherapists are often driven to look for short term empirical procedures and readily available comforts - the psychological equivalents of the anti-depressant pill. Insofar as psychology insists on the value of a theoretical framework then it inspires the psychotherapist to seek an overview rather than simply accumulate a ragbag of useful tricks, mini-theories and stylistic skills.
Thirdly, psychology, like any science, involves a continuous discussion as to the way in which hypotheses are formulated and evidence is evaluated. Such a concern not only forewarns the psychotherapist against simply bullying his client into compliant normality. It can in turn be offered as a direct gift to the client, so that he or she can review the nature of their own hypotheses and their own uses of evidence.
If a joyful reconciling of psychology and psychotherapy is to be achieved then it may be that neither of them can continue to stand on their traditional grounds. Psychology may need to find new focal models and metaphors. It may have to move from using as its classic foci the navigational problems of the Norway rat, the favoured fornications of the fruit fly, the quandries of the computer or people struggling to remember the eminently forgettable or learn the tremendously trivial. Equally psychotherapy will have to transcend some of the boundaries placed on it by institutional control and be less tamely accepting of social definitions of normality and abnormality.
It may be that the biggest barrier to effective interplay between psychology and psychotherapy has been our adherence to the convention that they represent pure and applied psychology respectively. The convention copies, say, the distinction between pure and applied mathematics. However the parallel breaks down since it is clear that most of the psychology which clinical, educational and industrial psychologists apply is home made for their purposes and is not in fact an application of academic psychology. Equally academic psychology has become its own club, its own way of earning a living; it has become psychology applied to the practice of university experimental laboratories. The distinction becomes more gravely limiting when we reflect that it is not only an intellectual distinction between aspects of psychology as a discipline. It is a distinction between psychologists, so that we have two fairly well separated groups of people respectively seeing themselves as pure psychologists and applied psychologists.
This divorce between pure and applied psychology and psychologists has lead to two kinds of evil. It has left applied psychologists unsupported by their parent discipline, so that they have been too dominated by the orthodoxies of the institutions within which they work. Clinical psychologists are intellectually as well as politically harassed by medicine, educational psychologists have been heavily trapped into bandaging the walking wounded of the educational system, rather than changing that system. Industrial psychologists have become too much an ancillary of management. Equally the separation has caused pure psychologists to trivialise their discipline and their activities because there is no demand on them to answer questions which are any more than academically fashionable.
If academic psychology took itself seriously then new psychology graduates would be capable of involving themselves immediately in psychotherapy. This is not to say that psychotherapy is easy - it is a never ending learning task which gets no easier because you have been given diplomas or certificates by your colleagues. It is to say that if academic psychology took itself seriously then it would demand that its students address themselves to the problem of their own nature and the nature of their relationship with others. It would thereby equip them to take at least an initial hold upon issues central to psychotherapy.
Nor am I arguing in this discourse that the particular relationship which evolves and is explored in psychotherapy is the only or the primary relationship that psychology should use as a model. The relationships confronting educational, social and industrial psychology, that is to say the relationships between teacher and pupil, friend and foe, master and man, are equally significant.
What I am asserting is that psychology is best seen as a mode of exploration rather than as a body of knowledge. If we discard the notion that we have a body of knowledge to apply then we can look on what is currently called applied psychology as the process whereby we create psychology and not simply particular cases to which we apply it.
The logical conclusion of this line of argument is that we should perhaps cease to regard ourselves as clinical, educational or industrial psychologists and certainly not as pure or academic psychologists, but see ourselves simply as psychologists. Psychologists who are engaged in testing out and thereby elaborating the usefulness of psychological ways of conceptualising human undertakings.
If Oliver Hardy represents hard-nosed, academic psychology and Stan Laurel represents the vaguer ventures of psychotherapy then certainly academic psychologists who confront the central issues of psychotherapy might well find that this is another fine mess you've got me into. But then there might be much to be made out of another fine mess.
Address to the British Psychological Society Annual Conference 1978