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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and 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Although first published in 1994, Ernesto Spinelli's Demystifying Therapy remains relevant to the current issue of statutory regulation in psychotherapy. His book focuses upon the power in the therapeutic relationship, and how this is reinforced by theory, politics and the current intellectual climate.
Spinelli begins by examining what is signified by the term 'psychotherapy', and the distinction between psychotherapy and counseling. In doing so, he addresses the prevailing assumption that counseling differs from psychotherapy in terms of depth and purpose. It is often assumed that the counselor deals with current problems and tends towards 'solutions', as opposed to the 'deep-seated' problems addressed by the psychotherapist. Spinelli examines BACP definitions and cultural attitudes concluding that this distinction probably has more to do with 'image-marketing' rather than any substantive, identifiable difference between the two. There is also the issue of one's 'status' as a practitioner, which tends to define the way in which the therapist conceives their work. The term 'psychotherapy' calls to mind the in-depth, and often extremely protracted image of traditional Freudian training, as opposed to the relatively shorter term required by counseling. However, this distinction merely a historical one, since it is now possible to undertake training in both psychotherapy and counseling of a similar length and depth. The greater prestige of psychotherapy may also be imputed to its perceived relationship to medicine, since many of the 'founders' of psychotherapy (including Freud) were also medical doctors. Again, this distinction is somewhat irrelevant today, as many practicing psychotherapists are not medically trained. Spinelli challenges and rejects such convenient distinctions in favor of a more sophisticated approach. Drawing upon the Wittgensteinian notion of 'games,' Spinelli argues that there is no one single criterion which must be fulfilled for psychotherapy to be referred to as such. Instead, he argues that there is a family resemblance relationship between the different forms of therapy. It would seem that Spinelli's position is supported by the burgeoning field of 'psychotherapeutic counseling', which rejects the notion of solutions-focused therapy as divisible from in-depth analytic work.
Spinelli's rejection of psychotherapy as clearly defined also has implications for the way in which we conceive the therapeutic relationship. If there is no single definition of therapy, then we are unable to point to a technique, theory or method that defines the work of the practitioner. Whilst this may complicate the future regulation of the profession, this conception also has a number of benefits. For, if we cannot point to one single body of knowledge, this prevents the practitioner from being comfortably placed as an 'expert.' Spinelli cautions against the practitioner becoming attached to a particular theory or picture of what therapy is/should be. If the practitioner is constantly reassessing what they are actually doing as a therapist, and why it is therapeutic, then therapy continues to evolve and has greater potential to be client-led, rather than dictated by the practitioner.
Always mindful of the socio-political climate, Spinelli examines ethical issues bound up with the provision (or withholding) of state-funded therapy, assessing such thinkers as Thomas Szasz. The justification for funded therapy is based largely on outcome-related evidence for the efficacy of psychotherapy. Spinelli examines the problematic nature of determining what counts as 'evidence' for the success of a particular therapeutic technique. Again, this is of great contemporary relevance, since CBT has recently been favored for funding by the UK government, based upon statistical evidence for its efficacy. Spinelli argues that outcome-related studies almost invariably focus on a direct causal relationship between therapeutic intervention and change. Whilst this may seem to be a straightforward way of measuring 'success' it is in fact fraught with problems. We do not know for example, whether change has been sought for its own sake, for the client, or in eliminating behaviors detrimental to society. Spinelli suggests that many therapists have themselves fallen into this trap, regarding change as the goal of their enterprise in order to give it meaning. This, argues Spinelli, can result in the therapist leading the client, and neglecting deeper issues in favor of changing surface behavior.
As well as the socio-political issues surrounding psychotherapy in general, Spinelli submits the psycho-analytic, cognitive-behavioral, and humanistic models of psychotherapy to his process of demystification. He shows, for instance, how recourse to theory can lead to a significant unbalance in power in the working alliance, with the potential for abuse. The psychoanalytic concept of the unconscious, for instance, can be used to reinforce the therapist's position of power. If a client rejects the practitioner's interpretation, the therapist may maintain that this is due to deep-rooted defenses not accessible by the client. The potential for abuse is evident here, as the recourse to 'hidden' motives leaves no room for the interpretation to be falsified. Indeed, any such attempted repudiation of the therapist's interpretation has the potential to be seen itself as symptomatic of unconscious, repressed conflicts. As an alternative to this, Spinelli defends a different model which does not allow the therapist a privileged interpretative position. He proposes a dissonance between 'beliefs about one's self and the experience of one's self' (p.93) which does not draw upon the notion of unconscious material. His notion of 'dissociated consciousness' rather than 'unconscious' material places the practitioner and client upon an equal interpretative footing.
Perhaps most relevant to the current political climate is Spinelli's examination of cognitive, and cognitive behavioral techniques. Whilst acknowledging the relative transparency of cognitive-based therapies when compared to psychoanalytic practice, Spinelli highlights the implicit assumptions made by cognitive therapies. There is, for instance, an assumption about what rationality and rational behavior entails. In much cognitive therapy, the client learns techniques and practices for challenging their own assumptions. The emphasis on method and learning coping strategies can place the practitioner in a didactic role. Spinelli cautions that this can promote an imbalance of power, rather than mutual exploration in the therapeutic process.
Spinelli's book is a superb introduction to contemporary debates in psychotherapy, and is relevant to current controversies in the psychotherapeutic community. In addition, the book is itself an ethical endeavor, as it prevents the therapist assuming the power of 'expert' in therapeutic relationship, whilst also acknowledging that subtlety and skills needed for the job. As such, Demystifying Therapy is useful for both clients and practitioners of psychotherapy.
© 2008 Laura Cook
Link: Publisher web page for book
Laura Cook is a research student at the University of East Anglia, and a trainee Integrative Psychotherapeutic Counselor. Her research interests include philosophy of psychopathology, modernist literature and psychoanalysis. She is the editor of Applying Wittgenstein by Rupert Read, forthcoming with Continuum Books.