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Clinician's Digest - Page 2

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Wise Therapists or Technicians?

In a report for the American Psychological Society in November, 2009, psychologists Timothy Baker, Richard McFall, and Varda Shoham decried the "prescientific" emphasis on subjective variables like intuition and empathy in the education and training of therapists. They proposed, instead, strict science, research-based curricula and empirically-supported treatments (see Clinician's Digest, May/June 2010). Their report, which was picked up by such major media outlets as Newsweek, made the profession look foolishly New Agey and insubstantial. Critics of the Baker report contend that it proposed too narrow a knowledge base for therapeutic practice, ignoring the mounting evidence that relationship factors count more heavily in positive outcome than specific clinical methods, however "empirically supported" they may appear.

Rather than moving in the direction of quantitative science, some believe that today's therapists should look for greater understanding of their fundamental task to the age-old concept of wisdom. Among these is Heidi Levitt, a prominent researcher of the therapeutic process from the University of Massachusetts Boston, who insists that therapeutic wisdom encompasses more than knowing the research and becoming adept at delivering manualized treatment. In one of her current studies, she and her collaborator Elizabeth Piazza-Bonin interviewed an elite group of therapists who'd been chosen as individuals who exemplify therapeutic wisdom by a sample of 800 therapists. What did this group of wise therapists consider the therapeutic task to be, and what did they have in common? Instead of seeing themselves as problem-solvers, they emphasized listening empathically to their clients, and knowing how and when to draw from their own life experiences to increase their attunement to their clients' experiences. In addition, rather than moving quickly to resolve their clients' doubts, questions, and confusion, they were at home with tolerating and exploring life's messy ambiguities.

Another psychologist trying to look more systematically at the nature of therapeutic wisdom is Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School, who, as part of a book project, asked 20 prominent therapists to describe therapeutic wisdom. While several of the authors in Siegel's book give the task of clinical problem-solving its due, most focus on the ability to help clients tolerate ambiguity and emotional pain.

Both Levitt and Siegel believe that training programs shouldn't focus exclusively either on working with empirical data or developing the capacity for wisdom. Nevertheless, they emphasize that wisdom is founded on an appreciation for questions. "Rather than reward students who come up with answers," Levitt says, "we should teach students to spend more time on learning to develop questions—with clients, with themselves, and with their research. Maybe we should admit students by looking at their interpersonal skills, their capacity for empathy, and their ability to tolerate ambiguity. As faculty, we need to model these values, and not just teach interventions."

Siegel feels that the movement to turn therapists into the equivalent of researchers focused on empirical evidence is unwise: "Virtually all models of wisdom, across time and across cultures, point to the limitations of intellect alone, and the importance of other faculties that we might call social intelligence, affective relatedness, intuition, and, in particular, appreciation of the complex interrelatedness of all things—faculties that a narrow focus on experimentally testable mechanisms is unlikely to develop." He has an intriguing suggestion for determining the best method to prepare therapists for the challenges of practice, because we lack clear data about effective training. "Let's have therapists devote two weeks of their lives to reading research studies and then spend a week in a silent meditation retreat," he says. "Then have them do some therapy and report which seemed to improve their treatment more."

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