When our services are provided without a partnership with those receiving them, the client can easily become a cardboard cutout. Moreover, as the trend toward evidence-based practice picks up steam, therapists and clients uncomfortable with this market-driven standardization will find themselves under enormous pressure to conform. So before carved-in care becomes the only game in town, those of us who envision a different future for psychotherapy must step forward to make the case for therapeutic multiplicity.
No matter how invested we are in our own particular clinical methods, we first need to acknowledge that there are many ways to respect our clients' values and perceptions, many ways to be effective and many ways to maintain our clinical integrity. This isn't as easy as it sounds. We have all worked hard to establish our own distinct identity as therapists. We've invested heavily in our own methods. But if we do not unite behind methodological pluralism, we will be easy targets for medical-model ideologues, the proponents of empirically supported treatment and the bean counters of the HMOs.
Clinicians today must take stock of both the values that underlie our practices and our responsibility for professional accountability. Each of us must do his own soul searching about these issues. So what follows is not meant as a blueprint for how therapy should be practiced, just my own conclusions (along with my colleagues Scott Miller and Jacqueline Sparks) about how to extend to clients the same therapeutic freedom we must defend for ourselves and some alternative ideas about what the empirical literature can teach us regarding accountable practice.
Not long ago, I worked with Erica, a woman in her mid-thirties who came into therapy searching for an identity that she believed she had lost. All her life, Erica had wanted to be a police officer. As a teenager, she rode with state troopers, and as a young woman, she became the first female to graduate from the police academy.