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Psychotherapy's Greatest Debates

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MA2012-3Assessing the State of the Art 2012

The State of the Art, the Networker’s first-ever virtual conference, offered an opportunity for leaders in our field who disagree to debate each other. Here’s your chance to hear what they said and consider what it means for the future of our profession.

Last fall, for the first time, the Networker held a two-week virtual conference called “State of the Art.” The idea was to collect together the most provocative articles, inspiring Symposium addresses, and compelling online courses that had appeared in the various media platforms through which the Networker carries on its mission of furthering the exchange of ideas and information throughout our field—our magazine, annual conference, and year-round program of online courses and interviews. Through the miracle of modern digital technology, “State of the Art” allowed a worldwide audience of therapists from more than 15 countries not only to experience this material, but also engage in an ongoing conversation about it.

In addition to highlighting what we thought of as the Best of the Networker, “State of the Art” offered an entirely new program of sessions that accomplished something rare in our field—an opportunity for debate and dialogue among prominent figures exploring the important issues shaping current practice. What follows are excerpts from three of those dialogues, which proved to be the most-discussed events.

The Great Attachment Debate, Round 2

By Jerome Kagan and Dan Siegel

At the 2010 Networker Symposium, celebrated developmental psychologist Jerome Kagan expressed his view that Attachment Theory, a view of human development inspired by British psychiatrist John Bowlby that’s generated a huge research literature during the past 60 years, had failed to provide an empirical foundation for its premises and become irrelevant. In a heated confrontation at the conference, psychiatrist Dan Siegel, a pioneer in bringing an understanding of brain development into clinical practice and a strong proponent of Attachment Theory, interrupted a workshop to challenge Kagan’s assertion. Their exchange became the happening of the entire conference. As part of State of the Art, we invited Kagan and Siegel to have a follow-up discussion. What emerged once again became the dramatic highlight of the gathering for many, but this time, for their unexpected agreement, rather than their differences.

Q: Could each of you take some time to talk about what you consider the key factors in early development and the weight you give to each of those factors?

JEROME KAGAN: First of all, to talk about development broadly without endpoints gets us nowhere. So let’s take as criteria the problems that most therapists deal with each day: bouts of depression, anxiety, suicide attempts, drug addiction, problems with the law as young adults. How can we predict these symptoms from early and later life experiences?

My view is that each of these symptom profiles is multiply determined: there’s no single cause for any one of them. As I reflect on my research and all I’ve read—and I read a lot—one can make general statements about the order of importance of certain factors that lead to different symptom profiles.

I’d begin by looking at the temperamental biases that a person was born with. Then I’d look at the person’s social or economic class as a child. Were they born into poverty, a blue-collar family, the middle class, or an elite family? Next I’d look at their experiences with parents in the opening years of life.

Then I’d look at the patterns of identification at age 5 to 6. Was a grandfather arrested? Was a parent an alcoholic? These patterns of identification can have consequences that are very different from those created in the first year of life. A child could have had a loving mother in the first year and learn at age 6 that his or her grandfather was Hermann Goering, which could precipitate a depression, despite a secure attachment to parents at 1 year. The child’s ordinal position in the family makes a small contribution. Was the child an only child, first born, second born, or third born? Finally, the culture and historical era are influential.

No psychologist knows the varying influence of each factor for an individual. That’s for future scientists to determine. All we can say today is that these are the ingredients. The first four are the most important; the others are less important, but they have power.

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