Theoretical Orientations as Straw Men

The appeal of reviling other therapists' approaches.

Posted Sep 25, 2017

If you want to stump many therapists, ask them to explain their theoretical orientation without putting down some other theoretical orientation. Nearly every theorist since Freud has constructed an image of a bearded authoritarian with a Viennese accent pontificating about the patient’s psyche that the new theorist decidedly is not. Perhaps this straw man once actually existed in the flesh, but it’s not possible that he was as ubiquitous as other theorists make him out to be.

Beck claims that there is an interesting cognitive behavioral (CBT) phenomenon that occurs when therapists have erroneous beliefs about their clients or apply mistaken schemas, and the name he came up with for this phenomenon is “countertransference.” He claimed at a conference that this has nothing to do with the psychoanalytic concept of countertransference, even though it means exactly the same thing (using a different vocabulary, beliefs versus relational paradigms).

Behaviorism’s Functional Analytic Psychotherapy (FAP) looks exactly how psychoanalysis looked in 1970. Their insistence that there is nothing to learn from psychoanalysts means that they have to discover for themselves such fascinating developments as self-objects and intersubjectivity. My guess is that once they do they won’t name them self-objects and intersubjectivity, but it’s not out of the question as long as the terms are pronounced with a behavioristic accent (if you will). Acceptance and Commitment Therapy (ACT) and FAP practitioners, I once wrote, are like Columbus, claiming to have discovered, for example, fusion—concrete equation of a thing and its name—as if no one had gotten their first. With Columbus, it was Native Americans; with fusion, it was Russell and Whitehead’s logical typing errors and Whitehead’s fallacy of misplaced concreteness. With FAP’s clinically relevant behaviors (CRB’s), it was good old transference.

It took systemically-oriented family therapists a long time to realize that some people are operating in hidden or remote systems, and that the reactions of colleagues or current family members are not relevant to the immediate system. In other words, they were so bent on not being psychoanalytic that they refused to consider personality as a variable. Psychoanalysts were so certain that behavior modification was too simple and that CBT was too naïve that they refused to solve problems. When I supervised a psychodynamic clinic, I always worried that someone would knock on our door one day, ask for directions to the post office, and be put into open-ended therapy until they could find their inner post office.

The straw men I see most frequently:

  1. All psychoanalysts do is sit there.
  2. All behaviorists do is shock you.
  3. All humanists do is hold your hand.
  4. All systems therapists do is make you hold each other’s hands.
  5. All cognitive-behaviorists do is argue with you.

The truth is that there are bad therapists of every stripe and good therapists are hard to find. I’ve posted here what good therapists do to distinguish themselves, and one of those things—the unique case formulation—implies that they don’t already know what is wrong with you when you call for an appointment. When therapists claim to have an “active” approach, it’s usually to awaken an image of largely non-existent therapists who watch you squirm while you try to help yourself. Wouldn’t it be better to have a therapist who speaks when they have something to say or when the relationship needs maintenance? Do you decide before you meet a friend how actively you will participate? If something important happened to you, wouldn’t it be great if your friend just listened while you told your story? Good improv actors don’t know beforehand how active they will be; it depends on what happens.

If therapists must create a straw man to knock down, I wish it would be the image of a therapist who claims to know what your problem is before you get there. Some ACT therapists already know that you lack psychological flexibility. Some behaviorists already know you need exposure to your negative thoughts and feelings. Some analysts already know you need attunement, humanists that you need to achieve your full potential, CBTers that you think you’re worthless, and so on.

The process takes hold early in training. It may be a function of earned dogmatism. Ottati found that subjects overestimated their expertise after taking an easy geography quiz. A sense of expertise leads to dogmatism, partly because the performance of expertise often involves certainty and partly because true experts have spent a lot of time making up their minds. As the training curriculum becomes easier and everyone gets A’s, to appease the dainty feelings of trainees, their dogmatism soars.

Dogmatism may also be thought of as a way of managing the anxiety that attends learning to do therapy. It’s a long process to learn such a complex skill, and it’s natural that trainees should feel anxious, especially since their patients expect more of them than they can possibly give. A colleague of mine says that a theoretical orientation is a transitional object, a teddy bear to hang onto through the throes of insecurity. Teddy bears occasion splitting, the maintenance of an idealized image by splitting off from that image any imperfections and attributing them to some other source. Idealization runs rampant when trainees don’t expect it to be a long haul, when they expect they will get a gold star and hear that they have learned it all. They know they are not ready, so they insist that their theory will tell them all they need to know. Competing theories must be bunk. This happens even when the faculty is rather cosmopolitan in their acceptance of multiple orientations. The last thing a convert wants to hear is that other religions may also be right.

In an old joke, a shipwreck survivor is marooned on a tropical island for 20 years.  When he’s finally rescued, the captain of the rescue ship asks for a tour of the island. He is impressed. The man has built an aqueduct system for indoor plumbing, a series of traps for food, a lovely three-room home, and most impressive of all, a temple with carved pews, inlaid parquet floors, and stained glass windows.  Continuing the tour, the man shows the captain another temple, equally beautiful, with carved pews, inlaid parquet floors, and stained glass windows. The captain says, “Excuse my asking, but you’ve been alone on this island for 20 years.  Why two temples?” The man replies, “Well, this is the temple I worship in, and the other is the temple I wouldn’t be caught dead in.”

Both are necessary for the true believer.

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