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by Brent D. Slife, Richard N. Williams and Sally H. Barlow (editors)
Sage Publications, 2001
Review by Brent Dean Robbins on Sep 9th 2002

Critical Issues in Psychotherapy

Today, we live in an age when practicing psychotherapists are faced with increasing economic and administrative pressure to conform to the status quo. Managed care, for good or ill, has forced psychotherapists to find very quick and efficient means to handle more and more complicated cases. With innovations in biological psychology and psychiatric medication, there is an increasing tendency for psychology as much as psychiatry to explain psychological meanings by reducing them to biological mechanisms. At the same time, psychotherapists are faced with contrary forces that demand attention to individual and cultural diversity among their clientele. As a way to manage the immense responsibility of their tasks in a shrinking job market with smaller and smaller pay, and in the face of the ambiguities encountered on a daily basis, some psychotherapists more rigidly adhere to manualized approaches to treatment while others succumb to a wishy-washy eclecticism for fear of making any commitment to a particular point-of-view.

In the face of the pressures outlined above, it is understandable how many psychotherapists have found little time to ponder what appear to be esoteric philosophical issues. Yet the re-examination of the basic assumptions undergirding psychotherapy practice is precisely a way for psychotherapists to re-imagine their craft so that it can survive and flourish in the face of difficult, ambiguous times. In this light, the edited volume Critical Issues in Psychotherapy is a welcome and much needed addition to the psychotherapy literature.

The editors of this volume are Drs. Brent D. Slife, Richard N. Williams, and Sally H. Barlow. All three are psychologists in the department of psychology at Brigham Young University. Slife and Barlow are both clinical psychologists who practice in the field. Slife and Williams have previously worked together as authors of the excellent text, What’s Behind the Research: Discovering Hidden Assumptions in the Behavioral Sciences, which to my mind still stands as one of the few quality texts introducing psychologists to the non-empirical theoretical and philosophical issues confronting psychology today. Slife, a past President of the APA Division for Theoretical and Philosophical Psychology, has also written three other texts, Time and Psychological Explanation, Taking Sides: Clashing Views on Controversial Psychological Issues, and Managing Values in Psychotherapy, that are exemplary of the kind of theoretical analysis that has direct, practical value for applied psychology. Likewise, Williams’ edited volume Rediscovering Psychological is an important contribution to the field of theoretical and philosophical psychological. With Critical Issues in Psychotherapy, these scholars continue their groundbreaking task of carving a niche for philosophical psychology in the field of psychotherapy research and practice.

The text is organized around fourteen themes: Empirically supported treatments, assessment, the biologization of psychotherapy, spirituality, culture, managed care, individualism, the scientist-practitioner model, free will/determinism, eclecticism, postmodernism, multiculturalism, diagnosis, and feminism. These topics were initially addressed at a 1999 conference held at Brigham Young University, and the format of the text follows the format of the conference. Each theme is first addressed by a scholar-researcher in the field who brings his or her expertise to the subject matter of the philosophical issue. The essay is followed by a commentary issued by a practicing psychotherapist in the field.

I am impressed by the manner in which the authors in this volume manage to apply difficult philosophical concepts to concrete issues in psychotherapy practice. Further, he great majority of the essays are quite accessible to an audience who is unfamiliar with the philosophical discourses from which these insights are derived. This text would not be out of place in an upper-level undergraduate course in clinical psychology; in fact, I would recommend it. And, given the gravity of the issues raised, I think it would be negligible if, at some point in their academic careers, clinical graduate students were not exposed to such meaty topics of concern. I can hardly imagine a clinical psychology text more likely to generate stimulating and passionate discussion. 

Stanley’s Messer essay presents a hard-hitting critique of the notion of “empirically supported treatments.” Constance Fischer’s essay on her technique of individualizing psychological assessment introduces her humanistic approach to a whole new generation of scholars. And Richard N. Williams’ treatment of the biologization of psychotherapy introduces the reader to the complexities and problems related to the biological reductionism that is today sweeping psychology and medicine.

Sally H. Barlow and Allen E. Bergin address the issue of spirituality in secular forms of therapy. While the topic is engaging and the thesis raises important questions, the essay unfortunately lacks rigor and focus. Nevertheless, similar issues are masterfully engaged by scholars such as Lisa Tsoi Hoshmand and Blaine J. Fowers who address the culturally situated nature of psychotherapy. Likewise, Joseph Rychlak explores how the notion of agency (free will) makes a difference for psychotherapy. If given two equally plausible theories of therapeutic outcome, he argues, the theory that supports the notion of free over that of determinism should be the theory of choice. Why? Because, even in the extreme case that we asserted a deterministic approach, we would still act as if we were free beings.

Donald Polkinghorne’s essay on managed care is a gracious and even-handed treatment of a delicate issue. By situating the issue of managed care in a historical context, he manages to point out the problems with our current predicament even while demonstrating how its arrival on the scene follows from ethically-questionable behavior on the part of working psychotherapists. Frank C. Richardson and Timothy Zeddies point out the assumptions of individualism in modern approaches to psychotherapy. Barbara Held critically evaluates the “postmodern turn” for psychotherapy, and Jeanne Marecek outlines feminist approaches to therapy. Finally, Robert L. Woolfolk’s exploration of “objectivity” in diagnosis presents an uneven but engaging argument for the problem of applying the evolutionary concept of “malfunction” to diagnosis and treatment.

All told, Critical Issues in Psychotherapy runs the gamut of philosophical issues that arise for psychotherapists. My one criticism is that the diversity of issues is not matched by a diversity of perspectives. The respondent clinicians, unfortunately, tend to affirm the theoreticians more than challenge them. Perhaps the volume could have benefited less from the input of working clinicians and more from commentaries of other theoreticians who are opposed to the arguments presented. At least then the readers would have a more even-handed treatment of these heated controversies and would less likely be lulled into the false impression that they are easily resolved. Then again, I realize I am playing Monday morning quarterback. Certainly, the initial idea to include the opinion of clinicians is ultimately benevolent and worthy of the highest praise.

 

© 2002 Brent Dean Robbins

 

Brent Dean Robbins, Ph.D. (cand.) is a clinical psychologist who is Visiting Assistant Professor of Psychology at Allegheny College. He is planning to defend his dissertation this Fall at Duquesne University. His research interests include emotion, philosophical and theoretical psychology, psychopathology, psychotherapy research, and the psychology of religion. He is a co-editor of the interdisciplinary journal Janus Head and a partner of Trivium Publications.