Michael Winters, PhD October 4, 2023
Psychotherapy is talk therapy that can help people cope with mental health problems, improve their relationships, and live more fulfilling lives. It is a complex and multifaceted endeavor, drawing on insights from science, art, and philosophy. What are the bases of psychotherapy? How does psychotherapy bring peace? These are difficult questions. This essay briefly addresses the ingredients for successful psychotherapy.
Psychotherapy is scientifically informed, but it’s not a science. Science – at least the physics model of science – requires a detached objectivity. This view requires the observer disengaging from the observed to make accurate, unbiased conclusions and predictions. Detachment does not work in psychotherapy. You need to be connected. You need to care about the other person actively.
In addition, most of the scientific research in psychotherapy uses a norms-based approach (nomothetic), seeking to understand general behavior patterns by comparing the individual against the norm. In making a psychotherapeutic diagnosis of anxiety, the individual’s symptoms compare to a broader set of anxiety symptoms. Everyone has some anxious feelings at times, but do they rise to the level of an anxiety disorder? Using a norms-based lens can help us categorize the symptoms to understand the condition compared to others. Understanding the pattern of symptoms can help the therapist choose treatment options statistically more likely to help the client. However, no matter how much they share with others, each person is unique. So, the norms model is limited. The alternative model, focused on the singular (ideographic), is not looking for general trends in a population but an understanding of the individual. Psychotherapy, while informed by a normative perspective, is an individual endeavor. Each client is unique.
If psychotherapy is NOT a science, then is it an art? Seeing psychotherapy primarily as an art is also problematic. It is not just an art. It does need to be scientifically informed. But there are qualities of psychotherapy that are art-like. Specifically, the more you practice, usually the better you get.
The more experience one has in providing psychotherapy, the richer the nuance, skill, and creativity one has in reaching the heart of the concern. It’s not perfect. An expert artist might still make a piece that could look better because they’re exploring something new, even though they’re in an advanced stage of their craft. But understanding the form and getting familiar with the concept are things which the more we practice, the better we get. Art is hard to describe objectively. It’s difficult to put into a clear perspective definitionally what makes good versus mediocre or bad art.
There’s something that we can ascertain, but it could be more complex to process cognitively. So psychotherapy is scientifically informed and art-like in that the more you practice, the better you get, and it’s sometimes challenging to define objectively.
Psychotherapy is also like a philosophy in that there are principles or ways of living that we can adopt. For example, Albert Ellis’s Rational Emotive Therapy is especially notable in cognitive behavioral therapy.
Ellis’s approach instructs abandoning the belief: “If something that I don’t like happens, my responding feelings must be bad.” Ellis teaches that one can change feelings by changing thoughts. In other words, “I can divorce my feelings from my situation. I don’t have to look at what’s happening in my life, judge it, and then judge the quality of my life based on it.” Breaking the link between thought and feeling is a popular idea in psychotherapy, and many, many people have been helped tremendously by adopting this philosophy.
A similar approach happens in Logotherapy – the psychotherapy of Viktor Frankl (to which I subscribe ). I don’t think of Logotherapy primarily as a set of practices or principles for therapy but as a philosophy of life suggesting one can find meaning in any situation. Logotherapy further postulates We can’t necessarily overcome suffering, but we can find a reason to go on despite the distress. So, this is another philosophical idea. And when the psychotherapist introduces a philosophy they’re helping the client try on, it doesn’t have to mean that you have to believe it. It’s not proselytizing but engaging in a way that says there are different ways to perceive and various ways to put together what you see about your life. There are other objectives or meanings that you might discover if you do an internal shift.
And finally, psychotherapy is a relationship. Relationship is the beginning and the ending of psychotherapy. The relational aspect of psychotherapy makes it difficult, if not impossible, for Artificial Intelligence (AI) to engage in psychotherapy at a high level. Yes, AI can have an algorithm that uses the best science, appears artful, and even has a positive philosophical underpinning, but it cannot create a genuine feeling relationship. Research shows that the relationship between the therapist and the counselee is the most potent predictor of good outcomes in psychotherapy. And is relationship a kind of art? It’s hard to define what makes a good relationship. Part of the art of a relationship must be concern and caring. There is cherishing and a desire to help that are sometimes communicated subtly. Effective psychotherapy requires building a connected relationship.
So psychotherapy is not a science, although it is scientifically informed. Therapy has elements of being like an art, but it’s more complex than art. Psychotherapy contains philosophical foundations and aims to confront maladaptive philosophies or, at a minimum, teach more adaptive, healthier attitudes. The therapist is helping the client gain a new perspective on their life. But at its core, psychotherapy is a relationship between two (or more) individuals seeking to understand better and create a better quality of life.
Michael Winters is a Psychologist in Houston focusing on marriage counseling and therapy. Michael received his PhD from the University of Memphis and has been practicing since 1991.