The Future of Training in Psychotherapy and Counselling

Instrumental, Relational and Transpersonal Perspectives

John Rowan

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317822257
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The Future of Training in Psychotherapy and Counselling presents a revealing and stimulating account of the current state of training that demonstrates how training will have to adapt if it is to sucessfully meet the needs and challenges of the future.In an attempt to look afresh at the whole question of training, John Rowan proposes that there are three ways of doing therapy and any examination of training has to consider each of these: * the instrumental, where the main emphasis is on the treating the client or patient
* the authentic way, where the main emphasis is on meeting the client or patient
* the transpersonal way, where main emphasis is on linking with the client in a more personal way. Each approach makes different assumptions about the self, about the relationship, and about the level of consciousness involved in doing therapy. By challenging the basic precepts of traditional training, John Rowan encourages the reader to reconsider subjects including the difference between counselling and psychotherapy, culture and ethics, the origins of disturbance in clients, and child development. The Future of Training in Psychotherapy and Counselling provides a much needed new perspective that will compel all psychotherapists and counsellors to take a closer look at training in the field.

Chapter 1

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Do we need training?

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Therapy generally is not in a happy state at the moment. A few years ago a book came out entitled Psychotherapy and its Discontents (Dryden & Feltham 1992), and in the years that have followed matters have not improved, as Howard (1996) and others have pointed out. If we are to find answers to these discontents, we have to dig deep.

Research findings

One of the most curious things about training, and the one we should look at first, is the research showing that untrained people can do just as good a job as trained ones. For example, Hattie et al. (1984) found 43 pieces of research in which professionals and paraprofessionals were compared in their effectiveness when treating patients. The conclusion was that the paraprofessionals were actually more effective than the professionals. A later critique of this paper by Berman and Norton (1985) went over the data afresh, and found that there was actually no difference between the performance of the two groups.

To cut a long story short, Roberta Russell (1981: 6–7) surveyed the research literature very thoroughly, and her six main conclusions were the following:

1 Comparative studies show that the outcome of psychotherapy does not depend upon the school to which the therapist adheres.

2 Experienced therapists are generally more effective than inexperienced therapists, and experienced therapists resemble each other to a greater extent than they resemble less experienced therapists trained in their respective disciplines.

3 Paraprofessionals consistently achieve outcomes equal to or better than professional outcomes.

4 A professional training analysis does not appear to increase the effectiveness of the therapist.

5 Therapists who have undergone traditional training are no more effective than those who have not, but microcounselling and skills training appear to be useful procedures in the training of therapists.

6 Congruent matching of therapist and patient increases the effectiveness of therapy.

This survey was later updated (1993) to take account of more recent research, but the basic results did not change.

These are quite striking findings, but the reason for them appears to be basically quite simple. Of all the influences making for success in therapy, the greatest is the readiness of the client for change. Art Bohart and Karen Tallman have shown at length that the client is highly active in the process of therapy, and that most of what happens depends on the activity of the client rather than that of the therapist. They urge us to think of the therapist not as a medical doctor with a set of cures, but rather as an existential-humanistic person who intends to work with the client in ways which the client is ready for: ‘We further argue that all therapy is ultimately self-help and that it is the client who is the therapist’ (Bohart & Tallman 1996: 9). If this is the case, how can it matter what the training of the designated professional is?

In a striking piece of research, Svartberg and Stiles (1994) found that the strength of the therapeutic alliance correlated positively (r = +0.48) with outcome in brief psychodynamic therapy, whereas the therapist's expertise at using brief dynamic therapy procedures correlated negatively (r = −0.55). Again it does not appear to be the trained skill of the therapist which is crucial.

In recent years, Barry Duncan and his colleagues (Duncan & Moynihan 1994; Miller et al. 1995) have based their whole approach on the idea that the client is the primary change agent and that therapists would do well to work within the client's framework. In a later book, Scott Miller and his colleagues (1997) have presented this argument at greater length. They also point to the importance of factors other than those within the consulting room:

Researchers estimate that as much as 40% of the variance in psychotherapy outcome can be attributed to the operation of extratherapeutic factors (Lambert 1992; Lambert et al. 1986). As such, they contribute more to outcome in psychotherapy than the therapeutic relationship (30%), the theoretical and technical orientation of the therapist (15%), or the operation of placebo factors (15%).

(1997: 36)

They remark that there is very little research evidence as to how these findings can be integrated into practice. Jerry Gold (1994) has presented a number of examples of the active, creative and innovative efforts of clients. Maureen O'Hara (1986) has suggested that the therapist can function something like a research assistant, providing support for the active change agent, the client.

And yet it stands to reason that training must do something. Perhaps part of the issue here is that most of the research has always been on short-term therapy. Yet it is common knowledge that most of the difficulties in the therapeutic relationship emerge in long-term therapy. If we look at the stages which are gone through in a typical long-term therapeutic relationship (see Table 1.1) it seems clear enough that the first five stages (the commonest and best researched) are the ones least likely to throw up interpersonal problems. And if the therapy finishes at or before Stage 5, as mostly it does, of course the effects of training will hardly have had time to show themselves.

Table 1.1 What happens in therapy? The alchemical sequence together with the research of William Stiles (Stiles et al. 1991, 1992; Leiman & Stiles 2001) (italics), the suggestions of Jocelyn Chaplin (1988) (normal script) and the research of Meier and Boivin (2000) (bold italics)

1 Materia prima and nigredo (colour black) Presenting problem. Establishment of working relationship. Level 0 — warded off Getting started and building trust Problem definition

2 Fermentatio The therapy process takes hold. Deepening of relationship with therapist. Level 1 — unwanted thoughts Identifying themes: separating out the opposites Exploration (1)

3 Separatio (colour blue) Internal conflicts and family of origin. Emotional release. Deeper patterns being recognized, accepted and dealt with. Level 2 — vague awareness Exploring the past: understanding the opposites and inner hierarchies Exploration (2)

4 Calcinatio Increased trust. First changes noticed. Feelings of movement which may be positive and negative. Level 3 — problem statement or clarification Dissolving the inner hierarchies and facing ambivalence: accepting the opposites Awareness/insight

5 Albedo (colour white) More experience of emotional release. Symptom relief. Feelings of success experienced. Level 4 — understanding or insight. Making changes: living with the opposites Commitment/decision

6 Conjuctio For men, dealing with connectedness. For women, dealing with assertiveness. ‘Joining the human race.’ A stage of practice out there in the world. Level 5 — application or working through. Level 6 — problem solution. Connectedness: expressing the opposites Experimentation/action and integration/consolidation

7 Mortificatio and second nigredo (black again) End of first phase, beginning of second. May leave therapy, may continue with greater commitment and deeper understanding. Level 7 — mastery. Endings and new beginnings Termination

8 Solutio and third nigredo (black again) The long haul where the deeper difficulties have to be dealt with. Everything is in the melting pot again. Doubts and complications. This is where we leave behind the research already published and forge on into new territory. Very little research goes this far, partly because the numbers tail off, and partly because long-term research is quite expensive. But see Blomberg et al. (2001).

9 Coagulatio (colour yellow) Relationship with the therapist may be problematic. Deepest material emerges. Feeling of real engagement.

10 Sublimatio Death and rebirth. A breakthrough. Something remarkable happens. Some kind of shattering of previous assumptions. Sense of initiation.

11 Rubedo (colour red-gold) The chymical wedding. Emergence of the Self. Ability to handle relationships in the best way. Full contact with all or most of one's potentials. Ability to suffer in a genuine way. Ecological consciousness.

In the case of psychotherapy, this is often followed by a phase of working through, designed to integrate the new person with the existing environment. For the full version of this, see Rowan (2001c).

The threefold division

But these matters can be clarified considerably if we take seriously the threefold breakdown introduced earlier. If we follow the instrumental way, training is absolutely necessary in order that therapists be held accountable for their actions. How can we do objective research on therapy if we do not manualize and specify correctly what is being attempted? Skills must be specified, honed and practised in order that correct procedures are followed.

Not only must therapists be trained, they must be trained very specifically in one named method. Otherwise we do not know how to test, or what to test for. Ideally, as Thomas Daniels and his co-workers have urged, trainees are tested repeatedly and at short intervals throughout the training: ‘Only one skill at a time is taught in a given microtraining situation. A single skill is learned to a predetermined criterion, and over time the trainees gradually develop and integrate a repertoire of helping behaviours. This proposition appears to be essential for beginners’ (Daniels et al. 1997: 279).

We must also make sure that different trainings are comparable. Windy Dryden (1994) has argued that a situation where a diploma in one institution is equivalent to a certificate in another, where an advanced diploma in one is equivalent to an MA in another, is too messy to be tolerated.

But it is people at the instrumental level of working who are most enthusiastic about training. They insist that many problems brought by clients (such as a fear of flying) can be cured in one session if the therapist is properly trained. Listen to this: ‘Years ago it took me an hour to work with a phobia. Then when we learned more about how a phobia works, we announced the ten-minute phobia cure. Now I've got it down to a few minutes’ (Bandler 1985: 45). That is how instrumental people talk. They really want to win.

Perhaps the most striking example of this is to be found in the work of Milton Erickson. Listen to this:

One of the author's most capable subjects required less than 30 seconds to develop his first profound trance, with subsequent equally rapid and consistently reliable hypnotic behaviour. A second remarkably competent subject required 300 hours of systematic labour before a trance was even induced; thereafter, a 20–30 minute period of trance induction was requisite to secure valid hypnotic behaviour.

(Erickson 1980: 143)

Can you imagine the determination of a hypnotist who would persevere for 300 hours rather than admit defeat? Only someone sure of his or her rightness could do anything like this.

One of the characteristics of the instrumental approach is that its proponents tend to be very loyal to the model adopted. This means in practice that strong emotions and personal needs may hold the therapist locked into a way of thinking that cannot be challenged. Lovinger (1992) details several reasons, both professional and personal, for a therapist's inflexible allegiance to a particular theory. Malcolm Robertson tells us that ‘when emotion is invested in a theory the theory becomes a personal mystique’ (1995: 22). He says that too often an adversarial stance develops in which proponents of the orientation adopt a protective posture and invest their energies in defending instead of challenging the status quo (Robertson 1986: 419).

We may say, in fact, that as soon as we find someone with an unswerving commitment to a single orientation, we have probably found a therapist with an instrumental position. This could be in any school of therapy, whether it be psychoanalytic, humanisticexistential or cognitive-behavioural. But it may be that such an adhesion is more common in the cognitive-behavioural schools, because their whole outlook tends to be black and white rather than relaxed and colourful. Someone who relies on research a great deal is very likely to feel that rightness goes with that.

And of course it is well known that some of the psychoanalytic schools are very particular about their boundaries. The Institute of Psycho-Analysis (founded in 1910) will not recognize anyone as a psychoanalyst who is not a member of the International Psychoanalytical Association, and they are in fact the only organization in the UK which has this membership (Morgan-Jones & Abram 2001). This has caused a great deal of criticism and resentment among people with a perfectly good psychoanalytic training not obtained at the Institute. Similarly, several of the senior psychoanalytic institutes withdrew some years ago from the UK Council for Psychotherapy, which is the broad umbrella organization for all forms of psychotherapy, and founded a breakaway organization, the BCP, all of whom consider themselves to be psychoanalysts. These statements of narrowness are quite remarkable and suggest an instrumental approach, even though many of the therapists involved may not be instrumental at all.

Nor are other schools immune from this sort of tightness. There are Gestalt organizations which refuse to acknowledge the legitimacy of other Gestalt organizations. There several different schools of transactional analysis which are not on speaking terms. Which of them are instrumental and which not is a matter of dispute.

One of the things which is particularly emphasized in the humanistic approach is communication, and many communication exercises have come from this orientation. One of the areas which is particularly important is what happens when we need to criticize someone. Life is not always smooth, and we may have to c...