by Tim Brunson, PhD
Psychotherapy is currently undergoing one of the most radical periods of change seen for the past hundred or so years. Originally, those who practice what we have come to consider as the sciences of mental health focused either on replicating methodologies associated with medicine or remained in the idealistic realms (i.e. Jungian). However, most recently those in the inner circles are now beginning to think more systemically and thus have created a hybrid that combines science and more holistic thinking. This trend has already crept into official literature. The recently published DSM-5, upon which most psychotherapists heavily rely, incorporates this new way of thinking for the first time – albeit while still holding on to the diagnostic categories contained in previous editions.
Traditionally much of psychotherapy has centered on very specific protocols, many of which have even been trademarked by their originators. These methods normally follow specific steps and in many ways tend to mimic medical diagnostic and treatment methods. Furthermore, by following the steps of scientifically researched and widely approved procedures, practitioners can avoid sometimes harsh criticism from their peers, reduce legal liabilities, facilitate third-party payments, and frequently achieve the desired results. However, according to members of the DSM-5 development team, this could also result in misdiagnosis and a failure to adequately relieve a client's suffering. For instance, if a therapist recognized that a subject displayed nine out of ten of the symptoms listed in DSM for a particular disorder, previously this meant that he could not be so diagnosed. Thus the patient did not qualify for treatment – to include third-party payment. The DSM team saw this inequity and wanted to fix it in the latest edition. They claimed that a new, more systemic approach is needed.
Another factor that heartens me is the increased discussion regarding Evidence Supported Principles (ESP) of change. At first, this seems to be an evolution of previous thinking. When discussing various protocols, for years I have constantly heard phrases such as "Is it in the literature?" and "Is it evidence-based?" These concepts come from the previously mentioned psychology-land obsession with maintaining similarities with medicine. This is an unfortunate offshoot of psychology originating out of that profession and the constant desire for credibility that comes from appearing to be its clone.
This fails to recognize that although they share some characteristics, the medical and mental health fields are significantly different. As an example, a person either does or does not have cancer or a broken arm. However, if one should have all but one symptom of a mental health disorder, they are still suffering. While systemic approaches are relevant to medicine, looking at a psychology client as a holistic system (or preferably a collection of systems) probably should be primary approach when considering potential disorders. Furthermore, even though medicine recognizes numerous syndromes – which are collections of symptoms (e.g. fibromyalgia), it seems that more so, when looking at a person from the mental health perspective, most disorders are syndrome-like and rife with comorbidities. Therefore, when considering mental disorders a systemic approach is the most logical way to view a subject.
The core of a systemic approach in psychotherapy must be principles. Successful transformation requires a set of guiding rules, which allow the practitioner to understand a case, make a diagnosis, and proceed with a treatment plan. This is not new. Guidelines such as empathetically viewing the problem through the subject's eyes, establishing an effective therapist/client relationship, overcoming client resistance, and recognizing that they have a strong desire for change have been around for a long time. In fact, these are the core values that are also reflected in most ethical codes of conduct. However, more is needed.
More importantly to the transformational process, these additional principles must come from a realization of the true nature of the subject. This includes looking at a client as a participant in several systems to include relational, spiritual, temporal, physiological, stability maintenance/change resistance, and even energetic. Additionally, change itself must be looked at as systemic processes.
When looked at rather holistically, there are three sets of interacting systems that must be considered. Two are process systems; the third, an environmental system. The former consist of environmental and therapeutic systems. These are the environments (i.e. relational, spiritual, temporal, physiological, stability, and energetic) in which the subject exists. The second and third are closely related therapeutic and transformative systems, which must be accommodated if change is to occur. Therapeutic focuses on the behaviors of the practitioner, while the transformative system refers to the subjective dynamics within the client. Effective therapy entails the interaction of the therapeutic and transformative systems within the context of the environmental system.
While this may make sense, caution must be considered. For years I have been exposed to numerous idealistic change systems that currently have little to no scientific credibility despite having numerous faith-based followers. This includes several organized religious practices – to include the one with which I feel most comfortable – and many New Age trends and pursuits that frequently arise in our popular culture. This is a far cry from the scientifically-minded thinking, which dominates medicine and mental health. The en vogue empirical rational/approach used in mental health emphasizes basing diagnosis and therapy on objective observations. Thus, if the value or acceptance of a particular diagnosis or treatment protocol is supported by specific evidence, it is considered to be more credible. However, this ignores that fact that evidence alone does not always facilitate complete understanding. That is why a more principles-based systemic approach is needed. Yet, even that must be vindicated by evidence. And, Empirical Supported Principle approach is one that seems to accommodate both a desire to keep therapy between the scientific lines while allowing the leeway needed to treat the patient holistically.
Tim Brunson, PhD, is the Executive Director of The International Hypnosis Research Institute and the principle developer of Advanced Neuro-Noetic Hypnosis.
(Note that the need to approach the use of hypnotherapy for medicine, mental health, and coaching also must follow this approach. It should be both evidenced-based, which means that hypnosis protocols that are based on idealistic, wishful thinking must be avoided, and it should rely upon a coherent set of principles. Advanced Neuro-Noetic Hypnosis was from its inception, designed to do just that.)