Avoiding an EST Monopoly: Toward a Pluralism of Philosophies and Methods

CBT Meets Process: Assimilative Integration with Reference to Group Psychotherapy

This paper offers a brief overview of the historically predominant form of psychotherapy research both for individual and group psychotherapies, the randomized control trial (RCT), and its surrounding controversies and critiques as the backdrop from which new directions in both clinical theory building and research are being pursued, including efforts at building integrative models of treatment. The paper explores one promising integrative model, namely the incorporation of process and dynamic orientations into the province of group cognitive behavioral therapy (CBT) and identifies challenges in implementing this model.

The Research-Practice Psychotherapy Wars: The Case of Group Psychotherapy in the Treatment of PTSD

In light of two recent meta-analyses of the efficacy of group psychotherapy in treating posttraumatic stress disorder (PTSD), this article critically reviews the randomized control trial (RCT) generated findings as well as two of its outgrowths-the production of a variety of clinical practice guidelines for treating PTSD and the dissemination efforts to transfer laboratory findings to clinical practice. All three of these activities have received considerable pushback from experienced clinicians and Boulder-identified scientist practitioners, creating an ongoing and entrenched gap or split between researcher and clinician. The article also reviews the various suggestions that have been offered to heal this gap and ending the hegemony of RCT outcome research as the only game in town for declaring what constitutes evidence. Specifically, the literature suggests two primary strategies for helping to realize the scientist-practitioner model and thus advancing the cause of psychotherapy, in general, and group psychotherapy, in particular: (a) leveling the playing field so that both researcher and practitioner have real authority and voices for shaping the field; and (b) shifting the research priority away from a purely outcome focus, asking only does it work, and moving to a more sophisticated, theoretically guided empirical study of process-outcome, examining the how, why, when, and for whom it works.

Which Methodological Practice(s) for Psychotherapy Science? A Systematic Review and a Proposal

Three main methodological practices have been employed in psychotherapy science: the empirical-quantitative, empirical-qualitative, and theoretical one. Some scholars have argued for a monopoly of the empirical-quantitative methodological practice, sustained by scientific monism. This systematic review aims at exploring the contribution of each methodological practice to the field. Fifteen journals were searched from 2003 to 2013. A total of 9796 publications and 9915 studies met inclusion criteria and were coded for the methodological practice employed. Empirical-quantitative studies were the most published overall, over time, and in most of the journals considered. This overwhelming prevalence increased when considering the citation rates of the publications. We argue that these results are indicative of a quantitative monopoly, which in turn is due to a lack of critical thinking sustaining scientific monism. We call for disciplinary critical thinking and the consequent scientific pluralism valuing the plurality, diversity, and multiplicity of all the existing methodological practices.

Development and validation of the Gestalt Therapy Fidelity Scale

Objective: Three studies were conducted to develop and validate the Gestalt Therapy Fidelity Scale (GTFS), a 21-item measure of treatment adherence for Gestalt Therapy (GT).Method: Thirty five items for possible inclusion in the GTFS were generated on the basis of a literature review. In Study 1, a Delphi methodology consulting 63 international GT experts was used to select items for the GTFS. In Study 2, six experts used the scale to rate video-based sessions of GT, and provided feedback on the usability of the scale. In Study 3, 176 participants from 18 countries used the GTFS to rate GT and not-GT video recorded sessions.Results: The Delphi study consensus method resulted in 25 items for consideration in the GTFS. The scoring system and items were subsequently revised following further feedback from experts (Study 2). The GTFS was found to significantly discriminate between GT and not-GT based sessions (Study 3): raters scored GT sessions significantly higher than not-GT sessions. High levels of internal and inter-rater reliability were found.Conclusion: The GTFS is supported as a psychometrically sound measure of treatment adherence for GT, and hence can be used to assess the degree to which therapists are administering GT.

On Critical Engagement with the Mainstream

This Special Issue foregrounds a need for critical reflection on the assumptions, biases, goals and effectiveness of the subdiscipline `theoretical and philosophical psychology.' Pivotal to the Issue is a contrast developed between criticism of and critical engagement with `mainstream' psychology. Contributions address a range of evaluative themes relating to theoretical and philosophical psychology's identity, representative breadth, impact, instrumentality, accuracy, fairness and flexibility. Themes include reflection on changes in the mainstream and on theoretical psychology's response. The aim is to offer a variety of perspectives rather than to seek definitive answers to any questions relating to the evaluative themes. Thus both pessimistic and optimistic accounts are given of the potential of theoretical and philosophical psychology to engage mainstream psychology critically. An additional organizing principle of the Issue is the representative inclusion of traditional branches of psychological research: cognitive, clinical, developmental, neuroscience, personality and social psychology. Within this structure, reflections on the status and efficacy of theoretical and philosophical psychology are both prospective and retrospective. Through its range of essays the Issue strives to make clear that `engagement with' is not equivalent to alliance or compliance, and that the relation of theoretical and philosophical psychology to the psychological community at large is a matter for continual and regular reappraisal.

The McDonaldization of psychotherapy: Processed foods, processed therapies, and economic class

Questions pertaining to “empirically supported treatments” (ESTs) frequently address concerns about “measurement” and “evidence,” but rarely frame the conversation in terms of differences in the linguistic possibilities represented in each treatment orientation and how the availability and marketing of therapeutic languages are parsed out along class lines. Moving the conversation “beyond ESTs,” the author addresses how language positions persons into a particular relationship with their experience—a way of understanding their suffering and identity—and the significance of understanding therapeutic orientations as representing an epistemological pluralism rather than existing merely on an evaluative axis related to evidence and effectiveness. Next, the intersection between language, experience, and class access to treatment orientations and discourses is considered. It is argued that the emphasis on evidence-based modalities and symptom-reduction models impacts the experiential possibilities of persons in important and often disguised ways and this has a particular bearing on persons with fewer economic resources who have access to a narrow range of therapeutic and epistemological possibilities. Linguistic options are circumscribed and pre-decided. Lastly, the author illustrates the segregations and hierarchies of therapeutic approaches available at different class designations and the marketing of evidence-based epistemologies through the cultural allure and capital of “science.” The author concludes with expressed concerns regarding present epistemological narrowness in the mental health delivery system and proposes that additional dimensions be explored in the “evidence-based” discussions.

Hermeneutic Realism: Toward a Truly Meaningful Psychology

This article presents a brief introduction to a hermeneutic realist approach to psychology, outlining its differences from mainstream psychology in its conceptions of context, change, and possibility. The term “hermeneutic” indicates that psychology's subject matter (e.g., behavior, cognition) is understood more as contextually constituted meanings than as the conventional notion of self-contained objects. The “realism” portion of this phrase implies that this understanding does not devolve to a relativism or subjectivism, but it is grounded in the reality of the world. Hermeneutic realism is not considered a replacement to psychology's current approach but rather is conceptualized and discussed as a needed supplement that leads to new psychological understandings, including new approaches to theory, method, and practice.

Where is the Dialogue? A Social Constructionist View of Empirically Supported Treatments

Since the publication of the list of empirically supported treatments by the American Psychological Association in 1995 a controversy has resulted between those who view positive psychotherapeutic outcome as resulting from the use of specific (listed) techniques and those who lean towards the so-called common or relationship factors rather than particular techniques as necessary for such outcomes. This paper examines the controversy and shows that both sides follow the same objectivist/empiricist and reductionist epistemology. In contrast, the paper adopts a social constructionist perspective and shows that the idea of therapeutic outcome as linearly determined by either technical or common factors or a combination of these is a misleading oversimplification which fails to account for the dialogue which is the core of psychotherapy. Rather, positive outcome is viewed as mutually constructed in a unique dialogue which encompasses both common and technical factors. This takes the form of the conversational development of a new understanding or reframe of the problem followed by action which is deemed appropriate to the new understanding. This view is illustrated by practical examples.

Older Adults’ Spiritual Needs in Health Care Settings

Recognizing that spiritual needs often emerge in health care settings, the Joint Commission requires spiritual assessments in numerous organizations frequented by older adults. Given that many gerontological practitioners have received little training in identifying spiritual needs, a qualitative meta-synthesis ( N = 9 studies) was conducted to identify and describe older adults’ perceptions of their spiritual needs in health care settings. Five interrelated categories emerged: (a) spiritual practices; (b) relationship with God; (c) hope, meaning, and purpose; (d) interpersonal connection; and (e) professional staff interactions. The implications of the findings are discussed as they inform the spiritual assessment process.

Beyond Neurobiological Reductionism

This paper examines the neurobiological explanatory trend in psychology, including the related and tacit roles of ontological materialism and reductionism. In addition, the role of Cartesian dualism in both psychology and cognitive neuroscience is explored. In both, the complex relationships between mind/brain and mind/body tend to be conceptualized through the framework of either ontic dualism or attribute dualism, both of which ultimately constrain notions of embodiment. Alternatively, this paper understands the body as the inseparable unity of being-in-the-world from which the Cartesian dichotomy of “mind” and “body” is abstracted. This alternative surpasses the constraints of dualism and reframes embodiment as intentionality incarnate and ultimately as “flesh.” The body, understood phenomenologically, emerges not as a “what” but as a “ what—how”—the manifestation in extension of our intentionality, the flesh of our projects in and of the world. We argue that this understanding is indispensable to a properly psychological perspective on embodiment.