Powerpoint Templates Page 1 Powerpoint Templates Uncertainty Being Uncertain and Refusing Uncertainty Can Therapists’ Ambition in the Era of Evidence-Based Practice Be Counterproductive? James Tobin, Ph.D. Licensed Psychologist PSY 22074 220 Newport Center Drive, Suite 1 Newport Beach, CA 92660 www.jamestobinphd.com 949-338-4388 Assistant Professor of Clinical Psychology, Argosy University 601 South Lewis Street Orange, CA 92868
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Uncertainty, Being Uncertain, and Refusing Uncertainty: Can Therapists' Ambition in the Era of Evidence-Based Practice Be Counterproductive?
This paper explores the important role of uncertainty in the clinical psychotherapy process. It argues that the field of clinical psychology is now prioritizing problem-solving, conviction, and analytic conclusions to the present generation of students in training at the expense of collaborative discovery between patient and clinician.
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Powerpoint TemplatesPage 1
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Uncertainty
Being Uncertain
and
Refusing UncertaintyCan Therapists’ Ambition in the Era of Evidence-Based Practice Be
Counterproductive?
James Tobin, Ph.D.Licensed Psychologist PSY 22074220 Newport Center Drive, Suite 1
Newport Beach, CA 92660www.jamestobinphd.com
949-338-4388
Assistant Professor of Clinical Psychology, Argosy University
In Between Conviction and Uncertainty: Philosophical Guidelines for
Practicing Psychotherapists, Downing (2000) argued that clinicians are guided by a personal epistemology: organizing schemas that serve as a heuristic for understanding patients.
In his review of Downing’s book, Kose (2003) called these heuristics “instrumental fictions,” [which are] “motivated by the conviction or desire to know the truth and provide useful illusions that allow us to work toward the fulfillment of that desire” (my italics, p. 214).
(1)Demanding Standards: “I have to cure all my patients. I must always meet the highest standards. My patients should do an excellent job. We should never waste time.”
(2) Abandonment: “If my patient is bothered with therapy, he or she might leave. It’s upsetting when patients terminate. I might end up with no patients.”
(3) Helplessness: “I feel I don’t know what to do. I fear I’ll make mistakes. I wonder if I’m really competent. Sometimes I feel like giving up.”
Predominant Self-Schemas for Experienced Therapists
Experienced therapists also highly endorsed the “Demanding Standards” and “Abandonment” self-schemas!
The third most highly endorsed self-schema was not “Helplessness” but “Excessive Self-Sacrifice”: “I should meet my patient’s needs. I should make them feel better. The patients’ needs often take precedence over my needs. I sometimes believe that I would do almost anything to meet their needs.”
Appealing to the “client” and “doing an excellent job”– therapists are intent upon helping the patient feel better and do better, sometimes to an extreme level of intensity.
This is potentially a narcissistic position, i.e., both personally and professionally (it can be argued that the treatment is more about us and the field than about the patient).
A person coming for help, already in distress, is likely to want to create order – an old order – in such a paradoxical environment. The analyst or therapist, in response to what the patient imposes, is just as likely to impose an old order, in the form of theory, expertise, authority and his or her own psychological complexes” (Young-Eisendrath, 1997, p. 642).
A Long Tradition of the Clinical Utility of Uncertainty
Jung’s transcendent function: “within the psychic space of the transcendent function, one is free to watch and wait, not compelled to assign meaning prematurely to images, affects, memories or actions …. [in order to make] the discovery of … a meaning that was not previously known” (Young-Eisendrath, 1997, p. 641).
A Long Tradition of the Clinical Utility of Uncertainty
Winnicott’s play space/transitional space.
John Keats’s famous letter which he wrote in 1817 to his brother about “negative capability” (i.e., the artist’s capacity to sustain him- or herself in the course of uncertainty; art is not what is done but what one is able to tolerate or take in).
A Long Tradition of the Clinical Utility of Uncertainty
Donnel Stern’s important works ,“Unformulated Experience: From Dissociation To Imagination in Psychoanalysis” (1997) and “Partners in Thought: Working with Unformulated Experience, Dissociation, and Enactment” (2009b) which describe his view of the mutually co-created discovery process in psychotherapy and psychoanalysis.
3.) The trainee must become aware of his or her “patterns of organization” and “organizing principles” (Klugman, 2003, p. 666) (one’s personal heuristic), and how these relate to intentionality in treatment (i.e., what is the pragmatic connection between therapeutic self-schemas and intervention tendencies for the supervisee?).
4.) Need to debunk the myth that there is a correct way of doing everything in psychotherapy (e.g., What do you say when a patient arrives to a session late?).
5.) More on witnessing: - Stern pays tribute to Harry Stack Sullivan who, according to Stern ,theorized that “we know ourselves reflected appraisals” (Stern, 2009b, p. 706).
- This idea is akin to Suzanne Johnson’s (2008) Emotionally-Focused Therapy (EFT) intervention of “heightening.”
- I describe this to students and supervises as “editing the scene.”
6.) Trainees must be encouraged to use their subjective self-experience and to be, at times, spontaneous (e.g., “Did you tell your patient something about what you were thinking or feeling?” – the response is invariably, “No!”).
-“You mean we can tell the patient what we really think?” (see Renik,1996, 1999)
“In truth, we have all felt the burdens of clients’ expectations that we fix their problems …. Understandably, though, we adopt these therapeutic roles because that is how we’ve been trained, or we just don’t know what else to do. Our limited tolerance for uncertainty ....
“.... together with client’s expectations of us, also restricts our sense of adventure and co-discovery, influencing us toward cookie-cutter practices and away from the great, beautiful, and largely unknown territory of a client’s path to change” (Duncan, 2010, p. 149).
• Cook, D.C. (2013). A comparison of therapist schemas: A quantitative study. Argosy University, Orange County, CA.
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