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Seven questions for twenty people produced 140 answers. In this 18th and final post I'll try to pull it all together and see what we've learned. (If you haven't heard of this project or you're foggy because I've dragged it on for so long, you may want to read the Introduction and Summary first.)
The Seven Questions Project was inspired by Three Approaches to Psychotherapy, a 1965 training film where celebrated therapists recorded sessions with a 30 year-old single mother named Gloria. I've been reading the entertaining and very well-written Living with the Gloria Films by Pamela Burry, Gloria's daughter. Intermingled with engrossing anecdotes about Gloria and the therapists, Pamela shared some of her own story and opinions of therapy. In this quote, she equated her experience in treatment with her mother at the time of the film:
Similar to most who seek counseling, we were both unnerved by the instability of our circumstances, and unmoored by the inapplicability of the standards and goals by which we had previously navigated our lives. We were hoping that the therapist - sitting on the chair just opposite - might recognize this foreign place within us and help give it voice. (p. 89)
Well said. This point is drilled home in her book, the films, this blog and everywhere else therapy is mentioned: a good fit between client and therapist is crucial. Today, with hundreds of theories spread among one million therapists, an uninformed client could search a long time to find a match.
Hence this project. I wanted to give readers a sense of the diversity within the field and show how a therapist's personality and theory influences therapy. I sent seven open-ended questions to today's celebrated clinicians to see how (and if) they would respond. Here are some results, conclusions and assorted musings:
Responses: I thought the up-and-coming authors and theorists would jump at the opportunity for free publicity and wide exposure, while the more established authorities in the field couldn't be bothered. I was exactly wrong. Most of the hotshots were too busy, so they politely declined, sent repeated "write back in a month" messages or simply didn't respond. The seasoned clinicians were happy to participate and seemed to enjoy sharing their wisdom and experience. Those involved in the governing bodies were the first to write back; this type of PR is probably in their job description. There was a 40% response rate overall (14 for 35), which is respectable for a soft science.
Similarities: Most everyone from Glen Gabbard to Harville Hendrix to James Bray to Thomas Szasz emphasized the primary importance of therapist/client rapport. Many stressed the need for therapists to set boundaries and practice healthy self-care. They griped about managed care and encouraged clients to leave bad therapy. Most underscored the client's right and responsibility to determine where they'd like to focus their therapy. And in my opinion, some had a similar approach to question 4 (ultimate goal of therapy): they phoned it in. Rather than getting their hands dirty by unveiling their model of health, they played it safe with "we set goals together."
Differences: As expected, dynamic types focused on working through pain from the past and CBT types emphasized interventions for changing thoughts and behaviors. Theoretical differences were fairly obvious, but personality differences were more subtle. For example, Judith Beck and Donald Meichenbaum are both pillars of CBT with similar viewpoints, but their delivery was incredibly different. Relationship experts John Gray and Harriet Lerner had answers dancing on different planets. David Burns felt good about a 2948 word response, while Hendrix gave the love in 113. Jeffrey Barnett returned his complete answers within hours of my request, while others took weeks or months or never responded. Personality is not just about what they said, but how they said it.
Mudslinging: Respondents weren't shy about criticizing one another's theories. Meichenbaum warned therapists of "questionable psychotherapeutic ‘BULLSHIT' that pervades the field." Irvin Yalom wondered if CBT therapists would really want to take their problems to another CBT therapist. Stephen Diamond's depth psychology response was a direct rebuttal to Beck. Daniel Amen jabbed at psychiatrists for ignoring the organ they treat. Burns critiqued all mainstream psychotherapy and several of my questions. Szasz knocked the entire field of mental health, but we wouldn't expect anything less from him. Apparently, these therapists empathically collaborate with their clients but they don't mind slamming the competition. Maybe that's why they're famous.
Best Question: I thought it would be questions one, four or seven, but question five (the toughest part of being a therapist) turned out to be the most revealing. The very honest and personal responses included concerns about self-employment, awkwardness at cocktail parties, staying awake in session and holding clients' pain.
Best Surprise: I invited any and all therapist bloggers to write responses to the questions and had a few takers. I found many of their answers to be less inhibited and more compelling than my big name guests. Also, I love being able to do a side-by-side comparison of the American Psychiatric Association president, a yoga instructor and a music therapist in an inpatient facility. Each has a unique, valuable viewpoint worth hearing.
Limitations: No research is complete without the author owning up to its shortcomings. The most glaring is a lack of theoretical, ethnic and gender diversity. A broad range of modalities are represented here, but the field extends far beyond psychodynamic, CBT and existential theories. I asked, but unfortunately didn't receive responses from therapists who represent some of the newer modalities (mentioned in the Summary). The project would also benefit from more diversity in the respondents to reflect the spectrum of modern clinicians.
Highlights: There are so many. The series spent a week on the APA homepage. A website for psychology students now includes it among their resources. Therese Borchard from Beliefnet's Beyond Blue interviewed me about the series. One interviewee sent me a couple of his books. A Polish psychology magazine is now asking Seven Questions to their own countrymen. Several other websites helped get the word out (here, here and here). But the biggest thrill for me was corresponding with dozens of clinicians who shaped my theory and practice in some way, several of whom became pen pals. Of course, the Yalom interview will always be a career highlight.
So what did we learn? Therapists appear to share beliefs about the fundamentals of therapy, but beyond that, they're enormously different. Some emphasize the science of therapy, while others focus on relational aspects. The governing leaders and popular icons are thoughtful, passionate people who are generous with their time and wisdom. They're also human: some have big egos and theoretical rigidity. Hopefully, through persistent dialogue and research that emphasizes our client's wellbeing (and policies that allow for such discourse), psychotherapy will continue to evolve and thrive.
Thanks again to each of the participants for their generous donation of time and effort. I typically find it difficult to get 20 people to do anything together, especially for free.
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Want some more? Not from me, I'm done with this topic for a while. But if you have a burning interest in the theory and practice of therapy, might I suggest you look into the Evolution of Psychotherapy conference. Several of the Seven Questions participants are featured speakers as well as many other prominent clinicians. I'll see you there.
