Ending the Psychotherapy Civil War

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There is absolutely no good reason for competition among therapies—none is by itself necessary or sufficient, and most are completely complementary, even synergistic.

TALKING THERAPIES

There are about 500 named psychotherapy techniques and an alphabet soup of 50 different named psychotherapies (Table).

Part of this sectarian proliferation is caused by narcissistic founders' complex; part by guild interest; part by competitive parochialism; part by institutional rigidity and inertia; and part by failure to keep up with the psychotherapy research.

The result is devastating. The different schools self-destructively engage in sniping internecine warfare, instead of joining together to form an integrated and harmonious psychotherapy.

There is absolutely no good reason for competition among therapies—none is by itself necessary or sufficient, and most are completely complementary, even synergistic. Therapists who worship a narrow technique fail to grow as therapists and do a disservice to their patients. They are like hammers always in search of a nail.

We have seen, live or on tape, many of the famous representatives of the different forms of therapy conduct sessions, sometimes with the same patient. Although therapists from the various persuasions used different terms to describe what they thought they were doing, what they actually said, and the nature of the therapeutic alliance they formed, all of them were usually remarkably similar. Experienced and skilled therapists of whatever school are a lot more alike than they are different. And they are a lot more alike than their followers and trainees, who are likely to follow their founder's beliefs more than their actual behaviors.

Psychotherapy training programs tend to be remarkably parochial, rather than ecumenical. Their theoretical disputes often have the ring of how many angels can fit on the head of a pin. Our use of religious terminology to describe the behavior of psychotherapy schools is deliberate—and not meant to be flattering.

If we focus on a level of abstraction that is somewhere between the higher order theoretical constructs of a therapy school and the specific techniques that it uses clinically, there is a sweet spot middle point where we can find the greatest similarities. This will be the subject of our next blog and podcast.

For more information on ending the therapy civil wars, go to our fifth episode of the Talking Therapy. View it here or listen here.

Dr Frances is professor and chair emeritus in the department of psychiatry at Duke University. Dr Goldfried is distinguished professorin thepsychology department at Stony Brook University. Find them on Twitter @AllenFrancesMD and @GoldfriedMarvin.