What All Good Psychotherapy Has In Common

Evolutionary approaches to human behavior often try to “carve nature at its joints.” This phrase, somehow evocative of Pinocchio, means that when we try to describe or classify psychological phenomena, we shouldn’t use just any old arbitrary organization scheme. Rather, we should base our thinking on underlying natural, evolutionarily informed, realities.

This principle is especially salient to evolutionary clinical psychologists, because psychotherapists are encouraged to each develop their own “orientation,” which is a particular way of thinking about where psychological distress comes from and informs how it can be treated. The orientation is unique to each psychologist but is typically created in part by assembling elements from a number of the most common established orientations, and usually (though not always) picking a primary allegiance: psychodynamic, humanistic, cognitive-behavioral, and family systems are among the most well-known orientations. Each of these orientations has its own distinct perspective on the nature of psychological distress, its own history, traditions, and associated therapies. While cognitive-behavioral is often considered to be the most scientific-minded of the orientations, the truth is that there is good science supporting the efficacy of therapy from each of the orientations (and plenty of bad science in each); and crucially, there’s very little evidence that any orientation is vastly more effective than any of the rest!*

Thus, the evolutionary clinical psychologist faces a paradox: How can we think about uncovering the “true” nature of psychological distress and mental disorders if any old way of thinking about psychotherapy is just as good as any of the others?

The resolution, in my view, is to focus on what elements all the orientations have in common. Looking past all the differences, what similarities do we see? If we get to the bottom of what these common factors are, we’ll have a better sense of the true mechanisms of psychotherapy, and thus a more satisfying and universal explanation for psychological distress and its treatment. Because, to me, for whatever reason, admitting that there’s a set of totally different points of view, all of which are equally valid, just doesn’t have that satisfying scientific ring to it. To me, it’s no kind of answer, but rather an invitation to ask further questions.

As it turns out, one thing that all effective treatments based on legitimate orientations do (intentionally or not) is get the client in touch with — and working WITH, not against — their naturally occurring emotions.

By this, I mean not just any old emotional reactions that people engage in, but the emotions that were naturally selected as appropriate responses to situations. For example, for a person with crippling self-doubts, fear is a situationally appropriate (although maybe exaggerated) emotional response to the possibility that others will judge you. Explosive anger towards your boss who asks you to give a presentation is not necessarily appropriate, if that anger is a way to avoid the real core fear of judgment. Treatments derived from each of the orientations go about this emotional approach in different ways.

Psychodynamic therapies do this by encouraging outward expression of unconscious, suppressed, repressed, or misdirected emotion (going back to Freud’s recognition of the power of “catharsis” — the sudden breaking-through of that true emotion). Humanistic therapies do it by fostering the therapist’s unconditional positive regard for the client, allowing him/her the space to guide him/herself through whatever emotions may arise on the journey to self-actualization. Cognitive-behavioral therapies teach skills to help the client examine and approach distressing thoughts and situations, which ends up resulting in the expression of long-avoided emotions (often, but certainly not always, fear or anxiety).**

Thus, a researcher seeking an evolutionarily informed understanding of why people encounter emotional disorders and adjustment issues (by this I mean clinically relevant depression, anxiety, post-traumatic stress, etc.) should focus, in large part, on this core mechanism of emotional avoidance, and how it so frequently pops up and gets in the way of our mental health in modern society.

If this perspective is true, it inevitably invites the question of why people seem to need so much help engaging in what evolutionists would consider to be a naturally selected adaptive function — something that should be a biologically primary ability! This is an important question, and whether the disciplines of evolution and clinical psychology can be reconciled depends on our ability to resolve this paradox. I’ll explore some thoughts on this in Part II of this entry (coming soon).

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*If the therapist’s orientation isn’t the most important determinant of therapy outcome, then what is? It turns out, it’s the quality of the alliance between the therapist and the client.

**I’m not necessarily advocating here that all orientations are equally good for all clients/issues — or even equally good overall. Nor am I saying that a therapist’s orientation doesn’t make any difference at all. However, I view that matter as a somewhat orthogonal point to the one I’m discussing here.

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Daniel Glass

About Daniel Glass

Daniel Glass is a doctoral student at Suffolk University. He is interested in evolutionary approaches to clinical psychology. Evolved This Way explores this burgeoning field, which uses evolution to understand, classify, and treat mental disorders and other clinical phenomena.
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One Response to What All Good Psychotherapy Has In Common

  1. Fred Welfare says:

    I doubt that eliciting emotional reactions is a good idea. I also doubt that spontaneous emotional responses are necessarily cathartic or adaptive.

    If we are to consider all the elements that all orientations have in common, we could reduce these to the 1). behavioral, or unconscious since why a person behaves as they do is not necessarily conscious although they may think they are aware of the real reasons and causes, values and beliefs underlying their behavior.

    2). The affective or emotional, feelings, are a necessary element to every orientation but the methodology in psychoanalysis, and perhaps for evolutionary adaptation, is to educate and discuss with the individual the sources of these feelings.

    3). Cognitive elements are perhaps the least well understood in these fields, psychoanalysis and evolutionary psychology, because the issue of rationality and its counterparts of irrationality and nonrationality are under the pressure of ideological beliefs and political expectations of conformity. Identifying another’s religious-political beliefs, clarifying them into conceptual formations and working through their reflections in everyday events and social contexts, like working with managers or with people of diverse backgrounds, requires recognizing and alerting them to their triggers, to mechanisms of dissonance reduction and rationalization, and to the particular social facts, like rates of social phenomena of which they are ignorant but at risk for. Cognitively, there are also issues of self-knowledge and self-deception about who or what one is in terms of their self or identity which may include several subselves or modified patterns of affect-behavior-cognition that is conditional to certain social situations or contexts involving race, sexuality and gender, social class and position in society, family relationships.

    Needless to say these factors are often deeply unconscious and involve exploration of ego defenses, like projection, denial, etc. Lastly, 4). there is language, processes of meaning making, signification or emphasizing, designation of definitions and the pragmatics of interaction where making clear one’s reasons for actions is part of being coherent and perhaps accepted by others in terms of morality, or at least appropriateness.

    The therapeutic alliance is very significant but the relationship is not easily generalized to other persons nor to other situations, so the achievement of self understanding in the therapeutic relation must generalize to other contexts, must become decontextualized and must be open to reflection and criticism. Perhaps one indication of progress or achievement is the expression of insights that modify one’s negativity, hatred or arrogance. There are techniques and conceptual frameworks for these elements and factors which I have very briefly enumerated.

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