Psychotherapy, ontology and therapist positioning: why simplistic integrationist approaches don’t work

In this post I explore some thoughts about the idea of ‘ontology’ and how this affects a therapist’s approach to working with their clients. I think this is an important underlying feature to our therapeutic work. I am going to suggest that all therapists have an ontological position from which they practice. This may be either implicit or explicit to their personal theory and philosophy for practice. It is helpful to try and understand your ontological positioning because as a therapist there are consequences for practice. One reason that I think ontology is becoming increasingly important is the current trend in psychotherapy towards integrationist and pluralist approaches to therapy. It is in some of these that I think the issue of ontology holds particular concern. I will argue that it is not possible to integrate therapeutic approaches at the ontological level. And because of this the approach taken to integration at the theoretical and practice levels have to be very carefully thought through.

So far this year I have examined two doctoral students through viva voce. One was a PhD and the other a PsychD. Both passed with only minor corrections. In each of the viva voce exams I asked the candidate to give an outline account of their ontological position for understanding psychological distress within the thesis. That is, I invited each of them to present in the viva their view on the nature of being a human and the suffering they encounter. This question is one that, I believe, lies at the heart of being a psychotherapist. What we believe about people, their basic nature and make-up, is the foundation upon which psychotherapy theories are based. However, I am not sure that all psychotherapists give this issue much thought and nor do I think that enough psychotherapy training demands students to develop a clearly defined understanding of their ontological position. The consequence of a poorly understood or vaguely defined ontological position as a therapist is that their practice is based on something that is not known to them and therefore the basis of their approach cannot be known to their clients.

So what are some of the different ontological positions that underpin psychotherapy? There are three main schools of psychology that we can easily link to each of the major schools of psychotherapy. First, there is analytic psychology that’s linked to Freud’s psychoanalysis. Next there is behavioural psychology that is linked to behaviour therapy. Third, there is humanistic psychology that is linked to humanistic/experiential psychotherapies. From within each of these there are many variations of how the therapy can be practiced. Therapies linked with a school of psychology naturally share more in common with other therapies from within that school, both in theory and in the way they are practiced, than with those others from other schools. For example, Freudian analysis and attachment therapies both fall under the analytic school and thereby share more in common with each other than either would share with person-centred therapy that comes under humanistic psychology. The reason for these major differences are important and relate to the ontological standpoints that each of the major schools of psychotherapy are based upon.

In the following paragraphs I outline the three ontological perspectives, as I see them, and relate these to each of the different schools of psychology and psychotherapy that have been outlined above. Following this, I point to some of the potential difficulties that arise when therapy is practiced in a way that is inconsistent with the ontological standpoint of the therapist. This is particularly evident when therapists try to ‘mix it up’ in a bid to match therapeutic strategies to their client’s problems, as the therapist sees it, when in fact this creates an incongruence between ontology and theory and practice.

Humanistic ontology
In the 1940s and 50s American psychologist Carl Rogers outlined his view on the basic nature of a human being. Rogers was a humanistic psychologist and together with other significant psychologists of his time, such as Kurt Goldstein and Abraham Maslow, he claimed that human beings are basically (ontologically) prosocial. In addition to this, they suggested that given the right socio-environmental conditions, the intrinsic nature of a person was to grow in a socially constructive direction. The logical conclusion of this viewpoint is that people can be trusted to grow in a constructive direction if the socio-environmental conditions are right. This is the ontological standpoint for what are known as the humanistic-experiential psychotherapies. Consequently, humanistic-experiential therapists trust their clients’ inner resourcefulness and therapy aims to promote clients’ innate tendencies for growth and recovery. They do not assume to know what is best for their clients, or how their clients should think or feel, and neither do they believe that clients need to be controlled or regulated by external forces.

Psychoanalytic ontology
The psychoanalytic position is very different and suggests that people are inherently destructive. If not controlled or regulated, people are believed to be unable to control their instincts and will behave in ways that will cause harm to either themselves or to others. The destructive nature of a person is understood by way of innate drives that need to be controlled through the moderating effect of the personality (ego). The innate destructiveness of a person is unknown to them as their impulses are unconscious. The practice of psychotherapy consistent with this requires that the therapist make the client aware of their unconscious impulses. Only the therapist can help them to do this as traditional psychoanalytic theory claimed that clients cannot make their unconscious known to themselves. Therapists help the client to become more aware through interpreting their psychological and behavioural processes. The therapist is the expert on the client’s unconscious world. To support the therapeutic climate required for psychoanalysis the therapist is neutrally distant and maintains an objectivity about the client in a bid to not contaminate the client’s projections with their own experiences, thoughts or feelings. The ontological position of psychotherapy based on analytic psychology is that the nature of a person is destructive.

Behaviourist ontology
The third ontological standpoint can be associated with that of classical behaviourist psychology. The classical behaviourist view is that people are born into the world as a ‘blank slate’, or ‘tabular rasa’ as it is sometimes known. Here it is thought that a person’s nature is basically neutral, neither socially constructive nor socially destructive; a blank canvas onto which everything is imprinted. In this sense the person is thought to be malleable and shaped to become his person through learning and reinforcement from within the environment. Over time, the therapeutic methods derived from this ontological standpoint have been developed to engage the client in therapeutic tasks. Techniques such as behavioural experimentation and reinforcement regimens, both positive and negative are used to help the client unlearn old and learn new behaviours in the world. The therapist is best thought of as someone that does not get personally or emotionally involved in the therapy. The idea that logically follows this approach is the more closely the therapist follows a strict procedure the more effective the therapeutic strategies will be. In the classical behaviourist approach the therapist directs the client to the tasks of therapy and the outcomes for therapy are typically predetermined by dint of the problem being presented.

What I have provided above might be considered a bit provocative and probably over simplistic overview of the main schools of therapy. I’m not a philosopher after all! However, as the accounts above suggest the standpoints for each ontological position are quite distinct. The fact that each therapy is based on a distinct ontological standpoint means that the ensuing therapeutic methods cannot be integrated at the ontological and philosophical level. In brief, humanistic-experiential therapists go with the client’s direction; psychoanalytic therapists appoint themselves the task to make the unconscious conscious to minimise the inherently destructive nature of a client, and behavioural therapists direct clients through reinforcement schedules to relearn their responses to events to repaint a new person on the blank canvas.

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6 comments

  1. Joey Wright

    Hey
    I’m hoping to cite this article for an essay I’m writing on how an ontology can affect psychological practice and I couldn’t find your last name anywhere. Great article by the way, was the major reason I chose the specific question I’m answering as it puts a lot in perspective for me

    Thanks heaps
    Joey

  2. Mark McDonnell

    Hi David. I like your blogg and the questions it addresses. Regarding ontology; are the ontological categories you draw possibly not as clear-cut as you suggest? For example, can I take a humanist, person-centred stance and yet acknowledge the importance of learning and conditioning (behaviourist concepts) in creating implicit memories (close to an analytic concept) which cause a belief system (conditions of worth, Rogerian concept) which may be out of awareness (incongruence, PC concept)? Is it incompatible to take the ontological stance that sees people as pro social, relational and self-actualising whilst holding that some of the psychological mechanisms underlying behaviour may be explicable in behaviourist terms? An example might be some of the reactions to trauma such as avoidance, over-alertness, sensitivity to triggering stimuli). If the humanistic therapies are to come to terms with current neuroscience will they need to revision the concept of the subconscious as implicit beliefs learned in an emotionally charged atmosphere which serve a positive, actualising purpose, that of survival in a hard environment? So in this view of things the ‘subconscious’ is refashioned as out of awareness and protective (rather than the Freudian pit of vipers) and built up from implicit and pre-verbal memories which are adaptive to a particular environment (so, some element of tabula rasa!).
    Mark McDonnell

    • Jay Bee

      I like this reply – I also don’t really see an argument for these positions being irreconcilable – at least if you allow for change over time rather than thinking you have to believe the same things permanently.

    • psychotherapyblogger

      Hi Mark, I hope you are well. It’s been a while since I worked on the blog and I apologise if I have neglected a response here. I think that what you say is important and helpful to enable further clarity on my point. Of course people learn and reinforcement is certainly one way to understand this. Likewise, I agree that people have implicit processing capacities, perhaps for very well learned reflex responses. However, this doesn’t change the notion that if the person is to be trusted, in the way that one would only trust a person that is inherently pro-social, then our actions in response to them, in a dialogue with them, when we encounter them is informed by the idea that they have the inherent tendency to actualize and can be trust to figure out the best direction for themselves. They do not need to be interpreted, the do not need to have faulty or irrational beliefs or learned behaviours changed for them. they are capable, resourceful and will change when the relational, environmental conditions are conducive to this. Does this get close to answering your question?

  3. halclyon

    Well summarized. My new book with Carl Rogers presents the context of the humanistic approach to psychology and teaching: On Becoming an Effective Teacher – Person Centered Dialogues with Carl R. Rogers and Harold Lyon .
    (Routledge 2013)

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