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Book Forum: Psychotherapies   |    
Humanistic Psychotherapies: Handbook of Research and Practice
Am J Psychiatry 2003;160:400-401. doi:10.1176/appi.ajp.160.2.400
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Lewisburg, Pa.

Edited by David J. Cain, Ph.D., ABPP, and Julius Seeman, Ph.D. Washington, D.C., American Psychological Association, 2002, 592 pp., $59.95.

Beginning in the 1940s, Carl Rogers reconceptualized psychotherapy by deemphasizing therapeutic technique in favor of the interpersonal processes he saw as critical for therapeutic change. This emphasis on interpersonal process is perhaps the most important aspect of the humanistic school of psychotherapy, initially differentiating it from the other main schools of psychotherapy. Although contemporary forms of humanistic psychotherapy differ somewhat in approach, all of them focus attention on the therapeutic relationship, involving empathy, authenticity, and the recognition of a subjective, individually constructed reality; the critical role of emotional experience; individual responsibility; and freedom of choice. The humanistic approach favors the skills involved in processing one’s emotions over the achievement of intellectual understanding.

From its inception, a primary goal of humanistic psychotherapy has been research-based validation of its hypotheses about the nature of constructive change within a therapeutic relationship. Humanistic psychotherapies share the fundamental premise that an optimal therapeutic relationship fosters maximal development of individual potential. Central tenets include nonjudgmental acceptance of the other’s personal experience as a precursor to mutual understanding and therapeutic change. The patient, not the therapist, determines the direction of therapy and is the locus of control. These core features of Carl Rogers’s client-centered psychotherapy emphasized the person over the problems and the feelings expressed in the here and now as opposed to thoughts. In 1940, Rogers and his students were the first to study audio transcriptions of therapy sessions, work that justifies the claim that this group initiated modern research in the field of psychotherapy. It was this research which led to the hypotheses and theoretical formulations that strengthened and enlarged the framework of the humanistic approach.

By the mid-1950s, genuineness and empathic understanding had become the cornerstones of humanistic psychotherapy. Advances since the mid-1960s include the development of methods to highlight the thoughts and feelings that underlie the patient’s self-concept in order to facilitate constructive change. Increasing emphasis on "here and now" experiential processes is seen as critical for developmental change. Certainly, many of these concepts parallel those found in psychodynamic modalities; however, my impression after studying this book is that humanistic psychotherapeutic approaches are less restrained by the residua or echoes of drive theory and therefore provide the therapist more freedom to explore the emotional arena in psychotherapy without fear of "contaminating the transference." The "real" relationship between patient and therapist becomes the core of therapy as opposed to the transferential relationship.

This text provides state-of-the-art information on the status of contemporary research and practice in the field of humanistic psychology. For the clinician, many of the chapters provide detailed discussions on therapeutic technique derived from the research, including transcripts from psychotherapy sessions that illustrate those techniques. The book is divided into six main parts. The first section provides "an overview of the history, defining characteristics, and evolution of humanistic psychotherapies" (p. xxv). The second part provides summaries of basic research findings, including a meta-analysis suggesting that "humanistic psychotherapies have substantial effect sizes and are equally effective or more effective than other major approaches to psychotherapy" (p. xxv). This part also includes chapters on process-outcome research and qualitative research, illustrating the epistemological maturity of this field. The third and fourth parts review the major humanistic psychotherapeutic approaches and modalities, including couples and family therapy, group therapy, and child therapy, along with corresponding reviews of supporting research. The fifth part focuses on current therapeutic issues and applications, as well as research reviews demonstrating the linkage between these approaches and therapeutic outcome. A chapter from this section, titled "Emotion in Humanistic Psychotherapy," is where I encountered my only significant disappointment. Specifically, it failed to differentiate the concept of affect as physiological from the concept of emotion as biographical and to differentiate cognitive processes from affective processes, distinctions I view as necessary for clarity and consistency. Nevertheless, I found the approaches presented for the targeting of emotion and subsequent therapeutic intervention important and valuable work despite my dissatisfaction with this chapter’s explication of terminology and underlying theory. The final section proposes the future direction of this field, presenting a contemporary theoretical model that integrates a synthesis of humanistic psychology with modern neuroscience and systems theory.

Despite the preponderance of research on psychotherapy indicating that the quality of the therapeutic relationship is the strongest predictor of a successful outcome, there is in psychology and psychiatry a growing bias toward "empirically supported treatments" dependent on the medical model. Unfortunately for the patients exposed to such attitudes, the consequent attention to remediation of symptoms and return of the patient to the "premorbid condition" encourages the therapist to be a technician and to ignore any opportunity to lead the patient toward new growth. However, humanistic psychology has a long heritage emphasizing a phenomenological approach, which provides a distinct advantage for the development of the therapist’s empathic skills. The conscious effort to recognize and suspend preconceptions, theoretical assumptions, judgments, and expectations allows for a greater appreciation of the other’s subjective experience. Nonetheless, an approach that allows for the optimization of empathic connection also runs directly counter to theory-based, reductionistic scientific epistemology.

During the mid-1960s to mid-1970s the "questionable practices and antischolarly attitudes" (p. xxi) of some humanistic psychologists damaged the reputation of humanistic psychotherapy. A number of humanistic psychologists bought into the rollicking ethos of that era and disregarded the rigorous approaches emphasized by their forebears. Some rejected modern science by overemphasizing phenomenology to the point of "anything goes" and subsequently seemed "on the fringe" and "out of it" to many of us. At the same time, the birth of modern neuroscience and the rapid growth of biological psychiatry threw into increasing disrespect a field far larger than its colorful miscreants. Important advances achieved through biological science came to overshadow the perhaps equally important contributions made by a persistent band of highly trained and committed individuals who had conducted rigorous, qualitative human science, an epistemology traditionally more accepted by psychologists than psychiatrists. The sober reader of this fascinating text will recognize the increasing need for a pluralistic approach.

The economics of modern medicine have reduced severely any financial motivation for psychiatrists to conduct psychotherapy, let alone invest the time and effort needed to acquire increasingly effective psychotherapeutic skills. Notwithstanding substantial biological evidence supporting the efficacy of psychotherapy (1), the realities of research funding also impede the study of psychotherapy by those interested in biological psychiatry. I can only imagine what we could discover if a pluralistic and integrative research effort were pursued. The editors and authors of Humanistic Psychotherapies emphasize the role of human emotion and the need to link psychotherapeutic technique to neuroscience through a new theoretical framework. Surely an approach to research that addresses both the quantitative and qualitative aspects of the phenomena under study will benefit both patient and therapist. Such an argument parallels and is consistent with those made by proponents of the humanistic psychotherapies in this highly recommended book.

Kandel ER: A new intellectual framework for psychiatry. Am J Psychiatry  1998; 155:457-469


Kandel ER: A new intellectual framework for psychiatry. Am J Psychiatry  1998; 155:457-469

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