THE EPISTEMOLOGICAL AND ETHICAL FRAMEWORK OF PSYCHOTHERAPEUTIC KNOWLEDGE
Psychotherapy is a form of therapeutic practice that is inspired from the sciences as much as is possible. It hopes to become at least as scientific as allopathic medicine some day. The influence of science manifests itself in two ways:
1. Psychotherapists accommodate their way of thinking to scientific discoveries, to the extent that these are relevant for their practice. When the scientific approaches cannot offer a relevant option, the therapist seeks useful propositions from other approaches. This entire my yoga blog illustrates this point of view.
2. Psychotherapy adopts a strategy to develop knowledge compatible with the ethics of science.
The second point interests me at this moment. It consists of giving a frame to the psychotherapist’s ethics in the face of what he presents as knowledge. The butcher guarantees wholesome meats that correspond to what is written on the label. The effectiveness of therapy is more difficult to evaluate, but the propositions of a method obey the same laws of ethics. The therapist is expected to propose a course of treatment that is relevant to a patient’s particular need for support. This ethical stance is based on the following basic principles:
1. A scientific enterprise is a collective enterprise. Science is an institutional construct that inscribes itself in a time period far longer than a lifetime. The idea of an institution implies not only a collective construction but also the necessity to communicate via the intermediary of the tools of communication. In effect, to admit a collegial construction is to admit the need to be informed about the activities of colleagues. Once this view is accepted, it becomes necessary for the individual to recognize one’s obligation to communicate knowledge in a comprehensible manner to colleagues. Personal impressions do not have the capacity to evaluate what is important and useful from an institutional point of view, or from the perspective of a society that emerges from these institutions. Personal views may be relevant and sometime innovative, but they often need to be calibrated through discussions with colleagues. This is why peer reviews of each other’s work are essential to scientific ethics.
2. The economy of hypotheses.31 Every observation awakens in us a multitude of associations, some of which we hold dear more than others. To maintain a useful collegial collaboration, the rule of the game is to try to find the most economical hypothesis possible that is, one that stays closer to the existing accepted knowledge. The root hypo is the opposite of hyper. Hypo is by definition something weak, as in the word hypotonic. A hypothesis is therefore a weak thesis.â This rule does not imply that the most economical hypothesis is the one that is the closest to what is really happening. Rather, in the short term, colleagues as a group can agree that it is the smallest common denominator they can use, given a set of published observations. An important issue in such discussions is to be able to separate belief from knowledge. The distinction will never be clear because even a collectivity is subject to the influence of belief systems and ideologies. But this procedure forces all involved to advance prudently and take the greatest precautions. Another advantage of working with hypotheses is that it is easier to demonstrate if they are true or false in a given methodology. This allows one to sort out, in a first pass, what can be immediately included in collegial discussions and what can be left for the future. When discoveries permit the construction of a new methodology, this sorting out must often be repeated and may lead to a different set of hypothesis. What was before a hyperthesisâ can now be included in the realm of a hypothesis. An example of a hyperthesis is the assumption that God or cosmic energy created the human species. One cannot know if such hypertheses are true, but we know that they cannot be assimilated in current psychotherapeutic theories and research systems. These domains remain the province of beliefs. We speak of a powerful hypothesis when a hypothesis, containing a minimum of presuppositions, accounts for a maximum number of phenomena. Widely known examples are Newton’s law of gravity and Wallace’s law of the survival of the fittest.
3. An explanation is never a truth. When one observes a phenomenon, one has the tendency to want to give it an explanation. An observation is necessarily fuzzy, because it is always subject to the limits of the perceptual mechanisms. But it can at least be experienced by many others, in many situations. An observation can often be replicated. Imagined explanations are even more fragile to the extent that they are limited by the mechanisms of thinking that build themselves in the intimate regions of the individual’s psychic system In psychotherapy, by default, the fundamental rule is: Never deny an experience, but never accept an explanation. This default rule must then be calibrated according to the available material. If someone claims to have spoken to the Virgin Mary, the psychotherapist accepts that such was the individual’s experience, or at least one of the experiences that so constructed itself at a certain moment. Once we admit this, all speculations are possible for the therapist and for the patient. Both may try to explain how this experienced emerged.38
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