Objectivity of psychotherapy

    A client in a psychologist's office says: "My mother (father) used to beat me as a child, and nothing, everything is in order, grew up healthy and sane, and you are saying here ...". And really, what are we talking about? About the influence of some events of a person’s life on its further course. And can we talk about it? Can we reasonably build forecasts, based only on the description of events that occurred in a person's life?

    Sometimes psychology is doubted as in science. Like, everything in science is repeatable and predictable, but in psychology, it is impossible to predict further developments in any event in a person’s life.Or, for example, a client says: “So this and that of my acquaintance had the same event as mine, but why is everything normal with them, but not with me?”, And then concludes about their abnormality, inferiority or chosenness, exclusivity (which is essentially the same). But let me say, in medicine of the body, everything is exactly the same: try to predict further events according to an event in a person’s life, which is described as “they hit me with a stick on my leg”. This is impossible and obvious enough - someone will have a slight bruise, someone else will have a serious hematoma, a third will have a fracture, the fourth will die of complications such as fat embolism, and the fifth will forget about this event in 5 seconds. On the example of describing the events of the life of the "body" of a person, it becomes quite obvious that there is no way to make predictions - only to calculate the probabilities of the occurrence of certain consequences, which by no means suit the one who expects "scientific repeatability" and reliable predictability. But in psychology in the same way - only probabilistic evaluations are given out and nothing more ... What by no means can an adherent of objective science be able to do.

    But if you pay attention not to the description of the events of a person’s life, but to the internal changes that led to these events, then you can be much more accurate both in the forecasts and in the therapy strategy. But if in the case of changes occurring in the human body, it is possible to monitor relatively objectively (for example, to clarify with X-rays, or to make analyzes, or to analyze the internal organs), then how to track changes in the psyche objectively? So far, there is no “x-ray” of translucent psyche in order to objectively determine at least banal “fractures” of what should be solid enough to maintain the internal structure.

    All the tools available to psychologists and psychotherapists are between the most “objective” (in quotes because, in my opinion, they are very far from objectivity), validated and standardized tests on the one hand, and the most subjective personal impressions, analysis and intuition with the other side. This is not much better than it was in medicine in the Middle Ages, when a person with a sore leg could be brought to the doctor, and he had to make a diagnosis and start treatment without having any objective tools — no X-rays, not even a banal general blood test. And what can he do? Try only to gently touch the injured place (which in any case will cause pain, and sometimes wild pain and the patient's desire to escape from such a "doctor").

    Well, if not this, then what? It remains for the doctor to only ask the patient about the events of his life that led to such a deplorable situation. Well, ask him about his feelings - what he felt and how. And ask, not relying on adequate and intelligible descriptions of internal experiences and sensations.

    And if a VIP client was brought to the doctor, whom he would be afraid to inflict pain on (or else he would send a doctor to the gallows for aggravating VIP sufferings)? And to all questions like “how do you feel now” or “describe in as much detail as possible what happened”, in response the doctor receives only a stream of VIP righteous anger: “chump, treat me urgently, do something, you are a doctor or charlatan I'll stand on the rack now ?! ”.

    And what remains to do the doctor? Based on that heterogeneous arsenal of unstructured models of diseases, he somehow tries to make a differential diagnosis in a vain attempt to understand a fracture or bruise, or maybe a dislocation, heart attack, gout ... And if there is another doctor nearby, then this other one can put a completely different diagnosis, even if he is an adherent of the same medical school. And if it is from a different direction, the diagnosis will be completely different and the recommended treatment will be the same. I will keep silent about what qualities the second doctor can impart to the first, and not the fact that this will not happen with the patient.

    In general, that “science” was once medicine. Nevertheless, doctors somehow helped, at least to give hope, which fed faith in the cure. And even modern science recognizes the power of the effect of faith, even if it does not want to (placebo / nocebo). But, besides, in this way, a knowledge base was developed, which over time was structured, corrected, verified and rechecked. It is because of this, after many centuries, medicine is quite justifiably considered a science, and it is thanks to the multitude of errors, incorrect diagnoses, erroneous treatment plans that we have that medicine which can justifiably make predictions and have a repetitive result.

    And what is psychotherapy now? There are many schools, each of which has its own models, its own descriptive terms, its own treatment plans. And if you dig deeper, many of them have in common, although it has a different name. And if two specialists from different schools make efforts, then they can largely find a common language - they will understand that in their school this or that phenomenon is called this or that, and in another school the same phenomenon has a different name.

    imageBut not all they converge, and here's why. Look at the widespread picture, where a three-dimensional object of complex shape has three completely different two-dimensional projections on the plane. Similarly, by studying a person in the modalities of different schools, it is possible to obtain fundamentally different representations and descriptive models that will never coincide with each other.

    Naturally, then the conclusion is that it is necessary to put together all these two-dimensional projections and simulate the original three-dimensional object on their basis. Unfortunately - nothing good (scientific and objective) will come of it, because there may be an infinite number of three-dimensional objects that give completely identical projections.
    Even according to this picture it is absolutely impossible to determine if there are cavities inside a three-dimensional object or not. Think it doesn't matter? Tell about this to a person who looks outwardly quite ordinary, with well-established life, work and family, but who feels a “deep hole in his soul.” By the way, his external “normality” only exacerbates internal torments, and sometimes such people “calm down” only by “letting their lives under the slope” or otherwise radically changing it. But they could just go to a psychotherapist ...

    Let me give you a small intermediate result: objectivity in psychotherapy is impossible until objective tools appear that allow infinitely detailed scanning of the state of mind in each of its dimensions (projections). And how many measurements does she have? Good question, no answer ...

    The MMPI test alone has 10 scales, each of which can be conventionally compared to one of the psyche measurement spaces. A valid test - hundreds and thousands, and to fill all of them a person will take months of work - this is a huge time and labor costs, not comparable to the speed and efficiency, for example, taking blood from a finger or X-ray. And even if part of the axes, from the whole variety of valid tests, intersect, all the same, there are neither models nor corresponding objective scanning methods for something whose dimension is obviously more than the three dimensions of space and one time that are objectively available to us.

    So, we are again in the office of the therapist. And what does he have of diagnostic tools? Objective and effectively applicable - not one, because thousands of tests will take months to complete, analysis and interpretation take another week, and you need to look for changes in the client’s dynamics weekly or even more often. Formally, the psychologist is limited to these tests, but the therapist has one subjective tool - his own psyche. And the dimension of his psyche is comparable (and maybe equal) to the dimension of the psyche of his client. So what is it that turns out that the maximum subjectivity of a psychotherapist can be extremely objective? Of course, this was said and written many times by the classics of psychotherapy - that the psychotherapist’s main tool is his soul or, I would say, psyche. And from that how skillfully the psychotherapist is to deal with his own psyche, how well he knows and understands it, how well he can feel himself and feel all his subjective processes - just as he is objective in his interaction with the client. But this was always said subjectively, metaphorically. I only casually showed that behind all this poetic subjectivism there can be quite a mathematically justified objectivism. And this means that they do not contradict each other, but can complement each other quite successfully. But it will not happen before the "physicists" to work out with the "lyricists" and vice versa. And until this happens, there will not be much progress in this area. how well he can feel himself and feel all his subjective processes - just as he is objective in his interaction with the client. But this was always said subjectively, metaphorically. I only casually showed that behind all this poetic subjectivism there can be quite a mathematically justified objectivism. And this means that they do not contradict each other, but can complement each other quite successfully. But it will not happen before the "physicists" to work out with the "lyricists" and vice versa. And until this happens, there will not be much progress in this area. how well he can feel himself and feel all his subjective processes - just as he is objective in his interaction with the client. But this was always said subjectively, metaphorically. I only casually showed that behind all this poetic subjectivism there can be quite a mathematically justified objectivism. And this means that they do not contradict each other, but can complement each other quite successfully. But it will not happen before the "physicists" to work out with the "lyricists" and vice versa. And until this happens, there will not be much progress in this area. that they are not contradictory, but can complement each other quite successfully. But it will not happen before the "physicists" to work out with the "lyricists" and vice versa. And until this happens, there will not be much progress in this area. that they are not contradictory, but can complement each other quite successfully. But it will not happen before the "physicists" to work out with the "lyricists" and vice versa. And until this happens, there will not be much progress in this area.

    And what about the client in the office of a psychotherapist? Here he comes in and says “my leg hurts”, oh, no, it was before. He says “my soul hurts” or “my life does not add up” or something else like that. In general, it is uncomfortable for him in life. But what exactly is the problem of this client? The essence of his problem is yet to be understood. But how to do it? If you start to do some kind of diagnostic manipulation of the "mental body" of a person, then it will respond with pain. And then the "important" client - will begin to resent the actions of the "horse" or even sue him. “Modest” - quietly slips away, and will no longer go to these “monsters”. A “patient” or “unimportant” client with low self-esteem - will loyally look at the psychotherapist and say “no, no, now everything is normal, does not bother anything” with the last of his strength restraining the flow of tears, caused by pain. In general, not an option, at least not always applicable.

    Well, if not manipulation, then what remains? It remains to ask the details of the events of a person’s life: what happened in his life, how he reacted to it and what he felt, thought about, what he wanted and what he hoped for and so on. And just like the doctor earlier, the psychotherapist does not have to hope for a sensible, adequate and understandable description of the events. And just as in the Middle Ages, the modern psychotherapist has a motley arsenal of various models, methods and techniques from various psychotherapeutic schools. And in the same way, he is largely forced to guess and rely on his own subjective experience, his instincts and his intuition. And turn this patient to another psychologist, it is very likely to get a different diagnosis. Well, or the same diagnosis, but decorated in other words, that sounds no better. As a result, the client is justified to have doubts about the effectiveness of psychotherapy in general, or of a particular psychologist in particular. And then the nocebo effect begins to make itself felt, in addition to all the other problems of the person who turned for help to a psychologist or psychotherapist.

    Gloomy picture emerges? Well, the Middle Ages seem to me rather grim. Similarly, the current state of psychotherapy in general does not delight me, but the understanding that this is a necessary evolutionary stage of development, through which medicine has passed in due time, inspires hope. And this means that it gives access to faith, which is a very strong and significant human resource.

    So, is psychotherapy objective? In my opinion, it is only then objective, when it is extremely subjective, but to reach this ultimate subjectivity is not much easier than to reach the moon - it requires incredible efforts from very many people, and very few people walked on the moon. The ultimate subjectivity is as far from ordinary, everyday subjectivity as the person who looks at the reflection of the moon in a puddle on earth, from Neil Armstrong, looking at it through the visor of his spacesuit.

    P.S. The difference between a psychologist and a psychotherapist is a separate big topic. Formally, they are different and strongly (including as described in this article, but not only), but in reality there is no such clear boundary, since One person can act both as a psychologist and as a psychotherapist. And by the psychotherapist, I mean the non-formal, still “Soviet” interpretation of the psychotherapist. And, of course, there will be more psychotherapists than people who walked on the moon on foot, but the subjectivity of their view (even when it is not extremely subjective) is very different from the subjectivity of the view of an ordinary man in the street.

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