A New Model for the Practice of Psychotherapy

Leland van den Daele, PhD, ABPP

Overview of Sections I. Faulty Meta view of Knowledge and Science

II. Natural Domains of Discourse Subjective

Objective

Normative

III. Current Culture in Crisis

IV. Psychoanalysis of Normative Values and Aims Frankfort School

Social/Cultural School

V. Integral Psychoanalysis

Leland van den Daele 2011 All rights reserved 2

At the foundation of much of psychology’s disorder thinking and conclusions about people and pathology is a simplistic, “closed loop” validation process that valorizes empirical findings and precludes further inquiry.


Agricultural Experiment Stations Provided Psych’s Model of Science The official version of psychology largely dominated by

Dust Bowl Empiricism, Simplistic Labeling, and the “Pharmaceutical Model” of medicine.

This arises from an implicit metaview, largely driven by a statistical methodology that requires “isolation” of single variables. Corn yield methods impel toward reductionism. In US agriculture, this has given rise to larger yields for mono crops with enormous costs to economy and ecology.

Dust Bowl Empiricism arises when thought and analysis stop at a statistical result. The result becomes the “finding” that becomes the “reason”.


US Culture Favors Simplistic Meta View of Causality Dust Bowl empiricism has gained extraordinary

traction in the US. US culture is uncomfortable with the complexity of consideration associated with intellectuals and possesses a concrete “results” oriented mind-set. As my mother used to say, “If you are so smart, how come you are not rich?”

By and large in European culture, intellectuality is valued and complexity expected. This gives rise to characteristic differences in style and action associated with these culture belts.


APA Approved Meta view Dust Bowl Empiricism (applied to evaluate corn yields

under different field conditions): Sums across individuals Ignores individuality Individuality equals error variance Simplistic Labeling: Ignores individuality Caricatures human problems

Perversion of psychological assessment: Increasingly geared to diagnostic labels Reductive: Analogous to a scientific approach which asks: Do

you have blue eyes? Yes or no?


Dust Bowl Empiricism, Psychology, & Drug-oriented Psychiatry Pharmaceutical Model:

Sums across individuals

Ignores individuality

Creates large numbers of unintended consequences, “side effects”. Many are unmonitored and/or long term and difficult to link to drug treatment.

Psychologists first line of referral is to “Meds”. Psychologists woefully uninformed and ignorant about biochemistry, physiology, and biological causality


Short-term Treatment Orientation Psychological distress is treated as an “acute” problem

rather than a “chronic” condition.

This accords with “one cause,” “one bullet” models.

One cause, one bullet multiples treatments. One treatment or pill prescribed for each condition.

Chronic conditions require individual assessment. Attention to: Personal history

Individuality

Interaction of variables

Underlying causality


New Paradigm for Professional Practice Abandon 1930’s Methodology

Employ current technology for computation:

Generate mathematical models

Examine least squares goodness of fit to non-linear and causal sequences

Employ new generation statistical modeling

Time sampling

Instead of Ag Experiment Station research, look to biochemistry and biology, complexity theory, and new mathematical models

Be suspicious of single factor causality.

In particular, examine patterns and results of interactions


Eschew Procrustean Diagnosis Abandon DSM and broad categorical labels for “disorders”

Characterize individuals by along dimensions derived from observation, research, or theory

Allow complexity: Employ ICD & ICF

Employ comprehensive screening and multidimensional testing

Systematically examine facets relevant to area of complaint Physical Developmental Social-Cultural, etc.

Employ tests that permit and reflect individuality Employ measures that yield new and unexpected findings


Include Ecological, Biological, and Social Causality and Interactions Psychoneurosomatics Model

No mind-body dualism

Recognition of multi-causality

Explore/Evaluate

Regime, individual ecology

Nutrition

Sleep cycles

Time of life


Psychotherapies, and dynamic psychotherapies in particular, have become heavily invested in the “inner world” with correspondingly less emphasis upon “outer actuality” and social “values and expectations”.


Natural Domains of Experience and Discourse Three natural domains define human experience and

discourse: Subjective, Objective, and Normative.

Different objects of consciousness

Different languages of expression, connotation and denotation.

Domain determines semantic reference and significance

Different quantifiers and modal operators

Different logics of inference and deduction


The Subjective Domain Expressed in poetry, fiction, autobiography, art, and

music.

Traditional therapy and psychoanalysis focus upon the subjective domain or the inner world.

Interpersonal and intersubjective approaches to psychoanalysis emphasize a “sharing of subjectivities” that result in a co-created, mutually validated assessment and reformulation of significant subjective experiences of self and other. An associated claim is that the subjectivity (self-states) of another may be directly experienced through empathy.


Facets of Subjective Experience Tactile, sensory-motor, and visceral sensation

Affect and emotion

Interior experience

Dreams and fantasy

Reflective process

Stream of consciousness (time series)

Solipsistic deliberations and private constructs

The “I” and “me”.

Autobiographical construction


Validation of Subjectively Oriented Interventions and Therapies Therapeutic “validation” depends upon the subjectivity of

the other and is only known indirectly. Assent (agreement) – perhaps the weakest criteria Increased coherence or consistency Reduction of psychic pain Increased spontaneity, freshness, and freedom from crippling

constraint Expansion of emotional pallet Greater imaginative breadth and depth Genuine recovered memory Sense of self, other, and world richer, more dimensional,

located in the present, linked with the past, with awareness of the future


The Objective Domain Oriented to the outer world

Expressed in non-fiction, descriptive literature, travel logs, cartography, and practical know-how.

Mortality tables

Cause and effect

Engineering

Natural and experimental sciences

Cognitive-behavioral therapy tends to emphasize critical thinking and adaptation to the outer world. The approach is psycho-educational and pragmatic.


CBT checklistof cognitive distortions Thinking errors & faulty information processing: Unhelpful thinking

styles Negativeautomatic thoughts (NATS): Extreme and unhelpful thinking Arbitrary inference: Jumping to conclusions Selective abstraction: Putting a negative slant on things Over-generalisation: Making extreme statements or rules Magnification and minimization: Focusing on the negative and

downplaying the positive Personalization: Taking things to heart; unfairly bear all responsibility Absolutisticdichotomous thinking: All or nothing (black or white)

thinking Practice in the real world to test assumptions is encouraged or required

(homework). In accord with learning theory, practice of adaptive cognitions and behaviors are likely to eventuate in rewards that reinforce these new patterns.


Behavioral Economics The “rational” man model of coping with emotions and life’s

vicissitudes has been recast. These are cognitive biases that operate relatively universally, i.e. the distortions are characteristic of healthy individuals as well as persons with DSM diagnoses.

Context based evaluation Cognitive dissonance Memory Distortion Herding Normalcy Bias Loss aversion Commitment Value attribution Anchoring


The Normative Domain Oriented to rules of conduct: Manners, social and

interpersonal and social expectations, values and morality.

Expressed in drama, fashion, cultural motifs and art, law, political philosophy, religion, and theology.

Virtues & Vices

What’s right

What’s good

Good family

Good community

What’s important


Normative Change Systems aimed at change, initiation, maintenance, and/or strengthening of

values and norms typically involve social membership in specialized groups with specific aims. Systems may be ordered in terms of their degree of control over individual members. Quasi therapeutic programs intended to change behavior and values are AA,

NA, 12 step programs, Faith based programs, Positive Thinking programs, Mantra programs, and so on. Weekly meetings.

Political groups and movements: America’s Weathermen, SDS, and Black Panthers; Soviet style Communism, German and Italian Fascism; Middle Eastern Al Qaeda and the Muslim Brotherhood are examples of groups with distinctive allegiances and purposes. More frequent meetings, Limited associations.

Rigorous programs which control the individual’s total environment and interactions with others are boarding schools, seminaries, monasteries, ashrams, cults, military training, reeducation and prisoner of war camps. Total control of ambient environment.

Intermediate in the array of methods to influence or change attitudes and behavior are retreats and intensives.


Normative Change and Psychotherapy Therapies display a wide range of attitudes and little consistency toward the

Normative Domain. As a general rule, therapies privilege either subjective or objective discourse or values. Therapists act as “secular priests” validating either the primacy of the inner world or the outer world –and thereby subordinate the normative to the subjective or objective.

Nevertheless the majority of therapies claim to be “value neutral”. This often means that the values embraced by the therapist, or that are implicit in the form of psychotherapy, or that are endorsed by a cluster group are unarticulated. Neutrality is a myth.

Christian therapists embrace a Christian theology and value system. Pastoral counseling and consultation with a rabbi, minister, priest, spiritual

advisor, even “coach” may fill the lacuna in the value/moral domain. Psychoanalytic therapists of the cultural school, Frankfort School, and/or

Critical Theory highlight the dilemmas and inconsistencies inherent in historical realizations of social structures. Karen Horney and Eric Fromm shared the perspective that neurosis arose from contradictions inherent in historically linked social expectations, roles, and values.


Since the 1960s, the USA has undergone a seismic change in values, attitudes, and manners. Social/cultural stress is evident socially and individually.


1960s Catalysts and Correlatives National expansiveness and wealth (following WWII)

Political assignation (John and Robert Kennedy)

Vietnam War and its corrosive impact upon participants and trust in government

The Pill and correlative “Sexual Revolution”

No fault divorce

Psychotropic drugs: Leary and LSD, magic mushrooms

Popularization of “Self realization”: Horney, Fromm

Radical cultural critiques: Adorno, Marcuse, Brown

Rise of racial politics: SDS, Black Panthers

Rise of feminist politics: Radical feminism


Pendulum SwingsBroad Social Consensus Low Social Consensus

Clear social expectations

Life World

Life Course

Conformism

Cohesiveness

Community

Few Cluster groups

Difference: “Look the other way”

Conflicting expectations

Social fragmentation

Isolation

Malaise

Dramatic Increase of Cluster groups

“Extremism” Political

Religious

Difference: “Politically incorrect not tolerated”


Popular Psychology Books of the 1960s Books critical of the social cultural status quo

Adorno, Authoritarian Personality

Lindner, Rebel Without a Cause

Brown, Life Against Death

Marcuse, Eros and Civilization

Horney, Neurotic Personality of our Time

Fromm, The Sane Society


Some Central Ideals of the1960s “Cultural Revolution”

Liberation Self-RealizationRectification of

Inequity

Do your own thing

Equalitarianism


Cultural StressTraditional and Revisionist BeliefsPre 1960s:Traditional Post 1960s: Revisionist

Hiring advantage should be given to head of household.

Hiring should be based on ability or performance alone.

At age 21, you are an adult and responsible for self support

Males differ from females in fundamental ways

Marriage involves an expected division of labor.

Marriage is “for better or worse”. People at a disadvantage have

nobody to blame but themselves

Hiring advantage should be given to under-represented minorities

Equal skill and effort should entail equal pay

At age 21, you are becoming Male and female differences are

socially imposed Equal work and contribution

negotiated between partners. Marriage is a contract that must

work for the benefit of each partner.

People at a disadvantage have been exploited or cheated


Contemporary Social Stress (after the 1960s cultural revolution) More than 2, 200, 000 men in US jails or approximately 12% of

African American men, 1.4% of Hispanic men, and 1.2% of Caucasian men in the 20 to 30 year old age group.

Young males are increasingly marginalized in education and the workplace.

Males currently approximate 40 percent of undergraduate students.

Females outnumber males in virtually all areas of graduate work. For the age range of 22 to 42, high income metropolitan zip

codes are predominately domiciled by females (approximately 65% female and 35% male).

Only two areas are projected as growth areas for male employment for the next 20 years: Software development and janitorial work.


Contemporary Social Order A large number of individuals have lost faith in organized religion and

traditional beliefs. They are rudderless and turn to psychologists presenting with “symptoms” that appear psychological in nature, but arise from the absence of numinous ideals, moral, and value confusion.

We are at point historically where contradictions and inconsistencies in cultural ideology, class membership, and the economic system create for individuals a fractured terrain. Overweight Drug dependent Entertainment preoccupied Have it all before there’s none left mentality Erosion of family Buried in debt Slack awareness of public issues Political correctness


Post- 1970s pathologies Dramatic increase in addictions Quintupling of criminality and gang activity Homelessness Child abuse False memories Anorexia Bulimia Narcissism Borderline spectrum Autistic Spectrum Alzheimer’s


The Frankfort School and Horney’s social cultural approach to psychoanalysis are exemplars of normatively focused psychotherapies. Both shared similar assumptions about normative development and the role of early socialization.


Normative Development Formation of the ego ideal: Internalization of ideals

through incorporation, identification mediated by observation, numinous ritual, myth, story, and fantasy. A continuum from ideals about the good, the true, and

the beautiful to manners. The ideal may apply to any content, usually culturally defined.

Possesses both a “deep” and “surface” structure.

Laid down during childhood and adolescence.

Gives cohesiveness to the ego.

Internalized conscience arises from external prohibitions and by reference to internalized ideals.


Frankfort School and Freudo-Marxism Freudian Marxist theory established in the 1920s. Early

exponents were Wilhelm Reich and Eric Fromm whose “preliminary” theories shared common assumptions. Critical theory was employed to deconstruct capitalist

societies to show underlying power relations.

Economic determination assumed independent from psychological mechanisms which arose largely in response to the social status quo.

Normative beliefs, ideals, roles, and etc presumed to legitimize an existing power structure.

Freudo Marxism aimed at psychological liberation and freedom from illusions and institutions that constrained human choice and self realization.


Frankfort School Fromm was a member of the Institute for Social Research

in Frankfort from 1930, a center of Freudo-Marxism. Members disbursed with the rise of Nazism.

Another member was Herbert Marcuse, muse for the counter culture, who write Eros and Civilization.

Karen Horney and Eric Fromm were colleagues in Berlin. Later she invites him to Chicago and New York.

Horney was influenced by Fromm’s Freudo-Marxism, but also by Ruth Benedict and Margaret Mead. Ultimately she embraced an anthropological perspective for the description of character, but with themes common to Hegel and Marx, i.e. “self-alienation”.


Social/Cultural Psychoanalysis The social/cultural approach to psychoanalysis was

overshadowed by the Self and interpersonal schools.

Horney’s approach was viewed as “ego” psychological, i.e. readily accessible to conscious review.

Horney’s “shoulds” and “claims” identify normative expectations.

Her approach is more accurately viewed as focused on the “superego”.

Little follow-up occurred in social cultural psychoanalysis. Alan Roland’s “In Search of Self in India and Japan” is a rare example.


Normative Therapeutic Focus Analysis of “shoulds”: Shoulds are internal aims/directives for personal

and social behavior. They are closely coupled with expectations about the life course and life world. Therapy (analysis) involves: How these affect behavior and impact upon life course and the life

world Examination of their internal and external consistency

With other aims and directives With life course and life world

Their sources Associated claims and entitlements

The experience of a normative vacuum, “emptiness”, “crisis of faith”, or feeling “unmoored” typically arises during the early and middle period of therapy.

Patients ought to be prepared for this stage. This is a period of “transition”.


Transitional Crises The “existential crisis” brought about by the analysis of

foundational aims and directives leads to the reexamination of existential foundations. Horney visits Japan DT Suzuki, Abraham Maslow, Rollo May, and Paul Tillich

were early contributors to Am J. Psa Fromm’s “To Have or To Be” Harold Kelman’s Intensive Analysis American Institute for Psa was a major center for training in

Existential analysis

Horney’s shoulds appropriated by Albert Ellis as “musts”. His approach to find new aims was through testing of empirical outcomes.


Wide-spectrum psychoanalysis examines subjective, objective, and normative distortions and lacunae about the life course and the life world. The therapeutic aim is to harmonize affect and schema across domains and provide the meta knowledge and skills for constructive/creative response to life issues.


Normative Premises Cultures, societies, and cluster groups provide definitions,

attitudes, roles, relations, expectations, and values that direct, guide, legitimize, and organize use of time, behavior, interactions, and communication.

Socially given structures of expectations and their rationales may consistent or inconsistent.

Normative internal and interpersonal conflicts arise from inconsistent socially given structures of expectations and rationales.

Societies with inconsistent expectations and values yield increased social and individual pathology. Social and individual pathologies go hand-in-hand.


Analytic Process A comprehensive approach to normative

transformation requires that ideals and aims be assessed in terms of subjective, objective, and normative criteria Subjective: Phenomenology and existential affects

Objective: Actualities and pragmatics

Normative: Cluster group and social cohesiveness

Analysis leads to a foundation for ideals and morality based upon subjective, objective, and normative attunement to the life course and life world –a continuing process.


Normative Social Case Studies Ms Don’t Mess with Me: Seventeen year old

incarcerated female who bullies and picks fights with peers. She has frequent altercations with binge drinking Mom and seeks contact with incarcerated father who had sexual intercourse with her when she was a preteen (She did not bring charges). Ms Don’t Mess with Me can’t sit still and tells therapist that she’s been “white-washed”. Therefore, she discounts therapist’s interpretations. At 17 she is serving her third term in a correctional facility.


Normative Individual Case Studies Mister Neither Here Nor There: Presents with

depression, lives with mom, does not have an idea when or with whom he might marry, does not know his visa status, nominally interested in playing music.

Mister Toy Boy: Lives with divorcee, divorcee involved with another man who lives in the house while husband still courts her. Mister Toy Boy is conflicted.

Mistress Cleverer than Thou: Cannot find the job that will make her happy, reads psychology and therapy books, disputes intellectually, but has obscure foundational beliefs and no clear path.


A New Model for the Practice of Psychotherapy

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