UNINTENDED CONSEQUENCES

This feature's title, Potential Space, is apt in highlighting my current thinking about the implications of Jonathan Shedler's recent article, "The Efficacy of Psychodynamic Psychotherapy." Shedler's article exonerates psychodynamic psychotherapy from accusations that it lacks empirical support by reviewing and analyzing research findings that offer empirical evidence for its efficacy. Such findings redeem our beleaguered tradition as a viable player in the marketplace of legitimate forms of therapy -- legitimate both in the minds of the public and in the pockets of third-party payers. Amidst this excitement, however, I am wondering if we have unwittingly entered into a Faustain bargain to restore the relevance of psychodynamic psychotherapy at the cost of compromising analytic thinking.

Shedler's findings certainly mark a victory for us in the context of working within a healthcare system driven towards greater demands for treatment efficacy and accountability. However, Shedler's call for more research employing experimental methodologies seems to herald a shift in discourse that puts analytic thinking in peril. The unrelenting march of such a reductionistic science "progresses" towards homogenizing the human experience by extracting abstract trends that become codified as normative and dismiss individual difference. The inevitable outcomes of this research enterprise are greater predictability, standardization, and ultimately automation. This shift in discourse reflects a capitulation to the bureaucratizing forces of the profession. Further, it threatens to mute subversive voices that highlight the complexity of the psyche, value the contextualized nature of the therapeutic dyad, and promulgate knowledge through in-depth case study. 

The danger here is beyond mere rhetoric; it relates to a collapse in thinking that is bound to reverberate in constricting the therapeutic endeavor. It seems just a matter of time before researchers elucidate more expedient routes to develop maximal psychological capacities and formalize such protocols in manualized treatments. Additionally, the implicit denigration of case study further reinforces the use of "objective" methods in an effort to sanitize the therapeutic process. The inherent messiness of psychotherapy, and with it the invitation to use creativity and play, are denied. The potential space for exploring sameness and difference and ultimately coming to terms with one's own unique psychology is truncated. What is at stake is the loss of subjectivity for both patient and therapist. The fear is that by adapting to market pressures, we become master technicians or, in the words of Max Weber, "specialists without spirit and sensualists without heart." 

Mark McKinley, MA
IMPULSE Staff Writer