Advanced analysis of the methods of psychotherapy

The Many Secure Knowledge Bases of Psychotherapy

RAYMOND M. BERGNER, Ph.D.

Psychotherapeutic practice, while it has benefited greatly from scientific

research, rests on many further secure epistemic foundations. In the present

article, this thesis is argued in two stages. First, a brief review of some

elementary epistemologicalfindings is presented. In this review, the generally

acknowledged degree of certainty attributed to different knowledge sources,

and thus the confidence with which we may believe and act upon them, are

recounted. Second, an extended analysis of the ways in which each of these

knowledge sources enter into the practice of psychotherapy is developed. In

the end, what is proffered here is a demonstration that well conducted

psychotherapy is an activity whose judgments and decisions rest on many

secure foundations.

THE MANY SECURE KNOWLEDGE BASES OF PSYCHOTHERAPY

. . .it is, rather, of the essence ofour

investigation that. . .we want to

understand something that is already in

plain view. For this is what we seem in

some sense not to understand.

—Wittgenstein (1953, # 89)

It is long since established that the scientific method represents an

indispensable tool for answering many questions pertaining to persons,

their disorders, and their effective treatment (American Psychological

Association Task Force on Psychological Intervention Guidelines, 1995;

Chambless et al., 1996; Grawe, 1997; Newman & Tejeda, 1996). Is therapy

X superior to therapy Y in its outcome? Is disorder Z found with regularity

to have its etiology in some current or historical state of affairs? Are

therapists skilled in the implementation of process variable A more

effective on average than those less skilled in its implementation? All of

Mailing address: Department of Psychology, Illinois State University, Normal, IL 61790-4620.

e-mail: rmbergn@ilstu.edu

AMERICAN JOURNAL OF PSYCHOTHERAPY, Vol. 60, No. 3, 2006

215

AMERICAN JOURNAL OF PSYCHOTHERAPY

these questions, and more, are ones that by their nature are properly

investigated via empirical scientific methods.

What seems far less appreciated, however, is the degree to which

psychotherapy rests on further epistemic bases. Granted that while

scientific evidence is an invaluable source of knowledge for clinical

practitioners, relatively little attention has been devoted to the matters

of what further knowledge sources are involved in the competent

practice of therapy and how much confidence can justifiably be placed

in these sources. The purpose of the present article is to address this

state of affairs. Its central thesis is that well conducted psychotherapy is

an activity whose judgments and decisions rest on multiple secure

foundations.

In part one of this paper, a brief review of some elementary epistemology

is presented. Recounted here are the generally acknowledged degrees

of certainty attributed to propositions yielded by differetit knowledge

sources, and the confidence with which we may believe and act upon them.

In part two of the paper, I develop an extended analysis of the ways in

which each of these differentially justified knowledge sources enter into the

practice of psychotherapy.

LEVELS OF JUSTIFIED BELIEF: A BRIEF REVIEW

The following analysis of levels of justified belief draws heavily upon

the mainstream conclusions of philosophical investigators (Hospers, 1997,

pp. 39-128; Pecorino, 2001; Solomon, 1989, pp. 117-271; Wittgenstein,

1922). On this analysis, ranked from most certain to least certain, are

propositions yielded by the following epistemic sources:

Level 1: Analytic, a priori knowledge

Level 2: Empirical observation and inductive generalization

Level 3: Established non-probabilistic scientific theory

Level 4: Established probabilistic scientific finding and theory

Level 5: AnecdotaUy based generalization

Level 6: Intuition, hunch, and impression

If this much is familiar to the reader, he or she may safely skip this section

and pass to the next one. If it is not familiar, a brief characterization of

each of these knowledge sources is presented in the paragraphs to follow.

LEVEL 1: ANALYTIC, A PRIORI KNOWLEDGE

True propositions of mathematics (e.g., the set theoretical proposition

that "if all A is B, and all B is C, then all A is C"), of logic (e.g.,

Aristotle's principle of noncontradiction: "nothing can be both A and

216

Knowledge Bases of Psychotherapy

not-A"), and oi conceptual tautology (e.g., "all bachelors are single") are

by common consensus entirely a priori in nature. When true, such

propositions are universally regarded as necessarily true and are subject

neither to rational doubt nor to empirical disconfirmation (Hospers,

1997; Pecorino, 2001; Solomon, 1989; Wittgenstein, 1922). Eurther,

when applied in real world contexts (e.g. when mathematics or logic is

employed in scientific endeavors), these propositional forms themselves

continue to be necessarily valid, while the deductive conclusions drawn

from their employment in such contexts can only be as sound as the

premises upon which they are based (e.g., the accuracy of empirical

observations).

LEVEL 2: EMPIRICAL OBSERVATION AND INDUCTIVE GENERALIZATION

Next in the order of confidence with which we may entertain propositions

are those deriving from empirical observation. These include, first

of all, reports of unaided sensory observations, such as "the apple fell from

the tree," as well as instrumentally assisted observations, such as "the cell

just divided." Also included here are propositions reporting the welldocumented

empirical observations of others. While these latter observations

pertain to many areas of life such as history, biography, and news

reportage (e.g., "Hurricane Katrina ravaged New Orleans in 2005"), an

important special case of such propositions pertains to established empirical

findings in the sciences (e.g., "DNA is composed of four distinct

elements arrayed in a double helix configuration").

Notwithstanding its high degree of certitude, the consensus is that

empirical observation contains an element of uncertainty—it is not infallible.

In the scientific realm, for example, it was "observed" for centuries

that the sun revolved around the earth, that planetary orbits were circular,

and that the earth was flat; all of these observations ultimately proved

incorrect. Nonetheless, we assign very high degrees of confidence to

propositions arising from careful and well-documented empirical observation.

Indeed, for the scientist, such observations are universally regarded

as the evidential bedrock for the adequacy of his or her conclusions.

Finally, though famously questioned by David Hume (1777/1988), we

assign confidence to empirical generalizations that we form via inductive

inference from such observations when these generalizations prove highly

reliable. Eor example, we have great confidence that unsupported objects

will continue to fall to earth and that light will continue to bend in the

vicinity of a strong gravitational field.

217

AMERICAN JOURNAL OF PSYCHOTHERAPY

LEVEL 3: ESTABLISHED, NON-PROBABILISTIC SCIENTIFIC THEORY

Theories, such as those of relativity, evolution, and the big bang, are by

consensus never regarded as immune from being superceded by newer and

more successful theories, and are perceived as having different likelihoods

of being successful theories. Thus, evolutionary theory currently is regarded

as very strongly supported by vast amounts of evidence (Gould,

2002), while superstring theory, due to its weaker evidentiary support, is

regarded as far more provisional (Greene, 2002). Accordingly, the propositions

of the most established scientific theories fall next on our scale of

confidence. Examples here would include: "Individuals possessing characteristics

advantageous for survival in a given environment will constitute

an increasing proportion of their species in succeeding generations;" and

"The universe originated billions of years ago with the explosion of a

hyperconcentrated matter-energy singularity."

LEVEL 4: ESTABLISHED, PROBABILISTIC SCIENTIHC FINDINGS AND THEORIES

Sciences such as psychology, economics, and sociology characteristically

issue their findings in probabilistic terms: "The likelihood of the

observed association between X and Y being due to chance is less than five

in 100;" or "On average, although there was a substantial overlap between

the two experimental groups, group A exhibited a higher group mean on

dependent variable X than did group B, suggesting that independent

variable Y has a varying but on average greater effect." Such being the

evidential base, propositions generated by these

...