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

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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:

...