Theory and Practice in Psychotherapy: Some Contradictions in Expressed Belief and Reported Practice

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Anecdotal reports from psychotherapists frequently suggest that theoretical guidelines are not readily adhered to in actual practice. Previous studies have found marked differences in viewpoint on many aspects of technique and practice among even relatively homogeneous groups of psychotherapists. In order to explore further the discrepancies between specific theoretical issues in psychotherapy and their practical clinical applications, the authors surveyed a large group of experienced, practicing psychodynamic psychotherapists. A comprehensive questionnaire addressing theoretical issues such as transference, countertransference, and goals of therapy was constructed. In all there were 70 items and respondents were requested to rate each item in terms of psychotherapy “as you practice it.” Numerous discrepancies between theoretical belief and clinical practice were found. Almost all of the 81 respondents agreed that the therapist should not impose his value system on the patient, yet half of the group viewed the therapist's encouragement of the enrichment of the patient's social life and encouragement of educational and vocational pursuits as an important aspect of the therapy. A significant number agreed that giving suggestions and advice to the patient may be harmful, but an equal number felt that the therapist should encourage more adaptive modes of behavior including sexual intimacy in the patient's outside life. Marked disagreements were found over issues of dependency, controlling the patient's outside behavior, and the development of countertransference feelings. Analysis of the data by age revealed that older therapists allowed themselves to be more liberal in their attitudes to such issues as the development of dependency by the patient, the promotion of the enrichment of the patient's social life and the development of countertransference than younger therapists. This study confirmed the presence of striking discrepancies between theoretical belief and clinical practice in dynamic psychotherapy. In particular, the incongruities in the data indicate that therapists may prefer a value-free therapy as an ideal, but invariably bring their personal values into the treatment situation.

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