Science and Therapy

What is the subject and what is the object?

It appears to me that scientific experiments may restrict the world of therapy. I believe it is a category error to place the world of psychological therapy into the world of rational scientific inquiry (as productive as that rationality has been over centuries).

A Category Error

What do I mean by this?  A category error happens when I give a label to something better described as something else.  For example, in my page on Blind Spots, I suggest we are sometimes happier to use ‘open doors’ to set out on a scenic route.  We go through that door only to meet small defeats in such abundance that it deters us from stepping outside our Window of Tolerance (WOT).  That open door provides a category that says: this is the way to go. We do not see other doors that present the potential to travel on a road less well travelled. We do not see the target doors or trap doors, as I call them.

As far as the ‘science’ is concerned, scientific inquiry can be a trap door when used in the world of therapy.  I am not intending to be rude about ‘science’; even if it sounds like that.  What I am saying is that the science method of inquiry, as it has developed – especially in the Western World –  may not offer the best insight into the processes of therapeutic change. The nature of ‘evidence’ that applies to ‘science’ is not best equipped to cast light on our understanding of change. By its nature, change, changes.  The fancy word for change, changing, is ‘meta-change’. Ancient Greece gets into every corner of the modern Western world!

There is some anarchy in effective therapy

Taking a ‘photograph’ of a change I may make can be out-of-date within days. Study of the natural order used in many sciences involves change that can take a long time. How long does it take to wear down a mountain chain?! Given the short life span of a human, geological study will reveal a pattern that is susceptible to ordered study.  Chemistry and physics have some similarly predictable qualities (until some-one upset the apple cart with Quantum Physics!). 

From this, I can see how the world of medicine has confidence in its own methods of study when it is assessing the impact of ‘treatment’ regimes on their patients. Despite the views of some people, therapy is not medicine; true, it can be about ‘repair’, and some diagnosis, prescription and protocol can help some people in therapy, some of the time.

For the most part, however, therapy can have unpredictable consequences. Often it is successful when there are unpredictable consequences. For example, the therapeutic notion of the ‘reframe’ – a change of outlook or attitude – is a change of a pattern in our head. It is not a change in the external world.  It not always evident what form that change will take until it happens and, even then, it might change again.

Neuroplasticity

Elsewhere, I touch on the topic, but I want to take it further on this page.  In my world, I cannot see that therapy requires organised change;  I may see some change coming from a mile off, only to change course when I least expect it.

Scientific experiment, where life-and-limb is at risk, cannot afford to be relaxed about that.  medicine and therapy have some things in common; it is evident to me that ‘neuroplasticity’ enables people to recover, at least to some extent, from strokes and brain injuries.

If it can be so, then neuroplasticity can play its part in that ‘reframe’ I mentioned above.  Neuro-plasticity is a tricky notion and it does involve the whole brain jiggling all of its parts, not just some, This presents a problem; it’s difficult to see those changes happening, despite modern technology. It is tricky difficult to see how the different parts converse one with another.

If our ‘plastic’ frontal lobes, and lower brain, enable change inside and outside the therapy room, then it’s ill-advised to seek out a single ’cause’ (or variable) of that change.  Scientific inquiry, as I understand it, rather depends on the control of variables.

What’s so special about therapy?

It seems to me that there is something special about the therapy room; it offers something that is different – not easily found in other areas of our lives, e.g. it offers some time for non-judgmental reflection by (at least) two people.  This quality brings art to therapy as well as science. It starts with some values;  art and science both have them but consider this: what is non-judgmentalism? I am not supposed to impose my judgments upon the person in front of me; it’s a rule of therapy. 

Science requires the converse – ‘good’ judgment in the design and implementation of the ‘good’ scientific experiment is essential. That judgment is informed by my more experienced or senior colleagues.   Scientific inquiry, like most relationships in the ‘outside’ world, involve at least two egos negotiating their way around conflicting interests – until some-one with authority decides what to do! By contrast, ‘good’ therapy depends on creating a very unusual relationship – one in which wisdom, curiosity and hope are shared – and the best outcomes arise when the ‘client’ decides on the change to nurture.

This leads me to conclude that skill and knowledge alone are insufficient to get a good result in therapy.  Solicitors, doctors, engineers and shop keepers – amongst others –  have plenty of skills and knowledge. It’s not even that the knowledge and skills of therapists will be central to an effective outcome. Knowledge and skills can make a difference to therapy outcomes, but only so far.

Two egos working it out

The effective therapeutic relationship melds those two egos into a very different working alliance. This melding consists of a constant tension which subordinates ego to a collaborative relationship: you-and-me.  It’s a meld that respects who can contribute what by shaping and respecting boundaries between one another. It does this negotiation best when those boundaries are formed without laying claim to the territory. In the outside world there are different boundaries between you and me. 

Uncertainties in our world can foster conscious or unconscious temptations to claim territory to ensure control over events.  In the everyday, it is too easy simply to put our blanket on the ground and claim it as our own. The blanket may be yours, but the earth underneath it, is not. One of the problems with model building is the temptation to lay claim.  This is fine if you are all spread out on a large exapanse of beach such as Rhossili on the Gower Peninsula in South Wales (gorgeous place!), but not so helpful at Brighton in July and August. 

Even at Rhossili our otherwise natural drive for control can be an abuse of power. It takes discipline to avoid such abuses and many folk fail at the task (including me).

In the wider world, our society has the police to help sustain those boundaries; in the world of therapy it is an unknown that needs attention.

Here’s a page with little to say about small, safe experiments. It’s a page of opinion and you can accept as little or as much as you wish.  It contains general points that may still help you with the design and implementation of your own experiments.   I’m reluctant to end with nothing practical to offer, so let me end with an example.

A practical example

Recently, I was talking with some-one about sleep management. They told me that they had read somewhere that it was not sensible for anyone struggling with their sleep to exercise late in the evening or in the night. Now that advice has some sense. The body is slow to adapt, and it needs time to absorb the benefits of exercise. Therefore, manuals recommend gentle exercise in the early evening, but not later on.

In discussion with this person, I discovered that this person had used late-night exercise to some good effect. She had walked up and down the corridors in her house. In practice, she believed that it had helped her. Please note, believed.  ‘Belief’ may be enough and sufficient to generate change – without any research study to prove whether this was so or not.

Reading the advice, reasonable based on scientific findings, was not bad thing in itself, except that it deterred this person.  Things in print do seem to have more authority, do you not think?!

That’s a shame in my view as the advice in print may not be so helpful as we think. I trust she is going back to her own experiment just noticing what the outcomes are over a period of time.

By the way, I do a few minutes of puzzling as I settle for sleep. Works for me but that’s another device that’s not recommended!

END RESULT: IF IT WORKS, DON’T KNOCK IT

Do more of what appears to work;  make decisions about stopping a small, safe experiment only when you have noticed that there is no evident good result for you. 

Other leads to consider

What is a nudge

Designing a small, safe experiment

…. and I mean small!

Actions that may qualify as safe experiments

Noticing the scenic route

Obstacles on the scenic route

Neuro-science and safe experiments

An index of all pages on Your Nudge

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