The True Nature of Psychotherapy

What is psychotherapy? This simple question can stimulate hours of discussion, producing more new questions for each new answer. For example, one may ask if there is a single answer to what psychotherapy is, or if in fact psychotherapy is always different for each unique client. Probing deeper, one may also wonder if scientifically informed “theories” of psychotherapy really add to the “truth” of what therapy is for any given client, or whether truth is actually derived through a constructive process. Such questions raise the question of the merits of “truth” versus “utility,” as even the most scientifically controlled or “manualized” approaches to treatment encourage the therapist to accommodate any approach to fit the values, goals, and unique situations of the client. It appears that defining psychotherapy is a difficult matter, creating practical and scientific questions that are worthy of deep exploration.

Psychotherapy has a great tradition of such deep self-examination. For example, Frank and Frank (1991) have influenced two generations of therapists with the well-reasoned yet apparently controversial suggestion that modern psychotherapy is based more on applied rhetoric than on scientific discovery. The psychotherapy field has generally been forced to conclude that factors common across approaches are better predictors of treatment outcome than are the use of a specific technique (Orlinsky & Howard, 1995), particularly the quality of the therapist–client relationship (Orlinsky, Grawe, & Parks, 1994).