The Humanistic Psychologist, 37: 223234, 2009 Copyright # Taylor & Francis Group, LLC ISSN: 0887-3267 print=1547-3333

online DOI: 10.1080/08873260903206347

INVITED ADDRESS

What is Psychotherapy for?

An Almost Official Answer
Alvin R. Mahrer
School of Psychology, University of Ottawa

Recent task force reports have cited a large pool of research studies on the effectiveness of psychotherapy treatments and therapistclient relationships. A careful examination of these studies has finally yielded an almost official, research-based answer to what psychotherapy is for, and enables psychotherapists to compare their answer to the almost official answer. The main purpose is to examine the implications of psychotherapies, including humanistic psychotherapies, that do not accept the almost official answer.

The purpose of this article is to provide an almost official answer to the question: What is psychotherapy for? If it is safe to say that psychotherapy has been a profession for about a hundred years, it also seems safe to say that it has only been since about the 1990s that the professions task forces have provided an almost official answer to: What is psychotherapy for? The answer is almost official because it is based on research, and because the task forces come very close to representing the science and profession of psychotherapy. I believe that there are at least two ways in which this question can be especially troublesome for some humanistic psychologists: 1. I believe that the idea of what is commonly referred to as humanistic psychotherapy is a myth. Whatever the almost official answer is to the

Editors note: Al Mahrer was unable to attend the 2007 APA Convention. This article is based upon the undelivered text of his Division 32 Invited Address. He would like to express his grateful appreciation to Sparky and Lily. Correspondence should be addressed to Alvin R. Mahrer, Ph.D., School of Psychology, University of Ottawa, Ottawa, Canada KIN 6N5. E-mail: amahrer@uottawa.ca

223

224

MAHRER

question of what psychotherapy is for, I believe that there is no identifying, characteristic, defining humanistic answer that many, or most, humanistic psychotherapists would either subscribe to nor uniformly decline in favor of some alternative. 2. In the past, a case could be made that humanistic psychotherapies offered a relatively distinctive and characteristic alternative to the mainstream, standard answer to what psychotherapy was for. That no longer seems to be the case today. By its own official pronouncements, humanistic psychotherapy can be said to have joined the mainstream, to walk and talk and dress like the mainstream, to act as if it were a respectable member of the mainstream (Caine & Seeman, 2002; cf. Mahrer, 2002). Judge for yourself. If we can arrive at an almost official answer to what psychotherapy is for, judge if the preponderance of humanistic psychotherapists sing the official anthem or, instead, give voice to one of the alternatives or, as I suspect, there is no preponderance of like-singing humanistic psychotherapists. Some are here, some are there, some are almost everywhere.

FOR THE FIRST HUNDRED YEARS OR SO, WHAT PSYCHOTHERAPY WAS FOR WAS NOT MUCH OF A PROBLEM Until the 1990s or so, the field of psychotherapy managed to get along quite well without having an especially clear idea, much less an official authoritative answer, to the question of what psychotherapy was for. We really did not have much of a generally accepted idea of what psychotherapy was for, but we could more or less agree on what psychotherapy was not for: It wasnt for fixing a leaky roof, increasing the salmon stock on the east coast, getting rid of unwanted hair, clearing up blurred vision in the left eye, increasing egg production of chickens, heightening the magnification power of telescopes, determining the proper fluoridation level in the city water system, coping with grasshoppers in the north field, or developing a useful alternative to fossil fuels. Very few people sought out psychotherapists for these reasons, even though we had no official answer to what psychotherapy was for. So what was psychotherapy for? One friendly, common, unofficial answer was that psychotherapy was for personal problems, but this answer was not especially satisfactory for at least three interrelated reasons: 1. It was not easy to get a clear and careful picture of just what constituted impersonal problems, and it could be hard to have much respect for a field that carved the world into personal problems and impersonal problems that were hard to distinguish from one another, the more carefully you tried.

WHAT IS PSYCHOTHERAPY FOR? AN ALMOST OFFICIAL ANSWER

225

2. The problem is that many so-called impersonal problems can look and sound much like personal problems Oh no! My roof leaks . . . . I just ran out of gas! Im already late for the meeting! Theres no electricity! The whole neighborhood is black. Im in big trouble now! If the bank is right, I dont have enough money to pay the taxes! The refrigerator just stopped working. Now what do I do? . . . There is too much ice on the wings of the airplane, I am stuck here for the whole day, and I already missed my connection in Hong Kong. It was hard to maintain that psychotherapy was for personal problems, when so many problems seemed both impersonal and personal. 3. If psychotherapy was for personal problems, psychotherapists could easily be dwarfed by all the others who would likely raise their hands if they were asked, Do you help people with their personal problems? The gathering crowd could include all sorts of professionals who help people with all sorts of personal problems: specialists who can provide sex partners, advice on bankruptcy, money laundering, house cleaning, care for the elderly, repair of computers, tutors in math or Spanish, voice and diction coaches. People have personal problems; we fix them say many companions, escorts, sex workers, dentists, nurses, clergymen and clergywomen, accountants, physicians, teachers, coaches, real estate agents, plumbers, taxi drivers, tax consultants, travel agents, and brick layers. For the first hundred years or so, psychotherapy could lumber along as being for problems, even though there were problems in this unofficial, but popular, answer to what psychotherapy was for. The field could look for alternative answers. What it was for did not seem to matter all that much. If there are problems with psychotherapy being for personal problems, a ready alternative answer was that psychotherapy was for psychiatric or, more popularly, for psychological problems. There, that answers the question. Except that answer was also not much of an answer. It mainly just begged the question, or moved the question sideways so that the question became: If psychotherapy is mainly for psychological problems, what makes a problem a psychological problem? If there is big trouble answering this question, if there is no clear and systematic way of identifying a problem as psychological, then the field is in danger of lots of other fields laying their claim to what the field tries to insist are psychological problems, and the field has a professional identity problem of being unable to say what psychotherapy is for. Here are some problems. On what careful and systematic principles can you identify them as psychological or not psychological problems? I doubt

226

MAHRER

if we have such sound and solid principles. I doubt if these people rush to their psychotherapists for solutions to problems like these: My left leg is shorter than my right leg! I fell down and broke my arm. How can I get it fixed? Please get rid of the rats in my apartment . . . . Its been three days and the airline still hasnt delivered my luggage. Help! My refrigerator just stopped working. Can you come over and fix it? The big filling just fell out. Can I have an appointment right away? It hurts! . . . The big party is tonight and I need my hair done right. Tell me you have an opening! On what basis are these psychological problems or not psychological problems? Almost from the very beginning, in about the 1880s, the field had big trouble being clear and systematic about what psychotherapy was for (Mahrer, 2005). The field solved this problem mainly by not talking much about it, and that was all right until two things happened. The Field Grew, Entered the Big Leagues, and Faced Big New Challenges Starting around the 1970s and 1980s or so, two major changes occurred, and the field was faced with a serious challenge to have some sort of formal official answer to what psychotherapy was for. One was that the field grew and grew, took on the trappings of a science and a profession, and entered the world of well established sciences and professions. The field had its own researchers, research journals, and research-based cumulative body of knowledge. The field also had ethical codes, accreditations, licenses, university training programs, internships and residencies, associations, professional meetings, national headquarters, professional insurance, boards, and committees. The field had become one of the sciences and professions, and the club rules made it important to identify where it belonged, what this newcomers subject matter was, and how it was distinguished from the subject matter of the more established sciences and professions. The challenge was a big one, but the field had little or no official answer to just what psychotherapy was for. Then a second thing happened, and the field was forced to say something about what psychotherapy was for. The second thing, starting in the 1970s or so, was that the field of psychotherapy became a mighty big business, dealing with big league money and big league financial power. Psychotherapy found itself in the big leagues, facing some big league competitors like drug companies and the medical establishment. How did drug companies and the medical establishment do battle on the mental health battle ground? Their weapons included extensive lobby groups, market experts, public relations specialists, business and management

WHAT IS PSYCHOTHERAPY FOR? AN ALMOST OFFICIAL ANSWER

227

organizers who played hard ball, media consultants, and teams of tough lawyers. These people were battle hardened, seasoned, with plenty of money backing them, and with a track record of successes in. big league competition. These people fought by financing the journals, hiring the researchers, backing the conventions, influencing the media, funding the departments, providing incentives to the legislators, sponsoring mental health committees, supporting the offices that supplied the grants, determining what the studies would study and monitoring how the findings would be used. When psychotherapy entered the big leagues and faced these highpowered competitors with their high-powered weapons, what did the field of psychotherapy bring to the battlefield? How would they combat the drug companies and the medical establishment? The science and profession of psychotherapy proudly and confidently relied mainly on the one power it reverently counted upon. It would fight their powerful competitors by citing research articles! The drug companies and the medical establishment and their powerful hired hands giggled as the science and profession of psychotherapy unleashed task forces to organize research in defense of the honorable science and profession of psychotherapy. The field of psychotherapy had entered the big leagues, and relied on its task forces to face the powerful challenge of showing that it belonged in the big leagues. Task Forces Provided a Way to Get an Almost Official, Research-Based Answer to What Psychotherapy is for Starting in the 1990s, the field authorized official task forces to show that psychotherapy was effective, that it worked, that the field had a right to be in the big leagues. There were lots of official task forces. Here are some: American Psychological Association Task Force on Psychological Interventions (1995), American Psychological Association Presidential Task Force on Evidence-Based Practice (2006), Chambless et al. (1996), Chambless and Ollendick (2001), Division 32 Task Force (1997), Nathan and Gorman (1998), Norcross (2001), Sox and Woolf (1993), Steering Committee (2001), and Task Force on Promotion and Dissemination of Psychological Procedures (1995). These task forces looked at studies, lots of studies. The task forces studied studies that were reasonably well done, that were worthy of study. These studies were the answer. These studies showed how we can finally come close to a research-based, almost official answer to the question of what psychotherapy was for. How? If these studies showed that psychotherapy worked, the chances were pretty good that the studies would show what psychotherapy worked

228

MAHRER

on. If these studies showed that particular therapies were effective, the studies would likely tell what the therapies were effective for. If task forces used the findings to come up with practice guidelines, it is likely that the guidelines would tell what the practices were for. All we had to do was to go back over the hundreds of studies, identified by the task forces, to see what the studies studied, and thereby to get a research-based picture of what psychotherapy was for. The methodology was relatively unsophisticated, relying mainly on careful examination of each study (Mahrer, in press). Some of the studies followed the pseudoscientific drummer so mechanically that they seemed to march right out of reality. These studies showed that psychotherapy is genuinely effective, the treatment successful. Psychotherapy works; it is effective; it provides the service; it is good. Furthermore, the outcome measures were smiling out to two decimals; the designs were impeccable; the methodology was first rate; the statistics were sophisticated. Unfortunately, these studies left out one little item. They showed that psychotherapy was effective, but the studies failed to mention what psychotherapy was effective at, what outcome was actually achieved, what actual problem was resolved, what the treatment was successful at bringing about, what the therapy actually accomplished. The studies asked, You sought psychotherapy for some problem, so is the problem resolved, taken care of, much less of a problem? The subjects answered: Yes it is. If you have some other problem, would you get psychotherapeutic help? Yes I would. Would you rate your psychotherapy as effective or not especially effective? I would rate my psychotherapy as effective. Notice that we still dont know what psychotherapy is for. We asked the researchers, You concluded that psychotherapy was effective, and the findings were often supportive, but neither your design and methodology nor your findings mentioned what the psychotherapy was for, or what it was effective for, so can you tell us what you studied? We are trying to get a research-generated idea of what psychotherapy is for. The researchers happily replied, We have no idea, but our outcomes were measured with scientific rigor. Two decimal places. Thank you very much. Leaving aside these quixotic studies, most of the remaining studies could be examined to get some idea of what psychotherapy is for, based on research. One by one, a team examined most of the studies cited by the task forces, accumulated a large body of research-defined answers to what each study identified psychotherapy was for, and tried to be systematic in arriving at a single answer to what psychotherapy is for, based upon the actual designs and methodologies of the studies.

WHAT IS PSYCHOTHERAPY FOR? AN ALMOST OFFICIAL ANSWER

229

Here is the Almost Official Answer to What Psychotherapy is for For perhaps the first time in the history of psychotherapy, task forces have given us a formal, research-based, almost official answer to what psychotherapy is for: In general, psychotherapy is treatment of mental disorders and their associated symptoms and problems, in helping clients to achieve or to regain normal functioning. Of course, there were some studies pointing to other answers to what psychotherapy is for, but this was the preponderant answer from the heavy, preponderance of studies. This answer has at least two virtues. One is that it comes from the research studies themselves, frequently in their own words, so it can claim to be evidence-based. A second is that it comes fairly close to having concrete meaning, rather than wrapping itself in wishy-washy, aerie-faerie, loosely meaningless jargon. As a result, you can come reasonably close to seeing if you agree or disagree with the almost official answer to what psychotherapy is for.

HOW DOES YOUR ANSWER COMPARE WITH THE ALMOST OFFICIAL RESEARCH-BASED ANSWER TO WHAT PSYCHOTHERAPY IS FOR? Now, for perhaps the first time, you can compare your own answer to what the science and profession of psychotherapy has to say about what psychotherapy is for. Do you generally accept their answer? Do you have slight or substantial reservations and modifications? Do you have your own answer? In his famous article on the necessary and sufficient conditions of therapeutic personality change, Rogers (1957) spelled out his own quite unique answer to what he believed psychotherapy was for, not just for his clientcentered therapy, but for psychotherapy in general. What is so noteworthy is that Rogers radically differed from both parts of the task-force-based, research-based answer to what psychotherapy is for: (a) Is psychotherapy for treatment of mental disorders and their associated symptoms and problems? No it is not. (b) Is psychotherapy for helping clients to achieve or regain normal functioning? No it is not. Rogers was clear and formal and radical in asserting that psychotherapy was for change in the personality structure of the individual, at both surface and deeper levels, in a direction which clinicians would agree means greater integration, less internal conflict, more energy utilizable for effective living, change in behavior away from behaviors generally regarded as immature, and toward behaviors regarded as mature (Rogers, 1957, p. 95). In his classic article, Rogers (1957) spelled out the necessary and sufficient conditions for achieving his bold and uncommon meaning of what

230

MAHRER

psychotherapy is for. For 50 years or so, the field acted as if his article spelled out the necessary and sufficient conditions for psychotherapy in general, rather than for his explicit meaning of what psychotherapy is for. For 50 years or so, the field got his article wrong (Mahrer, 2007). We now have an almost official pronouncement of what psychotherapy is for. Carl Rogers (1957) differed on all counts. Now it is your turn. How does your answer compare with the almost official pronouncement of what psychotherapy is for?

THE EXPERIENTIAL ANSWER DIFFERS ON ALL COUNTS ON WHAT PSYCHOTHERAPY IS FOR The experiential answer refers to experiential sessions only, not to psychotherapies in general. An experiential session is not for treatment of mental disorders and their associated symptoms and problems so that clients can achieve normal functioning. What is an experiential session for? There are two related parts to the answer (Mahrer, 1996=2004): 1. An experiential session is mainly and characteristically for transformation into the person you can become. The aim or goal is for you to undergo a wholesale, radical, qualitative transformation into the person you are capable of becoming. This is a quantum shift from one state to another state, a shift from the person you are to the person you are capable of becoming. The transformation is such that the person who entered the session is qualitatively different than the person who leaves the session. Your feelings are different. Your thoughts are different. Your experiencings are different. Your bodily-felt sensations are different. Your world is different. You essentially disengage from the person you are, and you emerge or awake as the qualitatively new person you can become. 2. An experiential session is also for being free of the bad-feeling scene, and the bad feeling in the scene. Each session is to begin by finding a time, a situation, or a scene of strong feeling. The feeling may be good and pleasant or bad and unpleasant. If the scene is of bad feelings, then the aim or goal of the session is for the person to transform into the qualitatively new person the person can become, and for this transformed new person to be essentially free of the former persons bad-feeling scene, and of the bad feelings in that scene. The transformed new person lives in a world that is generally free of the former persons bad-feeling scene and the bad feelings in that scene.

WHAT IS PSYCHOTHERAPY FOR? AN ALMOST OFFICIAL ANSWER

231

This is what an experiential session is for. The experiential answer seems to differ on all counts from the almost official answer. The case is that the experiential answer counts on none of the parts of the almost official answer, and the almost official answer seems to count on none of the parts of the experiential answer. What about your own answer to what your psychotherapy is for? What is your own answer, and how does your answer compare with the almost official answer? WHAT COULD BE SOME BIG IMPLICATIONS IF YOUR OR MY ANSWER TO WHAT IS PSYCHOTHERAPY FOR? HAS ESSENTIALLY NOTHING IN COMMON WITH THE ALMOST OFFICIAL ANSWER? Your answer and my answer probably have little or nothing in common, yet we both depart from the almost official answer to what psychotherapy is for, the answer of the task forces, the associations, the profession and science of psychotherapy, the establishment, the important offices and committees. Here are some, perhaps, big implications if your answer or my answer, or both our answers, have little or nothing in common with the almost official answer to what psychotherapy is for: There Can Be Plausible Alternatives to the Almost Official Answer to What Psychotherapy is for There may be an almost official answer to what psychotherapy is for. It may be an authoritative answer, the answer of the associations, of the establishment, of the important people in the field. It may even be a generally accepted answer. But it is not the only answer. There are plausible alternatives. Psychotherapy can be for more than treatment of mental disorders and their associated symptoms and problems, in helping clients to regain or to achieve normal functioning. Experiential psychotherapy offers one lonely but plausible alternative. Other psychotherapies can offer plausible alternatives with larger constituencies. Now that we have an almost official answer, the invitation is for psychotherapists to either accept the almost official answer or to spell out their own plausible alternatives. The interesting side challenge is to see if there is a humanistic alternative. There is another option. Instead of offering a plausible alternative, you can cling to safe, diplomatic nonanswers such as:
I think there can be some good points in most positions on the issue of what psychotherapy is for. . . . I can integrate various ideas of what psychotherapy is

232

MAHRER

for, depending on the treatment conditions . . . . For me, psychotherapy is to help the client, providing the services the client needs . . . . What psychotherapy is for can vary with the problem and the stage in the treatment process . . . . There can be multiple models, levels, and meanings of what psychotherapy is for.

These can be professionally common and acceptable non-answers if you prefer to answer the question by not answering the question.

We Dont Have to Obey the Practice Guidelines From the Almost Official Answer to What Psychotherapy is for We can decline their practice guidelines. We can establish and follow our own practice guidelines. We can also decline the implications and consequences of declining their practice guidelines. They do not apply to us. Here are some of these implications and consequences: 1. We can decline the authoritative body of truths, basic principles, canons, and dictums that go with the standard practice guidelines. We can decline their particular cumulative body of knowledge about the structure of personality, the origins of a person, unhappiness and pain, research inquiry, personality and behavioral change, how to do psychotherapy. We can establish and develop our own fundamental body of basic principles. 2. We dont have to follow their way of teaching and training psychotherapists, nor their way of supervising psychotherapists. We can establish and follow our own ways of teaching, training, and supervising. 3. We can decline their guidelines and criteria for approval and accreditation of therapies, training programs, internships and residencies. Instead, we can establish and follow our own guidelines and criteria. 4. We can decline what they regard as the relevant questions and the right answers for registration examinations, credentialing, accreditation, licensing examinations, and masters and doctoral examinations. Instead, we can establish and follow our own examinations. 5. We dont have to learn and do their therapies. We dont have to learn their approved treatments. We dont have to do their approved treatments or programs under conditions defined and dictated by their practice guidelines. Instead, we can do the psychotherapies we do. We dont have to obey their rules, regulations, and recommendations. 6. We dont have to learn and do their methods. Programs that are designed for different aims and purposes do not have to use similar methods. A program for a deviated septum does not necessarily have

WHAT IS PSYCHOTHERAPY FOR? AN ALMOST OFFICIAL ANSWER

233

to use methods for dealing with deviations in religious practices. A program for coping with an explosive volcano does not have to rely on ways of handling the effects of explosive rage. A program to treat seasonal affective disorder does not necessarily benefit by using methods aimed at predicting seasonal temperatures. 7. Disobeying their practice guidelines can usually lead to some hard, tough penalties and punishments such as failing the test, not getting the degree, position or job, internship or residency, postdoctoral position, promotion, bursary, stipend, grant, referral, honor or award; losing your license, approval, accreditation; not having your article, book, proposal accepted; being accused of unethical or unprofessional conduct by black-robed judges who enforce the ethical and professional conduct based upon the value system underlying the practice guidelines, rather than alternative ethical and professional codes based upon an alternative value system of what psychotherapy is for. We can complain and argue all we want, but disobeying the establishments rules and regulations can mean being hit hard by their penalties and punishments. What psychotherapy is for can be much more than a friendly, innocent topic of discussion. Its practice guidelines can pack a tough hard wallop. Be careful. It can pay off if you take the matter seriously. 8. Who gets to use the term psychotherapy? If we have an almost official answer to what psychotherapy is for, then one conclusion may be that other psychotherapies, with their own answers, are not entitled to be called psychotherapies. Find some other term. An alternative conclusion is that the almost official answer only applies to some psychotherapies, in which case we are back to square one: psychotherapy is for just about anything and everything; there are no generally accepted practice guidelines, and psychotherapists do whatever psychotherapists do in a kind of free-for-all. In any case, I am pleased (a) that there can be an almost official answer to what the establishment believes psychotherapy is for; (b) that I can spell out, by comparison, what experiential sessions are for; and (c) if the almost official answer is generally accepted, then my experiential sessions, along with the sessions of a number of other psychotherapies, do not officially qualify as psychotherapies. The conclusions can be put in the form of questions you can consider or decline, think about or shrug off, face or criticize: Are you ready and willing to provide your own serious and careful answer to the question of what your own psychotherapy is for? Are you ready and willing to deal with the serious implications and consequences of your answer? Are you listening, humanistic psychotherapists?

234

MAHRER

REFERENCES
American Psychological Association Task Force on Psychological Interventions. (1995). Template for developing guidelines: Interventions for mental disorders and psychological aspects of physical disorders. Washington, DC: American Psychological Association. APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271285. Caine, D. J., & Seeman, J. (2002). Humanistic psychotherapies: Handbook of research and practice. Washington, DC: American Psychological Association. Chambless, D. L., et al. (1996). An update on empirically validated therapies. Clinical Psychologist, 49, 518. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685716. Division 32 Task Force. (1997). Guidelines for the provision of humanistic psychological services. The Humanistic Psychologist, 25, 64107. Mahrer, A. R. (2002). Review of Humanistic psychotherapies: Handbook of research and practice. Psychotherapy Research, 12, 245249. Mahrer, A. R. (2004). The complete guide to experiential psychotherapy. Boulder, CO: Bull. (Original work published 1996). Mahrer, A. R. (2005). What is psychotherapy for? A plausible alternative to empirically supported therapy relationships and practice guidelines. Journal of Contemporary Psychotherapy, 35, 96115. Mahrer, A. R. (2007). To a large extent, the field got it wrong: New learnings from a new look at an old classic. Psychotherapy, 44, 274278. Mahrer, A. R. (in press). What is psychotherapy for? An alternative to the profession of psychotherapy. Montreal, Canada: Howard Gontovnick. Nathan, P. E., & Gorman, J. M. (Eds.). (1998). A guide to treatments that work. New York: Oxford University Press. Norcross, J. C. (2001). Empirically supported therapy relationships: Summary report of the Division 29 task force. Psychotherapy, 384. Rogers, C. R. (1957). The necessary and sufficient conditions for therapeutic personality change. Journal of Consulting Psychology, 21, 95103. Sox, H. C., & Woolf, S. H. (1993). Evidence-based practice guidelines from the U.S. Preventative Service Task Force. Journal of the American Medical Association, 169, 2678. Steering Committee. (2001). Empirically supported therapy relationships: Conclusions and recommendations of the Division 29 task force. Psychotherapy, 38, 495497. Task Force on Promotion and Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 323.

AUTHOR NOTE
Al Mahrer is professor emeritus at the University of Ottawa, a former president of Division 32, and recipient of the Divisions Rollo May Award For Pursuit Of New Knowledge. It took him over 40 years to cobble together his experiential psychotherapy. His current adventure is to revolutionize the field of psychotherapy.