Running head: WATERS OF METAPHYSICAL CRITICISM

The Waters of Metaphysical Criticism: A Meditation on the History of Psychotherapy and Its Place in Psychology Michael Morad-McCoy University of New Mexico

WATERS OF METAPHYSICAL CRITICISM The Waters of Metaphysical Criticism: A Meditation on the History of Psychotherapy and Its Place in Psychology What, Exactly, Is Psychology?

Almost exactly 40 years ago my first encounter with a psychotherapist started my journey into the world of psychologyor what I believed was a world called psychology. Those initial encounters were brief, but over the following 15 years more lengthy experiences of therapy effected major changes in my life and ultimately led me back to school to complete undergraduate credits in psychology. This first exposure to the academic form of psychology was fascinating, but presented a puzzle. It was fascinating because it exposed me to just how much we know about how humans work, which revealed just how much we have yet to learn. The puzzle was that, aside from my abnormal psychology professor, no one talked about how all this knowledge informed the practice of psychotherapy. Maybe, I thought, I have to learn all the science before getting to the therapy. So I waited until I could start a graduate course of study. In the interim, my first experiences providing clinical servicesin Washington, DC, at the height of the AIDs pandemicsparked a love of therapeutic work. That love was finally requited when I entered the Masters Counseling program at UNM. The academic work and the clinical training were powerful and my field training involved psychiatrists, psychologists, social workers, and counselors. So I never had reason to think about the puzzle that remained unsolved from my undergraduate work. After only a few months in practice, I found I had not finished scratching my academic itch, so I gained admittance to the Ph.D. program in Counselor Education. Once again, the mixture of academic work and clinical work (now supervising counselor trainees) was exciting.

WATERS OF METAPHYSICAL CRITICISM However, the Ph.D. required 24 credit hours in a specialization which led me back to psychology. This time, with deeper academic background and rich clinical experience, I was

faced again with the puzzle of what went on in the psychology department. This time the wonder of intellectual discovery was not strong enough to disguise the darker side of this puzzle. It came in my very first psychology class when I introduced myself as being from the counseling department. My introduction was met by my fellow students with a certain . . . attitude that was not at all pleasant. Perhaps, being an introvert, I was being oversensitive, but I felt very much the interloper in a private realm. This mixed experience continued through much of my stay in the psychology department. It came to a head in one class when, after weeks of readings of models and equations that seemed to be little more than exercises in quantifying the obvious (and in getting published), we got a meaty article about how some of this actually applied to the lived experience of real people in the real world (a phrase I was thoroughly excoriated for using early in the class). Yet, when discussing this exciting article, the professor, after taking it to task for its methodological shortcomings and theoretical muddle, blurted out Thank God Im not a clinician! After that I was left even more confused about what this strange world that called itself psychology was really all about. It was not until this course, even not until I began the work for this paper, that the puzzle pieces began to come together. For two years Id been shadowed by this vague feeling that what I was trying to do with psychotherapy was an endeavor quite apart from what Id found in the psychology department. By the middle of this semester that feeling began to take more concrete form. But it wasnt until Brennas presentation on clinical psychology and its reading from Benjamin (2005) that the scales fell from my eyes and I began to see that my difficulties were

WATERS OF METAPHYSICAL CRITICISM

not mine alone. Instead, Benjamins article and Robinsons (1995) last chapter helped me see the divide within psychology is very real, although it had never been discussed in a single psychology class I had taken. When Brennas presentation sent me to McFalls (1991) vision of psychology and practice I began to wonder whether my questions and the topic of this paper might even qualify as psychology at all. However, I found Elkins (2009) reply to McFall, remembered Benjamins (2005) admission that the practitioners within the American Psychological Association (APA) have taken more power, and found that APA actually has a division devoted to humanistic psychology. Finally, I found Millon (2004) who employs seven approaches to telling the history of mental illness. His description of these approaches convinced me that psychology is not limited to the academic, experimentalist view I had been immersed in for the past two years. As I said, until I discovered these works, I had been unsettled about my choice of topic. After all, the idea of psychotherapy, the idea of using our understanding about the human mind or soul or psyche to help improve human life, seems to have played little, if any, role in the readings we have explored. However, discovering proponents of practice, whether labeled clinical or counseling or humanistic psychologists, provided reassurance and a slight suspicion that maybe only a part of the story has been told during my time in the psychology department. Perhaps, although I had not found much support for the idea in my classes, psychology is not limited to a purely experimental endeavor and is not just about randomized, controlled trials. Perhaps the larger endeavor of psychology is not as bound to modernist positivism and mechanistic determinism as some presentations Ive seen might suggest. For someone whose identity is that of an existential psychotherapist, the thought is reassuring and

WATERS OF METAPHYSICAL CRITICISM lets me argue that the history of psychotherapy is as important to the history of psychology as is the history of experimental psychology. However, although the nature of the puzzle is clearer now, I have barely begun to actually put it together and this paper will certainly not complete that task. My only hope is that it can, at least, put the borders in place. Although many thinkers inform this journey, I was moved and reassured by James (1892/1984). His comments are over a century old and great advances in the science of psychology have been made. However, I agree that when we talk of psychology as a natural science, we must not assume that means a sort of psychology that stands on solid ground. It means just the reverse; it means a psychology particularly fragile, and into which the waters of metaphysical criticism leak at every joint. . . . This is no science, it is only the hope of a science. (pp. 334-335) How We Got Here False Starts My initial speculation was that this great rift in the world of psychology might have something to do with the history laid out by Benjamin (2005). The larger body of psychology gave rise to numerous guilds and in protecting their turf they drew distinctions and competed with the other guilds for control. Psychiatrists gave up on the asylums and took on the world of

psychoanalysis and spent the balance of the 20th century fighting off the psychologists and social workers and counselors until managed care forced their surrender. During this same period psychologists developed tests and assessments and when those instruments were needed in time of war they shared them with the psychiatrists (and the government). In return they got a taste of providing psychoanalysis (or psychotherapy) and began to compete with the psychiatrists for their own share of the therapy pie.

WATERS OF METAPHYSICAL CRITICISM This view has the advantage of feeding my own speculation that a major turning point was World War II. After all, it appears that the great divide was not only between psychology

and practice, but also between the U.S. and the Continent. How better to account for this than the vastly differing experiences of these geographical regions. For Europe, the second World War was devastating in every way imaginable, from physical destruction to the loss of an entire generation of lives to the almost complete loss of the population and culture of European Judaism. For the U.S., young mens lives were lost, which was certainly not a little matter. However, instead of physical destruction the U.S. emerged with a confidence and a thriving economy that would soon give it global hegemony. Where Europe experienced industrialism and science-fueled technology as an evil force that brought unthinkable destruction, the U.S. experienced these same forces as the keys to their victory and their newfound international preeminence. I wondered whether these differing experiences might underlie the divide. It would seem the European experience might have led to existential questioning and a caution toward science. At the same time, the U.S. experience might certainly have led to the kind of idealization of science and technology I remember as a child growing up in the 1950s and 1960s, an idealization that extended even to the relatively uncultured backwaters of Texas and Oklahoma. If this is the dynamic, how then to account for the rise of behaviorism and the way it came to dominate the world of academic psychology? If this is purely a story of a turf battle, how does the story account for the humanistic response to behaviorism, and its criticism of the medical model of therapy? Rather than a simple turf battle, what appears to be going on here is nothing less than a clash of worldviews.

WATERS OF METAPHYSICAL CRITICISM From Whence the Divide? But where comes this divide, this great rift in the world of psychology? That is the question I set out to explore. My initial thought was this was a divide between practitioners and

scientists. Having explored the history from the psychology perspective, I sought out histories of practice. Millon (2004) and Alexander and Selesnick (1966) became my guides. Yet I found no answers, for the history of practice seemed, for most of history, to walk along with the history of psychology. Both sources took me to the beginnings and confirmed Benjamins (2005) view that the practice of psychology has probably been extant since the beginning of human history. From burial mounds to skulls bearing evidence of trephining, evidence exists that human attempts to deal with the existential realities of life, death, and illness go back millennia. Alexander and Selesnick (1966) put it nicely: Psychotherapy began when one man attempted to relieve another mans suffering by influencing him (p. 17). Throughout this first part of the story, there is little, if any, distinction made between understanding human suffering and attempting to alleviate it. The story continued through time and culture. Primitive beliefs about mental illness also informed primitive practices. Animistic forces give way to deities who, in turn, give way to demons (Millon, 2004) and treatments are designed to appease these forces. In China, written records of mental illness have been dated from the 14th century BCE. Treatment with magic and sorcery was dominant in the 12th century. In the 8th century institutions to care for illnesses, including insanity, had been established (Millon, 2004). Buddhist methods of meditation to achieve tranquility were developed in India in the 6th and 5th centuries BCE (Alexander & Selesnick). But there still appears no great divide between understanding and practice.

WATERS OF METAPHYSICAL CRITICISM Through the classical period to the fall of Rome, the rise of Christendom and the dark ages, while there are disagreements about the nature of psychology and how one understands human beings, there still appears no great divide. In the early Medieval period, mental problems are treated with charity and community care and the famous Bethlehem Hospital, the one that will become the infamous Bedlam, provides humanitarian care for the insane (Alexander & Selesnick, 1966). But as feudalism disintegrates and political and religious chaos spreads, the demons and fear return and with them the witches, including, now, the mentally ill. With the Protestant Reformation and the rise of the city comes a rediscovery of Greek

thought and the Renaissance gives life to rationalism and, ultimately, empiricism (Millon, 2004). Here a divide appears, but it is not yet the one that divides academic psychologist from practitioner. A Nineteenth Century Fracture? According to Robinson (1995), the great rift in the world of psychology arises from the 19th century debate between the phenomenology of Hegel and the positivism of Comte as adapted by Mill. As Robinson says, the character of contemporary psychology is to be found in the failure of these two nineteenth-century forces to find a means of reconciliation (p. 336). Academic psychology, particularly in the United States, for the most part has taken the positivist road: In England and America . . . one was either a philosopher or an experimentalist. To fail to be the latter was to fail to be a psychologist (p. 337). Robinsons (1995) history provides some explanation my own experience of feeling an outsider in the modern psychology department. By these terms I am clearly a philosopher and not a psychologist. However, as incisive as it is, what Robinsons history does not discuss is how psychology outside the academy has attempted to carry on the debate. There may not have been

WATERS OF METAPHYSICAL CRITICISM a reconciliation between the 19th century forces, but neither has there been a surrender by those whom some in academic psychology would excommunicate. The Current State of Affairs Psychologists versus Philosophers Robinson (1995) argues that the triumph of experimental psychology, at least in the

academy, is based not on the validity conferred by logic nor the reliability demanded by science . . . Rather, what had taken place was the adoption of a metaphysical position not on the nature of truth but on the nature of psychology (p. 337). Benjamins (2005) history of clinical psychology provides some support for this claim. Academic psychology programs apparently needed the intervention of World War II and a forced collaboration with the world of psychiatry to move beyond their experimental and assessment orientations. However, even as interest in practice increased after the war, academic programs were slow to respond, resulting in the rise of the professional schools movement. Because these programs graduated more students than the academic psychology programs, eventually the academic programs sensed a loss of power within the psychology world (Benjamin, 2005). In addition, although Benjamin does not address the issue directly, academic psychologys resistance to training of practitioners might also have helped foster the rise of masters level practitioner training programs. This shift in power, combined with the rise of managed care has seemed to revive, or perhaps more accurately, brought into the open, the 19th century debate Robinson (1995) describes. In simplistic terms the psychologists criticize the philosophers for practice that is not based on the psychologists definition of science, while the philosophers argue that a purely experimental approach is not an adequate exploration of reality.

WATERS OF METAPHYSICAL CRITICISM As a practitioner, I am more comfortable in the philosophers camp and cannot be fully objective in this debate. While I now better understand the psychologists gloom and doom about the practice of psychology (Benjamin, 2005, p. 23), I am concerned about how some of the arguments in this debate appear to go to extremes. I am also concerned about the possible implications for practice and science. An Unsettling Conflation

10

A major problem, from this philosophers view, is the way some psychologists have chosen a narrow and restrictive definition of psychology and, by extension, of science. This is seen most clearly in the rise of scientific clinical psychology movement. As exemplified by McFalls (1991) manifesto, these psychologists appear to believe they should be allowed to determine what is and what is not valid science and, by implication, what is or is not valid practice. McFalls (1991) manifesto is a powerful piece of propaganda. From consistently interchanging the terms scientific and experimental, to his questionable comparisons psychotherapeutic treatments and drug trials is the most egregious exampleMcFall works hard to support his view that only scientific psychological services should be allowed. Although McFall does not specifically describe what these services are, his argument appears to imply that these services are ones that have been verified experimentally which, one might conclude, means in the form of randomized, controlled trials. The point of limiting his view in this way appears to be to allow him to ignore a body of literature that points in a different direction. Decades of research (Elkins, 2009; Norcross & Lambert, 2011; Norcross & Wampold, 2011; Wampold, Ahn, & Coleman, 2001; Westen, Novotny, & Thompson-Brenner, 2004) supports the view that interpersonal factors, not specific

WATERS OF METAPHYSICAL CRITICISM techniques, are the most important determinants of the effectiveness of therapy. In addition, many (Beutler, 1998; Elkins, 2007; Norcross & Wampold, 2011; Task Force for the Development of Practice Recommendations for the Provision of Humanistic Psychosocial

11

Services, 2004; Wampold, et al., 2001; Yalom, 2002) have argued that the very nature of testing a treatment experimentally casts doubt on its applicability in daily practice. First, the disorder being treated must be clearly defined and the sample chosen accordingly. Then the intervention must be scripted, or manualized, in an effort to avoid personal differences in delivery (and how possible is that, really?) and in an effort to make it replicable. What is most troubling about McFalls argument is the way he attempts to co-opt the very idea of science. As I noted above, McFall consistently interchanges the terms scientific and experimental. It is as if he has forgotten the basic philosophies of science and research design, for nowhere does he acknowledge the difference in the terms. It seems that if he were attempting to make a rational argument he would at least discuss the ideas of hierarchies of research design (Brighton, Bhandari, Tornetta, & Felson, 2003; Evans, 2003) and some of the criticisms of such hierarchies (Concato, 2004). Instead, in essence, he argues his views are scientific and everything else is unscientific. He appears to be unwilling to accept that science is not a simple, clearly-defined enterprise, and that in the world of psychology there may not be a single scientific truth. I agree with a small portion of what McFall (1991) argues. Although I vehemently disagree with his criticism of the philosophy of the scientist-practitioner training model, I do think the model, in some programs, can lead to lazy or sloppy practice. On the other hand, a therapeutic system based solely on findings supported by randomized, controlled trialssocalled empirically supported treatments (ESTs) presents serious implications.

WATERS OF METAPHYSICAL CRITICISM Implications for the Practice of Psychology

12

The first problem is that ESTs demand a specific diagnosis, usually by way of the DSM (American Psychiatric Association, 1994). First, this approach ignores fundamental questions about diagnosis, how diagnostic categories have been developed and promulgated, and how they get applied in a clinical setting. In my own practice, two particular areas reinforce the inadequacy of this approach. First, a large part of my practice involves couples and the very real distress relationship difficulties bring to my clients lives. Yet the DSM, relegates such distress to a V code that insurance companies will not reimburse for. More troubling are the children I work with. For the large majority (yes, I know this is anecdotal), the problem is not the child, but the parents. Yet the systems in place that provide treatment (and the simple reality of the human dynamic of the parent-child relationship) demand that I treat, and thus diagnose, the child, not the parents. This approach also ignores the messy reality that most clients do not fit neatly into a single diagnosis. If this is the case, what is the practitioner supposed to do? And if a client does not fit into a diagnosis for which an EST has been developed, what then? If practitioners are to limit practice to ESTs, that implies many clients will not be afforded any treatment at all. The second problem is that the logic behind limiting practice to ESTs is simply fallacious. In essence, the implied logic is if a treatment has not been empirically supported, it doesnt work. The reality, of course, is simply that other treatments havent been tested, not that they dont work. The third problem is that the EST-only movement appears to misapprehend fundamental assumptions of the scientific method being used. As Robinson (1995) might say, psychological research is not physics; predicting the behavior of the king is a far cry from predicting behavior

WATERS OF METAPHYSICAL CRITICISM of the billiard ball. My grasp of behavioral research may not be comprehensive, but what I do think I have a grasp on is that our method is statistical probabilities not certainties. McFall

13

(1991) cannot guarantee that every client walking in my door, even those who neatly fit into an EST protocol will respond to the treatment. Perhaps the biggest problem of the EST-only movement is that it provides ammunition for the truly dark side of our health-care system: the promoters of managed-care, specifically the insurance industry, whose only real interest in a particular treatment is how much it adds to the profit margin. Implications for the Science of Psychology Perhaps more troubling are the implications McFalls (1991) scientific clinical psychology poses for the science of psychology itself. In his attitude I see the kind of certainty and simplistic reductionism that speaks more of faith than science, more of answers than questions. This is something I have seen repeatedly over the past two years in the psychology classes Ive taken. At some point discussions of interventions eventually lead to The Question, usually asked in a reverential tone of voice: Is this empirically supported? It happened in this class a couple of weeks ago. Yet there is never any discussion of what this EST thing is, what its assumptions are, or what it implies. Perhaps those discussions took place in some earlier class. But what I hear is something that is more ritual incantation than rational argument. Things are no better in the counseling world. Some post-modern approaches we learn provide an intellectually rigorous approach to epistemology and so provide a nuanced discussion of the limits of science. However, some use these approaches as an apologetic (although justification might be more accurate) to, in essence, avoid scientific approaches altogether.

WATERS OF METAPHYSICAL CRITICISM

14

What seems common to both approaches is the desire for certainty. Neither the modernist scientific nor post-modernist phenomenological view can fully describe reality. Yet, as Yalom (1980) says, we are meaning seeking creatures. Thus, it may sometimes be difficult to accept that our particular view is only partial. However, we run into trouble, when we seek certainty. Yalom (1989) also says the capacity to tolerate uncertainty is a prerequisite for the profession (p. 13), and I wonder whether some of what is going on is the inability to deal with uncertainty. This is clearly the case with some New Age approaches to psychotherapy, approaches that claim to have discovered the reality that will help each client. This years flavor, for many, appears to be mindfulness. However, I cannot help but wonder whether this might not be the same dynamic that is driving the scientific clinical psychology movement and its efforts to impose ESTs on everyone. The danger for science is that in seeking certainty we may try to make science say more than it should. Not only can this undermine the credibility of science, it can result in actual damage. Last week The New York Times wrote of a forced sterilization program in North Carolina that was in operation until 1977 (Severson, 2011). This, of course, is only one in a long list of medical and psychological abuses perpetrated over the years based on the idea of scientific certainty. From ice baths, to lobotomies, to child-abusing satanic cults, to recovered memories, untold harm has been done using the certainty of science as the justification. Granted, some of these abuses were painfully misguided readings of science, but I wonder whether scientists desire to make the strongest case for their work does not sometimes lead them to fail to explain its nuances and limitations. In this way, perhaps, the attitude of certainty with which some, like McFall (1991), speak might lead to McFalls own criticism that scientists and practitioners promise too much.

WATERS OF METAPHYSICAL CRITICISM Implications for Clients Ultimately, my most serious concern is for those seeking help. It is fundamental to my philosophy of practice that it is the relationship that heals (Yalom, 1980, 2002). It is a faith

15

statement and I will admit to that. However, it is a faith that is based on some evidence (Elkins, 2009; Norcross & Lambert, 2011; Norcross & Wampold, 2011; Wampold, et al., 2001; Westen, et al., 2004). The evidence may not be from randomized, controlled trials, but it is evidence that is part of a scientific approach to the profession. As a result, I have been trained in, and worked hard to develop, my empathic skills. I will admit that I do not like all my clients, but I do work to treat each as an important individual and try to enter into each clients world. From comments Ive heard over my two years in the psychology department, comments from students about their training clients, I wonder how true that is for those trained to provide ESTs. I wonder whether the emphasis on experimental research and manualized treatments reduces the client to a research variable or a simple diagnosis and then to a character in a treatment script. I would hope not and would hope the disparaging comments I have heard are isolated instances. A Family Divided? Happy families are all alike; every unhappy family is unhappy in its own way. Tolstoy, Anna Karenina Perhaps it goes too far to see this divide in family systems terms. However, I continue to be confused by the current state of the profession. I understand Robinsons (1995) view that the divide is based on differing world views. However, the idealist in me wonders what nurtures and promotes the division. Certainly, some individuals may be economically driven and so see the competition among psychologists and practitioners, among psychiatrists, clinical psychologists, social

WATERS OF METAPHYSICAL CRITICISM workers, and counselors as some form of zero-sum game that can only have a single winner.

16

Others may be driven more by the desire to make their own names and careers than by a desire to help others. However, my personal experience with individuals from every part of the profession is that most, if not all, share a desire to, in the words of my alma maters first president, win some victory for humanity (Mann, 1859). My experience has taught me that each part of my professional lifepractice, teaching, researchfeeds the other. So I wonder about those who draw lines in the sand, those who say This and only this is acceptable. Whether talking about science or practice, I wonder why some believe the other has nothing to teach them. Again, my idealism makes me wonder why all members of the psychology family cannot benefit from Yaloms (1989) approach: We psychotherapists [or scientists or philosophers] cannot simply cluck with sympathy and exhort patients to struggle resolutely with their problems. We cannot say to them you and your problems. Instead, we must speak of us and our problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together. (p. 14).

WATERS OF METAPHYSICAL CRITICISM References

17

Alexander, F. G., & Selesnick, S. T. (1966). The history of psychiatry: An evaluation of thought and practice from prehistoric times to the present. New York, NY: Harper & Row, Publishers. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Benjamin, L. T., Jr. (2005). A history of clinical psychology as a profession in america (and a glimpse at its future). Annual Review of Clinical Psychology, 1(1), 1-30. doi: 10.1146/annurev.clinpsy.1.102803.143758 Beutler, L. E. (1998). Identifying empirically supported treatments: What if we didn't? Journal of Consulting and Clinical Psychology, 66(1), 113-120. Brighton, B., Bhandari, M., Tornetta, P., & Felson, D. T. (2003). Hierarchy of evidence: From case reports to randomized controlled trials. Clinical Orthopaedics and Related Research, 413, 19-24. Concato, J. (2004). Observational versus experimental studies: Whats the evidence for a hierarchy? NeuroRX, 1(3), 341-347. doi: 10.1602/neurorx.1.3.341 Elkins, D. N. (2007). Empirically supported treatments: The deconstruction of a myth. Journal of Humanistic Psychology, 47(4), 474-500. doi: 10.1177/0022167807302003 Elkins, D. N. (2009). Humanistic psychology: A clinical manifesto: A critique of clinical psychology and the need for progressive alternatives. Colorado Springs, CO: University of the Rockies Press. Evans, D. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12, 77-84.

WATERS OF METAPHYSICAL CRITICISM James, W. (1892/1984). Psychology, the briefer course. Cambridge, MA: Harvard University Press.

18

Mann, H. (1859). Commencement speech to the Antioch College class of 1859. Speech. Antioch College. Yellow Springs, OH. McFall, R. M. (1991). Manifesto for a science of clinical psychology. The Clinical Psychologist, 44(6), 75-88. Millon, T. (2004). Masters of the mind: Exploring the story of mental illness from ancient times to the new millennium. Hoboken, NJ: John Wiley & Sons, Inc. Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy, 48(1), 4-8. doi: 10.1037/a0022180 Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102. doi: 10.1037/a0022161 Robinson, D. N. (1995). An intellectual history of psychology (3rd ed.). Madison, WI: The University of Wisconsin Press. Severson, K. (2011, December 10). Thousands sterilized, state weighs restitution, The New York Times. Retrieved from http://www.nytimes.com/2011/12/10/us/redress-weighed-forforced-sterilizations-in-north-carolina.html?_r=1&nl=todaysheadlines&emc=tha23 Task Force for the Development of Practice Recommendations for the Provision of Humanistic Psychosocial Services. (2004). Recommended principles and practices for the provision of humanistic psychosocial services: Alternative to mandated practice and treatment guidelines. The Humanistic Psychologist, 32(1), 3-75.

WATERS OF METAPHYSICAL CRITICISM Wampold, B. E., Ahn, H.-n., & Coleman, H. L. K. (2001). Medical model as metaphor: Old habits die hard. Journal of Counseling Psychology, 48(3), 268-273. doi: 10.1037/00220167.48.3.268 Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin, 130(4), 631-663. doi: 10.1037/00332909.130.4.631 Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books. Yalom, I. D. (1989). Love's executioner and other tales of psychotherapy. New York: HarperCollins Publishers. Yalom, I. D. (2002). The gift of therapy: An open letter to a new generation of therapists and their patients. New York: HarperCollins.

19