Pragmatism and the Peaceable Kingdom: Pluralism in Psychotherapy

This special issue of the journal is dedicated to the 75^th anniversary of the American Group Psychotherapy Association AGPA). This special issue presents 18 models of group psychotherapy today, as well as ongoing research and future trends in the field. The introduction discusses the merits of pluralism and the role of pragmatism in the development of psychology in America.

There is a mid-19^th century painting in the National Gallery of Art called The Peaceable Kingdom. The carnivores, the herbivores, the omnivores, the young children—predators and prey—pose in a formal group to represent inter-species reconciliation. The most authoritative beasts are the big cats—glaring lion, tiger, and leopard—while a wolf and a bear are representing America’s fierce creatures. In the background, William Penn leads a human group to reconcile big hat Quakers with Native Americans who wear feathers. We should digress a moment to acknowledge the indirect influence on our group field of what was then called the “unprogrammed” Quaker meeting, where episcopal and gender hierarchy were dissolved and anyone had the right to speak from the heart. Obsessed with his theme of universal harmony, the painter made 62 different versions, scattered now in many museums and institutions. In the one hanging in the Worcester Art Museum, the impressively fanged bear is (hopefully) smiling. The subject—peace, cooperation, community—has little to do with animals. The painter, a Quaker preacher named Edward Hicks, would now be called a “primitive” or outsider artist, but the imagery speaks a language his religious community would have recognized at once, a verse from Isaiah (11.6): “The wolf shall dwell with the lamb, and the leopard shall lie down with the young goat, and the calf and the lion and the fattened calf together; and a little child shall lead them.” The predators’ glaring eyes are fixed on you, human spectator, with your compulsively violent ways.

LET A HUNDRED FLOWERS BLOOM

The editor of the International Journal of Group Psychotherapy should assume the peaceable kingdom, that is, equivalent value in the therapy orientations of all submissions to the journal. As an example, in two issues celebrating the 75^th anniversary of the American Group Psychotherapy Association, 18 therapy models are presented, and current research is yet another section. Like the painter, I conjure a therapy paradise where different theories and techniques dwell peaceably together, the short-term with the long-term, the inpatient with private practice, the psychoanalytic with cognitive-behavioral, the mindful with the manualized, psychodramatic with psychoeducational, Lacanian with neuropsychological, and the researcher with all of them. This is bedrock for my job. As I see it, an editor should not only be pragmatic—a complicated word— but should also dream that each of the field’s orientations shall flourish in its idiosyncratic way without political or economic disturbance.

The program of an AGPA conference embodies this notion of group psychotherapy as a large edifice (literally hotel), with different specialties peaceably sequestered in different rooms. Group-related applications of assorted theoretical models run concurrently; on a typical day at AGPA’s annual meeting, between 20 and 30 rooms are required for simultaneous presentations. This paratactic (side by side) approach is averse to the view that one theory is true and the others are false, the view often attributed to S. R. Slavson, AGPA’s formidable “chairman of the board” in the last century.

It is also averse to the view that theoretical difference is just a matter of perspective or repackaging, that new wine A is really old wine B in a new bottle. There have always been attempts to consolidate discrete forms of psychotherapy, something bravely attempted by Paul Wachtel (1977) 40 years ago with behaviorism and psychoanalysis, and by recent attempts to link Freudian theory to neuroscience (e.g., Schwartz, 2015; Solms & Turnbull, 2002). Letting a hundred models bloom—coexistence without consolidation—reflects three assumptions. One is pragmatic—to keep the peace, doctrinaire belief must be leavened through the trope of equality. Second is the social-science rule of thumb called the dodo bird conjecture, named after the bird in Alice in Wonderland who announced at the end of a race, “Everybody has won and all must have prizes.” Other things being equal, effectiveness differences among competing (individual) psychotherapies are minor (Wampold et al., 1997), less than the variance due to patient characteristics and quality of patient-therapist relationship (Shean, 2015). A third assumption was developed by Kurt Lewin. His work on group dynamics suggested that prevailing theories of established (dyadic) schools of psychotherapy were of limited help in understanding events in a group (Lewin, 1945).

The heuristic value of comparing different approaches to the same therapeutic material seems to have taken off in the 1960s. Competing psychotherapists, including some group leaders, flourished in an atmosphere of “liberation” from inflexible models—a creative period but attended by serious professional lapses. For example, senior readers may recall Everett Shostrom’s film Three Approaches to Psychotherapy (www.tastudent.org.uk/gloria), aka the Gloria tapes, where Carl Rogers, Fritz Perls, and Albert Ellis went head to head; Gloria Burry, née Szymanski, was their prize. (Shostrom had been Gloria’s psychotherapist for some years.) Each sought to showcase his model—client-centered therapy, gestalt therapy, and rational therapy—which all had group offshoots, for example, the basic encounter group, group holism and field theory, RET group therapy, which in turn influenced cognitive behavioral therapy (Rosner, 2014). Anticipating Reality TV, the attractive divorcée let it all hang out, with candid details about her search for the right man. Like Paris of the Greek legend who unleashed the Trojan War by choosing the wrong goddess, Gloria awarded her apple of discord to the man who had been most dominant with her, Fritz Perls. Next year, following a screening of Three Approaches at a conference dominated by Rogers, she changed her vote, something Paris could not do. Publicity was enormous; as if anticipating YouTube, it engendered “viral” communication mistaken for research. As examples of theory in action, the tapes were considered to be educational and were therefore shown to professionals, graduate students, and therapists-in-training in subsequent decades (MacGillivray, 2011). They dovetailed with popular notions of experiential learning, then called sensitivity training (echoing Lewin’s National Training Laboratories), and now a staple of psychotherapy conferences. In action—as distinct from the textbook—how do experts implement and depart from their theories? We are, obviously, way beyond three approaches today. As well as therapy groups in many hues and contexts, we have structured group demonstrations, experiential workshops, institutes, videoconferences, scripted role-plays, web therapy interactions, and the like, all for exploration of the reflex arc of theory and practice in our field.

PRAGMATISM

When Scheidlinger (1991) noted the shift in AGPA toward pluralism, he foresaw “a promising new eclecticism, pragmatism and search for commonalities” (p. 221). Perhaps he did not foresee the dominance of mental health insurance plans on one hand and research using short-term therapy models on the other, as well as the tendency of each to reinforce the other. Pragmatism has more than one meaning. It is of course pragmatic to let a hundred models bloom to avoid being sucked back to the old head-butting days of figures like Slavson and Jacob Moreno in the 1950s (Gershoni, 2009), or the struggles of non-psychoanalytic professionals for equal status in AGPA. This merely suggests tolerance, a way to avoid splitting the field and the organization. However, the history of pragmatism in American psychology is worth brief consideration to answer this question: Does evidence-based practice mean a return to the principle that only one model can prevail, or may we legitimately pursue the dream of the peaceable kingdom with a plurality of models?

PEIRCE VERSUS JAMES

Today, the economic stakes are new, but this debate is not. Pragmatism means, essentially, approaching reality without a priori assumptions, and what we call evidence-based practice is pragmatic in the sense that the philosopher C. S. Peirce first used that word: “Consider what effects that might conceivably have practical bearings you conceive the objects of your conception to have. Then, your conception of those effects is the whole of your conception of the object” (cited in Menand, 2001, p. 356, emphasis in original). Judge by consequences objectively measured; what differences do they make to what you are prepared to do? In addition to anticipating the field of semiotics, Peirce in 1884 anticipated by decades the stochastic orientation of clinical psychology introduced in the early 20^th century, for example, statistical sampling with artificial randomization, and thus the evidence-based research models in social science today (Hacking, 1990).

However, Peirce had little direct influence, but, as can happen in complex intellectual relationships, the master’s thinking endured in a form modified by his star disciple, William James. In the intense group discussions of the Metaphysical Club at Harvard in the early 1870s (Menand, 2001), Peirce may have been central, but it was James whose concept of pragmatism prevailed. (Peirce became a recluse and had to be saved from literal starvation with donations organized by James.) The crux was exactly the problem posed in these journal issues: Does it violate evidenced-based practice to conceive of a plurality of keys to the same clinical material? In Pragmatism (1907/1975), James expanded the word’s meaning to include the activity of the knower: “Mental interests… help make the truth which they declare” (cited in Menand, 2001, p. 357).

Indeed, in our field, experiences leading to belief in what is curative are often quite personal, even if not so described. They involve what James called “the emotion of conviction.” In the text (1890/1950) based on America’s first full-bore psychology course which James had given at Harvard a decade earlier, the chapter on the perception of reality opens with the psychology of belief. He writes, “In its inner nature, belief, or the sense of reality, is… more allied to the emotions than to anything else… An idea which is inwardly stable… fills the mind solidly to the exclusion of contradictory ideas” (p. 283). Belief about what constitutes effective psychological treatment is not exclusively objective, or—to put it another way—it derives from evidence objective and subjective. Psychotherapists not only prescribe treatments, they live with them hour by hour, patient by patient, group session by group session, and so they gather both kinds of evidence. Recent outcome studies suggest that even in conditions of fidelity to an evidence-based model, therapist personality is a variable factor in successful treatment (Boswell & Constantino, 2015).

Peirce would have rejected the dodo-bird conjecture that all models could be equally effective in their own way as an artifice, that is, kicking a priori assumptions out the front door but letting them in through the back. However, from James’s perspective, and that of these journal issues, pluralism makes sense; a model of psychotherapy should fit patient and therapist. Research into curative factors for group patients has become a virtual cottage industry: what about research into evolution of personal belief in what is curative (Schaffer, 2006)? Perhaps not wishing to show their hand, few advocates of psychotherapy models write about the various influences on their belief systems. Atwood and Stolorow (1993), who explored biographical elements in the theories of Freud and other major psychoanalytic figures, did not take the next step and tackle the role of personal experiences in the intersubjective model they advocate. Yet, to cite James again: “Pretend what we may, the whole man within us is at work when we form our philosophical opinions” (1897/1956, p. 92).

CONCLUSION

This paratactic program, developed by our guest editor Dr. Joseph Shay, showcases here the diversity and specificity of psychotherapeutic work in groups. It invites the reader to examine how the designated model and the practitioner’s own experience interact with each other, and how knowledge of group dynamics influences each. It also showcases Dr. Shay’s combination of scholarly depth and lively interest in contemporary trends in the field. The labor has taken two years from start to finish with many intermediate steps and snags along the way, and during all he has remained admirably determined and focused. This is a large contribution for which readers of the journal are in his debt.

Additional information

Notes on contributors

Dominick Grundy

Dominick Grundy is Editor of the International Journal of Group Psychotherapy and has a private practice in New York City.