Presidential Column

Exploring Theoretical Diversity: A Critical Process for Science

By Gary R. VandenBos, Ph.D.

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Dialogue between theoretical approaches is critical to the long-term success of any field.  This is true for clinical psychology as well.  Respect for the clinical models of alternative theories is critical to healthy debate and meaningful research exploration.  Being open to understanding the clinical experience of others is essential to building a strong clinical psychology.

There are multiple ways to understand what patients present to us, and there are multiple ways to respond.  Which is the best for a given patient, and how do we determine that? The core to a possible answer is to focus on the behavior – the words, the actions, the felt experience described for us by the patient. The reality of their life and their experience.  All too often when discussing clinical material with colleagues from different orientations, we discuss them in the “code” of our differing theoretical approaches rather than staying with the concrete specific descriptions presented by the patient. 

Exposure.  The coming APA convention in San Francisco offers each of us a new opportunity to engage with our colleagues in understanding the clinical phenomena regularly presented by our patients in therapy sessions.  I strongly encourage each of us to attend at least one clinical session focusing on a topic or patient type of interest that is being presented by someone of a theoretical orientation that differs from our own. 

Analyze.  Dig through the jargon used in the presentation to the behavioral description by the patients of their words and actions and of those around them.  What are the concrete behaviors?  What ways of cognitively understanding the words and behavior is the patient using?  How are past learning experiences shaping current perceptions and experience?  What faulty beliefs are contributing to the difficulties?   How would you conceptualize the problem from your perspective?  How is the current presenter conceptualizing the problem from their perspective? Can you find a way to discuss the patient and their experience with your colleague that does not involve using the jargon of either of you?

Dialogue.  Chat with your colleague after the presentation.  Invite them for a cup of coffee, right then or at a later time. Discuss the patient (or the clinical phenomena presented by a type of patient).  Start with behavior and words.  Explain what you “hear” from those words; ask what your colleague “hears” from those words.  Explore what each of you would say or do in response (and discuss why). What is important to each of you about the information you would like to learn next from the patient?  How would each of you use that information to help the patient to make change in their life? What is the balance for each of you between understanding how the patient got to their present situation and how they can change?

Support Change.  Both of you believe in the power of psychotherapy to support, even create, change. Discuss how concretely you would attempt to do that with this patient.  Consider whether each of you are now talking within your theoretical model, or whether you are talking within the life experiences and explanatory system of this patient.  What explanatory model might be the most effective or useable by this particular patient – to change their behavior,  to change their understanding of what is or is not happening in the situation, to change their experience of events so a different response is possible?

Share what you have learned.  Maybe the two of you can organize a joint panel together at a future convention.  Maybe you can write a manuscript on what you agree on and where your core disagreements lie. Maybe you can design a research project which is a fair test of significant elements related to both of your theoretical approaches.  Hopefully you can make a true contribution to the advancement of a more comprehensive understanding in clinical psychology. 

Enjoy the upcoming convention.  Engage with your colleagues, both those who share your views and those who utilize other models.  Respect each other.  Have a good time.