EMPIRACISM VS. AESTHETICS:
THE GIFT OF SPONSORSHIP & PSYHOTHERAPY IN AMERICAN CULTURE
By Mickey Skidmore, ACSW
Those familiar with previous “Perspective” articles offered at this site are aware of my position against managed care and insurance companies. (One need only review the “Perspective” archive to [re]acquaint themselves with several articles expressing concerns about how managed care and insurance impact the delivery of mental health care). Moreover, those who know me as a practitioner are also familiar with my interest and passion for clinical hypnosis – both as an effective tool in clinical social work practice, and as a personal way of life.
Recently, I have pursued the possibility of having the plenary conference address of a hypnosis seminar I presented (April 1998, Frye Regional Medical Center, Hickory, NC) to be printed in a professional publication. In this address, among many things, I attempted to discuss how hypnosis related to a deeper, broader, and more thoughtful approach to practicing psychotherapy, and perhaps more importantly, how fundamental clinical practice seem to be in direct conflict with the current trends of managed care and insurance practices. Hypnosis was also used as a centerpiece in examine how we relate to or sponsor these differences, and in exploring a third way or middle ground between these differences as we endeavor to practice psychotherapy amidst the ever changing backdrop of today’s healthcare system. (To review the contents of this address, the reader can review the May `98 “perspective.”).
Despite some positive encouragement about my ideas from Jeffrey Zieg, the Director of the Milton H. Erickson Foundation, William Matthews of Current Thinking and Research in Brief Therapy: Solutions, Strategies, Narratives offered a significantly different view: “as editor, I see my purpose in publishing this series is to bring empirically based practice to the readership. As such all authors are required to provide current research references for the significant claims they might make. The issue as I see it regarding the publication of your piece is that it suggests nothing new. What is being said is problematic in that there is little empirical support for many of the notions in the piece.” In short, “nothing new is being said.”
Rather than defend my ego, I wish instead to commend and agree with Dr. Matthews. The purpose of his publication journal is not in question, and if the position he espouses enhances the view and practice of clinical hypnosis I am in favor of it. Furthermore, I readily agree that the paper I submitted for consideration offered limited content based on empirical notions. Finally, I also agree that the ideas I was expressing were hardly “new”. Having said all that however, I do believe Dr. Matthews in his zest for empiricism may have overlooked the larger issues, which I was attempting to convey.
Dr. Matthews wouldn’t be the first to observe that there are finite ideas related to hypnosis and psychotherapy. Shakespeare said long ago “there is nothing new to say.” What I believe to be significantly more relevant is the notion of how these ideas might be presented or perceived as relating in new and different ways. And while I understand and even respect Dr. Matthews’ position, I believe our exchange raises the notion of a broader dichotomy, which has long been debated – the debate between empiricism and aesthetics. I believe the point can be demonstrated by better exploring some of the ideas expressed in the May `98 article found below:
Distinctions and contributions to the Ericksonian legacy…
One of the criticisms of the Ericksonian legacy has been that its primary documentation has
been predominantly anecdotal rather than scientific. The volume of anecdotal case reports of books and articles have been the underpinnings of a type of psychotherapeutic folklore, which despite its aesthetic impact and power on both practitioner and patient alike have been dismissed by the scientific community as non-empirical. I would have to agree with Dr. Matthews that a second generation of Ericksonian practitioners merely recanting or attempting to add to this folklore is nothing new. However, that a new generation of practitioners influenced by Erickson’s legacy might begin to express how practicing hypnosis might lead to developing a deeper and more intentional notion of psychotherapy, or cultivate healing and enhanced ethical potential in the era of managed care, I find quite interesting. In an age where there are no more mavericks, that this might be dubbed an extension of Erickson’s influence is also intriguing. Never mind that the aesthetic qualities and aspects of this observation are noteworthy in and of themselves, the task for an empirical contribution is to manifest such ideas into measurable, behavioral outcomes and scientific vernacular.
HYPNOTIC FUNDAMENTALISM: (Myths, Misconceptions & Reductionism)
Most of Erickson’s students and many other teachers of clinical hypnosis speak about the myths and misconceptions of trancework. (The fact that there is disparity and disagreement even within this field regarding how to conceptualize hypnosis is further evidence of the debate between aesthetics and empiricism). Moreover, Steve Gilligan among others is noted for his perspective on fundamentalism. Once again this is nothing new. However, if there is to be another generation of Ericksonian practitioners, I believe one of the responsibilities is continuing to shine a light and educate appropriately and professionally what hypnosis is and is not as part of a position of advocacy for its continued use.
Although there is significant available data discussing the issues of technique vs. therapy as it relates to hypnosis, I maintain that the notion of "Reductionism" – specifically in regards to the influence of managed care and its impact on healthcare delivery is a fresh contribution worthy of further exploration. I believe it would be a mistake to dismiss this pressing issue simply because there has not been a double blind research design project to empirically verify this hypothesis. The observations referred to in the May `98 article were based on my observations of the past 12 years of clinical practice in a variety of healthcare settings. Furthermore, one only need to pick up any newspaper, journal or periodical, or speak to any healthcare professional to realize that there is much being formulated and considerable consensus on this topic. I believe the particular way that I have organized and articulated this issue from the perspective of a second generation Ericksonian is both meaningful and purposeful, and holds value as a contribution for other professionals.
Solutions (A Third Way…)
Whether or not the reader prefers an aesthetic approach over an empirical one, both camps must realize that a vehement insistence on any singular approach as the "one and only truth" or superior perspective, merely confirms the notion of fundamentalism. I submit that we must make adequate room for both. While there may be nothing new to say, there may be new perspectives or views as to how it might be said or understood. Neither camp is without its flaws. Each approach has both its respective strengths and weaknesses.
I confess that I am more drawn to the aesthetics of hypnosis and psychotherapy. I submit however, this is more a reflection of the teachers I have learned from and what appeals to me as a person. I understand, appreciate, and respect the need for empirical study – and I am not opposed to it. I am however opposed to any approach, which results in divisiveness and arbitrary factions that rigidly restrict inclusion of new(er), ideas.
At the risk of proposing yet another anecdotal, non-scientific idea, in conclusion I ask the reader to consider one final thought:
When psychotherapy is practiced skillfully and professionally, it one of the most powerful and precious gifts our professions offer to our culture and society. I maintain however, (as stated in the May `98 article) that "we may very well be witnessing the systematic genocide of anything resembling long-term therapy, or psychotherapy as we know it." I submit that the growing numbers of television talk shows where people cathart their personal and private lives to public audiences, and people discard their privacy to give birth on the internet to an international audience is a trend we need to pay attention to. My personal view of these trends is that they are metaphorical responses attempting to create the next medium for emotional expression. In other words, the institution of psychotherapy, which used to provide for this is under attack. The cultural temenos is beginning to crumble. The gift we offer to society is not immune to the forces of "reductionism" and is no longer recognized as it once was. It would be sad to think that the diverse disagreement within our own field in some way contributed to or exacerbated this crisis.
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