Lucid Psychotherapy: Psychotherapy Integration In the Moment
by Jeffery Smith, MD
Dr. Smith writes, “I have recently developed an online essay describing a slightly different way of looking at psychotherapy that makes it more natural to bring psychodynamic and cognitive-behavioral theory and technique into the same frame”.
His website is in essence a sixteen chapter web book “which started life as course handout for resident psychiatrists” and
presents a way of thinking about psychotherapy integration combining psychodynamic with cognitive-behavioral theory and technique. The approach is built on the observation, derived from work with trauma patients, that lasting change takes place at moments of catharsis or of internalization or of both at once. Examining these moments helps to understand the action of therapy and makes it possible to bridge between competing schools, such as psychoanalysis and cognitive therapy. Furthermore, a focus on key moments helps to navigate towards healing and growth.
Dr. Smith’s goal is to bridge the gap between “the ‘art’ and [the] ‘science’ of psychotherapy”:
All therapies seek similar results, presumably through basically similar mechanisms. What is missing is a clear, detailed understanding of how people change in therapy. Such an understanding would allow translation between languages and traditions, including the cognitive-behavioral and psychodynamic ones. It turns out that how therapy works is not an easy subject. Change happens but it is hard to pin down when it happens, how long it takes and exactly what factors promoted it.
What follows is a lengthy but provocative discussion of the process and dynamics of psychotherapy:
Work with patients who have suffered major trauma brings out the fine grain of how people change and heal. The work clearly and naturally divides into two parts, resolution of painful affects (I will call it catharsis), and modification of pathological, internalized attitudes and values (Hereafter called internalization). An examination of the development of affect regulation in children will suggest that these two mechanisms originate at different developmental periods and have very distinct characteristics. Catharsis is optimized by empathy, while internalization works best in a context of slight aloofness. Understanding these two mechanisms in detail makes it clear that the many varieties of psychotherapy represent different ways of achieving conditions that promote catharsis or internalization or both.
He goes on to note that he is neither “offering new data nor contradicting observations that others have made. Instead… I will suggest the following principle of epistemology: Everyone is right except when they say the other is wrong.”
The theme of this writing is to make psychotherapy lucid. By that I mean seeking a quality of openness and clarity. In today’s world of informed consumers, the more lucid we are in our practice, the more effective we are and the better is our partnership with our patients. Psychotherapy does not have to be mysterious or rely only on arcane concepts and jargon. Beginning with a high resolution examination of how people change, these pages will give a detailed outline of this approach and its practical application.
A lengthy but worthwhile read for psychotherapists and students of psychotherapy.
therapy, psychotherapy, dynamic psychotherapy, psychodynamic, CBT, cognitive behavior therapy