The word ART has mainly positive connotations and that is why so manypeople (especially psychotherapists) would like to see psychotherapy as an art.
I have repeatedly sought to understand how it is possible to teach therapy that represents an art? Most likely, as in every art form, a special talent is required and a few available methods include the observation of the “master” at work and an effort to gain an insight into the master’s wisdom and skills. Many a time masters of “artistic therapies” cannot clarify mechanisms underpinning their treatment methods. This is how Bert Hellinger, a German psychotherapist associated with a therapeutic method best known as Family Constellations and Systemic Constellations, commented on an attempt to explain how his own therapy system worked:
Actually the theories aren’t important to me. I can see that these things happen, and explanations after the fact don’t add anything to the practical work. Many people would be interested in an explanation of exactly what happens and how it’s possible, but I don’t need an explanation in order to work with the phenomenon.
It would be interesting to know whether Hellinger’s students and followers also have this gift of “seeing” and thus do not need any explanations to understand what the master is doing. I wonder how they pass on this knowledge. Theory has to this day been the only known source of knowledge and description of the world. Another one, relevant to religious cognition exclusively, is revelation. Can it be that in psychotherapy we have already reached this boundary?
Eclectic psychotherapy, which currently represents one of the most popular approach, is also absent from the quoted reports and research studies. The eclectic approach allows the therapist to choose methods and measures that, in their view, will work for a particular patient. On what grounds? This must undoubtedly be that unerring intuition and experience that in no way can be explicated to an amateur.
Imagine a novice artist-painter striving to emulate his master’s style or to develop his own. Before he reaches perfection, many canvases are just thrown away or reworked with a bit of luck. It takes a lot of tools and supplies in order to achieve a satisfactory outcome. However, the cost of artistic experimentation is limited to the cost of canvas, stretcher bars, paints, as well as the time spent on using them all together. How do psychotherapy-artists develop their professional competence? Is psychotherapy by any chance the only art form that can be mastered without making mistakes? And if not, then which works of this art find their way to the waste heap of psychotherapy?
Let’s have a look at the research results. Quite often therapy brings negative results and a considerable deterioration of the patient’s condition. Successive studies have demonstrated that as a result of therapy no fewer than 10% of patients feel worse and even display psychotic reactions. Many couples who underwent therapy went along with their therapists’ suggestions to such an extent that their family lives disintegrated as a result. What is more, those recommendations and suggestions were formulated solely on the information presented by only one of involved sides, that is the patient.
Interesting conclusions can be drawn from an analysis of the results of the Cambridge-Somerville Youth Study:
In evaluating the effectiveness of a project designed to prevent delinquency in underprivileged children, 650 boys of six to ten years old were randomly divided into two groups with equal chances of delinquency. One group received individual therapy, tutoring and social services; the other received no services. The treated boys rated the project as “helpful” and the counselors rated two-thirds of the group as having benefited. However, the researcher, Joan McCord, followed the boys over time looking at effects on criminal behavior.The results showed little difference in terms of the number of crimes, but the counseled group committed significantly more serious crimes. A thirty-year follow-up showed the same pattern and revealed that, in terms of alcoholism, mental illness, job satisfaction and stress-related diseases, the treatment group was worse. McCord summarizes the results as “‘More’ was ‘worse’: the objective evidence presents a disturbing picture. The program seems not only to have failed to prevent its clients from committing crimes… but also to have produced negative side effects…”
When interpreting the results of her research, McCord identified three factors that might contribute to the harmful effects: encouraged dependency, false optimism and externalized responsibility. She suggested that:
1) Through therapy, the psychologists might have fostered a dependency among the boys, rendering them less able or inclined to cope with life’s problems on their own; 2) “the supportive attitudes of the counselors may have filtered reality for the boys, leading them to expect more from life than they could receive;” and 3) counseling may have taught the boys that they were not responsible for their behavior because it was a consequence of their underprivileged childhood experiences – an external cause to blame.
This was by no means the only such study. Keith Ditman and associates studied three groups of alcoholics who had been arrested and charged with alcohol-related offences.
The court had assigned these individuals to AA, an alcoholism clinic, or a non-treatment control group. A follow-up found that 44 per cent of the control group were not re-arrested, compared to 31 per cent of the AA group and 32 per cent of those treated in a clinic; 47 those that received treatment did worse than the untreated. “Not one study,” Peele asserts, “has ever found AA or its derivatives to be superior to any other approach, or even to be better than not receiving any help at all. Every comparative study of standard treatment programs versus legal proceedings for drunk drivers finds that those who received ordinary judicial sanctions had fewer subsequent accidents and were arrested less.”
Other documented cases of adverse effects of therapy include decompensation, that is a failure of the adaptive mechanisms of an individual overburdened with difficult situations, problems and tasks; deterioration of depressive states, including attempted suicide; lower self-esteem coupled with feelings of shame and humiliation; weakened self-control manifested in aggressive behavior or uncontrolled sexual behavior; the already mentioned dependence on therapy and/or therapists; loss of a sense of responsibility for one’s own life. There have also been cases of incomprehensible impulsive behavior of patients undergoing therapy in their own social environment. The behavior in question did not occur before the start of therapy. In another article Handley and Strupp have demonstrated that most psychotherapists agree that the problem of harm done during therapy is real and that it often leads to suicide. Moreover, the research results I have referred to, do not really worry the therapists, who make no effort to eliminate them. Robert Spitzer of the New York Psychiatric Institute once said with disarming honesty that: “negative effects in long-term outpatient treatment are extremely common.”
Carkhuff was of a similar opinion: “the evidence now available suggests that, on the average, psychotherapy may be harmful as often as helpful, with an average effect comparable to receiving no help.”
Is it possible that all these cases of adverse effects were a result of improvements in therapy treated as an art? Perhaps these are the discarded canvases, damaged stretchers, wasted lumps of precious metals that help artists to improve?
 Hellinger, B. & ten Hövel, G. (1999). Acknowledging what is: Conversations with Bert Hellinger. Phoenix, AZ: Zeig Tucker & Theisen, p. 66. More about Hellinger: http://www.hellinger.com/
 Lambert, M. J., Bergin, A. E., & Collins, J. L. (1977). Therapist induced deterioration in psychotherapy. In A. S. Gurman, A. M. Rogers (Eds.) The therapist’s contributions to effective treatment,(pp.452-481). New York: Pergamon.
 Dineen, T. (2007). Manufacturing victims: What psychology is doing to people. p. 48. Retrieved from http://tanadineen.com/documents/MV3.pdf
 Ibid. p. 55.
 Ibid. p.55.
 Lakin, M. (1988). Ethical issues in the psychotherapies,New York: Oxford University Press.
 Strupp, H. H., Hadley, S., & W. Gomes-Schwartz, B. (1977). Psychotherapy for better or worse. The problem of negative effects. New York: Jason Aronson.
 Hadley, S. W., & Stupp, H. (1976). Contemporary views of negative effects in psychotherapy. Archives of General Psychiatry, 33, 1291-1302.
 Mays, D. T., & Franks, C. M. (1985). Negative outcome in psychotherapy and what to do about it. New York: Springer.
 Spitzer, R. as cited in Sarason, Psychology misdirected,p. 42.
 Carkhuff, R. R. (1969). Helping and human relations: A primer for lay and professional helpers,New York: Holt, Rinehart & Winston.