Theory and Practice in Psychotherapy

Abstract
Anecdotal reports from psychotherapists suggest that theoretical guidelines are not adhered to in actual practice. Previous studies indicated marked differences in viewpoint on aspects of technique and practice among even homogeneous groups of psychotherapists. To explore the discrepancies between specific theoretical issues in psychotherapy and practical clinical applications, a large group of experienced, practicing psychodynamic psychotherapists were surveyed. A questionnaire addressing theoretical issues such as transference, countertransference and goals of therapy was constructed. There were 70 items; respondents were requested to rate each item in terms of psychotherapy as they practice it. Discrepancies between theoretical belief and clinical practice occurred. Almost all 81 respondents agreed that the therapist should not impose his value system on the patient, yet 1/2 of the group viewed the therapist''s encouragement of the enrichment of the patient''s social life and educational and vocational pursuits as an important aspect of therapy. A significant number agreed that giving suggestions and advice to the patient may be harmful, but an equal number felt that the therapist should encourage more adaptive modes of behavior, including sexual intimacy in the patient''s outside life. Marked disagreements occurred over issues of dependency, controlling the patient''s outside behavior and the development of countertransference feelings. Analysis of data by age revealed that older therapists were more liberal in their attitudes to issues such as development of dependency by the patient, promotion of the enrichment of the patient''s social life and development of countertransferance than younger therapists. The presence of striking discrepancies between theoretical belief and clinical practice in dynamic psychotherapy was confirmed. Incongruities in the data indicate that therapists may prefer a value-free therapy as an ideal, but bring personal values into the treatment situation.