5.3 Discussion of Deterministic Interventions
creative exercises that allow the client to change in a manner the client alone can know is best. Thus, deterministic interventions are of a largely contextual type in HEP.
Systemic approaches (SPT) are rather divided in this respect: Most SPT approaches follow, like HEP, a nondirective stance because their epistemology claims that reality is constructed by observers, and there are no objective truths that could be the targets of deterministic interventions and prescribed by the thera- pist. Here SPT holds postmodern idealist assumptions and works predominantly contextual. Interestingly, the reasons for choosing contextual interventions rather than specific techniques are different in HEP and SPT. A few SPT approaches however are more directive, and their deterministic techniques resemble BT inter- ventions but put the focus on the client’s relational behavior or entirely the client’s social system.
In the continuum spanned by directive and nondirective approaches, psychoanal- ysis occupies a position between these poles as it combines its deterministic theory with a therapeutic practice that is nondirective and contextual over long periods of therapy, where the therapist’s role is to maintain abstinence.
In conclusion, there are two types of deterministic interventions. A typical example of the first type is direct intervention in BT, when old behavior is extinguished or habituated, and new behavior is rewarded to shift and modify the initial attractor (Fig.5.1). The causation of change is on the side of the therapist.
The second type is indirect and most accentuated in HEP: The context of the problem is changed so that new attractors of the system arise as a consequence of the system’s new self-organization processes (Fig.5.3). In this second, contextual type of deter- ministic intervention, the change of the context parameters may be initiated by the therapist applying techniques, but the restructuring of attractors is determined by the self-organizing system (or the client) alone. An overview of the respective intervention types per therapy approach will be given in Fig.6.3and in Table6.1.
One may think that the effectiveness of the various deterministic interventions is an empirical issue, which might be settled easily by psychological experiments and randomized controlled trials. This however has not happened in several decades of competition between the various psychotherapy approaches. Although there is a tendency toward psychotherapy integration and eclecticism, the major differences between the underlying philosophies and premises of psychotherapy still exist.
In psychotherapy research, the unresolved differences are usually expressed as a conflict between proponents of specific factors (technical type of deterministic intervention) and common factors (contextual type of deterministic intervention), see Wampold and Imel (2015), Tschacher and Pfammatter (2017). We will further elaborate these open questions in Chap.6.
Our depictions of the prototypical change mechanisms of the four major therapy approaches in Figs.5.1,5.2,5.3, and5.5are hypothetical. They are based on the theories and philosophies of these approaches, not on empirical findings of real therapy courses. Such empirical work has yet to be done, and we will present methods and tools for this research work in Chap.9.
5.3 Discussion of Deterministic Interventions in Psychotherapy 69
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