The Future of Psychotherapy
Tong: So if I may, I have two more questions. One is more practical, and one is more broad and general. Let's go with the more practical one. If you're speaking to a group of entry-level therapists who are just starting their career in this business, what would you say to them about what they can do to be more effective therapists?
Beutler: The central theme: first is relationship. That's what I would tell the horse trainer, and that's what I would tell the psychotherapist. If I have one thing to tell them: learn to listen. And you'd be surprised at how difficult this is. But it's the one thing that they need to start with, the ability to sit and listen to another person without an agenda, without inserting some salesmanship, trying to sell a point or a point of view or a perspective. Don't sell a perspective. First, learn to listen. Now, for more advanced ones, then they can learn one principle at a time. The next principle I would say…
Tong: How many do we have? How many principles do we have?
Beutler: We can have a hundred principles.
Tong: Eighteen?
Beutler: Well, we've got 18 in STS, but we know there are more principles than that. But the ones that are going to have the most powerful impact are the principles having to do with the quality of the relationship, because most of the patients that you see will benefit just from that. They don't need anything else. So learn to listen. If you just learn to listen–I'm talking to you as everyone. You're a collectivist, right?
Tong: I'm integrative.
Beutler: Integrative. All right. This perspective, if people could just learn to listen and to do it without inserting. It's called motivational interviewing, it's called client-centered therapy, it's called humanistic therapy. If you could learn that concept of listening, most people that you see would benefit from it without adding anything else.
And then if you were to add the principle of intensifying therapy with the level of impairment that a person has. Just those two concepts. If I could get that across to new therapists out there, they would make a huge difference. But they don't believe me. They say, "research be damned." They don't believe me.
Tong: How many years did it take you to come up with these ideas?
Beutler: What am I? I'm almost 69.
Tong: It's 50 years of wisdom.
Beutler: At least.
Tong: At least. No, every year counts–69 years. Okay, one last question–it's kind of a broad one. What do you think of the future of psychotherapy, or the best possible approach to psychotherapy?
Beutler: Well, those are two different questions. My greatest fear is that psychotherapy will continue to persist in this fragmented way, and that we will see an increasing schism between the science of psychotherapy and its practice. And people will continue, as practitioners, to try to sell a point of view that is needed and will be valued, but which society will not ultimately support because society has a price tag attached to everything. And what the price tag is going to say is that you have to be able to prove what you do, and you have to be able to replicate it. That means we're going to have to move increasingly towards a broad view of science. Though I don't know, frankly. Back in 1970, George Albee, then president of APA, was asked to write an article on the future of psychotherapy. And I believe completely what he wrote, which was four blank pages. It has yet to be written.
I believe there will always be a place for people who can listen and who can provide, through whatever means they can, the experience of help to other people. There will always be a place for that. I don't think that we will continue to support it through health care indefinitely, because we will have to accept the fact that it is not health care–it is life care. Society is forcing us into that in part by credentialing all these other quasi-therapists–you know, life coaches, etc.–that have taken away the things that we used to call psychotherapy, and now they use them under a different label. And it tells us something: that our view has been too narrow. Within the narrow view that we use–psychotherapy to treat psychopathology–we're going to have all kinds of medical, biological, chemical treatments to do away with symptoms. What we won't be able to do is change a lot, through this chemical interjection, some of the basic angst that people experience in not being connected to other people, not being heard, not feeling relevant. Having another person, someone who is be trained to do something that is helpful and optimal, who will listen and care for them, is going to continue to be very important.
Tong: Thank you so much, Larry. Thank you for your time and wisdom.