Jack Ferrari: About technique in psychotherapy

The following article is by Jack Ferrari (see bio below the article).

I think a problem arises when we consider activities like DBT or EMDR as “techniques.” I had my gall bladder out a number of years ago, and the surgeon utilized laparoscopic surgery. That is a technique, a learned, skilled action, in the service of the larger activity of conducting an operation. The specific technique is part of the surgical art or technique.

The scripted, manualized activities that are often referred to as “techniques” in discussions about psychotherapy have, it seems to me, more in common with practice exercises, such as learning scales for the piano, or learning vocabulary lists when acquiring a new language. They may eventually lead to technique, when the actions become a natural part of the skilled activity (the “art”), but if focused on woodenly and rigidly, they will actually inhibit the acquisition of technique.

The real “technique” that we aim for in psychotherapy is the art of properly conducting the therapeutic conversation, often unfortunately dismissively referred to as the “relationship”, and inappropriately differentiated from the technique. When we refer to the relationship, we should realize that a therapeutic relationship is not a relationship in the colloquial sense. When a psychotherapist encounters a client, the do not explore what movies each likes to go to, whether they follow sports and, if so, what teams they root for, whether they enjoy Thai food, etc. Just the opposite, in fact. The therapeutic relationship is an asymmetric, non-reciprocal relationship, in which the psychotherapist has learned the art of conversing with the client in a way to guide them toward different ways of thinking and perceiving, support for needed actions in their lives, or acceptance of some of the realities of their being. This art will, of course, be informed by the therapist’s knowledge of how people perceive and think, how they develop, how they act in certain situations, how families operate, how people react to the events of life such as loss and death, etc. But the therapy is not determined by this knowledge, it is guided.

An interesting book appeared recently that I think has relevance to the discussion; the book is political, it is written by a Canadian economist named Brian Lee Crowley, and is entitled Gardeners vs. Designers: Understanding the Great Fault Line in Canadian Politics. Mr. Crowley is obviously talking about politics, and the role of government in society, but I think the distinction between the orientation of a Gardener, versus that of a Designer, is of relevance to our field as well. A review for the book states: “Designers believe that they have sufficient knowledge to impose their will on others, without any unintended consequences, while gardeners are more modest and are content to work with what already exists, especially where whatever already exists has virtues or beauties.”

As psychotherapists, we tend to be gardeners, accepting what is given, learning about it (the gardener learns about soil conditions, pests, climate, needs for sunlight and water, etc.—we learn about the factors mentioned above, family, job, illness, loss, etc.), and takes matters into account while realizing they do not ultimately control these factors. The designer seeks a perfection and control that is simply not theirs to achieve. (As an aside, understanding psychotherapy in this way can explain why there appear to be upper limits on therapeutic effectiveness—we simply do not, and cannot, control all the factors in a human life). The differentiation between gardener and designer should not lead us to excuse our failures; it should simply teach us to approach our role with humility, and to recognize the strengths and struggles of our clients.

Dr. Jack Ferrari is a Clinical Psychologist in Private Practice in London, Ontario. He worked in the hospital system (in two provincial psychiatric hospitals) for 35 years, his final position being  Professional Practice Leader, Psychology, for the St. Joseph’s organization. He was on the Adjunct Faculty of the Psychology Department of the University of Western Ontario (now Western University) for over 25 years, and with the Department of Psychiatry for 5 years. He has had considerable experience with professional issues, having served on the Council and on the Complaints Committee of the College of Psychologists of Ontario; and for 5 years on the Transitional Council of the College of Psychotherapists of Ontario (a new regulatory body in Ontario, overseeing the newly regulated profession of Psychotherapy). He was on the Executive of the Ontario Psychological Association serving a two year term as president (2006-2008). He currently conducts psychotherapy and assessments.

Published February 2021.