Researchers' images of psychotherapy: Their origins and influence on research

Abstract

In order to formulate research hypotheses, designs and procedures, researchers must rely on their prior conceptions of the phenomenon they study. The paradigmatic status of a science depends in part on researchers sharing a common basic image of the central phenomenon. However, psychotherapy researchers have been guided in formulating studies not by one but by four basic images, which represent psychotherapy alternatively (a) as mental health treatment, (b) as personal education, (c) as a reform or correctional process, and (d) as moral or spiritual redemption. The dominant image of therapy as treatment inclines researchers to define process in terms of technique, therapists as professionals trained in the application of techniques, patients as embodiments of psychiatrically diagnosable disorders, and outcome as the end result of a treatment episode. Other formulations of process, therapist, patient and outcome variables are suggested by less explicitly acknowledged images of therapy, engendering confusion among researchers. To repair this situation, the nature and origin of the four basic images of psychotherapy are discussed, their integration into a general research-based model is proposed, and the implications of this “generic” model for the design of future research are explored.