Doctor Boscolo, you have said that the move from psychoanalytic family therapy to the Palo Alto model translated into better results. When you described the replacement of that model by the one that later took shape in Paradox and Counterparadox, you grounded it in the need to answer your students’ theoretical concerns and in the shift of your interest from Pragmatics of Human Communication towards Steps to an Ecology of Mind. Do you mean by that that there were no clinical reasons for that change of model, but exclusively ontological ones, if one may put it that way?

The thesis

The quotation above serves to illustrate the central thesis of this article: in the majority of cases, psychotherapeutic models are replaced by others not because the new ones have any greater clinical reach, but because that novelty helps to keep therapists’ enthusiasm alive and therefore allows them to attend to their patients with renewed interest. As is well known, interest in what the patient brings is an essential factor in any kind of treatment; so that the formulation of new theories essentially has a clinical effect, not because it would allow us to understand more, but because it helps us go on paying attention with enthusiasm.

David Malan referred to this question in his own field, brief psychotherapy, when he said: “It seems beyond doubt that almost all the prolonging factors that played so overwhelming a part in the development of psychoanalytic technique can be countered or avoided in certain cases (…). One factor has been left aside, however, which may well prove the hardest of all to counter. It is, of course, the decline of enthusiasm.”

Malan then places his own work in its historical perspective: it began, he says, as an attempt to go back in time and return to a primitive technique, used by the first analysts and discredited for years; it ended with the development of a technique derived from the one used by today’s analysts. And he concludes that if only the problem of the decline of enthusiasm could be solved, it would seem far more likely that such a development would survive the test of time.

The claim that new models have no greater clinical reach than the previous ones will probably not be shared by the therapist who formulates or modifies a model, nor by those who subscribe to it. In general, very few people can be expected to show the lucidity of Doctor Boscolo’s remark; and it is natural that this should be so, since the lack of neutrality towards one’s own work, or towards the model that gives us an identity, is the very condition of the possibility of producing it or subscribing to it. Put another way: no one invents something, or subscribes to a model, that they would consider essentially not superior to the others.

We must nevertheless say that all the research on psychotherapy shows, with overwhelming monotony, that the different therapeutic techniques obtain identical percentages of symptom resolution, which implies that none of them can claim superiority over the others.

A rainforest of theories

What then leads to the feverish development of modifications, reinterpretations, inventions and revivals of different psychotherapeutic models?

The ground on which theories grow resembles a rainforest where plants of various sizes constantly spring up at great speed, struggling with one another for the space and light they need, declining just as quickly and, as they decompose, serving as fertiliser for those that follow them, without any of them being able to arouse interest or consensus for any length of time.

Those who grow these plants or climb them may preserve a certain illusion of having chosen the strongest and most durable one, but they surely cannot have the conviction with which Freud or Watson grew theirs. If they carry on with this task, it is because they draw other gratifications from it. One of the most important is certainly the one Doctor Boscolo alludes to when he says that the change of model was partly due to the need to answer the students’ questions. They, just like already trained therapists (or perhaps we should say just like the majority of people in this culture), direct their interest towards “what is new”, towards what seems to represent progress over what already exists. In the scientific field, novelty usually consists of an extension or an application of the existing model. From time to time a “revolution” occurs and the model in force is replaced by another, following the process admirably described by Kuhn. But even in those cases, knowledge is cumulative, since the old facts are not simply disdained but included in the new explanation. Moreover, and this is perhaps the central point, a new model is only “respectable” if it promises greater predictive capacity, from which usually follows a greater capacity to influence phenomena. Biology may serve as an example, if one wishes to move a little away from the well-worn examples of physics.

Therapists readily consider themselves scientists, but in general their models do not meet that condition. Popper had already demonstrated, many years ago, that psychoanalysis, since it includes no predictions that would make it empirically refutable, fell outside the framework of science. It does not seem to us that other therapeutic models can so far boast of meeting the necessary conditions any better.

There is more: it would seem that in many cases they do not even try, with the notable exception of the decimated remains of pure behaviourism and the vigorous cognitive cohorts. In the particular field of “systemic” therapies, constructivism shelters an ever more comfortable coexistence between divergent maps. These models, in turn, are not tested empirically: they are replaced by speculation. What matters is to create something new every day. In fact, a brief glance at the history of psychotherapeutic models shows that each of them gives way to others without anyone really having verified that the new ones are better. It is simply that a model falls into disuse, that it drops out of the zeitgeist. I suspect that any family therapist could read Adler with profit, for example, and yet the great majority of those trained over the last ten years barely know who he is. “He has gone out of fashion.”

We are not advancing: we are changing

Whether we like it or not, we therapists resemble artists far more than scientists in our behaviour. We are not advancing: we are changing. What confers respectability is being up to date with the current (which is not the same thing as being up to date with discovery, even if we claim to deceive ourselves on that point). It remains to be seen what makes this feature intensify over time (models change or are replaced ever faster), and what consequences this entails in clinical practice. We shall speak of this in a forthcoming article, if the editor survives this one.