The most important lesson I've learned in Experimental Psychopathology class so far is essentially this: that it all goes back to Persons. It was gratifying to reach the paragraph of the Smith (1999) paper in which Smith explicitly identifies the parallel between psychotherapy researchers' unbudging insistence on classification by "theoretical orientations" (which only serves to stunt actual theoretical development), and psychopathology researchers' insistence on DSM classification (which in turn stunts the pursuit of actual knowledge about the underlying causes and constructs that give rise to the "manifest symptomatology"). Really, though, I don't think it's even Persons that it all goes back to; I'm suspecting now that there's a more fundamental pattern, or "common factor," as it were, behind the separate controversies that these seminal papers are tackling, and that if we (as a field) can correctly identify and then break that pattern, we might be well on our way to a new age of scientific and practical progress in psychology (say I, the humble 1st-year grad student who knows it all :D ).
Let me explain: What Smith construes as a debate between the old "theoretical orientation" mode of thinking and his new proposed "meta-theoretical" mode of thinking, is a distinction I think might be more helpfully characterized as "dogmatic" versus "theoretical" (or even "dogmatic" versus "scientific") thinking. The insistence upon classifying clinicians' and researchers' "theoretical orientation" is, as I think Smith admirably demonstrates, a worn-out convention that's not informed by either empirical *or* theoretical considerations (if by "theoretical" we mean something like "intended to coherently explain and predict particular phenomena by identifying more general, basic mechanisms or principles that underlie those particular phenomena"). Instead it's driven by blind tradition, habit, and the inertia of the bureaucratically entrenched status quo. Sounds a lot like the conclusions we reached about the APA in our class discussion last week, doesn't it?
To clarify a bit more about what I mean, I think Smith is spot-on when he draws the distinction between a clinician's explicit, "avowed" theoretical orientation and his implicit, "underlying" theoretical orientation, both of which can come from distinct, non-overlapping sources (e.g. professional role models on the one hand versus personal life experience on the other hand) and can wield distinct and non-overlapping influence over the clinician's treatment decisions. However, it seems to me like a large part of that discrepancy can be explained by the fact that the explicit theoretical orientations that clinicians must currently "choose from" - the "boxes" they're given to check off - just don't fit most situations very well. It is a rare patient - a rare *person,* for that matter - whose mental health troubles can truly be reduced to a dash of specific spider phobia here and a touch of classically presenting OCD there, so that you can fit them snugly into your cookie-cutter pure-CBT model, throw the manual at them with great empirically-supported gusto, and send them home with a clean and happy-go-lucky bill of mental health. Therapy, at least any therapy worth researching and bettering our understanding of, has got to be more complicated than that - and once it gets more complicated, you have to drop your preconceived "theoretical orientation" and start developing an actual theory. The fact that clinicians are by-and-large already doing this on the implicit, unsystematic level of a "private project," as Smith describes, leads me to wonder just how much more we could accomplish as a field if we actually made the process explicit and applied the methodological rigors and resources of science to the task.
I think it's illuminating, not to mention highly ironic, that the modern "theoretical orientation"-based approach is entirely at odds with the theoretical approach of those who founded some of the "orientations" in the first place. Take Aaron Beck, for instance - who, as I recall, actually received his training and initially conducted his practice as a psychodynamic therapist. In the course of conducting his psychoanalysis, though, he noticed through meticulous observation and experiential data-gathering that his patients consistently expressed certain "automatic thoughts" that seemed to drive their emotions and behaviors without their own conscious awareness or control - and he noticed that helping patients to identify those automatic thoughts consistently helped them gain some conscious control over them, and to affect change in the resulting emotions and behaviors over time. The Westen (2004) article even references the fact that Beck examined the content of people's dreams and noticed certain cognition-relevant phenomena (such as lingering implicit associations and negative memory biases) on that basis. By the conventional modern understanding of a "cognitive-behavioral orientation," I think it's safe to say that Beck wouldn't qualify - and would have to check the "eclectic" or "integrative" box in order to avoid getting pigeonholed. The more I read and learn, the more convinced I become that the "theoretical orientation" categories, as they exist today, really are just "pidgeonholes" - i.e. static categories that don't actually reflect any of the fundamental principles or the openness to evidence-based revision and expansion that any "theory" (or "meta-theory," as Smith refers to it) must allow in order to actually serve as a useful epistemological tool (as against an impediment to real discovery and progress).
So, in a nutshell, I would like to emphatically second Smith's call to action, which he addresses to both clinicians and researchers (but especially researchers): A little less "theoretical orientation" and a little more actual theory, please!
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