Abstract
M.A.
The problem concerning the indication of psychotherapy is examined by means of a literature study. On the basis of the literature studied, it is observed that the question concerned has originated from Newtonian (linear) epistemology and that it has been stimulated by inter alia (i) research on the effectiveness of psychotherapy; (ii) the growing awareness of the possible adverse effects of psychotherapy, and (iii) the limitations of a single school of psychotherapy, which has given rise to the need for integrating the respective schools of thought. For the purposes of the discussion in hand the indication problem is divided into two problem statements: (i) When is psychotherapy indicated? (ii) What form of psychotherapy is indicated? In answering the question involved, an attempt is made to formulate a comprehensive definition of psychotherapy. Based on the literature studied, the assumption is made that there has occurred an epistemological shift in the conceptualization of psychotherapy. Psychotherapy, which was initially embedded in Newtonian epistemology, has shifted towards an ecosystemic epistemology. In the field of psychotherapy the latter is described as a means of gathering knowledge on problem situations and change. This is done from an epistemological framework as represented by ecology, system theory and cybernetics. It is concluded that an ecosystemic metatheory makes it possible to
integrate the different schools of psychotherapy by considering them merely as
different punctuations in a comprehensive circular process. In view of the latter statement psychotherapy is tentatively defined as a strategic description and manipulation of systems by the therapist who finds himself in a metaposition, but who forms part of the interactional patterns which he describes and manipulates. An attempt is made to give an ecosystemic description of problem behaviour in order to answer the question of when psychotherapy is indicated. Problem behaviour is described as a rigid manner in which a system interacts with itself and with other higher-order and lower-order systems, and this leads to the introduction of rigid system rules and the monotonous repitition of patterns of interaction. The linking of the initial complaint with the description of the circular interaction pattern constitutes a pivotal part of the attempt to find an answer to the question regarding the indication of psychotherapy. With regard to the question as to what form of psychotherapy is indicated, an ecosystemic diagnosis is eventually examined. By means of such an ecosystemic diagnosis descriptions of circular patterns between and within the respective hierarchic system levels can be offered. It is tentatively suggested that a functional, interactional and structural analysis, as well as circular questioning and psychometric tests should be
used in combination, since the respective analyses or diagnostic systems provide different information on different system levels. Finally a brief summary is given of the implications of the epistemological shift in psychotherapy for research, training and the role of the clinical psychologist in the mental health team and in the courts. Future
investigation into the role of the ecosystemic clinical psychologist in these fields is recommended.