Cultures of Psychotherapy - Different Orientations in Psychotherapy as Viewed by a Pluralistic Epistemology

A number of studies in psychotherapy outcome research suggest that Cognitive Behaviour Therapy (CBT) is overall more effective than other forms of therapy. As a result, CBT is today widely regarded as the empirically best-supported approach to psychotherapy. However, if we look at the situation from the perspective of a pluralistic epistemology, the legitimacy of these claims must be called into question. The concept of Cultures of Knowledge suggests not only that all knowledge is bound to its specific historical and social circumstances but also that within those there are multiple epistemic subgroups. These cultures of knowledge, like most different branches of science for example, have different practices and presuppositions related to knowledge. Their members share a consensus about what counts as knowledge and how knowledge can be gained. If we apply this conception to the field of psychotherapy research, it becomes apparent that CBT and Psychoanalysis can be described as two very different cultures of knowledge. They have incommensurable concepts of the possibilities of research and practice. CBT however, shares its concept of knowledge with contemporary psychotherapy research, which focuses on experimentation and measurable outcomes. Thus, within the framework of psychotherapy outcome research, CBT is compared to other forms of therapy by the benchmark of its own concept of knowledge. Since all knowledge is culturally bound however, there is no natural hierarchy of different forms of knowledge and thus no a priori legitimacy for one culture (of psychotherapy) to force its own concept upon others. As a result, we must investigate philosophically whether one concept of knowledge can be called superior to others within the field of psychotherapy. Philosophical reflection shows, however, that Psychoanalysis and CBT are both severely limited in the scope of their conceptions because both approaches produce system immanence. This means that neither of the two perspectives can preferably be used as a superior or even as an exclusive framework for understanding psychotherapy. As an alternative, possibilities for a symmetric dialogue between therapeutic orientations are discussed eventually.