Analyzing Psychotherapy: A Social Role Perspective
Analyzing Psychotherapy: A Social Role Perspective
Nancy A. Naples 0
Recommended Citation
0 University of California , Irvine , USA
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right to receive humane care and to participate in treatment decisions. These basic
assumptions are prevalent as discrete but powerful messages throughout the book
to confirm the magnitude of its importance.
Melvyn Fein has written a book that flies in the face of contemporary postmodern
critiques of grand narrativesand totalizing discourses. No therapeutic perspective
is missing from his broad reach as he argues that
a role-problem/role-change paradigm turns out to be a useful
instrument. In the best tradition of science, it brings order to enormous
diversity. It permits a grand synthesis that demonstrates the
connections between apparently antagonistic perspectives, (p.207)
Fein's overall goal is to demonstrate that "a social-role framework can enable
competing therapists to integrate what have seemed to be antagonistic
worldviews and will help them make further advances in developing effective helping
technologies," which will also lead to "a greater utilization of sociological
knowledge" (p.vii). He outlines the relevance of role theory to psychotherapy in
Chapter One, further describes the role change process in Chapter Two, then
broadly compares and contrasts diverse therapeutic specialties in Chapter Three.
One of the basic problems with Fein's analysis is his broad definition of roles:
"Indeed, for every social task we can distinguish, there exists a corresponding
behavior pattern that can be labeled a role" (p.16). To begin with, Fein never
addresses who determines the content of the behavior patterns appropriate to
certain social positions. Next, roles discussed range from family position (mother,
husband, daughter) to job (doctor, artist) to such diverse personal characteristics
or experiences as caretaker, free spirit, winner or loser, the leader, the martyr or
scapegoat, and the fat one. Since Fein views the goal of therapy as one of fostering
role change, the unreflexive inclusion of categories such as careers or family
positions is problematic. This approach obscures how power is imbedded in these
social positions. For example, a term frequently associated with sociological role
theory is role conflict. Women are likely to experience a conflict between the role
of mother and the role of worker. These are structural tensions best alleviated
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through increased valuation of women's paid and unpaid labor and material
changes in the gender division of labor. In other words, the solution may not be
located within the individual or even between role partners.
Chapters Four through Seven further explore the usefulness of role theory for
evaluating different psychotherapies. By presenting such a wide ranging set of
therapeutic approaches, frequently lumping divergent perspectives under one
broad category, Fein often truncates and misrepresents them. Consequently, his
approach may function inadvertently to undermine his overall goal. Chapter Four
applies role theory to psychoanalysis. The sweep of Fein's project is most
apparent in Chapter Five where he considers cultural therapies. Combined
together in this chapter are "those who brought social insights to their critique of
Freud," including Alfred Adler, Erich Fromm, Karen Horney, Harry Stack
Sullivan, Heinz Hartmann, Ronald Fairbairn, Edith Jacobson, Rene Spitz, Heinz
Kohut, and Margaret Mahler (p.98).
In Chapter Six, Fein turns his attention to ecological therapies: family
therapy, group therapy, labeling theory, social reform, sociotherapy/milieu
therapy, community psychiatry, temperamental fit, and alcoholism counseling.
In this chapter, he considers Alcoholics Anonymous (AA) alongside what he
terms "alcohol therapies." Given the decentralization of AA and its avowed
resistance to systematic research, Fein's bold assertions about the philosophy and
practice of AA are troublesome.
Chapter Seven covers what Fein calls "romantic" modalities. Therapies
included under this term are: "client-centered, gestalt, primal-scream, and
existential therapies, and also transactional and Jungian analyses" (p. 143). Fein
criticizes these therapies for sharing "an overly simple view of human nature and
interpersonal relations." Chapter Eight addresses itself to academic modalities;
behavior modification; cognitive, affective, and eclectic behavioral strategies.
Chapter Nine presents so-called "antitherapies": medical interventions which
rely upon pharmacotherapy, strategic therapy and hypnotherapy; reality therapy;
and vocational therapy.
Fein's terse presentations and dismissal of many therapeutic frameworks
could serve to alienate the audience he most wishes to convince. His book
highlights two significant and unavoidable obstacles to developing a broad-based
theoretical framework for psychotherapy. First, fundamental premises that
undergird divergent social and psychological perspectives cannot be ignored (...truncated)