The Choice of Clinical Methods

IVES HENDRICK ONCE REMARKED THAT when he entered psychiatry in the nineteen thirties it was necessary to learn not to ask questions but to listen. Teaching psychiatry and psychoanalysis in the fifties he said he found the problem reversed: the residents and candidates had all learned silence; they needed to learn to speak again (Hendrick 19550.

In more formal terms, the interrogative method of the mental status examination dominated the early part of this century; then free associative work became popular. Still later, awareness of the limitations of both these approaches called for fresh forms of clinical speech. I believe this is one reason for the great growth of the different psychotherapies. The present author has described what he believes are two basic methods, existential (empathic) and interpersonal speech (Havens 1978), (1979), (1980), underlying many of the others. The purpose of the present paper is to delineate how these newer methods overcome some of the limitations of the older ones.

I use as an illustration the problem of determining whether transference is present in a particular case. I will argue that this problem arises in part because of the lack of quantitative methods in much psychological work and because of the difficulty we have determining the effects of the observer on the observed. I will suggest that the schools deal with these difficulties by making various assumptions, for example, that mental disorders are predominantely intrapsychic, interpersonal, or biologic, or that an attitude of skepticism or credulity is best taken toward the patient's material (as in the approaches of Kernberg (1975) and Kohut (1977) respectively), or that the therapist is in a more objective position than the patient, or indeed that an actual patient can be readily identified and apart from the immediate social field. Sometimes, too, it is assumed that reliability of determination can be increased by increasing the precision