Lois Holzman

Presentation at the 112th Annual Convention of the American Psychological Association,
August 2004, Honolulu

I was trained in developmental, not clinical, psychology, and I do not practice psychotherapy. I
study it. I study it because I find the therapeutic activity, in particular, the social therapeutic
activity, to be fascinatingly paradoxical—simultaneously exhilarating and tedious, intense and
trivial, touchingly meaning making and incomprehensible, an extraordinary life-affirming
creative act whose materials are often anything but life affirming. Moreover, as a researcher into
human development, studying therapy has become important to me because of its developmental
potential or, to use the terminology of the humanistic psychology tradition, its potential for
experiences of actualization and transcendence.

Since I began my research career, about thirty-five years ago, I’ve always studied things that are
very difficult to study—some, I’ve discovered, even impossible to study—unless you go outside
the bounds of the existing research paradigm. The first time I encountered this was in my study
of language acquisition and development at Teachers College, Columbia University in the early
1970s. The existing paradigm looked at grammar and vocabulary and basically just counted
instances of words and grammatical forms. But Lois Bloom, my mentor, and I were interested in
the process by which children become speakers. And this was unstudiable according to the
prevailing standards for research and with the prevailing conceptions of what language was,
because for psychologists at the time how language was used, what children were actually doing
when they uttered sounds, who and what they were engaged in relation with, were out of bounds.
We were convinced that to discover anything about the process of becoming a speaker, you had
to include the pragmatics of language, or the performative. And once you include that, then you
are no longer studying the isolated individual of mainstream psychology. The living paradox we
tried to wrap our heads around was that in order to understand how a particular child becomes a
language speaker, you must study that child as unified in its relationships with others. Bloom
and I were among the first groupings of psycholinguists to enter into the world of young children
with an ethnographically influenced method for studying the socio-cultural development of
language users. And even though theoretically we were right in step as quasi-Piagetians, we got
flak for what was then considered an unorthodox methodology and, I would posit, an unorthodox
unit of analysis—the relationship. Today, our early research articles (Bloom, Hood and Lightbown, 1974; Bloom, Lightbown and Hood, 1975; Hood and Bloom, 1979) are classics of
the language development literature.

For some years after, my work focused on cognitive development. Working with Michael Cole at
his lab at the Rockefeller University, I was investigating how schools and everyday life compare
as learning environments and the broader issue of how learning occurs as a cultural phenomenon.
Put in everyday language, we hoped to discover the answer to the following question: “How
come kids who are street smart are school dumb?” We studied kids in a variety of social contexts in school and out. One of the things I did was look in non-school settings for individual
cognitive acts, those that are presumed to occur in psychological experiments and classrooms. I
couldn’t find any—not one. We began to see social practices, rather than individuals, as the unit
of analysis—groups of two, three, four kids performing remembering and problem solving as a
component of whatever it was they were doing. We marked the end of the initial stage of this
research by writing a lengthy manuscript that concluded that 1) experimental, cognitive
psychology was ecologically invalid; and 2) the unit of analysis for creating an ecologically valid
psychology was the “the person-environment interface.” The living paradox we were
studying—if learning is a jointly created, context-specific activity, how does “transfer” and
cognitive change in persons occur? —necessitated stepping outside the bounds of the laboratory
and its epistemological and ontological assumptions. We sent off our manuscript to
Psychological Review, which rejected it outright. We didn’t try to publish it after that, but the
manuscript had a long life as an underground manifesto provoking what has come to be known
as the cultural theory of mind (Cole, Hood and McDermott, 1978).

Armed with these experiences as a studier of what was considered unstudiable, about fifteen
years ago I plunged into a study of social therapy (Holzman, 1987, 1995, 1996, 1999a, 2003).
I’m interested in how emotional development happens, specifically, how the work activity of the
group in this specific therapeutic context creates emotional growth. I’ve come to see context as
inseparable from the activity of creating it, and so what I study is the living paradoxicality of the
group creating itself continuously. To me, this is analogous to, and continuous with, my prior
research at Columbia on language development and the Rockefeller work on cognition, only
more radically monistic in terms of the unit of analysis (Holzman, 1999a). And as was the case
with my previous research topics, in order to study what I want to study, the unit of analysis
could not be the individual, but rather necessitates looking at the relational, the person-
environment interface, the group.

So, how I approach studying social therapy is, clearly, different from how others, including
perhaps my colleagues here, do. Because we’re studying different things, no doubt we will have
different findings and if any of us happen to draw some conclusions, they will no doubt also be
different. This seems fine, as long as we all remain sensitive to the way that boundaries—in this
case, boundaries of discipline, intellectual tradition and institutional location—can be inhibitory
in relation to what we are able to see. For example, some people see groups as collections of
individuals. Others, myself included, see groups as a living, working entity/activity. (We also
see individuals, but that is a different entity.) Some people see human joint activity where others
see particular behaviors in temporal sequence.

What I see is that as persons, human beings learn, develop, transform emotionally, intellectually,
spiritually, morally through their participation in ensemble, relational activity. Further, the
ensemble, relational activity in which they engage is none other than creating or constructing
new environments, social practices, performances out of the context-specific elements at their
disposal. It is this dialectical, activistic process that I’m interested in (Holzman, 1997,1999;
Holzman and Mendez, 2003; Holzman and Morss, 2000; Newman and Holzman, 1996, 1997).

To approach psychotherapy from this perspective is to bump up against the boundaries imposed
by the currently accepted paradigm of psychotherapy. It is to raise questions about the validity of the assumption of individual cure, the nature of the therapeutic activity and the relationship
between therapist and clients. Further, it requires a rethinking of the criteria for delineating
psychotherapeutic ethics. Which brings us to the controversial topic of boundaries in
psychotherapy.

Any psychotherapeutic approach in which life is understood as relational rather than individuated
and that works with social and/or cultural units of cure, change and transformation rather than
individuated units poses a methodological dilemma from the research and evaluation
perspectives. For what is brought to light is an assumption of psychotherapy that—if
accepted—makes studying these approaches impossible. The problematic assumption is this: if
the entity that experiences emotional distress or disorder is the individual, then the treatment
(cure, therapy, etc.) must be individuated. If one accepts this, then there is no methodological
basis for the unit of cure being a social one. And if that’s the case, then therapies in which the
relationship or the group is the social unit being built and cured will be seen and judged by the
same criteria applied to therapies in which the individual is related to as the unit. This includes
the criteria employed when considering boundaries and dual relationships. For the very
conception of boundary, and with it concerns about boundary violations in psychotherapy, rests
on the assumption of the individual as the unit of cure and change.

So what is one to do? It seems to me that such alternative psychotherapeutic practices are rich
sites for potential new learning, including new ways of thinking through ethical issues, and
should be studied by practitioners and theorists of all perspectives. As a studier of social therapy,
which embraces and works with the living paradox that even though people experience
emotional distress and pain on their own, they cannot get help (be cured, change, transform,
develop emotionally) on their own, I would surely love some company. So I invite you to think
through some things with me about boundaries from my vantage point—that people need to be
organized as social units in order to carry out the task of getting therapeutic help and developing
emotionally or, put another way, that the cure for emotional pain is the creating of new social
units. Given humanistic psychology’s aim to “be faithful to the full richness of human experience” and its particular sensitivity to “experiences of actualization and transcendence”
(Aanstoos, Serlin and Greening, 2000, p. 26), one would hope that humanistic psychologists
would eagerly and closely examine the creating of transformative social units as a significant
human experience.

In my exploration of psychotherapeutic ethics—the issue of boundaries and dual relationships in
particular—I’ve been pleased to find a rich, generally well-argued and diverse literature that puts
forth philosophical, logical, therapeutic, moral and humanistic critiques and challenges. Perhaps
most familiar to this audience is the recent Lazurus and Zur volume, Dual Relationships and
Psychotherapy (2002), which contains chapters by 17 different authors, psychologists, attorneys
and social workers among them. But I would urge that people give equal attention to the various
feminist, theological and postmodern critiques (for examples, Combs and Freedman, 2002;
Heyward, 1993; Hugman, 2003; Ragsdale, 1996; Witkin, 2000, to name a few). Here I can only
give a cursory summary of what I understand the major arguments to be.

First, there is prevalent category mistake. The most common instances noted by critics are the
following: 1) confusing exploitation with actions that could or could not lead to exploitation; 2)substituting duality for exploitation (“I find the logical implication that dual relationships are the
source of exploitation extremely misleading,” Tomm, 2002, p. 34); 3) confusing boundary
crossings with boundary violations (“But the absolute ban on ‘dual relationships’ so prevalent in
most circles draws no distinction between ‘boundary violations’ that can harm a client, and
‘boundary crossings’ that produce no harm and often prove extremely helpful,” Lazurus and Zur,
2002, p. xxvii); and 4) confusing boundary violations with the application of a technique in
another model of therapy (“A major error on the part of many boundary-oriented thinkers is that
much of what they consider to be violating a boundary is actually the application of a technique
in another model of therapy,” Fay, 2002, pp. 151-2).

Second, critics point out that the failure to acknowledge that psychological discourse is self-
validating raises a few red flags about establishing a code of ethics. Witkin, a leading
postmodernist in social work, is especially concerned that, to the extent that psychology defines
morality based on what it declares to be real, it establishes itself as superior to morality (Witkin,
2000. p. 199)—and, I would add, as morally superior. Further, in declaring the reality of its
invented terminology, e.g., dual relationships and boundary violations, it presumes and
perpetuates the belief that fact and value are independent of each other, and silences discourse
exploring their historical and cultural interweaving (Witkin, 2000, p. 199).

Third, a code of ethics lets psychotherapists off the hook. To make morality contractual is to
imply that moral responsibility has limits (Hugman, 2003, p. 1028), resulting in psychotherapists
needing to consider only what is prescribed and proscribed in the code and nothing more. In
addition, making boundaries the central focus in determining ethical behavior discourages
critical examination of the complex issues and discourses that support injustice and exploitation
on the one hand, and connection and collaboration on the other (“...human enrichment
possibilities are being restrained, professional hierarchy is being privileged and social alienation
is being enhanced,” Tomm, 2002, p. 42; see also Combs and Freedman, 2002; Ragsdale, 1996).

Fourth, the boundary and dual relationship issue privileges one worldview and psychological
theory and de-legitimizes others, pathologizing certain cultural practices along the way. Many,
especially feminist, theological and postmodern oriented critics point out that what is being
privileged are the values of privacy, separation, individuation and independence, while the
values of sharing, reliance upon one another, connection and collaboration are ignored—or
worse, de-valued and viewed with suspicion. As Zur says, “In a healthy society, unlike our
modern culture, people celebrate their reliance on each other. The more multiple the
relationships, the richer and more profound the individual and cultural experience” (Zur, 2000, p.
98; see also Freedman and Combs, 1996; Dineen, 2001, 2002; Heyward, 1993; Ragsdale, 1996;
Walker, 2002).

Fifth, it is self-contradictory. The attempt to equalize the presumed inherently unequal
relationship between therapists and clients through a code of ethics resting on the notion of
boundary turns out to create inequality anew, as we wind up claiming to empower clients while
perpetuating a sense of weakness, dependency and vulnerability (Dineen, 2001, 2002; Rivera,
1996). Further, while we promote the values of idea of freedom and individuality, at the same
time we socialize therapists and clients to conform to prescribed roles. Both clients and
therapists wind up being infantilized, critics say, when their judgments are “superceded by a biased set of ethical standards” (Fay, 2002, p. 165). As DeLeon points out, we should not forget
that “psychology’s clients are individual people, with all of the rights and responsibilities granted
to them under our Constitution” (DeLeon, 2002, p. xxii).

Which leads to the final criticism prevalent in the literature: adherence to the ethics of
boundaries is unscientific, unethical or both. Arguments here reflect back on the ones already
discussed. For example, to Fay, the category error is unethical: “It is a fallacy to declare behavior
per se unethical. This argument may be summarized in one short sentence: Context is everything.
The operative ethical issues are exploitation and harm, not behavior itself” (Fay, 2002, p, 155).
DeLeon’s call for professional responsibility hearkens back to imposing the criteria of one
approach onto another:

It is not responsible behavior by any professional to attempt to categorize discussions
surrounding dual relationships (or any other aspect of treatment for that matter) in an
all-or-none fashion, or to propose blanket, uniform “solutions.” Just as children are
not little adults, psychodynamic-oriented therapy is not the same as providing
biofeedback services. In my judgment, those who attempt to impose their vision of
quality care upon others are not responsible professionals. (DeLeon, 2002, p. xxii)

I hope you find these objections to the conceptualizations of boundaries and dual relationships,
and attempts to control the therapist-patient relationship by appealing to them, thought
provoking. I do, and I also agree with most of them. Still, I find them lacking because the
subject of this literature is “individual” therapy, and the client (singular)-therapist (singular)
relationship. That there could be an entity other than the individual as the unit of treatment or
cure is unexamined. The question remains as to whether it is sufficient to extend these
objections to alternative psychotherapies that make a break with the individualist paradigm or activity, to develop emotionally is transforming, mustn't ethical considerations and questions
transform as well?

Discovering—or creating—answers to these questions presents an exciting opportunity for
psychology—in my opinion, especially for humanistic psychology. Historically, humanistic
psychology has played the important role of critic of mainstream approaches.
That is no small part of why Division 32 has been my home for nearly twenty years. Let me
remind you of what it stands for by reading a section from the Division’s guidelines for
humanistic practice:

Principle B: Integrity
Humanistic psychologists seek to promote integrity in the science, teaching, and
practice of psychology through the humanistic value of reflecting critically on the
effect of their own belief systems, values, needs, and limitations and the effect these
have on their work. Further, humanistic psychologists also serve as valuable critics
of more mainstream approaches by making explicit the hidden value assumptions in
them. When critiquing these approaches, humanistic psychologists remain as honest,
fair, and respectful as they are when dealing with any person or group. In addition,
whether a more thorough break with that paradigm is needed. If our understanding of what it is
to be human, to be in emotional distress, to get and to give help, to participate in a therapeutic they do not make statements that are knowingly misleading, false, or deceptive.
(From Training and Ethics: Guidelines for Humanistic Practice, written by the Task
Force for the Development of Guidelines for the Provision of Humanistic
Psychosocial Services, and appearing in The Humanistic Psychologist, 1997, Vol. 25,
No. 3, 309-317.)

The philosophical, scientific, ethical and cultural underpinnings of the boundary issue raised by
alternative approaches that reject deeply rooted assumptions of psychology and psychotherapy
are an invitation to continue this legacy of openness, integrity and scientific responsibility. Doing
so would require that humanistic psychologists examine their own assumptions as they work to
create ethics consistent with and inclusive of the diversity of approaches that comprise
psychotherapy in transformation. It would require studying these strange, unstudiable
practices—and questioning and critiquing them—without violating their integrity as self-
conscious attempts to transform psychotherapy, rather than as poor, misguided or deceptive
instances of current practices.

In addition to being fascinated by relationality, groups and group psychotherapy, I feel ethically
motivated to study these practices. I recently read James Surowiecki’s The Wisdom of Crowds:
Why the Many are Smarter than the Few and How Collective Wisdom Shapes Business, Societies
and Nations (2004). I was delighted to see a book of this kind reaching the public, yet I couldn’t
help but wonder why one of the few serious challenges to the belief that the individual is the
highest form of intelligence and creativity was written by the business columnist for The New
Yorker and not by a psychologist. Are we abdicating our responsibility by omission? Don’t we
have things to discover about groups, collectives and communities from careful scrutiny and
healthy intellectual dialogue? Shouldn’t we reflect on why the group movement died out and
why there has been so little study of and theoretical advance in group psychotherapy? To what
extent does an anti-group attitude persist not only in the general public but equally among
psychologists? Are we still functioning with the early 20th century belief in the “mob” mentality? Are we perpetuating, consciously or not, a fear of groups? As humanistic psychologists we owe
it to our past—not to mention our possible future—to engage in a process of reflecting critically
on our own belief systems, values, needs and limitations and the effect these have on the choices
we make and the company we keep.

References
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