The role of proscription in psychotherapy

This article discusses the role of proscription in decisions on psychotherapy modality, choice of interventions, and therapeutic stance. As many psychotherapy modalities have similar outcomes, decisions on the therapeutic orientation should be made based, at least in part, on the potential negative effects each treatment modality could have on the client. A distinction is made between a medical model and a holistic model of psychotherapy. Proscription is argued to better fit the holistic model in that it allows greater freedom of action and flexibility while providing a framework within which to conduct psychotherapy. Five interactions between client, therapist, and therapy variables that can be used as indicators of potential deterioration are reported. These include (1) the role of anticipation of emotional pain and therapeutically induced arousal, (2) client suspiciousness toward the therapist and therapist empathy, (3) level of interpersonal functioning and the focus of treatment, (4) diagnosis and treatment modality, and (5) relaxation therapy and clients' need for control. Therapists' and clients' collusion in underestimating clients' level of psychopathology is also discussed.