Some observations on the fallacy of value-free psychotherapy and the empty organism: Comments on a case study.

In this discussion of Kohlenberg's article it is asserted that the psychotherapist always treats a person not a passive organism and that the therapist's moral values inevitably influence his interactions with the patient, regardless of whether the therapist's stance is made explicit. Ultimately, all therapies are seen as attempts at persuading a thinking and feeling person to behave differently. Because Kohlenberg's (1973) article goes to the heart of what psychotherapy and behavior modification are about, I was challenged by the Editor's invitation to discuss some relevant issues. Let me begin with the patient's "motivation" for therapy. It is generally conceded (Meltzoff & Kornreich, 1970) that a patient's motivation to seek change augurs well for success, whereas lack of motivation tends to be associated with failure. For example, a patient decides to consult a psychotherapist because he wants to be cured of claustrophobia. (The italics in the preceding sentence serve to emphasize the patient's volition, intention, and status as an independent agent.) Regardless of whether the matter is openly discussed, the patient and the therapist agree that (a) the treatment of claustrophobia (by whatever means) is a desirable goal for the patient; (6) the problem principally relates to the patient's personal happiness and competence; and (c) society at large has no particular stake in the matter (except perhaps in the sense that if the patient loses his job as a result of his difficulty he might become a public burden). The patient may also have a domineering wife who derives certain gains from her husband's incapacity and dependence on her. In general, however, most therapists would agree that other things being equal, the foregoing constellation is "ideal " for successful psychotherapy. What makes the situation ideal is that by and large the therapist can count on the patient's cooperation throughout therapy. I can only mention in passing that from a technical standpoint this "therapeutic alliance " provides the therapist with enormous leverage and that it always