3, Torino, Italy
note is a provocation. Operational Researchers and Decision Analysts intuitively
feel to belong to a culture which completely different from the one of
Psychotherapists and vice-versa. Why this provocation?
this (more or less) apparent distance, the two professions share more than a
first glance may allow to think. There is somebody (a client or a patient) who
has a “problem”. She or he thinks that (s)he is not able to handle this
problem alone. Moreover, (s)he considers (or a third person suggests) that it is
necessary a support of somebody with precise skills and knowledge (an adviser,
not just your best friend). The client/patient expects that such an adviser (a
decision analyst or a therapist) is able to formulate a recommendation and to
convince him/her to follow it. The situation just described fits both for a
decision aiding setting and for a psychotherapeutic one. Nevertheless
practitioners and researchers in both fields still feel to do different jobs. It
might be interesting therefore to better explore where similarities end, and
what the common grounds of these two disciplines can teach us.
the two authors come from these two distinct areas, the first being a
psychologist (working for the Italian National Health Service), practicing
second being a decision analyst working for the CNRS (the french national
science foundation), mainly doing theoretical research. We had the opportunity
to discuss several times our respective experiences and theoretical backgrounds.
Although we still feel to belong to two different cultures and professions we
also discovered to share several common theoretical concerns and, what is more
important, several common practical concerns. In this note we try to summarise
part of these discussions, hoping this will be interested to the reader. The
note is organised as follows. The next two sections briefly describe the
settings of a decision aiding activity and of a psychotherapy (possibly
independently from the
followed). In section 4 we discuss the common characteristics, but we also
emphasise the differences, while in the conclusion we present our ideas for the
important characteristic of decision aiding, at least the one conceived by
decision analysts, is the use of an abstract and formal language, aiming to
reduce the ambiguity structured in human communication. Decision aiding aims,
among others, to clarify, to allow to better understand, to improve
communication, hence reduction of ambiguity is essential. Decision aiding is an
activity concerning at least two actors: a client who, involved in a decision
process, has at least a concern for which (s)he feels that (her)his resources
are not sufficient to handle, and an analyst who is invited by the client to
enter the decision process and provide some help in order to establish a
behaviour towards the above mentioned concern (for more details see [4, 18, 19,
20, 22, 23]).
two actors, possibly with the implication of others, engage themselves in a
decision aiding process aimed to produce a shared representation of the
client’s concern, a representation which is expected to be useful in order to
undertake an action (including waiting and doing nothing) with respect to the
concern and the reference decision process. The decision aiding process is
characterised by the emergence and establishment of the following cognitive
representation of the problem situation;
already shown in [5, 22] this is a very general descriptive model of the
decision aiding activities and allows to include any type of decision aiding
approach, from normative methods and optimisation techniques to constructive and
we want to focus upon in this note are the resources used by the two actors. The
client has a domain knowledge concerning the decision process in which (s)he is
involved and the precise concern for which the decision aiding has been
requested. The analyst has a methodological knowledge, independent from any
application domain, which is expected to be instantiated on the client’s
concern through the domain knowledge.
“successful” decision aiding process (cfr. [13, 14, 15]) is expected to
produce a final recommendation which is:
meaningful from a theoretical point of view (thanks to the methodological
knowledge of the analyst);
meaningful for the client and (her)his concern (thanks to the client’s domain
legitimate with respect to the organisational context and the decision process
(thanks to the craft and skills of the client and the analyst).
psychotherapeutic setting we can also recognise two actors: the client (here
called patient) carrying an uneasiness, possibly expressed through one or more
symptoms of mental trouble and the psychotherapist who is expected to work with
the patient in order to establish the origin, nature and structure of the
patient’s psychic pain and allow (the patient) to confront (her)himself with
such a pain, take posses of it and face it. There are at least two cognitive
artifacts established during a psychotherapy:
informal contract is generally established between the patient and the
therapist. In such a “contract” the timing of the therapy is settled as well
as the final objectives of the therapy (estimated by the therapist and accepted
by the patient). Such a contract may evolve during the therapy, but there is
always one such agreement
during the process. It should be noted that generally the patient recognises to
the psychotherapist a competence and a leading role within the process. At the
same time the psychotherapist is expected to fix a-priori:
timing of the therapy (how many sittings and how much time per sitting);
space of the therapy (which is usually precisely structured depending on the
type of therapy adopted);
rules which will be followed (how sittings are payed, what type of relations are
allowed between the two actors, if any etc., cfr. ).
resources do the two actors use within the process? The patient will carry (her)his
personality, (her)his relations, (her)his culture and possibly (her)his
commitment to the therapy. The psychotherapist will carry also a personality and
a culture (possible to a precise level of awareness due to a precise training),
a specific training in at least one particular type of psychotherapy, the
possibility to obtain a supervision by other peers or tutors and a finally a set
of rules: practical (depending on the type of therapy conducted, see for
instance ) and ethical ones (often precisely coded, cfr. ).
does a therapy can be considered successful? Usually is the patient who ends a
therapy for reasons going from simple regression of the symptom to a deeper
management of the (her)his psychical pain. The therapist may also decide to end
a therapy usually because it appears as leading to no where. In both cases is a
subjective evaluation that establishes that the therapy does not apport any
further improvement to the patient and that possibly the objectives fixed at the
informal contract at the “beginning” of the therapy have been reached. That
said, a third person is usually able to assess independently whether the therapy
has fulfilled the contract or not.
sponsor normally identifies a set of symptoms that have resulted from inadequate
decision making in the past. Our
first problem is to diagnose the situation; ....'' (quoted from ). Obviously,
we are not the first to notice the similarities between the two professions. A
first common characteristic of the two settings is the existence of two actors,
the first carrying a “problem” (for which no intuitive, ready made or
immediately available solution exists) and the second carrying a knowledge which
is recognized and accepted to be useful for this particular “problem”. A set
of interactions, a process, is then established between the two actors and in
both cases such a process is aimed to produce some cognitive artifacts which are
expected to allow the client or patient to understand the “problem” and to
establish a behaviour towards such a “problem”.
the same time a big difference between decision aiding and psychotherapy
concerns the vehicle of the interaction between the two actors. In decision
aiding the vehicle is a formal and abstract language (mathematics, logic,
abstract models), while in psychotherapy the vehicle is human language and
communication (see ). In some cases the language is THE TOOL of the therapy
(see [11, 12]). On the one hand decision aiding tries to reduce the ambiguity of
human communication and ultimately to reduce the complexity of the problem
situation. For this purpose decision aiding has to use models of rationality. On
the other hand psychotherapy uses the ambiguity of human communication as a
resource, while the complexity of human personality and behaviour is treated as
a whole. Under such a perspective psychotherapy might induce further complexity
since it focus on what the patient does not show (see for instance ). This
should not be understood as absence of any a-priori model of human personality
(each approach in psychotherapy do use such models). However, psychotherapy does not use models of rationality
this concept being irrelevant.
second common characteristic in both activities is their process dimension. Both
decision analysts and psychotherapists engage themselves in interactions with
their clients/patients under the hypothesis that the cognitive artifacts they
produce ought to be shared (owned) by both (if any success is to be expected).
Under such a perspective very little information is considered as given and
invariant. The information used during the process is co-constructed by the
actors during the process itself. Of course different approaches in decision
aiding and psychotherapy will start with different hypotheses about their
clients and will focus the interactions on different aspects (for instance a
psycho-dynamic approach will focus on the patient’s personality and
intra-psychical processes, while a family therapist will focus on the
patient’s relationships; in decision aiding a normative approach will impose a
model of rationality, while a prescriptive approach will try to derive such a
model from the client).
the way such a process is conducted is totally different. In decision aiding
there is no established procedures on how to conduct the process. It is left on
the craft and the skills of the analyst. The influence of the analyst on the
client is usually underestimated as well as the biases such an influence may
introduce in the process. It is expected that the use of a model of rationality
will prevent such drawbacks, but there is no guarantee that in practice this
will not occur. Indeed is rare that an analyst will submit a decision aiding
case to a supervisor in order to obtain advice and an external point of view on
the whole process. In the rare cases where this happens it occurs on a very
informal basis. On the other hand therapies are conducted following precise
rules and operational settings, depending on the approach used. Quite often such
rules are coded in manuals and in any case they are part of the informal
contract established between the patient and the therapist (cfr. , ,
). The influence of the therapist on the patient’s behaviour is a crucial
issue for the therapy and in several cases therapists are trained to situate
themselves with respect to their personality and the therapy (see ) . Last,
but not least, psychotherapists regularly submit their cases to supervision
sittings and this is expected to be part of their life-long training if not a
help for the precise therapy.
aiding and psychotherapy, although apparently grounded on different approaches
and purposes share several common characteristics. These mainly concern the help
that somebody (the analyst, the therapist) can provide to somebody else (the
client, the patient) facing an apparently difficult to handle situation of
brief discussion introduced in this note shows that, from a practical point of
view and despite the high complexity of human personality troubles and psychical
pains, psychotherapists have a much more structured approach as far as the
conduction of the aiding process is concerned. Decision analysts, despite the
use of models of rationality which are expected to simplify interaction, pay
little attention to the conduction of the process although they know this is not
first conclusion to establish is that a decision aiding methodology should pay
more attention on the decision aiding process conduction and try to develop a
“doctrine” about it and more general about the profession of decision
aiding. A second conclusion could be that decision analysis might dedicate more
research efforts in better understanding how precise approaches in psychotherapy
handle issues such as establishing a contract with a client, formulating a
problem, inducing a change in a person’s behaviour etc. (see for instance ,
, ). We consider
there is still several things to learn from this “sister discipline” which
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EWG-MCDA Newsletter, Series 3, No.8, Fall 2003