The nature of counselling and psychotherapy

This section is a little more conceptual than others. I must beg the forgiveness of some readers for its density in that reegard, while others will wish I had gone deeper or said more. In the last few months, some of those who have sought me out for advice on my work include a professor of philosophy at the University of Cambridge, and a young adult who is yet to study anything, and those who have sought philosophical counselling from me include a truck driver who has not read a book in thirty years and who wants to cultivate certain character virtues, and a clinical psychologist and an academic pscyhotherapist who want something different than psychological therapy. I am aware, as I write, that I am communicating with many different people.

People often approach counselling and psychotherapy with false assumptions. One is that these disciplines are similar to Clinical Psychology and Psychiatry, when in fact that are radically different. If you want to "trigger" me, refer to me as a clinician! Another is assumption is that counselling and psychotherapy are a product of intelligent design, that there is coherency in the design of counselling and psychotherapy, from top to bottom, from concept, to scope, to practice. Counselling and psychotherapy are a product of social evolution. They represent many different paradigms. The field often grows through brilliant therapist insights which break the boundaries of older theory and doctrine. Counselling and psychotherapy are often deeply humanistic, insight-based, experiential and relational. They are more like a growing, evolving, spilling over phenomenon, than a rationally-designed tool.
That is a part of what makes therapy so good, however it means there is much theoretical incoherence too. This means it is difficult, if not impossible, to offer a definition of these fields and many of their activities that is not controversial. There is no universal, defining set of factors they all share. There are exceptions to many of my claims, and they will be controversial among some therapists, even if others agree or are open to what I say.

Counselling and psychotherapy are generally used as interchangeable titles. That was how I was trained. At the same time, there are certain reasons for distinguishing them. Some people suggest that psychotherapy is a deeper form of work. There can be truth in that and the idea can be helpful. At the same time, it is too often said with a conceit which betrays a superficial, technocratic vision of the work--a failure of the humility which enables depth. It is the therapist and client who bring the depth, not the theory or technique. Furthermore, and I say this as a philosopher, depth has more to do with the heart, with the spirit, than with conceptual sophistication, even if the latter can lead to much greater depth when both are present. All this aside, and despite the fact that I tend to use the titles interchangeably, there is a conceptual and practical difference between counselling and psychotherapy which is worth exploring. 

It can shed much light if we think of counselling as the exercise and cultivation of what Aristotle called phronesis, or practical wisdom. Aristotle distinguished between contemplative wisdom (wonder, reflection on the nature of reality--insight and knowledge pursued without an immediate practical purpose) versus practical wisdom. Practical wisdom is the ability to see clearly what is true and good in the particular, often messy circumstances of a human life, and to respond well. It is not mere technical knowledge or the application of abstract rules, but a cultivated capacity. It is a cultivated capacity for sound judgement, right emotions, and skilful action. Remember my discussion earlier. Practical wisdom is wisdom, which is the ability to see what is true and good, and it is composed of both intellectual virtues and character (emotional and behavioural) virtues.

In counselling, practical wisdom is exercised by the counsellor in the conversation itself—in knowing what to ask, when to challenge, when to comfort, and how to help another person see their situation more truthfully and live it more fully. More importantly, it is guidance and training in the exercise and cultivation of the client's own virtue of practical wisdom. How should I be with my partner, or as a parent, or friend? What is just in this situation? How should I deal with that bully, or this loss? How do I make my career work, and how do I need to grow in order to achieve that? 

Of course—and this is proper to the nature of practical wisdom—the counsellor draws also on specialist knowledge that is relevant to your concern, be that be knowledge of social systems (e.g. the law courts), or of research that sheds a light on the concern, or psychotherapeutic theories and practices which help with that kind of concern. Many counsellors have a field(s) of specialisation which determines the kinds of further knowledge they pursue and share, whether they focus on psychological well-being, or personal growth, or success in your ventures, or a spirituality or religion, or grief, or relationships, or addiction, or trauma, or personality disorders, or careers, and so on. Some counsellors are generalists, but many differ in the same way that a plumber and electrician are both tradies but also possess very different competencies.

By contrast to counselling as practical wisdom focused on a field of concern, I define a psychotherapy as a psychological theory of human nature and what ills it, as well as what cures those ills, with a set of practices for effecting that cure. That theory tends to be the essential concern and lens of the psychotherapist. They are more interested in, say, psychoanalytic theory and practice, psychoanalysis as a path and a philosophy, than in the particular concerns psychoanalysis might help with. Because there are many such psychological theories, there are many psychotherapies.

We need to pause and consider that the concept of "the psychological" is not straightfoward, however, and it is often used vaguely, loosely, and over-applied in problematic ways. I will argue that we should identify the psychological as those psychological forces which are outside of consciousness, as discussed below. I mention this now, because a part of what distinguishes and justifies the different psychotherapies is their ability to conceptualise and work with different kinds of psychological unconsciousness, from the phenomenological work of the humanistic psychotherapies on the felt sense, to the hypothetical work of psychodynamic psychotherapy in recognising repression (that which is pushed out of access to awareness) and other psychological defenses.

My definition of psychotherapy as a psychological therapy does not cover all cases, or all its activities. Exisential Psychotherapy, for example, at least in the hands of Emmy van Deurzen, is arguably not a psychological practice, but rather a phenomenological and existential therapy. Even the majority of psychotherapies, which are psychological in their essence, do more than psychological work. For example, just as counselling draws deeply on psychotherapy, psychotherapy is often also the exercise and cultivation of practical wisdom. In her book Psychoanalytic Diagnosis, Nancy McWilliams writes that "beyond helping patients to change problematic behaviors and mental states, therapists try to help them to accept themselves with their limitations and to improve their overall resiliency, sense of agency, [...] realistic self-esteem, capacity for intimacy, moral sensibilities, and awareness of others [...]."  

The nature and validity of all these disciplines is dependent on the nature of a human being. A proper definition of human nature will clarify the nature of our psychology, and the nature of and need for both philosophy and psychotherapy. I define a human being as a centre of intelligent consciousness, woven into an animal life of bodily and psychological forces. As conscious beings, we can shape those forces; but they also shape us. They can hinder, blind, or distort our consciousness—our capacity to see what is true and good, and to live according to that vision.

Philosophy is the work of strengthening and expanding consciousness—wisdom and virtue. Such work is vital if we care about living well. Psychotherapy is the analysis and reshaping of our unconscious psychology or its effects on us. We need to do psychological work because, as the psychotherapist Carl Jung wrote, "until you make the unconscious conscious, it will direct your life and you will call it fate." As I wrote above, we can shape those unconscious psychological forces in us, but they can also shape us. The can blind and harm us.

There is a habit among many professionals and non-professionals of referring to both consciousness and those unconscious psychological forces as "the psychological." That habit should be abandoned. Not only is it vague and sloppy, it is harmful. Psychotherapy arose in the context of the 19th century obsession with reducing everything to mechanisms. Life, love, consciousness, all of that is nothing but psychological mechanisms, chemicals, and the like. The whole is reduced to the part, and to the most crude part. There was a kind of glee in this, a sense of moral and intellectual superiority, and a resistance to rational critique, all of which suggests that these "brave" intellectuals who threw dirt on life were really engaging in elaborate defense mechanisms. Life is dangerous, and that is made worse by our ignorance and lack of power. So we fantasise that we have knowledge and control, even if that means attacking and devaluing life through some kind of reductivism in concert with a posture of arrogance, or attacking ourselves for example through guilt or shame (blaming myself implies that I am responsible, which implies that I have the power to resist terrible things; if my child suicides, it may be more comforting to blame myself, than to face the terrible chaos in life which has just stepped forward and thrown its punch).

During the middle of the 20th century, a critical mass of philosophers and psychotherapists began to resist that psychological reductivism, or "psychologism," however many failed in their efforts, without realising it. Much of humanistic psychotherapy is psychological reductivism dressed in linen and the rhetoric of "holism." The problem here is a fallacy of equivocation. Psychological reductivism applies the word "psychological" to both conscious and unconscious life, because it reduces the former to the latter. A humanistic psychotherapist applies the word "psychological" to both conscious and unconscious life while consciously rejecting that reductivism, but this means they slide between the non-reductive and the reductive version of the same language. Reductivism as a powerful ideology written into Western modernity, and so the tendency when we do not have conceptual checks and balances, is to slide into that thinking. And of course, those who prefer that thinking, whether consciously, or because of their unconscious defenses as per above, are often happy if our language and rhetoric leads us into the reductive view. For this reason we should take care to avoid language that enables equivocation, and so I apply the word "psychology" only to those unconscious forces in us, and not to that which is in the domain of consciousness.

Despite the fact that psychotherapy does many things, as Nancy McWilliams points out (above), traditional psychotherapeutic theory, self-conception, research, and training limits the concept of psychotherapy to a therapy, and one that is psychological. In his book of advice to new therapists, The Gift of Therapy, the master therapist Irvin Yalom wrote that verything changed for him when he realised that "My task was to remove obstacles blocking my patient's path. I did not have to do the entire job; I did not have to inspirit the patient with the desire to grow, with curiosity, will, zest for life, caring, loyalty, or any of the myriad characteristics that make us fully human. No, what I had to do was to identify and remove obstacles. The rest would follow automatically, fueled by the self-actualizing forces within the patient."

Compare this to my quote from Nancy McWilliams above. On the surface McWilliams and Yalom are in contradiction. However, McWilliams expressing the fact that psychotherapy is many things, thanks to its evolutionary nature, which is driven by the observations and wisdom of many individual therapists. Yalom, by contrast, is expressing the traditional concept of therapy, which retains a very powerful place in our understanding. Psychotherapy is therapeutic—remedial, healing, bringing order to disorder. It gets us from minus one to zero. The function of psychotherapy is to clear away psychological obstacles to flourishing. Philosophy is growth in what makes us fully human, in what makes life worthwhile; it gets us from zero to plus one. This gives us a helpful way of understanding the difference between philosophical counselling and psychotherapy.

Philosophy needs psychotherapy—you and I need psychotherapy—otherwise our "wisdom" can become undermined or obstructed by our psychology. Our vision can become a mere projection of our psychology. At the same time, psychotherapy needs philosophy in the sense that "becoming more fully human" is the ultimate point and purpose of psychotherapy. Life is about more than clearing away obstacles.

This is why I studied counselling and psychotherapy. I did not want to spend the rest of my life as a mainstream therapist, rather I wanted to spend a decade or two in that work, and eventually to integrate that into philosophical counselling. My philosophical counselling combines both dimensions that Yalom spoke of: clearing the psychological ground, and cultivating our fuller humanity—wisdom and virtue.

Our society tends to reduce us to our psychology, and so it over-values psychotherapy, while neglecting the cultivation of wisdom, virtue, and our fuller flourishing. As a consequence it possesses a superficial conception of the meaning of life, which is reduced to psychological order, functioning, satisfaction, gratification. This is a terrible mistake in a range of ways. The pursuit of wisdom and virtue is far more important than psychological work, at least for the great majority of people. At the same time, philosophical counselling and psychotherapy need not be in competition, indeed they are complementary. We are far better off with both.

If I integrate counselling and psychotherapy into my philosophical counselling, am I simply practicing mainstream counselling or psychotherapy but under a different banner? No. Counselling and psychotherapy draw deeply on philosophy for many of their core practices: practical wisdom, phenomenology, The Socratic Method, the Stoic influence on the development of CBT. This does not mean that they are simply philosophy, however, under a different banner. A discipline is largely defined by its paradigm: a worldview, a set of values, a purpose. Psychotherapy is...therapy. And it uses philosophy to that end. Philosophy is the pursuit of wisdom, virtue, and flourishing, and it draws on psychotherapy to that end.