The Philosophical Roots of Modern Therapy

We often imagine psychotherapy as a distinctly modern invention, a product of 20th-century science emerging from the clinics of Vienna and the laboratories of academic psychology. This is a misconception. The truth is far more rich and interesting: psychotherapy is deeply rooted in classical philosophy, not just in its historical lineage but in its conceptual foundations, goals, and methods. This essay explores some of those foundations, but also reflects on how psychotherapy often falls short, with the implication that the therapy of the future may look different, by reaching more deeply into its roots.

​To understand psychotherapy is to recognise that it operates on a pre-existing philosophical substrate. Every therapeutic model, whether it admits it or not, must make foundational assumptions about the nature of reality, knowledge, and value—the traditional domains of metaphysics, epistemology, and ethics.

The journey from ancient Athens to the modern therapist’s room is a complicated but somewhat continuous path of dealing with life through reflection and wisdom. The first therapists were indeed the classical philosophers, and the founders of modern therapeutic schools were, without exception, engaging with philosophical ideas. To see this clearly, we will look to how the major schools of therapy today embody competing philosophical answers to humanity's oldest questions.

By viewing modern therapies through a classical lens, we cannot help but notice how their pragmatic and often reductionist applications of ancient ideas, fall short of the comprehensive philosophical visions from which they borrow. The following analysis will map the philosophical heritage of some major therapeutic schools, and then explore some of the ways that each therapy is philosophically incoherent or incomplete.

1. Cognitive Behavioural Therapy (CBT) and Stoicism: The Sovereignty of Reason

Philosophical Foundation
CBT, pioneered by Aaron Beck and Albert Ellis (pictured above), is the most empirically validated of modern therapies, and finds its inspiration directly in the Stoic philosophy of ancient Greece and Rome. The core Stoic dictum from Epictetus—"Men are disturbed not by things, but by the views which they take of them"—is the absolute bedrock of the cognitive model. CBT operationalises this insight by teaching clients to identify their automatic negative thoughts and to subject them to the rigours of Socratic questioning. The therapist asks, "What is the evidence for that belief? Is there an alternative explanation? What is the worst that could happen, and could you survive it?" This is not merely a technique; it is the practice of cultivating phronesis (practical wisdom) in the cognitive realm.

The Philosophical Shortcomings
CBT’s problem lies in its neglect of the ethical, of goodness. Classical reason is not merely a tool for subjectively feeling-better; it is the means to align one’s life with truth and goodness. Stoics examine their impressions not just to feel less anxious, but to ensure their judgments are in accord with Nature and Justice. Classical wisdom is prduced by rational reflection on life experience, but also by virtue, by the forms of goodness and justice which enable us to see truth.

CBT shifts the focus from the philosophical (Is this belief true and virtuous?) to the pragmatic and therapeutic (Is this belief functional for reducing your distress?). It reduces reason from a contemplative discernment of reality (which is rich in meaning and value) to a tool (instrumental reason) for getting what we want. 

CBT risks making us into skilled manipulators of our inner world, rather than rational "lovers of wisdom" (i.e. philosophers) and of truth, goodness, justice, virtue, who use reason to get at those things and to embody them. Of course, CBT is an expression of the ideology of modernity, which is technocratic and nihilistic. If, however, you think that life is much richer, and that we have deep ethical obligations, then CBT misses too many of the things we need, and even encourages a less than ethical way of being.

As a philosophical counsellor with decades of experience in mainstream therapy, I draw often on CBT, but I do so mindful of its significant limitations.

2. Humanistic Therapy and Aristotle: The Actualising Tendency

Philosophical Foundation
In stark contrast to the mechanistic view of behaviourism or the conflict-based model of psychoanalysis, Humanistic therapy, pioneered by Carl Rogers (pictured above), offers a philosophy of growth and potential. Rogers’ concept of the actualizing tendency--the innate drive of every organism to develop its capacities to the full--is a direct psychological counterpart to Aristotle's metaphysical principle of the movement from potentiality to actuality in any living being. The therapist’s job is not to diagnose and pathologise, but to create the conditions (empathy, unconditional positive regard, congruence) for this natural process to flourish. That is, for the person to actualise, or in Aristotle's language, for the person to fulfill their potential.

The Philosophical Shortcoming
The critical flaw in this framework is its assumption of innate goodness, and its consequent ethical vagueness. Aristotle’s view of actualisation was not a Rousseauian unfolding of a naturally benevolent inner core. For Aristotle, we are animals, with all their potentiality for good or evil, to speak in human terms. Our cultivation of the self according to our higher powers of consciousness, often runs counter to our initial appetites and impulses. As we see so clearly with children, the self must be sculpted by reason and culture toward an objective standard of the good life. Otherwise things can go very wrong. "If it feels good, do it" leads readily to doing stupid or even terrible things.

Furthermore, by placing the client's subjective experience as the ultimate arbiter of truth and value, Humanistic therapy provides no philosophical ground to challenge a client who is "actualising" in a destructive or narcissistic direction. What is the therapeutic response to a client who discovers their "authentic self" is a hedonist or a tyrant? Indeed, I have often challenged Humanistic therapists on this, and encountered a manipulative form of anti-intellectualism in return: essentially the hippy response of "Get out of your head!" I am far from the only one to complain of this experience.

It seems to me that, thanks in part to its anti-intellectualism and so failure to think carefully about its own assumptions, Humanistic therapy buys into reductivism, reducing us to the body. It imagines, however, that it is different to that nasty scientific reductivism, because it does so while wearing a linen shirt and other natural fibres. Because it is "in touch" and "processing" and "embodied" and expressing "the felt sense." 

The Humanistic therapies, such as Rogerian therapy, possess powerful methods for emotional healing and for unlocking potential, but they offers no coherent moral clarity to guide what that potential should be used for. They answer the question "What do I feel?" but stumble on "What ought I to do and become?" conflating the feeling of authenticity with the achievement of virtue and wisdom. The 1970s called, it wants its linen shirt back.

3. Existential Therapy and Existentialism: Confronting the Givens of Life

Philosophical Foundation
If Humanistic therapy is over-optimistic about human potential, Existential therapy is soberly realistic about the human condition. It draws directly from the wells of 19th and 20th-century existential philosophy (Kierkegaard, Nietzsche, Heidegger, Sartre). I spent time studying many therapies, but this was my focus, especially the version led by Emmy van Deurzen (pictured above) and called "the British school", but also the psychodynamic existential therapy of Irvin Yalom, and the Logotherapy of Viktor Frankl.

This approach (or set of related but differing approaches) is explicitly concerned with how we confront the givens of existence: death, freedom, isolation, meaninglessness. The therapy, at least as practiced by the British school, is fundamentally a form of philosophical inquiry. It does not seek to eliminate anxiety but to recognise that as an appropriate response to these givens. The task is to help the client move from a state of inauthenticity--living by the values and expectations of others ("the They")--to a state of authenticity, a concept central to Heidegger and Sartre. This involves grappling with one’s radical freedom and the concomitant responsibility for crafting a meaningful life in a universe that offers no pre-ordained meaning. Here, therapy becomes a workshop for cultivating virtues not in the Aristotelian sense of a mean, but in the existential sense of courage—the courage to be, to choose, and to face the abyss without despair.

The Philosophical Shortcoming
Classical Graeco-Roman-European philosophy located the good in an external order (human nature, the natural law, the cosmos). Existential therapy's primary incoherence is its struggle to ground value while denying human nature, and denying any meaning to the universe.  Existentialism's precription in the face of the nihilism it so dogmatically insists on, is to create one's own values. That readilty devolves into what Alasdair MacIntyre termed "emotivism," where moral statements are nothing but expressions of personal preference. Within the therapy room, this can leave the therapist without a foundation to challenge a client's chosen "authentic" path, even if it is nihilistic, solipsistic, or destructive.

If one authentically chooses a life of solipsistic pleasure or power over others, the existential framework, in its purest form, has no philosophical recourse. It brilliantly diagnoses the problem of a disenchanted world and the dizziness of freedom, but it offers a solution (groundless self-creation and self-assertion) which is demanding to the point of being untenable for many, and more importantly, which is ethically precarious for all. It provides the courage for meaning-making but cannot answer why one meaning is inherently better than another, leaving the self as the sole, fragile author of a universe which, in fact, it did not create.

I have the sense that this can lead to a kind of avoidant practice within existential therapy, of focusing excessively on the phenomenological analysis of experience, as though this will magically produce something that makes up for the lack of clear direction and meaning. That is a form of passivity. Classical philosophy is heroic, but in the way of the Jungian hero's journey, which is a response to reality. We must exert our mind and heart, our intellect and will, to answer to the call and demands of reality. Existentialism can have none of this. Whenever I read existential therapists like Irvin Yalom or Viktor Frankl or many of the British set, I get the sense of them reaching for something more--a belief in love, or a sense at times of an objective meaning to be discovered, or a perhaps technocratic sense of the potential of phenomenology to produce truth--which their own philosophy disallows. An incoherency emerges.

If existentialism and so existential therapy are the answer to the modern problem of nihilism--and that is what they aim to be--they are themselves merely the assertion of nihilism. The cure is itself the disease. This would be intellectually acceptable if existentialisn was a lucid description of reality, but at this point in late modernity it seems that we are not at the end of history, and that modernity and its attendant nihilism is a passing chapter, one more dogmatism which appeared to be truth, only from within its passing historical moment. Certainly, classical philosophy leads to a very different conclusion: that the intellect is made for reality, that we can discern much through the wholistic forms of reason and wisdom developed by the ancients.

4. Psychodynamic (Freudian) Therapy and Platonic Conflict

Philosophical Foundation
While Freud aimed for a biological, scientific model, the structure of his theory is deeply philosophical, echoing Platonic themes. Plato’s model of the soul (psyche--the root of our word psychology) as a tripartite structure—reason, spiritedness, and appetite--is a clear blueprint for Freud’s structural model.

For Plato, psychic health is achieved when reason, guided by spiritedness, governs the appetites. If you think carefully about this, you will see that it is an elegant and true description of your own life, both when it is ordered and disordered. For Freud, mental health requires that the Ego (the rational mediator) balance the demands of the Id (the primal appetites) and the Superego (the internalised moral authority, akin spiritedness). The process of "working through" in psychodynamic therapy--the repetitive examination of core conflicts and transference patterns--is a form of psychological habituation. It is the slow, laborious process of bringing the irrational forces of the unconscious into the light of conscious reason, a modern take on the Delphic injunction to "know thyself" and the Platonic work of ordering the soul for the sake of flourishing.

The Philosophical Shortcomings
The fundamental departure of Freud from his philosophical ancestors lies in his metaphysics of desire. For Plato, the appetites are a lower part of the soul to be managed by reason, which is itself oriented toward the contemplation of and participation in the truth and goodness as absolute, guiding values. For Freud, the drives of the Id are the primary reality; the Ego is not a vessel for truth but a pragmatic negotiator for survival and pleasure, born of necessity. This results in a teleological reversal. Psychodynamic therapy aims for "genital maturity" or the ability to "love and work," which are pragmatic, immanent goals of adaptation. It lacks any conception of higher values, or even a higher good, toward which the integrated self should aim.

Psychodynamic therapy is thus effective at resolving internal conflict and freeing the patient from the repetition of the past, but it is philosophically agnostic about what the conflict-free self should then do or become. It liberates the patient from neurosis but offers no higher purpose for that liberation, reducing the classical quest for a life of goodness and truth to the modern goal of adaptive functioning. The patient leaves the cave only to be told there is no sun to see.

5. Acceptance and Commitment Therapy (ACT) and Stoic Pragmatism

Philosophical Foundation
A "third-wave" behavioural therapy, ACT synthesises ancient wisdom with modern psychology in a particularly transparent way. ACT is built on the Stoic premise of distinguishing between what we can and cannot control. Its core process is psychological flexibility: the ability to be present, open up to difficult thoughts and feelings (acceptance), and do what matters (committed action). The therapy explicitly uses the language of values (a direct stand-in for Aristotelian virtues) as the compass for a meaningful life. "Committed Action" is the process of habituating behaviour that is in line with these values, even in the presence of suffering. The goal is not to feel good, but to live well--a perfect, operational definition of eudaimonia. The "acceptance" component is a pragmatic form of Stoic assent, while the "commitment" component is the exercise of practical wisdom in the service of a valued life.

The Philosophical Shortcoming
ACT’s primary weakness, despite its sophisticated synthesis, is the potential emptiness of its central concept: values.

In Aristotle's virtue ethics, virtues are objective characteristics of human flourishing, discovered through rational inquiry into our nature. They are not chosen but discerned. A human being longs for love, for truth, for goodness, for happiness, and so on, and the virtues are those activities which lead to these needs of the soul. This is what I mean when I speak of objective truth in classical philosophy. I am aware that some people have a narrow understanding of that word and assume it means a dogmatic stance on purely hypothetical matters, but in fact it is the deep but common sense work of trying to see reality more clearly, including the reality of who we are and what we need. It is descriptive, and open always to new insights. You cannot avoid dogmatism by means of relativism--that is merely a new dogmatism. And to assert truth is not thereby to be dogmatic.

In much modern ACT practice, "values" are treated as chosen directions, personal preferences, or "verbally constructed global desired life consequences." This risks a subjectivism where "being a master manipulator" or "winning at all costs" could be a value if it is personally chosen and consistently enacted.

The therapy provides a powerful technology for value-congruent living but often fails to provide a robust philosophical framework for critiquing or sorting the values themselves. It brilliantly answers "how" to live with purpose--through acceptance and commitment--but it gives a shaky, subjectivist answer to the more fundamental question of "what" is truly worthy of being that purpose. It is a world-class navigation system that lacks a definitive map of the good. If existential therapy is a therapy for cultivating meaning, which denies there is any real meaning, ACT is a therapy of value, which denies there is any real value. The choice between human decency and the concentration camps is purely a matter of personal preference.

Conclusion: The Incomplete Translation

The shift from philosophy to psychotherapy translates fragments of the great intellectual systems into pragmatic methods that alleviate suffering. In their quest for efficacy, scientific legitimacy, and broad applicability, however, modern therapies have largely jettisoned the broader, deeper work of reason, the care for truth, and for lucid goodness.

The therapies offer many tools taken from philosophy--Socratic inquiry, self-examination, value clarification, virtues such as courage--but too often divorce these tools from a conception of real goodness, truth, beauty, in favour of assimilating with the fashionable ideologies of modernity. The modern client is taught to be resilient, authentic, flexible, and integrated, but is often left without a compelling answer to the question: resilient for what? Authentic toward what end? Therapy can lead people to become worse as a human being, even as they feel better and achieve their petty goals more skillfully.

The therapist’s couch, therefore, stands not as a replacement for the philosopher’s porch, but as a waiting room for it. It is where we go to repair the broken tools of the soul--to calm the frantic mind, to integrate the fractured self, to heal emotional wounds, to develop skills in relaxing, accepting, and enjoying. But this is, as I say, only the start. Beyond this is the active, lifelong pursuit of a life of wisdom, virtue, truth, and goodness within a community and a cosmos that exceeds us (that is objective to us). The great task for 21st-century psychotherapy may be to rediscover, and re-integrate, the wisdom that its very practice implies, moving beyond a therapy that merely restores function and banal happiness, to one that also guides, however humbly, toward a higher vision of life. This is my hope.