A Problem with Therapy

Some have wondered and asked why I did not continue a career as a therapist. Here is a piece I wrote that started my journey away from the field.

I do think that therapy is very effective and good when practiced with intention and under a very skilled practitioner, but there has to be attention placed on "moral directiveness". If not, then there is an overemphasis on neutrality that damages society's moral compass. Enjoy.

Psychotherapy and the Moral Lobotomy

[The term “moral lobotomy” was borrowed from columnist Ellen Goodman as quoted in Doherty (1994)]

I constantly hear that psychotherapy can be an antidote to the social ills of today. But how can it be an antidote if all it teaches is a romanticized notion of individualism that separates one from the social structures that help to regulate moral ideologies? As Doherty (1994) points out the question is “. . . whether psychotherapy can speak to the profound social and moral problems of our day” without “ justifying the contemporary flight from personal responsibility, moral accountability, and participatory community” (p.42).? I would argue that therapy has done a lot to exasperate today’s social ills rather than assist in alleviating them. If therapists were to practice under the tenets written by M. Scott Peck then I believe our communities would be healthier and stronger for it. There are many reasons for today's sufferings and the burden does not lie wholly on the field of therapy but when practiced poorly, meaning without addressing moral rudders, then it has done some significant damage.

Many believe that therapy has cultivated a society of self-centered, narcissists (Collier, 1977; De Grazia, 1952; Doherty, 1994; Justman, 1998; Richardson & Guignon, 1988; Richardson, Fowers & Guignon, 1999; Weiner, 1993) and struggles extensively to become a mechanism of moral directiveness. Therapy teaches us that it is okay to be self-indulgent and provides for us an immunity from responsibility and a rationale for non-commitment. In the guise of greater self-awareness and personal freedom, psychotherapy has turned our attention away from important social connections and commitments. Instead, it has promoted petty personal analysis causing us to morally implode.?

Psychotherapy has bought into the romantic philosophy of letting the natural, intuitive, self be the moral guide and has promoted what Lasch called “cultural narcissism” (Richardson & Guignon, 1988; p. 13). Consequently, and not surprisingly considering the ease with which the majority of human beings can be convinced to be selfish, the core moral ideologies of society are becoming less clear as psychologists teach people to dance to the beat of whatever drummer. This is an attractive message considering our dispositions but it does not fill the void so many of us experience. The void ironically comes from the perceived freedom of separation from others, as outlined in Fromm’s classic work Escape From Freedom.? It is through this separation from others that we lose our ways and lose the guidelines that lead to personal fulfillment and moral living.? “When those [societal] ideologies are neglected instead of . . . made a central target for analysis, there is the possibility that psychotherapy will function more as a symptom of than a cure for some of the dilemmas in living . . .” (Richardson & Guignon, 1988; p. 14).? The underlying philosophy of psychotherapy has become moral relativism and people are confused and unhappy as a result.?

In an attempt to be all things to all people psychotherapy has sacrificed the integrity of the profession and of those it attempts to heal.? Lederer (1971) argued that as society “hungers” for moral behavior, patients hunger for moral direction. Lederer outlines a solution in the following remark:

We must . . . insist with our patients that they consider the right and the wrong of their actions carefully in the light of their own standards; that they expose their standards to the buffeting of diverse opinions; and that they try hard to identify and to dispel excuses and rationalizations and to arrive at the essential truth of their position. Integrity is, I submit, the goal of all therapy. In its attainment, moral issues, far from the treacherous bogs to be avoided, are the proper arena for our therapeutic battles (1971, p. 85).

?Yet, even though it is clear that a therapeutic session is an ideal place for moral discourse, therapists are hesitant to talk about moral issues with their clients and will not take a? moral stance. In an effort to be non-judgmental, value-free, and unbiased the words “ought” and “should” have been removed from the therapist’s vocabulary and counseling has become lukewarm.? Sadly, psychotherapy has lost its own integrity by ignoring the process that helps clients become truly congruent – by facing their own moral issues. Two examples come to mind.

Doherty (1994) gives us the first example that illustrates the looseness with which psychotherapy deals with moral issues and the potentially harmful effects it can have. Doherty tells of how the judge of the Woody Allen vs. Mia Farrow case blurts out her frustration with the expert witnesses. The psychologist was unwilling to veer away from his “ morally neutral therapeutic discourse” and from the use of terms such as “lack of judgment” (p.43). The judge exclaims that therapists need to use a stronger term for those who sleep with our children’s sisters.?

The second example is a personal one. Working with a depressed client I found myself ignoring the consequences of his amoral actions. This married, middle-aged, male client came to therapy to get over his depression. He had been suspected of fraud but was never charged. However, he was dismissed from his job. Soon afterward I found out he had been stealing from the company funds so he could support a mistress. Since he had been dismissed from his job he lost the means to support his mistress and she left him. Consequently, he was feeling down. I asked him what his goals for therapy were. He stated he wanted to get out of his depression so he could find a job and get his mistress back. So with no discussion of the consequences of his actions on his family (or society), I moved along with therapy to help him get out of his depression so he could pursue whatever goals he wanted.? In my desire to be value-free, unbiased, and non-judgmental (as I was trained) I circumvented any moral discussion that may have helped him analyze issues of commitment and/or character.? I was very uneasy with these sessions. How did psychotherapy get to this point?

In a recent presentation at Stanford, Bessel A. van der Kolk, Professor of Psychiatry at Boston University School of Medicine declared, “We have got to leave Vienna!”.? His statement implied that we have to begin to challenge the traditional notions of psychotherapy that linger. He argued that as social scientists and practitioners, we prematurely adopt inaccurate theories and have a difficult time letting go of antiquated ideas. It seems that therapists continue to ignore moral discussions based on the antiquated notions of morality originated by Freud.

While Freud may have lobotomized morality from psychotherapy, I believe Freud’s ideas grew out of events before his time.? In pre-modern times the morality of what “is” was connected to what “ought to be”. There existed a universal moral code among communities. 17th-century science, naturalism, and objectification increased the gap between “is” and “ought” (Sugarman & Martin, 1995). As the industrial age gained momentum traditional communities began to transform in a number of ways that influenced the ideas of self, community, and morality.? The words of the gods, prophets, and shamans were now being replaced with science, productivity, and the empirical.? The idea of self gained more attention as individuals became more and more alienated and independent of communities, social histories, and spiritual and/or mystical practices.? Traditional communities began to fade and moral regulation gradually transferred from “civil societies” to market and governmental institutions (Richardson, Fowers & Guignon, 1999). Consequently, people felt that they were losing control of their lives and the issue of freedom and obligation became more apparent as traditional institutions were being recognized for their oppressive ideologies and new organization were becoming more impersonal. For that reason, there was a desire for more individual autonomy.? What the pre-modern person lost was what Sugarman and Martin (1995) would state as the ability to make sense of one's life by “locating oneself in relation to constitutive goods and commitments” (p. 334).??

Combining Taylor’s theory of “moral philosophy” (Sugarman & Martin, 1995, p. 329) and Berger’s theory of? “modernity” (Richardson, Fowers & Guignon, 1999, p. 26) the individual moved from Inwardness to Abstraction, The Ordinary Life to Futurity, and Expressivist Fulfillment to Individuation. The former is rooted in a social context, history, and connectedness, the latter focused on escape from obligation. With the modern person’s ability to separate from the whole (individuation) they are now able to view the events of his or her reality as separate from the social context (abstraction) and he or she is now devotedly attached to their own problems.? The future is now the primary orientation of time and is the main force that keeps us out of the present where we may have to face ordinary life (futurity). The impact of all this is that the self has become the universe. ? Philosophers and social scientists have described this state as the “the empty self”, “cultural narcissism”, “ the mass man”, “anomie”, “alienation”, “ontological individualism”, etc.?

According to Richardson and Guigon (1988), psychotherapy was born to help individuals learn how to live in this “new” system and deal with the emptiness of the soul. Psychotherapy’s role was to help the individual find freedom from guilt and shame that came as a result of not being able to live up to the new standards or obligations of the new system. In essence, the goal was and continues to be to help people seek freedom from authority, obligations, and commitment.??

Interestingly, Cushman (1995) considers the empty self as an economic necessity to “stave off economic stagnation” and therapy is “the profession responsible for treating the unfortunate personal effects of the empty self without disrupting the economic arrangements of consumerism” (p. 6). He argues that psychotherapy is a cultural artifact that is developed to assist with local maladies, which are also culturally bound.? He states the consequence of this:

They [psychotherapists] cannot free themselves to comment directly on the structural causes of local emotional ills, grasp their unintended involvement in the perpetuation of those ills, or devise therapeutic practices that would attempt to heal those ills without simultaneously reproducing them. Most object relations, humanistic, cognitive, and addiction therapies, for instance, however effective in producing behavior change or emotional experiences in the short run, inevitably reproduce the very causes of the ills they treat by implicitly valorizing and reproducing the isolated, empty individual (Cushman, 1995, p. 7)

By the time Freud looked at morality he perceived it as a “psychopathology of the superego” as related to the oppressive and destructive nature of certain institutions (namely religion) of his time (Pattison 1968, p. 189). Religious groups represented the social controls that dominated the mores of the time. In an effort to separate the “is” and “ought” telos of premodern times Freud decided to put his faith in the new scientific method to describe morality (Sugarman & Martin, 1995). It is believed that Freud’s position grew out of his love affair with the new scientific method. “Freud considered psychoanalysis scientific hence amoral . . .” (Pattison 1968, p. 209).? As Pattison points out, in an effort to assist people in becoming independent of restrictive institutions Freud dismissed morality altogether:

But this particular view of morality confuses morality with religion. Freud’s critique of religious neuroticism has been taken as a critique of morality.? It fails to account for the normal and necessary functions of morality in the structure of the personality, and it fails to recognize the central function of moral values in culture (1968, p. 189).

In his work, one can see that the super-ego took on the role of social mores; in essence removing all responsibility from the individual.

Since Freud psychotherapists have refused to include moral discourse in therapeutic sessions. The reintegration of moral discourse is seen as the imposition of values and the oppression of individual autonomy; akin to the oppressive institutional forces of the past (i.e. religion and bureaucracy). Prilleltensky (1997) writes:

Social forces in and outside the discipline contribute to the confusion over values. At the societal level, liberal philosophies of self-determination and rugged individualism generate fears of moralizing or intruding into somebody else’s moral space, a fear shared by many psychologists (p. 517).

Cushman (1995) echoes the therapists’ fear when he writes:

It is difficult for psychotherapists to examine their theories with an eye to the moral and political, because they do not like to think of their work in this way.? Politics and morality are dirty words in our late twentieth-century world (p.279).

There continues to be a need to hang on to the romantic idea that the intuitive, natural man or woman needs to be freed from these forces and to pull on the reigns of control, character, and commitment means to enslave.? I would argue that the utilitarian rationale has provided the ideological buttress for this so-called freedom.? If people are left alone to succeed society will benefit. In psychological rhetoric, if we focus on our own psychological well-being then we contribute to the well-being of society (Doherty, 1994). This rationale remains intact because it does not threaten psychotherapists’ positions of relative comfort and contributes to the status quo depicted by Cushman.??

If psychotherapy is going to be an antidote to current social problems it needs to reassess its role in the moral education of those who seek therapy. Continuing to promote moral relativism will only add to the problem; beginning to challenge clients on moral issues will advance the solution.

Doherty reflecting on Alan Wolfe’s ideas that people are given unique opportunities to reflect on the consequences of their actions in daily life views the therapeutic session as an “ideal moral laboratory” to reflect upon these moral issues (1994, p. 51). In a treatise of psychotherapy as moral discourse Cushman (1995) explains that:

?Therapy is always a dialogue between the people involved over what is the proper way of being. It is an attempt to develop a set of shared understandings about what it is to be human . . .it is always in process” (p. 282).

Thus, the process of psychotherapy is a moral enterprise. Even though moral discourse seems to have been removed from the therapeutic practice it inevitably becomes a moral enterprise the moment the client and therapist engage. In essence, the social interaction and contract between the therapist and the client is the beginning of moral machinations. According to Pattison (1968), the therapist is an agent of society and should help people return to society as productive, fully-functioning members (Pattison, 1968). As Pattison wrote, “Human life is necessarily a moral life precisely because it is a social life” (1968, p. 192). Perry London, in his 1986 revision of The Modes and Morals of Psychotherapy describes the social nature of this interaction.

Most of its [psychotherapy] discourse has always concerned the vital social negotiations of people’s lives.? And the treatment itself was always mainly done by social intercourse.? The social life of human beings is the chief arena of their moral concerns. . . Psychotherapy is a moral force, and psychotherapists, in turn, are moral agents as well as healing technicians (p. 1).

Psychotherapists must lead clients in moral discussions if they are going to help resolve modern social ills. This implies that psychology is interested in being an antidote to today’s problems – but how????

I believe, as therapists, we need to begin to remind ourselves that therapy is a moral enterprise that can become a template for social connections outside of the therapeutic session.? This entails entering therapy with the notions of commitment and character in mind. Wilson (1993) defines commitment as living up to social contracts and character as finding a balance between what we offer others and what we want in return. The struggle between autonomy and authority or in other words how do I promote my self-interest as well as contribute to others and society? Psychotherapy has been vociferous on the former and silent on the latter. However, if psychotherapists attune themselves to moral discourse and listen to the dilemmas of clients through the filters of character and commitment they may begin to see the client’s dilemmas as the struggle of moral decision-making. ? Thus, helping clients see the results of moral and amoral actions on themselves and others.??

Some will argue that it may be too easy for the therapist to see their values as the correct moral path and impose those values on a client. However, I think therapists have been too well trained and are too frightened to even embark down that path in fear of negating the counseling mantra of “unconditional positive regard” for clients no matter the client's positions.? Imposing one’s values is akin to stating that your individual position is the right one.? I doubt therapists will do that.? I think therapists need to contemplate Lederer's (1971) admonition to “insist with our patients that they consider the right and the wrong of their actions carefully in the light of their own standards” and that they “expose their standards to the buffeting of diverse opinions” while at the same time trying to “identify and to dispel excuses and rationalizations and to arrive at the essential truth of their position” (p. 85).

Prilleltensky suggests a framework that integrates “discourse and action” (1997, p. 519). Cushman (1995) submits a hermeneutical dialogue that incorporates the idea of Gadamer’s shifting horizons. While both authors should be applauded for their thoughtfulness on the subject and their courage in tackling such a highly complex issue, in my opinion, Prilleltensky’s framework is easier to comprehend and integrate. As Kitwood (1990) has stated, “ . . . if the psychology of morality is to amount to anything it requires a grounding in practical action” (p. 194).

Without going into great detail Prilleltensky’s model of “Emancipatory Communitarian”, with its ideas of social obligation and concern for the disempowered without suppressing individual needs, lays out a program that helps psychotherapists design a practice that incorporates moral discourse. In his words:?

What in my opinion is missing is an integrative model that (a) will require psychologists to articulate their values and (b) will place as much emphasis on moral philosophy as on practice . . . I suggest a model that includes values, assumptions, and practices (p. 519).

The psychotherapists, under this model, are impelled to clarify their values, clarify their assumptions around moral values and define their practice in light of moral values and assumptions. He argues that the emancipatory communitarian approach to moral practice surpasses the shortcoming of other approaches (i.e. traditional, empowering, and postmodern) in integrating morality into psychology. A dangerous pitfall is sacrificing the individual for the good of the community.?

Prilleltensky suggests that therapists first think about what fosters the good life. He recommends that they clarify their values around five key concepts; “caring and compassion”, “self-determination”, “human diversity”, “collaboration and democratic practice” and “distributive justice” (p. 520). He then suggests that the therapist clarifies his or her assumptions of the following constructs; “knowledge”, “the good life”, a “good society”, “power in relationships” and “professional ethics” (p. 523). Finally, he asks that practitioners evaluate their practices and how moral issues play into their “problem definitions” of client issues, “the role of the client”, “the role of the helper”, the “type of interventions” used, and the “timing of interventions” (p. 524).

Counseling needs to jettison its morally neutral stance and direct clients in ways that promote the moral standards and moral development of society and themselves. Authors such as Cushman, Lederer, Prilleltensky, and Richardson are challenging psychotherapists to step out of the quagmire of narcissistic promotion that psychology has unconsciously maintained and use the therapeutic session for moral discourse.? Perhaps we therapists need to remind ourselves of the following before entering each session.

No man is an island, entire of itself; everyman is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were. Any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls: it tolls for thee.

John Donne

References

Cushman, P. (1995). Constructing the self, constructing America. Reading, MA: Addison-Wesley.

Collier, A.(1977). R.D. Laing: The philosophy and politics of psychotherapy. New York: Pantheon Books.

DeGrazia, S. (1952). Errors of psychotherapy. New York: Doubleday.

Doherty, W. J. (1994). Bridging psychotherapy and moral responsibility. The Responsive Community, 5,? 41-52.

Justman, S.(1998) The psychological mystique. Illinois: Northwestern University Press.

Kitwood, T. M. (1990). Concern for others: A new psychology of conscience and morality. London: Routledge.

Lederer, W. (1971). Some moral dilemmas encountered in psychotherapy. Psychiatry: Journal for the Study of Interpersonal Processes, 34, 75-85.

London, P. (1986). The modes and morals of psychotherapy (2nd ed.). Washington, DC: Hemisphere/Harper & Row.

Pattso, E.M. (1968). Ego morality: An emerging psychotherapeutic concept. Psychoanalytic Review, 55, 187-222.

Richardson, F. C., & Guignon, C.B. (1988). Individualism and social interest. Individual Psychology: Journal of Adlerian Theory, Research & Practice, 44, 13-29.

Richardson, F.C., Fowers, B.J., & Guignon, C.B. (1999). Re-envisioning psychology: Moral dimensions for theory and practice. San Francisco: Jossey-Bass.

Sugarman, J. & Martin, J.(1995). The moral dimension: A conceptualization and empirical demonstration of the moral nature of psychotherapeutic conversations. Counseling Psychologists, 23, 324-347.

Weiner, N.O. (1993). The harmony of the soul: Mental health and moral virtue reconsidered. New York: State University of New York Press.

Wilson, J.Q. (1993). The moral sense. New York: The Free Press.