Psychotherapy as a Human Science
Pittsburgh, Pa.: Duquesne University Press, 2006.
Reviewed by Patrick Favro
This is one of the many biographical anecdotes told by Burston & Frie, in order to make alive the philosophers they present.
Indeed, going through the table of contents, the reader discovers that most of the writers listed are mostly philosophers: Pascal, Kant, Hegel, Marx, Nietzsche, Kierkegaard, Heidegger, Sartre, to name but the most famous. Freud, Jung and Lacan, then Laing and Fromm are part of the minority of the actual practitioners of psychotherapy, the word being taken as a generic term for the practice of psychoanalysts, psychiatrists, counsellors and psychotherapists.
Why mention all these philosophers? The authors argue that “these philosophical assumptions often determine not only the objectives of psychotherapy, but also the actual framework in which it is practiced.” In order to marshal all these various ideological representations of the world, of human beings and their relation to their milieus and to themselves and the others, the authors resort to what they term a “heuristic schemata,” which comprises four categories of intellectual traditions, i.e. phenomenology, existentialism, humanism, post-modernism. Rationalism and irrationalism are added at times, as well as the attitude to religion, notably atheism. The end of the sections devoted to the various thinkers attempts to fit them in these heuristic categories; for instance “How does Buber’s work stand up in light of the heuristic schemata we have employed so far?” .
So, a great variety of ideological mindsets are presented, following a pattern applied to each thinker: biography, followed by a sketch of their ideas ; the authors then attempt to make their material relevant to their topic with sentences like, “What relevance, then, does Marx have to the theory and practice of psychotherapy today?” 
The relevance, here, seem loose. The authors underline the contradictions of Marx’s ideology:
Incidentally, in this quotation, one can gauge the profoundness of the prose by Burston & Frie, compact and substantial, elusive as it is abstract, uneasy to follow unless one takes pains to carefully grasp its full significance.
The concept of work was central to Marx’s thinking; an attempt is made to examine how far “labor” is relevant to “human ontology,” and to expose this alleged “gaping lacuna in most clinical approaches.” Erik Erikson seem to go along with this point of view: “Decades of case histories have omitted the work histories of patients or have treated their occurrences as a seemingly irrelevant area of their life in which data could be disguised with the greatest impunity.”1
The last words in this quote can be pondered at length, as is typical of Erikson’s writings: what kind of “data” is referred to? “Impunity” apparently applies to psychotherapists guilty of not taking that dimension into account. Several questions arise here. How important was the issue for E. Erikson? In other words, this reference to “labor” might be incidental; this author is not particularly known for belabouring it. In other words, Burston & Frie’s case sounds flimsy here. If so few clinicians took an interest in it, perhaps that is because its relevance to therapy is not central.
The third Marxist tenet discussed is the notion that capitalism is detrimental to man’s essential fulfilment; that inspired Fromm and Laing’s critiques of “adaptation,” i.e. the idea that mental health measures up to one’s degree of “adjustment” to prevailing cultural norms and expectations, according to the standards of ego psychology. These two authors concur, in that adaptation implies the stunting of one’s creativity and ability to express one’s real personality. Now the therapist is confronted with the following question: does the patient’s conflict originates in flawed cultural norms, or in his or her failure to adapt to them?
Fromm said that one task of analysis should be to enable analysands to shed ideological illusions and social filters that prevent them from being fully human and embrace a more grounded, ethically centered, non-conformist stance, to “live soundly against the stream” .
This essential issue hardly has a strong connection with Marx’s concern about the harmful influence of capitalism on human beings. That shows the limits of the intellectual exercise undertaken by the authors, across centuries and throughout varied philosophical trends. The almost contrived attempt is offset by its scope, depth, richness and originality. Yet the practical aspects of psychotherapy are only marginally apprehended. The closing lines of this chapter only confirm that impression:
The presence of a Marxist concept in an American academic’s thoughts, namely “division of labor,” is surprising. It becomes clearer and clearer that specialization is shunned; consequently psychotherapy is not concentrated on, as one might expect from the title.
Marx’s points of view reappear in the last chapter , as “the crucial question of human needs” is tackled, as well as the theme of alienation. The authors deplore its absence from today’s literature. Again, this might be explained by its remote relevance to psychotherapeutic and clinical issues. However, if alienation is to be understood as implying “the existence of an essential human nature or a singular core of immutable selfhood” , then this very concept takes on a deeper meaning. Regrettably, Abraham Maslow, as the renowned propounder of the theory of needs, is conspicuously absent from the discussion, and from the index as well. His “self-actualization needs” might very well correspond to the realization of the “core of immutable selfhood.” “Self-realization” is even mentioned [178-9], yet without comments or explanation, in the context of the discussion on Ludwig Binswanger.
It sounds as if by failing to take this “core” into account, the authors lead the reader through the meanders of the history of the trends of philosophical ideas, and take the risk of losing him or her in the process.
Since the text is not light reading, and possibly requires solid background in philosophy, it might not be accessible to anyone, but only to a few specialists. Each school of psychotherapy has its own Weltanschauung, however simple at times, and their members might not need such a puzzling wealth of ideas grounded in phenomenology and post-modernism.
Let’s remember the title: Psychotherapy as a Human Science. After a while, it sounds surprising, since the reader quickly feels that academic discussion of philosophers’ ideas is of more interest to the authors than the actual practice of psychotherapy. Nevertheless, the human being remains at the centre of the intellectual exercise, and human science is defined not only in contrast with natural science, which deals with nature and the entities living in it, but also with an “objectified“ conception of human beings, as is done in cognitive and behavioural psychology. Hence the arch-importance accorded to the concept of inter-subjectivity, which seems to be the guiding thread organizing the whole.
The authors are keenly aware of the approach they chose, and of criticisms that could be levelled at their work: “Those with a clinical focus may balk at this lengthy preamble, for fear of losing their way in the dense thicket of ideas” . Indeed they can lose their way, all the more because the book, if we trust the title, should deal more clearly, more directly and more substantially with psychotherapy.
The authors attempt to pre-empt criticism, as on p. 87:
Thus the reader can understand better that the aim of the book is theoretical more than practical.
In this thick forest of ideas, psychotherapeutic clearings happily emerge, yet not so frequently. Techniques are discussed, as on p.118 & ff : the “basic rule of psychoanalysis […] obligates the patient say anything and everything,” in keeping with “free association.” Likewise, the therapist’s attitude is considered—neutrality, being a blank screen—as well as the mishaps of the process —the psychoanalyst’s boredom or nodding off.
Original insights are provided into therapists’ practice, as with Laing . In contrast to Lacan’s rationalistic approach, and the little importance he gave to the theory of affect, Laing, “as an army psychiatrist, and later in private practice, […] spent many hours in silent communion with mute and catatonic patients. He often said that, even with less disturbed patients, many of the important moments in therapy pass in perfect silence or simply defy our attempts to express them in language.” He also claimed that objectivity is irrelevant if sympathy is absent: “real understanding of the other person as a person eludes us, even if we carefully enumerate all the ‘signs’ of their disorder according to prevailing diagnostic criteria” .
Along with Jung, Laing dismissed ego psychology and any theory that “construes the goal of therapy as the strengthening of the ego or as “normalization.” For Laing “sanity” and ‘normality” are profoundly ambiguous in our time; normality is a kind of pseudosanity .
Other practical aspects can be found on pp.172-73, in the section devoted to Martin Buber’s impact on psychotherapy. Some actual and practical aspects of psychotherapy are discussed, notably abstinence and confrontation. The first term “was coined by Freud to denote the analyst’s deliberate refusal to gratify what she or he perceived to be the patient’s attempt to elicit expressions of love or respect from the analyst.” Gratifying these requests would be detrimental to the psychoanalytical process, and was dismissed by classical Freudians as a “neurotic demand for love.” Buber, along with Ferenczi and Fromm, to name but a few, disagreed, arguing that “there are many instances when the therapist’s refusal to affirm the patient’s worth is tactless or positively harmful.”
Confrontation is another issue which finds its way in the psychotherapeutic relationship. It can occur “when a therapist calls attention to attitudes or inconsistencies in a patient’s conduct or beliefs that betray an element of insincerity or self-deception” . Now, confrontation is practiced in roughly two different ways. The first is informed with “accurate empathy,” that is “tactful, sympathetic and low key.” Buber prefers the energetic kind, influenced as he was by the prophetic literature of his native faith, Judaism; hence, anger “may be vital to establishing or sustaining the authenticity of the relationship between therapist and patient.” In other words, the therapists stands up for truth in refusing to “collude with a patient’s efforts to authenticate a false self.”
The discussion on “Authenticity,” in the last chapter, would have naturally found its place here.
Inevitably, defining the “self” comes to mind. Answers can be found in psychology, of course, but also in religion and spirituality, the latter apparently being eschewed by the authors, who prefer modernist approaches.
Buber, relying on his tough concept of confrontation, went on to consider that “what Carl Rogers terms ‘unconditional positive regard’ is not deemed practical or therapeutic in the long run.”2 Many a psychotherapist might beg to differ. Regrettably, the Rogerian perspective is not given a say, and that summary dismissal of the ideas of one of the most famous therapists of the 20th century, leaves interesting grounds uncovered.
Rogers’ absence from the index is telling too. Other famous, albeit sometimes controversial, therapists, like Roberto Assagioli, the founder of psychosynthesis, Frits Perls, Milton Erickson, Virginia Satir, or even Janov are disregarded.
The last chapter “Psychotherapy and Postmodernism” contains abstract discussions of issues surrounding psychotherapy like: “Embodiment, Gender and Race,” “Insight and Experience,” “Alienation and Engagement.” More closely corresponding to the title are questions like: What is a human being? Body, mind, or consciousness? What is the media for consciousness, the former or the latter? Maurice Merleau-Ponty, again, an author not noted for his interest in psychotherapy, is cited in this respect “[he] challenges the traditional division between mind and body, or intellect and soma, by elaborating the notion of bodily experience” .
For human beings, agency is a central concept here; it implies that we are actors in our lives.
This is the debate between determinism and free will, in which “individuality and autonomy, the myth of the Marlboro man,” come into play. By contrast, there is no agency for patients lacking a sense of themselves as agents, in other words disturbed patients.
Though the book is well organized and written, oddities appear, like a word for word repetition, in the midst of discussing Ludwig Biswanger’s ideas:
That must have been a cherished thought of the authors’, and nevertheless an unnecessarily dualistic statement: both aims are not mutually exclusive, in that distortion in relating to others derives from the unconscious.
The very last section “Clinical Postscript” is by far the more closely connected with practical issues. “Above all, therapists seek to understand their own myriad reactions to their patients—common known as counter-transference—and the ways in which they can use their subjective experiences in the therapeutic settings” .
To put it in a nutshell, the authors’ interest does not lie in clinical psychology per se, but in the connections it may have with corollary disciplines, most outstandingly here philosophy and its many trends, including of course phenomenology. It is in the main an exploration of how philosophy informs psychotherapy, loosely at times. Their contention that “the mastery of a particular technique or treatment approach is only half the story, and that a balanced approach to therapy needs theory as much as technique” may be completed. Beside the fact that the display of conceptual theory is rich to the point of being bewildering and probably fully accessible to a well educated elite only, is there not a third half to the story? A more subtle, intangible, spiritual dimension to the art of psychotherapy, even as a human science? That very dimension is partly found in humanistic psychology, most famously embodied by C. Rogers and A. Maslow, dismissed or simply missing from this mostly academic, if fascinating, debate. An essential element in the making of a good psychotherapist is his or her quality of being, intuition, insights, humanness and love; these qualities derive less from philosophical knowledge than from self knowledge, including the process of counter-transference, in the sense of the inscription on the temple in Delphi, “Know thyself, and you will know the universe and the Gods.”
1. Quoted p.58, from Erik Erikson, Young Man Luther. (New York: W. W. Norton,1958). back
2. Martin Buber, The Knowledge of Man (New York: Harper and Row, 1965: appendix). back