Get a load of this one, y'all...how would you like to lie on a couch and be treated -- not by a psychotherapist, but by a philosopher?

from Essay

What Is Philosophical Practice? by Gregory R. Johnson (First published:... February 17, 2000)

This is the first installment of a weekly column drawing upon Mr. Johnson's experience as a philosopher in "private practice," with occasional forays into music and other topics.

Since 1981, a small but steadily growing stream of people who might otherwise have visited psychotherapists, social workers, and clergymen, have been visiting "philosophical practitioners" or "philosophical counselors" instead. The reason is simple: They have philosophical questions, and philosophers (those who do believe that philosophy has something to do with reality and life, at any rate) are often best equipped to answer them.

In The Art of Psychotherapy, Anthony Storr writes, "Today, most psychotherapists are consulted by people whose symptoms are ill-defined and who are not 'sick' or 'ill' in any conventional, medical sense....[W]hat they are seeking is self-knowledge, self-acceptance, and better ways of managing their lives." In The Practice of Psychotherapy, C.G. Jung writes, "About a third of my cases are not suffering from any clinically definable neurosis, but from the senselessness and aimlessness of their lives. I should not object if this were called the general neurosis of our age."

Not a neurosis

But a crisis of meaning is not a neurosis. The anxious sense that one's life is senseless and aimless is not a neurosis. Instead, it is one's awareness of an existential problem: human beings are free, and it is our responsibility to find and follow the path to a happy and meaningful life.

This is a problem inherent in the human condition, faced by every mentally healthy human beinga problem exacerbated by intelligence, individuation, and self-reflectiveness.

The first modern philosophical practice was opened in Germany in 1981 by Gerd B. Achenbach. In 1982, he founded the Institute for Philosophical Practice and Consultation. Since then, other practitioners have sprung up in Germany, Holland, Canada, France, Great Britain, Norway, Austria, Switzerland, Israel, Slovakia, South Africa, Hong Kong, and the United States. Professional organizations now exist in Germany, Holland, Great Britain, Canada, Israel, Norway, Slovakia, South Africa, and the United States. The movement has also given rise to international congresses, web sites, institutes, newsletters, two journals, and a small shelf of books and special journal issues. On this side of the ocean articles have appeared in The New York Times, The Los Angeles Times, The New York Observer, and The Utne Reader, and in England in The Times of London, The Sunday Times, The Independent, and The Observer. There has even been a parody in The New Yorker. Yet there are still only a few dozen full-time philosophical practitioners in the world.

I count myself as one of these. I do not describe myself as a philosophical "counselor" or "therapist." My business card reads simply "philosopher." There are three reasons for this. First, the use of words like "counselor" and "therapist" is regulated by the government, and I want as little contact with that outfit as possible.

Second, I wish to distance myself as much as possible from our contemporary medicalized therapeutic culture. There is nothing "sick" about my clients. Indeed, their perplexities and dissatisfactions are signs of a deep spiritual health. While many who visit therapists feel ashamed and secretive, there should be no stigma of illness attached to visiting a philosopher.

Third, and most important, philosophy is a noble enough word to stand on its own, and I consider my activities to be closer to the true meaning of philosophythe pursuit of wisdom as a way of lifethan much of what passes for philosophy today.

The core of my practice is work with individuals. I began by advising students at the two universities where I have taught. Three years ago I began seeing non-students as well. Last year, I quit academic teaching to devote myself full-time to philosophical practice, writing, and private teaching.

Diverse goals

I have four types of individual clients.

First are people who have particular philosophical problems or puzzles. These clients generally require only one or two visits. Thus far, I have dealt with people grappling with relativism, determinism, the nature of death, the proper goals of life, the existence of God, and countless ethical issues, some of them extremely complex. I have also dealt with a novelist who needed help with writing convincing "philosophical" dialogue, religious people grappling with the relationship of faith and reason, and even a woman whose marriage was ruined when her husband started reading Ayn Rand (his egoism turned out to be not very rational).

Few of these problems can be thoroughly explored, much less solved, in a few short visits. But I find that in many cases, clients are not suffering so much from the lack of answers as from unreasonable answers that they have accepted hastily and uncritically. Many suffer not from the lack of certitude, but from unreasonable certitude. And it is often possible to remove these unreasonable views rather quickly.

(I should also mention that all of my dealings with clients are bound by a mutual confidentiality agreement, that I never speak of my clients by name to anyone else, and that I do not even speak of anonymous clients in general terms without first getting their permission.)

The second type of client is seeking non-technical advice, encouragement, and moral support in order to deal with loss, break bad habits, end destructive relationships, make momentous personal improvements, and negotiate major life transitions, such as a career change, a mid-life crisis, or a serious illness. Typically, these clients require more than a few sessions. I find that the greatest impediment to positive self-transformation is excessive attachment to harmful people, self-destructive practices, and negative self-evaluations, as well as the excessive investment of one's self-image and self-esteem in external things. Thus I spend a good deal of time encouraging my clients to "pull themselves together": to divest themselves of external and inauthentic attachments, to discover themselves, and to have the courage to welcome the next stage of becoming who they are.

The third type of client is simply interested in studying great texts in the history of philosophy with a tutor. These are typically retirees or professionals seeking intellectual stimulation. This sort of relationship can be extended indefinitely. Working with such clients is the most relaxing and enjoyable aspect of my practice.

Finally, there are the clients interested in philosophical practice in the classical sense: the pursuit of wisdom, the care of the soul, development of good habits, refinement of moral sensibilities, acceptance of reality, preparation for death, achievement of happiness and inner peacelearning to live joyously in the present. In short, the goal is full self-actualization. But before one can become oneself, one must know oneself. Thus I use the Socratic art of questioning to encourage self-reflection and self-discovery; I guide my clients through philosophical exercises which make extensive use of guided imagination techniques; I also encourage them to continue these activities outside of our sessions by keeping a philosophical journal, which often serves as a basis for further conversation and questioning.

With all my clients, I see myself as a Socratic "midwife." But the goal is not simply to give birth to ideas. It is to give birth to the self.

Gregory R. Johnson is a philosopher in private practice in Atlanta.

-- eve (eve_rebakah@yahoo.com), June 20, 2000

Answers

And some of the nuts 'n' bolts of the profession for ya (the author's second essay, from the same website)...

Beyond Psychotherapy Philosophy and the Care of the Soul by Gregory R. Johnson (First published on... February 23, 2000)

In my first column, I outlined my work as a philosopher in private practice.

But why is philosophical practice necessary? Why isn't psychotherapy enough?

Modern psychotherapy grew out of medicine. Psychotherapists saw themselves as curing "mental illnesses," just as regular physicians cure physical illnesses. The relationship of therapist and client was modeled on the relationship of doctor and patient. The doctor is active and authoritative, the patient passive and objectified. Finally, like doctors, psychotherapists are bound by the ethical canons of their profession, but they see themselves as applying value- neutral science in a morally non-judgmental fashion. Most contemporary forms of therapy are still marked by this medical origin.

From the very beginning, however, psychotherapy began to chafe against and then to burst the bounds of these medical concepts.

Psychotherapy on the couch

The first casualty was the impersonal doctor-patient relationship. Freud found that no matter how hard he tried to remain impersonal and detached, his patients would establish a personal relationship with him, if necessary by projecting a persona onto the blank screen of his scientific reticence.

Freud also came to discover that the manipulation of this so- called "transference" relationship could be an integral part of the therapeutic process.

The next casualty was the concept of mental illness. Many people seek therapy not because they have clinically definable illnesses, but because they face what Thomas Szasz, in The Myth of Mental Illness, calls generic "problems in living." These problems in living include questions about the meaning of life and death, the nature of the universe and our place in it, the nature of faith and knowledge, and the nature of the good life and how to pursue it. These problems are inherent in the human condition and are faced by every mentally healthy human being.

The third concept psychotherapy inherited from medicine is the ideal of value-neutrality. So far, it has been the most resistant to change.

Psychotherapists pride themselves on their own ethical integrity, but most of them insist that the facts of mental health and mental illness are value-neutral, and that their therapeutic interventions should be as morally non-judgmental as those of a surgeon or a plumber.

This sort of value-neutrality might be possible when prescribing drug therapies for organic brain disorders; it becomes problematic when dealing with clinical neuroses; but it is totally unsustainable when dealing with problems in living, for there is virtually no problem in living that lacks an ethical dimension.

Hit and run therapy

Consider, for example, the hypothetical case of a young man who seeks therapy because of intense anxiety over a hit-and-run accident he has committed.

The therapist could ask if he is anxious because he thinks he acted immorally. He denies this. He is anxious because he does not know whether his flight was moral or not.

The therapist could point out the dominant moral consensus on the matter, suggesting that he adjust himself to it. But this cannot work. The young man finds the truth of this consensus questionable and cannot judge himself by standards he thinks ungrounded.

The therapist could propose that he reconcile himself to his actions even if society condemns them as immoral. But this cannot work, because he does know whether his actions are right, and he cannot accept them unless they are.

Finally, the therapist could propose a prescription for a psychoactive drug to lessen the anxiety. But this is no solution, because the anxiety is not merely "in the head." It arises from his inability to morally evaluate an objective state of affairs: the accident and his flight from the scene.

The only way to gain relief is to come to a moral decision, but this avenue is closed off by the therapist's refusal to deal with moral questions.

Consider another widely used and abused concept: self-esteem. The most persuasive analysis of self-esteem I have encountered is Nathaniel Branden's The Psychology of Self-Esteem (Los Angeles: Nash, 1969), which argues the self-esteem has two components: a sense of one's ability to meet the challenges of life and a sense of one's worthiness to be happy.

One's ability to meet the challenges of life is purely a factual matter. Judgments of worth, however, are inescapably moral.

But psychotherapists tend to treat moral judgments merely as subjective facts, which may be interesting and revealing, but which are never true or false. Philosophy, however, looks at moral judgments in terms of their truth and falsehood. And surely it is relevant to ask whether the most important moral judgment one passes one's judgment of one's own worthis true or not.

A philosophical need

In sum, psychotherapy began as an offshoot of medicine. But the medical model immediately began to break down. Many people enter therapy not to be patients "etherized upon a couch," but to form interpersonal relationships through which they seek to grow as human beings. Many enter therapy not to have mental illnesses cured, but to meet perfectly sane and healthy needs for self-knowledge, self- acceptance, and a sense of the meaning and purpose of existencea sense of their place in the big picture. Many enter therapy, not to receive the non-judgmental ministrations of value-free science, but to grapple with moral questions, the greatest of which is, "How should I live?"

These are philosophical, not psychological questions. Metaphysics is the branch of philosophy that deals with the question of man's nature and his place in the universe. Moral philosophy is the branch of philosophy dealing with questions of values, including the pursuit of self-knowledge and self-realization.

How many people enter therapy with philosophical problems? Donald K. Freedheim, a professor of psychology at Case Western Reserve University in Cleveland, estimates that, "80 percent of the consulting that is now done could be done by them [philosophical practitioners]" ("I Bill, Therefore I Am," The New York Times, March 8, 1998).

Philosophical questions, however, fall outside the professional training and competence of people with M.D.s and Ph.D.s in psychology and social work. Of course, every intelligent human being is capable of pondering philosophical questions, just as every intelligent human being can think about psychological issues. I am dealing only with the issue of professional training and competence.

What should be done? First, philosophical practitioners need to educate the general public about the nature of philosophical questions and the appropriateness of posing them to professional philosophers. Second, philosophical practitioners need to teach psychotherapists to recognize people with philosophical problems so that they can be referred to philosophers, just as philosophers need to recognize people with psychological problems and refer them to appropriate therapists.

Philosophers and psychotherapists have a common task: the care of the soul. They should divide the labor according to their relative expertise.

Until then, people will continue exploring philosophical questions through psychotherapy. But because this is usually futile, they will keep searching, moving from therapist to therapist or reclining on the same couch for months, even years, hoping to get something out of an unproductive therapeutic relationship.

As Eric Hoffer once said, "You can never get enough of what you don't really need."

Gregory R. Johnson is a philosopher in private practice in Atlanta.

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

Oops...guess the link doesn't work. Let's try it again:

Essays

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

Eve,

Interesting essays. I think the author is right on the money. The link you provided is great and a keeper. I'm sure I'll spend many hours enjoying it. Thanks.

-- Debra (...@....), June 20, 2000.

Hi Debra,

You're very welcome -- glad you liked 'em, and the site. You know, I just discovered this site this morning! And as soon as I saw those particular essays (the titles tantalized me; I haven't read any of the others yet, but I plan to read most, if not all of 'em) I couldn't wait to post them. I think they neatly highlight some of the weaknesses in counting on the psychological approach alone -- something that's always kinda bothered me.

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

And a brief but interesting case study from his practice...

THE PHILOSOPHER IS IN The Price of Integrity by Gregory R. Johnson

(First published on... March 8, 2000)

Late last year, in the early evening, a close friend was driving near his home. He looked out his car window and saw an old woman laying on her back in her driveway, an anguished, helpless look on her face. Two barking dogs stood beside her. There was a long line of traffic before and after his car. But nobody else seemed to have noticed.

He told his driver to pull over and ran back to the woman. He tried to help her to her feet, but she winced in pain, so he picked her up and carried her into her house, followed by her dogs. She weighed only 70 pounds. He set her down in her chair. She said she wanted to call her son, so he brought her portable telephone and address book. He asked her if she was in pain, and she said no. "Are you sure?" "Yes." Since he had a commitment that evening and time was short, he took his leave. "Thank youthank you sweetly," she said, adding, "Please shut the inside door as you leave."

The door and the dogs

He noted her street address, went to his car and filled the driver in on the details. The driver called to have paramedics dispatched. A little further down the street, they saw a police car. The driver flagged the policeman and my friend told him the situation and the address. The policeman sped off, and my friend continued on his way.

Suddenly, he was struck with a twinge of horror: What if the front door had locked? What if the dogs attacked the paramedics? Shouldn't he have made sure the door was not locked? Shouldn't he have shut the dogs in one of the bedrooms?

Later that evening, when he told me the story, I was puzzled by his reaction. He clearly had done the right thing. Nothing would have been gained by staying with her. But he could take no satisfaction in his actions, and remained worried, agitated, and self-reproachful.

"But what about the door and the dogs?" he asked.

"You didn't leave her bleeding to death. It wasn't cold. She wasn't suffering from exposure. The police and paramedics can handle a locked door and a couple of dogs. Don't worry about it. If it bothers you, go by and check on her."

As it turned out, after my friend had arrived at his destination, his driver went back to find out what had happened. Sure, enough, the door was locked. When my friend was informed, he became even more agitated.

The next day, he returned to the house himself. There was a pair of tennis shoes by the front door. The newspaper had been picked up. The dogs barked when he knocked. But nobody answered. He concluded that the accident could not have been too serious if there were signs of life around the house. On a couple of occasions, when he walked by, he noticed signs of life, but nobody answered when he knocked.

Unearned guilt?

Finally, on February 17th, he passed by the house and saw the door ajar. He knocked and an attractive middle-aged woman answered. She was the old woman's daughter-in-law. When he introduced himself, she beamed, "So you're the Good Samaritan. We didn't know who to thank. Thank you so much for helping out."

My friend's satisfaction was, however, short-lived. It turned out that the old woman had died. She had broken her hip in three places. When the police and paramedics arrived, they found a locked door and barking dogs, and refused to go in. Fortunately, however, the daughter-in-law lived only a few blocks away and arrived just minutes later. Once the dogs were locked up, the old woman was taken to the hospital. She had hip surgery, but afterward developed a pulmonary embolism. She was in the hospital for three weeks and was steadily improving. But when it became clear to her that she would not be able to live in her own home anymore, she simply let go. She was 85.

Upon hearing this, my friend returned to his agitated, guilty brooding. Then he sought me out.

The first point I tried to impress upon him is that he did the right thing by helping, and that he should take pride in the fact.

Next we tried to determine the source of his guilty conscience. One factor was that the woman eventually died. But it was unreasonable to feel responsible for this. Her age, her frailty, and her triple fracture were the primary causes of her death. He neither contributed to these causes, nor could he have prevented them. The fact is, such falls are frequently the beginning of the end for frail old people, no matter what is done for them.

"But what about the door and the dogs?"

I had to grant that these were real oversights. Another person with greater presence of mind might have thought of them. But I asked if my friend would have stayed if the woman had been in more apparent and immediate danger. He agreed that he would have.

"But one reason why I did not think of the door and the dogs was the fact that I was worried about getting to my appointment on time."

Price of integrity

After some questioning, I managed to learn that behind this objection was the feeling that he was immoral to be thinking about his own goals when somebody else was in such dire need. But, again, this was unreasonable. Every human being has his own proper needs and interests. There is nothing wrong with keeping these in mind when helping otherseven though our mental capacity is finite, and even though to the extent we are thinking about our own projects we might overlook some ways to help others.

If my friend had left the woman bleeding to death on her sofa in order to rush home to watch a re-run of "Buffy the Vampire-Slayer," then he would have good reason to feel like scum. But he left a woman in stable condition after giving her means to call for help. He sent police and paramedics to her aid. Then he went off to meet with others who were counting on his presence.

He agreed that if his appointment had not been so pressing, or if he'd had no plans for the evening at all, he would have stayed to render more aid. But as it was, he rendered the most pressing forms of assistance, without sacrificing his own interests. He had nothing to be ashamed of.

He agreed with me, but somehow I still had not addressed he deepest source of his guilt.

So we began again. After extensive inquiry, we finally arrived at the following, not entirely satisfactory explanation. The source of my friend's guilt lies in the tension between his atheism and his moral absolutism and perfectionism.

As a moral absolutist, he believes that there is an objective right and wrong based on nature. As a perfectionist, he believes that he is obligated to make the best possible decision in every situation.

As an atheist, he does not believe that "all is for the best," that "whatever is, is right." The evils of the world are real evils not illusory evils, not providentially mitigated evils. Thus he cannot accept the imperfections of the world. He cannot simply say, "Thy will be done." He is obligated to control the world and perfect it.

But he can't. The world is bigger than all of us. The are realities that will always escape our control. Death is the most terrifying of these. Obligated to do the impossible, my friend is guilty by his very nature. It is his secular version of original sin.

In Mere Christianity, C.S. Lewis exploits this very problem to argue for the existence of a God who can forgive us and allow us to forgive ourselves. But as an atheist, my friend has nowhere to turn for supernatural absolution.

Once we arrived at this explanation, I asked him if he was willing to give up either his moral absolutism or his atheism. He refused to do either. "Only a coward abandons his convictions to make himself feel better," he said.

"Then accept your guilt. Accept it as the price of your integrity and courage."

Gregory R. Johnson is a philosopher in private practice in Atlanta

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

Eve,

You have found THE essay to help me through this day. I consider it a very personal gift. Thank you.

-- Debra (...@....), June 20, 2000.

Debra, I'm so happy that this essay touched you in such a special way. And you know...when I read your latest reply to me, my eyes got a little wet and I think I received more than a few goosebumps.

So...this time, Debra, I want to thank YOU. :)

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

Can I join this little hug-fest? :^)

Debra stole my exact words: "right on the money." If I had known a degree in philosophy might someday pay off...

I would hope these philosophers in private practice are well rounded in their understanding of various philosophies, or hang their shingles making clear they're specialists in one or another philosophical avenue.

Thanks yet AGAIN, eve.

-- Bingo1 (howe9@shentel.net), June 20, 2000.

You're welcome, Bingo 1, and here ya go...(((((((cyber-hug)))))))

You've made interesting points regarding well-roundedness and the necessity of making clear which philosophy they're specializing in.

I agree wholeheartedly with the latter but disagree with the former. A "well-roundedness" in philosophy -- or psychotherapy, for that matter, would probably include competing ideas, and therefore contradictions. So, we have to be very careful there. I think its more important for the therapist to hold to a single school of thought and advertise it as such. Im open to discussing the possibilities, but in general, I dont see how this could work.

-- eve (eve_rebekah@yahoo.com), June 20, 2000.

I see it this way, eve. The average person isn't locked into a school of philosphy from what I can tell. They'd need someone who is more skilled at drawing out their core beliefs, testing them, sounding them out. Nudging them along so that they may discover which way to go in their research. Square peg/round hole, eve. Why limit the possibilities?

For those who are decided on a school of philosophy, I agree they would do best to seek out one of their own kind, unless they were seriously questioning their chosen path. Test the waters, if your path doesn't meet your needs, answer your questions, move your heart, it's time to take a long, hard look at what you're doing. Tough to do that from within the fishbowl of a specific school of thought.

Thanks for the squeeze! I'll take it with me into meditation tonight.

-- Bingo1 (howe9@shentel.net), June 20, 2000.

Evenin', Bingo 1,

You made some very good points in your post. Maybe you implied this, but I would add that the philosopher needs to watch for and challenge any destructive values that the client may hold. And these values could be subtle, latent, insidious, etc. as well as a part of an accepted school of thought or philosophy. So they could be tough to eradicate.

-- eve (eve_rebekah@yahoo.com), June 21, 2000.

"There are more things in heaven and earth, Horatio,

Than are dreampt of in your philosophy"

Hamlet 1, 166-167

-- (nemesis@awol.com), June 22, 2000.

"...that part of philosophy will I apply that treats of happiness..."

The Taming of the Shrew, Act I, Scene I

-- eve (eve_rebekah@yahoo.com), June 22, 2000.

Sputter, sputter, grumble. Ya got me Eve.

-- (nemesis@awol.com), June 22, 2000.