Book Review: Philosophy and Psychotherapy

Philosophy and Psychotherapy by Edward Erwin. London, Sage Publications 1997,179 pp.

This is a deceptive book. At first sight it presents itself as an appeal to philosophers to take an interest in certain psychotherapeutic concepts which have also been the concern of philosophy, as for instance the "Self", and to psychotherapists to clarify the meaning of their assumptions. I feel strongly sympathetic to such an appeal: as a psychotherapist I am particularly troubled by the way in which some theorists use a term which can have a variety of meanings without telling us which of these meanings they have chosen and why.

The real purpose of the book, however, turns out to be quite different. The author believes that psychotherapy is in a state. He concedes that this by no means obvious, and that "a seemingly powerful case can be made, on the basis of growth, consumer satisfaction and perceived effectiveness" that psychotherapy is, in fact, flourishing. The crisis, in his view, is "intellectual". Its nature he expresses in the following words:

Most of the various forms of psychotherapy, as far as anyone knows, are not more effective than credible placebos; Psychotherapeutic expertise, as far as anyone knows, does not generally consist of knowledge about how to wield techniques that can routinely outperform a credible placebo (P 145)

Edward Erwin is a philosopher of science at the University of Miami, and, as the bibliography shows, has been devoting himself for many years to research into the validity and effectiveness of psychotherapy, particularly of cognitive and behaviour therapies, but also of psychoanalysis. His method of choice is scientifically designed and controlled research, and the book under review seems to be a summing up of his conclusions. Though these conclusions are, by his own criteria, rather bleak he implies that the effectiveness of psychotherapy - so clearly affirmed by many practitioners and clients - might still be proved. My own question is whether the method chosen by him could ever do this. Another question related to this is whether psychotherapy is or needs to be a science, and if so, whether the definition of science needs to be as narrow as the use of a controlled research implies.

It is, of course, important to remember that Erwin concerns himself with those forms of psychotherapy which define themselves as "scientific" in the classical sense and work within a framework of linear causality. Existential-phenomenological approaches which do not define themselves in this way he does not discuss.

There is one half-hearted exception to this. In his overview of the various meanings of "Self" in psychotherapy, he has a short section on "Humanistic Psychotherapy", defining it as "a diverse group including client-centered therapists, phenomenologists and existential psychologists..." (p 42). Among them he recognizes as a distinct school, Carl Rogers' "client therapy". Erwin's main concern is the various ways in which Rogers uses the term "Self", but in the course of exploring this, he also demolishes Rogers' proposition that congruence, unconditional positive regard and empathic understanding are "necessary and sufficient for therapeutic success" (p 43). But does Rogers actually propose this? The words I quoted are not Rogers' words but Erwin's paraphrase. The actual words Rogers used in the article Erwin refers to (Rogers 1989:10) are:

The client-centered approach has a number of distinguishing characteristics. These include the developing hypothesis that certain attitudes in the therapist constitute the necessary and sufficient conditions of therapeutic efficiency...

Comparing Rogers' words with Erwin's paraphrase we find nothing of Erwin's dogmatic finality in a "developing hypothesis", and "sufficient conditions of therapeutic efficiency" sounds very different from "therapeutic success".

Applying his usual criterion of either/or, Erwin seems to say that a proposition is invalid unless it can always be shown to be true. He claims "that the outcome record for psychotherapy will refute every one of these three propositions" (p 45). Though he does not elaborate this sweeping statement and does, in fact, not include client-centered therapy in the "paradigms" by which he illustrates his views at length in the second part of his book this example shows some aspects of his approach very clearly.

A chapter about "Postmodernist Clinical Epistemology" describes briefly those approaches which "have become disenchanted with traditional positivist and realist assumptions" (p. 61). He mentions "constructivists" who propose that it is our experience that constitutes the world, at least to some extent. Erwin comments that "if reality does not exist independently from our constructions, it may be pointless to try and validate knowledge claims by appeal to empirical evidence (p. 61). But the question whether there is a "reality" independent of our experience is, in fact, a fundamental question at the very heart of philosophical exploration, and asks for a radical investigation which it does not receive here.

The main objection of "postmodernists" to Erwin's views is, however, that "human beings are free and autonomous, or at least can be made so through the use of psychotherapy, and this fact is ...incompatible with determinism, and perhaps with any causation of human action" (p 77). Erwin's response to this is that "the sort of autonomy that we clearly have and which psychotherapists seek to enhance is obviously compatible with there being causal explanations of human action" (p 77). One does not have to be a "postmodernist", I think, to ask: obviously? Erwin starts his book with a discussion of determinism and free choice, but he leaves me unconvinced that they do not exclude each other.

It seems to me that an existential-phenomenological approach, with its distinction between what is "given" and our free response to it has come nearest to bridging the gap.

Hans W. Cohn