Book Review: Reason, Virtue and Psychotherapy

Reason, Virtue and Psychotherapy

Antonia Macaro. (2006). John Wiley & Sons: West Sussex. 152pp. £20.99.

Written in a clear, jargon free style this book does what it sets out to do – it provides an explication of Aristotelian ideas about the role of reason and virtue in achieving eudaimonia, the good life or human flourishing, and how these concepts can be employed in therapy today. Each chapter provides an academic discussion of the topic and 'practical applications' – strategies and exercises for applying theory to practice.

While Aristotelian thinking is central to this book, Macaro also draws from a range of thinkers and models, past and present, representing various schools of thought to produce a 'neo Aristotelian virtue framework' for therapy – Aristotle updated for our times. This framework aims to help us reflect on what is valuable, learn to make good decisions, develop virtues of character and apply self control when needed. Rather than a one size fits all route to the good life it offers a way of helping clients choose the 'right' course of action for them in relation to both general principles of what constitutes a good life and their particular circumstances, values and goals. Macaro describes this as 'a search for the best specification'.

She suggests this approach sits quite easily with therapies that focus on exploration of values and /or beliefs such as existential and cognitive therapies. Overall I agree and consider this book will be of interest to both trainees and practitioners. Macaro specialises in addiction therapy and as her chapter on self control focuses on addiction it will be of particular value to anyone working in this field.

Virtue here has specific meanings. The intellectual virtues are 'theoretical reason' (sophia) which is about contemplating unchangeable truths, and 'practical reason' or wisdom which is concerned with deliberation and choice where things can be changed. Being virtuous involves developing the virtues of character that will enable us to follow the dictates of practical wisdom. So you become the person you want to be through rationally chosen actions, behaviours and habits. If we can't manage virtue, where we want to follow our reason and behave in the right way, we have to use self control which may be laudable but is not virtue. Macaro begins by setting the scene and exploring possible ingredients of the good life and general principles for achieving it. She argues for rationality as a counter balance to the emotionalism, subjectivity and do your own thing attitude prevalent in some therapies. The good life involves reason, emotion, perception and action interacting in balance, and recognition that we are in society and bound by universal duties and ethical principles. There is an emphasis on the whole life (will it in total be one that adds up to something good and worthwhile?) and on character and choosing well as the means to flourishing.

Chapter 2 is about 'practical wisdom'. It explores the difficulties of decision making and gives strategies for weighing competing motivations and using critical thinking to distinguish good reasons from excuses and self deception. The aim is to learn to deliberate better – taking intuition, gut feel and emotions into account with the caveat that emotions are 'fallible indicators of value'. She concludes that therapy is a joint investigation into the best reasons for action.

Chapter 3 explores 'virtues of character'. These include courage, temperance, justice, generosity, friendliness, wisdom… (the list is long and debatable) and we are exhorted to develop our behaviour towards a 'mean'. For example: with fear the mean would be courage, deficiency would be timidity and excess, foolhardiness. This requires training ourselves to distinguish appropriate responses. Similarly with anger – some things warrant a furious response others are best overlooked.

Entitled 'reasonable emotions', chapter 4 delves further into our emotions and how we can 'manage' them in pursuit of the good life. Macaro ends with a summary of techniques. Some like querying underlying beliefs and meanings, considering alternative viewpoints, and reframing are consistent with existential therapy. Others like diverting attention from negative feelings, thought stopping and NLP may be beyond the scope of purist existential therapy (assuming we know what that is) but for the pragmatists they are interesting to consider.

Chapter five focuses on self-control and addictive behaviours. We are no longer aspiring to eudaimonia but grappling with overcoming self destructive behaviour and strategies for daily survival – 'less than virtue' is how Macaro puts it. She challenges the notion that substance addiction is an illness, instead she identifies 'a convergence between addiction and weakness of will… both show corruption of practical reason'. She argues that addiction to substances is on a continuum with ordinary bad habits - that people say they want to be rid of while indulging in them. Her answer is commitment to change, made in the cold light of day like Ulysses' strategy for avoiding the Sirens' call. This involves thinking ahead, predicting times of vulnerability, taking action to prevent oneself succumbing, using self control to gradually develop changed motivation and new habits. She provides lists of cognitive and behavioural strategies, useful for any situation where ambivalence and self control is an issue.

Overall this book is a useful summary and distillation of ancient wisdom and modern thinking about the good life and human flourishing. Many of Macaro's comments and exercises helped sharpen my thinking about some of my clients' dilemmas and how I might help them, although I would debate some of her suggestions.

I believe an indirect approach to behavioural change by exploring and challenging a client's worldview and belief systems is more likely to produce change than a direct assault with reason and self control but this is a matter of emphasis as Macaro is not saying either/or and I agree both approaches have their time and place.

On 'reasonable emotions' while I agree some self control makes sense, taken to an extreme this could lead to a robotic way of being which is very far from the aspirations of existential therapy. However, Macaro says a life rich in emotions and experiences is as important as rationality and peace of mind - although reason should be in charge it is worth surrendering some control in order to live a full life but not so much that it is chaotic and goals unattainable. The aim is to 'fortify our rationality, sharpen our thinking and deepen our wisdom', which seems reasonable to me.

In summary Macaro is offering practical suggestions on how to help clients develop behaviours more conducive to their own well-being. She is bringing reason into focus as an essential tool and suggests we 'cut reason down to size' rather than give up our claims to autonomy, responsibility and rationality – a suggestion most existential therapists would surely go along with.

Diana Pringle