Book Review: Psychotherapy as a Human Science

The human science part of the title of this book refers to a distinction made in German between Naturwissenschaften (the natural sciences) and Geisteswissenschaften (the human sciences). The context in which it is written is the USA in the early 21st Century where psychiatry and psychotherapy have been taken over by neo-Kraepelinean approaches, CBT and so-called evidence-based practice. In contrast to the bureaucratisation of psychotherapy and the emphasis on techniques and manuals of practice which ape a natural science approach, Burston and Frie seek to set psychotherapy in its historical and philosophical context. They argue that philosophers have much to teach psychotherapists (p.1) and that a dialogue with philosophy is vitally necessary for the gounding of theory, practice and research in psychotherapy (p.2).

In the ambit of barely 300 pages the authors cover a wide variety of thinkers from Descartes and Pascal to Benjamin and Stolorow. Not only do they cover a lot of ground but they also follow ideas through the centuries and they compare and contrast thinkers. Nor are they always uncritical of the authors whose ideas they summarise. For example, as clinicians they make a scathing attack on Freud's concept of the analyst as a blank screen, which fails to do justice to psychotherapy as a complex inter-relationship between two unique human beings.

While I tend to be sceptical of claims that psychotherapeutic practice can be based on the reflections of philosophers, what Burston and Frie cogently demonstrate is that the implicit assumptions which underlie therapeutic practice have a long history. So, in reading this book I discovered that, as a practitioner deeply influenced by both psychoanalytic and existential-phenomenological perspectives, that my intellectual ancestors include not only Kierkegaard, Nietzsche, Jaspers and Heidegger, but also Pascal, Kant, Hegel, Marx, Dilthey and Scheler. To take the example of Dilthey:

... (Dilthey) was the first person to discuss psychology explicitly as a human science, and his emphasis on empathy and communion as preconditions for inter-personal understanding and the situated character of human inter-subjectivity had a profound impact on Edmund Husserl, Karl Jaspers, Max Scheler, Martin Buber and R.D. Laing...

(p.87).

They set one thinker beside another clearly bringing out the differences in their views: for example the differing views on love and relationships held by Sartre and Lacan on the one hand are contrasted with those of Buber, Binswanger, Boss and R D Laine on the other. Similarly, they show how Laing's emphasis on non-verbal interactions undercuts Lacan's views on the primacy of language. Burston and Frie also make unexpected but telling comparisons; for example in their section on Binswanger they introduce a quotation from my favourite Object Relations theorist, Harry Guntrip, (in which the latter quotes R D Laing with approval):

Psychotherapy can only be carried on by those who are prepared to be exposed to all the subtle reactions that go on between two human beings who meet on an emotional rather than an intellectual plane... What is therapeutic when it is achieved is "the moment of real meeting" of two persons as a new, transforming experience for one of them, which is as Ronald Laing said, "Not what happened before (i.e. transference) but what has never happened before (i.e. a new experience of relationship).

(p.181 quoted from Guntrip 1969, p.353).

Similarly, they point out the similarities in thought between Binswanger and Harry Stack Sullivan.

Another part of the book which pleased me was that Burston and Frie give Binswanger his rightful place as a central figure in the development of the existential-phenomenological approach to therapy. Perhaps we have been too influenced by the view expressed in the Zollikon Seminars that Binswanger had misunderstood Heidegger (while Boss had not). However, Burston and Frie make a number of telling points:

First, Binswanger was a pioneer in seeking to put psychotherapeutic theory onto a non-dualistic footing more than three decades before Boss and Heidegger conducted the Zollikon Seminars. From 1927 onwards, Binswanger addressed the central defect in Freud's metapsychology viz. that in distinguishing between the inner world of unconscious representation and the external world, he replicated the Cartesian split between res mens and res externa:

This dualistic way of mapping experience fails to capture the fundamental co-inherence of person and world - being-in-the-world - that Heidegger highlighted and that Binswanger in turn sought to rectify with his concept of world design.

(p.177).

Secondly, it was not simply that Binswanger did not understand Heidegger – it was that he actually found Heidegger's view of personal relationships inadequate. The problem was that Dasein achieves authenticity in isolation from others and omits the authentic positive possibility of Being-with-one-another. (p.179).

Binswanger believed that authenticity is also achieved through the I - Thou relationship, so he is indebted as much to Buber as to Heidegger and he elaborates Buber's concept of the I - Thou encounter in terms of the therapeutic relationship.

And, finally, Burston and Frie point out that despite any superficial differences between them, the area of convergence between Binswanger and Boss are as broad and basic to understanding what psychotherapists are up to as one could possibly imagine. (p.190).

In the latter part of the book Burston and Frie cover the development of relational psychoanalysis which does draw on continental philosophy. I feel greatly cheered by the growing dialogue between existential-phenomenology and psychoanalysis, two of the richest veins of psychotherapeutic understanding.

This book is not an easy read, but I feel sure that anyone with an interest in the philosophical understanding of psychotherapeutic theory and practice will find their engagement with it richly rewarded.

References

Guntrip, H. (1969). Schizoid Phenomena, Object Relations and The Self. New York: Basic Books.

Heidegger, M. (2001). Zollikon Seminars: Protocols - Conversations - Letters. Evanston, Ill: North Western University Press.

Nick Kirkland-Handley