Australian Clinical Psychologist Volume 2  Issue 1  20111

ISSN 2204-4981

Opinion Piece
Why Clinical Psychologists Should Read Philosophy: An Introduction
Paul Rhodes
Clinical Psychology Unit, University of Sydney

and

Janet Conti
Clinical Psychology and Therapy Studies, University of Western Sydney

Abstract: The aim of this paper is to argue for a deeper engagement between the
fields of clinical psychology and philosophy. Clinical psychology has become divorced from
its philosophical roots, in part due to its efforts to attain the status as a science. In this paper
we argue for a clinical psychology that can recognise its philosophical roots in responding to
contemporary challenges, thereby generating a meta-modern project that can open up new
arenas for innovation.

Keywords: philosophy, values, social construction

For good ideas and true innovation, you need human interaction, conflict,
argument, debate.
Margaret Heffernan

Introduction

One of the defining features of clinical psychology is its paradigmatic affiliation with science
(Witmer, 1996) and its focus on the rigorous training and organisational monitoring of competence.
These have held our profession in good stead, ensuring that we are best protected from the risks of
charlatanism, accountable to both scientific evidence and professional bodies. Formulation also
remains a defining characteristic. Evidence and accountability protect us as a field, formulation
provides scope for our knowledge to be tailored to the needs of the individual; these together being
the heart of evidence-based practice (Norcross, 2011; Sackett, Rosenberg, Gray, Haynes, & Richardson,
1996). This has helped guard us against the reductionism of diagnosis and supported the sophisticated
integration of therapeutic modalities.

Corresponding author: Associate Professor Paul Rhodes, University of Sydney E: p.rhodes@sydney.edu.au

Australian Clinical Psychologist Volume 2  Issue 1  20111
ISSN 2204-4981

Despite these strengths, clinical psychology frequently risks being a conservative field,
maintaining itself strictly within the bounds of positivism and post-positivism. Positivism, described in
its most basic form, asserts that we must be guided by scientific knowledge, and that it is possible to
make truth claims based on science. The aim of research is to look for general laws about human
functioning through observation and measurement. Post-positivism, acknowledges the existence of
objective realities, but accepts that we may only be able to see them imperfectly or probabilistically
and that researchers inevitably influence phenomena that they are engaged in researching. Social
constructionism, on the other hand, also acknowledges that objective reality exists, however argues
that how humans access reality is through the language forms or discourses available to them within
a social and cultural context. Central to this turn, is the position that there exists “no ‘versionless’
reality” (Wetherell & Potter, 1992, p. 62) and that human social realities are given meaning and
constructed through language (Parker, 1992). Therefore any given reality or action may be multiply
understood and philosopher Michel Foucault (1980) has highlighted that this privileging of certain
versions of reality over others is an act of power.

Our profession of clinical psychology relies on the scientific discourse of objectivity in the
construction of mental disorders and endorses particular therapies as valid, regardless of their external
validity when implemented more broadly within the community. This confers power to those who
(even inadvertently) use scientific discourse to speak about the true nature of the reality of the human
condition in a way that is independent of language (Sampson, 1993).

Miles Little, renowned surgeon and ethicist, asserts that communities of practice are
‘discourse communities’, with unwritten rules about what can and can’t be said: “Commitment to a
discourse community provides support, but demands a certain degree of conformity, if acceptance by
the community is to be assured” (Little, Jordens, & Sayers, 2003, p.76). Many forms of knowledge
remain marginalised in our field including interpretative qualitative research that privileges the voice
and understandings of the experiencing person, narratives about therapists’ lives, reflective practice
and, for the purposes of this paper, philosophical inquiry. The issue for clinical psychology is it
privileges a certain form of philosophical enquiry restricted to positivist and post-positivist discourse.
These discourses need not challenge our scientific integrity, but expand our capacity to humanise and
heal.

Looking Back: Physicians of the Soul

Clinical psychology is both a science and an applied philosophy. The most prominent treatment
modality, cognitive behaviour therapy (CBT), draws on the Greek and Roman Stoic tradition

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(Robertson, 2010). Here, in the works of Marcus Aurelius, Epictetus, Cicero and others, lie the
fundamental precepts of this treatment; “If thou are pained by any external thing it is not the thing
that disturbs thee, but thine own judgment about it. And it is in thine power to wipe out that
judgement” (Marcus Aurelius). The novelty of a cognitive-behavioural approach, according to Ellis is
“the application of viewpoints to psychotherapy that were first propounded in radically different
contexts” (Ellis, 1962, p.35).

The ‘third wave’ of CBT has also been influenced by the philosophical canon. Dialectical
behaviour therapy (DBT) takes its name from Hegel’s dialectic, the concept of resolving ambivalence
through the synthesis of opposing positions (Mueller, 1958), although it does not serve as a rigorous
application of Hegel’s project. The synthesis in DBT is between the change-orientation of CBT and
acceptance-orientation of Zen Buddhism. Acceptance and commitment therapy (ACT) is also based on
Zen, but also draws on pragmatic contextualism, rooted in the work of Dewey and James (Baer, Wolf,
& Risley, 1968). The idea informing pragmatic contextualism is that events cannot be separated out
from the whole person or historical and situational contexts in which they exist. They aim to moderate
the mechanistic metaphor of CBT (Arch & Craske, 2008), but of course, the evidence is still out.

Clinical psychology draws on philosophy to develop innovative treatment modalities, but

reifying evidence-based practices as the only way to intervene therapeutically across diverse contexts
can disembody them from their historical sources and socio-cultural contexts. Is anything lost in the
process? Would philosophical literacy enhance efficacy? Are we doing ourselves a disservice? Our
hypothesis is that philosophical literacy can ground a training therapist in the value-system associated
with the model, deepening their understanding of the processes involved and raise pedagogy above
the realm of competency-based learning. Philosophical literacy implies that psychologists are more
familiar with the history of philosophical thought, at least in relation to those thinkers that have had a
direct influence on our practices. However, it also implies that we engage more assertively in dialogue
about ideas, both at an existential and sociological level.

Looking Forward? Critique

Coming out, as a science, but also as an applied philosophy, allows for a range of new
conversations and practices. Ethics, for example, are both codified obligations and one of the central
streams of philosophical thought. Our ethics codes focus on issues such as consent, competence, and
boundaries. They fail, however, to recognise the ethics involved in our role as makers of meaning and
the fact that we may be imposing our values and beliefs onto others. One of the dangers lies in
determinism. Do we see our clinical approaches as useful lenses through which we access reality or as

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representations of what is actually out there? If we are ‘married to our models’ (Cecchin, Lane & Ray,
1992) there is a danger that we might also colonise the cultures of our clients, resolving their symptoms
but still damaging their own meaning systems, for example through the pathologisation of their
suffering? How do we pay respect to our clients’ values and beliefs? How do we access and prioritise
their own hidden and potentially liberating voices? How do we tailor our therapeutic approaches in
ways that prioritise our clients’ values and voices rather than applying recipe book approaches that
assume one size fits all and may be potentially dangerous (Sackett et al., 1996)?

One of the difficulties we have had in responding to these issues has been the schism between
critical psychologists and clinical psychologists. Psychologists like Parker (1999) and Gergen (1985)
question our supposed industrialisation, focus on pathology and reification of psychiatric diagnosis.
They see us as part of the Psy-Complex (Ingelby, 1986), affiliated with psychiatry and ‘Big Pharma’,
leaving us beyond redemption. In turn, there is a tendency within the pedagogy and practice of clinical
psychology to position critical psychologists as radicals and conspiracy theorists. This polarisation
leaves clinical psychology cut off again, not just from its philosophical roots, but from considering how
different philosophical traditions can inform and potentially transform its practice and role in
contemporary society. Any contemporary philosophical inquiry must consider the problem of our
increasingly individualistic and commodified culture. We live in the ‘Century of Self’ (Curtis, 2002),
where Thatcher’s neoliberalism has run rampant. We can afford, as clinical psychologists, to ask
whether our understanding of human psychological distress as an intrapsychic phenomenon and
responding with increasingly branded treatments serve to collude with these developments in society.

Metamodernism and Dialogue between Social Constructionism and Scientific Accountability

If clinical psychology is to engage more with philosophy we need a theory of knowledge that
can cater for both values and evidence, for the more significant recognition of philosophical thought
alongside the accountability of science. One candidate is Vermeulen and van den Akker’s (2010) meta-
modernism. They reject both the endless critique of society and the utopian progress of science. “We
contend that the contemporary structure of feeling evokes a continuous oscillation between (i.e.
meta-) seemingly modern strategies and ostensibly postmodern tactics, as well as a series of practices
and sensibilities ultimately beyond (i.e. meta-) these worn out categories” (2010, paragraph 10). In
other words, we need to leave room for a deeper engagement between both worldviews, in the hope
of creating something new.

Seikkula’s (2002) innovative approach to early psychosis is an example of a meta-modern

project in clinical psychology. Known as ‘open dialogue’, or network therapy, this intervention is

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inspired by social constructionist practices in family therapy (Anderson & Goolishian, 1992), but has
been put the test using randomised control trials (Seikkula, et al., 2006). Reading the work of Seikkula
and his colleagues can be disconcerting if you are used to traditional scientific papers. The preamble
to randomised control trials includes references to the influence of philosophers such as Bakhtin and
Lacan (Seikkula et al., 2006). Proponents both reject the hegemony of the medical model and the
pathologising effects of diagnosis, while embracing the need for evidence-based practice. Open
Dialogue responds to acute episodes of psychosis by developing a community of care around the young
person in the home environment as an alternative to hospitalisation. Therapists bring together medical
practitioners, parents, neighbours, friends, case managers and others in large community meetings to
listen to the young person and each other as equal players in dialogue. Importantly, the voices of the
young person are considered part of the polyphony, to be understood and interpreted as ‘pre-
narrative’ contributors. The use of medication is minimised and diagnoses are only considered valid
when actual symptoms are manifest. Two year outcomes include 75% of the sample showing no signs
of psychosis and 80% returning to employment.

What Can We Do To Learn More About Philosophy?

Reading and discussing philosophy can be challenging for practitioners trained in the sciences.
This has certainly been the case for ourselves (the authors) who have struggled with the complexity
and sometimes arcane language that characterises the field. This has been one of the motivations for
starting the Australian Clinical Psychology Association Philosophy Special Interest Group, with the aim
of encouraging each other to take on challenging reading and dialogue together. A good place to start,
however, can be to read some of the work of colleagues who have written about the impact that
philosophical engagement can have on practice. Hall (2011), for example, has discussed how Kubler-
Ross’ universal stages of grief can serve as a social construction which diminishes the diversity of
responses that we find in clinical practice. Breen and Darlaston-Jones (2010) have written a wide
ranging critique of the positivist hegemony in Australian psychology, calling for greater methodological
diversity in our research endeavours.

Conclusion

As clinical psychologists we have inherited a long history of drawing on a wide range of

inspirations, incorporating philosophical thought into our practices and putting them to the test. Our
hope is that this introductory essay will remind us of our status, both as science and a form of applied
philosophy, allowing for our continued engagement with a diversity of ideas.

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References

Anderson, H., & Goolishian, H. (1992). The client is the expert. In S. McNamee & K. J. Gergen (Eds.).
The Social Construction of Therapy (pp. 25-39). Newbury Park, CA: Sage.

Arch, J., & Craske, M. (2008). Acceptance and commitment therapy and cognitive behavioral therapy
for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology-Science
and Practice, 15, 263-279.

Baer, D., Wolf, M., & Risley, T. (1968). Some current dimensions of applied behavior analysis. Journal
of Applied Behavior Analysis, 1, 91-97.

Breen, L., & Darlaston-Jones, D. (2010). Moving beyond the enduring dominance of positivism in
psychological research: An Australian perspective. Australian Psychologist, 45(1), 67-76.

Cecchin, G., Lane, G., & Ray, W., (1992). Irreverence: A strategy for therapists' survival. London: Karnac
Books.

Curtis, A. (2002). The century of self. British Broadcasting Corporation.

Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Stuart.

Foucault, M. (1980). Power/knowledge: Selected interviews and other writings, 1972-1977. Brighton:
Harvester Press.

Gergen, K. (1985). The social constructionist movement in modern psychology. American Psychologist,
40, 266–275.

Hall, C. (2011) Beyond Kübler-Ross: Recent developments in our understanding of grief and
bereavement. InPsych, 33 (6).

Ingelby, D. (1986). Professionals as socializers: The `Psy complex`. Research in Law, Deviance and Social
Control, 7, 79-109.

Kuhn, T. (1962). The structure of scientific revolutions. Chicago: University of Chicago Press.

Little, M., Jordens, C., & Sayers, E. (2003). Discourse communities and the discourse of experience.
Health, 7(1), 73-86.

Mueller, G. (1958). The Hegel legend of 'Thesis-Antithesis-Synthesis'. Journal of the History of Ideas,
19, 411-414.

Norcross, J. (2011). Psychotherapy relationships that work: Evidence-based responsiveness. New York:
Oxford University Press.

Rhodes, P., and Conti, J. Page 6 of 7

 Australian Clinical Psychologist Volume 2  Issue 1  20111
ISSN 2204-4981

Parker, I. (1992). Discourse dynamics: Critical analysis for social and individual psychology. London:
Routledge.

Parker, I. (Ed.). (1999). Deconstructing psychotherapy. London: Sage.

Popper, K. (1963). Conjectures and refutations. London: Routledge.

Robertson, D. (2010). The philosophy of cognitive-behavioural therapy (CBT): Stoic philosophy as

rational and cognitive psychotherapy. London: Karnac Books.

Sackett D., Rosenberg W., Gray J., Haynes R., & Richardson, W. (1996). Evidence based medicine: What
it is and what it isn't. British Medical Journal, 312, 71-2.

Sampson, E., (1993). Identity politics: Challenges to psychology's understanding. American

Psychologist, 48(12), 1219-1230.

Seikkula, J. (2002). Open dialogues with good and poor outcomes for psychotic crises: Examples from
families with violence. Journal of Marital and Family Therapy, 28(3), 263–274.

Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keranen, J., & Lehtinen, K. (2006). Five year
experience of first episode nonaffective psychosis in open-dialogue approach: Treatment
principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16(2), 214–
228.

Vermeulen, T., & van den Akker, R. (2010, July 15) Notes on modernism: What is modernism?
(Editorial). Retrieved from http://www.metamodernism.com/2010/07/15/what-is-
metamodernism/

Wetherell, M., & Potter, J. (1992). Mapping the language of racism. Discourse and the legitimation of
exploitation. London: Harvester Wheatsheaf.

Witmer, L. (1996). Clinical Psychology. American Psychologist, 51(3), 248-251.

Rhodes, P., and Conti, J. Page 7 of 7