Monday, July 19, 2010

Julian Baggini Assesses the Mental Health of Philosophical Counseling

Julian Baggini takes a look at the status of a little known area of mental health counseling, Philosophical Counseling, a kind of existential approach to psychotherapy, except that it's done by philosophers.

This comes from The Philosophers' Magazine, where Baggini is the editor.

Counsel of despair?

Julian Baggini assesses the mental health of philosophical counselling


There’s a new kind of philosophy on the rise. “More and more philosophers are leaving their departmental coffee rooms to offer ‘philosophical counselling’,” reports Times Higher Education, saying that there has been a “flood of interest from academic philosophers hoping to ply their trade.” And trade sounds good. “Many people are turning to philosophical counsellors,” says the Observer. It’s “booming” says the Independent.

The only problem is, those reports are from June 2000, November 2004 and October 2005 respectively. Indeed, I even contributed to the hype myself: in 1999, I wrote in the Times Education Supplement that “The past few years have seen an explosion in ‘philosophical practice’.” If so, like a backfiring exhaust, the bang was deceptively loud.

Philosophical counselling (PC) usually claims a pedigree stretching back to Ancient Greece, but it is generally taken to have begun in earnest as a distinct discipline in 1981, when its German founder Gerd Achenbach opened his practice near Cologne. A year later he founded the International Society for Philosophical Practice (ISPP). Around the world, like-minded individuals gradually began to form themselves into national organisations. The Dutch Association for Philosophical Practice (VFP) was formed in 1989, the UK’s Society for Philosophy in Practice (SPP) was founded as the British Society of Consultant Philosophers in 1998, and The American Philosophical Practitioners Association was established in 1999. These bodies typically exist to promote not only PC, but also philosophy for children, “Socratic dialogue” and other practical applications of philosophy.

Today, however, all these organisations remain very small. The Dutch VFP has 137 members, but only six or seven practising as full-time philosophical counsellors, and a further 40 registered and working part-time or not at all. There are still only eight practitioners on the register of the SPP in Britain, with a handful of others doing what they call philosophical practice outside its aegis. The APPA lists over 130 certified practitioners in more than 30 states, in a country of 300 million people and 50 states, but not all are active and only a handful practice full-time.

So what is the real state of philosophical counselling and why has it so far failed to move in from the fringes? To answer that, you first have to say what philosophical counselling is, and that’s not entirely clear. As with most new movements, the vanguard is a somewhat loose assemblage of people who have different visions of what the future should be. The broad picture is fairly clear. “Philosophical counsellors use philosophical skills and insights to help clients resolve issues in their personal and professional lives,” says the SPP. “A philosophical counsellor can help you examine your life, and your philosophy of living,” says the APPA. “By leading a more examined life, you may find new ways to resolve or manage your problems.”

However, these definitions are a little ambiguous and leave room for very different interpretations. In particular, should philosophical counselling be seen as essentially therapeutic, or is it simply a matter of investigating your world-view? Different practitioners pitch their services differently. “Philosophical Counselling is based on the use of philosophy as a therapeutic tool,” says Gerald Rochelle, while Stephen Christie says it is “an exploration of your world-view,” and Shlomit Schuster describes her approach as “a ‘free place’ where persons use philosophy to develop their own thoughts on relevant subject matters.”

These differences are sometimes a matter of emphasis, but they can also reflect deeper disagreements about the similarities and differences between philosophical counselling and therapy. Scepticism or outright hostility towards the use of drugs to manage mental well-being is widespread among philosophical counsellors. Lou Marinoff wrote a book called Plato not Prozac, and when he talks about the use of drugs to manage mental health, he uses “we” not “I”, speaking for his colleagues as well as himself. “We are saying that society as a whole is over-diagnosed and over-medicated,” he told me, “because it’s really about drug consumption, it’s not necessarily about health. Pharmaceutical companies are not interested in health they’re interested in your drug consumption.”

However, although strong scepticism about the value of anti-depressants is common among philosophical counsellors, it is not universal. There is even more disagreement about whether there really are diagnosable “conditions” such as depression, and whether philosophical counsellors are the best equipped to alleviate the kind of mental distress psychotherapists have traditionally tried to deal with. Some, such as Schuster, reject most psychotherapy more or less outright.

Others, however, take the view that psychotherapists have an expertise which people trained only in philosophical counselling lack, and should not seek to substitute for. “Philosophy obviously can be therapeutic but I think pure philosophical counselling is better restricting itself to issues more obviously amenable to philosophical methods,” says Tim LeBon, former chair of the SPP and the founding editor of its journal, Practical Philosophy. “So I would suggest that philosophical counsellors not trained in other forms of therapy should limit themselves to such topics as moral dilemmas, conceptual confusions, decisions, questions of value, and meaning and purpose in life. This list isn’t exhaustive, but I don’t think that pure PC should claim to be able to treat psychiatric disorders. Of course there is a grey area with cases such as mild depression or mild anxiety or problems with anger – all of which may be helped by seeing a philosopher – but I would argue that someone trained in psychotherapy who also has philosophical skills would be in a much better position to deal with many of these cases.”

The lack of clarity about philosophical counselling’s role in relation to psychotherapy is partly about real disagreements and partly presentation. Although almost all philosophical counsellors would say they are doing something different from psychotherapy – whether as an alternative or as something just different – in adopting many of the conventions of therapy they have inevitably ended up looking like a version of it: the term “counselling” became standard; the SPP and AAPA both talk of resolving issues or problems; practitioners have one-to-one meetings with clients that look superficially at least to be just like counselling sessions.

Lou Marinoff, president of the APPA, appears to embody these ambiguities. When I spoke to him in London recently, he said clearly that “We’re not competing with psychotherapists and we never were. And we’re not attempting to treat mental illness, we’re not attempting to treat anything, and we’re not dealing with people who are emotionally disturbed.” But in the same conversation he said “a lot of psychologists are opting out of the insurance system because of the bureaucracy and paperwork and just lowering their rates, so we’re now more competitive in that arena.” So is he in competition with psychotherapy or not?

These questions are not trivial or nit-picking, because one of the decisions philosophical counselling has to take is whether it should concentrate on building itself as a distinct discipline or whether it should see itself as enriching the practices of other modalities of psychotherapy and counselling. Marinoff is quick to point out that it’s not an either/or choice, and he is for “both/and”. LeBon agrees. “There are a number of people I know who have trained as philosophical counsellors and then gone on to work as philosophically-informed psychotherapists, psychologists or even hypnotherapists, using philosophy as an extra string to their bow,” he says. “Personally I have gone down this path too, training in existential and cognitive therapy, and I think this puts one in a much stronger position to treat the whole person, not just the bit that is amenable to philosophical argument. My book Wise Therapy advocates this approach and other people in the field such as Elliot Cohen agree that a way of working that integrates the best of philosophy and psychology is more powerful than either alone.”

The debate over whether this is the right way forward is one of the biggest in the fledging field. LeBon and Cohen have thus far been in the minority. LeBon says that the likes of Ran Lahav, Peter B. Raabe, Shlomit Schuster and Gerd Achenbach all agree that philosophical counselling should be “a ‘go-it-alone’ discipline which makes itself very distinct from psychology.” However, it seems that the APPA is moving more towards an embrace of integrative approaches.

“We welcome certified psychologists, psychiatrists, doctors, lawyers, social workers,” Marinoff tells me, describing the APPA’s affiliates programme. “Any co-professional who is licensed by a state to render some kinds of services, if they have philosophical interests and they want to develop philosophical tools that they can incorporate into their own practice, we will now admit them to a certification programme. We started this two years ago and we’ve got more than forty certified affiliates, and that shows that there are lots of people in these other professions who have had philosophical interests that have been neglected in their own professional development.”

Marinoff talks a good talk about the growth and future of philosophical counselling, but then he has been doing so for the ten years of the APPA’s existence and before. So what would actually take the discipline to “the next level” as he puts it?

“Personally from the beginning I’ve been convinced that we need a postgraduate programme in philosophical practice in order to further our aspirations as a profession and to be on a level playing field with the other professions. That has not happened in the US but we’re getting closer.” This is consistent with Marinoff’s long-held view that to be a viable profession, PC needs all the trappings of a profession, including certification and regulation. Many others disagree, but in America, it seems the majority have backed the APPA’s “professionalising” strategy, with varying degrees of enthusiasm.

Nevertheless, even Marinoff talks down the idea that PC could ever rival psychotherapy in popularity. “I think empirically there are always going to be more patients for psychotherapists than there will be clients for philosophers. If you look at the numbers in universities, most psychology departments are larger than most philosophy departments, more students major in psychology than major on philosophy. Similarly you see that disparity reflected in our client base. So I don’t think philosophical counsellors will ever attract the same numbers of clients in raw numbers as psychologists. I simply think it’s a very difficult discipline and it’s difficult for people to be clients in some ways. There are very thoughtful people out there who simply aren’t helped by other things and really want to be philosophical about their lives. And we exist to help them.”

LeBon thinks that philosophical counselling has got to do a better job at communication. “One of the problems is that whilst philosophical counsellors recognise that philosophy is a potentially practical and useful discipline, this isn’t how many of general public or counselling service providers (e.g. within the NHS) perceive it. Philosophy has still got a lot of persuading to do about its practical relevance and efficacy. Moreover, not many people know about PC, so even those who would be sympathetic to it don’t end up seeing a philosophical counsellor. So philosophical counselling needs to get itself better known.”

The issue of efficacy is one he returns to. “Philosophy for Children provides a useful comparison – I am sure its current success in the UK owes a lot to the research findings suggesting its efficacy. PC needs something similar.”

But this begs at least two questions. First, what would it mean for PC to be efficacious, especially if it is not promising straightforward therapeutic outcomes? There’s a potential catch-22 here: in order to be distinctive, it has to be shown to offer something different from psychotherapy; but in order to be credible, it has to demonstrate outcomes that can surely be measured only within the medical paradigm of treatment and outcomes. Second, LeBon seems very confident that philosophical counselling is indeed efficacious, but that is precisely what has not been shown. Proper research might not deliver the results he is expecting

Philosophical counselling’s failure to really take off thus far should not in itself be taken as an indication of any inherent failings. It is still a very new discipline, and as such may well need decades to emerge fully-formed. In some ways it would be odd if something like it did not establish itself: surely a lot of philosophy must be of help to people in resolving some problems of living. Perhaps the field hasn’t found the right paradigm yet, or maybe it just needs the right individual to bring it to the wider culture. Or perhaps, in an ironically Freudian way, trauma in its infancy is preventing its proper maturation. Only time will tell. Philosophical counselling has not yet delivered on its promise, but it hasn’t yet broken it either.

Julian Baggini is editor of tpm.

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