Psychotherapy and Hermeneutics Research Paper

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Well into the 1970s the atmosphere in the field of psychotherapy was characterized by a war of the schools. Psychoanalysis in its various forms, the humanistic movement, behaviorism, and cognitive therapy were the major players in a battle that included an ever growing number of contenders. The main assumption was that one theory was right and all the others were wrong; the question was which one would carry the day.

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The statistical meta-analyses of psychotherapy outcome studies produced a result that called this basic assumption into question. It turned out that by and large all psychotherapeutic methods were helpful, and that the theory and technique applied was a very poor predictor of outcome. The question therefore became what metatheoretical framework could make sense of what seemed a conundrum: It simply didn’t seem to matter how you worked. If anything it was important that client and therapist had a good rapport, and that the therapist had some convincing narrative framework that made sense of the client’s suffering and problems (e.g., Orlinsky and Howard 1986).

This in turn squared well with positions taken by anthropologist Claude Levi-Strauss ([1949] 1963) and psychiatrist Jerome Frank (1963). Both claimed that twentieth century Western psychotherapy was just a subcase of practices that were to be found in almost every existing culture. Levi-Strauss’s classic paper argued that the shamanic healer and the psychoanalyst did essentially the same thing: They integrated meaningless and therefore frightening phenomena into a symbolic system. Frank’s model was that psychotherapy included three factors: a socially established status of healer, a myth or narrative that was applied to the patient’s condition, and a ritual that structured the application of the myth to the patient’s condition. Essentially the difference between Western and other forms of therapy only concerned the institutions that conferred status of healer ship, the myths that were applied, and the rituals that were enacted. These theoretical positions foreshadowed the empirical result of psychotherapy research. It turned out that a hermeneutic understanding of psychotherapy was one of the better candidates to present the profession with a new self-understanding.




1. The Nature And History Of Hermeneutics

Hermeneutics originally denoted the discipline of interpreting texts. The place of origin of hermeneutics was the interpretation of the holy scriptures of the various religions, which entailed a variety of problems: how to derive laws from texts, and how to find out what the—presumably divine—intention behind the text was. There were several attempts to codify hermeneutic rules that were guided by specific religious, political, and social needs. The assumption of classical hermeneutics was that there was one right interpretation; the question was how to reach it.

It was in the nineteenth century, with the rise of philology and the Geisteswissenschaften as academic disciplines that methodological self-reflection of hermeneutics achieved a different turn. The sharpening of historical consciousness made it evident that the model of the one meaning behind the text (determined by the author’s intention) was problematic. Furthermore it became evident that interpretation varied according to the historical position of the interpreter.

In the twentieth century the groundwork for philosophical hermeneutics was laid by Martin Heidegger’s Being and Time ([1927] 1962). In it Heidegger claimed that the idea of the human subject as a mind contemplating the world was flawed and misleading. Human beings were primarily involved in what he called ‘being-in-the-world.’ This mode of being involved a pre-reflective interpretation of the world within which subjects projected themselves into a future on the basis of an understanding of their past. Interpretation was therefore not an activity confined to the reading of texts, but was essential to the human condition as such. There could be no such thing as meeting an object (or another subject) outside an interpretive framework. This preunderstanding was not created by individual subjects through conscious intention. Instead it was the horizon within which all action and understanding took place.

Heidegger’s student Hans-Georg Gadamer can be credited with having written the major text of philosophical hermeneutics, Truth and Method ([1960] 1975), taking Heidegger’s ideas as its foundation. Gadamer claimed that human beings always lived within a horizon of intelligibility, a preunderstanding that guided their whole mode of being. The understanding of texts was just a special case of the activity of understanding essential to human life.

The question of interpretation did not arise if two subjects moved in the same horizon of intelligibility. Understanding each other was then a matter of course as in everyday interactions with people and texts (like newspapers or bank statements). Interpretation becomes problematic only when the speaker’s (or author’s) and the listener’s (or reader’s) horizon or intelligibility diverges.

If they did, the reader needed to integrate the text into his or her own horizon of intelligibility, as there can be no understanding outside this context. But in doing so, the reader expands this very horizon of intelligibility. If for example contemporary readers try to understand a Platonic dialogue, they may find out that their horizon of intelligibility simply does not fit some of the assumptions needed to make the Platonic text intelligible. They may therefore try to reconstruct the horizon of intelligibility implicit in the Platonic text.

By doing so, they may come to the point of understanding Plato better than Plato understood himself. Plato (like any one of us) could not be fully aware of the horizons of intelligibility, the preunderstanding of the world that made his world and his life meaningful. Human beings are never completely transparent to themselves, as we are embedded in historical contexts that are not fully understood.

Historical distance therefore creates both the necessity for interpretation and the perspective that allows the interpreter to understand aspects of meaning that were not accessible to the author. At the same time the activity of interpretation also changes the interpreter. The integration of historically (or culturally) distant horizons of intelligibility makes the interpreter more conscious of his or her own point of view, and thus changes and widens it.

Philosophical hermeneutics provided an interpretive frame that made it clear why there could never be a final understanding of any text. Every historical period, and every cultural position, needs to integrate texts and cultural practices that are historically or culturally distant into its own horizons. The interpretive act is therefore much closer to a dialog between interpreter and text (or cultural practice) than to the unearthing of a pre-existing meaning.

2. Hermeneutics And Psychotherapy

The hermeneutic approach to psychopathology and psychiatry was already introduced at the beginning of the twentieth century primarily through Karl Jaspers (1913) and the existential school of psychotherapy. The latter (Ellenberger and May 1958) was primarily based on the direct application of Heidegger’s philosophy to the understanding of psychopathology. Psychotherapy was essentially viewed as the elucidation of the patient’s modes of being-in-the-world. The point of psychotherapy was therefore to interpret and change the patients’ interpretation of their Lebenswelt.

The European existentialist tradition in psychotherapy lost its cohesiveness as a movement, and philosophical hermeneutics began to be reapplied to psychotherapy within psychoanalysis first in Europe: Paul Ricoeur ([1965] 1970) in France, Jurgen Habermas (1971) in Germany, and then in the USA, Donald Spence (1981) and Roy Schafer (1983). Their common denominator was to argue that psychoanalysis had misunderstood its own nature by formulating itself in terms of a natural science model.

Psychoanalysis, they argued, was not a theory that discovered causal laws that connected between childhood events and psychopathological symptoms. It was the activity of helping patients to make themselves intelligible to themselves (Strenger 1991).

Schafer and Spence used literary theory in addition to hermeneutics in their attempt to clarify the nature of psychoanalysis. In Schafer’s model patients are seen as those whose narrative of themselves is overly narrow, simplified, and closed. This narrative (the term would correspond to Gadamer’s ‘preunderstanding’) narrows down the patient’s options of living, because life, human encounters, and actions are interpreted in overly rigid terms (e.g., ‘every interaction is a powerstruggle’).

Psychoanalytic interpretation in this view is not the uncovering of a historical cause or pre-existing unconscious wish. It is the making explicit of the patients’ interpretation of their world, their mind, and their interpersonal relationships. In other words: The object of psychoanalytic interpretation is the patient’s self-interpretation. Its goal is to change this interpretation by making it conscious. The very act of making it conscious will lead to a change of the patient’s self-interpretation.

In this manner Schafer achieved two objectives: first he freed psychoanalysis from the need of extraclinical validation of causal claims (e.g., unresolved Oedipal issues lead to psychoneurotic symptoms). Second, he made it possible to understand why analysts of different theoretical orientations would come to interpret the patient’s mental life in different terms. In Gadamer’s terms the analyst could only work from a particular horizon of intelligibility. Understanding the patient always meant the integration of the patient’s self-understanding into a new horizon of intelligibility.

Quite quickly the application of the hermeneutic point of view began to spread to other psychotherapeutic approaches. Collections like Hermeneutics and Psychological Theory (Messer et al. 1988) showed that the hermeneutic point of view was, in fact, fruitfully applicable to almost every discipline in psychology. Anything from behavioral-cognitive through family therapy to social psychology could be reinterpreted in hermeneutic terms.

Since the 1990s the term ‘hermeneutics’ has not often been used explicitly in the psychotherapeutic literature. Nevertheless it could be said that its tenets have turned into something like a metatheoretical implicit consensus in the field. Most authors implicitly or explicitly assume that psychotherapy intervenes in the patient’s meaning system. Furthermore it has become something like an implicit orthodoxy to accept that there are always many ways to construe the patient’s experience.

The hermeneutic understanding of psychotherapy tends to go along with a constructivist understanding of psychotherapeutic activity: Psychotherapy does not uncover (or change) the single cause of symptoms, maladaptive character traits, feeling states, etc. It reinterprets the patient’s actions, thoughts, and emotions in new terms. It is taken to be a matter of course that it is conceptually impossible to specify one correct such construal, since construals of the world are always perspectival (cf. Stolorow et al. 1987).

There are two major beneficial implications of the hermeneutic understanding of psychotherapy: first, it has led to a more ecumenical atmosphere in the field. The wars of the schools are largely over, and instead different approaches can enter fruitful dialogs. Second, it has led to greater sensitivity to the patient’s right to a subjectivity of his or her own. If all psychotherapy is hermeneutic construction, it is not fruitful and legitimate to impose such construal on the patient. Current writers (e.g., Aron 1996, Strenger 1998) emphasize the necessity of turning the psychotherapeutic interaction into a more egalitarian and dialogical activity.

Meanwhile there have been extensive efforts to detect trends that favor some forms of therapy for particular disturbances (e.g., Roth and Fonagy 1996) that seem to reverse the original verdict that theory and technique do not make any difference whatsoever (e.g., obsessive-compulsive disorder favors a combination between cognitive-behavioral therapy and antidepressant medication; generalized, nonspecific character disorders favor interpersonal and psychodynamic approaches; see Psychological Treatments, Empirically Supported ). Nevertheless these efforts have maintained the ecumenical trend in psychotherapy. The hermeneutic understanding of the nature of psychotherapy as an activity that generates meaning might well continue to serve as a framework that will enable the continuation of this discussion under the aegis of cooperation rather than competition between schools.

References:

  1. Aron L 1996 A Meeting of Minds. Mutuality in Psychoanalysis. Analytic Press, Hillsdale, NJ
  2. Ellenberger H, May R (eds.) 1958 Existence. Basic Books, New York
  3. Frank J D 1963 Persuasion and Healing. Johns Hopkins University Press, Baltimore, MD
  4. Gadamer H-G 1960/1975 Truth and Method. Seabury Press, New York
  5. Habermas J 1971 Knowledge and Human Interest. Beacon Press, Boston
  6. Heidegger M 1927/1962 Being and Time. Harper and Row, New York
  7. Jaspers K 1913 Allgemeine Psychopathologie. J. Springer, Berlin
  8. Levi-Strauss C 1949/1963 The effectiveness of symbols. In: Structural Anthropology. Basic Books, New York, Vol. 1
  9. Messer S B, Sass L A, Woolfolk R L (eds.) 1988 Hermeneutics and Psychological Theory. Rutgers University Press, New Brunswick, NJ
  10. Orlinsky D E, Howard K I 1986 Process and outcome in psychotherapy. In: Garfield S L, Bergin A E (eds.) Handbook of Psychotherapy and Behavior Change, 3rd edn. Wiley, New York, pp. 311–84
  11. Ricoeur P 1970 Freud and Philosophy. Yale University Press, New Haven, CT
  12. Roth A, Fonagy P 1996 What Works for Whom. Guilford Press, New York
  13. Schafer R 1983 The Analytic Attitude. Basic Books, New York
  14. Spence D P 1981 Narrative Truth and Historical Truth, 1st edn. Norton, New York
  15. Stolorow R D, Brandchaft B, Atwood G E 1987 Psychoanalytic Treatment, An Intersubjective Approach. Analytic Press, Hillsdale, NJ
  16. Strenger C 1991 Between Hermeneutics and Science. An Essay on the Epistemology of Psychoanalysis. International Universities Press, Madison, WI
  17. Strenger C 1998 Individuality, the Impossible Project: Psychoanalysis and Self Creation. International Universities Press, Madison, WI
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