Psychotherapy as Cultivating Character

Duff R. Waring argues that, in some instances, psychotherapy should be viewed as healing (or alleviating) mental disorders and also as cultivating good character in patients (Waring 2012). In these instances, psychotherapists should understand their patients as having character faults that are manifested as mental disorders, as having nascent virtues they can build on during therapy, and as moving toward goals that can be specified in terms of both improved mental health and greater moral virtue. Waring’s discussion is deeply illuminating, but it suffers from a major difficulty: the failure to take adequate account of the differences between the perspectives of third-party observers of therapy and of psychotherapists as participants in therapy.

Waring uses the example of a thirty-five-year-old man with a serious anger management problem. The man simmers with hostility, periodically erupts in violence at slight provocation, has obsessive thoughts of hitting others and being hit, feels persecuted by the world, takes great offense at minor slights, drinks to excess, and is twice divorced by women who became alarmed at his drinking and violence. The man feels shame and guilt about his behavior, and he suffers from chronic self-loathing and episodic depression. According to Waring, the man displays both mental disorders and moral flaws, both personality disorders and character faults. Moreover, the same patterns of behavior, emotions, and thinking are evidence for both the mental disorders and the moral flaws. In terms of mental disorders, he might fit the criteria (depending on further details) for Antisocial Personality Disorder, Borderline Personality Disorder, Impulse Control Disorder, Substance Abuse Disorder, and some type of Depressive Disorder. In terms of morality, we can say he lacks the virtues of self-respect, self-love, self-control, empathy, respect for others, and responsibility.

Likewise, the aims of therapy can be specified as simultaneously moral and mental health matters. In terms of mental health, the goals are to remove or alleviate his mental disorder and, more positively, to help him improve his skills in controlling his anger (and drinking), to increase his self-esteem, to improve his ability to relate with other people, and to exercise greater personal autonomy. In terms of morality, the goals center on moral self-development by increasing his self-control over his anger and drinking, his self-respect and self-love, his capacities for empathy and his ability to respect others, and his acting with greater moral responsibility.

Finally, the process of moving from problems to goals is a shared therapeutic activity that builds on and expands the patient’s autonomy, and simultaneously a shared moral endeavor that builds on and improves the patient’s nascent virtues in the direction of greater virtue. In understanding this process and its aims, we need a theory of virtue ethics that is psychologically realistic, especially in understanding moral goals in terms of what is morally satisfactory rather than ideally good, and that celebrates moral diversity in how the virtues are implemented in good lives. To this end, Waring invokes and insightfully applies Christine Swanton’s ethical theory (Swanton 2003).

Waring is recommending what I call an integrated moral–therapeutic perspective: morality and psychotherapy are overlapping and interwoven rather than mutually exclusive (Martin 2006). In particular, the same features of the man’s behavior, emotions, and cognition can be viewed through the lenses of health and morality. The situation is in some respects like looking at the familiar duck–rabbit drawing so as to see it as a duck or as a rabbit. For example, just as the same dot in the drawing can be seen as the eye of a duck or the eye of a rabbit, so the man’s violence can be seen as part of a moral fault or mental disorder. Again, just as the two interpretations of the dot are semantically connected via “eye,” the moral and health perspectives have some direct overlaps; for example, the terms “self-respect,” “self-esteem,” and “self-love” all convey both healthy and morally appropriate self-regard.

Waring’s Janus-faced vision (to switch metaphors) is far too rich to...