Virtue and Psychotherapy

Professor Waring achieves in his recent piece, “The Virtuous Patient: Psychotherapy and the Cultivation of Character,” an original contribution to that long-standing tradition of scholarship that has examined the relationship between values, meaning, spirituality, ethics, and morality, on the one hand, and the practice of psychotherapy and psychiatry, on the other.

Of course, there is a long history of recognition that psychotherapy is not value-free and that a narrow scientific perspective may fail to provide a sufficient framework to encompass the entire purview of psychotherapy. Committed scientific materialist though he was, even Freud (1926) in his later years came to believe that a medical education was actually a hindrance to developing psychoanalytic skill. For the practicing psychoanalyst he offered the term Seelsorger (literally “one who cares for souls” but sometimes translated as “pastor” or “minister”) as an appropriate appellation for psychoanalysts. Jung (1933) explicitly referred to the psychotherapist as a secular cleric, a notion that was endorsed later by numerous others who argued there is a lack of clear distinction between the roles of therapists and clergy, because both provide counsel in the choosing of life goals and in the resolving of morally laden problems of living (Lowe 1959; Murphy 1955). Also, there has been wide recognition that traditional systems of morality, on the one hand, and psychology and psychotherapy, on the other, offer alternative and often competing accounts of the same social and psychological phenomena (Bergin 1991; Vitz 1977; Wallach and Wallach 1983).

Virtually all of those who made original and significant contributions to psychotherapy—for example, Freud, Ellis, Rogers, Horney, Beck, Wolpe, and Perls—considered themselves to be discoverers of objective, empirical knowledge and viewed psychotherapy as an evaluatively neutral application of that objective knowledge to healing, growth, or behavior change. They did not see themselves as moralists. Early discord between psychotherapy and conventional values and practices was regarded by most therapists as a clash between a modern, scientific understanding of psychological health and reactionary forces of superstition and ignorance. In Civilization and Its Discontents, Freud (1930) described the conflict between the dictates of psychotherapy and those of conventional morality:

We are very often obliged, for therapeutic purposes, to oppose the super-ego, and we endeavor to lower its demands. Exactly the same objections can be made against the ethical demands of the cultural super-ego.

(108)

Among the innovators, only Ellis, Jung, and the existentialists anticipated the conclusion forced upon us by the frequent reappearance in the contemporary literature (Cushman 1995; Fancher 1995; Lakin 1988) of the conclusions of numerous mid-twentieth century critiques (London 1964; Lowe 1959; Rieff 1959): far from being a value-free endeavor, psychotherapy is a morally laden enterprise whose theories presuppose viewpoints both on ideal human functioning and on human peccability. As Margolis put it:

[Psychotherapy] is concerned with influencing changes in human action and motivation, a matter that ordinarily falls within the domain of morality. . . . The enterprise of psychotherapy, whatever the variety in doctrinal conviction, clearly presupposes a set of values in the name of which the alteration of the lives of patients is undertaken.

(1966, 25)

It is not difficult to recognize the moral dimensions of an avowedly philosophical approach to psychotherapy, such as existential therapy, which views itself, in part, as an anti-scientific antidote to the discontents of modernity and explicitly endorses a stance of courage and commitment in the face of the uncertain purpose and meaning of our being-in-the-world. The evaluative components of therapies that strive for scientificity and value neutrality are more difficult to pinpoint. However, every form of therapy comprises prescriptive, as well as descriptive, elements. Every system of therapy has an underlying ideology (Woolfolk and Richardson 1984; Woolfolk 1998). A therapy may disclose its aesthetic, cognitive, and moral values through the explicit location of thought and conduct on the continuum of health and sickness. Or values may operate tacitly in influencing patterns of therapeutic exploration, in establishing the grounds for therapeutic intervention, or in promoting implicit guidelines for the attitudes and conduct of clients. Each system of therapy has its apotheoses...