Another philosophical counseling conference paper.
THE NORTH AMERICAN CONFERENCE ON PHILOSOPHICAL COUNSELLING
Morals and Ethics in Philosophical Counselling
Saint Paul University, 223 Main Street, Ottawa, Ontario, Canada K1S 1C4
Date: November 1-3, 2002
It was quite a nice conferece, although I recall people were annoyed with me for not being sufficiently enthusiastic or optimistic about philosophical counseling.
The Limits of Philosophical Knowledge: Implications for Philosophical Counseling
The goal of philosophical counseling is to help individuals or groups sort through problems they face in their everyday lives. These problems can be ethical, epistemological, existential, metaphysical or conceptual. There are two central difficulties for the project of philosophical counseling. The first difficulty derives from the open-ended nature of philosophical debate. It is part of the very nature of philosophy that it focuses on areas of disagreement and controversy, and it is extremely rare for philosophers to achieve consensus on any issue. If no philosophical theory is generally accepted, then no philosophical theory will be very helpful to people trying to work out what they should do when facing a real life problem, because we cannot know which philosophical theory is the right one with any degree of assurance. The second difficulty is that of deriving recommendations from philosophical theories. Even if we restrict our attention to a single philosophical theory, one generally finds that when considering real life cases, it is very difficult to derive a substantive implication from the theory concerning the case. This problem has been discussed extensively in the literature on the foundations of medical ethics in the debate between principlism, rule-based approaches, and casuistry. I argue that these two difficulties exist also for anyone attempting to teach a course in "applied philosophy," and I discuss my own experience in attempting to design and teach courses that make philosophy helpful to students. I conclude that philosophers should be very careful in their claims that philosophy can be useful in decision-making when facing everyday problems. The most they should claim is that philosophy can help people to inspect the range of choices available to them, to understand the different points of view on the choices they face, to justify their choices once they start from their assumptions, and to be aware of the contingency of their own choice.
The goal of a great deal of philosophical counseling is to help individuals or groups sort through problems they face in their everyday lives. These problems can be ethical, epistemological, existential, metaphysical or conceptual. There are two central difficulties for the project of philosophical counseling that the literature on the subject has neglected. The first difficulty derives from the open-ended nature of philosophical debate, due to nature of which issues cannot normally be settled by empirical observation or scientific experiment. It is characteristic of most of philosophy that it focuses on areas of disagreement and controversy, and it is extremely rare for philosophers to achieve consensus on any issue. If no philosophical theory is generally accepted, then there is a serious danger that no philosophical theory will be very helpful to people trying to work out what they should do when facing a real life problem, because we cannot know which philosophical theory is the right one with any degree of assurance.
Indeed, even where philosophers have reached a good deal of consensus, the general public may well be reluctant to adopt the view recommended by philosophers. The clearest example of this concerns the metaphysical issue of the nature of the mind. Most participants in the current debate in the philosophy of mind agree that substance dualism associated with Rene Descartes is highly implausible, largely because the suggestion that the mind is composed of a non-physical substance has very little explanatory value and leaves unexplained crucual questions such as the nature of the interaction between mind and body, the justification in our beliefs in other minds, and why there should be one and only one mind associated with each human body. Nevertheless, substance dualism remains a popular theory among the general public, for whom it often associated with religious beliefs about life after death. The philosophical worries about substance dualism make very little difference to ordinary people. When it comes to most other issues, the philosophical debate continues and consensus about central issues is rarely achieved. The foundations of epistemology, ethics, metaphysics, and political philosophy remain disputed, and indeed, the very method by which philosophers should set about solving problems is a matter of deep disagreement. Even listing the five most important philosophers of the twentieth century can lead to fierce disputes. Maybe the only matter on which philosophers and the general public could all agree is that there is the deep disagreement about the fundamentals in philosophical debate.
If people are facing particular problems in their everyday lives, they generally need to come to a decision in a limited amount of time. Then a central question, if philosophy is to be useful to people in such circumstances, is how people can make a decision when faced with such a lack of resolution about the right perspective or theory. A further worry facing both philosophical counselors and teachers of philosophy as applied to the real world, especially when dealing with time constraints, is how to present a balanced and fair picture of the philosophical views on the issues in question, and to what extent it is problematic to openly or implicitly to favor one view over others.
The second difficulty I want to discuss here is that of deriving recommendations from philosophical theories. Even if we restrict our attention to a single philosophical theory, one generally finds that when considering real life hard cases, it is very difficult to derive a substantive implication from the theory concerning the case. This problem has been discussed extensively in the literature on the foundations of medical ethics in the debate between principlism, rule-based approaches, and casuistry. There is in the medical ethics literature a thriving discussion of to what extent it is possible to derive concrete conclusions from general ethical schemes when dealing with the complexities of particular cases. Real life cases typically bring with them a daunting complexity of issues, and many ethical considerations come into play. There is certainly no algorithm that will provide concrete recommendations from very general considerations, and some have expressed doubts whether general ethical theories have the ability to provide concrete answers to real life controversies. (For recent discussions of this topic, see the Iltis (2000), chapters 1 and 9 of Beauchamp and Childress (2001), and chapters 7 and 8 of Toulmin (2001).)
My aim here is to discuss how these features of moral philosophy can be dealt with in teaching courses of “applied ethics” to undergraduates, and to explore the extent to which they could be dealt with in philosophical counseling. It is worth noting the extent of my interest and expertise in philosophical counseling: I have over ten years experience teaching courses in ethics and applied ethics, and I have a strong research interest in philosophical issues in clinical psychology; I have attended various conferences on philosophical counseling and have written on the topic (Perring 1998, Perring 2000, Perring, 2001, Perring forthcoming), but I have no experience of working as a philosophical counselor. Indeed, while I wholeheartedly endorse the aim of using philosophical skills and knowledge to help people, I have concerns about the very project of philosophical counseling. As in much of my other writing on the topic, my goal here is to suggest that the problems faced by philosophical counselors have already been worked through in other areas of philosophy, and philosophical counselors would do well to learn from what has gone before. But here my focus is on the lessons learned in the classroom, and philosophers have rarely discussed in print the problems faced by teachers trying to show the ways that philosophy can help people in their everyday lives. So I will turn to my own experience in the classroom.
I have taught undergraduate classes on medical ethics, death and dying, philosophy of psychiatry, genetic ethics, general ethics, critical thinking, and many courses of introductory philosophy organized both by philosophical topic and by historical period. My aim in teaching is to provide students with an understanding of the philosophical debates about the topics on hand, and with skills to express their understanding in debate and in writing, and to form their own opinions on those topics. When a topic has clear relevance to everyday life, I emphasize the process of decision-making and suggest that philosophical training can enable more rational decisions.
Of course, students rarely sign up for such courses in order to help them with immediate problems in their personal lives. They generally take them because they have a prior interest in philosophy or they are required to take them as ways of fulfilling degree requirements. They frequently start out with an assumption that philosophy has little relevance to the “real world” and have very little conception of how a focus on philosophy could help them either professionally or personally. Although I hope that they benefit from taking my courses, and sometimes receive positive feedback from students, I have no solid evidence that these courses do actually improve my students’ decision-making abilities. Indeed, I know of no attempt to measure the beneficial effects of philosophy courses on students, nor of any attempt to measure the effects of philosophical counseling.
Nevertheless, an experience shared by many teachers is that exposing students to a variety of perspectives on controversial issues together with the main approaches to ethical theory can often lead to student confusion and even bewilderment; far from helping them to form opinions, exposure to philosophy can lead to greater indecisiveness. This is an unsatisfactory result for students, although it is probably a good thing to induce greater epistemic humility in some students who previous had strong convictions but little justification for their beliefs, one hopes using philosophy to help students to enable them to come to some decision.
Therefore, when teaching such courses, it is important to address the fact that rational and informed people will come to different conclusions and will form different decisions. There is a strong element of contingency in ethical decision-making, and while this should be a fact that leads to further discussion and investigation to pinpoint the sources of differences and the rational evaluation of each person’s decisions, it does not vitiate the whole decision-making process. Or at least, since the contingency of ethical decision-making is a feature shared by almost all approaches to ethics and seems to be an inescapable feature, only those inclined to skepticism about the possibility of ethical knowledge will find this contingency a highly problematic feature.
It is striking that in the few available descriptions of philosophical counseling, little or no mention is made of the problem of the uncertainty of moral and philosophical knowledge and the contingency of ethical decision-making. For example, Lou Marinoff and Shlomit Schuster both discuss their approaches to problems with clients and give the impression that the application of philosophy to real problems is a relatively simple affair. In Plato, Not Prozac!, Marinoff (1999) outlines his PEACE process, which has the following stages:
1. Identify the problem
2. Take stock of the emotions provoked by the problem.
3. Analyze the available options for solving the problem.
4. Contemplate the entire situation
5. Reach equilibrium.
Marinoff gives very little discussion of the move from stage 4 to stage 5, or of the uncertainties that bedevil difficult decisions. Furthermore, from the clinical vignettes offered in the book, one has strong reason to doubt that clients were offered a comprehensive survey of philosophical discussion that might be relevant to their problems. Often the conclusions the clients reached seem somewhat arbitrary; the main effect of philosophical counseling seems to be the conferring of an arguably bogus sense of justification concerning the conclusion reached. Certainly, it is clear that if a teacher offered such one-side approaches in the context of a philosophy course, the approach would be highly problematic in its incompleteness and possibly biased approach.
It is worth illustrating my point with an example. Marinoff describes a case of a client named Sean (seen by the philosophical counselor Richard Dance). (Marinoff, 1999, p. 106). Sean was concerned whether he should marry his fiancé Patricia: “his underlying themes were having strong opinions, seeing the world in black-and-white, and seeking control. He also tended to overanalyze things yet not quite trust his own decisions (taking, as just one example, the eight-year trial period he found necessary before deciding that Patricia was the woman for him).” (p. 107). In counseling, he learned a meditation technique where the client replays a recent event in which strong feelings occurred, and to look on the event without emotion, analysis, or judgment. Sean learned to restrain himself from expressing strong opinions and criticizing Patricia. The counselor also recommended that Sean evaluate whether his experience bore out the wisdom of Lao Tzu and Heraclitus about the coincidences of opposites, who held that opposites are interconnected, relying on one another to complement their mutual existence. Apparently this assignment was very helpful to Sean in coming to terms with his relationship and reduced the number of arguments the couple engaged in. Setting aside possible reservations about whether there was anything particularly philosophical about the form of counseling provided here, it’s clear that the counselor was extremely selective in his choice of which philosophers to mention in his counseling. From Marinoff’s telling of the exchange, it seems to be a particularly one-sided approach. Philosophy was used in getting the client to become more settled in his choice and happier in his relationship, but one wonders about the application of the idea of the complementarity of opposites to this sort of case. Nothing in the telling of the case assures that reader that the counseling included discussion of the limits of this approach or any evaluation of its rationality. It did seem to provide the client, Sean, with a new way of looking at the world and his relationship, and this apparently was helpful, although one may well wonder whether it wasn’t the effect of pronouncement of the names of some ancient philosophers and the ring of appealing “words of wisdom” that had the beneficial effect rather than Sean’s learning anything new. There’s no question that philosophical counseling may leave some customers pleased with their encounter: my concern is that in passing over the uncertainty of the claims made, the counselor risks misleading the client and offering radically incomplete understanding.
At this stage, I can briefly address a potential objection that may be raised by some philosophical counselors, who insist that philosophical counseling is very different from teaching philosophy. For example, Peter Raabe has surveyed the views on this topic, coming to the conclusion that, “the philosophical counseling relationship may be substantively didactic but that it is not procedurally pedagogic” (2001, p. 24). It is clear that it may be inappropriate in counseling to assign the client reading of philosophical texts, to demand that she write essays or take tests, or to lecture to the client for substantial periods of time. But these differences between classroom teaching and philosophical counseling are irrelevant to my point here. The uncertainty of philosophical knowledge and the difficulty of applying abstract principles to the complex details of real life remain important considerations whenever one is trying to apply philosophy to everyday life, regardless of whether one is using traditional pedagogic methodologies or innovative counseling approaches. Indeed, the problems I am focusing on may be even more pertinent to the morality of philosophical counseling as compared to teaching philosophy. A standard course in philosophy in a north American college involves at least 30 hours in the classroom, with an expectation that students will spend at least another 20 or 30 hours outside the classroom working on homework and preparing assignments. This sustained exposure to philosophical debate nearly always has the effect of driving home the difficulty of fully justifying one’s point of view, and showing students the epistemic problems inherent in the field. But if a philosophical counselor sees a client for only a few sessions, as apparently is typical, there will be far less time to fully explore more any philosophical ideas, and there is far more danger that the client will grasp onto one suggestion or idea mentioned by the counselor and adopt it because it seems to make sense at the time.
The problem I am highlighting has a clear solution. Teachers and counselors should never promise or hint that philosophy can provide certainty or definitive answers to difficult problems. There may be some cases where philosophers manage to substantially agree on answers to philosophical problems, but there is no reason to think this is a general rule. Philosophers should be very careful in their claims that philosophy can be useful in decision-making when facing everyday problems. The most they should claim is that philosophy can help people to inspect the range of choices available to them, to increase sensitivity and understanding of the different points of view on the choices they face, to justify their choices once they start from their assumptions, and to be aware of the contingency of their own choice. This may disappoint some prospective students and clients, but it is necessary if philosophers are to give an honest assessment of what they can provide to the general public.
I want to finish by comparing philosophical counseling with psychotherapy. One might ask whether I am holding philosophical counseling up to a higher standard than psychotherapy normally requires of itself. For it can very plausibly argued that the theories underlying the practice of psychotherapy are in a far sorrier state than philosophical theories, and there is very little good evidence that psychotherapy is more effective in helping people who do not have major mental illness than talking with someone with no specific training or knowledge of psychotherapy. The controversies over the scientific status of psychoanalysis are well known, and other major psychotherapeutic theories have equally problematic foundations. Even for approaches that seem to have the best evidence of effectiveness, such as cognitive behavioral, one might argue that there is limited evidence that the approach will be helpful for a particular individual. Yet psychotherapists do not agonize about the uncertainty of their claims to understand their clients or their suggestions for clients about how to solve their problems. It follows from my arguments that psychotherapists should more openly acknowledge in the therapy that they don’t have strong evidence for the effectiveness of their discipline. An obvious concern this raises is that such a declaration of uncertainty might undermine the therapeutic bond and make the therapy less helpful. That is to say, the client’s belief in the psychotherapist, while maybe not a necessary condition, is at least an enhancement for the beneficial effect of the therapy. However, this concern raises obvious ethical problems: it is a commonplace in medical ethics that patients should always give their informed consent to any medical procedure, and I see no reason why this should not apply equally to psychotherapy. This requires being open about the known efficacy of the treatment, or lack of it. It is also worth entertaining the possibility that one of the reasons that psychotherapy is sometimes viewed with some suspicion by the general public and medical professionals is not so much the weak foundations of psychotherapeutic theory as the fact that psychotherapists have been reluctant to be open and honest about the certainty of their claims to be able to help people. Indeed, being open with a client about the limitations of the evidence for the beneficial effects of therapy might not undermine the therapeutic project, since a great deal may depend on the manner in which this information is conveyed. Indeed, openness and honesty could inspire greater trust in the therapist on the part of the client.
Similar points can be made about honesty within the relationship between philosophical counselors and their clients. If counselors are straightforward with clients about the fragility of philosophical knowledge, then far from undermining the enterprise, this could enhance the relationship. Finally, an open humility about the experimental nature of the burgeoning profession of philosophical counseling would, I suggest, be likely to win it more allies among professional academic philosophers.
Beauchamp, Tom L. and James F. Childress. Principles of Biomedical Ethics. Fifth Edition. New York: Oxford University Press, 2001.
Iltis, Ana Smith (editor). “Specification, Specified Principlism and Casuistry.” The Journal of Medicine and Philosophy. 2000: 25:3.
Jopling, David A. “‘First do no harm’: Over-Philosophizing and Pseudo-Philosophizing in Philosophical Counselling”. Inquiry: Critical Thinking Across the Disciplines, Vol.XVII, No.3 (Spring, 1998) pp.100-112.
Kymlicka, Will. “Moral Philosophy and Public Policy: The Case of New Reproductive
Technologies,” in L. W. Sumner, (ed) Philosophical Perspectives on Bioethics. Toronto: University of Toronto Press, 1996.
Luborsky, Lester et al. Who Will Benefit from Pschotherapy? Predicting Therapeutic Outcomes. New York: Basic Books, 1988.
Marinoff, Lou. Plato, Not Prozac! Applying Philosophy to Everyday Problems. New York: HarperCollins, 1999.
Marinoff, Lou. Philosophical Practice. San Diego: Academic Press, 2001.
Perring, Christian. Reviews of Essays on Philosophical Counseling, edited by Ran Lahav and Maria da Venza Tillmanns, in Perspectives: A Mental Health Magazine, Vol. 2. Issue 4, September - October, 1997. Available Online at http://mentalhelp.net/poc/view_doc.php?type=doc&&id=336
Perring, Christian. Review of Lou Marinoff, Plato, Not Prozac! Applying Philosophy to Everyday Problems, Metapsychology Online Review, August 1999. Available Online at http://mentalhelp.net/books/books.php?type=de&id=119
Perring, Christian. Review of Schlomit Schuster, Philosophy Practice. Metapsychology Online Review, June 2000. Available Online at http://mentalhelp.net/books/books.php?type=de&id=292
Perring, Christian. Review of Lou Marinoff, Philosophical Practice. Journal of Mind and Behavior (forthcoming)
Perring, Christian and Lou Marinoff. "Debate: Who Can Counsel?," The Philosophers’ Magazine, Summer 2002, pp. 23-26.
Raabe, Peter B. Philosophical Counseling: Theory and Practice. Westport, CT: Praeger, 2001.
Schuster, Shlomit. Philosophy Practice: An Alternative to Counseling and Psychotherapy. Westport, CT: Praeger, 1999.
Younger, Stuart J. and Robert M. Arnold. “Philosophical Debates About the Definition of Death: Who Cares?” Journal of Medicine and Philosophy. 2001. 26:5, pp. 527-537.
 Peter Raabe (2001, Chapter 1) notes that some philosophical counseling is focused on the interpretation of world views rather than solving concrete problems.
 It is worth noting that some philosophers have voiced doubts concerning the usefulness of sophisticated philosophy in formulating policy on controversial issues in medicine (see, for example, Younger and Arnold (2001) and Kymlicka (1996)).
 For example, Beauchamp and Childress (2001) write, “Even conscientious and reasonable moral agents who work diligently at moral reasoning sometimes disagree with other equally conscientious persons…. Such disagreement does not indicate moral ignorance or moral defect. We simply lack a single, entirely reliable way to resolve all disagreements” (p, 21).
 David Jopling notes these sorts of concerns in his paper on the topic.
 Note that I am not saying that psychotherapy proceeds merely by a placebo effect, although I am also not ruling out that possibility. I am not very familiar with the scientific literature on the measurement of the beneficial effects of psychotherapy and I don’t know whether any attempt has been made to measure what difference it makes whether or not a client has a belief in the therapeutic process. Common sense would say it would, if only because without such belief, a client will be unlikely to cooperate fully with the therapist’s suggestions or even to continue in the therapy, especially when the therapy starts to delve into emotionally painful parts of the client’s life. Maybe a useful starting place for investigating these issues is Luborsky et al (1988).