Chapter

Psychotherapy, freedom, and responsibility

John S. Callender

in Free will and responsibility

Published on behalf of Oxford University Press

Published in print April 2010 | ISBN: 9780199545551
Published online February 2013 | e-ISBN: 9780191754616 | DOI: http://dx.doi.org/10.1093/med/9780199545551.003.010

Series: International Perspectives in Philosophy & Psychiatry

Psychotherapy, freedom, and responsibility

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Psychological research and investigation rest on an assumption that human thoughts, feelings, and actions are susceptible to the same processes of cause and effect that apply to other events in the world. This is clearly incompatible with our subjective sense of libertarian free will and may be seen as a threat to an important part of our self-concept. As discussed elsewhere, free will in this sense is a very difficult concept to pin down. If we have to relinquish libertarian free will, it is hard to say what, if anything, we have lost.

In contrast, the ability to understand ourselves in objective terms holds out practical possibilities for enhanced autonomy and positive change. Understanding our feelings and thoughts is a first step to acquiring a sense of control over them. Once we attain understanding and control we have greater opportunities to live in the ways that we desire. This expansion of understanding and autonomy is not threatened by causal determinism. In contrast, it is only by understanding the various causal factors that impinge upon us that we can expand our capacities to live in the ways that we choose.

There is an important moral dimension to the problems that patients bring to therapy that is not always fully recognized. These problems very often have their origins in violations of rights and entitlements. The emotional states that disturb patients in such cases are those that have been characterized as the moral emotions. There is a whole psychopathology of the moral emotions and the moral sensibility whose terrain is as yet unmapped.

There is an important and influential cognitivist and rationalist tradition in moral philosophy. This finds its therapeutic counterpart in cognitive therapy, in which the central therapeutic tactic is the bringing to bear of rational thinking on what it is that troubles patients. Rational deliberation in cognitive therapy is usually employed to help patients achieve a more accurate appraisal of their lives. I have argued that the problems of patients can often be conceptualized in moral terms and that a rationalist ethics can provide a language and concepts by which these can be discussed and resolved. There has been debate in the world of moral psychology on the relative contributions of emotions and cognition in determining moral decisions and actions. The conclusion appears to be that rational deliberation alone is unlikely to motivate moral action in the absence of emotions such as compassion, guilt, and pity. There has been a similar debate in cognitive therapy, arising from evidence that cognitive change alone is often insufficient to create changes in emotions and behavior.

Psychotherapy has also been used in offender populations with the intention of inculcating a sense of moral responsibility and in the hope that this will reduce recidivism. The outcomes of research to date have been disappointing. We are developing more sophisticated understanding of the psychology of offending and increased knowledge of the cognitive and emotional disabilities that predispose some people to criminal behavior. This may help us to target psychological interventions more effectively but also to appreciate the limitations of what may be achievable with psychotherapy.

Therapy can and should be a creative process. The patient who seeks therapy is trying to make something different of herself and to open a new chapter in her life. She wishes to feel better, think more positively and lead a happier and more fulfilling life. The good life is seen by many people as one lived creatively and spontaneously. This involves creating models of the person that one wishes to be and using these as a template for change. In achieving this task, both patient and therapist can draw on their capacities for spontaneous creativity.

Psychotherapy cannot liberate us from causal determinism or confer existential freedom upon us. In fact, it is understanding of the causal nexus in which we exist that gives coherence and meaning to our lives and opens up possibilities of change. We are creative beings in whom new possibilities for leading our lives arise spontaneously and unpredictably from chaotic brain processes. These capacities can be cultivated in therapy and can help the processes of positive change.

Chapter.  18585 words. 

Subjects: Psychiatry

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