Axiology of a psychodynamic psychotherapist
- Based on diverse sources of descriptive and normative propositions, we endorse a separation between knowledge rooted in a relevant theory and cognitive procedures and the professional code of conduct.
- We believe that the ethics of a psychodynamic therapist derives from the broader medical ethics.
- We make a distinction between the ethics of the professional group and the individual morality of a therapist; allowing for the influence of subconscious processes, we accept the existence of an internal conflict within the therapist, which cannot be resolved by a mere conscious statement of axiological neutrality.
- We understand psychodynamic therapy, along with the concepts on which it is based and which it employs, as a form of ethnocentric treatment.
- We believe that any use of the word “therapy” should rely on the common social understanding of the term as synonymous with treatment. By using the term in a different, subjective, or metaphorical sense, we abuse the trust of the patient and we should introduce the patient to our new definition of the term. The same principle applies to the term “pathology”.
- We agree that the above principle should also hold for the use of the term “patient”. We believe that a patient is a member of a given community, who, in the light of its criteria, needs assistance in changing their psychic functions and behavioural patterns through a process of therapy. The criteria are commonly accepted within the community.
Knowledge gained through therapy is related to the patient and serves the purpose of their treatment
We see no methodological justification for using knowledge about the patient’s psyche to derive conclusions about humanity at large or about any particular products of human culture. We endorse a separation between the knowledge of the patient’s inner reality, the product of their individual mind and psyche, and outer, material and cultural reality, whose origin and essence cannot be explained based on the knowledge of the patient’s individual psychology. We come to know the patient through the senses and the intellect, through intuition and empathy. Based on science and culture, this knowledge is understood as conceptual, partly interpersonal, and subjective. As a whole, its nature is not scientific.
Knowledge acquired in therapy relates to the inner world of the patient, its image, and the emotions and behaviours it inspires. This world is seen as changing in time, based on mental facts; it is partly conscious and partly unconscious, partly logical, relying on the Aristotelian definition of truth. It manifests itself in social relations through verbal languages, which to a varying extent, depending on the particular psychopathology, consciously employ social symbols, and through non-verbal and pre-verbal languages interpreted in an individual manner through intuition and empathy. Understanding of the patient’s inner world is achieved through operational concepts, such as conflict and deficit, and categorised with the help of terms such as defence mechanisms and relations to internal and external objects. All these terms retain their psychoanalytic meaning. We arrive at understanding of the patient’s inner reality through dialogue, based on the principles of psychoanalytic dialogue and using its phenomena, principles, and concepts. The process of knowing the patient through dialogue makes the concepts of fact, truth, and sense acquire a therapeutic and interpersonal notions; they no longer retain their philosophical meaning, which creates a situation of psychodynamic relativism. This is an epistemological consequence of our inability to construct the knowledge of reality outside the context of dialogue.
External reality is of key importance in two situations: when the patient invokes it to formulate ontological and aesthetic beliefs, and when it is described in the language of social signs and symbols. The concept of therapeutic truth, sense, and fact makes it impossible for a psychodynamic therapist to focus on the social genesis of a symptom. The process of expanding the patient’s consciousness applies to the not-yet conscious factors that influence their thinking, feeling, and behaviour.
The not-yet conscious factors encompass the unconscious, pre-conscious, and biological determinants of these psychic functions. With regard to biological and unconscious factors, we hold up a principle of separation of object languages, which makes psychodynamic knowledge diffuse, non-integrated, and the distinction between external reality and the methods used to know it; it does not give a coherent image of the functioning of the patient’s psyche and its ethiopathogenesis.
We believe that until a coherent and universally accepted theory of consciousness and integrated ethiopathology of the patient are elaborated, our therapeutic interventions will be a product of the knowledge, experience, and developmental maturity of the psychotherapist, based on the knowledge and faith. Their basic criterion will be therapeutic effectiveness, as measured by a reduction in symptoms, progress in the maturity of defence mechanisms, and the development of socially accepted interpersonal relationships.
Our attitude towards psychoanalytic theory and methodology is attentive and full of respect, as long as it is adapted to the individual patient and their specific psychopathology. We consider the ideas and suggestions of various psychoanalytic schools as invaluable and indispensable, as long as they serve to explain the ethiopathology of specific psychopathological syndromes. However, because of the priority of treatment over knowledge, we treat them in a utilitarian fashion as subordinate to their expected therapeutic results. They constitute, to be sure, a theory and a method of organising the therapeutic dialogue, indispensable for therapists who acknowledge the influence of unconscious processes on the patient’s psychopathology. Simultaneously, however, an effective change is a yardstick that places a limit on this theory and methodology. In the light of this perspective, therefore, we recognise that it is necessary to adopt a concept of deficit, understood not only as a psychoanalytic term. We take it to mean a psychological/psychopathological dysfunction, which seems impervious to a change in the eyes of the therapist and/or their professional reference group, based on their current state of knowledge and professional preference, the latter being understood as methodological principles and treatment procedures accepted within a given school. Deficits may affect the sphere of thinking, feeling or behaviour, according to psychopathological classifications. We also accept the notion of defect as a fixed pathology of the mind or brain, which may, but need not give rise to deficits. The value of these two concepts lies mainly in their very existence and function. Their function is to confront the therapist with certain limitations, safeguard them against omniscience, prophetism, and a missionary attitude towards the social role of treatment. They also constitute a challenge and condition for the development of our knowledge about psychological pathology and the methods of its treatment.
We find no convincing methodological justification for generalising the psychological statements formulated through knowledge and treatment of patients to other people, who are not patients or to the products of their activity. In our view, psychoanalytic knowledge about the patient does not warrant any conclusion about material, social, or metaphysical reality in a logically correct manner. We treat such conceptions, depending on their author, as a fascinating intellectual speculation helpful in enriching the therapist’s personality or as a mere “just-so story”. We also recognise a crucial need for psychiatric knowledge, and especially neurobiological knowledge, about psychological and emotional disorders. Because of methodological rigour, however, we see no possibility of integrating them with psychoanalytic language. We consider it as a positive development that demonstrates the complex nature of human psychopathology, which corresponds to the actual experience of professional therapists. The greatest advantage is to be found in the fact that psychiatric knowledge does not logically imply any anthropological proposition or any positive definition of psychological health that would not resort to euphemisms and tautologies. The main weakness of the psychiatric approach is the lack of conceptual rigour that would organise dialogue with the patient. This induces the use of a natural language, which differs from one psychiatrist to another, and the rise of various ethiopathological preferences that depend on different personalities, ontological, ethical, and even aesthetic views of individual psychiatrists.
Psychodynamic therapy versus other psychotherapeutic orientations
We believe that the emergence of different schools has its roots in the increasingly polymorphic nature of European culture, both in the area of paradigms and the imperatives that underlie them, and reflects the various ontological, cognitive, and ethical dogmas that currently exist on the continent. Various schools often employ similar concepts, such as, for instance, change, conflict, and problem, which may furnish a convenient point of departure for their integration. We recognise that the process is justified on a theoretical basis. However, we also believe that no convincing procedure exists to show in what manner a theory of integration can translate into individual kinds of integrative therapy. Likewise, it is unclear what specific process governs the translation of system theory into systemic therapy or contemporary humanist philosophy into humanistic therapy. We believe that the axiological basis of therapeutic actions and the manner in which new concepts of pathology and diagnosis are formed have not been sufficiently explained yet. The terms in common use among different schools encompass different concepts and meanings and rely on different languages describing the patient’s psychological reality. This leads us to believe that what is referred to as integration within psychotherapy is merely a nominalist trick, based on a flatus vocis phenomenon, where the sound of the word is similar, but a multiplicity of meanings exists. The terms are based on a natural language and their meanings are elaborated in different object languages. We know of no single common language/metalanguage, a common system of diagnosis/metadiagnosis, or a common theory/metatheory. What is missing above all is a commonly accepted theory of consciousness. Instead, we find a great variety of paradigms and imperatives that govern the formulation of theoretical claims and a diversity of axiological motivations for taking up the therapeutic profession.
These observations make it impossible for us to integrate psychotherapy, both in theory and in practice, and to place the psychodynamic orientation within the broader process of integration. We also see no possibility of placing the psychodynamic approach within the eclectic trend. Besides the reasons already mentioned above, eclectic therapy relies on various elements from different approaches, and, to the best of our knowledge, no criterion exists to govern this intersubjective process. We consider psychodynamic therapy as internally diffuse and non-integrated; the dichotomy between psychoanalysis and psychotherapy, as well as between the conscious and the unconscious, makes it impossible for us to see a chance for its access to integrative or eclectic therapy. With certain reservations, we could accept theoretical and methodological unification implemented through a process of syncretism. We look at our links to other schools of psychotherapy mainly through the lens of theoretical deficiencies and compensations, the lack of a theory of consciousness being the primary one among them. Despite the existence of these insurmountable differences and reservations, we approach other schools with tolerance. With the current popularity of the term “psychodynamics” in mind, as well as the countless doubts and interpretations around its meaning, we consider it our duty to present the position of the Kraków Psychodynamic Centre. The above is a record of our current self-reflection on the professional practice and the determinants of the psychodynamic approach, and is in no way meant to constitute a closed or canonical exposition of views.