Psychotherapy and Epistemology: Learning How to Think

Psychotherapy and epistemology–what do they have to do with each other?  Philosophy refers to how knowing happens as epistemology.  I would argue that addressing the process of knowing is at least as important for training psychotherapists as considering what is known.  Let me explain…

When I supervise graduate students who are training to be psychotherapists, I find the most challenging task is to teach them to think like a psychologist.  How does a psychologist think?  Or, more accurately, how do I think a psychologist should think? 

To me, the purpose of clinical psychology is to help mitigate human suffering to whatever degree we can.  In order to pursue that purpose, the psychologist has to understand the uniqueness of each patient’s suffering.  The patient is a person with whom we have a therapeutic responsibility and a person whom we are obligated to know and respect.

Knowing someone, especially someone who is a virtual stranger, such as a psychotherapy patient, is a formidable task.  We do not know someone by getting a list of facts.  Name, birthdate, place of birth, occupation, history of illnesses—these are all lists of categorical data, but they are not knowing.  We can only know someone by relating to them over time in a relationship.

In a relationship, we know someone by how we feel with them, what fantasies they stimulate in us, or how they communicate beyond words.  Being with another person allows us to become part of their (and our) creative process.  The key here is process…an ongoing interaction.

We are much better served by using verbs to describe relationships than by using nouns.  In fact, I would assert that mental disorders and pathologies are best understood as verbs as well.

Suppose, for a moment, that you wanted to get to know Vincent Van Gough.  Since he is dead, you couldn’t set up an appointment.  But you could read books about him, see a movie about him, or sit with a few dozen of his paintings and relate to them for a while.  I would suggest that, as a psychologist, you could get to know him very well from sitting with the paintings.  In fact, I would suspect that the books and the movie would be dangerously misinforming.  One does not need to be a trained art historian or critic to understand Van Gough from his paintings.  One needs to be able to be transformed by the perceptions and sensations created by the colors, swirls, and patterns.  The question you might have is whether these transformations are true and valid.  My answer is that they are as true and valid as one ever gets.  There is no ultimate truth to Van Gough any more than there is to you or me.

What is true is what we negotiate from our experience with one another.  And these truths are transient and evolving.  The truths we learn about someone are the products of our relationship.

In part, what we know is made up. We invent knowledge from information that is generated by our biological processes.  But it is not as if we just make it all up; rather we create information at a basic biological level that then gets transformed by complexes or networks of other biological processes that produce still more variations of information.  At some point, the product of these processes becomes a mental phenomenon that we refer to as thinking.  We link our thoughts together in patterns that are self-supporting and that afford us a sense of certainty or knowing.

In fact, much of everyday anxiety is caused by a lack of certainty or doubt that interferes with knowing.  Ask an anxious person why they worry and they can often tell you that they know that it doesn’t make sense, but that they “can’t help it.” Why not?  The thinking disrupts the links in the patterns of knowing and disrupts the certainty.  The result is to question what is known or to be anxious.

“What if…,” we think?  There are no limits to what we can imagine, but there are limits to what can be true.  Just because it can be thought doesn’t mean that the thought is true, but try to convince a worrier of that!  The dominance of our basic subjective position, our narcissism, can lead us to feel compelled to account for any thought as important simply because we thought it.

I doubt that most of us ever consider the epistemology with which we know.  We might be aware of certain beliefs or values and we might be aware of political or scientific theories that seem more right to us than others, but I doubt that we regularly consider the extent to which our knowledge is the product of a system for knowing.  We are most likely to entertain a challenge to our knowledge only as a last resort.

Even the onset of mental illness is not sufficient to cause us to rethink what we know.  I tell my graduate students that a patient’s psychopathology is the person’s best effort at staying sane.  A person is apt to make themselves crazy before they will lose their sense of certainty.  In fact, psychotics are quite certain about their delusions and hallucinations; it is we neurotics who worry and fret about what is true.

What is true, in any meaningful way to a person’s life, is always a subjective truth—what we “know to be true.”  This is a truth rooted in our sense of self—our being.  Scientific facts, religious truths, or mathematical proofs are only true to us when they have been incorporated into our being and embraced as our own.

Obviously, we have gone through quite an array of truths over the course of human history that were all touted as the unequivocal truths of their time.  Where did the Greek and Roman gods go?  They died when they didn’t have people to believe in them.  Why do we know that the Earth revolves around the Sun and not the other way around?  Because the mathematics for the former is much more simple and elegant.  Why do people go mad?  Because of abusive childhoods, biochemical imbalances, predisposing genetics, or socio-political persecution?  We are still struggling with that one!

Science is an epistemology, but only one of many.  The key to survival in nature is adaptability and diversity; likewise, the key to psychological survival is in adaptive and diverse epistemologies to help us learn to appreciate and respect the complexity of nature.

I am not arguing against science or for any particular epistemology for that matter.  Instead, I am hoping to inspire the reader to consider the basis and presuppositions that comprise one’s system for knowing.

Having spent nearly my entire life in education, either as a student or as a teacher, I am quite aware that we are rarely, if ever, taught how to think, but rather what to think.  I am also just as aware that what people benefit from most readily in psychotherapy is being emancipated from truths that are pathogenic and paralyzing.  These “truths,” however they may have been derived, can be redefined, diminished, or discarded for the sake of a person’s future mental health, but not without considerable resistance from that person’s loyalty to the “known.”

I welcome your thoughts.

~ Michael J. Gerson, PhD