Loyola University Chicago Loyola eCommons Dissertations Theses and Dissertations 1998 Values in Psychotherapy: A Philosophical Analysis of the Normative Assumptions in Freud's Psychoanalysis, Sullivan's Interpersonal Theory of Psychiatry and Frankl's Logotherapy Sally R. Kowalkowski Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_diss Part of the Philosophy Commons Recommended Citation Kowalkowski, Sally R., "Values in Psychotherapy: A Philosophical Analysis of the Normative Assumptions in Freud's Psychoanalysis, Sullivan's Interpersonal Theory of Psychiatry and Frankl's Logotherapy" (1998). Dissertations. 3730. https://ecommons.luc.edu/luc_diss/3730 This Dissertation is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Dissertations by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1998 Sally R. Kowalkowski LOYOLA UNIVERSITY OF CHICAGO VALUES IN PSYCHOTHERAPY: A PHILOSOPHICAL ANALYSIS OF THE NORMATIVE ASSUMPTIONS IN FREUD'S PSYCHOANALYSIS, SULLIVAN'S INTERPERSONAL THEORY OF PSYCHIATRY AND FRANKL'S LOGOTHERAPY A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL IN CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF PHILOSOPHY BY SALLY R. KOWALKOWSKI CHICAGO, ILLINOIS JANUARY, 1998 Copyright by Sally R. Kowalkowski, 1998. All rights reserved. ACKNOWLEDGEMENTS There are many people, without whom, this dissertation would not have been possible. I wish to thank Dr. Mark Waymack who was the inspiration for this project. It was his work, but most of all, his encouraging me to pursue my own ideas that allowed me to learn from this process. His guidance and open-door policy has enabled me to make this work better than it would have otherwise been. Mostly, I thank him for being the best role model for what it means to be a good philosopher. I wish to thank my family, who through all of this, never lost faith in me. Their very real support -- financially, emotionally and spiritually -- has been the most hidden but strongest anchor behind this project. In particular, I thank my brother, Andrew, whose honesty and dedication in his practice of psychiatry constantly challenged my thinking and forced me to bring theory to bear on practice. Also, a debt of gratitude to Gail who willingly sacrificed her time to do much painstaking editing. I want to thank my friends, Jeanne, Meg, Agnes, who never let me lose the person in this work. Their willingness to let me cry and to laugh allowed me to remain human in this process. Their presence in my life serves as a constant reminder that often the best therapists charge not a fee. For Michael Harling, the one beautiful mystery in my life CONTENTS ACKNOWLEDGEMENTS. iii ABSTRACT . vii INTRODUCTION.............................................. 1 Chapter 1. THE NORMATIVE ASSUMPTIONS OF THE ANALYST IN FREUD'S PSYCHOANALYSIS .................................... 15 Review of the literature: the role of the psychoanalyst Transition Stipulation of texts The many meanings of "reality" The nature of phenomenally shared reality Summary and transition to private property Private property Considerations of religion Conclusion 2. HARRY STACK SULLIVAN'S INTERPERSONAL THEORY OF PSYCHIATRY....................................... 66 Background What is the interpersonal theory of psychiatry?: historical background Development of the self: basic needs Why the "need for security?": the role of experience in the development of the self-system and individual personality Sullivan's conceptions of mental illness The role of the psychiatrist: the therapeutic encounter Goals of therapy 3: ANALYSIS OF VIKTOR FRANKL'S LOGOTHERAPY ......... 118 Historical background and purpose of logotherapy Logotherapy's view of the person "Logos" (meaning): The objective realm of experience How we know the objective realm of experience: the role of intuitive conscience Bridge: what has been accomplished thus far? The therapeutic encounter Conclusion 4: CONSIDERATION OF THE STATE OF CONTEMPORARY PSYCHOTHERAPY: AN ANALYSIS OF SHORT-TERM DYNAMIC PSYCHOTHERAPY................................... 187 Eclecticism and the problem of paradigm identification The origins of short-term dynamic therapy The logic of short-term dynamic therapy Selection criteria of clients Client diagnosis Techniques of therapy Goals of STDT Conclusion 5) WORKS CITED 6) VITA ABSTRACT Since the 1960's, there has been a growing consensus among health professionals and philosophers that psychotherapy involves a question of values. During that time, most contemporary work has been directed at two questions: 1) What are the values that therapist's make use of when treating a client? and 2) What is the justification for the presence of and reliance on these values? Current debate in this arena has been fueled by differing responses to these questions. As a result, little agreement exists regarding the number, nature, ordering and grounding of these values. The aim of this dissertation is to encourage some consensus in this arena by clarifying a proper locus for a discussion of values in therapy. In contrast to authors that establish a basis for values in various philosophical or religious ideologies, I argue that scholars need to look to the school of thought to which a therapist adheres. I believe that if scholars analyze the philosophical assumptions implicit in paradigms of psychotherapy, including notions of mental illness, view of reality, etc., they may begin to see the normative force that these assumptions create both within the therapeutic context and as the goal of therapy. It could be agreed, then, that while values in therapy are relative to a school of thought, universal prescriptions and prohibitions are made use of by the therapist and transmitted to the patient. In this way, psychotherapists and clinical ethicists could generate a consistent, rational plan of vii action for the benefit of the client. Three historically significant paradigms of psychotherapy are analyzed in this dissertation, namely Freud's psychoanalysis, Sullivan's interpersonal theory of psychiatry and Frankl's logotherapy. Their implicit philosophical assumptions are explored along with considerations of their normative force for the client who seeks this kind of treatment. A final concluding chapter considers the contemporary state of psychotherapy and a modem school of thought, short-term dynamic therapy. viii INTRODUCTION And are we to believe that a man who takes in hand a shield or any other instrument of war springs up on that very day a competent combatant in heavy armor or in any other form of warfare -- though no other tool will make a man be an artist or an athlete by his taking it in hand, nor will it be of any service to those who have neither acquired the science of it nor sufficiently practiced themselves in its use?1 Where pity is preached today -- and if you listen closely, this is the only religion preached now -- psychologists should keep their ears open: through all the vanity, through all the noise that characterizes these preachers (like all preachers) they will hear a hoarse, groaning, genuine sound of self-contempt...... The man of "modem ideas," this proud ape is immeasurably dissatisfied with himself; that is certain. He suffers -- and his vanity wants him to suffer only with others, to feel pity.---2 Since the 1960's, there has been a growing consensus among health professionals and philosophers that psychotherapy involves a question of values. During that time, most contemporary work has been directed at two questions: 1) What are the values that therapist's make use of when treating a client? and 2) What is the justification for the presence of and reliance on these values? Current debate in 1 Plato. The Republic, in The Collected Dialogues including the Letters, ed. by Edith Hamilton and Huntington Cairns, (New Haven: Princeton University Press, 1961), II, 374d, 621. 2 Friedrich Nietzsche. Beyond Good and Evil, trans. and with commentary by Walter Kaufmann (New York: Random House, 1966), 149-150. 1 2 this arena has been fueled by differing responses to these questions. As a result, we presently find ourselves with little agreement regarding the number, nature, ordering and grounding of these values. The aim of this dissertation, as originally conceived, was to attempt to achieve some consensus in this arena by clarifying a proper locus for a discussion of values in therapy. In contrast to authors that establish a basis for values in various philosophical or religious ideologies, I wished to argue that those who wish to write on this topic needed to look within the paradigm/school of thought to which a therapist adheres. I believed, then, that if one were to sufficiently analyze the philosophical assumptions implicit in schools of thought, an analysis if you will of their notions of mental illness, view of reality, etc., one could begin to see the normative force that these assumptions created both within the therapeutic context and as the goal of therapy. If the normative force of these philosophical assumptions could be established, then it could be agreed that while values in therapy are relative to a school of thought, universal prescriptions and prohibitions are made use of by the therapist and transmitted to the patient. In this way, psychotherapists and clinical ethicists could generate a consistent, rational plan of action for the benefit of the client. In sum, I believed that if values could be discussed as intra-paradigm phenomena, at the very least, consensus could be achieved regarding values based upon the commitment of the therapist - if one were to identify themselves as a Freudian, Sullivanian, Frankelian Logotherapist, etc. To my knowledge and to date, no study exists on the nature of norms within paradigms of psychotherapy. Not only 3 for its benefit to clients, but also for its novelty, I pursued this idea. So conceived, the thesis itself depended upon two assumptions only.