Dual realities – The search for meaning: Psychodynamic therapy with physically ill people

Abstract

We summarize Kohut's (1971) bi-polar self which enables counsellors to understand and treat narcissistic behaviours and narcissistic personality disorders in a psychoanalytic framework. After Patton and Meara (1992), we describe Kohut's formulations regarding self-development and disorders of self and how such formulations inform critical components of psychoanalytic counselling with particular emphasis on the explicit and implicit strategies and characteristics the counsellor brings to the process. Finally, we suggest that a promising arena for future theorizing and applications of Kohut's ideas is consultation with parents, teachers and other community leaders to help prevent or remedy psychological self-injuries with systemic interventions outside short-term counselling or long-term therapy.

We have suggested that Kohut's self psychology is a good vehicle for understanding what brings a client to counselling: namely, disorders of the self or self-injury. We review strategies and ‘ways of being’ a counsellor must bring to and offer in the counselling encounter if the work is to succeed. We also examine implicit qualities (beyond the achievement of a mature bipolar self) we believe a counsellor or any facilitator must have if counselling or other helping relationships are to be effective. We purpose further conversations and empirical analyses which specifically and conceptually link critical components of psychoanalytic counselling to self psychology and to essential counsellor traits or virtues that seem intrinsic to good counselling practice.     

Inexact Knowledge without Improbable Knowing

Abstract

In a series of recent papers, Timothy Williamson has argued for the surprising conclusion that there are cases in which you know a proposition in spite of its being overwhelmingly improbable given what you know that you know it. His argument relies on certain formal models of our imprecise knowledge of the values of perceptible and measurable magnitudes. This paper suggests an alternative class of models that do not predict this sort of improbable knowing. I show that such models are motivated by independently plausible principles in the epistemology of perception, the epistemology of estimation, and concerning the connection between knowledge and justified belief.     

Work-related counselling-a psychodynamic approach

Abstract

The paper sets out to stimulate interest in counsellors and therapists about the unconscious relationships which people form with their work, through describing and analysing what goes on in work-related counselling with a psychodynamic approach. The author draws on twenty-five years of experience to reflect on the changing nature of what was once termed ‘vocational guidance', and offers some short case studies, as examples of ways in which a person's world of work can become intertwined with their internal world in a confusing and disabling way. The core concepts and techniques which have evolved are identified and discussed; attention is directed particularly to the importance of the client's expectations, die effect of time limitation, the place of work in the whole life, and dealing with transference.     

Life story research: A relevant methodology for counsellors and psychotherapists

Aims: This paper introduces, describes and proposes life story research as an important, relevant and appropriate contribution to counselling and psychotherapy research. It shows how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing’ (Bruner, 1986). Methods: Drawing on life story research with people who linked their history of problematic drug use with experiences of historic trauma/abuse, the paper contributes to the ongoing discussion related to the similarities/differences between therapy and research and what we might learn from each that informs the other. Implications for practice: The paper offers narrative ideas and practices as ways of researching matters of social and psychological importance. It suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of using life story methods which one participant described as helping him to face ‘out into the world, without unduly or specifically delving into, or focusing on [my] emotional state’. This learning may be particularly relevant for therapists working with traumatised clients.     

Paradox lost: Understanding vague predicates

Abstract

The paper is concerned with the status of vague predicates. It is argued that they are for the most part ‘classifiers’, which are covertly comparatives and name not monadic properties but relations. The Sorites Paradox, it is claimed, is thus defused and a verdict theory of vague predicates is presented. Our practice in using vague words is described and it is contended that in our use of these predicates we always have a permanent possibility of independent demarcation. Wittgenstein's picture of the wall and the swamp is deployed to avoid the Transition Problem and it is argued against Fregeans that we need vague language for the advancement of knowledge and understanding.     

Knowing that, knowing how, and knowing to do

Ryle’s distinction between knowing that and knowing how has recently been challenged. The paper first briefly defends the distinction and then proceeds to address the question of classifying moral knowledge. Moral knowledge is special in that it is practical, that is, it is essentially a motive. Hence the way we understand moral knowledge crucially depends on the way we understand motivation. The Humean theory of motivation is wrong in saying that reason cannot be a motive, but right in saying that desire is essential for motivating us. The right response to the Humean theory of motivation is to see that moral knowledge is desire-related rationality or thought-related desire. Moral knowledge is neither knowing that nor knowing how but rather a third species of knowledge which we may call “knowing to do.” Knowing to do is to be rationally disposed to do the right thing. This understanding of moral knowledge is exactly what we can learn from Aristotle’s ethics.     

Cancer counselling in the United Kingdom

Abstract

A national survey of 289 people from a variety of professions (nurses, social workers, clinical psychologists, psychiatrists, etc) involved in counselling cancer patients and their families within the United Kingdom obtained a response rate of 82%. The primary findings discussed in this paper cover a range of issues, including the working conditions and responsibilities of the counsellors, what professional qualifications they possess, the extent and availability of supervision and support, as well as the types of counselling intervention employed. Particularly disturbing was the fact that only 25% of our sample had any recognised formal counselling qualification and that 75% did not belong to any professional counselling organisation. In view of the wide diversity of qualifications, salary scales, responsibilities and working conditions and practices amongst the respondents, we propose that the National Health Service (NHS) should establish clearer guidelines as to the minimum acceptable qualifications for people employed as oncology counsellors, and that more adequate provision and resources are made available for training and supervision.     

Some reflections on the links between psychoanalysis and literature

Abstract

I taught literature to students from overseas for a number of years before entering the world of student counselling. Both experiences helped to develop and clarify thoughts that I had long held, albeit in a rather vague fashion, about the ways that literature and psychoanalytic thought can reflect our inner worlds. In the first part of this article I look at certain ideas that I think they have in common, what they both can illuminate and how they can contribute to opening up a therapeutic relationship. Then I give an example, from my work experience, of how I was able to draw on some of these ideas in such a relationship with a student. The psychoanalytic process and the reading of a literary text touch at frequent points: both are ways of finding out about oneself, about one's inner and outer worlds, and how they interact. They enable us to ‘read’ our experiences. They have, therefore, a certain congruence of direction towards self-knowledge. They search for a particular kind of understanding. In exploring the literary text one is discovering oneself, gaining insight into the complexities of the multifarious self. Katherine Mansfield, commenting on the creative act of writing, said that a writer tries to go deep, to speak to the secret self we all have (Lee 1985: xv). Symington (1986: 15) speaks in terms of psychoanalysis occurring ‘at the centre of the individual’, but occurring only ‘through a personal act of understanding’.     

Discourse analysis: Rich pickings for counsellors and therapists

Aim: It is only relatively recently that discourse analysis has begun to rise to prominence in the fields of counselling and psychotherapy. This paper briefly explains ways of understanding discourse analysis, discussing what the approach can offer counselling research and practice. Approach: An initial categorisation of recent discourse analysis studies is offered, to demonstrate diverse ways in which this type of research can address issues relevant to counselling practice. The five categories proposed range from the examination of language use in therapy to analyses that focus on the social structures, meanings and power relations related to therapy. Implications: The paper demonstrates that through the critical analysis of counselling sessions, research interviews, written texts and other materials, discourse analysis can provide insight into ways in which counselling operates as a social practice, and so help counsellors to contextualise their work within broader social structures and processes.     

Blind Intuitions: Modernism's Critique of Idealism

Adorno contends that something of what we think of knowing and rational agency operate in ways that obscure and deform unique, singular presentations by relegating them to survival-driven interests and needs; hence, in accordance with the presumptions of transcendental idealism, we have come to mistake what are, in effect, historically contingent, species-subjective ways of viewing the world for an objective understanding of the world. And further, this interested understanding of the world is deforming in a more radical way than just obscuring what is there for the sake of interested needs and purposes; these instrumental ways of knowing and acting, are broadly self-interested, in the interest of survival, without effective concern for the well-being and worth of others; by becoming generalized and exclusive, hegemonic, by driving out modes of encountering things and persons that support their differences and independence, their needs and interests, these instrumental practices are the deepest cause of the ills of our time. As heightened forms of rational self-interest, self-interest being the drive of reason, transcendental interests suppress the interests of others. Adorno argues that modernist artistic practices perform a critique of the set of assumptions governing idealism by demonstrating how there is a suppressed rational form of human comportment directed towards the making and comprehension of unique sensuous particulars. Art, according to Adorno's ‘Aesthetic Theory’, is a broken off and isolated fragment of human knowing; in its hibernates the rational forms of acting and knowing that have been suppressed in the coming to be of Enlightened modernity.     

NEUROMEDIA,EXTENDED KNOWLEDGE AND UNDERSTANDING

Imagine you had the functions of your smartphone miniaturized to a cellular level and accessible by your neural network. Reflection on this possibility suggests that we should not just concern ourselves with whether our knowledge is extending “out” to our devices; our devices are extending in, and with them, possibly the information that they bring. If so, then the question of whether knowledge is “extended” becomes wrapped up with the question of whether knowing is something we do, or something we can share with, or outsource to, instruments. And that in turn raises the two questions of this paper: First, to what extent does such technology put pressure on the idea that we might have more than one conception of knowledge (or types of knowledge)? And second, what is the value of states that fit these conceptions (or types) of knowledge?     

Epimelia Heautou as Philosophical Counselling

Abstract

Philosophical counselling is practice aimed at alleviating suffering though the application of a range of philosophical skill and methods. Presupposing that critical investigation of one’s values and assumptions will be sufficient to bring about a meaningful transformation is presumptuous – both of the force of rationality, and the breadth of philosophy’s application. Self knowledge is a precursor to transformation, but not solely responsible for it. This appears to call the foundation of philosophical counseling into question. The ancient notion of epimelia heautou (care of self) attends to this concern. Care of self is a call to form a relationship of self with self. This is not a process of coming to know ourselves through reflection and analysis alone, but entails an active involvement with our very formation. I will argue that care of self is exemplar of philosophical counseling, in that it contributes to the understanding and practice of philosophical counseling in a way that significantly enriches it.     

Challenges for the Democratic Management of Technoscience: Governance,Participation and the Political Today

Abstract

The democratic management of technoscience and techno-scientific products, in and by society, has become a contentious issue. The issues have been framed in diverse ways, often marginalizing the question of power and of political‐economic macro-regulations. This paper advocates more down-to-Earth, anti-euphemistic, and realpolitik-oriented ways of describing what organizes today's techno-scientific world. In our market-based democracies, dialogic and participatory democracy is not central to the regulation of technoscience, techno-scientific knowledge and products. These are regulated mainly by other institutions that lie outside the dialogic order. Democracy is not a political regime free from conflict; discourses of participation have become central elements of a new form of governmentality. New concepts such as ‘sustainable development’ may conceal more than they reveal about what is at stake. Deconstructing them in a systematic manner, and building genealogies of their deployment and acceptance, would be helpful.

These recent developments should induce us to reconsider two key questions: how to talk positively about various kinds of knowledge, and how to understand the various links between science, the political order and democracy. Today we are living at a time of maximal tension between two great historical dimensions of the ‘modernization’ process—one linked to democracy and its extension, the other to human invention and technophilic business. Given these developments, we should develop a reflexive look at the roles we play in the globalization process. We must take up these difficult and contradictory questions, while not restricting ourselves to what may be instrumentally realizable.     

The ethics of complexity and the complexity of ethics

Abstract

In this paper, we investigate the implications that a general view of complexity - i.e. the view that complex phenomena are irreducible - hold for our understanding of ethics. In this view, ethics should be conceived of as constitutive of knowledge and identity, rather than as a normative system that dictates right action. Using this understanding, we elaborate on the ethics of complexity and the complexity of ethics. Whilst the former concerns the nature and the status of our modelling choices, the latter denotes a contingent and recursive understanding of ethics. Although the complexity of ethics cannot be captured in a substantive normative model, we argue that this view of ethics nevertheless commits one to, what we term, ‘the provisional imperative’. Like Kant’s categorical imperative, the provisional imperative is sub-stantively-empty; however, unlike Kant’s imperative, our imperative cannot be used to generate universal ethical principles. As such, the provisional imperative simultaneously demands that we must be guided by it, whilst drawing attention to the exclusionary nature of all imperatives. We further argue that the provisional imperative urges us to adopt a certain attitude with regard to ethical decision-making, and that this attitude is supported and nurtured by provisionality, transgressivity, irony, and imagination.     

Giving the Benefit of the Doubt

Abstract

Faced with evidence that what a person said is false, we can nevertheless trust them and so believe what they say – choosing to give them the benefit of the doubt. This is particularly notable when the person is a friend, or someone we are close to. Towards such persons, we demonstrate a remarkable epistemic partiality. We can trust, and so believe, our friends even when the balance of the evidence suggests that what they tell us is false. And insofar as belief is possible, it is also possible to acquire testimonial knowledge on those occasions when the friends know what they tell us. This paper seeks to explain these psychological and epistemological possibilities.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

Reasons for Randomness: A Solution to the Axiological Problem for Theists

Abstract

In this paper we bring to light several ways randomness—i.e., undetermined and unintended events—may contribute to our understanding of God's providence and personality. We begin by making clearer a certain problem that randomness has been thought to pose to theism. We then discuss recent criticisms of certain contemporary solutions to this problem that emphasize the value of an autonomous creation. From there, we propose a fresh way of understanding the value of a semi-autonomous creation that does not succumb to these recent critiques. Our end goal is to explore new reasons God might have to value randomness. In particular, we highlight two plausible, interrelated candidate values: (1) There are certain aesthetic properties that a partially random, self-forming creation enjoys; and (2) Such a creation grants God and creatures certain pleasures, such as wonder, anticipation, curiosity, surprise, and appreciation. In articulating our version of the autonomy defense, we position it within two opposing accounts of divine providence, specifically open theism and simple foreknowledge.