Philosophical counseling as pseudoscience?

Philosophical counseling (PC) is the idea that people may benefit from discussing their everyday problems or long-term goals within a framework offered by one or another philosophical approach. Although the term “philosophical counseling” has been in use only for a few decades, this is what (some) philosophers have been doing for literally millennia, from the ancient Stoics and Epicureans to modern Existentialists, from Buddhists to Confucians, both ancient and modern. It’s a philosophical genre that for good (according to some) and ill (according to others) has given us Boethius’ Consolations of Philosophy and Alain De Botton’s How Proust Can Change Your Life.

One of my colleagues at City College, Lou Marinoff (interview with him by Julia Galef and myself here), has been catapulted to fame thanks to his, shall we say spirited defense of PC and his best-selling book, Plato, Not Prozac! (In which, I hasten to say, he immediately clarifies that if you do suffer from a mental condition, by all means take Prozac or whatever medical help is available; but keep in mind that what that will do is to bring your mind back into a normal functioning range, after which you will still face the same small problems and large existential questions as before — hence Plato.)

Before turning to Stoicism as a general framework to live my own life, and to teach others who might be interested, I practiced PC for a couple of years with a number of clients, so I have first hand experience of what it means to be a PC counselor. I found that experience rewarding, and so did my clients, without exception — at least judging from their own comments. Whether it “worked” or not, however, is a complex question that requires a lot of careful thinking. Which brings me to the current essay.

A few months ago Roxana Kreimer, a writer and researcher in practical and experimental philosophy (who is also a PC practitioner herself), sent me the draft of a paper she has co-authored with Gerardo Primero, entitled “The future of philosophical counseling: pseudoscience or interdisciplinary field?” The paper is to be published as part of a collection entitled Practicing Philosophy: New Frontiers, Expanding Boundaries, edited by Lydia Amir, Cambridge Scholars Publishing. Roxana asked me to read it and publicly comment on it, both because I’m interested in practical philosophy myself, and because I’m a scientist with experience in issues surrounding the so-called demarcation problem, i.e., the distinction between science and pseudoscience.

Roxana and Gerardo’s paper is very critical of current PC, raising a series of important issues. It also attempts to make constructive recommendations in order to move the field forward. In the following I will summarize and discuss the main points of the article in the interest of furthering open debate on the issue.

Before we begin, however, I will present two different ways to conceive of philosophical counseling, which the reader will want to keep in mind throughout the rest of the discussion. It will soon be clear which way I prefer, and what I make of Roxana and Gerardo’s criticisms, but my main conclusions will be acceptable or not almost entirely depending on how one sees PC and what its practitioners are trying to do.

Model 1: philosophical counseling as a type of therapy. One way to think of PC is as a type of talk therapy, analogous to, say, Freudian psychoanalysis. This is the model adopted by Roxana and Gerardo. It is expressly rejected by Marinoff, but it is an open question whether, and how many, PC counselors actually behave in accordance to this model. If PC is a type of psychotherapy, then it makes claims to be a scientific, or quasi-scientific practice, with medical import. Those claims should accordingly be backed up by systematic evidence, just as we require (or should require) of Freudian psychoanalysis, Cognitive Behavioral Therapy, and the like. (Incidentally, let me note that of the latter two, CBT’s efficacy is abundantly empirically verified, while a number of people consider Freudianism to be pseudoscientific. A lot of other psychotherapies fall close to one or the other of these extremes.)

Model 2: philosophical counseling as advice or life coaching. A second way of looking at PC is that it is closer to life coaching, or pastoral or rabbinical counseling. (Yes, I’m aware that life coaching does not enjoy a high reputation among intellectuals, but this is just an analogy.) Its practice is therefore more humanistic than scientific, and it is not accompanied by general claims of efficacy, because “efficacy” varies from individual to individual, with the specific philosophical approach deployed, and with the different goals of both the client and the practitioner. Some PC counselors, like Marinoff, use the word “art” to highlight that there aren’t specific methods or set outcomes to the practice.

Let me now go through each of Roxana and Gerardo’s objections to PC, with associated personal commentary. At the end I will return to the two models and to a broader discussion of what I think may be going on.

(Further) preliminary note: as the authors of the article themselves acknowledge: “Some of the assumptions and beliefs that we want to discuss are not usually mentioned in academic publications, but they can be found in more informal sources (e.g., personal communications, blogs, conferences). This is the reason why we’ve used videos and blogs to approach those kinds of issues.” This is somewhat problematic, because it doesn’t distinguish between the academic practice of PC and what some of the counselors may say in an informal setting. It also means that a study that criticizes PC for lack of rigor and evidence based methodology suffers, in substance, from similar issues. This, however, does not mean that Roxana and Gerardo don’t make good points, so let us proceed.

Criticism 1: we lack evidence that PC works, and is not instead ineffective or even harmful.

Roxana and Gerardo maintain that PC has “empirical aspects,” and that therefore it ought to be subjected to systematic investigation to make sure that an “incorrect choice” on the part of the counselor doesn’t cause direct or indirect harm to the client. They add: “In both clinical and non-clinical psychological problems, it’s relevant to assess whether the interventions and encounters have positive, null or negative effects.”

Broadly speaking, I agree. One of the problems is that literally anything humans do has “empirical aspects,” and that therefore the question is what, exactly, one should test, and why is testing relevant or desirable (and who’s going to pay for it!). For instance, if I claim that I’m writing this while sipping some excellent Cabernet Sauvignon (which I am), that claim is obviously empirical. But it is both hard to test (I’m along at my desk in my apartment, on a Saturday night — there are no witnesses; also, I will soon clean the glass and put it away — no residual traces of my activity), and a test would be irrelevant (why would you doubt what I’m saying? And even if I’m lying, who cares?)

Of course, if PC practice falls under model 1 above, then Roxana and Gerardo have a very good point, though they are pretty vague about the sort of “harm” that may derive from exposing someone to Stoicism or Confucianism. But if PC falls under model 2 above then their criticism loses a lot of its force, and it comes closer to someone insisting to see evidence for any claim made, regardless of reasons or context. As you will see, the issue of model 1 vs model 2 will recur throughout the remaining points raised by the authors of the paper.

Criticism 2: PC counselors lack training in assessment skills.

The main critic of PC mentioned by Roxana and Gerardo is Angelo Fasce (who, by chance, was a visiting student with me at the Graduate Center in New York a couple of years ago). At a 2015 conference (from which a lot of Roxana and Gerardo’s material originates) Angelo “quoted several web sites of philosophical counselors that offer their practice as treatment of several psychological problems, like anxiety and depression.”

During an exchange with a defender of PC at the same conference, Fasce was asked “why would fear be a clinical problem?” To which Fasce answered: “How do you know if it’s fear or phobia?”

Again, good point, and yet. To begin with, if some counselors are indeed claiming that they can treat conditions that are clearly considered psychological pathologies, then they are stepping outside of their proper boundaries and should be called on it, or even threatened with legal action, whenever possible. This, however, is (in part) precisely why trade associations like the American Philosophical Practitioners Association keeps asking for official recognition and regulation, so that more precise (if always somewhat fuzzy) boundaries between PC and psychological treatments can be defined and patrolled.

Second, while Fasce is right, of course, that some fears may raise to the level of phobias and thus require psychological or even psychiatric intervention, there are two obvious problems that come into play: i) the psychological and psychiatric professions themselves have been accused — not at all without foundation — of medicalizing perfectly normal human behaviors, both in order to arrogate to themselves a larger number of patients and to gain financially from the move. ii) Psychology and psychiatry in turn have received heavy criticism for poor replicability of their findings (psychology) and for basing their notions of disease on the highly questionable methodologies that produce the different editions of the DSM. The latter has in fact been discarded altogether by the National Institutes of Mental Health as a reliable guide to conduct research in the first place, and DSM-type psychiatry has been called by some a pseudoscience. Seems like the problems of PC, whatever they may be, are actually small potatoes compared to those of both psychology and psychiatry — especially, again, if one classes PC as an activity falling under model 2 above.

Moreover, people with mental disorders often decide for themselves whether to seek treatment or not, and they don’t find out if they actually have a condition until they are seen by a psychologist or psychiatrist. This isn’t going to change regardless of the future of philosophical practice, which numerically speaking accounts for a small number of clients anyway.

Criticism 3: PC practitioners are guilty of professional intrusion, i.e., unlicensed practice of psychology.

Roxana and Gerardo state: “Some philosophical counselors have argued that the word ‘therapy’ has different meanings. Mónica Cavallé has proposed that ancient philosophy presented itself as ‘soul therapy,’ but this meaning is unrelated to the contemporary meaning of the term ‘therapy,’ which is linked with the health sciences.”

Well, to begin with, my dictionary gives as one of the meanings of the word therapy: “any act, hobby, task, program, etc., that relieves tension.” Thus, it is simply not the case that the term is characterized only by a medical connotation. Besides, the point is entirely semantic. Marinoff talks about PC as a kind of “therapy for the sane,” and it is perfectly clear what he means by that. If the objection is that only medical practitioners (and psychologists, who are not actually doctors) should use it, then fine, but nothing of substance hangs on it, and I suspect that lawyers will sort this out in the courts.

Criticism 4: PC practitioners have misconceptions about psychology and psychotherapy.

Roxana and Gerardo accuse PC practitioners of having misconceptions about psychology and psychotherapy, which is of course entirely possible. Yet, the sort of misconceptions they list seem to me to reflect the intended demarcation between philosophical counseling and psychotherapy (PT). They include:

• PT makes diagnoses, PC doesn’t.
• PT focuses on symptoms, PC on worldviews.
• PT is committed to a theory, PC is not. (Though to be fair, PC practitioners do deploy a number of philosophical accounts when they advise their clients.)
• In PT patients are under the influence of their symptoms (i.e., they suffer from a medical condition), while in PC the counselee is an active agent (i.e., he is a normal person seeking advice on specific or existential problems).
• In PT the symptom’s intensity is judged by the patient (who has to tell the therapist how he feels), in PC the criterion of validity is an ideal of consistency and communicability (not sure what this means, actually).
• In PT the goal is to alleviate the symptoms, in PC emotional relief is judged by conceptual satisfaction. (Actually, people seeking philosophical counseling don’t necessarily seek emotional relief, they want advice concerning their problems.)
• In PC, philosophical positions remain open to question, while in PT any given therapist adopts a particular school of thought. (While often the case, this is not necessarily true: in the last part of my active career as a counselor I shifted to an exclusive focus on Stoicism, which of course may or may not work depending on the individual client.)
• PT conceives of symptoms as caused by dysfunctional experiences in the past, while PC is atemporal. (So are CBT and other related cognitive therapies, which, however, did in fact originally derive from types of philosophical counseling, like Stoic practice.)
• In PT, symptoms cause occupational and/or social distress, in PC philosophical concerns don’t usually impair social/occupational functioning. (The key word here is, of course, “usually.”)

Essentially, Roxana and Gerardo are trying to say that there is no sharp demarcation between PT and PC, and that therefore PC should be subjected to the same approaches, methods and standards of PT. But it is well recognized in the philosophical literature that most complex concepts do not admit of sharp boundaries, without this leading to the erasure of all meaningful distinctions. For instance, there are clearly borderline cases along the science / pseudoscience continuum, but nevertheless most sciences are very clearly and unequivocally sciences (physics, biology, chemistry, geology), and most pseudosciences are clearly and unequivocally pseudosciences (homeopathy, astrology, ufology, creationism). The occasional fuzzy boundaries (evolutionary psychology, parapsychology) are interesting and deserve serious discussion, but their existence does not undermine the broader distinction between the two areas or types of activity.

Criticism 5: PC practitioners have misconceptions about science and empirical testing.

Roxana and Gerardo report another bit of dialogue from the above mentioned conference, this time between Fasce and another attendee: “She asked: ‘Shouldn’t we take in account the counselee’s feeling as a criterion of validity? Do we always need an external validation? Fasce answered: ‘They can feel whatever they want, but this is not evidence that philosophical counseling is helping with his problem.”

Angelo, again, has a point here. A counselee’s feelings aren’t necessarily indicative that the treatment is working, which is why psychotherapies (which do present themselves as scientific in nature) ought to be independently validated, or at least subject to reasonable empirical protocols of confirmation. But that is precisely what is under dispute here: is philosophical counseling a type of psychotherapy? If it isn’t, then Fasce’s objection misses the mark, or is at least significantly blunted.

For instance, one my of clients was in search of a new way of interpreting what was happening in her life, in terms of a number of practical everyday problems, such as the lack of a relationship, mixed feelings about not having had kids, and her lack of satisfaction at work. None of these issues are pathological, and I don’t need an expert psychiatrist to tell me that. (Indeed, I would be highly suspicious if one did!) Moreover, the exploration of Stoicism that we began together over a number of sessions led her to: i) develop a new framework through which to see and analyze her problems; ii) accept some of the things that she had no way to influence at the moment (lack of a relationship, kids); and iii) work on the things she could influence in the here and now (behavior at work, and long-term career plans).

It seems to me obvious that PC worked in that specific case, by any reasonable, subject-oriented conception of “work.” But of course it may not have worked with a different counselee, one who may not have responded to Stoicism. Regardless, if the criterion of “working” has explicitly to do with how the counselee feels and how her views change, then the counselee is, indeed, the only one who can tell whether her PC experience worked or not. External validation can only play a role in terms of behavioral changes — such as those targeted by CBT. But even there, it is exceedingly difficult to do long-term systematic studies on whether PC, say, leads people to develop better relationships or find better careers. (Much of the empirical evidence about standard psychotherapy only targets short term behavioral changes, for reasons of both costs and logistics.)

Moreover, those external outcomes are not necessarily, or primarily, the goals of counseling. Counseling aims chiefly at helping the client to think differently about her problems, which may or may not lead to action or behavioral change. Sometimes all we want is a different way to perceive things. Indeed, strictly speaking, at least Epictetus’ brand of Stoicism aims precisely at this: changing not the external thing, but our perception of that thing: “Don’t hope that events will turn out the way you want, welcome events in whichever way they happen: this is the path to peace.” (Enchiridion 8) Of as Nietzsche put it, Amor Fati. How, exactly, would one go about testing the efficacy of Epictetus’ (or Nietzsche’s) advice, since it has to do with internal attitude, and since the Stoic philosopher in particular explicitly says elsewhere that this requires a life time of practice? It would make just as little sense to test the empirical adequacy of the Buddhist precept of non-attachment, or the Christian injunction to offer the other cheek — hence my analogy above between PC and pastoral or similar counseling.

In the dialogue reported by Roxana and Gerardo the above mentioned Fasce, predictably, gets accused of “scientism.” He answers in this way: “I’m not saying that the only thing in the world that has value is science. Literary criticism, ethics and other disciplines that do not belong to the sphere of science are very valuable, but when it comes to health care, you need to test things, and science takes precedence. Socrates didn’t do pseudoscience because he lived before the appearance of science.”

While it is nice to see Angelo making the distinction between disciplines where a scientific approach is appropriate and those where it is irrelevant, he is massively begging the question when he automatically defines the issues addressed by philosophical counseling as “health care.” Since when are one’s doubts about whether to have or not to have kids, or whether to quit her job, a matter of health care? Again, I think we should actively resist the medicalization of normal life. We simply shouldn’t go to a psychologist or, worse, a psychiatrist, every time we encounter a problem in life, no matter how normal it is.

As for Socrates, no, that’s not the reason he didn’t engage in pseudoscience, and it’s astonishing that anyone with a modicum of philosophical training would even suggest that. Socrates was interested in epistemology and ethics, and even according to Fasce himself at least ethics doesn’t fall under the purview of science, and I would claim that epistemology (as a prescriptive discipline, distinct from the study of cognitive biases, which is descriptive, and properly belongs to non-pathological psychology) doesn’t either. Just read the Euthyphro, for instance, where Socrates questions the character that gives the name to the dialogue about the nature of “piety” and whether the gods approve of something because it is good, or rather something is good because it is approved by the gods. What sort of systematic empirical validation of Socrates’ claim could one possibly seek? How would that not amount to a profound misunderstanding of the entire Socratic project?

Criticism 6: philosophical counselors lack training in critical thinking and cognitive biases.

Roxana and Gerardo write: “During the sessions, both counselor and counselee are exploring and trying to make sense of different situations and experiences, by constructing and improving their respective hypotheses and framings. In this process they are exposed to many cognitive errors, immunizing strategies, and epistemic defense mechanisms, including the confirmation bias and the confusion of correlation with causation.”

As a general warning this is perfectly sensible. But it is hard to imagine (and so far as I can tell, Roxana and Gerardo do not provide empirical evidence for the claim) that: i) psychologists and psychiatrists are somehow immune from those biases; and ii) PC counselors, who are, after all, credentialed philosophers, have not studied logical fallacies and cognitive biases. Critical thinking courses are usually mandatory in philosophy programs, so if a counselor — or a psychotherapist, or a psychiatrist — has not been exposed to one they probably shouldn’t practice. But this hardly counts as a general criticism against philosophical counseling, or psychotherapy, or psychiatry.

Criticism 7: problems with the arbitrariness of methods and goals.

The last broad criticism moved by Roxana and Gerardo to philosophical counseling has to do with what they perceive as the arbitrariness of PC methods and goals. They again quote Fasce from the same conference as above, as to say that “philosophical counseling has no method, and each counselor chooses his own one.”

That’s right, and that ought to be clue number one that PC is not meant to be a scientific type of psychotherapy. I began my own practice by using the full range of philosophical traditions with which I am familiar (i.e., mostly Western philosophy) and chose which one I thought might be more helpful to a given client, depending on the problem and the client.

For instance, if the issue is love and relationship, Stoicism and Buddhism have relatively little to say, but the Existentialist literature is very rich in that regard. If the issue is friendship, Epicureanism comes to mind; but if it is social and political engagement then Epicureanism is close to useless (except as a general advice to avoid such engagement).

That’s what Marinoff means when he says that PC is more akin to an art than a science, in the broad, humanistic sense of “art.” Aristotle would have called it a techne, a skill, an Ancient Greek word that is often translated as “craftsmanship, craft, or art,” distinguished from episteme, which referred more properly to “knowledge, science or understanding.” This distinction is yet another example — as I have recently discussed with my colleague Dan Kaufman, of something that the ancients got right and that we modern get confused about.

Toward the end of my practice, as I mentioned earlier, I began to focus only on Stoicism, because I found it the most useful for a broad range of problems, and because I was personally interested in it. Another counselor may have made an equally valid choice and zeroed on Buddhism, or Existentialism. That’s because in philosophy there is no truth, but only a range of more or less adequate or useful accounts, or ways to think about stuff. To some this makes philosophy somehow inferior to the natural sciences. To me it simply makes it different.

Roxana and Gerardo, however, believe this is a problem, which they label the issue of “the [proper] selection of intervention and conceptual frameworks.” Interestingly, they claim that such selection ought to be based on the hypothetical-deductive method, which they claim to be characteristic of the natural sciences. Except that philosophers of science have given up on the idea of the existence of the scientific method, and the hypothetical-deductive solution in particular, which was offered early on by the logical positivists, was one of the first candidates to go down the drain, for very solid reasons. So it is strange to fault philosophical counseling — which explicitly claims not to be a science — for not adopting a framework that the sciences themselves demonstrably do not adopt.

Conclusions

In the end, the disagreement comes down to how one thinks of the nature of philosophical counseling in particular, and the nature of philosophy in general (an issue, the latter, about which I have written a whole book, available for free on this site).

Roxana and Gerardo’s position is clear: “We agree with Mosterin’s proposal when he writes: ‘Science and philosophy are continuous. Philosophy is the most comprehensive, reflective and speculative part of science, the area of discussion that precede and follow scientific developments. Science is the most specialized, rigorous and well contrasted part of philosophy, the part that is incorporated in standard models and textbooks and technological applications.”

I too think that science and philosophy are continuous with each other, as I see them as different aspects of the broader approach that I call scientia. Yet continuity doesn’t mean only gradation, but also the existence of distinct areas of expertise and applications, as well as of distinct methods. If one denies that, then one is only talking of continuity, but in effect advocating a unification or, in the specific case, a subordination of one field to the other.

I think that philosophical counseling is not a type of therapy, and does not deal with human mental health pathologies — unlike much of psychology and the entirety of psychiatry (fields, as I’ve pointed out, with plenty of serious problems of their own). It is, instead, more akin to life coaching or pastoral or rabbinical counseling, though even those are of course imperfect analogies.

If PC counselors want their practice to be paid for my health insurances, or if they do claim that what they are doing is therapy in the medical sense of the term, then they are mistaken and professional organizations like the APPA should discipline them. Moreover, when proper laws are applicable, such claims should be prosecuted as fraudulent.

But when practitioners of philosophical counseling explicitly say that they are not engaging in medical practice, and that it is a defining characteristic of what they do that their goals are not to cure anything, but rather to offer a variety of potentially useful perspectives on existential problems, then they should be taken at face value and allowed to practice their art, or, more precisely, their techne.