Hermeneutics in psychotherapy

By Ian Rory Owen PhD

This paper is written with the belief that all forms of therapy have more in common with each other than they are different. It makes introductory comments prior to the many considerations and principles that guide practice. This paper does not have the aim of trying to introduce conformity to a profession with many different viewpoints. Rather, from understanding hermeneutics what is being urged is a personal responsibility for professionals to become self-reflexive in understanding how they make sense of clients, themselves and the events of sessions. The outcome is aiming at a cohesive approach where practitioners can differ in personal style and work from a code of ethical practice. Assessment and treatment require explanation and mutual agreement in order that both client and therapist are working on the same focus in an agreed way. Such decisions are made against a background of considered choices about the full range of therapeutic interventions.

Hermeneutics in therapy and everyday life

Hermeneutics is formally understanding, making sense of any situation. It is the study of how any person makes sense of any object, person or idea. Clients make sense in ways that are depressive, anxious or paranoid. Therapists make sense according to the assumptions of their theory and training.

One role of hermeneutics in therapy is identifying, through collaborative assessment and formulation, which disorders are current and creating an agreed focus for work towards change. For instance, a hermeneutic stance is what understands clinical pictures. It understands how early abuse, rape, neglect and surviving murder attempts can change the life-course. The impact of these types of violence are profound and in the absence of early treatment, survivors may experience decades of life in confusion and distress and make attempts at creating their own solutions to the problems they face: which is their response to lack of understanding. However, psychological hermeneutics is the body of knowledge that enables insight and the discussion of biopsychosocial cause and effect. Insight is the experience where clients understand themselves and make sense of their own personalities and psychological problems. Insight is psychological understanding of self (emotional and social intelligence is the whole). Insight co-occurs with empathy, the ability to understand others. Where hermeneutics comes in, following Dilthey and Heidegger, is the ability to distinguish between accurate and inaccurate readings of situations by contextualisisng them and comparing them. Without accurate understanding, clients may never recover their vitality and become able to take control of their destiny as best they are able, and given the limitations that they face. Accurate understanding proves itself in promoting recovery and self-care, in reducing distress, regaining good mood, and improved functioning. Inaccurate understanding shows itself in promoting lack of satisfaction, continuing distress and poor quality relationships with others. A hermeneutic stance is shown in the total body of psychological theory that enables psychological distress to be managed and minimised through the medium of meetings that promote clients to self-care and change. What this means is that psychological theory for practice is experientially-based, easily accessible and only shows its worth in its pragmatic ability to promote self-directed change. It is also the case that hermeneutics concerns judging psychological accuracy from inaccuracy. If false or inaccurate understanding and beliefs are followed then it means that clients follow false paths in life and try to create themselves in a defensive and inauthentic image. This is often fired by the desire to protect self or create short-term satisfactions and avoidances. On the other hand, accurate beliefs deliver long-term satisfactions at home, work and play. Such satisfactions in relationships are called attachment security and enable exploration in life and the ability to withstand the inevitable stresses of everyday living.

The relevance of hermeneutics to therapy is that a great deal of the psychological life is not perceptual but co-occurring with what is experientially present. Whatever is conscious exists in addition to psychological meanings that occur in relation to present, past and future relationships between people - and in relation to the relationship that people have with themselves. Psychological meanings are emotions, understanding the intentions of others as caring or hurting and many other types. Hermeneutics is relevant to the therapy because listening and being with clients frequently is centred on what mental process they are having, or in working out what is influencing them: be they angry, sad, or troubled in any way. Making sense of other people means working out what their personality is like. So the ways of making sense of people in all situations is inextricably tied up with working out what exists for them and about them.

The role of hermeneutics is called formulation: formally establishing ways in which specific events should be understood. A small number of ways in which this occurs in therapy can be listed as formulation, understanding the personalities and psychological problems of clients, and understanding what is happening to oneself in meeting clients. There a number of other situations in which perceptually-observable events are made sense of by applying rules for their interpretation. Sometimes the rules are explicit and formally-defined. At other times the ways of drawing conclusions may be inexplicit and entirely personal. Let us take the example of the checklists that define personality disorders and psychological disorders in Diagnostic and Statistical Manual of Mental Disorders IV (“DSM IV”, the American Psychiatric Association, 1994). Whilst these check lists serve the purpose of providing a common language for mental health professionals. Just in themselves they say nothing about the causes and co-occurrences of complex and novel constellations of psychological problems and the personalities of clients. The hermeneutic research question is to work out how specific feelings, such as people who lack a sense of themselves, make sense in different contexts. Does it mean that they are people pleasers who are devoted to others and never take time out to think about themselves? Does it mean that a person has grown up in a household where the blood relatives never talked about how they felt and what their hopes and dreams were? Does it mean that the person has a personality disorder and the only thing that can help them is a specialist type of therapy? How is it possible to decide between these alternatives and make the right conclusion? These are questions where therapists make sense of what they are being told.

Because there are literally hundreds of brand name schools of therapy, it is possible to claim that there never has been a single overall paradigm in therapy. Therefore, it must be noted at the outset that the task of applying philosophy to clarify therapy is a difficult one. Hermeneutics can be applied to two main aspects of human being. Firstly, some thought needs to be given to its overall collective nature. What this means is describing the way that ordinary existence is lived.

Currently there are many approaches within theory, practice and research into effective and desirable therapy. Instead of converging, these fields seem to be continuing to diverge. Some of the major dimensions of the field of therapy include brief and long-term work; group, family, couple and individual; psychoanalytic, cognitive-behavioural, systemic and humanistic; gender-sensitive and cross-cultural. From the perspective of hermeneutics, the task of research about what is effective or ethically desirable practice, across the spectrum of therapies, is ambitious and multifaceted. It follows that there is no simple way out of the profusion of different therapeutic processes. Instead, these become interesting phenomena within the world.

Before going any further other prefatory remarks need to be made to keep this paper on target and within limits. First of all, it is very difficult to discuss actual sessions because these are confidential meetings which happen in the context of the everyday world, which are open to all manner of interpretations. Therapy as it is practised is not a text or a psychological experiment, but a real human interaction in which there lies a great deal of variability. When hermeneutics looks at the full range of therapies, it projects its own categories onto what it sees, whilst trying to see that which is truly there, for the persons involved.

The purpose is revitalising and restating some original questions. What this means for therapy is that the meanings, social boundaries and taboos that are felt, and lived out as being real, are part of the way in which people find themselves meaningful. Experiences are meaningful because of their overall position in the totality of involvements in the world. We are thrown into a tangled web of conflicting meanings, motivations, values and ethics. Once born into the specific body, family, place and time in which we live, we have to deal with the details of ordinary life. So, an analysis of human being reveals the nature of temporal contexts and social relationships in advance and can show how therapy theories shape their material. In this view there is no doing without being, no thought without feeling, no action without reaction, no values without ethics, no self without others. Being in a context is a multi-faceted whole.

The importance of hermeneutics

Hermeneutics means a formal theory of how to make sense of some situation. Because therapy and the everyday world are meaningful, hermeneutics could be applied to many sections of it. One case in therapy is trying to grasp the understanding of the other, as he or she grasps it. It is not just that there is a circle of theory and evidence. In the therapeutic situation the therapist is caught between already existing theories, beliefs and assumptions and what is interpreted as appearing. The sense that is felt- and interpreted to exist might be wrong with respect to what clients feel, want and experience. Such wrong steps are entirely as a result of the wrong attitude of approach of therapists. The ontological-hermeneutic tension is between interpreting and initial understanding. Consequently, in searching for something like the truth of the matter, humans are torn between the ideal of letting something be seen for what it is; and the actuality of how we initially look at it determining what we see. The hermeneutic circle refers to all descriptive and explanatory activities. It becomes a problem when the already acquired belief system of the claimant is seen as being the case in all new situations.

In consequence of the above, it can be seen that a therapy that does not have a theory of hermeneutics, and does not use this understanding in practice and theory, cannot claim to be fully aware of its own actions. Another consequence of an awareness of hermeneutics is that if a very fine mesh were applied to look at individual differences between practitioners, it could be argued that there are as many therapy theories and practices as there are practitioners. This will always be the case. It is not possible to produce therapists who are all the same. So, contrary to those who think that there are strictly separate schools of thought, this paper suggests that there is a wide amount of variation and interpretative free play that occurs within the belief systems and specific modes of practising that therapists of a single school may have. When therapy is studied, some therapists who think they practice therapy x, might actually be regarded as carrying out therapy y, when interpreted by a researcher. Some professionals may have a manner of relating with clients that does not accord with their school of practice or the particular beliefs they espouse.

In conclusion of this section on hermeneutics, it can be seen that the same philosophical and methodological problems beset therapy, philosophy, psychiatry and the branches of the human sciences. But, that is not the focus for this paper. For the moment let us note that what lies within human ideologies, social practices and the various socio-cultural worlds, is, has been, and always will be, socially and historically constructed. People make ideas and institute social practices based on the patterns that have been laid down in the past. Often these are part of a complex of social forces that are far beyond the control of one person. The influence of hermeneutics and its understanding of context can be seen in the deconstructive analysis of the social history of ideas and social practices have already been begun by thinkers including Jacques Derrida and Michel Foucault. It is now time to move onto a more practical and theoretical fundamental level of analysis, in the remaining sections of the paper.

Stages in the therapeutic process

1. The attempts of clients at solutions are the starting point for therapy. The usual starting point is one of confusion and not knowing cause and effect, or the personality style and the influence of social contexts past and present. The lack of insight and psychological understanding promotes avoidance of consequences, negative changes in mood. When it comes to long-standing problems these may create false identity and defensive and insecure attachment relationships. The overall problem of the first stage is that the sense of self accepts the false beliefs and problems as inevitable parts of self.
2. What assessment and formulation achieve is the understanding of cause and effect. Part of the stage concerns the acceptance of the present and the past, because there are matters that cannot be changed. The formulation and assessment stage also requires the identification of attainable targets for therapy. Hermeneutics is necessary to identify defensive purposes that dictate motivations and the choice of lifestyle. Explanation occurs through a comparative process with clients entirely on-board. The outcome of formulation is that clients are able to distinguish the problem and the set of beliefs that drive it. Only when this realisation happens can clients become self-caring and consciously work to attain their goals.
3. The working through stage is the main process of having therapy itself. It requires therapists to support and motivate clients towards the realistic and attainable targets that are the agreed focus for the meetings. The process of working towards targets that are not yet achieved requires courage, determination and the expenditure of energy without the reward of attaining the target itself. One of the drawbacks of this stage is frustration as clients clearly want the endpoint but have not yet received its reward. The process includes using the understanding to plan actions in the real world. It demands using effort and the honing of skills in order to attain the pay off.
4. The pay off, the target of self-managed psychological understanding, is that clients can solve their own problems and know how they do that. This includes managing mood and other aspects. Positive outcomes need to be maintained. They are the results of accurate understanding. The proof of accurate understanding is a higher quality of life.

An example of the history of thinking about insight (self-understanding) and empathy

This final section moves further towards revealing the phenomena of empathy, in the main, in its connection to insight, that involves reconsidering current understandings by questioning them, in line with the phenomena. Now taken over by the term mentalisation, Husserl's aim was to see clearly the actual experiences themselves in relation to the mental processes within human being as a social form of being in history. This sections will briefly introduces facets of a generally phenomenological study of therapy. The point about the projection of understanding in the development of therapy practice is related to the centrality of what is generally called insight and empathy.

The first focus of this section aims to introduce two phenomena that are contradictorily both present and absent in empirical therapy research, as well as theory and practice. The imprecise and partly obscured relation between empathy and insight needs to be revealed to empirical researchers because it is a philosophical and practical contradiction at the heart of practice and research into the process and outcome of therapy. Often the terms interpretation, empathy and insight go unquestioned. This state of affairs is unacceptable. Therapists and human scientists often assume that these qualities are easily understood and that the experience of them can be taken for granted in making sure knowledge. Below, these current, historically-received, assumptions about empathy and insight are briefly analysed according to hermeneutics. It is intended to promote a discussion about the difficulties and shortcomings of any approach to understanding human beings. One aim is to promote understanding of these pivotal experiences and abilities on which knowledge-claims are based: therapists and human scientists are claimed to be only as good as their ability to understand themselves and others accurately. The subjects of empathy, understanding the perspectives and experiences of others, and psychological insight, understanding oneself, are crucial to psychology, human science, daily living and therapy. This section begins by commenting on these subjects from a historical and philosophical perspective, because they are insufficiently acknowledged, discussed and made explicit. Often insight and empathy are assumed to be facts, merely “on-hand” without any interpretation, they are treated as easily understood and readily apparent. But, given their place within major theoretical and practical activities, this lack of awareness, debate and criticism is unacceptable as it holds back theory, practice and research from further development.

In answer to this lack of awareness and insufficient understanding, hermeneutics is suggested as being able to introduce the problems of interpretation that are inherent within insight and empathy. Asking questions about theoretical and empirical assumptions is necessary though to sort between inaccurate and accurate ideas about conscious evidence. This analysis defines the current beliefs in assumptions about empathy and insight, and then comments on their relations to interpretation and hermeneutics. However, it is not the purpose of this section to explore the actual phenomena of empathy and insight in detail or to suggest how they arise. The aim is to show that current therapeutic research, theory and practice ignores an important set of phenomena and is not operating through understanding its own biases in manking sense.

It was Edmund Husserl who was the first to question and reject the ideas of Theodor Lipps on empathy, which he did from 1905 onwards. At first Husserl was critical of Lipps who espoused the inference by analogy theory that is still at the heart of most current assumptions. Previously, in 1925 Husserl claimed that empathy is basic to the ability to be a human scientist. Consequently, psychological knowledge is based on the ability to project oneself into another, to empathise and imagine what it is like to be another, and ‘see the other’s point of view’ for oneself. However, we are never other people nor do we ever have access to their consciousness. We cannot feel what they do or have the same life experiences as they. We can only interpret others from our prior understanding. Empathy occurs within oneself but is the central connection to others. To be empathic is to interpret empathy “out of” one’s own experience of other people.

If empathy is not understanding, it bases therapy on unclear ground. Husserl’s position on empathy is parallel to that of psychodynamics where projections onto others occur in the transference of meaning to the other. If this is true then we never do gain the experiences of others but only of ourselves for we only project what we feel onto them. So, what are these “mirages” that appear to be the direct experiences that we have of each other? Again, empathy seems to have been discussed in most detail so far within psycho-analysis where, it has been described as vicarious introspection or temporarily identifying with another. As a case for analysis and consideration, the current psychoanalytic and psychological assumptions of empathy accept the model that Lipps provided (Grundtatsachen des seelenlebens, The basic facts of mental life, 1883). Freud accepted without question Lipps’ idea that empathy is demonstrated, firstly, in the ability whereby artists can produce an object about events in the world. Secondarily, empathy enables the object to be appreciated and understood by others who “feel into” the work.

To sum up these discussions, it appears that lacks can occur in a person’s own knowledge of self, other and world. These are presumed to be knowable by therapists and others who make claims about human nature. Making these claims is to engage oneself in a process of becoming more insightful and empathic. However, the degree and amount of insight varies through time, alternating between true and false, and changing in quantity and accuracy as the amount of knowledge a person has about themselves varies as they remember and forget aspects of themselves. Some key questions include: “what makes some people non-empathic and non-insightful?” “How do people come to not know their own experience?” And “how may they undo the self-deception and gain a new truthful clarity? The concepts of defence, the unconscious and self-deception still occupy philosophers, psychologists and therapists. Understanding, insight and empathy are innate fluctuating capacities of human being. But some people appear incapable of them. If practitioners and theorists were more willing to set aside their preconceptions in an open-minded manner, then a greater emphasis on the difficulties of interpreting data would help them to see more of the possible phenomena that are waiting to be seen.

In conclusion, there is little agreed understanding of the nature of neurosis and classificatory systems such as Psychodynamic Diagnostic Manual or Diagnostic and Statistical Manual of Mental Disorders V, focus on individual pathology, rather than the shared ontological assumptions and consequent interpretations of behaviours, illness-health experiences and beliefs in society. It is no wonder that a profusion of beliefs and therapies appear, many of which are mutually exclusive and opposed. It is hermeneutics that shows how each brand name of therapy has its view of the whole. If hermeneutics is ignored then what exists is ungrounded confusion or claims about material facts.