Beyond an abstract and technical conception of psychotherapy: The indispensable role of practical wisdom

Abstract

The work of psychotherapy is complex and seems to resist algorithmic formulation. Psychotherapy theory, technique, and research help to manage this complexity to some degree, but clinical excellence also seems to require clinical judgment, and this judgment cuts across therapeutic theories. However, the content and process of clinical judgment remain relatively untheorized, often relegated to the “art of psychotherapy.” This article focuses on elucidating clinical judgment in terms of the neo-Aristotelian concept of practical wisdom, which includes recognizing what is salient, integrating multiple considerations, infusing emotional experience with reason, and pursuing an intervention plan with discernment and flexibility. The argument is that practical wisdom provides a rich description of the work of clinically adept therapists by more clearly portraying therapists’ decisions and activities than the general, unsystematic concept of clinical judgment or in terms of the many theories of psychotherapy.