The Proper Aim of Therapy: Subjective Well-Being, Objective Goodness, or a Meaningful Life?

Abstract

What should psychotherapists be aiming to achieve with their clients? In seeking to answer this question, this chapter enquires into whether there is good reason to believe in a certain final end that is appropriate for therapy. In seeking out the final end of therapy, this chapter is not fundamentally inter-ested in means that are particularly useful for attaining it. Making a client feel heard and interpreting a dream s/he has shared are often apt tools for obtaining a certain, ultimate goal, where this chapter is solely concerned to identify what that goal ought to be, not how to achieve it effectively. Similarly, it is not concerned with moral constraints on the way that a therapist ought to pursue the proper aim of therapy. A therapist normally ought to keep facts about a client's past confidential and ought not to engage in a sexual relationship with him/her. These are plausible restrictions on the way a therapist should interact with clients, and clearly do not constitute what the point of the therapy is. Some might suggest that there are myriad points of therapy, varying from client to client. That is of course true at one level, but is quite dubious at another. At a certain level of specificity, each client is of course different and calls for a particular aim on the part of the therapist. Some clients have an interest in overcoming a fear of intimacy, others an addiction, others a tendency to dominate, still others an incli-nation toward wishful thinking, and so on. However, stepping back, it is plausible to think that there are some commonalities among how clients are badly off and what a therapist ought to be striving to achieve with them. After all, dependence on alco-hol is not qualitatively different from addiction to drugs; and then arguably those conditions are not all that distinct from being overly attention seeking or being 18 submissive out of an unreasonable fear of abandonment. There are plausibly types of mental illness and hence some general final ends of therapy. Even if the reader agrees with the point that there are, at a broad or theoretical level, not as many final ends as there are numbers of clients, s/he might still think that there are a plurality of general final ends, and not just one that captures the proper aim of therapy for every person who is a suitable client. It is true that there might not be just one. However, it would be intellectually fascinating if there turned out to be only one comprehensive final end of psychotherapy. And if there were just one, knowing what it is would naturally have some practical implications for the way therapy should be conducted. This chapter therefore seeks to ascertain what the final end of therapy might be, on the supposition there may well be one. Specifically, it addresses three prima facie plausible theoretical candidates, and argues that one is preferable to the other two, which are currently more influential among therapists, psychologists, and related enquirers such as philosophers. According to one of the two dominant approaches, the basic point of therapy should be, roughly, to help clients become clear about what they want deep down and to enable them to achieve it by overcoming mental blockages. The second section spells out this conception of therapy's final end in terms of subjective well-being, explains why it has been so influential, and then presents some counterexamples to it. The third section takes up the other major theory of what a therapist ought to be aiming to achieve, namely, to psychologically enable clients to live an objectively good life, say, one that involves developing their inherent talents or exhibiting a true/ whole/strong self. After presenting counterexamples to this theory, it is noted that combining the two approaches would not avoid the objections, and hence that it would be worth considering a third approach that avoids, and indeed explains, them. The fourth section advances the novel view that the proper aim of therapy is to mentally facilitate a meaningful life as it is broadly understood by contemporary philosophers. The suggestion is that fostering meaning in life, suitably construed in light of recent work in English-speaking philosophy, is not merely the appropriate final end of existential therapy (e.g., Yalom, 1980) and of logotherapy (Frankl, 1984), but of therapy as such. The concluding section of the chapter provides an overview of its findings, indi-cates their limits, and makes some recommendations. It points out that what the two dominant views of therapy's final end have in common is a strict devotion to the cli-ent's welfare, construed either subjectively or objectively. It notes that seeking to enhance the meaningfulness of a client's life is not identical to—although does largely overlap with—promoting a client's good, and is what enables the favored theory to avoid the problems facing its rivals, while capturing their kernels of truth. However, it also concedes that this chapter has not provided enough evidence to convince a skeptic that there is only one final end of psychotherapy, let alone the one toward which this chapter is sympathetic. At best it shows that the category of mean-ing in life, as recently construed by philosophers, is under-explored as a ground of therapy's proper aim. Supposing, though, that this chapter has demonstrated that meaning is worth taking seriously as therapy's final end, it closes with some advice addressed to therapists.