Does counseling need the mind?
By recent counts, there are hundreds of approaches to counseling (Ivey, D'Andrea, Bradford Ivey, & Simek-Morgan, 2002). One common thread uniting most approaches is that counseling is largely a verbal enterprise. The primary tools used in counseling are the words exchanged between clients and their counselors. Counselors talk with clients in the fervent hope that their clients' lives will somehow improve. In doing so, counselors and clients use words like think, or remember, or self to refer to constructs within counseling practice and then typically begin a course of action based on these constructs. Before attempting any course of action within the counseling process, however, it might be beneficial for the parties involved to pay closer attention to the assumptions implicit in the language of counseling. The purpose of this article is to first examine the mentalistic assumptions underlying counseling practice and then to explore the practical consequences of retaining or discarding such mentalism.
Mentalism in Counseling Language
Several theorists have argued that the use of mental language is pervasive in Western culture (Gergen, 1999; Uttal, 2000; Westerman, 2005). As Gergen stated, "The language of the mind plays a pivotal role in Western cultural life" (p. 225). Mental language is readily apparent in a number of knowledge disciplines. According to Uttal (2000), "Our literature, our therapies (both medical and psychological), our commerce, our religions, in fact all aspects of our lives are expressed in terms of personal awareness" (p. 64). Gergen similarly stated, "Disciplines such as psychology, anthropology history and the like carry the culture's traditions on their shoulders. They keep the language of the mind alive" (p. 226).
Counseling is one such discipline that keeps the language of the mind alive. Counseling language tends to be mentalistic in nature. The words and concepts used within counseling reflect reference to mental states that are assumed to exist within the person. Counselors frequently reference these mental states without awareness of so doing. In a general sense, counselors use words such as think, feel, remember, and self in such a way as to imply the existence of internal mental states. This use of mentalistic language is readily apparent in the diagnostic categories of counseling. For example, a counselor may describe someone who binge eats as "having an eating disorder." Similarly, a client who frequently expresses feelings of sadness and hopelessness may be described as having "depression." The implication is that a disorder is something the client possesses and presumably possesses within the mind.
The use of mentalistic language in counseling invariably creates a condition wherein counselors focus their intervention efforts first at identifying and then somehow altering the mental state that has resulted in the client's current difficulty. Counseling interventions may focus on identifying feelings, desires, wishes, goals, beliefs, or other internal states that preceded the presenting problem. With the exception of behavioral modification, most counseling approaches seem to focus their interventions on the mental state rather than on the behavioral manifestations of that state. This certainly seems true for counseling approaches stemming from psychodynamic and humanistic theories (Plaud, 2001; J. M. Russell, 1980). Yet, even so-called cognitive-behavioral counselors are prone to using such an approach. For example, a central tenet of rational emotive behavior therapy (REBT) is that it is their beliefs about events that cause human beings to become disturbed, not the events themselves (Ellis, 1995). Plaud stated of REBT, "In other words, maladaptive thoughts cause maladaptive feelings. This is a very typical mentalistic analysis, focusing on the covert thoughts that are hypothesized to underlie and therefore cause psychopathology" (p. 1099). Likewise, in Beck's (Beck, Rush, Shaw, & Emery, 1979) cognitive therapy of depression, it is asserted that "an individual's affect and behavior are largely determined by the way in which he structures the world" (p. 3). From this perspective, an individual's ways of structuring the world can sometimes become distorted. If such distortion exists, then "correction of these faulty dysfunctional constructs can lead to clinical improvement" (Beck et al., p. 8). The point is not to criticize the efficacy of these various counseling approaches, but to highlight their reliance on mentalism.
One may ask, what's the problem with such reliance? The answer to that question reflects a long history of debate over what is commonly referred to as the mind-body problem. Various positions have been taken in that debate including dualism, monism, epiphenomenalism, interactionism, and radical behaviorism, to name but a few (Uttal, 2000). Although these positions are familiar to philosophers and to those in the cognitive and neurosciences, such discussion is generally lacking in the counseling literature. Mentalism is commonly equated with dualism in the common language usage of the profession. In short, the answer to the question, what's the problem with reliance on mentalism? is that many regard dualism, and therefore mentalism, as unscientific. Belar (1995) argued that scientific evidence does not support dualism in health care. Others have argued further that mind-body dualism actually has a severe negative impact on the health care system (Levant, 2005). Some have taken the stance that in the neuroscience community "mind-body dualism is dead" (Mahoney, 2005, p. 339). Although the radical mentalism of mind-body dualism may have been abandoned long ago in the philosophy, cognitive science, and neuroscience communities, mentalism is alive and well within the disciplines of counseling and psychotherapy (Mahoney, 2005). The obvious question then is, why does it persist?
To answer this question, a brief analysis of the mind-body problem is in order. Although this problem has roots stretching back throughout the history of philosophy, no one person is more closely associated with this problem than Rene Descartes.
Setting the Cartesian Coordinates
Descartes is responsible in many ways for the persistence of mentalism within counseling. In Descartes' (1641/1996) view, each person is made up of two things, a mind and a body. Minds are nonphysical and do not take up space. Bodies are physical and do take up space. Minds think, but bodies do not (Descartes, 1641/1996). According to Robinson (1989), Descartes' philosophy of the mind is characterized by three simple doctrines: (a) the mind and body interact causally; (b) the mind depends on the body for the input of information from the outside world, but does not depend on the body for intellectual operations performed on that input; (c) the mind is, in and of itself, a self-conscious entity. Descartes' often-cited dictum "I think, therefore I am" (Descartes, 1637/1999, p. 25) asserted the existence of a thinker. Descartes was stating that the only facts about which we, as human beings, can have absolute certainty is of our own experience and our knowledge and awareness of ourselves (Brennan, 1986). All other facts may be doubted except for the fact that I exist, for if I doubt my own existence, there must exist some entity, "I," to do that doubting (Malcolm, 1986). The idea of counseling as an introspective enterprise is directly tied to the philosophy of Descartes. The introspectionist nature of counseling continues to be visible in many forms of therapy today.
Descartes (1637/1999) took for granted that each person knows what the process of thinking is for him- or herself. No one can be certain, however, that what they call thinking is the same thing that someone else calls thinking. This uncertainty exists for any subjective experience (such as love, hate, fear). Briefly stated, this is the view that each person possesses within her or his mind some sort of inner state or occurrences to which only that person has direct access. In other words, each person has immediate nonlinguistic knowledge of her or his own inner experiences. For knowledge of others' inner experiences, one must rely on inferences drawn from their behavior (Descartes, 1641/1996). As stated before, Cartesian dualism is the basis for the commonsense understanding of the mind and has become the "official doctrine" of folk understanding (i.e., the everyday understanding of mental states; Moody, 1993). Some have argued that Cartesian dualism is also largely the official doctrine of counseling and psychotherapy (Plaud, 2001; Russell, 1980). Kendler (2005) stated, "dualistic thinking and vocabulary remain deeply entrenched in our approach to clinical and research problems" (p. 434). Counselors make statements such as "the client thinks or feels" as if these qualities reflected inner states of occurrence to which only the client has direct access. Through various counseling techniques such as paraphrasing and reflection, Socratic questioning, interpretation, confrontation, and numerous other approaches, counselors attempt to gain access to their clients' inner states of mind.
Challenge to the "Official Doctrine"
On the surface, Cartesian dualism seems rather appealing. It makes common sense that, as human beings, each of us has our own personal consciousness to which we have direct access, but others do not. Even the staunchest critics of dualism have admitted that it appeared that "it was something inside a person that determined what that person did" (Skinner, 1987, p. 780). Appearance of truth is no guarantee of truth. It also once appeared that the earth was flat and the center of the solar system. Common sense alone cannot serve as the standard by which to evaluate claims of mind-body dualism. It has been said of common sense that "all too often in the past, decisions about human nature of far-reaching importance were not based on rigorous objective arguments, but on common sense and humanist criteria" 0dttal, 2000, p. 65). Applying such "rigorous objective arguments" reveals that there are more than a few holes in the Cartesian quilt.
There are four standard challenges to dualism. One challenge is commonly referred to as the "problem of casual interaction" (Baker, 2002, p. 22). If Descartes was right, and mind and body are separate things, then how can a nonphysical substance called mind possibly have any influence on a physical body? Moreover, where would such an interaction take place? Would this interaction occur in the material world or would it occur in the nonmaterial world of minds? The second standard challenge follows from the first and can be thought of as a "problem of evolutionary history and biological development" (Churchland, 1984, p. 20). According to this challenge, it certainly seems that the minds of human beings undergo changes throughout their physical development. The mind of a fertilized ovum certainly appears to be different from the mind of a 5-year-old child or a 40-year-old adult. Relying on a person's life experiences as an explanation for these apparent developmental changes returns one to the question of how life experiences in the material world could effect changes in a nonphysical mind. The third standard challenge levied against Cartesian dualism is typically referred to as solipsism or the "problem of other minds" (Baker, 2002, p. 28). If mental events are private events that are not directly accessible to others and knowledge of others' minds may only be obtained indirectly, it cannot be assumed that other minds even exist. Acceptance of such a view can only reduce to absurdity. Finally, the fourth standard challenge rests on the law of parsimony (Churchland, 1984, p. 18). There is simply no need for mind-body dualism if the monistic assumption that mind is brain can also account for the experience of a sense of self.
Additional challenges to dualism emerged from analytic philosophy. Briefly stated, analytic philosophers, like Bertrand Russell and G. E. Moore, argued that many philosophical problems are rooted in misunderstandings about the uses of language. Epimenides paradox (also known as the liar paradox) is one example of such a problem (Barwise & Etchemendy, 1989). This paradox is commonly stated as "this sentence is false." This statement leads to a contradiction, for it can be neither true nor false. Analytic philosophers regarded Descartes' concept of mind as one of these philosophical problems that become understandable through the refinement of language. As Russell (1921) stated, "As language grows more precise, there is less and less of the target outside the bull's eye" (p. 165).
Two influential philosophers emerged from this tradition to raise serious questions about the commonsense view of mental language. Their arguments have particular relevance to counseling practice. In his Tractatus, Logico-Philosophicus, Ludwig Wittgenstein (1921/2001) presented the idea that the object of philosophy is the logical clarification of thought. The importance of this declaration is that Wittgenstein asserted that most philosophical problems resulted from puzzlement about words.
In his Philosophical Investigations, Wittgenstein (1953/2001) levied a devastating attack on the possibility of a "private language" (p. 75). His key argument was that if a word referred to something to which only its user had access, no one could have instructed its user on its appropriate use. According to Johnston (1993), Wittgenstein took Descartes to task on the understanding of pain words. Wittgenstein (1953) argued that pain words reflect behavioral tendencies rather than reports of inner processes. Wittgenstein (1953) did not directly deny the existence of inner states of mind, but rather made the assertion that discussion of such states is a meaningless pursuit to be avoided by scientists and philosophers of the mind. Wittgenstein (1953) held that the answer to the question of the inner states of mind lies in attending to the kinds of things the rules of conversation permit one to say about these matters. In his view, the purpose of language was not, as Descartes would have it, to express to someone else the contents of one's own mind. Rather, it is language that defines the mind.
Gilbert Ryle (1949) presented an even more direct attack on what he referred to as Descartes' "ghost in the machine" (p. 15). Ryle (1949) said it is a mistake to assume that mind and body are different. Furthermore, one makes what Ryle (1949) termed a "category mistake" (p. 16) when one assumes that mind and body are different but then treats mental words in the same way as physical words. Said differently, mind and body are not on the same level of analysis. Ryle's (1949) well-known example is of someone visiting Oxford for the first time and, after having been shown the colleges, libraries, museums, playing fields, and administrative offices and other departments, asks "but where is the university?" (p. 16). The mistake was to allocate the university to the same category as that to which the other institutions belonged.
Ryle (1949) offered a dispositional analysis as an alternative to the commonsense language used to refer to mental states. Dispositional analysis examines how things would react given certain circumstances (Lyons, 1980).
The word brittle is an example of a dispositional term. Brittle does not refer to something in an object (such as a glass) but rather what occurs to that object under certain circumstances. A glass is brittle if it is struck. Soluble is another example of a dispositional term. In Ryle's (1949) analysis, "to say that sugar is soluble is to say that it would dissolve, or would have dissolved, if immersed in water" (p. 43). The important point is that the word refers to what will happen under certain circumstances. In Ryle's (1949) estimation, so-called mental words do not refer to anything within a person, but simply to a person's tendency to act in a certain way given a certain condition. One does not have a disposition in the same way one has an arm or a leg. A disposition is a behavioral pattern. In Ryle's (1993) account, a person using her or his mind is exercising a certain capacity for behavior.
Giving Up the Ghost?
The challenges to dualism that have been outlined are formidable. Yet these challenges are themselves challenged by proponents of dualism. Arguments in favor of dualism generally come in the form of arguments against physicalism. These include the special sciences argument (Robinson, 2003), the conceivability argument (Chalmers, 1996), and the argument from personal identity (Madell, 1981). One frequently used argument against physicalism is that for the existence of "qualia." Philosophers generally use the term qualia to refer to the subjective aspects of persons' mental lives. In other words, qualia are the way it feels to have some mental state, such as the experience of sweetness when eating an apple. Those who argue for their existence claim that qualia cannot be reduced to anything physical. These arguments are typically expressed in terms of thought experiments. Frank Jackson (1982, 1986) developed a well-known thought experiment intended to show that qualia exist and to refute the physicalist account of the mind. He invited readers to imagine Mary, who was born and has lived her entire life inside a black and white room. All of her visual sensory experiences since birth (her food, her skin, her television programs) have been in black and white. Mary spends her life learning all there is to know about the physical world, including all there is to know about the physical aspects of colon Yet, she has never experienced colon One day she is released from her room and experiences color for the first time. Jackson (1982, 1986) argued that because Mary has already known everything that there is to be known about color, any new knowledge she gains upon experiencing color must be knowledge of something nonphysical. Hence, qualia must be real, and physicalism must be false.
The seemingly devastating challenges offered by Ryle (1949) also have limitations. Ryle's critics point out that, although dispositional analysis may accurately describe character traits, it seems inadequate when describing affective states (Hofstadter, 1951; Lewis, 1969). The construct of being in love can be used as an example. If the dispositional model holds true, it should be possible to define love by a person's tendency to behave in a certain way. For the most part, this seems to be possible. If someone holds the hand of her or his companion during a candlelight dinner and says nice things to and about her or him, it can be reasonably assumed that person loves the other. However, this does not hold as a universal truth. People can demonstrate their love for one another in a variety of ways. Teenagers often express feelings of being in love with someone yet resort to behaviors such as avoiding that person. Moreover, a person may act as if she or he loves another (sending flowers, holding hands, etc.) but not be in love with that person. Perhaps this person is trying to make someone else, whom she or he really does love, jealous, but does not show that person behaviors that indicate love. In sum, when dealing with affective states, dispositional analysis seems no better than the Cartesian concepts it aims to replace.
Finally, although Wittgenstein (1953) has offered a serious challenge to the existence of minds, he has also helped to preserve the concept. Advances in artificial intelligence (AI) suggest that computers might one day be thought of as thinking beings, if thinking is defined in strict behavioral terms (Moody, 1993). For example, a jet airplane does not fly in the same way a bird flies, "by converting food to energy and flapping its wings" (Devlin, 1997, p. 147), and yet both can be said to fly. Words are often metaphorical. Questions about what it means to think are in fact referring to two different things. Thinking is certainly a behavioral pattern or disposition, as Wittgenstein (1953) and Ryle (1949) have demonstrated. Yet, thinking also remains a specific behavioral pattern that refers to living beings. The mind-body debate cannot be resolved because different people in the language community use words in different ways. Wittgenstein's (1953) concept of language games might simultaneously cast doubt on the mind's existence while preserving its necessity.
Current State of the Mind-Body Debate
The mind-body debate is far from resolved and will not be resolved in this article. The complexities of that debate are beyond the scope of this article and have been analyzed more eloquently by others (Dennett, 1992; Pribram, 1986; Uttal, 2000). There are a handful of individuals, such as David Chalmers (1996), who remain dualists. Chalmers argued that the problem of consciousness should be divided into easy problems and hard problems. He suggested that cognitive science has been successful in answering many of the easy problems of consciousness but that the hard problem of explaining subjective qualitative experiences remains. A slightly larger handful of individuals, such as Joseph Plaud (2001), remain wedded to radical behaviorism. He argued that "thoughts and feelings do not cause behavior--they are behavior in need of explanation" (Plaud, 2001, p. 1096). He further posited that mentalistic terms "stand in the way of a thorough scientific investigation of the phenomena mental terms purport to describe" (Plaud, 2001, p. 1094). Others have "resolved" the mind-body debate by allowing the use of mentalistic terms but generally recognizing that such terms refer to the physical functioning of the brain. In short, mind is neural activity that must be referred to using mentalistic language. Emergent materialists such as John Searle (1992) have accepted that mind is brain but have argued for the irreducibility of mind. In Searle's view, mental states are no less real than interest rates or points scored in a football game. Those in the "new mysterian" camp have suggested that mind may indeed arise from the physical functioning of the brain but have advocated that humans may lack the neurological hardware at our current evolutionary state to understand the relationship between mind and brain (Flanagan, 1991; McGinn, 1989).
The Future of Minds in Counseling
Where does this leave counseling? A few options are available. Counselors may retain a Cartesian view with all its inherent challenges. To do so flies in the face of calls to make the counseling and psychotherapy practice more evidence-based and ignores criticisms that mind-body dualism has had a negative impact on the health care system (Levant, 2005). Alternatively, counselors could follow in the footsteps of radical behaviorists and solve the mind-body problem by ignoring the mind and focusing solely on observable behavior. This solution has been criticized as being too limited to explain the fullness of human cognition and as being "past its prime" (Ilardi & Feldman, 2001, p.1114). Furthermore, given that the major tool of counseling is language and given the linguistic community within which counselors work, it simply seems counterproductive to abandon mental concepts. Clients will continue to "frequently speak of private events as causes of their suffering" (Forsyth & Kelly, 2001, p. 1138). This places counseling on the horns of a dilemma: to adhere to a dualism that is criticized as being anti-intellectual or to adopt an approach that seems wholly impractical.
Another option is for counselors to follow the path of those in the neurosciences. Some researchers have suggested that neuroscience has much to offer the counseling and psychotherapy practice (Cozolino, 2002; Etkin, Pittenger, Polan, & Kandel, 2005; Kendler, 2005). Neuroscientists have recognized that mentalistic language is merely shorthand for monistic concepts that cannot be expressed any other way. Neuroscientists have retained mentalistic terminology while moving away from dualism and using sophisticated technology to map internal events. Recent research efforts suggest that some mental events may even be observable. Etkin et al. (2005), for example, reviewed the current status of neurobiological applications for psychotherapy. They contended that "there is no longer any doubt that psychotherapy can result in detectable changes in the brain" (Etkin et al., 2005, p. 155). In other words, effective treatment leads to changes in tissue. Although counselors may be steeped in Cartesian heritage, they need not accept the implicit difficulties of Cartesian dualism. Instead, they too may speak like dualists but act like monists. An obvious fear is that by adopting the path of neuroscience, counseling would be subsumed into the field of biology. Such fear may be overstated. A possible unexpected advantage is that counseling may flourish if it can be demonstrated that counseling can produce brain changes similar to changes produced by pharmacology.
Yet, before counselors jump on the neuroscience bandwagon, it is important to recognize that neuroscience has not developed to the point of identifying a one-to-one correspondence between mental events and brain events. Critics have argued that such a relationship may never be demonstrated (Plaud, 2001; Uttal, 2000). More important, at its present state of development, neuroscience has provided little value to practitioners in their routine work with clients (Forsyth & Kelly, 2001; Strauman, 2001).
Cognitive science offers yet another option to counselors that rejects dualism, retains mentalistic language, and offers practical value. Common factors research has indicated that therapeutic relationships, rather than specific techniques, account for the greatest amount of variance in treatment outcomes (Norcross, 2002; Wampold, 2001). Some have recently argued, however, that cognitive processes should be explored as common factors that are even more fundamental to therapy outcome than therapeutic relationships (Arbuthnott et al., 2006). Cognitive science uses rigorous methods to study cognitive processes that are assumed to arise from neurological functioning but are not reduced to such. Cognitive scientists have developed detailed models of cognitive processes, such as decision making, reasoning, and memory, that have direct application to the practice of counseling.
For example, research on confirmation bias in clinical decision making has indicated that therapists tend to recall information that confirms their hypotheses about clients more frequently than they recall information that disconfirms their hypotheses (Strohmer, Shivy, & Chiodo, 1990). Such bias appeared to continue even when the majority of the information with which therapists were presented was disconfirming (Pfeiffer, Whelan, & Martin, 2000). In other words, therapists' cognitions influenced their assessment of clients. Other research exploring autobiographical memories has suggested that such memories are not simply recollections of stored events but are constructions created in a given context for a specific purpose (Arbuthnott et al., 2006). Given this, it is likely that both counselors' and clients' memory processes may have an impact on the course of therapy. Counselors' training or current concerns may influence the questions they ask or the interventions they apply, which, in turn, may influence what clients bring up in counseling. Knowledge of decision making, memory, and other cognitive processes, therefore, seems particularly relevant to counseling practice.
Shifting from a Cartesian framework to a cognitive sciences framework has several implications for counseling. From a cognitive science perspective, counseling should be viewed as an interactive, relational process. To do so, counselors should focus both on their clients' and on their own cognitions and contributions to the counseling process. Rather than exploring problems assumed to reside within the client, counselors should focus on the co-creation of meaning within the counseling relationship. Furthermore, because of the possibility of confirmation and other cognitive biases, counselors should regard diagnoses as working ideas about their clients rather than representations of correct categorization of client problems.
Cognitive science has provided a useful pathway for counseling to follow. The question becomes, are counselors appropriately trained to follow this path? It appears that a change in counselor training is in order. Counselors should, at minimum, receive foundational training in the cognitive sciences. They need not become experts in this area but should become better informed consumers of cognitive science research. Future counselors should also receive additional training in research methods, statistics, biology, and philosophy.
Hansen (2004) suggested that counseling "is fraught with profound and fundamental philosophical issues" (p. 131). The main intent of this article was to bring the issues of the mind-body debate to the audience of counseling professionals, with the belief that it is beneficial to understand some philosophical assumptions underlying counseling practice. As Kendler (2005) stated:
Whether we know it or not, to practice or to do research in the field of mental health requires us to assume certain positions on several philosophical issues, two of which are particularly central. The first such issue is the nature of the interrelationship of the brain and the mind. (p. 433)
Mentalistic language has provided the counseling profession with a useful vocabulary. If it is coupled with a firm scientific approach to understanding mental processes, counselors are not likely to "lose their minds" any time soon.
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Jerry L. Kernes, Department of Psychology, University of La Verne. Correspondence concerning this article should be addressed to Jerry L. Kernes, Department of Psychology, College of Arts and Sciences, University of La Verne, 1950 Third Street, La Verne, CA 91750 (e-mail: firstname.lastname@example.org).
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|Author:||Kernes, Jerry L.|
|Publication:||Counseling and Values|
|Date:||Jan 1, 2008|
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