In this interesting book, Erwin addresses
some issues concerning the justification of psychotherapy as a remedy for
psychological disorders. In particular, he discusses some of the criteria for
the assessment of psychotherapy, such as the obtainability of its aims and its
success in improving the condition of clients. The merit of the analysis Erwin
offers is to provide a well-informed and accessible account of the current
state of psychotherapy, its history and its philosophical grounds.

Erwin’s book is supposed to fill a gap in the
literature on psychotherapy. Few philosophers have shown an interest in issues
related to the foundations and practice of psychotherapy and practitioners have
been reflecting too little on the general purposes and overall success of their
discipline.

In the first part of the book, Erwin
addresses what he calls "foundational questions", what the aim of
psychotherapy is, how psychotherapy can achieve its goals, what epistemic
standards should be relevant for the evaluation of psychotherapeutic evidence.

In the second part, he reviews three
paradigms in psychotherapy, the behavioristic, the cognitive and the
psychoanalytic.

In the epilogue, Erwin concludes that
psychotherapy is successful only in so far as it has a placebo effect on
the client. The reason for this claim is that, according to the author, we lack
satisfactory evidence for regarding any treatment factor of psychotherapy as
remedial for the disorders that might affect the client.

Erwin’s argumentative skills and knowledge of
the literature are remarkable and most of his original claims are persuasive.
Although I am largely sympathetic to his critical approach to psychotherapy, I
found his final conclusion not entirely supported by his previous discussion.
My main worry is that Erwin sets unrealistically high standards for the
adequacy of evidence for the success of psychotherapy. Let me offer an example
here.

Erwin addresses the issue of how we can
establish the truth of psychotherapeutic hypotheses that posit unobservable
states such as repressed wishes. One option is to rely on the inference to
the best explanation. The idea is that we posit the existence of
unobservable entities to explain some observable phenomena. If we manage to
predict the observable phenomena on the basis of the behavior of the entities
whose existence we have posited, then we have reasons to believe that our
explanation is a good one. Whether the hypothesis is the best available will
depend on epistemological criteria (e.g. internal consistency) and pragmatic
considerations (e.g. simplicity). Erwin is not persuaded by the reliability of
this method. He writes: "However one decides what is the best available
explanation of certain data, does the fact that it is the best one anyone can
think of suffice for having grounds for thinking the hypothesis is true?"
(page 77). Erwin concludes that the inference to the best explanation is too
low a standard for judging therapeutic hypotheses.

I think Erwin’s conclusion is too quick. The
inference to the best explanation is a legitimate scientific tool for the
generation and acceptance of hypotheses about all sorts of phenomena. If we had
not relied on inference to the best explanation to some extent, we would not
have posited the existence of electrons, or other unobservable entities that
play an important role in the explanation of physical phenomena. The point to
keep in mind is that the generation of a hypothesis is only the first step
towards its acceptance. Once the hypothesis is on the table, it needs to be
verified via experimental evidence and it needs to outcompete other available
hypotheses in terms of predictive success and explanatory power. Moreover, the
hypothesis has to resist revision in order to become part of our dominant
theory about the phenomena under investigation. Even though the initial
formulation of the hypothesis might be little more than an informed guess, the
competition with alternative explanations and the necessity of empirical
confirmation contribute to setting high standards for the acceptance of the
hypothesis.

Erwin invites us to consider whether
psychotherapy can be a science. This is an important question that needs an
answer. But Erwin’s answer is biased if he claims that the standards for the
acceptance of a psychotherapeutic hypothesis need to be higher than the
standards for the acceptance of a scientific hypothesis. Erwin is right to put
pressure on the criteria according to which we evaluate hypotheses in
psychotherapy and to ask for a more rigorous examination of the available
evidence. Yet, some of Erwin’s observations throughout the book suggest that
not many hypotheses in psychotherapy or any other discipline would count as
well grounded in the light of his demanding criteria.

© 2002 Lisa Bortolotti

Lisa
Bortolotti studied philosophy in Bologna (Italy), London and Oxford (UK)
before starting her PhD at the Australian National University in Canberra. Her
main interests are in philosophy of mind, philosophy of psychology,
rationality, mental illness and animal cognition.

Categories: Philosophical, Psychotherapy