First published in 1965, The Ethics of Psychoanalysis is a valuable account of the theory and method of what Thomas Szasz has named “autonomous psychotherapy.” His account is called an “ethics” because it is an outline of both the principles governing the relationship between analyst and analysand and the practical application of these principles. The primary guiding principle of the ethics is the preservation of the autonomy of both parties. In fact, Szasz claims that whenever the autonomy of either participant is compromised, analysis becomes impossible. Throughout the entire book, Szasz is not only concerned with giving a full and detailed account of his ethics, but he takes great pains to challenge the traditional medical or therapeutic model employed by many psychiatrists and psychotherapists. He objects to the power dynamics of this model as it diminishes the responsibility that therapist and patient assume for themselves and the degree to which the patient can be involved in an educational and self-transformational process, which is what Szasz claims analysis is. He also objects to the language of illness being employed in the analytic context because of the way in which it detracts from the autonomy of the analysand.

In Part One, entitled “The Scientific Study of Psychotherapy,” Szasz takes up a wide variety of questions and themes from freedom and autonomy in psychotherapy, to Freud’s legacy and its internal contradictions on the question of autonomy, to whether psychotherapy is for the individual or the community. These sections appear somewhat scattered, and it is at times difficult to locate the logic governing their order. Szasz also seems to the have felt the need to address a number of possible objections which may not be foremost in his reader’s mind before proceeding to an outline of his theory. Yet, these sections contain valuable insights and reflections for analysts, analysands and those considering this form of therapy. In Sections Three and Four, Szasz focuses on two crucial themes that will be present throughout the rest of the book. Section Three is entitled “Psychoanalytic Treatment as Education” and provides an alternative to the medical model of illness by claiming that the treatment is an education in autonomy, responsibility and self-understanding. Section Four is entitled “Psychoanalytic Treatment as a Game,” and it establishes the idea of a contract between two equal parties which guides many of Szasz’s theoretical and methodological considerations. The game which most exemplifies his purposes is contract bridge. This is because it is a game where people have to work in a partnership. It is the language of contract which at times gives the impression of inflexibility in Szasz’s writing. However, it is not impossible to sympathize with Szasz as he is trying to address and rectify what he perceives to be frequent ethical breaches in the conduct between analyst and analysand as a result of a lack of contractual thinking in psychotherapy.

Part Two, “The Theory of Autonomous Psychotherapy,” and Part Three, “The Method of Autonomous Psychotherapy,” follow the same structure based on the phases of analysis which Szasz employs. These phases are the initial contact between patient and therapist, the trial period, the contractual phases I and II and the terminal phase. In addition to being very clear and well-ordered (i.e., the sustained analogy of a contractual game is conducted in a helpful and convincing way), these sections constitute an invaluable resource for a wide range of professionals and the individuals they serve.

I would recommend this book to analysts and analysands, but also to anybody in the medical and counseling professions who is concerned about the autonomy of the people they help. I would also recommend it as a resource for those people considering beginning a practice in the new area of philosophical counseling, as questions of autonomy, responsibility and self-understanding lie at the heart of the dialogic interaction which characterizes this form of counseling.

Heidi Marx-Wolf is both a lecturer at Santa Barbara City College and a philosophical counselor. She has also established a community based public forum for the practice of philosophy called The Aletheia Society. She received her Ph.D. from the Pennsylvania State University in 1999 in Medieval Philosophy and continues to write in the areas of philosophical counseling and medieval thought.

Categories: Philosophical, Psychotherapy