Thursday, 27 December 2007

Making up the Mind 1

I was recently sent the cognitive neuropsychologist Chris Frith's latest book: Making up the Mind, subtitled 'How the Brain Creates our Mental World'. Reading the book reminded me of another recent work containing a controversy between Daniel C. Dennett and Peter Hacker (amongst others): Neuroscience and Philosophy: Brain, Mind, and Language.

Here Hacker takes cognitive neuroscientists to task for their 'conceptual confusions' regarding terms like 'inner representations', 'information', 'mental processes' and the like. His argument is not trivially with their choice of language. Rather he claims that a surface clarity of presentation obscures deep underlying confusions about the nature of our mindedness. Such supposed tacit confusions within cognitive neuroscience are, Hacker claims, what drive much of the putatively empirical theorising. Clear them up and what seems to need to be explained will be quite different. Neuroscientific work can go ahead, but wrongheaded conflations of neurological and psychological functions can be put aside.

In reply, Dennett suggests that Hacker fails to take note of the way in which terms such as 'internal representation' (or what have you) are actually used by cognitive neuroscientists. Hacker is supposedly committing the very fallacy he accuses the cognitivist's of: failing to pay attention to the actual 'grammar' of the terms employed in the language games of cognitive neuroscience. Attend to this and the appearance of conceptual confusion will, on the whole, be dissipated.

I propose to use Chris Frith's book as a test to see who is right in this debate. If Dennett is right, then the plaudit from Oliver Sacks on the back cover 'Chris Frith is well known for his extremely clear thinking on very complex psychological matters' will be to the point. If Hacker is right, Frith's clarity is a surface illusion which masks a considerable lack of conceptual clarity. Once this confusion is uncovered, we would no longer find ourselves wanting to ask and answer many of the questions Frith poses.

Now I'm afraid I'm going to spoil the story and let you in on my diagnosis. This diagnosis is in fact one which undoubtedly owes something both to Dennett himself - although not the Dennett of Neuroscience and Philosophy: Brain, Mind, and Language, but rather the Dennett of, for example, Consciousness Explained or Sweet Dreams: Philosophical Obstacles to a Science of Consciousness - and to Hacker. It is as follows:

Frith's work is fatally compromised by a tacit conception of the relation between the brain and the self which tacitly positions the self at the receiving end of putative 'information processing' which goes on in the brain. (When I say 'tacitly' what I mean is: the only way to make some kind of sense of the explanatory structures Frith mobilises is by considering them as presupposing some such positioning of an inner self; I do not for one moment suppose that Frith ever says anything of the sort about an 'inner self', and it is not of interest to me whether or not he even explicitly believes or disbelieves that 'the self' exists (whatever believing or disbelieving that would amount to). I'm not trying to describe his explicit theory of the mind, but rather to describe what seems to me to be a tacit commitment which underlies the way in which he develops his theories.) Experience is accordingly considered as a kind of 'output' from brain processes, tacitly conceived of as a kind of delivery to 'consciousness'. Consciousness is conceived of as a kind of inner screen or a 'mental world': the 'representations' which are delivered from a neurological working over of the deliverances of the senses are displayed there. We are accordingly said to be mistaken if we think we have direct experience of (what now becomes) the 'external' world. Cognitive neuroscience can show (as the book's subtitle suggests) that 'the brain creates a mental world' which does not concord with reality in interesting respects; it is of this inner world that we are 'directly' aware.

Frith lets us know (pp.188-189) that he is fully aware of the temptations in psychology to commit the 'homunculus fallacy'. That, in effect, is pretty much the fallacy that Dennett refers to when he talks of the inner 'Cartesian theatre'; the homunculus is the viewer of the inner goings on in such a theatre. But somewhat bizarrely Frith traces the fallacy to the temptation to suppose that we rather than our brains are in control of our actions. This, he suggests, is an illusion: our brains are in control, and they merely give us the illusory experience of being agents. This isn't the right characterisation, however, of the basic metaphysical mistake involved in making the homunculus fallacy.

It can be difficult to find a successful analogy through which to understand the homunculus fallacy, since it is so very bound up with the difficulties we have in thinking about the relation between our very own experience and its physiological substrate. But consider attempts to explain the forward movement of a car. Fuel is injected and ignited in the engine, pistons turn, crankshafts rotate, and spinning wheels grip the ground. The car goes foward. Essentially, we do not take ourselves to be required to provide an explanation of how a car resting on the ground is able to harness the power of the movement of its own wheels. The explanation is already over by this point. It is not as if this wheel movement has to be fed back into another inner system, turn some further crankshafts of an inner car, and cause its inner wheels to move.

So too: light from a waterfall hits the retinae, optic nerves are excited, striate cortex is innovated, etc. The person sees the waterfall. The consciousness of the waterfall is the consciousness belonging to the whole person seeing it and who's neurological functions subtend this perception. We do not need to suppose that there is some 'output' from visual processing into a kind of 'inner' visual field; we do not suppose that the brain provides 'inner representations' for the perusal of another consciousness. We do not need to 'harness' in consciousness, as it were, the firings of the visual cortex. The explanation just was of our consciousness of the waterfall, and it's now already over.

But hang on a minute!, Frith would say, 'the whole point of my book is to provide reasons for believing why 'our perception of the world is a fantasy', why 'it may feel as if we have direct access to the world and to our bodily states, but this is an illusion caused by our brain'. And, yes, he'd be right, I have yet to consider his actual claims. Furthermore, Frith claims to not be interested in explaining consciousness. Now I think that this extraordinary idea - that he's not interested in explaining our consciousness (what else is he doing?), comes primarily from a non-transitive conception of consciousness as something fairly epiphenomenal. Consciousness becomes something extrinsic to our perceptuo-motor engagement with the structures in our lifeworld. All of that engagement, all of those perceptually guided responses, can apparently occur without 'consciousness'.

In Frith's book it seems that we are to be said to be conscious of something in our environment, not if it effects our non-verbal behaviour, but only if we can put it into words in order to respond to questions. I do not see why certain behaviours should receive such a privileged position as criterial for the 'presence of consciousness', but let me leave this for another time and turn to the arguments of Frith's book.

Sunday, 23 December 2007

On the 'Mysteries of Consciousness'

I've always found it frustrating that, by shoving a 'ness' on the end of a perfectly respectable adjective with an unproblematic meaning, a mysterious entity seems to have been born with properties that are taken to defy our understanding. We all know perfectly well what it is to be conscious. It's to be, well, not recently bashed over the head, to be able to respond to questions coherently, to have the capacity to draw on and lay down memories whilst engaging in complex actions, and all the rest of it. There are some rough edges to the concept which are exploited, as it were, by dissociative phenomena, sleepwalking, so-called blindsight, and the like. But on the whole we know what we are doing with it. Nominalise the adjective, however, and the temptation arises to suppose that one is suddenly in intimate possession of some quite marvellous and mysterious entity. All those Wittgensteinian lessons about such derivative nouns not gaining their meaning through an act of reference to a thing of some sort just go out the window.

Imagine if the same was true of the adjective 'tired'. We know what it is to be tired - it's, well, to be unlikely to be conscious for much longer. Stick a 'ness' on the end of it and suddenly we have this mysterious entity, this dying inner flame, called 'tiredness'. How will we ever fathom its hidden nature? How will we reconcile it with our otherwise respectably naturalistic worldview? This inner world of tiredness, this dimly evanescent internal force.... No! No-one feels compelled to even begin to wax mystical about tiredness. It is so obviously a noun which is the name of a fairly tractable property, a property the essence of which can be happily explicated through a list of what is true of someone if they are tired.

Similarly with happiness and sadness. In these long-post-vitalist days we are hardly likely to go round supposing that an analysis of happiness will be incomplete if we simply describe what is true of someone if they are happy - thinking that there is some mysterious stuff or property that these miss out - 'happiness itself'. But when it comes to more cognitive terms we immediately, or so it seems to me, start going off the rails. We forget to take 'belief' back to 'believe', and instead imagine that 'beliefs [who (setting aside for a moment political and religious uses) except a philosopher would use a plural of 'belief'?] are mental states' or some such, states apt for 'identification' with 'states of the brain' (whatever those are supposed to be). The active character of 'oh, i've got an idea, let's go down to the ...' gets lost, and we start to elaborate a philosophy of entity-like ideas, and even talk of 'mental representations'...

When it comes to the 'wondrous container' for all these states, ideas and experiences, the metaphorical nature of the 'mind as an inner realm' trope gets utterly forgotten. 'Conscious-ness' becomes a kind of final frontier for science. Yet, to me, (Lockean?) speculations about it are as likely to hold water as the commonplace speculations about the mysteries lurking in the depths of another famous Ness. Whilst the 'mysteries' cited in the 123,000 entries found by Google for mysteries of consciousness typically reference putative mysteries about the supposed referent of the term, the real mystery is why this mystifying hypostasisation still enjoys such philosophical currency.

Sunday, 9 December 2007

Who needs Relational Frame Theory?

I have recently learnt a lot from ACT - the Acceptance and Commitment Therapy developed by Steven Hayes. I have come to greatly appreciate the diverse, skillful and humane strategies developed there to help the client (well, and the practitioner too) to, well, 'get out of their mind [through becoming mindful of what is occurring there, and staying in a relationship to thoughts and feelings, rather than becoming identified or enmeshed with them] and into their life [through a discovery and commitment to one's values - to what really matters]'. The entire approach to human suffering strikes me both as profound and also as providing a theory of what goes on in diverse therapies - not just ACT - when they are working at their best.

What however has troubled me, when I have my theorist rather than clinician hat on, is the claim that 'functional contextualism' (FC) and 'relational frame theory' (RFT) are the way to provide the theoretical foundations for ACT. (It is RFT in particular which underlies the prima facie surprising claim that "language is at the heart of much human misery".) This is because I am not even convinced that they are altogether theoretically cogent positions. My basic concern, I think, amounts to the following:

  • RFT and FC are just too reductionistic (especially in their behaviourism)

  • They redefine psychological and other essentially normative vocabulary in non-psychological, non-normative, ways

  • This redefined terminology is then used to theorise ACT

  • However to understand ACT we must rely on irreducibly psychological understanding; the theorisation cannot work

  • Nevertheless, the appeal of RFT and FC needs to be explained. This can be done by noting the tacit equivocation on the nature of 'the mind' in the theory and therapy

  • On the one hand 'the mind' refers in ACT to an illusory neurotic realm which traps us. Its goal is to change the mode of our thinking and to begin to be able to learn from and trust in experience again

  • Yet there is another sense of 'mind' which simply refers to everyday intentionality, life, experience, meaning, purpose, non-neurotic thought

  • Behaviourism may seem to appeal because it provides a kind of extra-mental perspective which allows us to undercut the otherwise-endless neurotic machinations of 'the mind'

  • This however is unnecessary; the notions of everyday behaviour and action, of intentionality, mindedness, non-neurotic thinking, understanding, etc., are both irreducible to non-intentionally specified behaviours, and also essential to making sense of ACT

  • I am not going to argue here for this rather bold set of propositions above. (Make up your own mind by having a look at chapter 2 of Hayes, Strosahl and Wilson's (1999) super book Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.) It should be said that the theory of RFT is complex and, well, I may just fail to do it justice. If this is the case I hope there is someone out there who can put me right, since I suspect that I may not be alone in my confusion.

    I shall finish this post with a thought about what Hayes et al describe as the "Need for Philosophy" (pp. 16-18). Here the authors encourage the idea that it is important to state and own the fundamental assumptions which structure and constrain, and provide the 'rules of evidence or criteria for truth' for, the psychological theory one develops. Next they tell us that:

    the goal of examining the philosophical level is not to justify one's own philosophy, but to specify and integrate analytic assumptions. Put another way, the goal of philosophizing is nothing more than clarity and responsibility. ... It is important to keep this goal in mind, because there is an enormous temptation to use philosophy to bludgeon those outside one's own philosophical camp. This is an especially delicious form of useless activity if you criticise the assumptions and values of your intellectual adversary, because you are then in the untouchable position of laying waste to others' assumptions and values by virtue of empirical/logical analysis secretly based on your own
    assumptions and values.
    Now I wouldn't want to just baldly disagree with this; partly this is because I am unsure whether the authors intend it as an expression of their own "analytic assumptions", or whether they intend it as a statement which anyone might recognise from reflecting on common shared meanings of terms like 'philosophy', 'analytic', 'asumption', etc.
    I do however wish to 'fess up to a basic philosophical assumption of my own - although it is certainly not one which I would wish to render immune from the criticism of others. This is that the noble philosophical pursuit of attaining reflective clarity and taking on responsibility for what one is saying is not limited to specifying assumptions. I shall rather assume that we all sometimes get in a muddle, even when we are doing philosophy, and that this muddle can go unnoticed by us. In fact it may be that others are in a better position to spot the assumptions we are unwittingly making than we ourselves.
    It is of course important not to bludgeon each other with philosophical arguments. However I shall further assume that we have a comon, shared, understanding of the context-specific meanings of the terms of our language, and that we can make appeals to such a putative shared understanding when we philosophically question whether what someone else, or our past selves, made as much sense, or the kind of sense, that they or we supposed.
    I should admit that I have felt the need to state this here to try and ward off an attempted reply to my philosophising regarding the theoretical foundations of ACT which would accuse me, say, of 'bludgeoning' or of not playing by the rules the authors have set for discussion of their work. I want to urge that a different set of rules governs such discussion: a set which does not lay claim in advance to limit the possibility of this or that critique striking a chord, but which allows for the possibility of genuinely critical and open dialogue about what exactly the underlying assumptions are that we all undoubtedly have.

What is Clinical Psychology?

According to H J Eysenck, Emil Kraepelin ought to be recognised as the founder of clinical psychology, because of the methods he used.        But I always imagined that the first clinical psychologist - in terms of an embodiment of the logos of the discipline - was Pierre Janet

Perhaps I can get the meaning of the title's question into focus by distinguishing it from readings which invite answers such as the following:

Wikipedia: "Clinical psychology includes the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration."

British Psychological Society: "Clinical psychology aims to reduce psychological distress and to enhance and promote psychological well-being. A wide range of psychological difficulties may be dealt with, including anxiety, depression, relationship problems, learning disabilities, child and family problems and serious mental illness. To assess a client, a clinical psychologist may undertake a clinical assessment using a variety of methods including psychometric tests, interviews and direct observation of behaviour. Assessment may lead to therapy, counselling or advice."

These answers tell you what clinical psychologists do, but they don't tell you how they do it. Or better, they don't tell you about the spirit in which it is done, the fundamental attitude towards its object (e.g. the client in emotional distress) adopted by the psychologist. In this and related posts I want to consider this question - the question of what might be called the
logos of clinical psychology. I shan't be supposing that every or even any clinical psychologist - defined in terms of someone with the requisite qualification - manages to embody this logos for much of the time, even when practicing clinically. Yet it is, at least, the form of that particular disclosure of the individual human being, imminent within the possibility of a distinctly clinical psychological practice, actualised when and where ever it is, that interests me.

"Ah", I hear someone say, What you mean is the model the psychologist uses." The
scientist-practitioner model, for example, or the reflective-practitioner model. These are descriptions of the ways of being a psychologist - the psychologist as applying scientifically gathered knowledge to the psychological needs of the client, for example, or the psychologist as thoughtfully directing their practice through reflection on their own ongoing experience. And yes, that is nearer to the sense of the question, but still not quite there. For these are prescriptive models for psychological practice. What they give us are precisely models. Whereas what I am after is a reflective account of what good clinical psychological practice is, of the logos immanent within it, not an external guiding model of how it should be conducted.

"But how do you know there is any such 'logos'?" I hear another psychologist ask. Such a response is perhaps almost a reflex these days. "If you want theory and fundamentals, then turn to the model. If however you want to uncover 'fundamental attitudes' then, well, all we have are the shifting sands of attitudes of psychologists feeling one way or the other towards their patients, in this or that setting, from this or that training, with this or that character." Now if there's one thing I want to achieve in this particular blog posting, it is the recognition that this kind of institutionalised reflex response may well contain a kind of prejudice, a prejudice which excludes without reasoning a kind of patient attempt to uncover meanings which one may be embodying without realising it.

Let me say up front: "Of course, I don't know that there is any such logos". But, well, lets look and see. I'll suggest something, and you tell me what you think. Have I uncovered something or not? What I do want to avoid is a kind of thin 'empiricism' or 'positivism' which too often seems to lodge itself in the
culture of clinical psychology, a tendency which questions the value and meaningfulness of questions which cannot be easily answered with recourse to either a definition, or to a fact (ideally a scientifically derived fact), or which, if such options are not available, is simply dropped into a 'pending' tray until the chance arises to collect such a fact (through an experiment, say). A beguiling straightforwardness is the name of the positivist's game, limited patience with vagueness one of its key parameters. 'How could you test that?' is a core mantra of positivist psychology, the implication being that, if you can't, then the question needs refining. The idea that there might be a non-perspicuous essence to the discipline, then, is something which is unlikely to convince the positivistically minded. What is essential comes from a combination of the definitions within the explicit models, the guiding theories that have been proposed, and the established facts of psychological science. From such a perspective, the attempt to unearth a hidden logos to clinical psychology might seem like nothing other than an unacknowledged strategy of foisting one's own explicit model onto the discipline, whilst pretending that it is not merely an idiosyncratic personal perspective on it, but rather something essential in it.

So, without pretending to know in advance whether I am uncovering or foisting, let me at least put forward a suggestion. My suggestion is that there is something deeply ironic in such a clinical psychologist's positivistic response to the phenomenological attempt to unpack the logos of clinical psychology. It is ironic because an essential part of what it is to practice clinical psychology, I want to suggest, is to be able to notice and step back from, and encourage the client to step back from, the narrative structures which have, without the client realising it, framed their experience. Of course one listens empathically and respectfully to the story that the client presents, in the terms in which it is presented. That is perhaps even the most important thing. But it isn't enough, and doesn't distinguish the psychologist from, say, the counsellor. For what the psychologist's client needs, perhaps why they have come to you as a clinician, and what their sometimes extraordinary trust in you has to do with, is: a quite different perspective. They have come because they are stuck, because their own many attempts to solve their problems have not worked. There is perhaps a dawning recognition that there something 'underneath' all of the problems they have faced and all the solutions they have tried, something which needs unearthing. We might or might not describe that as the 'unconscious'; here at least I wish to avoid the implications of a motivated unawareness that that term brings with it. The psychologist's job - for which their fundamental guiding sensibility or logos prepares them - is the unearthing of such hidden frames of meaning, and the ability to not get caught up in them, the ability to notice them in the first place, and the ability to bring into the foreground, for the client, what had previously tended to frame their entire perspective on their difficulties. Hence the client's extraordinary trust: they hope (and perhaps fear or resent) that the psychologist will know their mind better than they themselves.

Let me first touch on the irony before returning to the claim about the logos which will later be unpacked with an example. The irony is that, whilst in practice clinical psychologists are experts at not getting caught up within the frame of the client's experience and self-understanding, the influence of positivism has, I believe, meant that psychologists have been unwilling to stand outside certain framing assumptions of their own self-understanding as professionals. The spirit of positivism provides certain criteria for meaningfulness - ideas must be readily intelligible within an agreed framework, must be testable, or be true by definition. The biggest and well known irony here of course is that the positivistic criteria do not pass their own test. They cannot be read off uncontroversial definitions of meaningfulness, and it is hard to see how they could be brought to the test. The idea of trusting a philosopher, or even of trusting one's own 'inner philosopher' (i.e. trusting in their own capacity to ask and answer philosophical questions), someone with the capacity to notice the tacit acceptance of intellectually or theoretically framing assumptions - does not in my experience come all that naturally. (cf Hubert Dreyfus on 'breadth' psychologies.)

But yes, back to the claim about the logos of clinical psychology. The point can I believe be made for a variety of different therapeutic strategies - narrative or behavioural or psychodynamic or mindfulness or systemic or neurological or what have you, although it is really the way the theories are used rather than their content that matters for the point I am making. But let's start with a simple behavioural case.

Someone is depressed, caught up in an experience of the world and a self-image structured by rumination, deprecation, and pessimism. They are lost within their own thought, and the emotional grammar of the narrative they are living has no place in it for openness, hope, spontaneity or laughter. Now for such a person in such a state, reflective listening does help, of course it does, as does acknowledging the reality and validity of their feelings. Sometimes this alone, along with the sense of recognition and acceptance as the person they are that such listening conveys, may be enough for the client to themselves spontaneously recollect the missing 'grammar', and thicken or shift sideways the narrative of their life. But at other times the relentless inwards focus and negativity is hard to shift through listening alone. Simply arguing with them about their value judgements, or encouraging them to argue with themselves, may also occasionally help, but will often be unhelpful. And the reason it is often unhelpful is that it just urges a change within the story, and does not enable a different kind of story altogether to be told.

An example. Here would be two tunes unhelpfully in the same key as the client's that a clinical psychologist who is failing to embody his or her logos might play: Try to help the client find reasons for living (love, walks, nature, sport, children). Or try to help them recollect the good deeds they have done which constitute their entitlement to their life. These responses might provide momentary relief, and they might well work for the mildly depressed, but they are not what the client who is seriously stuck in a frame really needs. They do not enable the client to change the frame. The basic assumptions underlying the narrative: that a meaningful life is one lived for reasons, or that one has to earn one's entitlement to the gift of life, are left unchallenged.

To return to the behavioural treatment of depression. What the psychologist does who is embodying her logos is, I believe, to focus not on the thoughts and feelings that show up within the client's frame, but rather to consider the maintaining factors of the frame itself. And this first involves the taking of an attitude to the client which, whilst respectful, is noticing of the simple fact that they do have to do here withh a frame, with one amongst others. The client is feeling unmotivated, and can't find any reasons to get on with their housework. The psychologist knows that motivations don't typically precede any and all action, but are rather created in and through a living engagement with the world. So activity is prescribed, activity which will break the frame in which the world is set over against a self which itself has retreated even from a body now experienced as a heavy obstacle. Activity which will instead develop a frame of meaning which discloses the world under a different aspect. Activity which encourages the taking of the world or of others for the object of thought and experience, and not the self. Activity which does spring first from a reflective 'top-down' recognition of the reasons in life for which that activity should be done, but activity which constitutes one strand of the unfolding of a life, which 'bottom-up' unfolding itself generates the missing meaning.
It is this capacity to notice and to operate at the level of the frame rather than the content which, I want to suggest, constitutes the logos of the clinical psychologist.

Many things stand in the way of the clinical psychologist's self-understanding. For example, the definition which heads this report seem at least tacitly to suggest that it is the clinical psychologist's scientific approach which is essential to their identity. What I want to suggest is that this often satisfies only because it touches on the right issue whilst theorising it in a wrong way, albeit a wrong way which satisfyingly generates kudos by trading on the prestige of the natural sciences. That is to say: what is essential to the 'scientific' approach in its clinical applications may not the extent to which it grounds the practitioner's interventions in the evidence base, but rather the extent to which it enables the practitioner to maintain a firm grip on the need to not only understand the client's own perspective, but also to more cooly consider the framing assumptions of that perspective. (cf Jonathan Lear's subjective objectivity.)

This is what seems valuable to me in the above-mentioned therapeutic approaches and the frutiful metaphors they employ which constitute the foundations of their theorisations of human distress. Whether it is seeing the client as in the business of embodying narratives which are less optional than they had considered (narrative therapy), or bringing out the framing role of the total systemic pattern determining the behaviours of individual family members (systemic family therapy), or understanding the significance of helping the client to alter their relation to their thoughts and feelings, rather than attempting to alter the thoughts or feelings themselves (mindfulness therapies), or looking at the environmental reinforcers of behaviour rather than, say, only at the meanings the subject understands their experience to hold (behavioural therapy), or encouraing the 'mentalisation' (recognition as such and feelingful acknowledgment) of feelings which otherwise overwhelm and are 'projected' onto the world (psychodynamic therapy) - may not matter so much as the simple fact that what they are offering is an opportunity to step outside of the framework inhabited by the client and to work directly with this framework.

It is then, I think, simply wrong to view the different therapies just mentioned as simply holding to different 'theories' of the origins and maintaining factors of psychological distress. That is a shallow understanding of their value, which value I suggest is not simply to theorise, but rather to promote what the narrative therapists describe as the 'externalisation' of the client's framing narrative. Able to see the frame, the skilful psychological therapist is able to help to open up a gap for the client between themselves and their framing assumptions. Inevitabilities which were not even noticed as such now become options amongst others, and the client is freed from the tyranny of the endless stories which their depression, for example, told them about who they were. Sometimes the psychologist invites the client to join them in this recognition of the role of the tacit frame, and to actively and cooperatively set off on the somemtimes frightening journey of shifting it. Or at other times the psychologist may feel they need to take an 'expert' role, introducing changes to the frame themselves. Whatever one thinks about this, however, it is surely not defining of the psychologist's logos, but rather simply determines the individual preferences of the clinician.

I want to note one consequence of the approach towards the essence of clinical psychology that may strike some as strange, perhaps even absurd. This is that cognitive therapeutic attempts to promote change in beliefs, or psychoanalytical attempts to foster straightforward insight, are excluded - almost by definition, as it were - since they work at the level of what shows up or is hitherto hidden within the frame. I am not convinced however that this is all as bad as it sounds. For, on the one hand, the cognitive behavioural tradition has itself come to question the value of cognitive restructuring, instead promoting the value of changing the client's relation to their thoughts and feelings, rather than trying to change the thoughts and feelings themselves. On the other hand, psychoanalysis is hardly reducible to a form of clinical psychology, and in any case typically depends only to a small degree upon insight. Taken in a relatively pure form it provides a forum for regression and renewed development, an intensive relational encounter between analyst and analysand, the development of play and mental flexivbility, the analyst's containment of the client, their metabolisation of the client's projective identifications, etc. And that is simply another enterprise altogether than the one I have described as clinical psychology. Nevertheless, in applied forms, psychodynamic psychology has also moved away from the idea of change occurring through insight, to that of the importance of (for example) mentalisation. And here once again we have the idea of the client coming to an altered relationship with their feelings. Where what is important is to be able to develop the capacity to recognise one's feelings as feelings, as containing a perspective, information, as representing other people and relationships fairly or unjustly. The client thereby gradually becomes able to stop being lost in their feelings, looking out through them unawares, and instead to appreciate them for what they are - as containing perspective. As psychoanalytic psychotherapists from Irving Yalom to Anthony Bateman have suggested, what may then be important about interpretations, when the therapist does give them, is more the process of mentalising that they embody and inspire than the particular content they carry. (Interpreted another way, it could be argued that actually what any 'good' insight interpretation achieves is just this: the moving of a desire or fear that had been structuring a client's world from the framing background to the visible foreground - into the 'clearing' as Heidegger would say. Perhaps it is only the ways in which we have tended to theorise what insight interpretations are that causes the appearance of incompatibility mentioned above.)

If this really does capture what I have called the 'logos' of clinical psychology, why has it been hard to recognise it? Why does this fundamental skill, of combining the counsellor's 'subjective' empathising with the psychologist's 'objective' 'externalising', not feature in the definitions on the BPS website, or in the textbooks? I suspect several reasons:
  • Psychologists learn this skill unawares, on the job. They develop it as a clinical skill, and are hardly aware of doing so. In part it is a skill which develops naturally, simply through having the clients they do and from learning the therapeutic models they learn (which implicitly promote the skill in question).
  • The power of 'positivism' or 'empiricism' in psychology means that ideas of the clinical psychologist as fundamentally a scientist practitioner - or the emphasis in post-positivistic understandings of the clinical psychologist as fundamentally guided through inner reflection, or as developing a new product for the client through mutual co-constructions - maintain their status. We can also cite the prestige of the natural sciences - or of hermeneutic accounts in the human and social sciences - as responsible for this.
  • It is hard to maintain the capacity to become empathically aware of the client's framing assumptions (although noting one's countertransference may help). And it may seem disingenuous to define 'clinical psychologist' in terms of something they often fail at, and easier to define them in terms of the people they serve or the general job they do. (We need to remember cases where we are inclined to describe a 'good' X as an X the essence of which is more fully realised.)
  • It might feel morally easier (less uncomfortable) to disown the power which comes from holding onto one's understanding of the client's framing assumptions, the phantasies which structure their world - and to humbly throw oneself into a kind of non-expert co-traveller relationship with the client.

So let me finally return to the question of the logos of the clinical psychologist. When I ask a clinical psychologist what it is to be one, they typically say: "Ah yes, a clinical psychologist's identity comes from their being a jack of all trades. I do assessment, formulation, this or that therapy (hey, I get to choose depending on the circumstances), neuropsychological assessment, consultancy, supervision, etc...". But, you know, I'm not convinced that the essence of clinical psychologist is so distributed, and so reducible, as that. It seems to me that what is forgotten here is something essential and something important about the clinical psychological identity, something which makes itself manifest in all of the psychologist's activities, all of their therapies, and in their inter-professional dealings as well. At its best, clinical psychology is the pursuit of a kind of subjective objectivity, the creation of a space for thought, the ability to step into, but also see the outside of, the client's frame. Irrespective of the therapeutic 'model' or the nature of the work being undertaken, it is the ability to use these in the service of 'externalisation', in the service of the creation of 'mental space', which, I am claiming, constitutes the logos of the psychologist.