Value in Therapy

Part 2, Therapy Beyond Radical Skepticism

In the last post, I described how flourishing is connected to value. Read The Shape of Joy for the details and the science. And yet, despite the findings from positive psychology, the practice of therapy tends to eschew value. This is mainly due to the, very legitimate, ethical concerns about imposing values upon clients along with the nonjudgmental posture therapists adopt to create a space of acceptance. Therapists allow their clients to espouse their own "personal values," taking these as givens. All this seems routine and obvious. But the question I want to raise in this post is if this value-neutral posture in therapy is more harmful than helpful.

I'm going to let James Mumford make this argument using his 2022 New Atlantis article entitled "Therapy Beyond Good and Evil: A nonjudgmental psychology is failing patients who need to hear hard truths." I discuss Mumford's essay in The Shape of Joy to raise the point about the role of value in mental health.

Mumford, an ethics professor, begins his essay in a psychiatric facility where he is undergoing treatment for bipolar disorder. In a group therapy session a psychologist is leading Mumford and his fellow inpatients through a "values clarification" exercise. Mumford describes the exercise:

I’m in psychiatric hospital in central London and the psychologist is taking us through a “values-clarification exercise.” I’m interested in what the psychologist has to say about values, because I used to teach ethics, at the University ofVirginia. But now I’m the student, because I’m the patient. And I’m about to be given a strong dose of moral relativism. I’m about to be told that there are no objective values and, by implication, that good and evil are merely projections of our minds. This, apparently, is going to make me feel better. “What does the word ‘values’ mean to people?” the psychologist begins. “What are some of our values?” Unfazed by an unresponsive group — a circle of depressives is not always the most forthcoming of audiences — the psychologist circulates a handout. It’s a list, including the following words:

Swimming

Honesty

Wealth

Honor

Skiing

An odd jumble of hobbies and virtues, the psychologist asks us to circle the “values” we particularly identify with...

Presented with the handout listing various values, we’ve been asked to circle the ones that resonate with us. Next, the psychologist, with a flourish, ventures an observation. Each of us, he says, has different values. What’s more, we often disagree about our values. “So,” he concludes, “values are subjective.” And our recovery, our restoration to sanity, hinges upon our willingness to choose our own values. He lets us know that while morality “is externally imposed by society,” it is imperative that we be the ones to pick which ideals, morals, judgments, precepts, and rules to live by.

As Mumford recounts, values clarification exercises like these have become ubiquitous due to the rising popularity of Acceptance and Commitment Based Therapy (ACT). According to ACT, one of the sources of mental distress is caused by becoming alienated from your values and deepest concerns. Consequently, healing involves bringing those concerns and values into view. The values clarification exercise is a tool to help with this process.

And yet, these values are choices. Which is why Mumford raises the charge of moral relativism. He goes on to unpack his criticism of the assumptions at work in the values clarification exercise:

Who would deny that it’s vital that my values be ones I’ve properly signed up for rather than had simply foisted upon me — by my parents, my teachers, my culture? But this truism — that I will more likely be able to live out a set of values if I have consciously adopted them — doesn’t exhaust the sense of what’s being said. My psychologist is implying something more radical when he insists on the pivotal importance of choosing your own values. When he claims that “values are subjective,” he is painting a picture of the world according to which the only values that exist are ones we have created. To say values are subjective is to say there is nothing independent of our own minds that answers to our talk of right and wrong. It is to say that our ethical beliefs do not track a reality which is “there anyway.” According to his picture, values are determined, not discovered, and selfhood — what it means to be a person — is therefore fundamentally about choice, not vision. It is about picking a course of action arbitrarily, not about seeing a reality that transcends you — goodness — and integrating with it.

Now, again, allowing the client to choose their own values might simply be a posture of non-judgmental acceptance. But Mumford sees something more sinister going on. Here's what he thinks is really happening in the field of psychology:

It may seem that the relativism on offer here is just professional etiquette. In a pluralistic society, isn’t it right that psychologists stay neutral and refuse to impose particular moral systems, refuse to foist upon us what the political philosopher John Rawls named “comprehensive conceptions of the good?” Isn’t the psychologist, taking me through my values-clarification exercise, merely showing restraint in keeping with his discipline? Isn’t he simply applying the golden rule that therapists must suspend judgment? “The first duty of a psychotherapist,” writes Frank Tallis in his recent book The Act of Living, “is to create a safe space, a situation where difficult and sometimes dangerous truths can be articulated and explored without fear of judgment, rejection, or condemnation.” Indeed, wouldn’t any other approach open up the whole enterprise to abuse, returning us to an age when the cause of lunacy was simply put down to “laxity of morals?”

I don’t think so. I think the psychologists are up to more than suspending judgment. I think they really believe they’ve got straight on what is and is not the case in the world, that they’ve really uncovered the truth of the matter, which is that there are no moral facts, that good and evil are not part of the fabric of the world. This is not just wariness on psychology’s part. It’s radical skepticism. The idea that “we as therapists shouldn’t talk about right and wrong” has become the very different idea that there is no right and wrong in the first place.

As Mumford goes on to discuss, from Freud to the radical behaviorists, "professional psychology has a long history of flirting with, or outright endorsing, skepticism about objective values." Mumford quotes the influential existential psychologist Irvin Yalom who has stated, "there are no rules, no ethical systems, no values; there is no external referent whatsoever; there is no grand design.”

We can appreciate Mumford's point. It's one thing to be non-judgmental and respectful toward other people's values. It is quite another thing to deny objective values outright. Mumford's concern is that modern psychotherapy is trafficking in the latter rather than the former. Which, in light of my last post, raises the question: Can mental health be effectively pursued in an environment of radical skepticism? As Mumford goes on to explain:

Psychiatrist and Holocaust survivor Viktor Frankl insisted that we’ll never be able to treat mental illness properly until we acknowledge the existential dimension of depression. “Man’s search for meaning,” he wrote in 1946, “is the primary motivation in his life.” So long as we conceive of a patient’s suffering as resulting solely from a chemical imbalance that needs to be fixed with medication, we stand little chance of helping him. Even the most efficacious pharmacological regimen will not quell someone’s deepest questions about how to live.

Now in one way my psychiatric hospital grasps this, making space as it does for patients to make inquiries about which values are worth pursuing. But in another way the hospital’s therapeutic regime forecloses that search for meaning by denying the reality or importance of objective, transcendent truths by which men and women have historically navigated their lives. The provision of Acceptance and Commitment Therapy whets patients’ appetite for meaning only to deprive them of real nourishment by extracting the very substance on which meaning depends: its orientation toward the absolute.

And lest you think Mumford's concerns are getting overly moralistic, the example of objective value that he turns to in his essay concerns the topic of my last post, the issue of existential significance and cosmic mattering. In the grip of his depression, Mumford describes the exhaustion of carrying what the writer Michelle Thomas calls the "weight of your own worthlessness." And cracking under that weight, Mumford raises his hand in the middle of the values clarification exercise to push back upon the psychologist leading it:

So here’s what I say to my psychologist. “The care I have received in this hospital is superb. The support, the understanding, the empathy. I am treated by your team as if I have irreplaceable value. When I am feeling worthless, you don’t act as if values are subjective. You don’t reply, ‘Yes. You’re right. If you feel worthless, you are worthless!’ No, you and your team always speak and act in ways that imply fundamental disagreement with my estimation of myself. Valuing my worth, you betray your proclaimed belief in the subjectivity of all values. You embrace truths far beyond any of our mere preferences.”

Once again, mattering. And how mental health depends upon living in relationship to objective value. As I describe in The Shape of Joy it is the objective, existential, and cosmic nature of this value that keeps our worthiness and significance from becoming variable, fluctuating, and contingent.

And if this is so, Mumford concludes, therapy has to step away from radical skepticism. Objective value needs to be reintroduced into the modern pursuit of health and happiness. As Mumford concludes his essay:

What would it look like for psychologists to preach what they practice, to accommodate the intrinsic value they presuppose their patients to have? It would not, I think, necessarily entail a return to Victorian-style moralism...Rather, it would see psychologists refusing to rule out from the outset a transcendent good that is the natural end of “man’s quest for meaning.” It would see psychologists encouraging patients to search for values beyond themselves, but making that quest for themselves. It would see psychologists echoing Iris Murdoch’s challenge, that each of us make “an attempt to look right away from self towards a distant transcendent perfection, a source of uncontaminated energy, a source of new and quite undreamt-of virtue.”

There are values and obligations and demands out there in the world that I may never have assented to, that simply come with the territory of being human. Any psychology that is going to be therapeutically beneficial, that is going to help people attain personal growth and become good again, will help us acknowledge and reckon with values — with truths — we may never have circled in an exercise.