Over the last two posts I've made the argument that therapy is not as value-neutral as it claims to be. Rather, as Brent Slife, Greg Martin, and Sondra Sasser put it in their chapter from The Hidden Worldviews of Psychology's Theory, Research, and Practice, therapy smuggles the values of neoliberalism into our pursuit of mental health. As I shared in the last post, Slife, Martin, and Sasser have enumerated six hidden values at work in therapeutic contexts:
Atomism: Individual identity is relatively independent of context and relationships.
Autonomy: Individuals have the power and right to govern themselves and decide their own therapy goals.
Happiness: Individuals should pursue the satisfaction of their own desires, including happiness and well-being.
Instrumentalism: Individuals should use the world, including people, as resources for their own ends.
Neutrality: Therapists should strive to practice in a manner that is as free of their own values as possible.
Freedom From: Individuals should reject unnecessary obligations as obstacles to their freedom and self-expression.
As I described in the last post, these are the values of neoliberalism, a market-shaped view of human flourishing that conceives of individuals as autonomous, self-interested agents within a marketplace of choices where we pursue utility maximization. But this is only one way of envisioning human flourishing, and it rests upon assumptions and values rarely made explicit or interrogated within therapy. The vision of neoliberal flourishing is simply assumed.
What, then, would be an alternative?
In their chapter from The Hidden Worldviews of Psychology's Theory, Research, and Practice, Slife, Martin, and Sasser contrast neoliberalism with a worldview they call "strong relationality." Neoliberalism, they point out, is characterized by "weak" relationality. They unpack the contrast:
[The] weak form [of relationality] assumes that all individuals are first self-contained entities (selves, personalities) before they form relationships, whereas the strong form assumes that all individuals are first and always nodes or nexuses of relationships. With either form, psychotherapists can care deeply about relationships. However, the quality of the relationships is different for each. In the weak sense, people are primordially individuals who house within themselves their essential identities and only later form relationships with other identities. In the the strong relational sense, people have a shared being with their contexts from the outset. Relationships are the primordial reality, and if anything is "formed" later, it is the cultural notion of individualism from the relationships (culture), and not the other way around.
Again, this should be familiar stuff, how Western culture has been characterized by individualism. This is in contrast to more collectivist cultures, or even how we were more tightly connected to family, culture, and tradition in the West hundreds of years ago. But the point to notice here is how modern therapy can traffic in weak relationality by implicitly and explicitly conceiving of the identity of the client as something self-contained and created over against existing relationships. Health is achieved via a "freedom from" others.
Strong relationality, by contrast, assumes that identity is formed by and inexorably bound up with relationships. You've never existed as an isolated ego. You begin life as a son or daughter. You're born into a family, already entangled in a social and moral matrix. Our identities are always relationally embedded.
To make the contrast with the values of weak relationality, Slife, Martin, and Sasser offer a list describing strong relationality. (They present this list side by side with the list above in their Table 3.1 on page 28. I'm adding the "contra" to connect and contrast this list with the one above.):
Contra Atomism: Individual identity is dependent upon context and relationships.
Contra Autonomy: Individuals and their therapy goals are and should be informed by their moral tradition.
Contra "Happiness": Individuals should pursue the quality of relationships and meanings.
Contra Instrumentalism: Individuals should pursue moral relationships, and not use people as means to an end.
Contra Neutrality: Therapists cannot help but value their values and instead should facilitate an interchange of client/therapist values.
Contra Freedom From: Individuals should embrace obligations and duties as a key to meaning and self-development.
To be sure, this list raises questions, some ethical and some practical. Who gets to say what a "moral relationship" would look like? Who determines which duties and obligations must be embraced? And what if a client doesn't have a "moral tradition" to inform their therapy goals? And so on.
But set aside, for the moment, those questions and concerns. What I'm most interested in here is how the vision of "strong relationality" sets forth an alternative set of values.
Minimally, the strong relationality list makes it clear that therapy is trafficking in value judgments, if only in the rejection of the values of strong relationality. Put the lists of values presented here side by side and it's much harder to claim that therapy is "value-neutral." Even if a therapist rejects inserting overt conversations about morality into their work with clients, they shouldn't be under any illusions that they are, in fact, morally forming the people they work with. To ask a client "What do you want?" versus "What is the right thing to do here?" isn't being neutral and non-judgmental. You're putting your thumb down on the scale of values. You're implicitly privileging an autonomous pursuit of happiness in "freedom from" existing obligations and relational commitments. Which might be exactly what you think should happen. But don't pretend that should is "neutral" or "non-judgmental." There are no neutral or non-judgmental questions in therapy. Values are always being communicated. Moral formation is always occurring.
If so, perhaps the better thing to do is drop the pretense. Following Slife, Martin, and Sasser, therapists should facilitate a conversation about values with their clients. But what would this look like? That's the sticky practical and ethical question. A question I've been thinking about a lot. And while I don't have any great answers or definitive solutions, I'll float some thoughts in the next and final post.
This is somewhat off-topic, but I realize that our economic system is a big reason for our atomism. Of course, a large portion of this philosophy comes from the Enlightenment idea, but I think it has only worsened as that idea has spread into our everyday systems.
When individuality (a good and necessary quality) morphs into individualism it becomes destructive, just like any ISM.