What are the unspoken moral and ethical assumptions of common psychotherapy practices for the client?

Thanks for the question, Jeff.

I’d say “that depends.” It depends on the the training of the therapist, their level of moral development, their own personal ethical praxis, and the system within which the therapist is practicing. This introduces a lot of variables. For a client-centered practitioner who is forced to maximize client load and minimize interaction time in service to group practice profitability, corporate cost-saving mandates, or a paucity of insurance coverage for their chosen modality, all but the most bare-boned moral and ethical assumptions can practically be followed. And even then, it may only be according to the letter of the law, rather than its spirit. That said, the APA has developed a very robust Ethical Principles and Code of Conduct: https://www.apa.org/ethics/code/

Given that some methods like CBT and DBT have a mountain of evidence to support their efficacy, one could conclude that “all that really matters is to effectively teach these helpful cognitive behavioral tools, and the rest is up to the client’s willingness and compliance.” And there are certainly many therapists who either lack the internal psychosocial makeup to transcend this position, or who become exhausted enough by the constraints of for profit practice, that they arrive at this pragmatic distance from their clients.

But there are many therapists — and I would argue the really “good ones” — who recognize that their practice is really about relationship. That relationship has boundaries, to be sure, but it is deeply empathic, deeply committed, deeply involved in the client’s well-being. It is authentically engaged in the client’s perspective and felt reality, rather than merely prescriptive. And it is actively adapting to the client’s individual needs, rather than treating them as another cookie-cutter application of proven principles. In short: it embodies love.

In this latter, and arguably rarer, case, the unspoken moral and ethical assumptions run much deeper that the APA guidelines. The relationship isn’t just about client benefit, avoiding harm, and navigating a maze of laws — that’s a given. It is also about compassion, attentiveness, empathy, and a profound honoring of the client’s agency and personhood. And why is this considered important — if not critical? Because most “good” therapists know that a client’s trust, openness, and empowered agency are not just sacred and precious in the abstract, but are also primary factors in healing, growth and transformation itself. These features of the client relationship will contribute to potential outcomes in much more enduring and arguably richer and more fundamental ways.

So on the one hand there is the efficacy of technique, and on the other there is the efficacy of relationship. Whether this position is a common or not I will leave for others to judge and comment upon. I would say, however, that it is essential.

My 2 cents.

Comment from Jeff Wright:

I wonder if you’d be interested in taking it another step (because I could not make this more explicit in the original question)—

What are the unspoken moral and ethical assumptions that delimit what is and is not in the APA guidelines (since they represent a kind of social consensus reality orthodoxy about the relevance or absence of such themes within mainstream practice)? What would “run much deeper”?

This involves your highlighted themes of client, agency and personhood, so there are embedded implicit ideas about the nature and extent of those notions. And I believe those are the key points in any (deconstructive or reconstructive) inquiry into the sociology or philosophy of psychology and its practical applications. I was going to say “clinical applications” but that is a good example of a relevant tacit assumption.

And to put this in a less abstract frame, are you aware of ways that practicing therapists engage these questions in their own work, with or without the ability to articulate them?


To further answer the deeper, tacit moral and ethical assumptions question, here are some possibilities — perhaps not universal, but I suspect pervasively involved once again with the better/best therapists:

Client independence from care. That is, a level of health, wholeness and harmony that allows the client to be free of any form of mitigation or ongoing clinical support.

Client happiness and equanimity. Beyond mere increases in function, a desire for the client to feel fulfilled, at peace, etc.

Client momentum towards emotional growth and moral maturity. There are inevitably more profound evolutions in people when they engage thoughtfully in self-aware therapy. The hope is that they will really “grow up” beyond the infantilized and/or traumatized state in which they first presented. More than independence from care, this is about self-transformation.

Most importantly, that the therapist does not interfere with any of these liberating processes and conditions, but actually facilitates them earnestly and devotedly.

Comment from Jeff Wright:

Thanks. These are good statements of the main positive ideas of humanistic psychotherapy, the ideals of the “better/best therapists”.

However, tacit ethical assumptions are not limited to positive and aspirational ideals, the traditional moral focus on virtues, the “this is our best version of who we want to be”. They also embody negatives or shadow features. It’s possible I think that practitioners who work in public service settings are probably both more embedded in these and more aware of them, compared to those in private practice who work with voluntary, aspirational clients (“improve my life” or “suffer less”, or “be happier”).

There are assumptions that are widely operative within psychology and psychotherapy that express a “medical model” (based on various forms of scientism) pathology, disease, mechanization, depersonalization, individualization, disconnection and isolation of the person from their family, world, depoliticization, a turn away from social issues, and so on.

To understand some of these themes, one thing we can do is look at what gets initially emphasized and more easily carried forward through a paradigm change. For example, there were attempts at spiritualization in psychotherapy (a.ka. “transpersonal”), which never became mainstream, and more successful attempts to import ideas from Buddhism (e.g. “mindfulness”), and now more recently, “positive psychology”, which seems more successful at gaining traction in research-oriented psychology.


All true. I think what you’re touching on becomes much more specific with the modality/philosophy of care involved. Some are more somatic while others focus on relationships; some incorporate transpersonal considerations while others focus on cognitive-behavioral tools. With so much variation, it becomes difficult, I think, to make broad generalizations about pervasive moral and ethical assumptions. But it’s worth a try nonetheless! :-)

In what ways could restorative justice improve America?

Sadly restorative justice could improve America by re-introducing a basic sense of community and connection between individuals. I say “sadly” because I believe it is the disconnection and isolation in these relationships that leads to a culture of criminality in the first place. Let’s take drug subculture as just one example. Why does it exist? Because too many folks can’t see any way out of their poverty and pain, and feel isolated, hopeless, and desperate…and drugs are a way out. Not an easy way out…just one of very few ways out they believe is available. How much violence intersects with illegal drug use? A lot. How much crime? A lot. How much destruction to families and friendships? A lot. So if we model healing of crime itself around restoring a sense of belonging, relationship, family, community, intimacy and so on…well, then we’re really just addressing the malady that led to the crime itself. We are removing a cause — one incentive — for criminality by relieving what reinforced a need for drugs. The accountability is secondary…it is the healthy, mutually supportive relationships are primary. How many other crimes (or patterns of criminality and criminal subculture) are a consequence of the breakdown of community, a loss of the sense of belonging, and a paucity of nourishing interpersonal relationships in modern society…? I’d bet that when you take severe psychopathology and cycles of abuse out of the mix, that this breakdown is responsible for nearly all of the remaining serious crime.

My 2 cents.

Is it ethical to provide guidance and counseling (in a professional setting) if you yourself suffer from the same conditions and have not surpassed them?

In answer to the question “Is it ethical to provide guidance and counseling (in a professional setting) if you yourself suffer from the same conditions and have not surpassed them?”

Surpassed? I’m not sure what is meant by this term. I don’t know of anyone who has “surpassed” anything. Sure, they’ve learned to manage, self-monitor, develop alternate habits, become more disciplined, heal deep and chronic wounds to varying degrees, become incrementally more whole, etc. But “surpassed?” I think that’s probably an ego-based term for a particular flavor of narcissistic delusion, and has no place in any therapeutic or mentoring relationship.

That said, if we replace “surpassed” with “learned to constructively manage,” then I would say it depends — on many different factors, including the nature and severity of your condition, where you are in your own healing/wholeness journey, and the functional level of self-management you have been able to maintain over time.

So for instance:

1. A therapeutic relationship dealing with out-of-control addictions (of any kind) should probably not be entered into by a professional suffering from an out-of-control addiction. Even when, as some of the other answers indicate, that condition can be helpful to empathy and informed therapeutic or mentoring techniques, it can also be extremely destructive to the relationship, and likely to the person you are trying to help. So in that case…a firm “not ethical” IMO (again, if it is still unmanaged). I think the same would be true of unmanaged depression, unmanaged severe personality disorders, unmanaged schizophrenia, unmanaged self-destructive behaviors, unmanaged anger and hostility, unmanaged anxiety, unmanaged compulsions, unmanaged relationship dynamics, etc.

2. On the other hand, if you have demonstrated a high level of efficacy in managing a particular area, are maintaining genuine intentions to continue that course, and have become more high-functioning over time (i.e. can have a modicum of confidence about a given technique or process), then why not share your experiences in the therapeutic or mentoring relationship? Again, mastery is not really the issue…rather, it’s about ongoing integrity around your own intentions, and regarding your efficacy in “walking the walk” in your own life. In such a case, a conditional “ethical” IMO.

3. A very common pattern in folks who become healers, teachers, mentors, therapists, counselors, etc. is that they are initially drawn to the field because of their own struggles. This can be both helpful and unhelpful. On the one hand, they can understand and inhabit the perspective of the people they are trying to help, because they’ve been through it themselves. On the other hand, they may fall into a pattern of projecting their own desire for self-healing onto their clients, students or patients. In other words, they may perpetually be externalizing their own issues. At some point, a good teacher/mentor/therapist/healer will recognize this pattern in themselves, and address it. They may need to take a break from practice to do so. Or they may feel they need to give up the field entirely. This is a reality/integrity check that everyone I’ve known — across many different fields — eventually has to confront. Perhaps that’s where you are now, but the answer is going to be different for every person, and at different stages of their life. It’s a process where we must measure our own strengths and weaknesses against the effectiveness of our work…and when we must finally learn to check our ego at the door — and let go of our own issues — every time we engage with the person we are trying to help.

My 2 cents.

What are the flaws of modern psychotherapy and why do so many people (myself included) feel so disappointed with it?

Great question. My take on some common flaws in modern psychotherapy:

1. Consumer model. Both clients and therapists often (consciously or unconsciously) fall back on the producer/consumer model, where the therapist is there to “provide” a solution that a client pays for and “consumes.” This ends up emphasizing external resources vs. internal solutions for both client and therapist, and creates an unhealthy, disempowering dynamic — even despite client-centered intentions and protocols — which often results in a lack of willingness to “do the work” that is required.

2. Incompetence or poor training. I often use the analogy of a violinist when describing good therapists: How many virtuoso violinists are there in the world? How many first and second chair violinists? And how many folks squeak away in their basement until a position opens up in the local community orchestra string section? Virtuosos are rare, and hacks are plentiful…so it can take a lot of effort, persistence and luck to find a really good therapist.

3. Lack of cultural integration/acceptance. Psychotherapy should be considered a normal, healthy, even prophylactic resource for well-being…like going to the gym, or going to an MD for a checkup. Unfortunately, it has been polluted with social stigma so that people who could benefit often don’t seek it out — or feel ashamed when they do. This leads to a disproportionate volume of psychotherapy engaging in: a) court-mandated treatment; b) “last ditch effort,” extremely acute, crisis intervention conditions; c) self-help hobbyists. This is not a great group of folks to work with, generally — not in terms of process, or in terms of outcomes — and IMO often results in excessive “lowest common denominator” practices.

4. **The profit motive. **Evidenced-based methods are great — but what if the latest “proven” approach for a given condition isn’t working for a particular client? Well, insurance companies don’t allow such variability; everything must be cookie-clutter compliant with their actuarial tables (i.e. clear diagnosis = rigid treatment protocol). At the other extreme, a provider receiving (uninsured) private pay may not be motivated to use some provenly efficacious, short-term approach, but instead be motivated to create a longer-term income stream. “Perverse incentives” all around….

5. Lack of holism/multidimensionality, and reliance on “silver bullet” modalities. Modern medicine is struggling to reverse over a century of hyperspecialization, where only the separate systems and components of a patient are considered, and not the whole. There are efforts to integrate different disciplines, engage in group consults and assessments across departments, and change this paradigm…but it has been slow, and frequently ineffective. And so modern medicine tends to treat symptoms, and ignore underlying causes. Psychotherapy has fallen into this habit as well — people are complex, and solutions to their problems may also require complexity. This takes time, and multiple perspectives, and acknowledgement that there is no “one size fits all” treatment that is appropriate for a given set of conditions.

FYI I have a guide intended to help folks find a good therapist, here: https://www.integrallifework.com/resources/How-to-Select-Mentor-Coach-Therapist.pdf

Also here is a free assessment process for a more holistic approach to well-being: https://www.integrallifework.com/resources/NourishmentAssessmentV2.pdf

My 2 cents.

How can I contribute more to society?

Thanks for the A2A. This is a huge question and could take you in many different directions depending on how you begin to answer it. So I’ll focus mainly on that beginning. In order to ferret out how you - with your unique values, resources, perspective and abilities - can best contribute to society, you will first need to:

Clearly define your personal, interpersonal and social values. I saw that you began to do this in your response to one of the answers here, but IMO you could really drill down deep to understand and document what you think is most important in your relationships, your personal standards of ethics, and in what you believe to be societal standards and mechanisms for good.
Clearly understand what you bring to the table. What are you strengths, aptitudes, skills and resources? What is your work style, relationship style and communication style? What are you really good at, and what do you enjoy doing the most?

Begin to explore how your values intersect with your individual strengths, aptitudes, skills and resources. This can be the trickiest part of the process, and it is important to avoid locking yourself into a single trajectory too quickly - instead, you can remain open, and look at what is already being done in the world that resonates with both what you care about, and what you are good at.
Identify communities, collaborators and institutions that support your values and strengths. Make an extensive list of these, research them online, and talk with as many people as possible about the options that already exist (there are likely many!). There are probably whole communities whose philosophy of values and approaches to societal contribution align closely with yours.

Try things on for size. Try out a number of different possibilities that you think will allow your values and strengths to be put to good use. Take some classes in a promising field, do some volunteering at a promising organization or work in an entry level position, engage in some activism with a like-minded group of folks, etc.

Be willing to start something on your own if you need to. For me, it became clear after a few decades of “trying things on for size” that there wasn’t a prefect match for me already out in the world in terms of a career, volunteer organization, community, etc. So I started my own business, wrote exclusively about what I was passionate about, and began more informally connecting with folks who had similar values and concerns.

This can be a lengthy process - it took me nearly twenty years to figure all of this out. So be patient, and persistent. Also, to begin with step #1, check out the Self-Assessment Resources on my Integral Lifework website.

I hope this was helpful.

What are the goals and effects of self inquiry meditation on who am I?

Answering the question: "What are the goals and effects of self inquiry meditation on who am I?"

Thanks for the A2A Pete. I had to laugh when I saw this…it’s a big question with a simple experiential answer: try it and you’ll see. So as to be less trite, however, I’ll offer a few nuggets to mull over:

- After seven years of self inquiry Jorge realized there was nothing there. Nothing at all. Self was annihilated and only emptiness filled the place it had once occupied.\

- After fifteen years of self inquiry Martha became God; that is, she recognized a complete absence of differentiation between her Self and the Divine. It was a very humbling experience.

- After a lifetime of self inquiry Wu Wei encountered a unitive substrate of being that consumed all independent and personal aspects of identity, so that all that remained was the Tao.

- After twenty-seven lifetimes of self-inquiry, Advika became extremely bored with the practice and began living her life very simply and without artifice, with an endless well of compassion for everyone around her, and with plenty of time to watch children at play.

As for negative effects: self-obsession, attachment to spiritual progress, and a breakdown of survival functions can occur if more constructive intentions are not cultivated from the beginning. Because of this, whenever any form of meditation is taught, I believe students should be encouraged to set this intention in their hearts and minds, and to try to feel it deeply in their bones, before each session: “May this be for the good of All.”

My 2 cents.

On Somatic Psychology

In Response to Quora Question: "What is your experience with somatic psychology? Was it useful?"

Body-centered psychotherapy has been immensely useful in my experience, as have many other body-centered therapeutic techniques. This is from the perspective of someone who has both experienced personal psychological, emotional and physical healing through these therapies, and helped others discover healing through them. In particular, the practice of Hakomi has been very effective, mainly because it so actively integrates the body's felt experience (and provocation of/interaction with somatic memory, repressed material and volatile emotions) with talk therapy and client-centered collaboration. Modalities that focus solely on releasing "stuck stuff" through bodywork can also be powerful aids in this self-awareness and healing process (for example, craniosacral therapy, myofascial release, etc.), but it is the inclusion of conscious introspection, metacognition, and compassionate modification of counterproductive thoughts and emotions that further promotes individuation and "moving beyond" merely coping with internalized trauma, confusion or persistent unhappiness. In any case, I hope that this field will continue to expand to include more and more dimensions of self, and not restrict itself to, for example, mind-body-energy relationships. In my own work, in-depth exploration and development of the spiritual dimension has been a critical component, as have a sense of purpose, relationship to community, sexuality and so forth. The various manifestations of somatic psychology are certainly an important piece of the overall puzzle of our human experience, but only a piece. Such inherently "interdisciplinary" approaches will, I hope, become more inclusive as we come to better appreciate the totality of our being. My 2 cents.