The Application of Phenomenology to Psychiatry and Psychotherapy

Article excerpt

The concept of phenomenology is an unfamiliar one to American readers but has a considerable following on the continent of Europe. For example, the major work by Karl Jaspers, General Psychopathology, (University of Chicago Press, 1972), is the pioneering application of this approach by an individual who was both a talented philosopher and psychiatrist to the subject of psychiatric diagnosis and psychotherapy. Some sections of that work are of great value even today, and those mental health professionals who are interested in the application of phenomenology to psychotherapy, and who have little background in philosophy, would be well advised to start their study of the phenomenological approach with the sections of Jaspers's book that deal with psychotherapy.

On the whole, phenomenology is a philosophical movement. It began with the obsession of Husserl (see Husserl, Ideas: General Introduction to Pure Phenomenology, Macmillan, 1962), who attempted to put philosophy on what he thought was a scientific basis. His proposal was to grasp one's experience, for example, one's experience with a patient, "phenomenologically," that is without theoretical preconceptions such as DSM-IV ordinarily used in advance to organize the data. Pioneer psychoanalysts such as Boss (Psychoanalysis and Dasein Analysis, Basic Books, 1963) and Binswanger (Being-in-the-World, Basic Books, 1963) took up this approach especially in their effort to understand seriously disturbed and psychotic patients, and it is of great value even today in psychotherapy. Unfortunately, phenomenology has been applied and used in many ways in philosophy, psychology, and psychiatry, and it takes a book (see Spielberg, Phenomenology in Psychology and Psychiatry, Northwestern University Press, 1972) to review this. One should remember that Freud attended a seminar in philosophy once a week for a couple of years, and that seminar was run by a very popular teacher named Franz Brentano, whose ideas foreshadowed the phenomenological movement.

A phenomenon is whatever appears for us immediately in experience. Husserl's method rests on what he calls "transcendental-phenomenological reduction"; he does not permit the selection out of experience of certain specific things, sensations, feelings, and so on, since to do so would assume classificatory principles about the world. Phenomenological statements cannot be called empirical because empirical statements are about already assumed "things" out there. Phenomenological statements therefore attempt what Husserl called presuppositionless inquiry-no theories, just descriptions of phenomena as they present themselves to an unprejudiced view.

Husserl defined phenomenological reduction as the "bracketing of existence" or epoché, the unbiased contemplation of phenomena without intellectual considerations. One must suspend belief in everything, use "imaginative variations," and then intuit the essence of the phenomena. From the point of view of the psychotherapist, the phenomenological stance is just to react to what is simply there in a felt experience. The therapist does not disconnect, isolate, or interpret aspects of this experience. Phenomenological reduction demands refrainment from judgment about morals, values, causes, background, and even the subject (the patient) and the objective observer (the therapist). One pays special attention to one's own state of consciousness in the presence of a patient-for example, to the "feel" of a schizophrenic, the ambience such an individual creates (see Pao, Schizophrenic Disorders, International Universities Press, 1979).

Phenomenologist psychotherapists such as R. D. Laing attempted to bridge the gap between the couch and the analyst's chair by focussing on the effect of the therapist as a detached technician who reinforces the patient's problems by becoming one more in a chain of powerful individuals who have pretended to take an interest in the patient. What is more and what is worse, they argue, is the demand that the patient too must pretend that this interest is real, while in truth both therapists and patients know that therapists' responses are all too often determined by their definition of themselves as therapists rather than by the feelings that the patient as a person arouses in them. …