Academic journal article American Journal of Psychotherapy

Ethics in Practice: A Critical Appreciation of Mikhail Bakhtin's Concept of "Outsideness" in Relation to Responsibility and the Creation of Meaning in Psychotherapy

Academic journal article American Journal of Psychotherapy

Ethics in Practice: A Critical Appreciation of Mikhail Bakhtin's Concept of "Outsideness" in Relation to Responsibility and the Creation of Meaning in Psychotherapy

Article excerpt

High standards of ethical practice are paramount in psychotherapy and involve the negotiation of complex issues in societies characterised by ethnic, cultural and religious diversity.

Bakhtin's concept of "outsideness" offers a potential way of thinking about the ethical implications of therapist interventions that is transtheoretial and that pays particular attention to the use of language and the embodied nature of human interaction.

KEYWORDS: ethics; theory; responsibility; outsideness; insideness


Two interrelated philosophical questions of crucial importance in psychotherapy are how intersubjectivity, consciousness, and selfhood are understood in theory and what the implications of these understandings are for ethics in practice. Whilst codes of ethics necessarily provide general principles that apply to all therapists and their work with all clients, ethics in practice refers to the particular: the continual evaluation and reevaluation of our activities as psychotherapy practitioners in both interactions with patients and with other professionals. Bakhtin scholar, Tim Beasley-Murray, has aptly termed this conception of localised and situation specific ethics as the "ethics of a non-categorical imperative" (2007, p. 84). In this article I will discuss how Mikhail Bakhtin's philosophy of human intersubjectivity could contribute to thinking about ethics in the practice of psychotherapy. I will try to show how Bakhtin's ideas could be used to think about some of the ethical issues involved in the use of theory as a way of giving form to human subjectivity. Bakhtin describes an ethics of intersubjectivity and interdependency, of which psychotherapy could be considered to be just one form, not a privileged relationship set apart from other human relationships. This needs to be born in mind when considering the relevance of his ethical philosophy for the practice of psychotherapy.


As psychotherapy practitioners,1 our attitude towards ethics in practice depends on how we position ourselves in relation to an imaginary fault line that divides those who prioritise the relationship in psychotherapy from those who are primarily guided by theory. The latter group is sometimes referred to as the "scientist practitioner" paradigm, where practice is primarily theory driven and in which human beings are the "objects" of study. The former, whose starting point is the human relationship and human subjective experience, could be loosely referred to as the "relationship practitioner model." Whilst the "scientific practitioner" bases therapy on a theoretical understanding of the symptoms and causes of psychological distress and how to ameliorate them, the relationship practitioner sees symptoms as the signifiers of meaning that is unique to each individual and that emerges or is created in the context of the human relationship.

The "scientist practitioner" is guided by faith in the power of reason and knowledge based on rational enquiry. There is often an unquestioning assumption that human psycho-social functioning can be studied and conclusions reached in the same manner as in the natural sciences. The assumption of equivalence between the social and natural sciences has been criticised by Chomsky (1976) and Hacking (1999) in terms that echo Bakhtin's critique of "theoreticism" in the realm of human subjectivity. Chomsky observes that what often passes for scientific research in the social sciences is merely common sense observation and that description translated into technical jargon often masquerades as expert knowledge (1976). Hacking points out that human beings, unlike other animals and inanimate objects, react to how they are diagnosed and categorised in ways that undermine attempts to standardize and predict outcomes (1999). R. D. Laing (1967) articulated an even more penetrating critique of scientific psychology, pointing out that the only evidence of the nature and process of subjectivity is experience, and the experience of the other is invisible to us and can only be inferred from his or her behaviour. …

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