This post by Anna Drożdżowicz and J.P. Grodniewicz explores the epistemic injustices that can arise in the context of psychotherapy.
Despite the recent surge of interest in the topic of epistemic injustice in various health care settings, relatively little attention has been paid to the risks of perpetrating epistemic injustice in the context of psychotherapy. In our recent article (Epistemic injustice and psychotherapy) published in Philosophical Psychology, we focus specifically on this topic. We propose, first, that many forms of epistemic injustice can arise in psychotherapy, and, second, that we should pay close attention to them, as they threaten an important goal of therapeutic work, namely, helping and empowering clients/patients to understand themselves better.
The goal of psychotherapy
But let’s start from the beginning. What is psychotherapy? In general, we can think of psychotherapy as a psychological service that relies on collaboration between a psychotherapist and a client/patient. Usually, psychotherapy consists of a series of meetings and conversations that often span years (although some therapies are considerably shorter). The therapist and the client/patient talk about different aspects of the client/patient’s life, focusing especially on various forms of mental suffering that the client/patient experiences, and looking for ways to alleviate them. During that process, they also develop a relationship that most psychotherapeutic traditions consider to be an important healing factor.
Typically, the main goal of psychotherapy is to improve the client/patient’s mental health and well-being. Interestingly, an important aspect of therapeutic work consists in creating the context in which clients/patients can learn more about themselves, know themselves better, or—as we like to think about it—deepen their self-understanding.
It is no different in the case of self-understanding. In order to understand ourselves, we have to possess a lot of information about how we feel and what we think in various situations, what motivates us, how we behave and react, and so on. Moreover, we have to figure out what the relations between these things are. What causes what? Which elements tend to co-occur, and how do they influence each other?
Good psychotherapy can be an excellent opportunity to acquire such self-understanding, thereby helping us make various choices and decisions on the way to the life we envision for ourselves and hope for.
First, if the therapist treats the client/patient only as a source of information and not as an active partner in their joint work, the client/patient loses the chance to contribute their perspective. In the paper, we interpret cases like that as cases of participatory injustice in psychotherapy. In such cases, the resulting self-understanding of the client/patient may be less accurate or limited.
Second, we can think of cases in which a therapist attaches little weight to, or outright does not believe, some of the things the client/patient says, because they have previously classified the client/patient as suffering from a particular psychiatric disorder (e.g., narcissistic personality disorder) and have acquired a certain prejudice against that group. We present this as an example of testimonial injustice in psychotherapy. In such cases, the therapist may prevent the client/patient from acquiring new information about themselves and from grasping the relations between different pieces of information.
Finally, if the therapist is excessively attached to using certain categories, such as medical categories employed in a classification of mental disorders, which are alien to the client/patient, they may deprive the client/patient of the opportunity to develop their own, and more helpful, forms of self-understanding. We interpret this as an instance of hermeneutical injustice in psychotherapy.
Epistemic injustice in psychotherapy may not be more common than in other areas of medicine and healthcare. Nevertheless, the epistemic harms it can produce are, in our view, particularly interesting, given that psychotherapy relies heavily on fostering one’s self-understanding.
Anna Drożdżowicz (left) is a Professor of Philosophy at the University of Inland Norway (website: https://annadariadrozdzowicz.wordpress.com/)
Understanding and self-understanding
What is understanding? Whenever we try to understand a complex phenomenon, be it the political history of 19th-century Poland, jet propulsion, or genetic drift, we need to do two things. First, we need to acquire a lot of information about this subject domain, a significant portion of which has to be true. Second, we need to figure out the ways in which the information relates to each other. How did partitions and uprisings shape the fate of 19th-century Poland? How do the forces of combustion and aerodynamics interact to make jet propulsion work? How do random mutations and population size together influence genetic drift? And so on.It is no different in the case of self-understanding. In order to understand ourselves, we have to possess a lot of information about how we feel and what we think in various situations, what motivates us, how we behave and react, and so on. Moreover, we have to figure out what the relations between these things are. What causes what? Which elements tend to co-occur, and how do they influence each other?
Good psychotherapy can be an excellent opportunity to acquire such self-understanding, thereby helping us make various choices and decisions on the way to the life we envision for ourselves and hope for.
Epistemic injustice in psychotherapy
Unfortunately, epistemic injustice in psychotherapy can preclude clients/patients from improving their self-understanding.First, if the therapist treats the client/patient only as a source of information and not as an active partner in their joint work, the client/patient loses the chance to contribute their perspective. In the paper, we interpret cases like that as cases of participatory injustice in psychotherapy. In such cases, the resulting self-understanding of the client/patient may be less accurate or limited.
Second, we can think of cases in which a therapist attaches little weight to, or outright does not believe, some of the things the client/patient says, because they have previously classified the client/patient as suffering from a particular psychiatric disorder (e.g., narcissistic personality disorder) and have acquired a certain prejudice against that group. We present this as an example of testimonial injustice in psychotherapy. In such cases, the therapist may prevent the client/patient from acquiring new information about themselves and from grasping the relations between different pieces of information.
Finally, if the therapist is excessively attached to using certain categories, such as medical categories employed in a classification of mental disorders, which are alien to the client/patient, they may deprive the client/patient of the opportunity to develop their own, and more helpful, forms of self-understanding. We interpret this as an instance of hermeneutical injustice in psychotherapy.
Epistemic injustice in psychotherapy may not be more common than in other areas of medicine and healthcare. Nevertheless, the epistemic harms it can produce are, in our view, particularly interesting, given that psychotherapy relies heavily on fostering one’s self-understanding.
Author bios
J.P. Grodniewicz (right) is an Assistant Professor of Philosophy at the Copernicus Center for Interdisciplinary Studies at the Jagiellonian University (website: www.grodniewicz.pl)
