Ethical Issues In Philosophical Counseling, Not So Different From Ethical Issues In Psychotherapy

Chapter 3 : Ethical issues in Philosophical Counseling, not so different from ethical issues in psychotherapy.

3.1. Client suitability and client selection in both psychotherapy and philosophical counseling, a difficult endeavor.

Client suitability is certainly a big issue in Philosophical Counseling profession.

What makes somebody a good client for philosophical counseling? What makes somebody not a good client? Generally, the same question is asked when we refer to the suitabilty of the client of psychotherapy and/or psychiatry services. Using the diagnostic tools, like clinical instruments and tests, makes us more aware of the client problematics and psychopathological existing issues and also allows us to make an informed recommendation for the client, either refering him to a psychiatrist, an psychotherapist or both.

At the moment, there is a specific protocol and an IRB-approved scope of practice pioneered in the 1990s by Lou Marinoff, employed succesfully in the Philosophical Counseling research protocol at CCNY, SUNY Cortland, Eastern Michigan University, University of Northern Colorado and also employed by all the supervisee counselors trained by APPA. This way, even though the Philosophical Counselor does not use diagnostic or psychological instruments in order to assess the counselee problematic, he or she follows a systematic approach in the relationship with the counselee (Marinoff, 2002). I will investigate in this chapter the necessity of further training in philosophical counseling profession, in the hope that the counselee will be offered the best possible help in solving the complex problematics or predicaments that brought him in the consultation room and will not be deprived of good case management.

This chapter also investigates the attitudes of philosophical counselors and psychotherapists in private practices towards various factors concerning the selection of clients. As I have already argued in the article “Moral Dilemmas and Existential Issues Encountered Both in Psychotherapy and Philosophical Counseling Practices” published in Europe’s Journal of Psychology in 2015, the psychotherapists and counselors are influenced not only by diagnostic criteria, but also by other factors relating to the client. The most important selection criteria are: desire for change, motivation for therapy or counseling and evidence of psychopathology, although there is no clear consensus about the criteria overall. However, it is worth mentioning here that most clients of philosophical counseling are self-selecting and also, the process of selection being a two-ways process: while the counselor may select his or her client, also the client may select his or her counselor.

In both practices, philosophical counseling and psychotherapy, the selection of clients may be difficult, but it is a crucial task for the success of these processes. Looking at the psychotherapy field, when the psychotherapist is using validated psychological assessment tools for detecting the client’s problems during the anamnestic interview, the practitioner may happen to diagnose as well a psychiatric disorder, such as paranoid schizophrenia or delusional disorder. However, the non-maleficence principle of bioethics stated in most of the ethical codes and also in the “Ethical Framework for Good Practice in Counselling and Psychotherapy” (British Association for Counselling & Psychotherapy, 2012) urges the psychotherapist to refer this particular client to a psychiatrist and, only then, the client can also enter in a psychotherapeutic process with the best chances of recovery. Therefore, there will always be an overlapping of interventions in the case of a psychiatric patient: a psychiatrist’s intervention and a psychotherapist’s intervention, preferably one trained in an evidence-based psychotherapy (as CBT) and practicing a bona-fide therapy.

Looking at the philosophical counseling field, as Lou Marinoff acknowledged in one of his initial works, “Therapy for the sane” that philosophical counseling should address normal people who don’t have psychiatric problems that need to be dealt with by using medication (Marinoff, 1999, 2003). At first glance, the selection of clients with the possibility of referring them to a psychiatrist may be done properly only if the philosophical counselor has clinical training or has acquired diagnostic skills. This is not always the case, in the philosophical counseling practice, the counselor is supposed to be able to seize if he client is neither rational nor functional or to assess if the client does not fit scope of practice.

Marinoff, also the author of “Philosophical Practice” acknowledges that the philosophical dialogue is mostly “educational in intent and content, and is neither adversarial nor diagnostic” (Marinoff, 2002, p.81), reflecting the current opinion in mental health that using diagnostic labels is not useful for the client’s recovery. However, in order to be able to help a psychiatry patient find professional help, the Philosophical Counselor would be advised to use few clinical selection guidelines, also developed in this chapter. The psychotherapy profession is rather easily accessible worldwide, since people with all sorts of BA degrees: theology, sociology, medical school, nursing, psychology, are able to get training in psychotherapy, not always being required to hold a MA degree in psychology or psychotherapy. In a philosophical counseling practice, the selection of the counselee’s has the same degree of the difficulty as in a psychotherapy practice. One of the aspects that may differentiate a philosophical counselor from a psychotherapist is that the philosophical counselor did not acquire in the process of training the diagnostic skills that the psychological practitioner has, which may make the process even harder. Apparently this fact would drastically limit their area of intervention to the ‘normal’i, non-symptomatic persons who would only like to have few sessions meant to clarify their thinking regarding personal problems, moral dilemmas, moral conflicts or who would also like to achieve an eudaimonic well-being, in the Aristotelian sense. Eudaimonic well-being reflects traits concerned with personal growth, self-acceptance, purpose in life and autonomy (Ryff, 1995).

For a professional, it is much easier to decide if a person asking for psychotherapy or philosophical counseling should actually be referred to a psychiatrist, since the symptoms of a psychiatric disorder are usually florid and, during the interview, a trained eye could see if the person in front of the practitioner is in reality or is constructing his or her own reality. The problem of selection could get even more complicated when a person comes to a philosophical consultation in order to ask for life advice or for help to solve a moral dilemma. If this person has also emotional disturbances or has previously been diagnosed with depression, anxiety or panic attacks, the philosophical counselor should be able to refer this client either to a psychotherapist or to a psychiatrist. The discussion is ample and may elicit further questions since the NIMH has rejected the DSM-V, precisely because of symptomatology.

The selection of clients is a common issue also encountered in life coaching, since this sort of overlapping is usual in the counseling professions.

Another situation is also stated in the American Philosophical Practitioners Association’s FAQ about philosophical counseling: “many clients of philosophical counseling have sensibly explored psychology as a prelude to philosophy, that means none of the psychological theories or methods suited them perfectly”; this could lead to the idea that they were dissatisfied with the solution offered by the psychologist or with the psychological approach (American Philosophical Practitioners Association, 2015b). I would argue in this subchapter that there may also be a lot of clients for whom none of the theories or techniques of psychotherapy work on their particular type of problems (moral or ethical dilemmas) and here is where philosophical counseling or training in ethics may help.

Therefore selection, as simple as it may seem at first glance for an untrained eye, it is actually a difficult process which should be regarded with the highest concern. Emmy Van Deurzen regards the selection issue in a more detached manner, in the sense that: “clients who come specifically for existential therapy usually already have the idea that their problems are about living, and are not a form of pathology” (van Deurzen 2006, p.205). In other words, it is mainly the client’s responsibility to assess the type of approach he or she needs. In my view, this responsibility is shared between the counselor (psychotherapist) and the counselee (the client), with an emphasis on the counselor (or the psychotherapist) opinion, considering at least the temporary disorientation or heteronomy of the person entering the therapy or the consultation room.

In the helping professions field there is an increasing need to establish a set of guidelines in order to determine which method should be applied in a specific clinical situation. Moreover, we may consider the opportunity of using an ethical decision making strategy in this process. In this subchapter I will also address the issue of developing a set of criteria when a new client enters the consultation room of a counseling professional, that would help the professional make a correct and informed decision, either keeping the client in his practice or referring him to another practitioner. In the initial interview or discussion, the client is usually asked first:

1. What is the reason of approaching a particular professional (a psychiatrist, a psychotherapist or a philosophical counselor)?

2. What are the objectives he or she would like to achieve in the sessions?

The interview would be more successful in addressing the client issues if it followed some selection guidelines that are highlighted below.

Guidelines for referring the client to a psychiatrist:

a. A psychiatric diagnosis of psychosis on Axis Iii (schizophrenia, bipolar disorder, etc.) and client being currently under medication;

b. Even though not been previously diagnosed with a psychiatric condition, the client currently has suicidal ideation or suicidal thoughts. Scores higher than 30 on BDI-II-Beck Depression Inventory indicate a severe depression that should be addressed with the highest care;

c. There is evidence of drug addiction or substance abuse, even though the client is undergoing treatment;

d. The client suffers from other debilitating symptoms not mentioned above that prevent him or her to function normally and also desires fast symptom relief.

Guidelines for referring the client to a psychotherapist:

a. Existence of symptomatology such as hypochondriac complaints, anxiety, phobia, conversive symptoms, somatization, depressive symptoms, that client desires to treat without medication, only via psychological methods;

b. There is suspicion of a personality disorder (antisocial, borderline, dependent, etc.) on Axis IIiii;

c. There is a history of child abuse or trauma;

d. Even though not previously diagnosed with a psychiatric condition, the scores at BDI-II indicate a mild or moderate depression (lower than 30); severe depression with suicidal ideation is considered a psychiatric emergency;

e. Even though the client is currently seen by a psychiatrist for depression or other psychiatric condition, he or she can still receive psychotherapy in order to prevent relapse and learn new coping skills.

f. The client would like to have a specialist teach him how to develop skills in order to address issues such as lack of assertiveness, procrastination, self-esteem, how to cope with frustration, with difficult social situations, the type of non-clinical issues that can be addressed with talk therapy.

Guidelines for referring the client to a philosophical counselor:

a. The client does not suffer from a psychiatric condition and he is not currently prescribed psychiatric medication;

b. In the particular case the patient had a previous psychiatric condition that is in full remission e.g. a depression episode in the past that had been successfully treated using psychotherapy and/or medication, he/she does not have any symptoms at the time being and only wants to investigate other issues that could improve his/her wellbeing;

c. The client wants to explore the meaning of his or her life, to explore existential issues, to develop his or her ability to understand personal problems, to solve conflicts or moral dilemmas;

d. The client needs to develop critical thinking abilities in practical or theoretical contexts, to identify and eliminate cognitive distortions, argumentation errors and prejudice;

e. The client wants to refine his world view, his set of beliefs that guide his daily actions and determine his choices or life options.

The above criteria are drawn largely from the definitions of the three intertwined and frequently overlapping fields of the helping professions. However, perfect and accurate delimitation cannot be made since there will always be an overlapping area between psychiatry and psychotherapy (at least in mild and moderate depression and anxiety) and another overlapping between psychotherapy and philosophical counseling (at least in the existential issues and moral conflicts area), but we can strive for more and more accuracy in the future and hopefully this is the first attempt that will encourage other researchers to study the client selection topic. The selection topic is illustrated by the first case study in the applied section of the thesis.

3.2. Ethical issues in Philosophical Counseling – counselor’s ethical issues.

A special section in this chapter will be dedicated to unethical behaviors in the philosophical counseling and CBT/REBT sessions, which would consist of any situation involving the counselor:

– failing to develop a rapport with the client based on supportive and empathetic dialog, in which the client leads the counselor in the direction which counseling will take;
– pushing clients into realizations they have not arrived at for themselves, and are not ready to deal with, rather than collaborating with them in identifying areas to work on;
– exhibiting a lack of acceptance of the client, in a way which would jeopardize the client's ability to develop "rational self-acceptance";
– imposing beliefs or belief systems on the client which contradict or oppose currently cherished beliefs.

The counselors issues in therapy and counseling are:

Dual role relationships

Dual relationships are rarely a precise matter. Very often, judgment calls and the careful application of ethical codes to specific situations are needed. Dual relationships are filled with ambiguities and they can be problematic along a number of dimensions: (1) they are pervasive. (2) they can be difficult to recognize. (3) they are sometimes unavoidable, (4) they can be very harmful but are not always harmful, and (5) they are the subject of conflicting advice from expert sources. "A dual relationship is created whenever the role of counselor is combined with another relationship, which could be professional (e.g., professor, supervisor, employer) or personal (e.g., friend, close relative, sexual partner)" (Herlihy & Remley, 2001, p. 80). For example, a counselor who serves as both a therapist and a business partner or friend to a client is engaged in a dual relationship (Maley & Reilly, 1999). Because there are many types of dual relationships and because ethical codes provide only general guidelines for handling these relationships, counselors sometimes find difficult to understand what dual relationships are and how to handle them. The purpose of this subchapter is to explore this issue and to provide both philosophical counselors and psychotherapists with solutions to manage ethical dilemmas relevant to personal and professional entanglements between practitioners and their clients. Although other forms of dual relationships have been discussed in the literature (e.g., between supervisor and supervisee, professor and student), this article is focused on dual relationships between counselors and their clients.

There is a continuum ranging from potentially beneficial interactions to harmful interactions in the dual relationships. One dual relationship that is always considered harmful is a sexual relationship with a client. The 2005 revision of the ACA Code of Ethics reiterates and expands the ban on sexual relationships with clients. Under the new code, counselors are ethically prohibited from engaging in sexual relationships not only with clients but also clients’ partners or family members (Standard A.5.a.).

One of the major problem with dual relationships is the possibility of exploiting the client (or the counselee). Borys studied a variety of possible nonsexual dual relationship behaviors and concluded that they all were related to the principle, "Do not exploit" (Borys, 1988; Borys & Pope, 1989). Kitchener and Harding (1990) argued that dual relationships lie along a continuum from those that are potentially very harmful to those with little potential for harm. They concluded that dual relationships should be entered into only when the risks of harm are small and when there are strong, offsetting, ethical benefits for the consumer. How does one assess the potential for harm? Kitchener and Harding (1990) have identified three factors that counselors should consider: (1) incompatibility of expectations, (2) divergence of responsibilities, and (3) the power and prestige of the professional. First, the greater the incompatibility of expectations in a dual role, the greater the risk of harm.

The 2005 ACA Code of Ethics clarifies that nonsexual dual relationships are not prohibited; however, navigating dual relationships can be challenging. Counselors are ethically mandated to approach dual relationships with care and caution. Informed consent is a critical component of engaging in nonsexual dual relationships with clients, and this includes specifying the potential negative consequences of such a relationship. It is wise for counselors to consult when faced with a dual relationship to ensure that clients are not harmed. Though the standards related to dual relationships in the ACA Code of Ethics have undergone significant changes, the spirit of their intent can still be summarized in one sentence: Do what is in the best interest of the client.

Pope and Vasquez (1991) have noticed that dual relationships are relatively easy to define but much more difficult for us to recognize in our daily practice. Dual relationships can evolve in some extremely subtle ways. This is particularly true when they are sequential rather than simultaneous. Yet, "the mere fact that the two roles are apparently sequential rather than clearly concurrent does not, in and of itself, mean that the two relationships do not constitute a dual relationship" (Pope & Vasquez, 1991, p. 112). A lot of questions arise: Can a former client eventually become a friend? What kinds of post-therapy or post-counseling relationships are ever acceptable? Is a simple run in a park or a attending a social event with a former client harmful even though the therapy or counseling has been terminated?

I would argue though that dual-role relationships are not always harmful. There can be some positive aspects to the combining of roles, however. In fact, I would argue that a wide range of outcomes to dual relationships is possible, from harmful to helpful. Some dual relationships are clearly exploitative and do serious harm to the counselee, others are benign; that is, no harm is done. Still others, we think, can be facilitative and serve a positive purpose. One example would be the case of a philosophical counselor or a psychotherapist invited to a public event (eg. A book launch of the client or the counselor) after a period of time the counseling has finished.

The potential for harm is also highlighted by Pope and Vasquez (1991) by identifying several major problems with dual relationships. Two of them, the potential for conflicts of interest and the power differential have already been discussed. Another problem is that dual relationships distort the professional nature of the therapeutic relationship, which needs to rest on a reliable set of boundaries on which both therapist and client can depend. Yet another problem is that dual relationships affect the cognitive processes that benefit clients during therapy and help them maintain these benefits after termination. A further problem is that if a therapist were invited or compelled to give testimony regarding a client, the objectivity and integrity of the testimony would be suspect if a dual relationship existed.

Private practitioners confront myriad dual relationship issues in their work, some of which I have not covered in this subchapter. For example. is it ever ethical to have a business relationship with a client? To sell a product to a client? To counsel an employee, or employ a client? Borys and Pope's (1989) article that addressed some of the above questions. We hope, however, that this subchapter has provided a thought-provoking discussion of some of the dual relationship issues that are most problematic for private practitioners and that they encounter most frequently in their work. It is clear that some issues are complex and that situations will arise about which there is no consensus. Golden summarized nicely when he stated that counselors must be guided by an internal compass in such situations.

A case study of dual role dilemma in psychotherapy practice.

I will discuss an ethical situation in my psychotherapy practice when a dual role dilemma arose. I conducted few solution oriented brief therapy life coaching sessions with a woman client who worked as a digital strategist in a creative agency. I have counseled her through a job switch for a period of 3 months, in total 12 sessions, no psychopathology was present, only some issues linked with low self-esteem regarding the actual job-matching and constant worry linked to underperformance and the “impostor’s syndrome”. The counseling did not involve digging into life history, since the client was very objective-orientated and her only goals were to get more and more accustomed with the new position. Just in the day when the therapy ended, I have received an invitation via mail to a launch event of a book. The client and I have been discussing in the therapy many times about her future intellectual projects and this lovely illustrated children’s book was in the making. Due to the fact that in the given situation my presence would have been beneficial and shown admiration and appreciation, I have attended the launch, I have also bought the book and requested an autograph.

Conclusion of this subchapter is that if it is beneficial for the client and supports his autonomy, regardless the dual relationship, the counselor or the therapist should make a decision based on an ethical decision making strategy also listing the costs and benefits and always do what is best for the client and not worry too much regarding the consequences. If the counselor has any reservations, it is very useful to consult with a supervisor or colleague, search the literature, etc. There are many ways to consult.

Ethical issues in counselor-counselee boundaries

Ethical boundaries in counseling and therapy are a crucial aspect of any effective client-counselor relationship. They set the structure for the relationship and provide a consistent framework for the counseling process. Most of the counselor/therapist boundaries are clear. Whilst situations such as these are clearly problematic, outside of such elementary confines are numerous situations where the delineation of boundaries is less clear. These situations fall outside of the formal code of ethics and lie instead in an ambiguous gray area.

Should a counselor, for example, who runs into a client socially (such as at a restaurant, party or their local gym) engage in social chitchat or leave immediately? Can a client and counselor both serve on the same school or charity committee without distorting their therapeutic relationship? Would a counselor who has supported a client through years of counseling be able to ethically attend that client’s wedding? Would a counselor be able to walk in a park with a client after the termination of therapy? Can a counselor give a compassionate hug to a distraught client after a particularly painful session? Is it ethical for a counselor to receive flowers at the beginning of a session or on his birthday?

The answers for many counselors will be made alone, being reliant upon their individual theoretical persuasions and personalities as each dilemma arises. Other factors the counselor needs to consider are the client’s personality, emotional maturity and insight. This is why some counselors will have a cup of tea with their clients during the counseling session, and others will not. Some counselors will have family photos in their offices and others will not, some counselors prefer to disclose details about their personal life while others will not. Some will attend an occasional social function where a client is present and others will leave a party as soon as they see a client across the room. For the counselor who is struggling with these ambiguous boundaries, the question that must remain uppermost in his or her mind is, “Does this serve the client’s therapeutic interests?”

Ethical boundaries in counseling are guidelines that are based on the basic principles of the counselor / practitioner code of ethics. Corey (1996) briefly outlines five of these principles:

Beneficence: a counselor must accept responsibility for promoting what is good for the client with the expectation that the client will benefit from the counseling sessions.

Nonmaleficence: “doing no harm”. The counselor must avoid at all times, (even inadvertently) any activities or situations with the client that could cause a conflict of interest.

Autonomy: the counselor’s ethical responsibility to encourage client independent thinking and decision-making, and to deter all forms of client dependency.

Justice: the counselor’s commitment to provide an equal and fair service to all clients regardless of age, gender, race, ethnicity, culture, disability and socioeconomic status.

Fidelity: being honest with clients and faithfully honoring the counselor’s commitment to the client’s progress. (Herlihy, B., & Corey, G. , 1996)

The confusion caused by boundaries is best described by Corey (1996) as a continuum, ranging from disengagement (rigid, inflexible boundaries/guidelines) to enmeshment (flexibility to the point of diffusion) with a large gray area in between that is ambiguous and dependent upon the counselor, the situation and the clients changing needs and circumstances. To be an effective counselor, one cannot disengage from the client to the extent that the counselor cannot empathize with the client. That is not the purpose of counseling and is counterproductive to the therapeutic relationship.

However, the counselor does not want to empathize with the client to the extent that they hug the client upon meeting them, nor would the counselor pop in to visit at the client’s home on their own way home from the office. This is the behavior of a friend, not a counselor. Hence, boundary violation has occurred. Ambiguous boundaries often arise in counseling, but strict responsibilities do apply to the counselor in relation to their duty to inform clients of the limitations on client confidentiality. Such information forms a large part of informed consent and informed consent is a fundamental client right.

Another ethical consideration is that client's have the right to know the limits to confidentiality. During the initial consultation period, counselors should give the client a prepared form to sign, the informed consent (one for the counselor and a copy to be retained by the client) where they are informed of their rights to privacy and the limits that may apply. The counselees also have the right to know about the theory and practice of philosophical counseling, the risks associated with counseling in general, if any, and alternative available treatment options. Some clients may decide that philosophical counseling is not for them: they should be given the opportunity to reflect upon the scope, depth, and limits to philosophical treatment approaches. Clients who have been truthfully informed and who freely choose to undergo philosophical counseling are accepting their responsibility in the therapeutic process and are less likely to launch a complaint or take legal action provided that the counselor behaves professionally and appropriately throughout the treatment. Failure to obtain consent opens the doors for potential future complaints. This also takes us back to the selection process, which is, as I highlighted in a previous chapter, both the practitioner and the client responsibility. I should not be left to only one of them, but the main responsibility is the practitioner’s, since he may be involved in potential ethical and legal matters.

Kate Mehuron, philosophical counselor and Dean from Eastern Michigan University finds that the deeper issue is whether US philosophical counselor ought to follow the same code of ethics as the licensed psychological/psychotherapy counseling professions in the US. If so, the prohibition against dual roles is simple to understand and to abide by. But there is much disagreement in the United States among philosophical counselors, regarding similarities and differences to psychological/psychotherapy counseling professions. Kate Mehuron follows, as other philosophical practitioners, the American Philosophical Practitioner Association code of ethics that is modeled more or less on licensed counseling organizations in the US. Most are stringent about avoiding dual roles in the counseling relationship. In this regard, breeching confidentiality (for serious purposes such as self-harm or others harm) is a matter that is clarified by US licensed counseling organizations and is also a model for the APPA. 

The problem is that there is no unique philosophical counseling code of ethics, in the US or internationally, but this is true for most of the professions. Mehuron believes that the reason for this indeterminate situation is that philosophical counselors are either philosophers trained in academic institutions, in which case there is no precedent, or they hail from other academic training which also has no precedent. Since philosophical counseling practice is a somewhat anarchic field, there has been no collective and systematic effort to develop a professional code of ethics. The closest to a code of ethics that higher education institutions would have for the professoriate would be in the realm of teacher-student relationships and professional conduct among employees in the university. Colleges and universities in the US are widely disparate with respect to articulating such policies. But such policies, where they exist, are irrelevant to the topic you explore, anyway. But because these are disparate, they offer no model for philosophical counseling practice. 

Even though most therapists have regularly received gifts from clients (Borys & Pope, 1989; Knox, et. al., 2009; Pope, Keith-Spiegel, & Tabachnick, 1986), the phenomenon of gifts in therapy has received minimal attention in the theoretical literature (Knox, et. al., 2003; Kritzberg, 1980, Spandler, et. al., 2000). Therapists have been reluctant to openly talk about it for fear of being accused of some sort of boundary violation or exploitation of clients (Lazarus & Zur, 2002; Zur, 2007). For the same reason many therapists are even less willing to discuss the gifts they give to clients. In the beginning of the 21st century there seem to be growing willingness to discuss issues of gifts in a more complex and less dogmatic ways (Barnett & Barteck, 2009; Brendel, et. al., 2007; Zur, 2007).

David Brendel, psychiatrist, coach, philosophical practitioner and medical ethics expert in US has carefully researched the issue of receiving gifts from a patient. In the psychoanalytical tradition and also in the majority of code of ethics that guide psychotherapists in their practices, receiving gifts from a client is forbidden, stating that this gesture may cross the boundaries counselor-client. “When a patient or patient's family presents a psychiatrist with a gift, the clinician is challenged to maintain appropriate professional boundaries but have the flexibility to respond with warmth and appreciation. The psychiatrist must consider such factors as the intention of the gift, its value to the patient, and the anticipated effect of accepting or refusing it on the patient and the treatment. Psychiatric practitioners are ethically obligated to consider patients' best interests when deciding about how to handle the offer of a gift. Ethical deliberations about such situations occur on a case-by-case basis and require careful analysis of how to promote the patient's best interest while adhering to professional ethics.” (Brendal & all, 2007). Members of the McLean Hospital Ethics Committee present a pragmatic model for managing the presentation of a gift from a patient or a patient's family member. The pragmatic model, which focuses on the practical results of accepting or declining the gift, minimizes the risk of exploiting the patient by accepting a gift or hurting the patient by declining it.

The gesture of accepting a gift from a patient is very much related to the symbolic value of the gift, more than the actual pragmatic value. Accepting flowers from a client on important events such as mother’s day or 8th of March may not be considered a real ethical issue, since in all culture, Western and Eastern, flowers have a symbolic value, not a pragmatic one. However , in the corporate environment there are strict guidelines for giving or receiving gifts from a client since there are real concerns linked to the anti-bribery policy, which every employee should sign on an yearly basis. However, receiving or declining gifts in psychotherapy and counseling has nothing to do with this issue, more to the danger of jeopardizing a good therapeutic alliance or crossing the boundaries.

Boundary issues mostly refer to the therapist's self-disclosure, touch, bartering and fees, length and location of sessions, contact outside the office and to the exchange of gifts between therapists and clients (Guthiel & Gabbard, 1998). Boundary crossing in psychotherapy is an elusive term. A boundary, according to Gutheil and Gabbard (1993), is the "edge" of appropriate behavior. Lazarus and Zur (2002) define boundary crossing as any deviation from traditional analytic and risk management practices, i.e., the strict, 'only in the office,' emotionally distant forms of therapy. Appropriate gift-giving, by either clients or therapists, falls under the definition of boundary crossing. While most analysts, ethicists, attorneys and "experts" may use a broad brush in describing boundary issues (Epstein, Simon & Kay, 1992; Simon, 1991; Strasburger, Jorgenson, Sutherland, 1992), it is important to differentiate between harmful boundary violations and helpful boundary crossings (Williams, 1997). A boundary violation occurs when a therapist crosses the line of decency and integrity and misuses his/her power to exploit and/or harm a client for the therapist's own benefit (Guthiel & Gabbard, 1998; Lazarus & Zur, 2002). Boundary violations usually involve exploitive business or sexual relationships. Boundary violations are always unethical and are likely to be illegal. However, boundary crossings, such as appropriate gift-giving, non-sexual touch or self-disclosure are often part of an appropriate and healthy therapist-client relationship and, as such, can increase therapeutic effectiveness (Zur, 2004).

Regarding gifts and invitations, not all the therapists abide the same ethical codes or reinterpret them in a manner that suit also the client’s need. Some therapists or counselors see and embrace these gifts as the real, heartfelt signs and expressions of the mutual respect, friendship, love, admiration, joy, and gratitude for the sharing of this journey together, and for the shared recovery of their whole, autonomous subjective self and existence. That is, these exchanges recognize and

reflect the needs and interests of the client, the reasons for which they have come for therapy or counseling, and the methodological search for truth, for real meetings, real relationships, and the integrity of being that is philosophically recognized as the means for resolution of mental problems and disorder. On this basis, they are not so much expressing a dual role relation, but are simply part of (an extended expression of) the therapeutic principles and methods.

The majority of the philosophical counselor from US, NZ and Europe I have interviewed assume in their practice that the standard ethical issues apply to philosophical counseling apply also to any of the psychotherapies and also in the relations between professionals in the academic field, for those practitioners who also hold a position in the University. Therefore, ‘grey’ areas in the relationship may occur, such as being invited to a concert where the client performs or receiving free tickets to musical performances, but none of the interviewed practitioners would consider go to a show with a client.

3.3. On ethical decision making process in counseling and psychotherapy

Ethics and ethical decision-making are the critical part of the training or practice of professional counselors, either psychological or philosophical (Corey et al., 2003; Cottone & Claus, 2000; Scott, 2000). Training in ethics typically focuses on: professional code of ethics, ethical decision-making and general theories of ethics (Corey et al., 2003; Freeman, 2000). Cottone & Claus provided a comprehensive review of several ethical decision-making models. They also noticed that there has been minimal research into the effectiveness of ethical decision-making models. Welfel (2002) offered a sound ethical decision-making theory that incorporated several recommended approaches to ethical decision-making (Cottone & Claus, 2000). Welfel proposed ten steps to ethical decision-making (see Figure 3).

Figure 3. Traditional Ethical Decision-Making Model

Source: Welfal E. (2002). Ethics in counseling and psychotherapy: Standard, research and emerging issues. Pacific Grove, CA: Brooks/Cole.

The Welfel model is comprehensive and addresses most of the steps of other models. Kitchener (1984) suggested that ethical decision-making models provide a guide for the process of decision making and not for explicit outcomes or ethical decisions (Houser et al., 2006). However Cottone & Claus (2000) when reviewing the practice of ethical decision-making and ethical research, found that little investigation has been completed. Therefore, they conclude that ethical decision-making models should be used with caution when training students.

Despite of all available literature regarding ethical decision-making, ethic codes cannot do our questioning, thinking, feeling and responding for us. These codes can never be substitutes of the actual thinking process by which the individual therapist or counselor struggles to understand the unique constellation of questions, situations and contexts when helping another person. Pope & Vasquez (1998) claim that ethics that are out of touch with the practical realities of clinical work with the diversity and constantly changing nature of the therapeutic venture, are useless” (Pope & Vasquez, 1998, xiii-xiv).

An ethical dilemma and resolution case scenario using Welfal decision-making model – vignette case.

Sperry suggests this definition of an ethical dilemma:

Conflicts that arise when competing standards of right and wrong apply to a specific situation in counselling practice. They arise because of competing and conflicting ethical standards, because of conflict between an ethical and a moral standard, because specific ethical standards do not address complex situations, or because other factors prevent a clear-cut application of the standard. (Sperry 2007:37)

One day I have received a phone call from a well-known neurologist in her area.  I am trained in cognitive behavior techniques in helping patients with eating disorders, but I have never received referrals from this physician.  The neurologist wants me as a psychotherapist to treat his 16-year-old daughter, who suffers with an eating disorder and perhaps some borderline personality disorder traits.  He explains that he has been medicating his daughter for about three months with antidepressant medication, once he became aware of her eating disordered behavior.  Because of his status as a well-known neurologist and professor of neurology at the medical school, he does not want to refer his daughter to a psychiatrist because he believes that he can handle the medication piece of her treatment, being also trained as neurologist and having enough clinical training for this.  He prefers to pay for all treatment in cash, as he wants as few as possible people from the hospital to know about his daughter’s issues. Feeling uncomfortable with the medication management issue, I have indicated him that I will call him later back after looking at my schedule.  Then I phoned him for an informal consultation.  I also expressed my concerns about working with a patient whose father is prescribing medication.

There are the following ethical considerations in this dilemma:

1. The father-physician wants to be a treating professional as well as father. This is a conflict of roles situation. Even though a father is trained in a medical field, he should always refer his daughter to a professional, especially when it comes to mental health issues which perhaps may involve parenting issues. In this case, the father’s specialty is not even psychiatry, but neurology, therefore he is not fully certified to prescribe psychotropic medication.

2. Another ethical consideration involves the issues of level of risk to the adolescent (i.e., does she need hospitalization rather than outpatient treatment) and the conflict of interest of father's wishing to medicate the daughter himself rather than referring her to a psychiatrist. The treatment plan he wishes to implement is imposing his decisions on the psychologist.

3. Considering my specialization, I have the ultimate responsibility for determining what the optimal treatment interventions would be after evaluating the daughter herself. There are clearly separation and control issues involved in the father's contact. Also, there are questions of his motivation for maintaining secrecy.

4. I should be cautious when communicating the decision to the neurologist, since there is a strong suspicion of narcissism. After all, the neurologist values his professional reputation and public recognition over the wellbeing of his daughter.

The potential advantage of the given situation include finding a way to help the daughter recover.

I initially evaluated the pros and cons of accepting the client. A first recommendation for the father would be for a clarification of roles and boundaries in the father-daughter relationship. Well known or not, father's duty is to see that his daughter gets the best possible treatment, not to protect his professional reputation. Given the privacy rights the daughter would have with the psychiatrist or any professional she sees for treatment, it seems that the father's concern for secrecy is related to his narcissism and fear of discovery. When calling the father back, I would explain that it is part of the psychologist's duty to provide the prevailing standard of care and to engage in best practices. Then I would explain what those things entail: First, establishing boundaries in a respectful but clear manner. I would indicate that psychologists are required to make an independent evaluation and determination of diagnostic considerations and interventions, much the same way that the father must do when he is referred a patient. I might also raise the question with him of what he would think if a person came with him and presented a treatment plan such as his. I also would indicate that best practices require that the psychologist refer to a psychiatrist, especially since the problems present potential danger to the daughter's health, if not overall wellbeing. I would ask the father if he wanted time to make a decision or if he was ready to commit on the phone. I do not believe that the father's evasiveness about sending the daughter to a psychiatrist and paying in cash are clear indicators of neglect and/or abuse. She may require hospitalization for medical problems prior to being eligible for outpatient therapy.

Len Sperry (2007) has also issued few guidelines for effective ethical decision-making in his work “Dictionary of ethical and legal terms and issues: The essential guide for mental health professionals”. It is an eight-step process in which the initial step (0) of the decision-making strategy is a general and ongoing process rather than specific to a given ethical problem or dilemma.

0. Enhance ethical sensitivity and anticipating professional ethical considerations

1. Identify the problem

Is there an ethical dillema here? If so, how do you define it?

What facts of the case lead you to define it this way?

2. Identify the participants affected by the decision.

Which individuals are directly involved? Indirectly involved?

How are you being affected by it? Yor client (s)? Others?

3. Identify potentially courses of action and benefits and risks of the participants.

What potential options or courses of action can you identify?

What are the risks and benefits of each course of action for each participant?

4. Evaluate benefits and risks with regard to key contextual, professional and ethical considerations.

What’s your sense of ethical intuition about the case?

How might your personal values be operative here?

How is your level of professional development and ethical perspective operative here?

How might your blond spots, unfinished business or countertransference be operative?

What is the level of trust and mutuality in the client and other participant?

What if any ethnic, gender or cultural factors are operative?

What are the spiritual/religious beliefs of the client and what is their influence?

What are the stated versus actual core organizational or institutional values?

What is the community’s attitude toward and impact on the dilemma?

What is the relevant standard care in the community?

If applicable, what do research, best practices and so on, have to say?

What is the prevaling scholarly opinion about this issue?

What theories, ethical values and ethical principles are applicable in this case?

Which professional codes are applicable? Standards?

Are any legal statutes applicable? If so, which ones?

5. Consult with peer and experts.

What views do your supervisors, colleagues, lawyers and so on suggest in resolving the dilemma?

If different from ethical standards and principles, how is it different?

6. Decide on the most feasible option and document decision-making process and rationale.

Are the original options still viable or is revision necessary?

What is the best opinion? What’s your rational for it?

Should you inform your supervisor or an administrator of the decision?

7. Implement, evaluate, and document the enacted decision.

How should you implement the decision?

What is the result of the various ethical tests: publicity, universality, moral traces and justice?

How would you document the decision, process and rationale?

Sperry, L. (2007). Dictionary of ethical and legal terms and issues: The essential guide for mental health professionals. Routledge.

3.4. Moral dilemmas and existential issues revisited both in philosophical counseling and psychotherapy.

In this subchapter I will not focus on the key ethical issues that affect the work of a counseling professional, such as: “autonomy, beneficence, non-maleficence, confidentiality, dual relationships” (Vyskocilova & Prasko, 2013), but I will mainly focus on ethical or moral dilemmas that may torment the client’s or the counselee’s lives and usually brings them into the consultation room in order to have a resolution.

The client may come in the therapy room or in philosophical consultation room with all sorts of ethical or moral dilemmas that arise from his own experience or from his experience with others: decisions about whether to stay in a love relationship, how to cope with a divorce and the legal issues linked to it, overcoming lack of satisfaction with one's job, decisions whether to report a corrupt employer (professional ethical conflicts), working through a religious crisis, resolving fights with in-laws, accepting one's sexuality and gender identity.

Ethical dilemmas raised by clients or counselees are the type of dilemmas that can have a huge or a limited impact on their lives, but nevertheless there is not a single psychotherapy client who does not have some sort of moral dilemma unsolved: either he is “in an delicate couple situation following an affair or a divorce, or in a dilemmatic situations in their professional lives or perhaps thinking of changing’s one religion” (Pope & Vasquez, 2007). There is not a guarantee that a philosophical counselor could better solve a moral dilemma than a psychologist with ethical training, but there are reasons to believe that a specialist in ethics is much more equipped at least theoretically to deal with all sorts of situations that may occur in practice that require specialization in ethics.

Many times, in psychotherapy practice, people come with difficult situations that cause them a great deal of anxiety. A common situation is when a client has a friend who is a drug addict and the client does not come easily to terms with the friend’s new status. The client has to face a distinction between “what is legal, what is ethical and what is moral”iv, he or she also needs to cope with conflicting values and duties. I believe that this type of dilemma could be solved by a practitioner with ethical training. There is counseling literature suggesting that “it is not useful to avoid dealing with dilemmas by retaining a neutral position and that common-sense-based interventions can be harmful rather than helpful” (van Deurzen, 1999a, p. 581). In order to clarify the client’s conflicts and in the hope of solving their current existential issues, the same author recommends the psychotherapists a more thorough examination of philosophical and moral issues and rely less and less on common sense to guide their interventions.

On the other hand, Lydia Amir’s view on resolving conflict and dilemmas is quite opposed to Van Deurzen view, suggesting that resolving moral conflicts in the counseling sessions is not always the case and humor only may help us in a more efficient way to cope with moral conflicts. Amir (2004c) embraces the thesis that humor “however helps us to get self-knowledge, humor is ambivalent and least, but not last, humor enables deliberation”. Compassionate criticism is the key to well-being, not an attitude of obsessively seek to resolve all conflicts.

Moral dilemmas, both in psychotherapy and philosophical counseling, are occasions to test the practitioner’s skills to help clients and counselees to solve their ambivalence and cognitive dissonance regarding various issues such as inappropriate romantic involvement, jealousy, coping with extra-marital affairs, etc. Sometimes psychologists, blinded by the power of emotionality and less inclined to help clients exercise critical thinking, see those dilemmas more as opportunities to elicit strong emotions in their clients, hoping that the clients themselves will deliberate and get to resolution. They cannot do much in terms of helping them with acquiring new skills to actually resolve the issues that brought them into therapy. Here is where a specialist in ethics or moral philosophy is expected to have a valuable unprejudiced opinion regardless of common beliefs on how things ‘should be done’.

Many influential psychologists or psychiatrists coming from various psychotherapeutic traditions (psychoanalytical, person-centered, rational emotive): Jung, Rogers, Ellis, Frankl, Fromm and lately Yalom moved toward philosophical or existential ways of counseling. Most philosophical counselors and also CBT or REBT therapists have similar views regarding the process: they appeal to higher aspects of our being than our emotions, such as our reason, which in the long run is a stronger force to be considered in our life. Many clients of philosophical counseling have wisely explored psychology as a prelude to philosophy, that means none of the psychological theories or methods suited them perfectly” (APPA Code of Ethics, 2015).

Currently, Irvin Yalom and Emmy van Deurzen, both famous existential psychotherapists consider the following philosophical issues or “fundamental worries” as causing many psychological disturbances or life crises: death as a main source of anguish, freedom – responsibility and existential guilt, existential isolation – a new approach of interpersonal relationships and lack of meaning, which may have psychological and philosophical implications (Yalom, 1980). Existential psychotherapists, as opposed to cognitive behavioral therapists, focus also on emotions, both as means of detecting client’s values and as revealing objects of the client’s Weltanschauung (LeBon, 2001). Existential psychotherapy being the only established form of psychotherapy that is directly based in philosophy rather than in psychology, can take many different shapes and forms, but it always requires a philosophical exploration of what is true for the client (Van Deurzen, 2002).

Focusing on the issue of meaning in existential psychotherapy and philosophical counseling, I intend to support the claim that the lack of meaning may have clinical implications, along or despite other problems one may encounter in his own existance: emotional turmoil, marital troubles, death of the loved ones, lack of financial support or adversities of any kind.

Famous psychotherapist and psychiatrist Irvin Yalom makes a courageous claim: the lack of sense or the dissolution of sense can generate suicidal thoughts. Carl Gustav Jung was also keen on the idea that the absence of meaning in life plays a crucial role in the neurosis ethiology: ’About a third of my clients don’t suffer from any neurosis that can be clinically identified, but from a lack of meaning and scope.’ Victor Frankl suggested that 20% of the neuroses he encountered in his clinical activity are ‚noogenic’neuroses, deriving from the absence of life meaning. Lou Marinoff in his book ‚Plato, not Prozac’ acknowledges that ‚one of the most important plagues of XX century philosophy is the widespread feeling of absence of personal meaning and scope.’ In my private psychotherapy practice I have also had women clients whom I treated using cognitive behavior therapy and solution-focused methods and who reported significant improvement in only few sessions. Although the initial symptoms have completely disappeared and the person was completely free of the anxiety and depression that has brought her into therapy, there were also few questions that remained unadressed, such as ‚what caused her that void in her life?’, „how can the void be filled?’ and ‚what can she do in order to find meaning in her life’? Meaning is not a general purpose that can be embraced by anyone, meaning is so personal and also can be found in apparently unimportant aspects surrounding us. Many of the psychotherapy clients performing routine, repetitive jobs and not having a significant couple relationship, family or kids, may find meaning in volunteering for an NGO or an orphanage or being mentor to a child who has no parents. A lot of clients working in corporate settings may find meaning in doing charity work or community work for senior citizens.

J. Michael Russell, philosophical counselor, psychoanalyist and philosophical counselor, Emeritus Professor of Philosophy and Human Services at California State University in USA believes that philosophical counseling might be a form of existential analysis. He tends to reserve the term ‚existential analysis’ as suggesting long term work whereas ‚philosophical counseling’ does not so readily carry that nuance, being short-term. Also, Russell understands ‘existential analysis’ by way of how Sartre presents it, seeking to reveal something like a global “fundamental project” or “fundamental choice” about dealing with freedom and identity which is re-chosen in each of our specific deeds. In practice that means the counselor would like a client to develop something like a “working narrative,” an evolving and flexible story about what one is all about, typically utilizing selected life events as metaphors for large patterns in ones life.

Narrowing the analysis of moral dilemmas and existential issues in my private practice, few clinical observations that support the arguments of my thesis have been made. Following the anamnestic interview and psychological evaluation session, by using validated psychological assessment instruments: BDI II (Beck Depression Inventory), BAI (Beck Anxiety Inventory), SCL-90 Symptom Checklist, WHOQOL-BREF 26 items, Inventory of Interpersonal Problems (IIP-64) and Sentence Completion Test (80 items), I have noticed that behind most of the invalidating symptoms and current life issues or feeling of inadequacy, almost always lies a deeper, most profund cause, that is not necessarily a childhood traumatic event or an adult trauma. Sentence Completion Test (SCT- 80 items) is a psychological instrument of psychodynamic origin and high-face validity. When applying the test to a new client, the following existential issues may arise: meaning of life or lack of it, unclear professional identity, lack of professional identity or identity crisis, fear of death, fear of solitude and loneliness, issues linked to the freedom of choice and liberty. Hypochondriac complaints are mainly linked to fear of death in a less obvious form, as fear of getting a terminal disease, such as cancer. Cancer phobia complaints in their extreme forms are disguised forms of fear of death, that can be dealt with in different manners, using cognitive behavioral techniques or having an existential approach via desensitization to death (Yalom, 1980, p.16).

There are 14 questions that elicit existential issues in SCT-80:

Q13: The most awful thing that can happen to me is

Q16: My life………………………………………………………………….………………………

Q21: I haven’t succeded in………………………………………………..…………………………….

Q24: The future……………………………………………………………………………………

Q38: When I am honest with myself………………………………………………………………

Q43: When I am alone……………………………………………………………………………..

Q44: When I work………………………………………………………………………………….

Q45: My dreams……………………………………………………………………………………

Q57: At my job…………………………………………………………………………………….

Q65: To be……………………………………………………………………………………………

Q66: My profession…………………………………………………………………………………

Q74: The truth is that………………………………………………………………………………

Q75: I am afraid of………………………………………………………………………………..

Q80: To live…………………………………………………………………………….…………

Apart from the obvious phrases or sentences completed that reveal thoughts and considerations on meaning, scope, professional identity, in the actual anamnestic interview the therapist is also expected to explore all the fears experienced by the client and especially the fear of death, the most invalidating of all. The existential psychodynamic emphasizes a different form of fundamental conflict, a conflict “emerged from the individual confrontation with his or her existence” (Yalom, 1980, p.17).

Quality of life was evaluated using WHOQOL-BREF, a 26 items instrument, which measures the following broad domains: physical health, psychological health, social relationships, and environment and also the ORS scale (Miller, S.D. & Duncan, B.L., 2000), a self-report wellbeing scale with 4 dimensions: individual, interpersonal, social and global. Depression and anxiety levels were evaluated using the Beck Depression Inventory II and the Beck Anxiety Inventory. Symptom Check-List (SCL-90) is a brief self-report psychometric instrument designated to evaluate a broad range of psychological problems and symptoms of psychopathology, such as somatization, interpersonal sensitivity, depression, anxiety, hostility, etc.

One of my research limitations was that the psychological instruments were only used in order to assess the pre-therapy and post-therapy states of the person evaluated and treated. I have not conducted real philosophical counseling sessions, neither I have evaluated the outcome of any philosophical counseling session. Although, since I am trained in Cognitive Behavior Psychotherapy and Rational Emotive Behavior Therapy, two of the few forms of evidence-based psychotherapies and also two of the therapies that use techniques similar to those used in philosophical counseling, nevertheless I regard the PC approach as a promising avenue for improving psychotherapy.

Ethical questions and moral dilemmas are an important part of the therapeutic or philosophical counseling process that cannot be neglected. The success of the therapeutic or counseling process depends on ensuring the best practices in the field (either psychotherapy or philosophical counseling). Existential issues are of utmost importance in both types of practices, since issues like meaning, scope, death, freedom and isolation are intrinsic to the human conditions and not psychiatric topics. There is also a multitude of ethical and moral dilemmas to be solved, both in therapy and philosophical counseling, and it is preferable for the counselor or the therapist to have an active role rather than a neutral position. Apart from several case studies presented in Chapter 5 of my work, future research is needed in order to assess the importance of dilemmas and ethical issues in both practices. Also, future research is needed in order to investigate whether it is possible to achieve in philosophical counseling certain results, such as a superior levels of well-being or quality of life, as in psychotherapy.

Chapter 4. Critique of Peter Raabe’s attempt to consider PC as an approach to solving people’s mental health problems.

4.1. Diagnosis in Philosophical Counseling, pro or con? (Dialogue, not diagnosis!)

In this subchapter I will argue why diagnosis is not recommended in the philosophical counseling practice and it should be replaced by dialogue. There has been a lot of debate lately regarding the necessity of diagnosis in Philosophical Counseling and there are different opinions clashing, the same as in psychotherapy. Sometimes psychotherapists, especially those employed in the mental health clinics, use diagnostic tools and formulate a clear clinical diagnostic (using DSM V criteria), in order to gain acceptability from the medical community and also in their search to become more objective when assessing client’s treatment needs. However, it has been proved in many research studies that formulating a diagnosis does not ensure the success of the therapy, there isn’t a positive correlation between formulating a diagnosis in the DSM style, communicating it to the client and the achievement of the therapeutic goals. Also, revealing the diagnosis to the client is not a good idea, on the contrary. At the moment, in the mental health community there is a lot of work being done in the area of the de-stigmatizing and de-labeling. British Psychological Society has come with a tough critique on the latest DSM 5. Diagnostic and Statistics Manual – fifth edition that is trying to clinicize even the mourning, calling it: ‘complicated grief disorder’.

The reception to the new DSM-5 has been mixed. The British Psychological Society (BPS) published a largely critical response in which it attacked the whole concept of the DSM. It stated that a “top-down” approach to mental health, where patients are made to "fit" a diagnosis is not useful for the people who matter most – the patients. The British Psychological Society believes that “any classification system should begin from the bottom up – starting with specific experiences, problems, symptoms or complaints.” It is also documented that “Since – for example – two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice.”

However, other associations, such as the UK mental health charity Mind took a different approach: “Mind knows that for many people affected by a mental health problem, receiving a diagnosis enabled by diagnostic documents like the DSM-5 can be extremely helpful. A diagnosis can provide people with appropriate treatments, and it could give the person access to other support and services, including benefits.” The BPS is concerned that “clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.” BPS also comes with a proposal: “to include a profile of rating the severity of different symptoms over the preceding month. This is attractive, not only because it focuses on specific problems (see below), but because it introduces the concept of variability more fully into the system. That said, we have more concerns than plaudits. The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations “. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value, and co-morbidity. Diagnostic categories do not predict response to medication or other interventions (psychological) whereas more specific formulations or symptom clusters might (Moncrieff, 2007).

Looking at some forms of psychotherapy, such as Existential Pyschotherapy, Logotherapy, Ellis’s Rational Emotive Behavior Therapy and Experiential Psychotherapy do not require diagnosis in the strict sense of identifying underlying, unconscious causes. Peter Raabe believes that the therapist employing these approaches must instead have the ability to deal with the client’s issues and concerns that clearly exist at the conscious level, and can be said to be more philosophical and cognitive in nature than unconscious and causal. For Raabe and the other philosophical practitioners, this raises an important question: “how much skill and competence in the area of philosophy and cognition does such a psychotherapist possess who has been trained primarily in the area of psychology?” (Raabe, 1999, p. 124)

The same applies to philosophical counseling. Even in philosophical counseling, issuing a certain diagnosis (not even following DSM criteria) but a simple diagnosis, would certainly have a lot of negative implications in the counselor-counselee relationship: would imply the idea that the guest is not looking for a solution in his life, or for having someone challenge his worldview, but for medical or psychological help, therefore the person would subconsciously be fed with the information that he or she is suffering from a disorder or is ill, which may not be true. However in philosophical practice, dialogue tends to replace diagnosis completely and even philosophical counselor who are trained in psychoanalysis or other form of psychotherapy (evidence-based) are now giving up the idea of diagnosing the person who asks for their services.

Michael Russell sees philosophical counseling as not being accurately described in the term “therapy”, because Philosophical Counseling does not deal with sickness or suffering, there is no diagnosis and the counselee is not expected to passively receive treatment, in the sense of being cured by the therapist. He also prefers to see the philosophical counselor as someone with a talent of ”inviting something like self-expression, self-understanding and an exploration of self-deception.” (Raabe, 1999)

Since formulating a diagnosis is at the time being not advisable even in the psychotherapy practice, the main reason being the fact that research has shown its uselessness in the recovery process, for philosophical counseling diagnosis is definitely a bad idea. Therefore, using the dialogue as a method of investigation in what we could consider to be the equivalent of “anamnestic interview” or “clinical interview” but not formulating a diagnosis is what we ought to do in the philosophical practice in order to have the best results.

Of all the various techniques or procedures used in philosophical counseling, the dialogue is present in all methods, even in Achenbach’s “beyond-method method”. One of the primary goals of dialogue in philosophical counseling is for the client to be self-reflective. Ideally, dialogue is meant to be: “authentic, open, and non-confrontational”(Lahav, 1995). Schuster sees dialogue in philosophical counseling ‘proper’ as is envisaged by Achenbach as a “pluralistic, eclectic, skeptical, humanistic and ethical dialogue, which creates a free place for investigation” for both the counselor and the counselee. Peter Raabe sees four variations of dialogical techniques that can be used in the PC sessions, depending on the objectives: first, the Socratic approach, as in REBT, meant to develop a reflective attitude allowing the counselees to find insights and solutions to their own problems. Second, there is the type of dialogical approach in which the practitioner assumes the client wants to be informed of alternative points of view or philosophical theories. In the third type of approach, the philosophical counselor becomes a teacher while the client takes the role of a student, very similarly to a psychoanalyst’s position.

Fourth dialogical approach is in groups of clients, such as students, incarcerated persons or addicts, in a close manner to the group psychotherapy professed by Irvin Yalom.

Lou Marinoff also sees dialogue as highly important in the process of philosophical consultation, opposing it to the monologue. He thinks that even people who are legitimately helped by neuropharmacology need dialogue, once their "chemical imbalances" are equilibrated. (Marinoff, 2002, p. 49) During a philosophical dialogue, the client is invited to reexamine his assumptions or inferences, which can itself entail the client's critical reappraisal of certain values or strongly held beliefs and counseling exercise need not be conducted from an adversarial perspective, but from a collaborative one, since it is a reexamination, not a cross-examination.

“Neither is philosophical dialogue diagnostic, for everyday human problems are not regarded as illnesses by philosophical counselors. In fact, the opposite is the case: people who recognize their everyday problems and seek to manage or resolve them are regarded as fundamentally (and mentally) well, not ill.” (Marinoff, 2002, p. 82)

Marinoff seems to be particularly fond of Nelsonian Socratic dialogue, employed in group facilitation. Nelsonian Socratic dialogue aims to make explicit what is implicit.

Following the thinking of Kant and Fries, Nelson believed that participants in a group could together investigate critically their own beliefs and opinions by ‘retracing’ the judgements that are implicit in our effort to give meaning to our experiences.

“The facilitator of a dialogue elicits from a group of participants their particular experiences of the sought-after universal, which are then used as vehicles for exploring opinions of the universal itself, and for probing the shadows of misunderstanding until an articulation of the form is recognized and illuminated by understanding itself” (Marinoff, 2002, p.128).

The facilitator is a trained and skilled philosophical catalyst, who adds nothing to the dialogue itself but who guides its participants through various reactive stages, until the end-product – a clear definition of the universal in question.

In the more traditionally Socratic approach, Kristof Van Rossem considers that the facilitator does not direct or intervene in the content of the dialogue, he doesn’t offer his own opinions in matters of content, not even when participants ask him to do so. “Instead, he does everything he can to intensify the philosophical investigation the participants themselves are engaged with. This ambivalent role of stimulating the courage of the participants to investigate the questions while respecting the independence of the participants is very typical” (Van Rossem, 2006). For example, from time to time, the facilitator can help to establish mutual understanding by asking participants to repeat, or summarise what has been said.

Romanian philosopher Cristian Iftode is also trying to offer a perspective on PC as a process in his book “Philosophy as a way of life” (Filosofia ca mod de viață), stating that philosophical counseling means to do philosophy starting from personal problems of at least one participant in the discussion, “a dialogical activity, a way to discuss existential issues that highlight reflexion skills and philosophical konowledge, trying to apply in life some generical solutions, strategies, criteria in the field of academic philosophy” (Iftode, 2010, p. 34).

4.2. Critique of Peter Raabe’s attempt to consider PC as an approach to solving people’s mental health problems.

Peter Raabe’s approach is a controversial one in the philosophical counseling world. However, his theoretical and practical contribution is highly important to the practice of philosophical counseling worldwide and especially in Canada. In his book “Philosophy's Role in Counseling and Psychotherapy” (2013), Peter Raabe argues that philosophy is an effective method in treating mental illness. Calling for a paradigm shift away from the standard belief that the brain and mind are identical Raabe argues that so-called “mental illnesses” such as depression and schizophrenia are not the actual causes of psychological misery. Instead, they are just labels for symptoms. For example, the word “depression” is merely a label attached to a collection of symptoms such as sadness, hopelessness, and low self-esteem.

Raabe posits that distressing or painful life events can cause symptoms that are often clinically labeled as the mental illness of depression. The suffering brought on by painful life events can often be alleviated with helpful discussions, and without resorting to medications. Because philosophy is the foremost form of discussion, it means that the suffering that is labeled mental illness can be treated and even cured with philosophy. Raabe ultimately concludes that philosophy is beneficial in three ways: it can prevent the onset of a so-called mental illness in the person who studies it, it can be used to help individuals suffering from the distress that is labeled “mental illness,” and it will enhance the competence of the counselor or therapist who practices it.

Unfortunately none of these three claims has benefited from extended research, therefore supporting Raabe’s view uncritically and without a thorough examination of the client medical history and problematic could be also an act of bravery from the practitioner itself, if not even a case that could be subjected to malpraxis.

But Peter Raabe’s view on the concept of mental health and also on the medicalization of mental health is not new, it has also been reflected in the work of few other important figures in the psychiatric field: Thomas Szasz, Peter Breggin and lately Neel Burton, psychiatrist and philosopher. The same authors refute the medical model of mental health that considers that all psychological problems/disorders have a physical symptom profile, therefore the condition is a physical (medical) problem, eg. blood chemistry changes in depression, physiological changes in anxiety disorders. The assumption is that abnormal behavior is the result of physical problems and it should be treated medically. This approach posits that disorders have an organic or physical cause and the focus of this approach is on genetics, neurotransmitters and neurophysiology.

There are also many authors in the bioethical field who argue passionately on the medicalization of mental health. Different authors have different answers to the question: what is medicalization? Based on critical articles of psychiatry, the term “medicalizing” denotes:

the inappropriate labeling of a “normal” condition or “problem of living” as a disease, disorder, or illness;

the assertion that a condition or state of affairs requires the services of a nurse or physician;

the assertion that a condition is due to disturbed physiology, a “chemical imbalance”, or some other bodily defect;  or

the assertion that a condition requires a somatic treatment, such as a medication, ECT, etc. (Pies R.,2013)

The famous critic of psychiatry, Dr. Thomas Szasz, highlights the fundamental philosophical problem raised by medicalization:

The concept of medicalization rests on the assumption that some phenomena belong in the domain of medicine and some do not. Accordingly, unless we agree on clearly defined criteria that define membership in the class called “disease”or “medical problem” it is fruitless to debate whether any particular act of medicalization is “valid” or not”(Szasz T.S., 2007).

Modern psychiatry tends to “treat human problems as medical problems” (Parens, 2011, p.2) and in this concern, makes an error about the nature of the world. However, the critical thinking requires us to avoid such errors. “It requires that we learn to affirm, rather than try to erase, variations in our moods, behaviors, and appearances” (Parens, 2011, p.2). The same author also proposes the view that there are few problematic “assumptions built into the notion of medicalization”: too broad conceptions of the goal of medicine, Conrad’s assumption “that he knows the difference between valid (or real) medical diagnoses and invalid (or fake) ones, the medicalization critique’s narrow conception of the goals of medicine” (Parens, 2011, p.3) and the tendency to embrace “an individual-differences model, which seeks to understand why it is that, within populations, there is almost always continuous variation with respect to any trait or cluster of traits” (Parens, 2011, p.4).

What modern psychiatry seems to forget is that people’s life situations and existential crises do not have to be medicalized, but rather resolved in therapy. Not only sociologists like Peter Conrad, but also psychiatrist like Peter Breggin, think that medicalization leaves us incapable to distinguish between emotions, behaviors, and also incapable to acknowledge limitations that are a normal part of human living and those that are abnormal. By seeking instant cures for sadness, exhaustion, uncomfortable situations and unhappy memories, medicalization tries, but not always succeeds, to turn us into perfectly functional creatures, incapable of assuming our human condition. Also, the ethical aspects of mood-altering medication are exposed frequently in his books (Breggin, P. R., 2008).

Peter Raabe’s approach regarding medicalization, in line with other authors mentioned before, is clear and supports the theory of the “The Myth of mental illness” (Thomas Szasz). According to his views, Peter Szasz believes that it does not make sense to classify psychological problems as diseases or illnesses, and that speaking of "mental illness" involves a logical or conceptual error (Szasz, 1979). In his view, the term "mental illness" is only an inappropriate metaphor and there are no true illnesses of the mind. His position has been characterized as involving a rigid distinction between the physical and the mental. Philosopher Karl Popper in a 1961 letter to Szasz, called the book fascinating and admirable, while Peter Breggin sees it as a seminal work. Peter Raabe also draws his conception from Thomas Szasz work, arguing in "Philosophy's Role in Counseling and Psychotherapy" that all the approaches in the field of mental healthcare that are called "talk therapy" are based on philosophy. In fact the famous men (Freud, Jung, Beck, Ellis, etc.) who established the various methods in psychotherapy were all trained in philosophy and used their knowledge of philosophy to treat their patients. They developed their methods using philosophy at a time (1950's) when philosophers were unwilling to help real people deal with real-life issues. Research is showing that talk therapy is the most effective and has the most long-term benefits for the patient (or client). This means that any student who wants to be a counsellor or psychotherapist should be trained in philosophy. It is with philosophical reasoning that the patient's answers to a "psychological: questionnaire are evaluated by the counsellor or therapist.

Peter Raabe’s thesis supports the view that people suffer from is existential, or life, issues and as Szasz and Breggin, affirms that “there is no evidence that any of the many so-called mental illnesses are in fact biological brain disorders. Raabe things that there is a confusion in the mental healthcare systems of the world as to what so-called mental illnesses actually are. “This is the acceptance that the brain is somehow the same as the mind. But in fact the brain is an organ (like the liver or kidneys) while the mind is non-material beliefs, values, assumptions, fears, etc. So the brain the container while the mind is the content. The problem with the so-called medical approach to mental illnesses is that the pharmaceutical treatments that affect the brain are believed to benefit the mind. This is just not true.” Raabe, as his mentors, things that there is no "medical model" of mental healthcare, this is a myth. And so-called mental illnesses, such as depression, don't cause a person to suffer. “The word 'depression' is just a label for a collection of symptoms such as sadness, lack of appetite, insomnia, etc. Depression doesn't cause misery. Misery causes depression. And the same applies to all the other so-called mental illnesses. Once this is understood by my students they can see that medications can't help people deal with their problems; but philosophy can.” (Raabe, 2015) In “Philosophy’s Role in Counseling and Psychotherapy”, Raabe considers that “the separation of medicine and philosophy in mental healthcare is a non-issue and there is no need to discuss medicine in mental healthcare because the patient's thinking about life issues can't be improved with medical treatments”.

In his view, the question of whether a mental healthcare provider ought to have a medical license is irrelevant. Raabe thinks that only "talk" can help alleviate mental suffering or distress, and the most helpful kind of talk will be with a counselor or therapist educated in all the different areas of philosophy. “This includes the principles of bioethics and it includes metaphysics, philosophy of religion, political philosophy, feminism, critical thinking, and so on. I have applied all of these fields of study to my client's issues and concerns at one time or another.” (Raabe, 2015) Raabe also mentions that he has seen many clients who were psychiatrically diagnosed but then successfully treated and even “cured” with philosophical counseling.

Raabe’s books are very well documented accounts (reports) of what is wrong with current bio-psychiatry movement, the side effects of psychiatric medication and all the other problematic assumptions in the world of psychiatry and clinical diagnosis. However, there are few controversial issues in which Raabe’s approach seems to have limitations, especially by the lack of methodological structured approach and by an idealized image of a philosophical counselor able to solve all human problems, not taking into account, as in psychotherapy, that there are also limits of psychotherapy when judging a particular approach. Below are some of the inconsistencies I have found in Raabe’s approach:

There is no suggestion that some clients could be intractable or at least problematic and reading Peter Raabe’s book leaves us with an unjustified optimistic view on recovery;

Since there are unresolved cases in the clinical literature, as well as alleviated cases, the claim that philosophical counseling can ‘cure’ mental illness is a very unubstantiated claim, especially when we refer to a method that has benefited from no research in the past and there are no currently studies that test the efficiency of philosophical counseling vs. psychotherapy and vs. medication;

Not even the cognitive behavior therapy, the modality of treatment which had benefited from consistent research budgets did not issue claims that it could actually ‘cure’ psychiatric disorders such as: schizophrenia, bipolar disorder or psychoses. Therefore the claim that philosophical counseling could be a cure, not a method of managing the symptoms of grave mental illnesses and preventing a relapse into those symptoms is also a dangerous one;

The idea that philosophical counseling can be used as an alternative treatment when medication or psychotherapy are ineffective or simply ‘in lieu’ of medication is also a hazardous claim, since the philosophical counselors are not qualified to issue judgments regarding the mental status of a client and from ethical viewpoint, the philosophical practitioners should know the limits in which they can intervene and limit their interventions within the boundaries of their qualifications;

Another limit of Peter Raabe’s approach is that he does not consider the possibility of referring a client who doesn’t qualify for philosophical counseling; in this case selection of clients could be operated using few guidelines that I highlighted in Chapter 3 (3.1) of this thesis. In this regard, Marinoff has a best practice procedure put in place, which makes Marinoff’s practice recommendations safer than Raabe’s in a case of liability or malpraxis;

Peter Raabe’s approach is critical of the medical model and also on few psychotherapy models, but does not offer a clear framework of approaching the mental illness in terms of procedures, methodology and future development; while deconstructing DSM, ICD, the psychological/ assessment procedures, Raabe does not replace them with different methodologies, neither proposes different tools of evaluation, leaving us completely unarmed in the face of the complexity of human problematic and human suffering.

There is no suggestion either that the clients might be taught to do philosophy for themselves so as to be enabled to engage with the world in their own way.

Not having clinical training, Raabe dismisses or overlooks the idea that there are also other factors that contribute in the recovery of a client or patient, except for the relationship (therapeutic alliance with the counselor or therapist) and the orientation or the approach employed in helping the counselee or the client. The common factor model and the “dodo bird effect” are both helpful when judging any kind of approach, either psychological or philosophical, but Raabe simply does not take them into account or does not consider them worth mentioning.

Chapter 5. Case studies in philosophical counseling

In this section of my paper I will try to argue that in many ways, philosophical counseling resembles psychotherapy, not only considering the width of issues or predicaments involved, but also taking into consideration the idea that human problems cannot be completely separated into philosophical versus psychological viewpoints, since psychology has evolved initially from philosophy. Therefore, psychotherapy and in this particular case, cognitive behavior therapy, is not to be neatly distinguished from philosophical counseling by the presence of a problem focus, and philosophical counseling is not to be neatly distinguished from psychotherapy by a purported absence of a problem focus. Also, the lack of neat and firm distinctions between philosophical counseling and psychotherapy with respect to what they do and why they do it provides an argument against a monopoly on therapy-like activities by psychologists, to the exclusion of philosophers. On the liberal side this is, I think, an argument in favor of freedom of speech, of belief, and trade, for the applied philosopher. On the conservative side, it may also be an argument for certification (as opposed to licensure) for both psychologists and philosophers, in the interest of protecting the vulnerable by promoting truthful selfrepresentation. The nine case studies are from my own psychotherapy practice and I would believe that, since there is no clinical symptomatology involved such as depression or anxiety and since we cannot formulate a clinical diagnosis on Axes I or II, this entitles us to think that these cases could have also been resolved by a philosophical counselor, not only by a trained psychologist.

Case study no.1

A 50 years old famous Romanian architect, Vlad, has come into the counseling session with a complex professional ethical dilemma which has given him a lot of insomnia in the last few years. He is not symptomatical, no depression or anxiety as a pervasive pattern, only some worries issues on punctual matters, such as when his son is ill or tipical worries linked to the project deadlines and payment procedures. He is happily married for 29 years, in a loving and caring relationship and did not have any trauma related issues other than few bullying episodes in the primary school. The architect’s dilemma is more than a moral dilemma and transcends the deontological ethical theory, following more a positive ethical view, an aspirational view:

Being already famous in his community and the recession being over, he is now faced with a lot of challenges in the projects he manages. He is not a person avid for money and he would not take any kind of projects only considering the monetary criteria (paycheck) or the extension of the project, he also seeks to fulfill his deep professional ambitions, which are mostly culturally and philosophically related than purely professional from a strict viewpoint.

He developed a complex system through he seeks to evaluate every single project he wins and he also presented me a diagram illustrating his view:

The client’s identity refers to everything in the project dealing with the client’s personality, aspirations, cultural background, demands. For Romania unfortunately, the client’s identity is more linked to a perceived financial status than to a cultural background. The architect’s identity refers to the informational baggage via academic education and also his individual professional style following the cultural orientation and the architectural paradigm. Limited local identity is a problematic strictly related to the close physical neigbourhood that implies stylistic, ambiance, proportions, dimensions, withdrawals, alignments, etc. Extended local identity is a concept meaning to the local culture, history, the local spirit, local traditions to the national features.

My client’s view is that he would rather avoid making former “architectural blunders” where even famous internationally recognized architects such as Le Corbusier have lost their way (Centre Chandigarh in India where he proposed at 250 m North of New Delhi a huge concrete ensemble) by not being able to fit the local spirit into the project brief. He is completely disappointed by the fact that all his beneficiaries with no exception pay little attention to all 3 dimensions (the architect’s identity, the local limited identity and the extended local identity) sometimes completely overlooking the architect’s philosophy or the space philosophy, which makes the collaboration between the beneficiary and the architect a very difficult and tensed one.

Therefore, his main problem was that he usually finds extremely difficult to compromise between his own professional philosophy based on various criteria (including estethics, local urban identity) and his clients requirements based mainly on profit. This was an inner conflict difficult to deal with every time he pitched for a new contract. He also seems emabrrased by the idea that his peers will judge his work via professional standards and this is why he was also shy to present some of his former projects in local or international workshops.

At first, as a psychotherapist and also from the philosophical counseling viewpoint I had the feeling that I could not help my client overcome his distress regarding his professional dilemmas concerning jeopardizing (sacrificing) his personal style and the extend to which he could eventually go on compromising his complex vision.

Afterwards, I have become a bit more optimistic while reviewing Aristotel’s Golden Mean theory which I believed would help to solve my client’s dilemma or at least to alleviate his distress and restore his ‘professional sanity’ and also referring to the Confucius emphasis on the importance of the doctrine of the mean. I have tried to deal with this dilemma strictly using Aristotle’s Golden Mean applied to the complex fourth-dimensional system proposed by my client. To the Greek mentality, Golden Mean was an attribute of beauty.

In the ancient and modern world there was this belief that mathematics is close association with truth and beauty. Greek philosophers believed that are three “ingredients” to beauty: symmetry, proportion and harmony. Beauty as an object of love was frequently imitated and reproduced in their lives, architecture, education (paideia) and politics. In Chinese philosophy, a similar concept, Doctrine of the Mean, was proposed by Confucius. Also, Buddhist philosophy includes the concept of the Middle Way. The essence of the Middle Way is to follow the Way or “practice between extremes” – to put into practice the fundamental principle that pervades the universe and all life.

Therefore, I have suggested my architect client instead of trying to connect at the same intellectual level with the beneficiary, to try and incorporate all the 4 multi-dimensions into his work of art or final product, the actual architectural project, not by negotiating or explaining a priori the beneficiary the whole philosophical background behind, but actually presenting him the solution in terms of following the Aristotle’s Golden Mean.

Perhaps trying to define other individual features than the ones referring to the status symbols and financial power of the beneficiary, I adviced the architect to explore further resorts of his own client’s personality, maybe diggind deeper into his early ambitions as cognitive schemas or patterns. Motivations behind a project may be various, most of them psychological, others philosophical, not only pragmatic. Some people are trying to balance a low self esteem level, others reflect a deeper understanding of the world, others reflect earlier phobias, such as the fear of poverty. Also, the architect’s own professional ambitions should be temperated by the scale of the place, the place’s cultural pattern, the neighbourhood’s urban personality or other criteria encompassing the limited local identity and also the extended local identity.

Supposing my client would successfully balance his own style together with his own client’s ambitions while considering the local identity of the architectural site, the complex dilemma could be solved not by using complicated decision-making strategy in few steps but more elegantly by using the Aristotelian concept of “golden mean” or the Buddhist concept of “Middle Way”.

Case study no.2

Camelia, a 38 years old woman client working in a bank in a managerial position comes into counseling with the following moral dilemma or moral conflict: she has been torn for more than 4 years by the idea of having to choose between her husband whom she married 12 years ago and her secret lover (X) whom she met 4 years ago. Her relationship with her husband is satisfactory on almost all dimensions, based on mutual understanding and love, but lately rather distant, while the relationship with her lover is also significant, based on mutual understanding, love, friendship and intellectual fulfillment. What distressed her mostly was the trust dimension, which she has clearly broken for so long time and also the loyalty dimension in marriage. Both men expressed their wish to have a child with her and also a bit of pressure was given by the advanced age in order to conceive a baby. She obviously did not want to rely on IVF (in vitro fertilization) or adoption only as a last resort.

In the first session, during the anamnestic interview and also after applying the BDI – I and BAI – II, it was obvious that the client did not have any invalidant symptoms, she did not suffer either from depression or anxiety, the only issue that intensily conflicted her was the utter inability to make a decision concerning the matter. She tried hard to deliberate but has not been able to get to a reasonable conclusion on her own, therefore she requested professional counseling in the hope she would resolve the issue in a favorable manner.

In the second session, I immediately tried to find out what ‘favorable manner’ means for her and I was told that it represents an elegant manner in which a satisfactory solution should not presume further regrets at minimum and a dramatic situation at maximum. Being aware that this is a decision highly emotionally charged and also with serious consequences that menaced my client wellbeing even more, I have tried to develop a decision making strategy involving the important criteria my client was considering when chosing her lifelong partner for the rest of her life.

Together with my client I also analysed her feelings for both men and tried to decide if the balance is somehow inclined towards one of them. Unfortunately it was very difficult for her to decide, and this is why she requested professional help.

Before presenting my client with a certain strategy and exploring her motivation behind the actual discomfort, I have warned her that whatever solution she choses (either to stay in the marriage or leave the marriage) she will have to accept the consequences, the fact that revealing the truth will be most probably perceive a violation of truth by her husband and he will want to divorce immediately. She has informed me in the first session that her husband does not agree the idea of open relationships and he would probably leave her when he will find out. Also, I have tried to warn her that the moment her husband will leave her, there is also a low possibility that her lover (X) also will leave her, in this case the phenomenon would be triggered by the probability that the love relationship with X has not been transformed yet into a ‘marriage’ relationship. I explored this way the idea of a very small probability she would remain single and abandoned by both men.

Therefore, in the second session I have presented her the decision making strategy I have developed for her, involving few important criteria that define her ideal stable and romantic relationship. Few helping questions were the following:

The client has answered all the questions and she reached the following conclusion: to remain in the marriage, having to choose to sacrifice the adventure for stability. She never regretted the solution afterwards, even though feelings of despair have arisen when the actual broke-up with X happened.

Observations: In the three sessions of philosophical counseling I have tried to check my client’s assumptions regarding life, marriage, loyalty, stability, motherhood and notice which relationship would best fit her description of good life. I have of course tried to be morally neutral in my approach, since the client has come to the counselor (psychological or philosophical) in order to solve a predicament, not to be judged following the counselor own moral value grid. My intention was not to add additional burden to her distress risking that my client will also develop depressive symptoms generated by guilt, but rather to solve the issue she came for help in an elegant manner, with the best chances of not regretting the gesture later. The most difficult part was to try and benchmark the actual life with the ideal envisaged life and see how close she could get by making a certain decision. Another difficult part consisted in trying to be also neutral and trying not to consider my own preferences when dealing with my client’s issues. But the most difficult part has actually been to elicit the final resolution from the client. A deliberation time of one month has followed our three sessions, time in which she compared and contrasted the possible solutions and finally has chosen the right one that fit her values, in this way also dissolving the cognitive dissonance which has torn her for a long time.

Case study no. 3

Alina, a 28 years old copywriter with a limited experience as a copywriter (only one year for a national printing house) has come to the counseling room with a very low level of performance anxiety, but not in a clinical way. She has just landed a job at a digital research and strategy company and she was really excited regarding the new assignment. The old colleagues and her former bosses have regretted a lot her decision to move on and are still looking forward to her coming back.

Clinically, the ORS (a wellbeing 4 items wellbeing scale) score was 6.5 on a global level, which means a medium level of wellbeing and the criteria for depression by BDI were not met. She feels a bit anxious (subclinical score 10 on the Beck Anxiety Inventory) about the new job but she was not capable to detect between performance anxiety or an anxiety that came from conflicting ideas regarding her role as a digital copywriter and her true talents as a writer. She has all the materials for launching a book with stories for kids and fancies to complete the project and other freelance projects by the end of the year.

In the personal relationship domain things are excellent, she has a supportive, calm and interesting boyfriend whom she would like to marry as soon as possible, thinking also of having a baby till she will be 30 years old. She had a good relationship with her parents and also with her relatives, she also has a history of good work relationships and an excellent academic record from the primary school to the university.

Her main complains are: she feels insecure about moving from a low-paid but steady job at a large national company to an insecure but slightly well-paid job at a small digital planning and strategy boutique. On one hand she is happy about this change believing it will represent a great opportunity by not only changing the domain but also by learning new skills, acquiring new industry knowledge and perfecting her CV. On the other hand, she is profoundly conflicted regarding the fact that her new CEO has ‘purchased’ her just as a product and her free time has completely vanished with this new assignment.

Her dilemma or her inner conflict is either to keep this well-paid job in the advertising industry which she already got with the opportunity to launch a book a year or to return to her former job to the national printing house where she would use her talent as a writer/copywriter in order to publish children’s books and also to make professional translations of famous authors books, while relying only on this income. Of course it is a tough decision, on one hand she is aware of the fakeness and superficiality of the advertising domain but on the other hand she knows that after a certain age the entrance in this competitive landscape will be tougher than tougher and when she will retire she would basically not be able to rely financially on the income made at the national printing house. On top of this, she is not certain either if the national printing house will not collapse in 10 years time or even earlier. She also has doubts about the retirement schemas and pension plans and even about the whole system in 20 years time.

Regarding the current job which she just landed, she is not very pleased with the income, considering that she is less paid than her industry colleagues in the same corporate positions and she is also really dissatisfied about the working weekends before pitches or in order to meet certain deadlines.

In the first session we have analysed together the other job opportunities she could have with her experience and her professional background and we came to the conclusion that she hasn’t got sufficient experience to apply for a senior position, neither for an academic position to a local university. We have also explored her options to land a job abroad for a digital strategy company or even for Google Inc. All seem to be decent variants, except the one working abroad, since her boyfriend would not consider relocating yet.

Faced with such a dilemma, we have started listing the reasons why she should stay in the new job and the reasons why she would consider returning to the old job.

Reasons she should remain in the new job position:

The new job is challenging regarding new colleagues from various professional backgrounds and also by the variety of different briefs for different clients;

The new job would be financially fulfilling in few years, if not right now; it provides a steady paycheck and also few trips abroad a year for specialization;

The new job may provide continuous training and exposure to multinational environment;

The new office is in a central area in an old reconverted villa and has access to a lot of facilities and also has a large courtyard dedicated to the brainstorming sessions;

The new job confers a status in society and also an opportunity or further promotion;

On the long run, this type of job would allow to landing a better paid one with the possibility of contracting a mortgage payment for a new apartment and allowing her to spend vacations abroad, one of her hobbies;

Reasons she should return to the old job:

More time with the loved ones and especially with her boyfriend;

More time if she decides to have a baby;

More time to indulge into her beloved hobbies such as writing kids books and novels;

More comfortable in terms of not being personally involved in client pitches or getting contracts, the management being responsible with these issues.

Also, we have analyzed together the drawbacks of each decision. Staying in the new job would involve working excruciatingly long hours, in the pitches periods even 10-12 hours a day with no possibility of turning down the management decision. It would also involve extremely limited time with the loved ones during weekdays and also some working week-ends. On the other hand returning to the old position would be regarded by her relatives, her friends, colleagues and even for her parents as some sort of failure, no matter the complex explanation behind.

Analyzing the reasons behind each decision, she finally decided to take the risk of staying in the current position as long as it’s humanly possible and trying to avoid burnout by not working in week-ends and taking all the legal holidays provided by the company. This has been a really good decision in the long run, since it has been the platform for a more satisfying and creative job at a bigger company. Also, one of my client’s desires would be to have her own small agency when she is more mature as a professional, entrepreneurship being a thing she highly values.

Alina only came to another session of philosophical counseling a year after, but this time not related to work issues. The dilemma this time was related to how she should ethically react when a friend of hers was starting to have problems related to drug addiction. She felt she was not sufficiently equipped either psychologically or ethically in order to deal with the complex addiction problems of her fried, who just lost her job as an art director for a fashion magazine and also had problems in her personal life. Alina came rather disturbed after her friend has called her for support. It was not the first time she helped her and had been supportive when her friend repeatedly relapsed into smoking Marijuana.

We analysed together my client’s values and at what extend her values would conflict with her friend’s values and have also discussed from a moral perspective the idea of using drugs. She has also expressed her worries that her boyfriend whom she also values a lot and wants to marry has expressed several times his desire of not getting too close too her friend problematic, fearing that they could have problems with law, which would be inadmissible and would probably jeopardize even their nice and trustful relationship.

Providing that her art director friend is not a very close one she also has a family, a brother and a boyfriend, after all she is not alone, my client has come to the conclusion that putting her friend’s interests before her own interests would not probably solve her friend’s issues longterm, but the chances to ruin her own relationship with her future husband would be high. Therefore, in order to solve her moral dilemma created by the situation, for the first time she did not respond to her friend’s desperate but also demonstrative cry for help.

Case study no. 4

Marius, a 38 years old client has been sent to the counselor office by his girlfriend. His girlfriend, 30 years old, is a medical professional in a small town hospital, already being assigned a job in the radiology department. She is fullfiled professionally but still in competition with her sister for the love of their mother and father.

My client is an IT professional (a game developer for a multinational company) who has chosen to come to Romania after few successful assignments in few European countries: Portugal, Italy, Spain and lately France. He has been involved in several important cross-country projects in CEMEEA and he has been very well viewed and paid in all his assignments. In one of his travels to Romania he met his actual girlfriend through his sister and he fell in love with the idea of finding a job and moving back to Romania which he left 10 years ago on the occasion of his first serious professional assignment.

Regarding the personality structure, Marius is the tipical type of introvert who likes outdoors but does not like socializing or big family reunions. He has a colorful innerlife populated by science fiction characters that play in some sort of utopian movie scrips he develops. He is very imaginative and creative, having lots of talents, drawing portraits and landscapes being one of his dearest hobbies.

Before meeting his girlfriend whom we will call G., he used to connect online with network buddies in order to play online interactive games. Apart from this, he likes going outdoors for runs, bar-b-Q-s, badmington or other fun activities or sports. His job entails long hours spent weekly in front of the PC, in the busy periods with deadlines even 10-12 hours a day and this is why he cherishes any activity outside home. One of his deepest fantasies included acquiring a countryside house with a large orchard of wineyard and eventually swithing for good from the busy ITst schedule to a more calm and relaxed outdoorish type of life, in the middle of nature, where he could grow his own food together with the love of his life.

He initially approached me very shy sent by his girlfriend who hoped I could ‘fix him’ properly using some cognitive behavioral techniques in order to function in her desired fashion and according to her objectives.

From the first session, Marius’s dilemmatic issue appeared to be more complicated than her girlfriend has anticipated, not in a sense that he suffers from a pathological condition blocking him to be a good partner or displaying some sort of symptomatology such as depression or anxiety, but in the sense that my client started to question his own desires related to the relationship, to the meaning of life, etc. For the first time, he had the courage to admit that he is not very comfortable being regarded as a ‘trophy partner’ by his girlfriend and that he senses that he is consider more a provider than a romantic partner.

His girlfriend, the medical professional, has a very strong sense of social skills and veneer and values a lot the social relationships in the community, she also has ambitions of pragmatic fulfillment and prosperity, being deprived since childhood of stuff other kids used to have. She became a bit invasive by suggesting him what to wear, in which circumstances, what sort of stamina he should display in the public and by also suggesting him all sorts of things he should actually do in the social situations. She is very sensitive when it comes to the couple’s social image and highly sensitive regarding her own image in front of her family (father, mother and sister). She is very jealous especially when it comes to her sister’s opinion on her own achievements and she has a low self esteem when comparing herself to her sister, who is already married and has a child at an age lower than hers.

In the second session, Marius has already been able to detect few behaviors of his girlfriend’s that he doesn’t like and agrees with. He is bothered by the continous competition in which G. tried to impress other family members and especially her sister with her own achievements. Now he feels she uses him for her own public image and he also thinks that before being a fulfilling relationship, his relationship with G. is more like a ‘commercial barter’ in which he comes with the steady job, the high salary, the unconditional acceptance and affection, while she only comes with the good looks and her tantrums.

He is also continuously bothered by her fits of rage and tantrums when the smallest unimportant issues arise. He thinks that most of the issues she considers important are in fact without any importance and nothing really important is at stake. In a way, he uses a philosophical stance when judging all matters, not a pulsional approach. He has been conducted in his own endeavors by a seeker’s viewpoint, not by a consumer. I could say that philosophically their worldviews practically collide. They are not philosophically and existentially linked as a couple.

Therefore, his dilemma is the following: to stay in this tensed and uncomfortable relationship or not?

Examining his cognitions and emotions linked to the whole existential situation, I have found that: “Even though I am in love with her right now or I think I am in love, I am scared by the development of further tensions”, “There is no the actual butterfly in the stomach feeling when thinking of her”, “For a 7 months old relationship feels a bit romantically disengaged”, “She puts me through consistent financial efforts, from buying her an outrageously expensive dress for her sister’s baby Christening event to buying her a car to show off at the event in front of all her relatives”, “I do not think she actually cares for me as a human person, she regards me from a bank account viewpoint”, “If I think well, I believe I can get back to the old lifestyle, more secluded, more withdrawn”, “I am not very afraid of being single, I have been till now, with the exception of few brief relationships”, “I am very uncomfortable when thinking that my whole existence I will act by proving her and her relatives that I am a good person and most of all, a good provider”, “I am honestly afraid that if we will have a child, the child will inherit all her bad personality traits and I won’t be able to be a good enough parent”, “This competition with her sister’s family annoys me, bothers me and gets me really tired”, “On the long run, this relationship may become exhausting if I don’t take some necessary steps to stop some behaviors”.

In the third session I have asked my client to make a list of reasons why to stay in the relationship and also a list of reasons for what to leave the relationship in order to understand his motivation fueling a certain decision and the emotional implications each decision would bring in the picture.

Reasons to stay in the relationship:

I am afraid of solitude;

Before having this relationship I did not really value the importance of a stable relationship and now I am afraid that my worldview has changed in the sense that includes a partner in it;

I am afraid of getting old alone and I think there is nothing sadder than getting old by yourself;

I am thinking of having a kid and it might be too late if I wait forever for the “perfect person”;

Reasons to leave the relationship

It is too difficult for me to carry on with all her tantrums and it’s becoming tireing;

I believe that if in the first year which is supposed to be a romantic one, our relationship is so tensed, this implies that no further improvement will occur, therefore in the long term the relationship is doomed (catastrophizing);

I am not so sure that G. is the person whom I would like to spend the rest of my life with;

It is becoming difficult for me to ‘play’ in somebody else’s theatre play, a minor role, an extra, a background performer, I would rather prefer to play in main part in my own movie or life script;

I feel this relationship is not a healing one for me, but one in which I need to continuously prove myself, my skills, my financial power and status to some people who are not even my family;

I consider I am being used and not regarded as a human being with feelings, opinions, values and thoughts;

I am being continuously patronizing and told what to do even if I am old enough to have kids;

My personal comfort has been dramatically jeopardized on the ‘social image’ altar;

My other extracurricular activities do not interest my partner, we basically do not have many things in common;

In the fourth session the client was visibly disturbed by a new event that was supposed to take place in G’s hometown: her sister’s baby Christening party which is invested by G. with a lot of importance and she desperately wants to look good in picture, if not even brilliantly. Therefore she started putting a lot of pressure on my client to buy her a very expensive unaffordable dress, afterward she pressured him to choose a car he cannot afford and to pay for it, in order to make jealous all the event participants on how she is: up to the job, flourishing and prosperous. In this way she instructed him to answer only to the unavoidable questions, to keep a very high and mysterious profile on his work position in order to impress the people present at the small family reunion and especially her little sister. My client strongly disagrees all this ‘façade behavior” and asked me to help me with his inner struggle regarding the authentic way he would like to present him to the friends, family and the ‘ingenuine’ type of presentation he should actually make in order to fulfill G’s fantasy.

In the same session I have tried to find out what are the biggest fears and worries my client experiences when he thinks of the forthcoming event, which were the following:

I will make a fool of myself while trying to impress others;

I will fail establishing a good rapport with the main ‘actors’ at the event: G’s mother, G’s father, G’s sister and G’s brother in law;

I will look ridiculous in that suit bought especially for this event;

Nobody will actually notice the new dress my girlfriend is wearing and neither the new car which I had put tremendous effort in buying them just for her sake;

My presence at the event will be a total disaster and it will be the main cause of splitting;

At first, few cognitive distortions were noticed, such as catastrophizing, black and white thinking, negative anticipation, affective judgment, mind reading, etc. Then, we would move further to explore these thinking patterns and try to see if they match the whole picture or not.

Fortunately, all cognitive distortions behind the fears and worries listed before are not typical ones Marius is using in his personal, professional or social life. He has been functioning perfectly normally throughout all his lives events, moved from a job to a better one, travelled outside his native country, established few solid friendships, switched flats, etc. He is a person accustomed to change and nothing scares him apparently. Now it is a first time in his life he is confronted with a lot of difficulties and also with a dilemmatic situation.

The role of the psychotherapist or the philosophical counselor is more the role of a neutral observer, who tries to notice the particular problematic brough by the client and helps him or her to solve it in the optimum manner, with the minimum of emotional costs. A difficult mission at first glance, the approach may be helpful only if it follows the client’s particular values, needs and hopes. This is why the counselor does not force his or her own views upon the client, trying also to be completely free for prejudice and prejudgments.

Between the forth and the fifth session the event has taken place with no critical incidents. None of my client’s fears has been confirmed, therefore a more rational strategy had to be employed. Unfortunately, he was feeling rather nervous about making extra-spendings in order to book an excursion to Kenya and also paying for the redecoration the new house.

In the fifth session of philosophical counseling, I was in the position to try to explore again with my client his beliefs and cognitions regarding his relationship, his ideal and meaningful relationship and his future.

Regarding his ideal relationship, few features have been acknowledged:

A relationship in which he may also be an actor in the script, not only act as an extra;

A comfortable relationship in which he would like no more tensions between families and in-laws;

A relationship based on trust and empathy and not subject to the other’s scrutiny and feedback;

An enriching relationship in which he may develop intellectually and spiritually;

A relationship not so much based on a materialistic and commercial viewpoint;

Looking at the actual relationship Marius is currently in, it seems that none of the ‘ideal relationship’ features or criteria is ever met, which creates a lot of cognitive dissonance when he confronts his real situation with the ideal one. Solving cognitive dissonance is a difficult task for him, since many times from the beginning of this relationship he wondered if he should stop it or carry on.

In the sixth session we explored a future without the actual partner, trying to understand the extent to which he can live a fulfilling or at least a satisfactory one without his girlfriend. Imagining a life without her was difficult at first, but gradually he got attracted to the idea of restoring his former inner peace like when he was travelling Europe holding different job positions. Suddenly he also became attracted to the idea of finding a job position in France or Germany or maybe relocating to another expat assignment in order to distance himself from the hassle of his girlfriend’s family and he started to fantasize again about freedom and being single again.

Since it was not possible to deliberate in this session and find an optimum solution, Marius insisted we would continue the analysis of reasons in the seventh session.

Most useful for the process was his own strategy of constructing decisional trees and dealing with any problems in his life by applying this method. The client already has critical thinking skills and he is also accustomed with critical analysis. His only weak point is the actual fear of solitude and the emotionality linked to it. He was certain that if the emotional aspects of the situation would be reasonably dealt with and his decisions would be mainly taken rationally, the task of choosing would be much easier.

In the seventh session Marius was capable of giving himself a deadline till which he would be able to either resume the relationship in the current terms or continue it with a set of prescriptions for her girlfriend, prescriptions that would make his life easier and more pleasant and would also give him the feeling that he is an actor in his own movie.

Case study no. 5

Fabian, a 50 years old graphic designer in private practice has come to the philosophical counselor office in the hope of solving a moral dilemma which he is now faced with: he cannot provide home care for his elderly father (80 years old) who has been developing a form of Alzheimer’s disease with a rapid onset course. When perfectly functional, his father has repeatedly and obsessively expressed his wish to be cared for at home, by his own family (wife and son). Fabian and her mother have been in a very good relationship till she died, few years ago. Unfortunately, he has no sisters and brothers and his relationship with the extended family is cold, since they do not visit themselves and are rather withdrawn people.

It has been 5 years since Fabian’s mother died from a rare type of cancer and he is now the only next of keen of his old father. Apart from the Alzheimer disease that started developing soon after her mother passed away, Fabian’s father’s physical health is still good.

Nowadays Fabian is confronted with his private entrepreneurship’s challenges regarding clients, pitches, new contracts and with his personal challenges having to also take care of his wife and his teenager son.

Fabian’s dilemma is the following: he fears that if he puts his father into a nursing home for Alzheimer’s patients he would betray his father’s trust, since he promised him before suffering from a cognitive disorder that he would never allow other people to take care of him. He has strong feelings regarding his promises and he is constantly tortured by the thought that he is not making the best decision for his father’s wellbeing.

On the other hand he is perfectly aware that no matter the specialization he would obtain in profesional caring for people with dementia and strokes, he would not be better than any medical professional, either nurse or doctor. For three years he had employed a nurse that could come daily to care for his needy father and this project has been successful until few months ago, when the illness has become gallopant and the deterioration was more visible and the old father needed a live-in carer, who would also attend his needs at night and also in week-end.

In the first session of PC, we analysed the reasons supporting the alternative of caring at home for his father (with specialized help) and also the reasons supporting the alternative of sending his father to a palliative service facility or a nursing home specialized for people with senile dementia and Alzheimer.

We know senile dementia is a degenerative illness with a life expectancy of 10 years from the moment it is diagnosed.

The first series of arguments were the following:

Fabian would respect his father’s wish formulated when he was cognitively functional and in full capacity of caring for himself;

He would have the feeling he acted morally and in accordance with his values and his father’s values;

He would be closer to his father and more able to meet his needs (the proximity argument);

He would not fear his relative’s judgment when finding out that he dismissed his father’s will;

The second series of arguments were the following:

The science of caring for elderly with special needs has been developing dramatically in the latest decades and it would not make sense to dismiss these advancements;

The idea of having professionals caring for his father appeals to him more than having a semi-professional or retired nurse caring for him in the house;

One of his greatest fears that his father could wake up in the middle of night and harm himself or damage the kitchen would disappear, since at a nursing home there is also night surveillance and 48 hours care’;

The money argument is also strong, since paying for a full time carer would be even more expensive than paying a monthly allowance at the nursing home’;

This sort of arrangement would also allow to take the father home in week-ends or whenever the family wants and it would also allow the father to be involved with other people outside his family, this way preserving both the bond with the family and also the

socializing aspect.

Apart from the arguments supporting both decisions, I have invited Fabian to look into the palliative services philosophical background, finding meaning in this sort of endeavour. He would probably not need to convince his father about the decision, since the father is not currently capable of recognizing familiar faces.

I certainly understand Fabian’s struggle and the fact that he clearly meant what he said when he promised his father to never place him in a nursing home. However, what he was really promising was that he would be there for his father and only do what he believed would be in his father’s best interest. Generally we would all say that we wouldn’t like ending up in a nursing home, but we all seem to forget that they exist for a good reason and many loving families resort to placing their beloved relatives in this type of institutions since it is the best and safest place for them to be.

The decision about when is the right time to move a parent with Alzheimer's to a care facility is always challenging. As a person's dementia progresses, it is crucial they are in a safe place in which they have 24 hours a day care and where they can still be active, both physically and mentally. It requires real skill to know how to continue to keep people with dementia active.

In the second session, I advice Fabian to take the time to carefully look over the various facilities that can help his father , keeping in mind that if he waits too long, his memory will be so impaired that the facility will never become familiar and he will never feel at home there. “Once he is there, you can spend as much time as you like with him, but as his son rather than his caretaker. This may also help him to not feel guilty about having to trouble you to get her needs met. If your guilt continues to wear you down, we may discuss this further.”

In the third session, I presented Fabian a very brief summary of the evolution of this disease. In a few years, depending on the evolution, the Alzheimer sufferer may need a ‘speech and language therapist” and a medical specialist in order to identify in due time the way the person eats, since one of the dangers of this disease is disfagia and also the bacterian infections such as pneumonia and other complications. Without stressing the psychiatry part, senile dementia brings with it a high risk of depression and anxiety, even psychotic episodes, irascible moods, apathy, aggression, etc. The personal caring for persons with senile dementia in specialized nursing homes consists not only of the nurse or carer who ensures feeding and corporal care, medication, but of a more complex therapeutic team, represented by:

Carer – the one who works in 12 hours shifts, who ensures hygiene, feeding, change of sheets, helps them to get to lounge or living room.

Nurses – medical professionals who have responsibilities such as: medication for the residents, rapid intervention in crises;

Family physician – who follows the health status and prescribes the medication, decides if there is need for hospitalization (eg patients with diabetus melitus who have wounds that require hospital treatment)

Leisure and lifestyle assistant – organize pleasant activities activities for residents (teaching them cognitive and motricity skills)

Social worker – performs tasks as massage, chat with them, helps them with meals

Occupational therapist – to fiind solutions in order to make the residents independent

Psychiatrist – follows the course of degenerative disease and prescribes medication.

Therefore, I have explained Fabian that placing his father in a specialized care facility would be the best thing that a loving family can do, since at home there are no minimum conditions met in order to treat the person with dignity.

In the fourth session, we discussed again the reasons behind any of the two decisions and Fabian would be able to make an informed decision himself and also to alleviate his own guilty feelings regarding the decision. His decision was to place his father in a specialized caring facility at least for few months, in order to follow his evolution. If the decision is correct and seems to also fit his father’s wellbeing, it could become permanent.

This way the dilemma was solved and Fabian’s moral dilemma was solved, at least for a limited period of time.

Case study no. 6

Teodora, a 42 years old professional lady working for a multinational telecom company in a managerial position in Bucharest, came to the philosophical counseling room to solve few predicaments:

First one – to decide whether she should inform her 2 years old adopted boy that she is not her natural mother and her husband is not the little boy’s natural father

The second one – to decide if she is able to downshift from the high managerial position that allows her to have very little family time to a part time position or a freelance job

Teodora is a beautiful, very confident and very perfectionist woman, who came to the psychotherapist without any anxious or depressive symptomatology, but with few issues “giving her headaches”, as she likes to express when she describes her problems. She is happily married with the general manager of a small design company and they have adopted 2 years ago a baby boy, perfectly happy and healthy. Apparently her life could be described as perfect, but there are few aspects that bother her and after a long deliberation, she finally got into the counselor’s room to try to solve them.

The decision to adopt a baby boy was taken collaboratively with his husband, a passionate biker and an Indian born British citizen, Cambridge educated. They also considered to adopt an Asian born boy but they finally decided to adopt a Romanian born child, since they consider Bucharest they residency at least for the next 10 years. The reason they adopted a child was because after they have tried for several years to become parents, they did not succeed, therefore was a rational and long-tought decision, not a hasty and desperate one, after they also analyzed together the IVF alternative (in-vitro fertilization). The psychological theories usually advise to inform the child about the adoption as soon as he or she is able to understand the issue, and if not completely capable to understand the reasons and the arguments behind this sort of life important matter, the child can be at least informed that is a natural gesture and many people chose to become parents in this way. However, Teodora’s worries are that her boy will not understand the issue and also that the bond with the adopted parents is not perfect and she is also really worried that Alex’s natural mother, very young, who has also three other kids, could possibly look for him later and maybe try to contact him and convince him to return to her.

For the first moments, it was clear for me as a counselor that at the basis of all her worries were a lot of irrational thinking patterns or cognitive distortions, such as: catastrophizing (my boy’s natural mother will find my baby and will take him back), black and white thinking (I am not capable of telling my son the truth, that we are not her natural parents) and also she tends to make emotional judgements about all the decision she has to take in her life at the moment.

From her own accounts on her husband’s behavior, I understood that he is much more relaxed about all the issues and tends to solve the problems rather than thinking and worrying about them. Therefore it was clear that at first my client needed to be taught several new coping skills and strategies in order to deal with her new status, apart from the professional, being a mother.

We explored in the second PC session the thinking behind the decision to reveal her son Alex that he is adopted and we have noticed few directions to be explored and few arguments to be brought:

The little boy will notice sooner or later, even brought-up in a multinational environment, that he does not resembles (regarding the face features and the skin color at least) with his father who is of Asian descent and he will probably wonder about it;

There is a large possibility that the boy could find out from the extended family, at a familial reunion or even at school that he is adopted; kids are also very perceptive when finding other kids weaknesses;

There is no real benefit in keeping the boy away from the truth, since there is a body of research on adopted kids who admitted that they have been better of psychologically if they had been told the truth from the beginning;

On a long run, the truth is always better than a lie, from a philosophical viewpoint, regardless of the first emotions elicited;

Adoption became lately a regular practice in the developed countries and the inter-racial couples are no longer a curiosity, therefore nobody will regard them as strange even in a very traditional society, such the Romanian one.

In the worst case scenario, even though if the boy’s natural mother shows up, the law doesn’t allow her to take steps and the legislation is in this way constructed that the moment she signed to allow the adoption taking place and a judicial acknowledgement has been signed, the boy cannot return to his natural mother, legally-wise;

Even if we assume the natural mother shows up, the chances are that she lives in poverty having other kids she cares for, not being married and also not having a steady job and a home and most probably the little boy, faced with the new situation and having to compare the two situations, at his home with two loving parents in a comfortable lifestyle or with a mother who abandoned him when he was a baby, he should most probably choose to stay with her loving adopted parents.

Disclosing the boy he was adopted, earlier between 3 and 7 years old rather than he will be a teenager is better, since teenagers usually start revolting to everything is being told.

After listing the most important arguments for revealing the adoption truth to her daughter, Teodora felt much more in charge when making the decision and she also discussed with her husband the issue. Her husband was completely in love with the idea that they should not conceil the truth from their son and they could start disclosing it when the little one will be prepared cognitively and also emotionally to deal with the issue, after 3 years old, with no fears, in an adapted manner, according to his power of understanding.

Regarding the second predicament, Teodora has been having this idea of downshifting ever since she considered adoption, when she was 40 years old. The long office hours, the working weekends, the business trips made outside Bucharest, the time away from her husband few times a month and even a sense of existential unfulfillment when envisaging another 20 years of her lifetime spent in the same manner simply made her more concerned as the time passed by. But when the boy arrived, she simply found unbearable the extratime spent in the office, especially form 4pm to 8pm, the time she got home. Although she employed a fulltime specialized nanny who looked after Alex while she was at the office, she was permanently tortured by the fact that she only has 2 hours a day to spend with her son, while her husband, even though is a general manager, has a more relaxed schedule at least from the location and time viewpoint (he could work from home and also while traveling) could actually spend more time together with his son. The first year was not very bad, the company allowing her to have 6 months of adoption holiday but it became more and more difficult to cope with the lack of free time when she returned to work fulltime.

She has listed all her judgements and fears against making a downshift from her managerial position to a less important position, a freelance position or a stay-at-home mother position:

I am not equipped either professionally neither financially to make such a shift, since the only professional life I have been accustomed with for the lastest 20 years has only been corporate;

I am not ready yet to risk sending a resignation paper to the management, fearing that if I move from this financially comfortable position to a stay-at-home mom position will be disadvantageous for me;

I fear the fact that becoming financially dependent, my husband will not respect me anymore, even though he comes from a traditional Asian background where it is culturally acceptable the woman to stay at home especially in the children raising period;

I am afraid that if something happens to my husband (an unexpected illness, a biking accident, etc) and he disappears, I will not be able to care for me and my son from a noncorporate position or with no financial backing at all;

My job position is a very specialized and niched one and if I take a pause of few months or few years I might not be able to find a similar position paid equally and I might be forced to accept a very low paid position in a different company, which will result in a lot of psychological strain.

After providing my client with the basis of cognitive behavioral therapy prescriptions regarding the issue of disclosing the truth to her son and also when balancing the reasons to support or not a downshifting decision, I also looked for the philosophical meaning of both issues. Since the couple was content with the adoption decision and the only thing to decide was to tell her boy he has been adopted, I went into the philosophical importance of truth. American pragmatists were offered the closest perspective of truth to the above existential situation of this couple: “Truth is the end of inquiry” (Charles Peirce) and “Truth is satisfactory to believe’ (William James). Especially William James understands this principle that tells us what the practical value of truth is. Peirce's slogan is perhaps most typically associated with pragmatist views of truth, so we might take it to be our canonical neo-classical theory.

Regarding the choice of downshifting or staying in the same fulltime job, I also approached this view philosophically and also considering the sociological theories of downshifting. As Erich Fromm claimed in his work The Sane Society describing a consumption society, a human becomes totally alienated to his work, to the products he consumes, to his friends and family and, finally, to himself (Fromm, 1955, 2012). He is lost in the world which he himself has created and it is hard to differentiate between real and artificial. Anna Paukova acknowledged in his article “Downshifting: foundations and dynamics of personal choice” that downshifting phenomenon may be also regarded as a process of having to make an inner choice between two options of personal actualization: personalization and personification. The same author noticed that in spite of the fact that downshifting is a rather new phenomenon, there are some precedents for “downshifting behavior” in history and culture, one of them being Diocletian, the Emperor, who refused to govern and abdicated to cultivate cabbages in a country side. Another downshifter would be Leo Tolstoy, Russian count, who came to an ideology of life simplification during his spiritual crisis, which is described in “Confession”. The philosopher H. D. Thoreau who lived an ascetic life in a wood and described the results in his book “Walden” and even the philosopher Ludwig Wittgenstein spent few years of his lifetime as a gardener, outside academia.

These early downshifters were only a few and they could not be recognized as a movement but at least they highlight some specific features and provided framework for future downshifters. Eraly downshifters were not many, since before the industrial revolution people would not make enough money to afford to retire or downshift. Downshifting is a rather new phenomenon, characteristic for the recent decades, allowed by importance changes in the social structure. Pankova also notices that in some countries a quarter of the population consider themselves downshifters and one of the most famous type of downshifters is so called “Goa-shifter” (Butonova, 2009). The Goa-shifter is a person who decides to leave her job for a while and move to a developing country, where living expenses are cheap (Thailand, Goa, Indonesia, etc.) and makes a living either spending savings, doing unqualified occasional work or subletting a property. These types of downshifters are seekers for calm and relaxation, for personal growth, mindfulness meditation or altered states of consciousness. They are different from people who take a sabbatical year off-work, since in the case of latter there the idea of any work is forbidden.

When downshift, it is expected that the fundamental discrepancy between “Ideal self” (visions and images borrowed from other people) and organismic experience (Rogers, 1964) is being reduced while the area of Real self (ideas about myself which are validated by real experience) is growing. Ibarra (2003) describes such mechanisms of changes in self-concept among downshifters: a person moves to strengthening the Real self by testing so called “possible selves”. He or she cannot just jump into the desired image and status of Self: positive changes are always imply searching for a solid ground and relating to complex reality which may not support personal ideas of what is appropriate.

I have explored with my client her motivation and most of all if she reached the stage (financially, psychologically) to downshift. Exploring also her worries while delving deep into the meaning of her relationship with her husband, the client got to the conclusion that she would definitely do this, not now, but in 10 years time, when either she will be prepared to start a freelance activity or maybe if she would move to South-Asia with her husband.

Case study no. 7 (a hybrid case of cognitive-behavior therapy, existential psychotherapy and philosophical counseling)

Andrei is a 22 years old client who dropped-out from the civil engineering school a year before he presented to the psychotherapy (PC) office looking for answers to some burning existential questions and also trying to solve a professional and romantic crisis. He is not symptomatical, does not have depressive or anxiety symptoms, he did not have any trauma issues in the childhood and he has been neither confronted with other significant losses lately, except for recent romantic break-up with his girlfriend whom he dated only 8 months. He has a loving and empathic mother and a supporting family, a supportive aunt trained in psychology and a brother whom he shares the same opinions and worldviews. From personality viewpoint, the counselor is more inclined to consider few accentuated personality traits: narcissistic and histrionic, however there is also a slight suspicion that the client may suffer from a mixed personality disorder (narcissistic and histrionic types). Personality disorders are yet very difficult to be diagnosed, especially because they are egosyntonic and the people who may suffer from a personality disorder usually prefer not to come to a mental health counselor for an evaluation or treatment. However, in Andrei’s case, I maintain the view of a personality structure with histrionic and narcissistic accentuated traits, not a full personality disorder diagnosable by DSM-5 criteria, Axis 2. Also, the client is a very perceptive and intellectually gifted person, who also reads a lot and has been developing a passion for philosophical and psychological readings, he tends to be anti-dogmatic, he is attracted to science and evidence-based literature and considers religion too dogmatic for his open views.

The verbal association test is revealing few important details about my client’s complaints defining his existential crisis:

I regret dropping out from the civil engineering university

I always had this problem of lack of meaning

In my heart I feel that I find no meaning in anything I do

To be the best is not good enough

My profession does not reflect my entire personality

I would like to know what is true and what is not

I never manage to choose what is best for me

My current problem is loneliness

Therefore, the hypothesis drawn from my client’s predicaments or complaints are:

He acknowledges he is passing through an existential crisis and would like to solve it

He does not know what to do professionally-wise since he dropped out of the civil engineering university and procrastination seems to be the only „strategy” at the moment

He would like to find a person who loves him for what he is and who does not want to change him

My client is a voracious reader since he was in the primary school and his readings brought him from Western Philosophy to Eastern Philosophy, being lately attracted by the topic of Buddhist Enlightenment by which he is completely absorbed and also by conscientiousness studies. He reads Western philosophy, from Nietzsche, Kirkegaard, existentialist authors, Camus, Frankl, he is also an admirer of Tarkovski’s filmography and other directors, has a complex fantasmatic inner world and he is attracted by a lot of cultural endeavors. He is also a mountain lover and endulging in martial arts from time to time.

Unfortunately the rather young age and the fact that he comes from a modest provincial background has been stopping him to take a more creative path such as a script writer or a movie director. He thinks that he cannot afford to go into a non-pragmatic domain such as movie directing, scriptwriting or documentary film-making, instead he actually needs to become more pragmatic and choose a contemporary and well-paid professional path. He alternates this rational path with a more spiritualistic endeavour when he thinks at a professional domain.

My client refuses to see that he uses the Buddhist teachings more as a means to escape the uncertain and rather unpleasant reality in which he is currently immersed, floating between the pleasure principle and the reality principle. The pleasure principle would be the cultural path (a creative profession), while the reality principle would be the pragmatic path (an engineering profession or a consumerist one). However, he is not able to solve this cognitive dissonance and make a reasonable choice at the moment and this is the reason he sought help. He uses the topic of Enlightenment as an escaping road from the pressing theme of having to choose a profession which is satisfactory both intellectually and financially or at least a profession or a job. He obviously does not like the idea of being financed by his parents at this age, but does not seriously consider the idea of taking any kind of job, just as a survival strategy.

When exploring the reasons he dropped out from the civil engineering school, my client acknowledged that the requirements were too high, the curriculum was boring and also he admitted that this was the first recommendation from his father, who is also a civil engineer and he would have liked to start a business with his son. He also admitted that in principle he would fancy becoming a famous engineer, but he is rather discouraged by the amount of work and the amount of exams he must take in order to graduate and eventually start his private practice. As his counselor, I am inclined to consider his choices, either in the civil engineering field, or in other creative fields as narcissistic lifestyle choices, building upon his self esteem and also trying to breakaway from the modest countryside environment he was brought up in and also as a strategy to overcome his modest condition. His parents could not be specific when recommending him a career path and for a period, father’s recommendation was a good one. In their view, apparently any ‘intellectual’ career would be good for him, therefore not specific recommendation could be made, which contributed to his confusion. Also, in the theoretical high school he finished there were no vocational counselors that could give him any valuable hint.

As an avid seeker for truth via Enlightenement path, my client has not been either orientated in this path by any spiritual guru and he is neither keen to recognize a mentorship figure apart from Buddha himself.

I have taken this challenging case in the hope that helping my client to use the rational thinking and also the critical thinking, I will be able to extract him from the confusion and inability to choose a path and by procrastinating his entry to a new profession with the highest possibility to enjoy it. From the beginning I have noticed that one of the biggest impediment is his low frustration tolerance level and an inner critic that continuosly challenges every steps he takes. Here the meditation techniques or simply the teachings of few prominent Buddhist teachers helped a lot, but not entirely, since the client has been engaging in this type of thinking for as long as he rememembers and some of his thoughts have become recurrent in time, forming a pattern of thinking. I had to use some cognitive reframing techniques in order to address those basic assumptions that elicited his present negative emotions.

Few of my client’s thoughts forming his inner monologue were:

1.“No matter the degree of wellbeing you will reach, it won’t last forever”

2.“There is no use in having self-confidence, it serves no purpose”

3. “It’s too good to be true”

4. “The world is unstable”, “You will not be able to control anything”,

5.“You are not good enough”,

6.“People will harass you”,

7.”You will die anyway, therefore your efforts will be useless and won’t have concreteness”

8. “You don’t have anything stable or a solid frame in which you live”.

Initiating a dialogue, I have tried to deconstruct each irrational though and provide arguments, whenever it was possible, for building a more rational thinking or a critical thinking habit:

1.”How do you know that the wellbeing state won’t be permanent? Do you have any proofs?”

2. “You may have confidence as an experiment, exercizing your imagination.And even you may not have enough self-confidence, there are still people who like and love you unconditionally, as your parents, your relatives, your brother and now as our counselor I also accept you unconditionally. ”

3. “It is perfectly fine to be like this, why don’t enjoy it?”

4.”World is unstable and unsafe, everything is unstable, but this doesn’t stop us to enjoy it as it is and find meaning in it”.

5.”Good at everything? Define the domain. People cannot be good at every domain, you need to specialize in one.”

6. “This is simply a cognitive distorsion, negative anticipation. Do you have any proofs? You cannot rely on few isolated episodes of bullying in order to make such a bold statement. However, if some of them will do, others won’t. You need to look at thinks in a grey perspective, not using a ‘black and white’ thinking”.

7. “We will all die, but we will survive through legacy. Start and create your own legacy.”

8. “Nobody has anything completely stable, people look for solid ground but uncertainty will forever be part of our lives. We cannot escape certainty, therefore we need to learn how to deal with it and adjust to whatever lives brings us as the next challenge.”

Another hypothesis I presented to my client regarding his own discomfort was one based on his own representation of a complex life and career choice: “It would be nice to try and move people with film. I am attracted by a lot of domains. There are so many fascinating domains that if I chose only one, so many remain untouched. I suppose I need to make a choice finally. I don’t understand the majority of people who answer simply the question ‘why do you settle for medicine’? with the sentence: ‘Because I cannot see myself doing something different’. Does it represent a terrible narrowing of horizons or maybe having a well-delimited individual scope? I see myself doing a lot of different things now and in the future.”

In addition, I have introduced my client to Barry Schwartz’s theory named “The paradox of choice” which may stay at the basis of his chronic indecision and procrastination when looking for an acceptable career choice. According to the Paradox of Choice, Schwartz argues that when people are faced with having to make a decision amongst many choices, they will begin to consider hypothetical trade-offs and this makes us evaluate our options in terms of missed opportunities, as opposed to the opportunities potential. The downside of making these hypothetical trade-offs is that it reduces the satisfaction we experience from the option we decide on. He accepted the idea that indeed some of his troubles in finding a satisfactory path is that there are too many, also the fact that he is perhaps talented in many areas, humanities, creative endeavors and settling to only one would be rather frustrating.

I have also reviewed with my client the basic 10 axioms of the Choice Theory by William Glasser:

The only person whose behavior we can control is our own.

All we can give another person is information.

All long-lasting psychological problems are relationship problems.

The problem relationship is always part of our present life.

What happened in the past has everything to do with what we are today, but we can only satisfy our basic needs right now and plan to continue satisfying them in the future.

We can only satisfy our needs by satisfying the pictures in our Quality World.

All we do is behave.

All behavior is Total Behavior and is made up of four components: acting, thinking, feeling and physiology.

All Total Behavior is chosen, but we only have direct control over the acting and thinking components. We can only control our feeling and physiology indirectly through how we choose to act and think.

All Total Behavior is designated by verbs and named by the part that is the most recognizable.

The Choice Theory, developed by William Glasser, MD, offers an explanation of motivation which is different from the original definitions of human motivation. A central feature of Choice Theory is the belief that we are internally, not externally motivated, it is a theory that values intrinsec motivation. While other theories suggest that outside events "cause" us to behave in certain conventional ways, Choice Theory teaches that outside events never "make" us to do anything. What drives our behavior are internally developed notions of what is most important and satisfying to us, the so called “basic needs”. The Basic Needs that stay at the foundation for all motivation are: to be loving and connected to others, to achieve a sense of competence and personal power, to act with a degree of freedom and autonomy, to experience joy and fun and to survive. Another major concept in Choice Theory is the notion that we always have some choice about how to behave. This does not mean that we have unlimited choice or that outside information is irrelevant as we choose how to behave. It means that we have more control than some people might believe and that we are responsible for the choices we make. In a way, the choice theory is a theory which encourages personal responsibility in every aspect of life and draws very closely to Albert Ellis’s line of thinking that no matter what happened in our past, we, not our parents or the events in our childhood, are responsible for our own destiny.

Last but not least, we have touched the sensitive area of solitude both philosophically and from Albert Ellis viewpoint he describes in his paper “How to conquer the dire need of love”. The idea of how solitude may represent a strong motivational force was somehow new to him.

Approached both philosophically and psychologically, the predicaments seem to be solvable, especially considering the client’s high level of intelligence and motivation for change.

The only two indicators that may slow the progress would be:

1. too many paths to choose from in the professional area;

2. the fact that the client uses especially avoiding strategies (arts escapes, the ideas to go into a Buddhist camp or a retreat, the idea of giving himself another year to think about the correct decision, the reclusion to his parent’s house, etc) that he is completely aware but he cannot control in this very moment and he is less inclined to use more emotion-focused coping strategies that problem-focused strategies to solve his problems. Some of the emotion-focused strategies he uses now (and that did not help him at all in the past) are: brooding, imagine/magical thinking, avoidance/denial, blaming himself and others. Problem focused strategies would be: analyze the situation, working harder towards a chosen goal, applying what he already learned to the other real-life situations, talking to a person who has a direct impact on the situation (a mentor, a parent, a vocation counselor, a university professor, etc)

Regarding the professional domain and trying to narrow down to the correct choice, I presented my client few alternatives to choose from:

Enrolling back to the civil engineering school and engaging also in a creative hobby, in the hope that his narcicissm will be met and also his passion for contributing to the world welfare;

To try and enroll for studying at an university abroad where the idea of major and minor axes is frequent and possible, such as for example choosing business studies or communication for his major and humanities or arts for the minor, trying this way to match many of his passions;

To engage in any job until he finds his true meaning and also attend online Buddhist studies at a university abroad;

To have a start in a completely different domain that does not require university studies but only short time courses or on the job trening and that would also lead to freelance careers: graphic design, video game programming, web developing, media studies, communication, etc.

To engage in a completely different type of training that would allow him to have a good, fulfiling life, but also an adventurous one, such as being a pilot or a cruiseship captain, leaving out other talents and interests as hobbies. After all, 20 years old is an age of adventurous choices.

My client had analysed the choices I have presented him and after few weeks of deliberation, he decided that he would opt for communication and media studies at a local university since abroad the costs were too high and he would also like to start studying the Enlightenment via a professional institute of Asian Studies, partially via online webinars, partially attending their courses in a nearby location. Additionally he became volunteering for Peace Corp, Save The Children and Red Cross in Bucharest whenever the schedule allowed him.

Case study no. 8

Milena, a 35 years old professional in the field of oil and petroleum, highly successful and in a fresh romantic relationship she highly values has presented to the counseling office with only one predicament: to resolve her jealousy in the relationship with her younger partner of 32 years old whom she has been invoved with for 5 years. The client does not suffer from depression or anxiety and all the personality questionnaire and scales reveals a happy personality, a lively life outlook, an outgoing personality adored by her friends and family and also loved by her partner. She is also good-looking more in an old fashioned way, but always competing and comparing with other women friends or celebrities whom she values. Very competitive in her professional life, she was at the beginning a high achiever and she also had an excellent academic record. She knew from the beginning what professional route she should chose when he enrolled in parallel to the geography faculty and also to a masteral programme at the business and finance department in the Bucharest Economic Academy. Therefore, professionally things are going amazing for her, more than she ever planned. Regarding the personal life, she is in a loving and caring relationship with a person whom she feels may fulfill her marriage fantasies, but the wondeful picture of the perfect relationship is occasionally endangered by her jealousy.

Her boyfriend is also a professional working in a highly paid position on an oil exploitation multinational platform, he is good looking and fit, a bit younger looking than his real age and he was also a successful and eligible bachelor when they met. On few occasions, she has found some private messages on the phone, on the mail and also on his facebook account, which she presumably though they were from other women her boyfriend currently sees. These events, although not frequent, gave her the unease feeling that their relationship could be jeopardize and she became suspicious about her boyfriend loyalty and romantic behavior. At this stage, even though she is an attractive, young and fit person, she became questioning his looks and some old unsecurities have arised, digging into her vulnerabilities. Before these punctual events she has never seen a psychotherapist or a counselor and she surpassed successfully all the difficult situations, having a set of very efficient coping strategies.

Before starting any discussions going deeply into her particular problematic, Milena has stated that she is determined to have a resolution for her problem in less than 8 sessions and she insisted to pay in advance, this behavior proving the high motivation for solving the problem.

I felt compelled to start with a philosophical discussion about the roots of jealousy. And also to add some humourous flavoring to the discussion regarding the rather low possibility for her boyfriend to cheat of her since he is working almost 6 months a year at 5o meters under the water, on a maritime oil exploitation platform, with limited access to even digital communication. This was a helpful strategy which allowed for a total openness that allowed other irrational thoughts to break from the unconscious to the conscious mind.

We discussed the meaning of jealousy from a psychological perspective, also the ethics of jealousy and the moral judgment reasons. We also made a distinction between to be a jealous person or to have the disposition to feel jealous from time to time. And we came to the conclusion that jealousy in her case is not a character or personality trait of her, since she did not have the same behavior with the other boyfriends.

In the wide topic of moral ideals, jealousy and envy are often confused. Jealousy involves displeasure caused by the tought that the person one loves is being pleased by someone other than onself. One who loves another selfishly may actually seek to deprive her of pleasure that is caused by someone else. Jealousy involves wanting to keep the love of another and anger at the thought of losing it to someone else. Althought the thought of losing the love of someone to another may lead to fear, fear is not an essential component of jealousy. A jealous love is a possessive love, a desire to have and to hold. Jealousy is about possessiveness and the fear of losing the beloved object of possession. Counscious beliefs often become motives and are regarded by the agents as an acceptable explanation of his actions, because they are related to desires. Philosophers have not always distinguished clearly between beliefs that can make otherwise irrational actions rational (reasons) and beliefs that do explain them (motives). Further, they have not distinguished desire from neither of reasons or motives. The confusion between motives and reasons is one of the explanations for psychological egoism. Getting back to Aristotle’s thinking, jealousy is seen as both reasonable and belonging to reasonable men, while envy is base and belongs to the base, for the one makes himself get good things by jealousy, while the other does not allow his neighbour to have them through envy. Looking close to the jealousy in relation to love, I explored together with my client the perspective on love and jealousy of the French philosopher Henri-Frédéric Amiel: “Jealousy is a terrible thing. It resembles love, only it is precisely love’s contrary. Instead of wishing for the welfare of the object loved, it desires the dependence of that object upon itself, and its own triumph. Love is the forgetfulness of self; jealousy is the most passionate form of egotism, the glorification of a despotic, exacting, and vain ego, which can neither forget nor subordinate itself. The contrast is perfect.”

In another session, we also explored the possible causes of these jealousy feelings she experiences towards her boyfriend and she listed few reasons that seem reasonable:

1. the fact that she does not perceives herself as being very attractive, which conveys into a lot of insecurity that forges deep into her self-esteem;

2. the utter need of control over her boyfriend’s actions, feeling and thoughts;

3. the utter need of exclusivity;

Concluding, in the light of the issued discussed above, it seems that jealousy is an irrational feeling, therefore more reasonable human beings would not get so possessive on issues of romantic exclusivity. Remains to be seen at at extend we, as normal human beings are actually capable of being reasonable creatures.

Another argument supporting the idea of being reasonable when requiring exclusivity came from the evolutionary psychology and this is the controversial idea that we, as human beings with utter biological needs, are not primarily monogamous. In addition, we have also discussed the theories about socially imposed monogamy. Richard Alexander’s SIM theory states that there are strong associations between wealth and reproductive success in traditional societies from around the world. Wealthy, powerful males are able to control very large numbers of females. The elite males of the vast majority of the traditional urban societies of the world, including those of China, India, and Muslim and New World civilizations, often had hundreds and even thousands of concubines. The children from these relationships were legitimate. They could inherit property and they were not scorned by the public. Therefore, according to Richard Alexander, while in tribal or barbaric communities are promiscuous societies without marriage rituals and no fatherhood, in civilized countries there is a socially enforced universal monogamy. Kevin McDonald found also that the emphasis on monogamy was primarily responsible for the uniqueness of Western civilization and its subsequent achievements.

Having listed all these arguments, both philosophical and psychological, my client has been able to refine her thinking and conclude that there are no benefits whatsoever in keeping this eagle eye on the relationship and trying to penalize all her boyfriends faults.

Another common sense argument would be that there is no benefit in worrying and being tensed about the relationship and the only healthy attitude is to relax and be less and less concerned about looking for evidence that would eventually confirm an affair.

This attitude was finally saving, since she started being less focused on her boyfriend moves, she completely stopped cheching his facebook account or spying on his correspondence when he was in another room, did become completely uninterested about the phone calls he received suddenly and stopped creating scripts in her head. This also led to her boyfriend getting less tensed in the relationship and her affection and attention towards her increased. Her self-esteem and self-image also increased as a direct effect of getting more secure and more self-confident and also philosophically aware about the dangers of being jealous in a relationship.

Case study no. 9

Michael, a 39 years old mechanical engineer for a multinational automotive company came to the counseling office with a professional ethical dilemma involving his department manager’s work ethics that affects his own performance and worries him about his future in the company. Initially Michael was reluctant to address this issue to his boss’s superior, the general manager, in the hope that the behavior will disappear in time, but unfortunately things became even more complicated, jeopardizing the safety of the passengers.

The issue for which Michael came into the counseling was related solely to work, especially regarding some fake performance reports that he needed to fill in order to satisfy the middle management who is interested in getting a promotion, a bonus via the department performance. Those reports show some current performance parameters benchmarking with former performance indexes and also with competitor’s performance indexes. Usually they are also done by a neutral independent agency, but this year the management did not have the budget to hire a third party to make an independent assessment. However, the report covered a lot of indexes, from safety such as in the crash test results to electrical fitting equipment and oil consumption level.

Michael, his colleagues and his superiors have to sign a yearly anti-bribery document after they complete an online training on the subject. Until this moment things were correct from all viewpoints and he did not have to worry about his working ethics or particular dilemmatic situations which required deliberation. The current situation though was not linked to bribery issues, but to the consumer’s safety issues. Michael fears that becoming complice to this situation of handing to the upper management and to the authorities the fake report, he will not only betray his moral values he inherited from his parents, but he will also become liable for legal punishment, not only for losing his job. However, the situation became very dilemmatic since his current boss is also his friend (they became friends after he joined the company) and he feels he will also betray their friendship and he will lose him as a friend after he reported him to the upper management. Needless to say that before coming to the counsultation room he expressed all his worries to his boss, trying to convince him to take a more legal path both towards the management and the authorities. The fact that his boss did not respond to his worries with the same type of attitude has made him think that there may be an attiude that the management also has and for the first time it crossed his mind that maybe this is not only his department issue, but a more complex problem. Really problematic was also the fact that since his boss and also his friend did not work on the project, he does not carry the responsibility of the data included and the data remains the sole responsibility of him and his colleagues.

Another detail that complicates the situation is the fact that his boss relies heavily on this job, since he took a house mortgage, his pregnant wife does not work and he also has one daughter in hospital with medical complications.

Ethics in business implies making the right choices in situations where there is no obvious one right way and one must choose the best in the circumstances. There are many situations when managers are confronted with ethical dilemmas or “choices that create conflict between ethics and profits, or between their private gain and the public good”.Any decision where moral considerations are relevant can be considered an ethical dilemma, for example:

•A decision that requires a choice between rules

•A decision where there is no rule, precedent or example to follow

•A decision that morally requires two or more courses of action, which are in practice incompatible with each other.

•A decision that should be taken in one’s self-interest, but which appears to violate

a moral principle that you support. (Robinson, 2003)

Therefore, it is the imperative to act, combined with the uncertainty of which action to take, that causes an ethical dilemma. Michael’s wish was that the counselor would help him with his tough decision: either handing the fake report and losing his job and the friendship or reporting to the upper management the fact and still not knowing he could keep the job but definitely losing the friendship.

We only needed one session of counseling to list all the possible situations and also evaluate the emotional costs of each situation.

The possible alternatives were:

1. To hand the superior the fake report signed by him and other colleagues, jeopardizing his position and abiding the professional ethics code.

2. To report directly to the upper management the situation, hoping that his boss and friend will not be sacked and will get away with only a disciplinary sanction.

Few helpful questions were the following:

Why might people disagree over whether whistle-blowing is a positive thing to do?

Why would the management find it useful to survey employees on their reactions to unethical behavior, ask them to take online training and sign the documents ?

How might the values of fairness and loyalty come into conflict over a decision involving a workplace promotion, or a decision about whether to disclose sensitive documents to the public?

Can people’s preference for fairness or loyalty, by themselves, predict whistle-blowing? Why or why not?

How do the researchers suggest that people who value loyalty might be persuaded to support whistle-blowing activity?

In the business world, rarely companies have a whistle-blowing policy and this is why many authors have started to research the issues more carefully in the latest years. Barnett has defined three imperatives for what companies need to have a policy dealing with this topic:

1. the legal imperative, which deals with increasing protections for whistle-blowers;

2. the practical imperative, which deals with the inevitability of wrongdoing, the likeliness of increased whistle-blowing and the ineffectiveness of retaliation;

3. the ethical imperative, the most important one, which deals with improving the ethical climate, stresses the need for fairness, basically the ethical imperative proposes to create a just workplace, where employees are treated fairly.

After a week of deliberation, Michael came to the second and last session with his firm decision to report the above complicated situation to the upper management. He did not regret it, even if afterwards his direct manager was downgraded from his position to the one of a simple employee and he also got a penalty. Michael did not get a promotion either, but he was happy to have made a difference in his domain and most of all, to protect the consumer from unwanted and perhaps dangerous consequences of hiding the true parameters.

Discussion and conclusive remarks

Psychotherapy and philosophical counseling have many features in common, especially when we narrow down the focus of the comparative analysis to the cognitive-behavior/rational emotive behavior therapy and PC. Therefore, in this case, philosophical counselling may be regarded as an extension of philosophical consultancy which focuses on outcomes of an emotional or psychological nature. Many of the cases presented above have in common the existence of a moral dilemma or an inner conflict which once solved can also help the client to get rid of the initial cognitive confusion or cognitive dissonance that usually generate emotional discomfort.

As the above case studies show, many times in the real world, the scope of practice of philosophical counseling may overlap the scope of practice of psychotherapy, especially in the situations in which no diagnosis criteria for a mental disorder are met or when there are no symptoms blocking temporarily the normal functioning of a person. It is not a novelty that philosophical counselling can have profound psychological benefits, since the counsellors engage in dialogue about personal problems, predicaments and values trying to address the issues of concern in a professional and respectful manner. We may risk to make a bold statement, that philosophical progress can alleviate the sources of stress and anxiety more directly than courses of medication and maybe equally effective as the programmes of psychotherapy. For many people, having one or few sessions of philosophical counseling may be exactly what they need at a stage in their lives and we should not underestimate the power of the dialogue, especially when philosophical assumptions are made.

In the case studies presented, the problem of demarcation between sciences (psychology and philosophy) and approaches (psychotherapy and PC) arises again, since there is still a grey area of intersection between normal and pathological, between good and bad, between correct and incorrect, between moral and immoral. The conceptual and moral relativism could be the solution for a lot of predicaments in the real life and paraphrasing Lydia Amir, conflicts or moral dillemas should not always be solved but perhaps sometimes only treated with humour, acknowledging the therapeutic value of humour in the daily life. Stoicism, existentialism, Confucianism, epicureicism are only few of the philosophical traditions in which a predicament may be solved, but despite the complexity of approaches and variety of methods, what is important is the trust relationship between the counselor and the counselee and their common dedication for the Good in the Aristotelian tradition.

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