The concept of agency is a thorny issue in the practice and research of psychotherapy. The issue is usually debated along the lines with determinism on one end of the continuum and unconstrained free choice on the other end. Both extremes have their limitations. As clinicians, we are often caught somewhere in the middle where an uneasy tension exists between a desire to uphold the traditional values associated with agency, including choice, meaning, and responsibility, while simultaneously privileging scientific methodologies consistent with a deterministic paradigm. In clinical situations, we often borrow from both positions despite the incompatibility of these views.
Agency is typically understood as a capacity to act freely or outside a chain of causality. This capacity suggests that human behavior is not the necessary outcome of a determined cause. An individual is therefore able to act in a multitude of ways in response to a specific event. Accordingly, one’s particular action can be construed as meaningful because it could have been otherwise. It is only insofar as an individual has the capacity to choose how to behave that such an individual can be held accountable for his or her actions. The possibility that one could behave in a variety of ways lays the groundwork upon which our commonsense understandings of responsibility and morality rest.
In contrast, determinism presupposes the natural world (including human behavior) is ordered by causal relationships. An individual can, therefore, not be credited or blamed for his or her actions because such actions are the mere playing out of material or efficient causes. Reducing human behavior to purported causes, however, nullifies the meaningfulness of one’s actions because one could not have acted any other way. For example, the output of a computer is not taken as meaningful because it is determined by its programming. Construing the individual as necessarily following mechanical processes is consonant with a Newtonian worldview where all action can theoretically be predicted, controlled, and manipulated if one could identify all the relevant causes preceding the action. The benefit to upholding this viewpoint is it provides a sense of grounding for our knowledge claims as we seemingly progress towards greater and greater levels of epistemological certainty in our research endeavors.
The real danger of a deterministic framework is that it objectifies the human being, imagining the individual as a machine-like system of gears. Psychopathology is construed as broken or maladaptive pulleys and cogs in the machinery of the human being, and psychotherapy research aims at trying to isolate the specific mechanism associated with therapeutic action. From this perspective, the practice of psychotherapy is the process of identifying which lever to pull (intervention), when to pull that lever (frequency), and how hard (dose) in order to repair the broken system of gears and restore the individual to a more adaptive level of functioning.
The allure of a deterministic framework is its perceived sense of control, predictability, and certainty. The cost, however, is that it robs the patient of the ability to take responsibility for his or her own life because it presupposes the individual could not act otherwise. This is most disturbingly clear in the movement to identify evidence-supported treatments, which ostensibly argue that you can make a horse drink. That is, the patient is absolved of any responsibility in occasioning therapeutic change and is rendered a passive participant to some intervention imposed by the therapist that in itself effects change.
An alternative to seeking causal explanations for human behavior is to explore the motivation occasioned by the action. In the Zollikon Seminars, Heidegger argues that human action is grounded in our openness to being claimed by something. How we respond to or address the claim (e.g., hunger, sex, or companionship) reveals what is meaningful to us. Focusing on one’s motive restores a sense of responsibility back to the patient for the ways in which the patient engages with his or her life. To be responsible in this context means to be more responsive to the claims on one’s being. Accordingly, a patient’s psychological distress is not the result of a breakdown in his or her internal machinery, but rather is a constriction in how a patient can respond to claims made on his or her being. Such constrictions limit the patient’s ability to fully participate in certain aspects of his or her life. Therapy can therefore be seen as supporting patients to find their own way to address or respond to the claims made on their being and thereby find a more authentic way of carrying on in the world.
A concerning trend is underway in the field of psychology where the only privileged knowledge claims are derived from methodologies rooted in a deterministic framework. The practices of existential-humanistic therapies are not immune to this trend. As we embrace a more scientific mindset—one that carries with it the search for causal relationships—the more we bring a deterministic view to bear on our patients. This manner of thinking is evident in our clinical work when we quest after historical or traumatic origins to our patients’ current distresses. By searching for a root cause, we obscure the idiosyncratic meanings associated with how our patients have responded to certain life events. Without being thoughtful about the issue of agency, we can fall into conducting a type of therapy that Heidegger argues cannot result in a healthier human being, but only in a more polished object.
— Mark McKinley