Sahanika Ratnayake (PhD candidate, Philosophy, University of Cambridge)
Riana Betzler (McDonnell Postdoctoral Fellow, Department of Philosophy/PNP Program, Washington University in St. Louis)
Evaluating thoughts, violating agency? Cognitive Behavioural Therapy and Client Agency
Cognitive Behavioural Therapy (CBT) is one of the, if not the, most widespread school of contemporary psychotherapy. CBT claims that the various maladaptive behaviours and negative affect diagnostic of mental illness, stems from certain patterns of distorted thoughts, referred to interchangeably as 'cognitive distortions', 'thought distortions' or 'negative automatic thoughts'. These thought distortions are a key area of intervention for CBT, whose therapeutic approach consists of teaching clients to identify, evaluate and replace distortions with alternate (non-distorted) thoughts. I will argue that the evaluation and replacement of distorted thoughts presents particular ethical challenges for clinicians, particularly with regard to client agency.
The talk is based on my work from a chapter on the Ethics of CBT, for the forthcoming OUP Handbook of Psychotherapy Ethics. A preprint is available on the Academia website.
Dr Riana Betzler
Empathy and Agency in the Clinical Encounter
Empathy is widely assumed to be an important part of clinical practice. The Association of American Medical Colleges, in its report on learning objectives for medical schools, states: ‘Physicians must be compassionate and empathetic in caring for their patients’ (AAMC, 1998, 4). The Cambridge-Calgary guide to the medical interview, which is widely used in UK medical training, likewise lists empathy as an objective. But recently, the value of empathy has come under significant scrutiny. One of the dark sides of empathy is that it can lead to burnout and empathic distress, where people feel too consumed and overwhelmed by others’ emotions to help them effectively. Avoiding burnout and empathic distress is crucially important, as it is associated with high suicide rates in physicians. The concept of agency has been curiously absent from this debate about burnout, emotional distress, and empathy—although many physicians who experience burnout report feelings of ‘inefficacy’. In this talk, I examine the relationship between empathy and agency in the clinical encounter. Might a sense of agency—a feeling of being able to intervene effectively in the situation—be protective against empathic distress? And what constitutes an effective intervention? Are some forms of empathy—especially those that involve careful attuned listening—conducive to creating senses of agency?