What Is the Goal of Psychotherapy? | Psychology Today

Is there a general, final goal that psychotherapy should aim for? In a paper that raises this question, Thaddeus Metz considers three possible replies.

The first reply is that the goal of psychotherapy is subjective happiness. According to this view, psychotherapy’s goal is to make people feel subjectively well, without taking objective factors into account. Supporters of this view hold that the therapist’s end should be, for example, to diminish clients’ suffering, enhance clients’ sensations of happiness, increase their feelings of powerfulness, augment their tendency to judge their lives positively, or strengthen clients’ self-confidence, self-acceptance, and optimism.

Metz points at various authorities on psychotherapy, such as Winnicott and Jung, whose writings suggest that this is indeed their view of the proper goal of psychotherapy. This view also suits the fact that many people enter therapy because they are subjectively unhappy about various aspects of their lives. This view of psychotherapy also coheres well with the convention that therapists should respect their clients’ values.

However, Metz suggests that this view is problematic. Think, for example, of a heroin addict who has all the supply he could want, is happy about his addiction and doesn’t want to do anything else with his life. If the addict continues and even deepens his addiction through therapy it seems that the therapist may well be justified in feeling that the therapy wasn’t successful and didn’t achieve its goal.

The same would be true of narcissists who are pleased with their successful manipulations of others, of histrionics who manage to find others who give them the attention they want, or psychopaths who are content with their behaviors. The first reply seems problematic since it is plausible to hold that some therapies did not end successfully even if clients are, according to their own values, very pleased, and find or create the environment that cooperates with them.

Perhaps, then, we should opt for another reply: the proper aim of therapy is to enhance clients’ objective well-being, that is, to let clients have objectively good lives—lives that are good for clients not only because the clients see them as such. Again, Metz presents various authorities in the field, such as Erich Fromm and Abraham Maslow, who seem to have supported such a view on the final goal of psychotherapy. This reply has the advantage of not being vulnerable to the counterexamples above.

However, even if we bracket questions on how to identify objectively right values, Metz argues that the second reply, too, is vulnerable to some counterexamples. Consider a parent who decides to remain a few more years in an unhappy marriage because he or she knows that, in those particular circumstances, a divorce would be very harmful for the child. Metz holds that, in such a case, the therapy’s goal could well be to help the parent in carrying through this decision although it will not enhance but rather diminish the parent’s objective well-being.

Another example has to do with fighting for a just cause (e.g., joining the French resistance against the Nazis in World War II) although, through wounds, torture or death, this may well undermine the client’s objective well-being. Thus, supporting clients’ decisions to live in ways that may well diminish their objective well-being can sometimes be the goal of successful therapy. But this conflicts with the second reply to the question on the goal of psychotherapy.

The third reply that Metz examines is that the goal of psychotherapy is to enhance meaning in life. Metz explains meaning in life as having much to do with what it is appropriate to admire in the lives of others and oneself, what merits esteem, reverence and awe, or what one may justly take pride in.

Metz is generally supportive of this third view, which isn’t vulnerable to any of the counterexamples that undermined the previous two. A psychotherapist who holds the third view will not support the heroin addict’s decision to deepen his condition or the narcissist‘s efforts to manipulate unconfident others. But such a therapist will support the decision to remain some more years in the unfulfilling marriage and join the fight against the Nazis.

Metz seems to favor the third reply, and does not suggest any counterexamples to it. But perhaps some counterexamples could be found. Consider the painter Van Gogh or the poet Emily Dickinson. Their lives are considered meaningful thanks to their impressive artistic work. But this work, it seems, had much to do with their troubled lives. Van Gogh was distressed for significant parts of his life and suffered from delusions, psychotic episodes, and emotional breakdowns until he committed suicide at the age of 37. Dickinson was reluctant to meet people and, later, to even leave her bedroom. Many of her poems are about illness, dying, death, and unrealized love.

Suppose that therapy that would have helped these two artists to have subjectively happy or objectively good lives would have also led them not to create their art, that is, to have regular subjectively happy lives of objective well-being that are less or not meaningful. It intuitively seems to me that a psychotherapist would have done well to help Van Gogh and Dickinson to progress in this direction. However, this conflicts with the third reply.

Although Metz seems to favor the third reply, he is clear that the considerations he has presented are yet insufficient to substantiate the view that therapy has one single goal, and that that goal is to enhance life’s meaning. He hopes his arguments will facilitate further work on the topic. Moreover, he is open to the option of a pluralistic view that would take the general goal of psychotherapy to be a balanced combination of subjective happiness, objective well-being, and meaning in life. In some circumstances, one of these goals may need to be emphasized more than the others, and there may be some trade-offs between the three. More work on the proper end of psychotherapy, which also takes into account the hitherto relatively neglected option of meaning in life, is called for.