Although the science of mind promises to deepen our understanding of the dynamics of behavior and theories of change across the foundational schools of psychotherapy, neither neuroscience nor theoretical formulations can tell us what particular actions will be therapeutic in the given clinical situation. This is why it is crucial to establish orienting perspectives, basic principles, and values that guide critical thinking and facilitate efforts to consider ideas and methods across the therapeutic traditions as we carry' out our practice.
In Chapter 1 I explore fundamental elements of pragmatic philosophy and propose a working formulation of clinical pragmatism. I review concerns and themes that William James and John Dewey pursued in developing their classical versions of pragmatism and show how their contributions provide points of reference in our efforts to establish a working formulation of clinical pragmatism in therapeutic practice. I outline basic values and principles that guide our efforts to consider divergent ideas and methods across the schools of thought, bridging scientific and humanistic domains of understanding. In doing so I emphasize the individuality of the person and subjectivity; collaboration, open-ended dialogue, and the co-creation of meaning; the dynamics of experiential learning; and the practical outcomes of ideas and methods over the course of help and care. As we will see, the principles of clinical pragmatism help us join the findings of neuroscience and theories of psychotherapy with the phenomenal realm of the individual in the concrete particularity' of the clinical situation.
Toward a Clinical Pragmatism
Owing to the fact that all experience is a process, no point of view can ever be the last one.
A diverse group of thinkers shaped the emergence of pragmatism at the end of the 19th century, creating what scholars have come to see as a distinctive American philosophy.1 William James and John Dewey, the principal architects of classical pragmatism, emphasize pluralist approaches to understanding and the practical outcomes of beliefs and ideas in everyday life. James traces the term to the Greek word of the same name, meaning “action,” from which our words “practice” and “practical” come (1907/1975, p. 28). Our theories should seek to serve human good, James argues, and the fundamental aim of knowledge ought to be concrete outcomes that help us negotiate the challenges of everyday living. The mind is ever active, experimenting, creating, adapting. In the most fundamental sense, as Louis Menand emphasizes, pragmatism is about “how we think, not what we think” (1997, p. xxvi). The approach is practical and instrumental, focused on immediate concerns, searching for what is useful, finding what works.
James, widely recognized as the leading American psychologist and philosopher at the turn of the 20th century, graduated from Harvard Medical School and became an academic celebrity following the publication of his classic work, The Principles of psychology, in 1890. Although he had hoped to establish psychology as a science of mind, he challenged the reductive materialism of the late 19th century', introducing versions of pluralism and pragmatism in his later writings on psychology and religion. Working as a phenomenologist, he sought to document the essence of the divine in The Varieties of Religions Experience, published in 1902, exploring the concrete realities of inner life, belief, and faith. In fashioning his pragmatic point of view, he emphasizes the plurality of factors that influence our experience and acknowledges the limits inherent in human understanding, urging us to approach concerns from multiple, independent perspectives, encompassing scientific and humanistic points of view.
He challenges any account of reality that would divorce it from the concrete particularities of actual experience. For James, the world of everyday' life is
“multitudinous beyond imagination, tangled, muddy, painful, and perplexed,” continually presenting us with ambiguities and complexities, confusions and contradictions; the universe, in his rendering, is better understood as a “multiverse” (1907/1975, pp. 17-18). Our paradigms of explanation offer but “a summary’ sketch, a picture of the world in abridgement, a foreshortened bird’s eye view” of the immediacy and particularity’ of real life (1909/1967, p. 8).
In advancing his pluralist point of view, accordingly, James rejects conceptions of a unitary’ world of experience set forth in philosophical systems of monism and notions of grand theory', based on what we take to be objective, absolute truths. His pragmatism challenged the grand, sweeping visions of Kant, Hegel, and Schopenhauer. No single paradigm can encompass the multiplicity’ and complexity of human life, he argued; we can never synthesize our experience into a unified whole. At best our theoretical formulations offer but fragmentary', provisional renderings of experience.
James challenges us to consider different ways of seeing, understanding, and acting as we approach our work. There is room for novelty', contingency', and engagement of divergent ideas. We find equally valid points of view that inevitably contradict one another yet lead to insight, understanding, and action. Differing lines of inquiry' may' converge, providing a basis for belief—for our best guess as to the “truth” of the matter—but we are willing to accept the limits of our understanding, ever aware of the dangers of presuming to know too much. According to his notion of fallibilism, we regard uncertainty' and contingency' as conditions of knowledge. “The fundamental fact about experience is that it is a process of change... Owing to the fact that all experience is a process,” he writes, “no point of view can ever be the last one” (1904/1975, p. 220-221).
For James, our ideas are tools for thinking and problem-solving. Theories, he explains, are “instruments, not answers to enigmas, in which we can rest. We don’t lie back on them, we move forward... Pragmatism unstiffens all our theories, limbers them up and sets each one at work” (1907/1946, p. 53). In the pragmatic tradition, as Menand explains, an idea “has no greater metaphysical status than, say, a fork. When your fork proves inadequate to the task of eating soup, it makes little sense to argue about whether there is something inherent in the nature of forks or the something inherent in the nature of soup that accounts for the failure. You just reach for a spoon” (Menand, 2001, p. 361). Thinkers did not believe that ideas are ‘“out there’ waiting to be discovered, but are tools—like forks and knives and microchips—that people devise to cope with the world in which they find themselves” (2001, xi). The question is what we can do with any particular idea—what concrete difference it makes in the particular and unreproducible circumstances of everyday living.
James was an empiricist before he became a pragmatist, as Dewey observes, and he came to think of pragmatism as empiricism carried to its conclusion (1925/1998, p. 7). The pragmatist rejects “abstraction,” “absolutes,” “fixed principles,” and “closed systems,” he writes, searching for “fact,” “concreteness,” “action,” and “adequacy” in light of the practical tasks of the particular project, (James, 1907/1946, pp. 43-81). We can think of pragmatism as an
Toward a Clinical Pragmatism 13 open system, embracing the experience of ambiguity, complexity, and uncertainty, allowing the practitioner to join the unexpected and the odd. Richard Sennett characterizes James as a philosopher of “street smarts,” explaining: “the maker follows a crooked path from the possible to the doable” (2018, p 9). In the most fundamental sense James believes that we should approach experience as “experiments in adapting to need,” cautioning us not to equate the pragmatic with systematization, speed, or efficiency, ever attuned to the needs, possibilities, and constraints of the particular situation.
Action and experience, James shows in his accounts of pragmatism, serve as the final test of beliefs and ideas. In his view, truth happens to an idea: it is made real, becomes true, through the concrete particulars of experience. In following the pragmatic method, he writes, “You must bring out of each word its practical cash value, set it at work within the stream of your experience. It appears less a solution, then, than as a program for more work, and more particularly as an indication of the ways in which existing realities may be changed” (1907/1946, p. 53). The strength of the pragmatic approach, James emphasizes, lies not in beliefs or ideas but in the outcomes of experience.
James returns to the practical consequences of ideas in elaborating his pragmatic conceptions of truth: “The true is the name of whatever proves itself to be good in the way of belief and good, too, for definite, assignable reasons” (James 1907/1946, p. 76). If we take an idea to be tine, he asks, “what concrete difference will its being true make in any one’s actual life?... What, in short, is the truth’s cash value in experiential terms?” (James, 1907/1946, p. 200). For James, the question is not “Is it true?” but rather “How would our lives be better if we were to believe it?” What is the use of a truth in any given situation?
Dewey, a public intellectual, political activist, and social reformer, drew on James’ work in developing his accounts of pragmatism that would influence social, political, and cultural life through the 20th century. His scholarly work encompassed the disciplines of psychology and philosophy, but he is best known for his work in the field of education, where he is regarded as one of the most influential practitioners of the Socratic tradition. He joined the faculty of the University of Chicago in 1894, where he established the Laboratory School, an experiment in progressive education that continues to this day to emphasize the importance of active learning and engagement of practical concerns in everyday life. He worked closely with Jane Addams, participating in the programs of Hull House, and his writings informed progressive social, political, and industrial practices in the early 20th century. He brought a moral energy to his accounts of war and peace, race relations, women’s suffrage, and economic alienation. His focus on the social surround and his faith in experimentation and action shaped distinctive visions of the emerging social work profession (Borden, 2013; Orcutt, 1990; Rockefeller, 1991).
In fashioning his pragmatism Dewey seeks to bridge the gap between thought and action, focusing on the particular contexts of experience and the ways in which we make use of intelligence to address real problems in everyday life. Action should be intelligent and reflective, guided by curiosity and openminded, flexible, deliberative habits of thinking (1925/1998, p. 12). Like James, Dewey embraces pluralism, believing that multiple lines of inquiry strengthen understanding and action, and he centers on the practical consequences of beliefs and ideas in efforts to address “the active urgency of concrete situations” (1931, p. 219).
In elaborating his version of pragmatism, however, Dewey comes to emphasize the crucial role of collaborative interaction and experiential learning in our efforts to generate understanding and negotiate problems in living (Dewey, 1897/1998). He argues that philosophers have made a false distinction between knowing and doing, and he introduces the principle of learning by doing. In creating the Laboratory School he embraced the pedagogical functions of real activity in everyday life. Children would tend a garden, care for animals, cook, and weave cloth. He thinks of knowing and doing as indivisible features of the same process, active and muscular, fundamentally concerned with learning, adaptation, and instrumental outcomes. Our task is to raise questions, to figure things out, to act, to learn from experience. We learn by doing; we call upon the knowledge we have gained as we proceed with our work; the outcomes we generate continue to deepen and enlarge understanding, which we bring to bear in the next experience.
Experiential learning is an ongoing, self-corrective process; we clarify and revise our conceptions of knowledge in light of changing circumstance and outcomes. When we limit conceptions of knowledge to textbooks, Dewey argues, we deprive it from the authority of our lived experience and compromise our relations with the world. Knowledge is, in essence, “an instrument or organ of successful action” (Menand, 1997, p. xxiv).
He emphasizes the critical importance of context in his formulations of learning and understanding, emphasizing the dynamics of process and change: “We are not explicitly aware of the role of context just because our even' utterance is so saturated with it that it forms the significance of what we say and hear” (Dewey, 1931, p. 204). We can think of “experience,” Dewey writes, as “a process of undergoing: a process of standing something... Our undergoings are experiments in varying the course of events; our active tryings are trials and tests of ourselves” (1917/1998, p. 49).