Hermeneutic psychotherapy: Collaborative, dialogical and epistemically just approach to psychosocial distress and mental disorders

Abstract

In this article, philosophical hermeneutics is used both as an epistemological framework and as a broader conceptual tool. We examine different philosophical interpretations of hermeneutics and point to possible bridging of traditional epistemological gaps in scientific and professional observation and understanding. The idea of a “creative circle of epistemology” is used, in which objectivism and constructivism are seen as complementary recursive dynamics of objectification and construction. We are critical of the current diagnostic system of mainstream psychiatry and question the assumed neutrality of therapists and the impact of this assumption on their relationships with clients. We contrast objectivist psychotherapy with constructivist approaches and warn against the hegemony of the dualistic Western psychotherapy culture and the imposed global standard of the DSM-5. We argue for the social construction of psychiatric diagnostic categories. We define the psychotherapeutic encounter as a communicative act and argue for hermeneutic, non-theory-centred approaches to psychotherapy. The article presents some selected philosophers, psychiatrists, and psychotherapists who have contributed to a shift from traditional objectivist to hermeneutic psychotherapy. We give an example of an interdisciplinary project to integrate objectivist and hermeneutic paradigms and quantitative and qualitative methods of consciousness research in the field of neurophenomenology. We emphasise the importance of understanding the client’s theory of change and address critical issues arising from the epistemology of testimony. We conclude that the hermeneutic approach to psychotherapy fulfills the criteria for a testimony in the epistemic sense, with established trust as a necessary condition. Finally, we return to the problematic consequences of using psychiatric diagnostic systems, pointing out the epistemic injustice and arguing for hermeneutic psychotherapy as an empowering, collaborative and dialogical approach. This approach addresses traditional epistemic injustice by recognizing clients as experts in their experiential worlds and as equal partners in the co-creation of new knowledge in the processes aimed at achieving agreed upon change.