Monday, August 5, 2013

Intentional Action, Empathy, and Psychotherapy

Intentionality and its observed manifestation as intentional action are central concepts in psychology. In the realms of cognitive neuroscience, psychoanalysis, the practices of cognitive and behavior therapy, and various humanistic approaches to psychology, everybody talks about intentionality but often without clarity or agreement on meaning. This is a common problem in psychology.

The formulation of Intentional Action used in Descriptive Psychology is serviceable across other disciplines and is intended to be part of the general conceptual framework of psychology.  It is particularly useful when comparing and coordinating different theories in the behavioral sciences. The existing theories pay attention to certain aspects or parameters of Intentional Action while underplaying or ignoring others. 

Intentional Action is the general case of purposeful, goal directed activity and is a common feature of all behavior. 


The varieties of Intentional Action specific to Persons are Cognizant Action and Deliberate Action. In Cognizant Action people know they are engaged in some sort of an Intentional Action.  (This will be represented by the small diamond above the Knows parameter). In Deliberate Action people both know what they are doing and are choosing to do so from a set of known options.  (This will be represented by multiple small diamonds above the Knows parameter). Cognizant Action highlights the person's "conscious awareness". Deliberate Action highlights the person's choices in the circumstances. Not all a person does involves cognizance and deliberation, but the ability to behave cognizantly and deliberately is fundamental to the Paradigm Case of Personhood. 

Here are the parameters of Behavior as Intentional Action. Each parameter is a conceptually separate distinction required for a full appreciation of an Intentional Action. For some descriptions of behavior, we might not need the full set. For some purposes, we might only be interested in describing a behavior's performance, or what the behavior achieved, or the stimulus and response, or the behavior's significance, and so on. Here's the full set, unless you can think of more.  



Here's a way to represent Cognizant Action. The representational convention used in Descriptive Psychology is for the Diamond to be a shorthand way to represent an Intentional Action. 



The question marks on the small diamond in the Knows parameter are to remind us of the "more or less" and uncertainty features of awareness. 

And here's a way to represent Deliberate Action:


IA=Intentional Action; I=Identity; W=Wants; K=Knows; KH=Knows How; P=Performance; A=Achievement; PC=Personal Characteristic; S=Significance.   Adapted with permission from Joe Jeffrey, Ph.D

The larger blue diamond notations are a shorthand that represent an Intentional Action without commitment to the Identity of the actor, the Significance of the act, and the Personal Characteristics that the act reflects. The little blue diamonds represent the person's Intentional Action options given the circumstances. In a Deliberate Action, the actor is both Cognizant of what he is doing (IA in K) and Chooses to do it (IA in W).

The full case of Intentional Action has the conceptually separable parameters of Identity, Wants, Knows, Knows How, Performance, Achievement, Significance, and Personal Characteristic.

The parameters are pre-empirical.   They refer to distinctions that locate the "empirical data" but are not themselves a discovery in nature. They are akin to the "X" and "Y" axis of plane geometry. The parameters provide the framework for organizing the empirical data. Finding the specific content of the parameters requires observation. The parameters remind us what to look for.

The remarks that follow concern each of the parameters and focus on their use in maintaining an empathic relationship during psychotherapy. They could just as well serve as reminders for understanding any other activity that requires an adequate map of behavior. 

Wants. Perhaps the most general answer to the question of why someone does something is answered in reference to some state of affairs that the person wants to bring about. Wants refer to the motivations or values that are involved in how people appraise their opportunities and dilemmas given what they see as their options in any given circumstance.  

Although the paradigm case of human behavior involves a cognizant person knowing their values and being able to deliberate, i.e., choose whether or not to act on the values, it is also clear that a person can act on motives and values that are not consciously or accurately recognized (Schwartz, 1984). We would be blind if we didn't see that some of our actions involve motives we are reluctant to own (Kris, 1982). 

Distortions in reality may be a part of transforming the intolerable or unthinkable into the more manageable. A maxim: what a person acts on successfully tends to become real for her. This is the domain of psychological defense and the dynamic unconscious, a traditional focus of psychoanalytic inquiry. 

Motivations and opportunities that create reluctance or unconscious defense require empathic tact to be explored.  The analytic attitude of nonjudgmental empathy that establishes the “conditions of safety” (Schafer,1983) are traditionally employed. The therapeutic relationship has to be safe.  Safety comes first. Analysis second.

Some reminders:  Actors and their observers might be accurate in knowing what “wants” are in play or they might be mistaken.  Even when known, people might not be in a position to articulate what they want. Clarity and accuracy have a “more or less” quality and this will hold for the content of all the parameters. It is important to keep this in mind since insistence when attributing motivation, especially when there is disagreement or discomfort, tends to disrupt the safety of a relationship and may foreclose on exploring and appreciating the complexity of the situation. There is often disagreement, and people are sometimes reluctant to acknowledge what they know to be the case. 

What a person wants is often simple, clear and easy to say. Other times, it is complicated, multiply determined, conflicted, murky, ambiguous or “unspeakable”, especially in the dilemmas that bring people to therapy.  People often sense their complexity even if they are not able or ready to talk about it, and this is frequently the case when they feel they are not understood. They may have reason to expect misunderstanding. 

Telling someone the reasons you think they act as they do is frequently met with the rejoinder, “but it’s more than that”, since it often is.  And some people take offense when told what they are feeling especially if it intrudes into their privacy.

Ossorio (2013) indicated that there are four classifications of intrinsic or fundamental motivation:  hedonic, prudent, aesthetic, and ethical.  There may be more. They intrinsically provide reason enough to do something. They stand on their own. These reasons for action can conflict, operate in a complementary or independent fashion, and so on. If you have two or more of these reasons to do something, you have more reason than if you only had one.  Any general theory of the human behavior that does not adequately address these motivations will be defective.  

Hedonics refers to pleasure, prudence to self-interest, aesthetics to values of truth, rigor, objectivity, beauty, closure or fit, and ethics with concerns of right and wrong, of fairness and justice.  Hedonic and prudent motivations can operate consciously, pre-consciously or unconsciously.  Aesthetic and ethical motivations require the actor is eligible to choose or refrain from an action, to potentially deliberate about a desirable course to follow.  In the service of being able to choose, a person’s aesthetic and ethical motives are often consciously available (Schwartz, 1984).  I can’t help it that it feels good, or that I see it as in my self-interest, but I can consciously attempt to refrain from seeking pleasure or self-interest on aesthetic and/or ethical grounds.

Another point. Not doing a pleasurable act because of utter coercion, overwhelming guilt, or unconscious taboo may appear to be an ethical performance, but if the actor had no choice, their performance was not one of renouncing pleasure or self-interest but of forced constraint. A person can appear to do “the right thing" because he had no choice.  It might be a mistake to point this out. Without enough shared history, it is hard to judge how a critical observation will be tolerated. This is a key feature of therapeutic tact and why careful listening comes first and may take considerable time before problematic motivations and constraints are interpreted. 

A person's observable performance and their psychological state are conceptually separate. This is why they involve distinct sets of parameters. Identical performances may follow from very different motives or appraisals. 

What a person wants is often not a simple matter. An empathic appreciation is respectful of this. It can be the case that what looks intended is instead accidental or coerced, and in those situations the empathic response acknowledges the absence of motive. Still, while we tend to be skeptical of the claim that “the devil made me do it”, it pays to be sensitive to why a person makes such a claim. The empathic therapist waits until it is safe enough to suggest otherwise.

Knows.  Along with the basic question of why a person does something comes the question of why they are doing it now. The answer will always be some version of their recognition, correct or not, that the current circumstance provides an opportunity to do something they now want to do.  Action requires a correspondence between motive and opportunity.

The Knows parameter contains the range of concepts, facts, and distinctions a person has available and employs in a given situation. Knowledge, a personal characteristic, is acquired by observation and thought. Knowledge is relevant to the extent that it involves recognitions that can be acted on, differences that make a difference in behavior. As a rule of thumb, people tend to notice what they value, including what they want to avoid. People can also act on distinctions and not be cognizant of making those distinctions, just as people might not recognize an opportunity when it stares them in the face.

A person might be wrong about what they know and this will have consequences especially if they believe they are competent or eligible in ways they are not.  Knowledge can be clear or unclear, certain or uncertain, serviceable or unserviceable. Knowledge relevant to behavior is evaluated on how effectively the known distinctions can be employed, and this necessarily has a “more or less” quality to it.

The Knows parameter includes the potential awareness or cognizance of one’s own actions and potential choices.  Cognizant recognition of choice is an aspect of Deliberate Action, and is a conceptual requirement for an ethical perspective to be employed or considered.  The recognition of choice or option, including the potential to renounce a choice, serves as one of the ordinary standards for accountability.  Negligence occurs in situations where community standards hold that an ethical dilemma ought to be recognized but isn’t. Significant negligence of ethical consideration with attendant action (or inaction) is central to most formulations of criminality and tort (see, e.g., Prosser, 1941).

The eligibility for certain recognitions and choices has a learning history.  The empathic actor knows this about the other.  Given where and how someone has grown up, what can they be expected to know?  What we expect people to know will be influenced both by shared cultural expectations and by an appreciation of the idiosyncratic.  Even though membership in a culture involves knowing standard choice principles, we should be careful what we presume.  Similarly, understanding that a person might have an underdeveloped or diminished capacity is also part of the empathic observer’s knowledge of the other. If a situation would ordinarily call for a person to do something, if they lack the relevant knowledge (or values or competence), they will do something else instead. A person can only act on the values, concepts and skills they have available unless their performance is coerced (or they get lucky). 

Know-How. An action is always an expression of a particular skill, competence, or know-how if it is something a person can expect to perform non-accidently.  Competence is acquired through having a prior capacity and the appropriate practice and experience.  Not everyone has the needed prior capacity, practice and experience to develop the competencies a community might take for granted. And some people are more talented than others in acquiring or exceeding the expected skills.  Their performance can look like magic (Putman, 2010).

Having the relevant know-how means that a person can perform an action in a variety of ways with the expected outcome that the actor achieves what is intended. Think of driving a car or dancing with a friend or throwing a fastball high inside at ninety-five miles an hour. Drivers, dancers and professional pitchers have their expected know-how acquired by having the prior capacity and sufficient practice and experience. Behavior going wrong calls for an explanation once adequate competence has been achieved; behavior going right requires no explanation.  Bobby’s walking toward the couch and sitting down requires no explanation, but his repeated stumbling does.

Akin to what some call procedural memory, once competence is acquired, people are rarely self-conscious of each move necessary in the performance of a task. We tend to be more self-conscious when we believe, correctly or not, that we lack the competence to act in the manner a situation demands. The absence of self-recognized competence may turn what would be opportunity into threat, manageable hazard into feared danger.  It is unsurprising when worry, anxiety or panic are features of a situation when a person believes they lack the relevant competence to handle a problematic or even desired state of affairs.  This is why the Know-How parameter is of special relevance to what a person can tolerate (Schwartz 2002).

Defensively, we are only somewhat able to tolerate how we are seen or what we consciously know. Defensive styles represent personal characteristics, sometimes unconscious, that limit or shelter a person’s awareness to what they can tolerate at any given time. Defenses may be automatically applied even when a person has outgrown their serviceability. The empathic clinician keeps this in mind.  I think that a good deal of successful “interpretations of defense” are a result of an empathic therapist recognizing that the client can now tolerate what in the past gave them good reason to remain defensively unaware. What was good to avoid in infancy and childhood may no longer be intolerable, even if the person hasn't recognized this yet. Successful confrontation that a person can do more than they claim follows a careful gathering of evidence. 

Psychotherapy is often an exercise in acquiring the competence to sit still and experiment with thought and emotional response.  Empathy is a major aspect of making it safe enough to sit still and practice confronting what might otherwise be unthinkable or intolerable. Patience and practice are required. This is the love in the work.

Significance.  Significance is what a person is also doing by doing an act in question. It is, so to speak, what they are up to. Behavior is organized by its significance and implemented by the particular practices a person engages in. 



Empathically, I am aware that what a person’s behavior signifies to me may be different from what it means to them.  I also keep in mind that they may not appreciate what I see as the significance of their behavior, regardless of how compelling the evidence. I don’t have a pipeline to the truth.  I to Thou involves being clear that mystery and uncertainty remains.

In appreciating and acknowledging the significance of an action, especially when that acknowledgment involves interpretation, all the dilemmas of attempting to make the unconscious conscious, all of the problems of attempting to get someone in touch with what they are reluctant to see, come into play.  Therapeutically, confronting someone while they are defensive requires tact.  Tact requires empathy; it requires an empathic appreciation that a person at any given time can tolerate only so much. People have to cope with how they are seen and this comes into play during psychotherapy. Being seen in ways that a person might be reluctant to acknowledge is akin to the vulnerability that attends intimacy.  One’s lovers, close friends, and therapists may be given permission to test the boundaries of self-understanding, but even when insight comes from a person’s closest confidants, it still might be intolerable.

Here's a story that I tell my students.

A baseball player, a pitcher, regularly throws a fastball high inside at ninety-five miles an hour. He mixes this up with a nasty curveball and is known for the occasional wild pitch.  He has hit more than one batter in the helmet. Those that know him outside the game have seen him tease his wife and children beyond what makes his audience comfortable.  This teasing clearly upsets his children. He doesn’t seem to notice their unhappiness. With his wife and kids, he thinks he is just being playful. You might think he is sadistic and mean and enjoys making people uncomfortable and helpless.  This is why his preferred pitch to a batter he has previously hit is to throw fast, high and very inside.

He had a severe and strict moralistic upbringing and now looks at himself from a perspective of moral superiority. Guilt is very hard for him to acknowledge or bear. It is reasonable to assume that he’d feel guilty and ashamed if he knew how he looks but defensively he is not going to see himself in that light. 

Instead, he sees himself as a talented pitcher with a clear appreciation of the strike zone and of the pitches hardest for his opponent to hit.  He views himself as a tough-minded sportsman, hypercompetitive but fair, and accepts only that the significance of his pitches is to strike out the batter, end the inning and win the game.  If he was asked if these pitches are also how he’ll get his contract renewed, feel the admiration of the crowd, and live the life of the ball player, he could probably acknowledge all of that.  But beyond what he can acknowledge about the significance of his pitches, he may also use his style of throw to achieve some sort of sadistic pleasure. It could be that the way he felt helpless and punished as a child is being worked out unconsciously in his manner of play both on the field and off.  He cuts that high inside corner on the wrong side more often than his consummate skill should allow.  His satisfaction at making the batter wince is too much for him to resist.  Since he is unaware of his sadism, he doesn’t control it well. In looking over his life a through-line of sadism emerges implemented by his treatment of family and opposing players. An empathic interpretation of his sadism would require considerable tact and care. It would be resisted. 

Identity. Every action is someone’s action and that someone has a name and a title or some sort of individual status marker.  The Identity parameter specifies that. A person’s name or title used out loud or silently in social interaction is a significant status marker and may frame how one person appreciates the context and meaning of the other’s action. Addressing or responding to someone by their nickname has different implications than responding to them as Professor or Doctor or Ms. or boy or "hey you".

How a person feels understood, and what they will tolerate from another’s representation of them may significantly reflect the names that are used. Empathy involves being held in mind in a fashion that may be reflected in the means of address. And, of course, people have various responses to their names being forgotten and may experience such a forgetting as a breach in empathy.

Personal Characteristics.  People’s behaviors are an expression of their personal characteristics as they show their colors, true or otherwise.  People vary in their Powers and Dispositions. A person’s behavior in their world follows from their psychological state and status, their values, knowledge and skills, and their traits, attitudes, interests and styles. 

People may want their actions judged as “in character” or not. Problematic or laudable behavior labeled as “out of character” does not create the conditions for degradation or accreditation that these same actions do if they are recognized as “in character” (Ossorio, 2005; Schwartz, 1979).  We offer praise or give people breaks in ways that depend on this distinction.  It gives them and us wiggle room.

Performance and Achievement.  A performance is an episode of behavior in real time with a beginning and an end. It can be interrupted and it achieves some difference.  

We do not directly observe what a person wants, knows, and knows how to do in the sense of being inside their head; instead, we observe their performance. We watch and participate in their social practices. But whatever their behavioral performance, if it is an aspect of an Intentional Action, it achieves some difference in the world, be it trivial or profound.



Behavior as "Intentional Action" is one of the basic interdependent components of the more general "Person Concept". The others are Individual Person, Language, World and Community. Some of this has been discussed in these writing and the rest will follow.  A full formulation can be found in Peter Ossorio's The Behavior of Persons.


Earlier, I posted on a method for regaining empathy and the problem of finding a common understanding of empathy.


Adapted from my “The Parameters of Empathy:  Core Considerations for Psychotherapy and Supervision”, The Advances in Descriptive Psychology, Vol. 10, 2013

Thanks to Joe Jeffrey for his powerpoint adapted here "Intentional and Deliberate Action".

This posting is an introduction to Descriptive Psychology. I have posted another more elaborate introduction:  A Short Course In Descriptive Psychology.
           
The Boston Descriptive Psychology Study Group has a FACEBOOK  site that contains a repository of basic Descriptive Psychology resources and current articles of interest. You are invited to join in. 

11 comments:

  1. Good stuff here. It's a point of view that is not a familiar one, and requires the reader to stretch a bit and be open to new things. But it's worth the effort.

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  2. The story of the baseball player that you highlight in your entry reminds me of a book but I am currently reading ("The Drama of the Gifted Child" by Alice Miller). Essentially, she addresses the reasons why many of us become therapists. She does this by highlighting "our" childhood story. She gently but clearly explains how surviving an abusive -this term is used broadly- childhood affects the rest of our lives. She also goes on to explain how not understanding ourselves and lacking insight into our motivation for engaging everyone and everything can manifest itself in therapy, whether we are the therapist or the client.

    Your entry compliments this book very well. I appreciate the chance to explore this further.

    J. Garcia

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  3. Really interesting article examining the complexities of human motivation and behavior. I can imagine that if someone is told why they acted in a particular way he or she might feel that there is more to that than the given explanation. I am curious about specific techniques/questions therapist may utilize to demonstrate/promote empathetic action (in addition to those we know enhance therapeutic interactions such as being present, unconditional positive regard, hope, etc). MK

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    1. I have a bit to say about this in the April entry "Regaining Empathy."

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  4. “We need to know if we are arguing about the same thing or trying to understand something else. Without shared concepts, we are clueless.”

    This statement resonates with how I conceptualized the theme of this article. Without shared concepts and understanding how and what motivates human cognition and behavior than what are we studying. I appreciate the acknowledgment of this so little talked about notion. I look forward to reading more of your blog!

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  5. What qualities define us? More specifically, what qualities make up the essence of being a psychotherapist? This entry validated my thoughts that psychoanalytic methods are designed to establish conditions that are safe enough for clients to say what is on their mind without having to feel restricted in their outward expression of them. Such methods become a skill that really does require tact.

    Dr. Schwartz states that "Therapeutically, confronting someone while they are defensive requires tact. Tact requires empathy; it requires an empathic appreciation that a person at any given time can tolerate only so much. People have to cope with how they are seen and this comes into play during psychotherapy". Empathy goes beyond being present with a client at that moment it time. It also encompasses the idea that through empathy, the therapist is creating an atmosphere "safe enough" to allow the client to confront what at one point they thought of as being "intolerable". Again, it circles back to being tactful and knowing when to help the client overcome what once were barriers to them.

    ~G.Cruz

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  6. Very interesting article discussing behaviors. A theme I noticed throughout the post relates to developing a relationship with the client and learning his/her possible unconscious expressions. In the section about wants, the empathic therapist is suggested to wait "until it is safe enough to suggest otherwise." This thought is expressed again when discussing defense mechanisms and the appropriate time to confront a client.

    Although patiently waiting and truly understanding the client is ideal, how can these concepts be applied to short-term settings, such as a hospital? Is it possible to truly understand an individual without long-term psychotherapy?

    -Tara G.

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    1. Like most everything else we deal with clinically, understanding is "more or less". Less time, a smaller sample of life to observer and share. Some of the value of structured interviews and assessment tools are that they potentially provide a way to focus inquiry when there is not all the time in the world. That's why they are of considerable use with inpatients, short term clients and non volunteers.

      It takes time to know even a small portion of another person's general awareness let alone what they are reluctant to share or unaware of.

      But as you point out, it has to be safe enough to come out of hiding.

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  7. “Pathology in the broadest sense concerns restrictions in a person's ability to effectively and knowingly choose… The point of awareness is the possibility of making better choices.”
    This resonates with me as I have believed for some time that therapy can be a profound tool to reduce the factors (inward and outward) that cause an individual suffering and anything that may get in the way of a person’s ability to experience his or her own life in a meaningful way. I’ve come to recognize and accept that my own understanding of what constitutes health and pathology is greatly informed by my own context which places high value on individual choice, a priority which might not be shared universally to the same degree.
    In this regard, I am wondering how analysis with Americans is different than analysis with populations outside the US. Specifically in terms of its efficacy and reception and also differences in implementation.
    MK

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    1. MK, I think you pose a very interesting question regarding how receptive individuals outside the US are in regards to psychotherapy. This made me think of how analysis is a very western concept where individuals are viewed as agents of their own change. They are expected to be active participants in concocting their own remedy and really teaching the analyst what it is that helps them best. However, in several other cultures (i.e. many Asian and Latino cultures), the clients are more accepting of what the therapist says and in a way are expecting a remedy and rarely challenge what their therapist says. With the North American culture, the analyst expects the analysand to generate a way forward and the job of the therapist is to stay in the tension and support the client. However, this might be different for other clients who engage in therapy expecting an answer.
      ~ G. Cruz

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  8. Most of the time I don’t make comments on websites, but I'd like to say that this article really forced me to do so. Really nice post!
    Wilmette Psychotherapy

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