Clinical philosophy (Koestenbaum)

Domain XV · Nature, philosophy, social & rites of passage · Peter Koestenbaum · 1978

What it is

What it is. Koestenbaum, a philosopher who taught at San Jose State University for thirty-four years, called his approach "clinical philosophy". He used it to give psychotherapy the philosophical foundations he argued it lacked: the book opens with "The Need for Philosophy in Psychotherapy". It is…

Format

• Book One, "A Model of Being". Philosophy as phenomenology and theory of knowledge. The phenomenological model of being. Reflection and the mind-body polarity. Transcendental consciousness. The individual-universal polarity. A "bipolar personality theory". Three "philosophic facts": (1) mysticism…
• Book Two, "Revelations of Anxiety". First the description, provocation, diagnosis and value of anxiety. Then six revelations, most paired with a "coping" chapter: birth; evil; the nihilism-ground issue; freedom (with "In Defense of Freedom"); death and individuality; guilt.

Who practises it, and how they are trained or regulated

• Evidence status: no controlled evaluation of clinical philosophy is known. In this guide its ideas are used by a licensed psychotherapist within therapy. It is never offered as a stand-alone treatment for a mental disorder, and non-clinical philosophical practitioners who use it refer clinical problems on (section 4.24). Related guides: British existential-phenomenological therapy (III 075, via pointer 052),…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Abreaction that overwhelms, retraumatisation, and dependency.
• Role drift into consulting, and employer pressure. Do not reproduce Koestenbaum's diagrams or tools.
• Clients agreeing out of deference to the "philosopher". Check understanding by asking them to explain it back.
• Dependence on the therapist as the "philosopher". It is working when the client uses the stance independently.
• Insight with no change; tighten the link to action. Avoid exercise or diet targets; route to qualified professionals.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.