Phrenology and physiognomy

Domain XVI · Historical, discredited & harmful · Franz Joseph Gall, Johann Gaspar Spurzheim · 1796 · Vienna

What it is

This guide concerns two discredited doctrines, not a therapy. It is written for the psychotherapist's own work: understanding the history, recognising the reasoning when it turns up today, and helping clients who are interested in it, who have been judged by it, or whose family history touches it.…

Who practises it, and how they are trained or regulated

• Repair and advocacy. Goal: address injuries from discrimination or misclassification, support complaints or challenges the client chooses to make, and deal with any colleague or institution that uses appearance-based inference. Follow up as needed; set the number of sessions by clinical need.

Evidence status, as the guide reports it

• Psychoeducation and meaning-making. Goal: give the evidence in proportion, and work with what the belief or the experience of being judged has meant to the client. Move on when the client can hold the facts without feeling shamed and has a supported alternative for any decision they had been basing…

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?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• 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

• The clinician's own discomfort leading to minimising. It is working when the client feels heard and has agency.
• Withdrawal, giving things away, statements of being a burden. It is working when the plan is agreed and the client uses it.
• Exhaustion and re-traumatisation during long processes. It is working when the client feels effective whatever the outcome.
• Requests for cosmetic procedures to "fix character", and suicidal thinking. It is working when distress and checking reduce.
• Financial investment in courses or kits, and conflict with family. It is working when the client makes an informed decision.

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.