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Are Therapeutic Affirmation and Validation Morally Good?

A Personal Perspective: Therapists should value efficacy more than cheerleading.

Nietzsche, in The Genealogy of Morals, taught us that “morally good” originally meant anything that the elite do, while “morally bad” referred to anything that commoners do. History teaches us that as long as there have been kings and oligarchs, a circular argument has scaffolded their power and wealth. This argument says that the gods want them to be powerful and wealthy, and the proof is that they are powerful and wealthy. Divine approval also signals that anything they do is morally good.

It was only much later that morality was described as a set of principles, such as the Ten Commandments or Kant’s categorical imperatives. But it is also well known that such principles are for commoners; the elite always and everywhere know that they are allowed to do whatever they feel like doing. Indeed, the linguistic origin of privilege is a “private law” or special treatment, like a parent who is privileged to check a child’s diaper which, done by a stranger, would be a battery (offensive touching). The person’s status determines what they can do and remain on the right side of righteousness.

The famous historians, Will and Ariel Durant, wrote in The Lessons of History, “Nothing is clearer in history than the adoption by successful rebels of the methods they were accustomed to condemn in the forces they deposed.” In other words, power corrupts, but one reason it corrupts is that the autocratic selfishness associated with power is a function of status, not of principles. The rebel, now with power, thinks something like, “I am good; whatever I do is good.” Tolstoy put it like this, in War and Peace: “Clearly it was Napoleon’s long-standing conviction that the possibility of mistakes did not exist for him, and to his mind everything he did was good, not because it agreed with any notion of what was good and bad, but because he did it.”

Nearly everyone thinks this way, but most of us don’t have so many things we can get away with, such as invading Russia or canceling people. As parents and therapists, we have a great deal of power within the particular context, but we are constrained (usually) by caring about what is best for the person and by our concern about our reputation with respect to group norms.

Of course, most parenting and almost all therapy occur in private, so one can act like a good person with respect to group norms while still indulging that ancient meaning of goodness, meaning “anything I do.” It doesn’t take much effort in the way of self-delusion to convince ourselves that whatever we feel like doing is good for children and patients.

Most therapists lack a method for examining whether what they do with patients is good for the patient; instead, they go by how it feels. In the name of “democracy,” they may also ask the patient, but of course, the patient is no expert, either, and the patient may feel they have a vested interest in appeasing the therapist. Also, patients, like many people, tend to prefer things that feel good in the moment over things that are frustrating in the moment but lead to change and growth.

Affirmation and validation of therapy patients is not something I’ve ever done, and I’m not sure where the impetus to do it has come from, but I find that many contemporary trainees tend to think it’s the first and best approach to try. “You are wonderful exactly as you are; it’s natural you feel as you do.” Of course, the entire purpose of psychotherapy rests on the fact that the patient is not wonderful exactly as they are—if they were, they should receive something besides therapy, something like involvement in politics or celebration by their loved ones. The strategy of psychotherapy rests entirely on the fact that the way the patient feels on occasions of interest to therapists is idiosyncratic and outmoded.

Therapists who think it’s more important to be gratifying than clinically effective reenact the basic narrative of psychopathology, namely, that immediate relief or reward is more important than successful living. What affirmation and validation really affirm and validate is that the therapist is a good person in a good cause, that therefore anything they do is good, and that anyone who says otherwise is a villain. Efficacy is irrelevant in that way of thinking. It is the same with parents who spoil their children.

I argue that there’s an unspoken lie in affirmation, because no therapists affirm everything: they affirm the feelings, identities, and thoughts that align with the therapist’s values. This becomes a good thing because the therapist is good, even if it means twisting the patient in the same kinds of knots that they came to therapy with, but instead of deep ambivalence about themselves because of the parts that don’t align with the values of family or society, they feel a deep ambivalence about the parts that don't align with the therapist.

Affirmation and validation change the social face of the patient but they do not lead to self-acceptance. The desired state is for the patient to feel seen, to feel that the therapist gets them in Peter Buirski’s felicitous phrasing, not to feel that the therapist approves of them, because where there is approval, there is the shadow of disapproval.

Even worse, the message that the patient is goodness personified produces the ancient morality that anything such a wonderful specimen feels or does is morally right. This leads to the ridiculous true stories I’ve heard of two spouses or two roommates, each in individual therapy, each affirmed and validated, each convinced that the other spouse or other roommate is an unreasonable narcissist. Everything therapists prefer to do or that is convenient or that they already know how to do should be examined skeptically for whether “it’s good because it’s I doing it.”

More from Michael Karson Ph.D., J.D.
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