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Therapy

Agency via Knowledge: A Unifying Therapeutic Theme

What lies at the heart of all successful therapy.

Despite the wealth of research and clinical insight that psychologists have accumulated over the past century, there is still no unified theory of how, when, or why therapy works. Instead, the field's knowledge is scattered across hundreds of particular "schools of therapy" that largely talk past each other, despite their many common elements . Among other issues, this makes it frustratingly hard to know what to look for in a therapy or therapist, or what strategies to use when undertaking one's own self-change.

To address this problem, psychotherapy researchers have been working to distill the principles of change found across many therapeutic approaches. Building on this work, I've proposed that we can go a step further and articulate two fundamental tenets implicitly shared by all effective therapies:

  1. that helping people exercise agency over their lives is a core therapeutic aim;
  2. that agency is exercised primarily by acquiring and internalizing knowledge.

An “agent”, according to Merriam-Webster, is “one that acts or exerts power” or “produces or is capable of producing an effect.” Applied to one’s own life, this means one has and exercises the power to produce experiences and circumstances of one’s own choosing—be that a particular career, a loving family, trusted friends, a life of serene contemplation or adventuresome travel, a sense of optimism, etc. Exercising agency is not the same as being all-knowing or all-powerful, nor does it guarantee that all of one’s chosen goals will be fulfilled. Rather, it means that one does the things that constitute self-authorship and tend to generate success: one is able to choose one’s own goals and strategies based on the information available, and to take action in light of them; to solve problems in flexible and creative ways; to learn from failures and adjust one’s goals and/or strategies accordingly. In short, it means one is a competent and responsible manager over the project of living one’s life.

By "knowledge," I mean awareness and understanding of whatever aspects of oneself and the world are relevant to managing one’s life. This includes, for example, a knowledge of what kinds of careers or relationships or lifestyles are possible; what steps, activities, or challenges are involved in pursuing each one; how and why one thinks and feels toward each, and where these thoughts and feelings come from; one’s strengths and weaknesses; the nature and malleability of human beliefs, emotions, and habits; and, indeed, what further knowledge or skills one needs in order to figure these things out.

To have an internalized knowledge means you can access it when you need it, and that it has fully “sunk in” for you; it has the power to stir your emotions and motivate your actions.

To have acquired knowledge, versus just any set of beliefs and attitudes that stir and motivate you, is to have done the work of forging your beliefs and attitudes through active engagement with reality—which includes gathering the needed data (both introspective and extrospective), reflecting on it critically, and checking and updating your conclusions through continual experience. This is hard work, and it is work that never stops. It is chosen, self-directed work. It is agential work. For individuals struggling to make sense of deep loss, failure, misfortune, or injustice, it can be very painful work. But it is work that needs doing if one wants the power to envision and enact a more satisfying life.

To briefly illustrate this "agency via knowledge" process in context: Imagine you've been stuck in an abusive relationship of many years. Perhaps you believe “on an intellectual level” that “my life would be better if I ended this relationship,” but you cannot begin to imagine what such a version of your life might look like, nor specify any concrete steps you could take to bring it about. Your belief is at the level of a vague, untested speculation, and is unlikely to motivate you to leave. To turn this belief into “working knowledge,” you would need to do a lot of work to specify, in vivid enough detail, the realistic costs and rewards associated with staying in the relationship versus leaving it. Consider some of the steps this might involve:

  • First you may need to gain awareness of the unadmitted anger and resentment you feel toward your partner, or the unadmitted fear that you would be unable to make it on your own. This is the kind of insight that psychodynamic therapy might help you gain. A humanistic approach could also aid you in this task, both by reflecting and validating your emotional states in a way that helps you more fully articulate them, and by providing a supportive space for you to open up to aspects of your experience that might have previously felt too threatening.
  • Having consciously admitted your fear that you cannot make it on your own, you might then need to check it against reality, both by considering the evidence you already have available (e.g., your ability to get by prior to this relationship) and by gathering new evidence (e.g., making some independent decisions and seeing how they go). In other words, you may need to do some cognitive restructuring and conduct some behavioral experiments—two of the main building blocks of cognitive-behavioral therapy.
  • To do this data-gathering successfully, you may need tools to help you tolerate the distress that certain painful conclusions (e.g., “I’ve been needlessly tolerating abuse all this time”) and anxiety-inducing behavioral experiments (e.g., standing up to your abusive partner) would entail. This is where interventions like mindfulness, acceptance and commitment therapy, or dialectical behavior therapy would offer you ample tools for tolerating and distancing from distress enough to bring your growing knowledge base to bear on your choices.

By understanding these varied strategies through the "agency via knowledge" lens, you gain the power to select among them based on an assessment of what further knowledge you need to acquire and/or internalize to make more informed choices in your life.

References

Goldfried M. R. (2019). Obtaining consensus in psychotherapy: What holds us back? The American psychologist, 74(4), 484–496.

Gorlin, E., I., Bekes, V., & Kansas, M. (2020). Agency through awareness: A unifying meta-process across schools of psychotherapy. Poster presented at annual (virtual) meeting of Society for Exploration of Psychotherapy Integration (SEPI). Retrieved from https://psychology.unt.edu/sites/psychology.unt.edu/files/Gorlin.png .

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