Psychotherapy As A Language Game
I’ve experienced a wide range of psychotherapeutic approaches (and of psychotherapists) over the past half-century, both in college and graduate school but — more significantly — in my own therapy. While in graduate school I saw an earnest young therapist who encouraged me to yell, as did, many years later, a psychoanalyst. Long before the latter experience I saw an existential psychoanalyst and found it almost impossible to make any sound at all. It took several sessions before I spoke a word.
Moving to take a job in another city and being accepted by still another psychoanalyst as a potential analysand, the word I’m glad I spoke was “no;” his fee would have impoverished me. Much later I spent a decade in weekly meetings with a psychologist, engaging in friendly conversation though never really getting at whatever problems were within me. I would hesitate to call that experience therapy. It did help me to cope in my role of caregiver to a spouse with a slow degenerative disease, until that role grew to the point that it all but consumed me.
During “covid times” I engaged in a course of neurofeedback therapy. An electroencephalographic (EEG) analysis was used to design programs for what looked like video game activities. These games were intended to teach my brain to modify my brainwave patterns. Although I can’t prove it I believe that this helped me to focus on living in the moment. But so has much less technologically-driven mindful meditation.
A range of medications I’ve tried over the years sometimes took the edge off of the problems I was experiencing. I have, however, stubbornly persisted, to this day, in one or another version what one of Sigmund Freud’s early patients called “the talking cure”. Most recently the writings of a friend who is a therapist led me to explore the nature of that cure in terms of the verbal interaction between therapist and patient.
My friend’s focus was on phenomenology and existentialism, philosophical views developed in the early and mid-twentieth century, and on extending those views into twenty-first century psychoanalytic psychotherapy. I found much of interest in his ideas; we discussed some of them, and their sources, at length. However, it seemed to me that it might be especially relevant to turn to a philosophy focused specifically on language and the use of language to bridge the gap between two individuals. After all, a talking cure (though not necessarily the one originally developed by Freud and his followers) operates through linguistic action and interaction. That’s how I came to examine the work of Ludwig Wittgenstein who, while not as well-known as some others, is considered by many to be the greatest philosopher of the twentieth century. For example, a survey of philosophy teachers in US colleges and universities ranked Wittgenstein’s “Philosophical Investigations” (published in 1953, after his death), as the most important twentieth-century philosophy book.
The Language Game
In the early part of the last century Wittgenstein studied in England with Bertrand Russell. During that time he produced the only book published in his lifetime. Later, however, he rejected much of what was in that work. But he continued thinking and writing throughout his life, and in his later work he developed a concept he called the “language-game”.
Wittgenstein observed that a word or phrase can have a variety of very different meanings, depending on the context in which it is used. Not long ago my psychotherapist friend and I were discussing the nature of consciousness. While he was able to easily and clearly define for me three types of consciousness, neither of us was able to develop a definition of what consciousness is, despite an extended conversation. Many terms, from the simplest, such as “water”, to the most complex, such as “life” — and consciousness — have no straightforward definition that everyone understands. For example the exclamation “Water!” might in one situation refer to a puddle to avoid stepping into. In another context it might be a command to put out a fire, and in still another setting it could be the plea of a desperately thirsty individual.
Wittgenstein points out that many words, from simple words like “water” to terms referring to complex concepts such as consciousness, can’t be precisely defined. He ridiculed classic philosophers such as Socrates and Plato for trying to define things such as “truth” or “beauty,” which they believed referred to “real” things that had an objective existence. The physical substance called “water” is relatively easy to define, if you are careful to specify whether you’re speaking of water in its gaseous, liquid, or solid form. But the examples given above all deal with the need for water, a much more complex concept and clearly not a “thing”.
The most famous example of Wittgenstein’s idea is the word “game,” which — if you look closely — seems impossible to precisely define. Does a game, by definition, have physical pieces? Some, but not all, do. Must a game have explicit rules? Not always. And so on. So, perhaps in a somewhat joking manner, Wittgenstein coined the term “language-game” to refer to the way words specifically, and language in general, are used in an effort to communicate meaning clearly when precise definitions may not be possible.
Language is not, according to Wittgenstein, the basis for defining objective truth, that is, reality. Language is, rather, independent of an objective reality. It is a tool developed and used to derive consensual, agreed-upon, meaning. We cannot ever truly know what is in another person’s mind. The language game is a way people can agree on the meaning of words and concepts, despite the inherently subjective meanings we assign to them.
So there are two reasons it’s so difficult for people to agree on the meaning of words and concepts. Not only are precise definitions often impossible, but we can never perfectly perceive what is in another person’s mind. The aim of the language game is to approach agreement as to meaning, even though complete agreement might never be reached. Wittgenstein argues that we can approach agreement in conversation by sharing examples to illustrate an idea. He points out how foolish it is to assume that a precise definition of that idea or concept not only exists, in some abstract reality, but is shared between and among individuals. So, using language is, itself, a kind of a game that each of us plays others throughout our lives.
Language Use in Therapy
Carl Rogers was one of the most influential psychologists and psychotherapists of the twentieth century. I learned about one of his most useful inventions, “active listening”, in my studies as an organizational psychologist. Active listening is a type of language game Rogers invented to improve understanding between the individuals in a two-person interaction. The game is that one person has to restate in their own words what the other has (a) said and (b) was feeling. When the other person agrees that they have been accurately understood, the process is repeated in the opposite direction. This provides an opportunity for clarifying both words and feelings and in this way increasing mutual understanding. In my past life as a consulting organizational psychologist I taught active listening skills to managers and employees. This proved very helpful for dealing with communication problems and conflicts (which, if you’ve ever worked in an organization, you know are common). The practical implications for therapy are obvious.
In therapeutic interactions one of the therapist’s aims is to help patients rethink their understanding of reality as objective truth based on their own experience. But what patients — and, indeed, everyone — perceive as objective truth is actually a “phenomenological” interpretation of events. Events — phenomena — are real but interpretations, the meaning of events, are subjective. In an often-cited classical statement Edmund Husserl, a philosopher of the late 19th and early 20th centuries and a founder of this approach, said
we can absolutely not rest content with ‘mere words’, that is, with a merely symbolic understanding of words, meanings inspired only by remote, confused, inauthentic intuitions — if by any intuitions at all — are not enough. We must go back to the ‘things themselves’. (Italics added.)
In a manner much less constrained and formalized as compared with the active listening game, a therapist interacts with a patient to develop agreed-upon shared (or what some psychotherapists call “intersubjective”) understandings and interpretations. This means going back to the actual phenomena, the events experienced (and then interpreted) by the patient, to the “things themselves”. In this way therapist and patient can begin to identify and address the basic issues confronting the patient.
Existential philosophers of the nineteenth and early twentieth centuries, such as Søren Kierkegaard, Martin Heidegger, and Jean-Paul Sartre, along with therapists of the late twentieth and early twenty-first centuries such as Irving Yalom, identified four particular basic psychological issues: anxiety, despair, meaninglessness, and freedom (or, more specifically, the problem of choosing to take the freedom to act). These problems stem from two crucial facts.
The first fact is mortality. That is, life is limited and all living creatures die. Human beings, as opposed to most other sentient organisms generally find this a problem, as observed by the writer Jorge Luis Borges who said,
To be immortal is commonplace; except for man, all creatures are immortal, for they are ignorant of death.
The second fact is the isolation human beings experience due to the impossibility of actual, full understanding of another person. We may know (or think we know) our own minds, but it is clearly fantasy to believe we can know the mind of another person. Rudyard Kipling put it this way:
We’re all islands shouting lies to each other across seas of misunderstanding.
Therapy as a Language Game
The process of therapy as a language game is similar for many types of psychotherapy. It might seem that the notion of therapy as a language game would be particularly appropriate in the case of the talking cure, that is, therapy based in some way and to some degree on a psychoanalytic approach. However, analysts who follow what is often called an “orthodox” Freudian approach do not generally engage in two-way conversation with patients. Rather, they listen to what the patient says, for hints of underlying unconscious issues that reflect the problems that led the patient to begin therapy. Only after such therapists gather enough information may they make “interventions” based on their interpretations of patients’ underlying problems. In my first psychoanalytic encounter I experienced this as a problem, when I sat through my initial sessions unable to speak.
Some other much more recently developed therapy approaches might not find the language game especially useful. For example, Albert Ellis’ Rational Emotional Therapy and Aaron Beck’s Cognitive Behavior Therapy focus on specific problems patients have, such as depression and anxiety. Therapists deal with those issues by challenging distorted thoughts, beliefs, and attitudes directly and working to changing them. The therapist’s role is to help patients identify and practice new behaviors that address their problems and decrease or eliminate their symptoms. Unlike psychoanalysis, which can take years, CBT therapists often explicitly limit the number of sessions offered.
In a long-ago group session with Albert Ellis I was impressed by his open and straightforward manner when he explained at one point that he needed to deal with his diabetes by eating a tuna sandwich. While in that meeting I came to appreciate his knowledge and skill I didn’t feel that I might find solutions to my own problems through his RET approach.
What is specific in the application of Wittgenstein’s language-game concept to the therapeutic situation might be the therapist’s efforts to help patients connect their thoughts and comments to other of their thoughts and comments. The aim would be to use Wittgenstein’s concept of identifying similar things in order to approach or uncover and define understandings that relate to and address a patient’s specific issues. This would apply in particular to the issues I’ve noted — anxiety, despair, and meaninglessness — and to ultimately finding the freedom to choose to address those issues in action.
This goal would, I think, generally involve actions relating to the two facts of human life I have noted, that is, mortality and isolation. In his memoir Self-Consciousness John Updike addresses the first fact, mortality, writing
Perhaps there are two kinds of people, those for whom nothingness is no problem, and those for whom it is an insuperable problem.
I doubt that there are really many for whom nothingness — ceasing to exist — is no problem. And if it is really an “insuperable” problem, which means it can’t be overcome, therapy is not likely to help. (As it happens, Updike hides from the reader which of these categories he falls into.) My own most recent psychotherapeutic efforts have, I believe, substantially relieved the concern with “nothingness”, what psychotherapists often call “death anxiety”. I think this has come about as a result of neurofeedback therapy that has helped me to live and act more in the present moment. I came across a particularly apt expression of my changed feelings in a quote from the book Band of Brothers. An officer is trying to make it more likely that a soldier will survive by telling him, “Your only hope is to accept the fact that you’re already dead!” In reality this is, of course, the truth. When asked about the long-term effects of a particular policy the economist John Maynard Keynes said, “In the long run we’re all dead!” Understanding and, most of all, accepting this fact can reduce, if not remove, fear and enable effective action.
With regard to the second fact of life Holden Caulfield, the young central character in J. D. Salinger’s Catcher in the Rye, explains what isolation feels like:
I felt so lonesome, all of a sudden. I almost wished I was dead.
My most recent therapy has helped me identify the effects of emotional isolation in my childhood. This was not merely a result of being a “late” and unplanned child. My brother and sister, about fifteen years older than me, had some of the same issues, a result of our emotionally distant mother. In Paul Simon’s “She Loves Me Like A Rock” he sings, “She get down on her knees and hug me”. Neither in childhood nor as an adult do I remember my mother ever hugging me. I did, however, get her attention when I was accidentally cut by a broken bottle hidden in weeds behind our house. So, at the age of four or five, I tried to gain further attention by cutting myself. Several years later I tried (but obviously failed) electrocution. I think such self-destructive efforts may have been crushed by the extremely painful treatments I received from a sadistic physician when I was nine or ten. So, on reflection, Dr. B. may have actually done me a favor.
In the second half of the twentieth century John Bowlby, a British psychoanalyst, developed “attachment theory,” which has had a major effect on our understanding of child development. Where Freud saw the key motivational issues of early child development as food and sex, Bowlby believed that emotional attachment to an adult (typically the mother) was central. Such attachment provides a crucial sense of security which permits a child to explore, take risks, and learn that he or she is able to achieve and accomplish goals. Underlying that sense of security is the development of the ability to establish lasting emotional connections, a central problem for Holden Caulfield as it was for me and my siblings. While I don’t think that they ever did develop the capacity for emotional intimacy, my efforts at therapy have helped.
Updike and Salinger present quite well the existential problems central to human life. However neither of these extremely well-regarded writers offer solutions. The reason is simple: there are no generic solutions. Which, of course, is the reason for therapy.
Successful psychotherapy should result in patients’ actions to resolve symptoms that reflect their anxieties, their despair of positive improvement in their lives, and their feelings of failure at finding meaning in life. The language game can help a patient work with a therapist to understand the issues at the root of symptoms, that is, the sources of anxiety, despair, and meaninglessness. Patients are successful when they become able to seize the freedom to address and resolve not just symptoms but the underlying sources of anxiety, despair, and meaninglessness. I think that an important step toward that goal occurs when therapist and patient create new understanding on the part of the patient by successfully playing the language game. As for me, I’m still in the game.