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Larry Davidson
Yale University
Phenomenology and Contemporary Clinical
Practice: Introduction to Special Issue

ABSTRACT

This special issue reconsiders the contributions that phenome-

nology can make to the development and practice of a clinical
science of psychology. In it, we suggest that earlier attempts to
apply phenomenological principles were influenced heavily by
psychoanalysis, with few, if any, alternative versions of a “depth”
psychology available on which to draw in reframing the nature
of psychopathology and its treatment. We suggest that this lin-
gering presence of psychoanalysis runs counter to the founding
principles of phenomenological method and offer a few exam-
ples of a constructive alternative grounded in Husserl’s tran-
scendental phenomenology. Borrowing from Mohanty, we offer
this approach as a respectful—as opposed to suspicious—phe-
nomenology, and begin to outline ways in which a transcenden-
tally-grounded psychology reconceptualizes both clinical research
and practice, from the initial intake interview and interpretation
of interview data to the aims and strategies of psychological inter-
ventions.

How can we ward off, in the practice of the cure, this abject
desire that makes us bend our knees, lays us on the couch,
and makes us remain there?
(Deleuze & Guattari, 1983, p. 65)

Journal of Phenomenological Psychology, 35:2

© Koninklijke Brill NV, Leiden, The Netherlands, 2004
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Students of phenomenology will know that clinical psychological and psy-

chiatric practice was first influenced by phenomenological philosophy through
the descriptive psychopathology of Karl Jaspers, a contemporary of Husserl’s,
and through the Daseinsanalytic School founded by followers of Heidegger.
While the existential, hermeneutic, and empirical phenomenological approaches
to clinical theory and practice that followed may have been begun to be critical
of psychoanalysis, earlier attempts to apply phenomenological principles
were influenced heavily by Freud and the various derivative schools developed
by his students. Even in the 1970’s and 1980’s, when the Louvain and Duquesne
departments of phenomenological psychology were attempting to articulate
their own versions of clinical science, psychoanalysis remained the primary
default point of reference. It seemed at the time, at least to some of us who were
in training then, that there was no other version of a “depth” psychology on
which to draw in reframing the nature of psychopathology and its treatment.

In this introduction, and in this Special Issue as a whole, we revisit this issue
and suggest that the lingering, and at times unacknowledged, presence of a
psychoanalytic framework runs counter to the founding principles of phe-
nomenological method, at least as articulated by Edmund Husserl. Being
engaged in clinical practice ourselves, and thereby not being content with
merely criticizing others, we then also take a few steps toward offering a con-
structive alternative grounded in Husserl’s transcendental phenomenology.

Leaving Behind a Phenomenology of Suspicion . . .

Given the epic and revolutionary nature of the legacy left by Freud, Jung,
Ferenzi, Erikson, and others, it is understandable how phenomenological
pioneers would find it difficult not to be seduced by their worldview. This,
however, was despite the fact that the “things themselves” with which psy-
choanalysis was concerned were precisely the very things of which the
persons in question would have no conscious awareness. In this respect, phe-
nomenology and psychoanalysis make, at best, curious bedfellows. In fact,
it is hard to imagine—within the relatively small universe of the human
sciences—two more fundamentally different, if not diametrically opposite,
points of view. For Husserl, phenomenology was to be grounded in the sub-
jectivity of experience, in conscious awareness, because that is where the
truth, and the real, were to be found. Although this ground may always have

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given way, through Husserl’s perpetual reflection, to a yet deeper ground

found buried in sedimented layers of constituted sense, it was Husserl’s con-
viction that he was simply explicating meanings that were already present,
albeit at times implicitly, in the person’s (most often, his own) experience. In
this way, it has been both phenomenology’s great challenge, and its great
contribution, to articulate the “obvious.”

Outside, perhaps, of his own self-analysis, Freud would have been highly
skeptical of any such attempt to render what he considered the latent con-
tent of experience to be manifest through reflection alone. This was not only
because of the various mechanisms of repression and defense, which serve
to conceal or disguise the latent content, but also because of the very nature
of subjectivity itself. The vast majority of psychic life is considered by psy-
choanalysis to lie outside of the person’s awareness, at various levels of the
unconscious. And even for Freud, the only access to this unconscious was
through the (further) indirect means of interpretation. Reflection on one’s
own conscious experience was not only difficult, but it also was misguided,
as the truth, and the real, were to be found elsewhere. In fact, even, or espe-
cially, those things that appeared to be obvious were to be questioned, chal-
lenged, and explored as they most likely were merely (manifest) symbolic
representations that concealed but at the same time provided clues to uncon-
scious (latent) content. As a result, the old joke asking when a cigar is just a
cigar represents a fundamental epistemological challenge to the foundations
of psychoanalysis that, to my knowledge at least, has never been answered
satisfactorily.

In practice, this challenge unfortunately has traditionally been bypassed by

assuming that the psychoanalyst is the one who will be able to determine,
by an unspecified deus ex machina, when this particular cigar is just this par-
ticular cigar and not also something else of importance of which the person
is unaware. Mistakes will be made even by the psychoanalyst, of course,
because he or she will have his or her own unconscious demons that will
lead him or her occasionally astray. In general, however, Freud adhered to
Nietzsche’s principle that it takes at least two people to produce a truth. In
this case, though, it was not so much because truth was considered to be
socially constituted as it was that the individual is ruled, and perhaps also
trapped, by forces of which he or she is largely unaware.

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Liberationist, feminist, and other politically-minded critics of psychoanaly-

sis have since taken on this issue with zeal, criticizing both psychoanalytic
theory (e.g., anorexia, repression; see Bernheimer & Kahane, 1985; Bordo,
1993; Butler, 1993; Hepworth & Griffin, 1995; Malson, 1998; Masson, 1984)
and individual psychoanalysts (e.g., Lacan; see Roustang, 1980, 1982; Turkle,
1978; Weber, 1982), for generating truths that serve to maintain oppressive
political institutions and systems. There is not much difference, in their col-
lective opinion, between power residing in the phallus and power residing
in the person of the analyst. Rejecting a therapeutic practice that focuses solely
on, and attempts solely to fix, what they perceive as the victim—and thus
leaving problematic social structures and institutions at best untouched, and
at worst reaffirmed or strengthened—these critics have worked to lift the yolk
of therapeutic oppression off of the shoulders of marginalized or otherwise
disenfranchised groups. We find these approaches to be provocative and per-
suasive in calling into question the epistemological claims of psychoanaly-
sis. We find little in these approaches, however, that is of immediate assistance
to individuals who are suffering from various forms of psychopathology or
to those who have dedicated their careers to lessening this form of suffering.
Anti-psychoanalytic critiques specifically, like anti-psychiatric critiques more
broadly, fail to offer a positive alternative for clinical practice, either wishing
away the phenomena we have described traditionally as pathological, abdi-
cating any responsibility for addressing these phenomena, or insisting that
the only hope lies in an idealistic future in which such oppressive social struc-
tures no longer exist.
Those of us working in clinical settings in the present need more direction
and concrete guidance from phenomenology than this. We need a feasible
and helpful approach that can be implemented in the “real world” of every-
day contemporary clinical practice while remaining faithful to the principles
of phenomenological philosophy. We suggest that such an approach is pos-
sible, and have spent the last 15 years developing our own particular ver-
sion of this approach in both the research/theory and practical arenas. To
describe the essential elements of this approach, we return to our initial com-
ments about early attempts to apply phenomenological principles to clinical
practice and some of the lessons we hope to have learned from these efforts,
and we return, by necessity, to the nature of conscious awareness. As most
of our own research and practice has been in relation to adults diagnosed

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with schizophrenia-spectrum disorders, we will illustrate these principles

through use of the example of psychosis.

. . . Moving Toward a Phenomenology of Respect

Jaspers is deservedly a significant figure in the history of clinical psychiatry,

having introduced the dimension of experience to our understanding both
of our patients’ presentations and to our work as clinicians. Following Rumke,
however, Jaspers chose as a distinguishing feature of schizophrenia the fact
that clinicians inevitably have moments in working with people living with
this condition in which they experience the patient as alien, as other, as intrin-
sically impossible to understand or empathize with. While few experienced
clinicians will argue with the presence and salience of such experiences, it is
unfortunate that Jaspers chose to understand these experiences as indicative
of a disorder or deficit in the individual patient, rather than as the result of
an interactive, interpersonal process taking place between clinician and patient.
If one sticks to the experiential givens of these interchanges, it is in princi-
ple just as likely that the failure of empathy that occurs could be attributable
to the clinician (i.e., it is, after all, his or her experience of failing to under-
stand the other) as it is attributable to the patient’s disorder. How many clin-
icians working with people with schizophrenia, for example, have had
first-hand experiences of poverty, homelessness, rejection by family and
friends, and social stigma, not to mention hallucinations? What makes us
think that it is the illness per se that is to blame for the clinician’s failure of
empathy, and not his or her paucity of experience with these other factors
that may be associated with living with this illness as well? R.D. Laing’s early
work (e.g., 1959, 1961) provided several examples of how what appears at
first to be unintelligible rambling can become intelligible discourse when con-
text and life history are taken into account.

What appears to be at stake, both in Jaspers’ attribution of unintelligibility

to the patient and to Freud’s implicit attribution to the analyst of the power
to define the truth and the real, is a subordination of the patient’s experience
to that of the clinician. Without digressing into lengthy philosophical argu-
ments that we have already made elsewhere (e.g., Davidson, 1988, 1994;
Davidson & Cosgrove, 1991, 2002), we view this subordination of one
person’s experience to that of another as one of the several undesirable

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consequences of stopping short of Husserl’s “transcendental reduction” (1970)

in the pursuit of human science. This argument is made, once again, in one
of our contributions to this Special Issue, in which we use the Husserl/Heidegger
debate over Husserl’s “Phenomenology” article for the Encyclopedia Britannica
to illustrate the problematic position in which the transcendentally naïve
clinician finds him or herself in relation to the patient’s “personal world” (David-
son, Staeheli, Stayner & Sells, 2004). The basic issue is this: Is it necessary, in
order to carry out research or treatment related to psychopathology, to view
the patient’s experiences themselves as deficient, dysfunctional, or disord-
ered? Is the pathology to be found within the individual’s experience, to
reside within his or her conscious awareness, or does it lie elsewhere? What
kind of phenomenology, in particular, would consider a person’s experiences
to be distortions or disguises of a truth that lies hidden and inaccessible?

Following a leading transcendental phenomenological philosopher, J.N.

Mohanty (1985), we suggest that these pre-transcendental approaches repre-
sent a “phenomenology of suspicion.” The “suspicion” involved is the the-
orist or therapist’s questioning of the legitimacy of the patient’s experiences.
In the form of a tautology, once I know that you experience psychosis, I feel
entitled to question the credibility of your experiences. Then, once I estab-
lish the lack of legitimacy of your experiences, I am able to infer from this
that you have a psychotic disorder. How are we to escape such circular rea-
soning? By pursuing instead what Mohanty refers to as a “phenomenology
of respect” (1985). By returning, that is, to Husserl’s foundational insight into
the role of (transcendental) consciousness in constituting the real—as no indi-
vidual, profession, political party, majority population, gender, race, ethnic-
ity, nationality, sexual orientation, or religion has a monopoly on transcendental
subjectivity to the exclusion of others.

According to Husserl, each and every experiential flow is to be respected as

precisely what it is in the way that it appears in consciousness; i.e., it legiti-
mately and credibly is the flow of experience that it presents itself as being.
By invoking the epoche—arguably that element of phenomenological method
which makes it most unique—we have suspended our concern with the real-
ity status of the objects of experience in order precisely to explore and under-
stand the experiences in their own terms. Within this context, experiences of
hallucinations, for example, are taken to be just that: experiences of halluci-

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nations. On what possible phenomenological grounds, then, could we deter-

mine some experiences to be more “real” or more legitimate than others?
Rather than approaching another person’s experiences with distrust or sus-
picion, it is an essential foundation of phenomenological inquiry to treat each
and every moment of experience with the same degree of basic respect for
what it is: one experiential moment out of the life of this particular instanti-
ation of transcendental subjectivity.

It is on the basis of this foundational, “ontological” respect for all experiences

that we propose to develop an alternative approach to research and practice
in psychopathology. Again following Mohanty, we propose to view this
approach as grounded in a “phenomenology of respect.” The respect, as we
had said, is for the patient’s experiences, taking them in their own terms to
be precisely what they present themselves to be, in the ways in which they
present themselves in the patient’s own conscious awareness. This is not to
say, as we noted above, that hallucinated voices are therefore “real” voices
in the sense of having actually been spoken by embodied subjects, but, by
virtue of the phenomenological reduction, to suggest that people who hal-
lucinate actually (“really”) do have experiences of hallucinations. Hearing a
voice when no one else is around is an actual experience just like any other.
It is not its status as an experience that is called into question by our psy-
chopathology, and it is not the person’s experiences themselves that are
regarded as deficient, disordered, or dysfunctional. They simply are what
they are. The question for us is how this changes our approach to psycho-
logical research and treatment.

We suggest that it does, and in profound ways. It has been the mission of
the Yale Program for Recovery and Community Health to identify, elaborate,
and evaluate the utility of these ways in the three areas of empirical research,
social policy, and clinical practice. The list of selected Program publications
provided at the end of this Introduction provides glimpses into both the meth-
ods and the content of this approach, and readers are encouraged to take a
more in-depth look into any of the areas that interest them. For the purposes
of this Introduction, I will restrict myself to a brief overview of our Program
and its approach.

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The Yale Program for Recovery and Community Health

Why don’t you ever ask me what I do to help myself?

—Woman with schizophrenia speaking to psychiatric researcher

The Program for Recovery and Community Health (PRCH) is jointly spon-
sored by the Yale Department of Psychiatry and Institution for Social and
Policy Studies and the Connecticut Department of Mental Health and Addiction
Services, which is the state agency responsible for public sector behavioral
healthcare in Connecticut. While PRCH has only existed officially for four
years, it has been in development since the late 1980’s. In an effort to develop
a human science that embodies Husserl’s (1970) notion of “a return to posi-
tivity” following the transcendental reduction (Davidson, 1988, 1994; Davidson
& Cosgrove, 1991, 2001), the guiding mission of PRCH has been to work
alongside of people affected by urban poverty and homelessness in addition
to psychiatric and substance use disorders in promoting their recovery and
enhancing their access to meaningful opportunities within the community.
In this relatively benign mission statement, we mean to imply two impor-
tant aspects of PRCH’s approach.

First, we view ourselves as working alongside of people within the context of

a collaborative partnership. Our motto is borrowed from The Home Depot,
which conveys its self-help ideology through the phrase: “You can do it, we
can help.” In this spirit, we view recovery from serious mental illness and
addiction to be the job and role of the person with the disorder or disability.
He or she has to do the hard work of learning to manage his or her condi-
tion and regain a life in the community; we, as professionals, have resources,
information, tools, and supports to offer in the process. In this spirit, we talk
of “promoting recovery” and “enhancing access” rather than of treating ill-
ness, minimizing dysfunction, or reducing symptoms. Instead of attempting
to bring about a cure or remission, we have the important roles of enhanc-
ing access to opportunities and providing the supports people may need in
order to be successful in taking advantage of these opportunities. Funda-
mentally, however, it has to be the person’s own role to engage in the activi-
ties required to manage his or her disability and rejoin community life.

Related to this emphasis on the role of the person in recovery is the second
implication of our mission statement. We view ourselves as working along-

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side of people affected by a variety of factors, including but not limited to

psychiatric and substance use disorders. This implication is more difficult to
articulate, as it appears to many readers to be “obvious.” In our experience,
though, we have found this not to be nearly as obvious in practice as it
appears to be in principle. For us, it represents the most important difference
introduced by transcendental phenomenology, and therefore is worthy of
every attempt to clarify. Like the notion of the “transcendental” itself, we
often have thought that we had the substance of the concept adequately elab-
orated, even nailed down, only to find that we had missed an important, per-
haps essential, component or characteristic. The concept in this case is that
people with psychiatric and/or substance use disorders are people first and
foremost, and are only secondarily struggling with a particular set of life chal-
lenges that are somewhat, but not that much, different from other life chal-
lenges such as chronic illnesses like asthma or diabetes or traumatic events
like abuse or rape. What would it mean to view behavioral health conditions
as conditions like any other?

Our colleague and fellow phenomenological psychologist, who also has her
own history of psychiatric disability, Patricia Deegan, has suggested that it
involves “the simple yet profound realization that people who have been
diagnosed with a mental illness are human beings” (1993). In our own recent
work, we have suggested that it involves viewing people with psychiatric
disabilities as “normal people who develop, struggle with, fight against, and
recover from psychosis” (Davidson, O’Connell, Tondora, Staeheli & Evans,
2004). Why do we need to make such apparently trivial or vacuous state-
ments? Partly, I imagine, because of the hundreds of years of stigma and dis-
crimination against people with mental illness or addictions that we have
inherited from our predecessors that unwittingly lead us to treat people as
something other than human beings. It is for this reason that we seldom speak
of people “battling” their mental illness the way we would ordinarily talk of
someone battling cancer. More importantly, though, is the equally formida-
ble fact that we do not yet really know that much about the nature of psy-
chiatric or substance use disorders beyond the boundaries of our inherited,
stigmatized view.

To illustrate this point, let’s return to the example of hearing voices when no
one else is around; considered a classic symptom of psychosis. What does it

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mean to insist that experiences of hallucinations are legitimate experiences?

In asthma, for example, one of the more distressing signs of the illness is the
person’s experience of having difficulty breathing. Depending upon its sever-
ity, frequency, and responsiveness to treatment and environmental factors,
such an experience of gasping after breath can be terrifying, frustrating, infu-
riating, demoralizing, mildly bothersome, etc. Perhaps we could say the same
of the person experiencing hallucinations. We don’t yet know what causes
them, but experiences of hearing voices also can elicit a variety of responses
from the person, from being frightened by sudden intrusions, becoming
enraged by taunting, or feeling demeaned by criticism, to becoming over-
whelmed by a cacophony of unrelated discourse or feeling comforted by
friendly chatter. Irrespective of the response, the hallucinatory experience is
something the person with the psychotic illness has to find a way to deal
with, similar to having difficulty breathing. Also like asthma, people with
psychosis are not the only people who hear voices when no one else is around.
Hallucinations do not necessarily signify psychosis, just as gasping after
breath does not necessarily signify asthma.

And this is not only true of hallucinations. We have yet to discover, in fact,
any specific sign or symptom of schizophrenia that is found in every case of
schizophrenia and in no other illness or condition. Everything people with
schizophrenia experience can also be experienced by people who do not have
schizophrenia, and yet we are convinced that schizophrenia represents a fam-
ily of illnesses that affect one out of every one hundred people regardless of
nationality, race, culture, social class, ethnicity, etc. (DHHS, 1999). It also rep-
resents a condition that can be tremendously debilitating, but yet one from
which many people can still recover (Davidson & McGlashan, 1997). There
is, quite simply, a lot we do not yet know about serious mental illness.

While our colleagues in the neurosciences attempt to identify and understand

the disease processes that bring about serious mental illnesses, we have
adopted the approach—suggested by the woman quoted above—of asking
people with psychiatric disabilities about their experiences, about what they
find useful (or not), and about how their lives could be improved. With their
first-hand knowledge of the terrain, we consider them to be the experts on
their own lives and conditions, and appreciate that they are the ones who
have to find a way to live with, compensate for, or overcome these condi-

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tions. This represents an obvious departure from previous practices, in which

people with mental illnesses were treated as unpredictable and untrustwor-
thy, with impaired judgment, and incapable of making their own decisions
or taking care of themselves. Adopting both a participatory and an emanci-
patory paradigm in both our research and clinical practice has brought us
into partnership with “consumer” or “user” groups (i.e., collectives of peo-
ple who have lived with, and to some degree recovered from, serious men-
tal illnesses), and has led to our recruitment of people in recovery as members
of our research team. Through action research that directly informs prac-
tice and public policy, we aim to foster the inclusion and political presence
of capable and intact people who, due to their disability, have historically
lived on the margins of society. Current activities include intervention, peer
support, and service system development and evaluation; public policy
development and analysis; and education, training, and consultation pro-
moting the recovery and social inclusion of people with behavioral health
disabilities.

Within this broader programmatic approach, empirical phenomenological

research and the transcendental framework that informs it provide the foun-
dation for all of our other efforts. An interdisciplinary Program including
psychology, sociology, anthropology, psychiatry, people in recovery, peda-
gogy, community organizing, and the humanities, our methods of generat-
ing data for phenomenological analysis include ethnography, focus groups,
and various avenues of artistic expression as well as traditional qualitative
interviews with individuals. As described in the contribution to this issue led
by Sells, our analytic method typically involves using several independent
investigators to conduct interviews and to code thematically all transcripts
for a given study prior to coming together to develop consensus on the themes
and autobiographical narrative summary for each participant or group. Final
steps involve identifying themes across individuals or groups, synthesizing
these into a general summary, and then soliciting feedback from our partic-
ipants on what we think we have culled and learned from their experiences.

In addition to elaborating on the contributions of phenomenology, having

this process in place has facilitated the training of a new generation of phe-
nomenological investigators who are able to get hands-on experience and
supervision in conducting participatory action research that directly impacts

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policy and practice (e.g., Davidson, Stayner, Lambert, Smith & Sledge, 1997).
It also has enabled us to embed phenomenological inquiry within the con-
text of a variety of more quantitative research designs that at first may seem
foreign, if not antagonistic, to such pursuits. The contribution to this issue
led by Staeheli offers one example of the kind of crucial, yet often overlooked,
information that can be gleaned from adding a narrative, phenomenological
component to a traditional randomized clinical trial. Finally, exploring the
contributions phenomenological inquiry can make within applied contexts
such as clinical practice and public sector mental health policy has brought
us into collaboration with like-minded investigators from other countries,
including Australia, France, Italy, Norway, Sweden, and the United Kingdom.
The contribution to this issue from Stanghellini, for example, represents com-
patible work being conducted in Italy on the early phase of the treatment
enterprise: the psychiatric interview.

Respecting individuals with psychiatric disorders as the foremost experts on

their own legitimate experiences seems to us both to be consistent with basic
phenomenological principles (i.e., “to the things themselves”) and to gen-
erate valuable contributions to clinical work and research on recovery. As
community psychiatry continues to evolve toward a person-centered and
recovery-oriented approach that restores dignity and respect to individuals
with psychiatric disabilities, we hope the following papers make a strong
argument for including and broadening the contributions that phenomeno-
logical inquiry can make to this very deserving task.

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