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Integration Paper





Submitted in partial fulfillment of the

Requirements for the degree of

Masters of Arts in Psychology



I am of the belief that philosophy is the underpinning of psychology. Philosophy

directly addresses, head-on, the meaning of existence, and provides a guidepost for the

transformation of how a patient can live in the world. Psychology addresses the suffering of

the mind, and the resulting cognitive, behavioral, and affective outcomes. I subscribe to the

writings of Emmanuel Levinas. Herein is found a basis of ethics in psychological practice,

both for the therapist and for the patient. The therapist is enjoined to clearly hear the call of

the patient in their suffering, to recognize their alterity by not totalizing their existence, and

to meet an ethical responsibility by responding to their needs with such attuned sensitivity

that no violence is done. For the patient, the ethical objective of the therapeutic encounter is

to help enable the patient to not only tend to their own life, but also to grow resilient enough

to assume the responsibility of caring for the Other.

In previous coursework, found in Sections I and III of this paper, I theorized about

the implications of Levinasian philosophy in the therapeutic forum. Now that I have begun

to work with patients, in this paper I revisit these writings and reflect on how they

concretely apply in my therapeutic practice. Using case studies of patient sessions, I

consider how Levinasian philosophy can be applied in psychological treatment. In

particular, I highlight what aspects of Levinasian philosophy that hold significant potential

in working with patients in the community-based clinic serving the underprivileged and


Keywords: Levinas, exteriority, interiority, ethics, intersubjectivity, metaphysics,

psychology, existential-phenomenology, therapeutic practice, embodiment




This section examines the applicability of Emmanuel Levinas’s philosophical

concept of interiority and exteriority in psychological practice. It considers various

implications of movement between these existentially lived states as a paradigm for treating

the suffering patient. In particular, it addresses the ability of the patient to break through

their barrier of interiority, and to interact with the world, despite their own internally

focused suffering. The objective of the therapeutic encounter is to help enable the patient to

not only tend to themselves, but to grow resilient enough to assume the responsibility of

caring for the Other.

Toward the Other, a Capsulated Summary

Levinas refutes the basic notion of the sameness of the Other and turns the idea

completely around in a startling and counterintuitive way: the Other is not the same as me.

The testament of this is known by the presentation of the face of the Other.

The face with which the Other turns to me is not reabsorbed in a representation of
the face. To hear his destitution which cries out for justice is not to represent an
image to oneself, but is to posit oneself as responsible, both as more and as less than
the being that presents itself in the face. Less, for the face summons me to my
obligations and judges me. The being that presents himself in the face comes from a
dimension of height, a dimension of transcendence whereby he can present himself
as a stranger without opposing me as obstacle or enemy. More, for my position as I
consists in being able to respond to this essential destitution of the Other, finding
resources for myself. The Other who dominates me in his transcendence is thus the
stranger, the widow, and the orphan, to whom I am obligated. (Levinas, 1969, p.

As a face, the face of the Other possesses the capability of expression that exceeds

the knowledge and control of the Same. It overflows with meaning, with otherness, such

that the Same that confronts it is itself overflowed. It is not the Same; it is alterity,

foreignness, exceeding all possible understanding. Levinas states: “The face is a living

presence; it is expression…The face speaks….The manifestation of the face is already

discourse” (Levinas, 1969, p. 66). The face is intentional, not to be overlooked and denied,

as it announces: do not totalize me, do not objectify me, do no violence unto me. Such a

view breaks the power of the State over me and it derails any march to tyranny.

The Other is always above me. In their neediness the Other calls me to exercise my

responsibility. It is an ethical choice we are each presented with: we can choose to recognize,

honor and support the Other. We can choose to provide to them with even more than what we

provide to ourselves. Or instead, we can place ourselves above all, tending to our own

devices, leaving the Other to fend for them self. This is in our nature: we cannot avoid

hearing the call of the Other, but we can choose to ignore it, or pretend it is not heard.

The Same and the Other are now and forever separate. The face of the Other is

transcendent as it asks the Same to accept their alterity, that their otherness will never be fully

understood, and that they will forever be infinite. Yet paradoxically, their face is remarkably

close, so close that its mere presence is capable of generating strong feelings that necessitate

the on coming of difficult ethical decisions within the Same. The face is thus an ethical

relation, and calls me to responsibility. In my response to the Other I give to them freely and

openly the gifts of by being: the gentle compassion, wisdom, teaching and the transfer of

tangible possessions. In return I am presented with the opportunity for transcendence that

only the ethical service to the Other can provide.

The implication of Levinas’s philosophy on the practice of psychological therapy is

both startling and broad. It calls on the therapist to view his practice as an ethical relation that

is stringently higher than that professed in traditional psychological practice. This idea is

reflected by Richard Williams (2007) who states:

To many who encounter Levinas's work, his notion of the fundamental,

ubiquitous, and inescapable nature of ethical obligation and responsibility for the
Other seems extreme. It accomplishes nothing less than placing ethics at the
heart of Western thought, placing it at the level of metaphysics—the starting
point of all analysis and understanding. In some sense it is an extreme position,
but, for that, all the more compelling. It calls us to consider it. It is not easily
dismissed out of hand because of the momentous implications that follow if
Levinas happens to be right. (p. 687)

Interiority and Exteriority: Home and the World

Levinas asserts the concept of interiority and exteriority as a basic component in his

philosophy. The world of others is a world of ethical commitment and responsibility.

Where ever I go in the world, in this exteriority to myself, Others in their suffering call to

me. My nature is such that I cannot truly evade their cry. With such insistent but gentle

demands, insatiable in their neediness, where can I go for respite and peace, to care for the

egoist I that is also in our nature, and to enjoy the fruits of my labor? Levinas observes that

it is in the place of interiority that we go for required enjoyment and renewal. “Egoism,

enjoyment, sensibility, and the whole dimension of interiority —the articulations of

separation—are necessary for the idea of Infinity, the relation with the Other which opens

forth from the separated and finite being” (Levinas, 1969, p. 66). Thus interiority may be

interpreted as a psychological haven, where the separation of the I from the exterior is

secured. Separation is also achieved by a physical partitioning of a space that is personal

and private. And that physical space is called the home.


The home is a place of refuge from the responsibilities of the world. As Levinas

(1969) writes, “To be separated is to be at home with oneself” (p. 147). The isolation of the

home provides a respite to the demands of the world. It is a private and comfortable place

that is a sanctuary and a blessing. The home is a place which accommodates my interiority,

and accordingly, allows me to reflect on the conditions of my life. Reflection constitutes the

acts of remembering, recollecting, considering and evaluating. In reflection I am led to a

renewal of ideas, actions, plans and activities that I accomplish in the exterior world. This

respite brings me renewal and generates the energy to enter the world that calls to me from

just beyond the walls of my home, and to act responsibly and ethically within it. Says

Levinas (1969): “The home occupies a privileged place” (p. 152). It is the concretization of a

place of separation and refuge where I can recollect and find enjoyment. The need for a home

is embedded in our nature; so much so that even those with nothing still seek to delineate a

private space, be it a cardboard box, in order to sleep relaxed and unguarded.

Consider then the psychological perspective of interiority, the confluence of mind and

body, where we exist in our ipsiety. This is the center place of the I: our cognitive thoughts,

our embodied feelings, all components of our unrelenting observant ego. It is a private

interior world that none can enter. It is a given that when we enter the world we present our

face to the Other, so passive and expressive, which is beyond our very control. But to share

in our psychological interiority we must speak; for it is only in dialog with the Other can we

avail ourselves to the exteriority of the world.

Our psychological interiority provides us a place to dwell in comfort, to be at home

within ones self. However, while psychological interiority presents a barrier to the world, it

cannot be so concrete as to prevent the world from reaching me. Interiority must be a

permeable membrane, susceptible to penetration by the exterior world, and must permit our

senses to feel and respond to its influence. “In the separated being the door to the outside

must hence be at the same time both open and closed.” says Levinas. (1969, p. 149) If one

was to exist only in interiority they would be so introvert they would live in narcissistic

isolation; if one lived only in exteriority they would be hyper-manic. In either case, their

existence would be psychosis.

The Meaning and Objective of Psychological Therapy

A patient comes to therapy for many reasons. They may be facing an immediate and

stressful crisis: the ending of a major relationship, the death of a loved one, a financial

catastrophe, or a health setback. Perhaps they are experiencing deep depression or

excessive mania, or a cycling between them. They may be facing a joyless and general

unhappiness and dissatisfaction in their life activities, relations with others and profession.

Or, they may be experiencing a more deeply felt loss of self esteem, an acute sense of

anxiety and an eerie feeling of disconnection from the world in which they live, leaving

them drifting and alienated. Maybe they have fallen into a habitual pattern of destructive

behavior such as gambling, consumerism or substance abuse. The reasons go on and on.

All aspects of the human condition and their sufferings are represented by our patients: the

neurotic, the psychotic, those with mild or deep seated behavioral issues, mood disorders,

loss of identity, life crisis, anxiety and alienation, or existing in a joyless and negative state.

What do all these conditions have in common? They are our dysfunctional

reactions to existing in the world, of human life itself. The consequence of these events is

the embodiment of suffering, which more often than not, results in psychological

internalization: a fixed condition of separation, loneliness and hopelessness.


The practice of psychology, with its methods, processes and techniques for relating

to the patient, for treating their cognitive, behavioral and affective disorders, goes just so

far. It is not in the realm of psychology to address the underlying meanings of life; it cannot

present a context of existing, and for that we look to works of philosophy. Here we seek an

existential and metaphysical context in which to organize and secure a psychological


This is where the Levinasian notions of interiority and exteriority, the alterity of the

Other and the practice of ethical responsibility come into play in the therapeutic forum. It

sets a philosophic view of human existence, defining the bounds and benefits of separation

from the world and the responsibility we have for our self and for the Other. From this

philosophic point of view the psychologist can approach the patient in treatment, enabling

them a path from suffering to transformation.

What then is the goal of ethical psychological therapy? Alvin Dueck and David

Goodman (2007) first provides a picture of what it is not: “The goal of therapy is less a

matter of the self discovering itself but the therapist engaging in self sacrifice in the

presence of the patient (Sorenson, 2004) The focus is less on encouraging the patient to

assert him or herself, exercise rights and power, master the ego and the environment. The

goal is not so much individuation from the Other, the constellating of a unique identity. Nor

is the self constellated in comparing oneself to Others as one being among many so as to

discover one’s uniqueness in abilities and differentness in personality” (2007, p. 615). In

Levinasian terms the goal of therapy is to enable the patient to exercise the ethical call to

responsibility: to care for the Other. As Steen Halling (1975) writes: “The therapy situation

might then not just be a protective environment where one is relieved of distress, but a place

where one is called from unreal obligation and false guilt to real responsibility and genuine

guilt in the face of the Other. It is not just a situation in which I as the therapist am simply

involved in divesting someone of fantasy preoccupations, maladaptive behavior, or in which

I am the dispenser of "insight." More fundamentally, it is a situation in which the Other

calls upon me to be responsive” (p. 218).

The Notion of Interiority and Exteriority in the Therapeutic Forum

It is posited that a substantial portion of neurosis and psychoses is founded on an

obsessive focus on the patient’s conditions of suffering, such that they remain fixed in their

personal interiority, unable to sense and break through the barrier that partitions them from

the world. This is a psychological condition that locks the mind, behavior and affect,

resulting in a sometimes profoundly dysfunctional existential state. The suffering patient is

stuck egoistically in their interiority, unable to recognize or respond to the callings of the

exterior world. They may be fixed on their own problems and immediate issues. Their

perspective may be self-centered and narcissistic. They may feel distrustful or paranoid.

Whatever there state of existence is, one thing is clear, they are feeling encapsulated in their

personal interiority.

Existence is not static and all is in constant change; it is only in mental dysfunction

and emotional disturbance that one’s life seems static and unchanging. “With alienation,

isolation, loneliness …we can summarize the fact that all these mental states never stand by

themselves and are never abstractions, but ceaselessly reveal themselves in the reality of the

surrounding world, in the reality of objects in the reality of personal relationships, and in the

reality of body and of time” (Berg 1972, p. 108). In other words, in neurosis and psychosis

the patient is stuck in a timeless and unchanging existence, locked in an internal separation

infinitely distant from the fraternity of Others.

We are in our nature intersubjective beings. It is in our wiring as the human animal,

when at the dawn of man, we huddled together in social bond to insure our survival. Within

the Levinasian perspective, a radical intersubjectivity can be defined as the relation to the

Other in total passivity and goodness: hearing the cry of the Other, understanding and

appreciating their alterity and in responding with ethically responsible giving. The one who

suffers presents their face to the Other, so passive and expressive, which is beyond their

very control. However, even for the sufferer, a radical intersubjectivity places an ethical

responsibility for them as well: they should try at least to recognize the gifts that the Same

provides. When the sufferer is locked beyond their ability to control their interiority, this

essential intersubjectivity is broken, and psychological pathology must surely follow.

The suffering patient that is hopelessly caught in interiority is unable to enter the

world to announce their suffering. They cannot intentionally turn their face to Others

around them. They cannot intentionally cry for help in a voice that can be understood.

They cannot hope to receive the aid of Others; they are unable to receive gifts when given.

They are lost and adrift in an interior that permits no contact. There is yet another loss in

this rigid interiority. As they are mute and have no voice for calling, they have no ears to

hear the cries of Others. They cannot go beyond themselves and cannot break the crust that

separates them from the exterior. There is little if any sense of intersubjectivity. There is

no opportunity to meet the ethical responsibility to the Other. To do so would require a

release of focus on their own suffering, an egoistic grasp that obscures everything but their

pain. They miss the bond of fraternity. And worse yet, they deny themselves the

opportunity for transcendence found in the move to ethical responsibility to Others.

As a patient they are present in the therapeutic encounter, which by itself is a first

movement to exteriority, and herein provides a strategy by which the ethical therapist can

be of aid: to be a constant beacon of the exterior, a representative of fraternity, and an

enabler of intersubjectivity, such that the patient can begin to penetrate the barrier that

separates them from the world.

When a patient comes to therapy in a state of interiority, too fearful, stuck and weak

to act, the therapist can work with them to build an opening of hope and possibility. It is in

these cracks in the wall of interiority that the patient can exercise the courage to achieve a

movement to exteriority. As the patient comes to understand their relation to the Other a

shift in their existential existence may occur. They are no longer held in a lived-experience

of isolation. They can freely express themselves to Others, they have the ability to

recognize and receive the gifts of the Other, and they can find an existential comfort in the

relation. Now that interiority is made porous, a different context of existence is available to

the patient.

Thus enacted, the patient’s psychological transformation may be achieved: less a

goal of self discovering and personal mastery, and more the recognition and assumption of

ethical sacrifice and service to the Other.




This section presents a series of psychological issues that arose during my practicum

at a community-based mental health clinic. As opposed to the theoretical philosophic

considerations such as those described in the first section, these issues were presented to me

by the face of the Other, the suffering patient, with whom I am engaged in psychological

treatment. What I am probing is this: in the face of such concrete presentation, and piteous

suffering, what can Levinas’s philosophy do to address the urgent needs of these patients? A

discussion of the world of the clinic is first presented, followed by an evaluation of the

psychological disposition of the patients I am treating. For each psychological theme the

application of Levinasian philosophy is discussed.

On the Formation of Interiority

The first section of this paper argues that suffering, and the other vicissitudes of life,

draw us away from the world and into our own interiority until we are stuck in an internal

prison unable to get out. In reflecting on my therapeutic practice, most patients

acknowledge the “stuckness” of their psychological disposition. They cling to their

distorted beliefs that drive them to interiority despite knowing that their terrifying grasp

holds them back. As Patient C stated on more than one occasion “…it is more work to stay

stuck then to take a risk…” and went on to say that “…it is madness to hold so tightly to an

idea that serves me so poorly.” What drives these poor people to cling to such mistaken

ideas and conclusions about life which distort all expectations and drive them into a

secluded madness?

One path these erroneous conclusions develop is at an early age, when the child is

called upon to make sense of the suffering he or she feels within and about them.

Confronted with a dysfunctional family life, confused and inconsistent attachments, and

outright abusive physical and emotional relationships, the sensitive child seeks an

explanation to make sense of their suffering. But their sense is limited to a child's world and

experience; they do not possess a broad view or a nuanced understanding of the world.

Thus, their explanation of suffering is presumed to be caused by their own faults and

limitations. In explaining his general sense of unworthiness, Patient C said “I was always

told as a child what I thought and felt was not right.” He could not recognize his

remarkable sensitivity to the world as a positive attribute, but rather, sought to deny and

destroy it in the wake of the Others taunting and derision. In another case, Patient F simply

concluded in childhood that “My feelings are not my friends.” Having put her feelings

aside, she had no measure or compass in which to evaluate critical life decisions. Instead

she went fumbling through unproductive and discouraging human relations throughout her

life, all the while searching in her interiority for the missing components of existence that

she felt were so lacking.

The bleak ramifications of a misguided conclusion about life are not limited to

children. Be it through worldly circumstance or by interior failure, misery and suffering

demands an answer and even as an adult we choose explanations, beliefs and conclusions

that fail to serve us well. These misguided notions distort reality, diminish our transcendent

capabilities and leave our psyche dry and lifeless. An example was Patient G, a person who

grew tired of the repetitive calling to life that life itself is, and intentionally withdrew,

resigning from the world in shame, guilt and self-hatred. Yet another person, Patient B, who

through the unfortunate circumstance of ill health, first of his dying wife and then of his

own bodily illnesses, drifted into a state of existential doubt, having come to the conclusion

that resolution and joy was beyond his reach.

Levinas and Psychotherapy

Prior to delving into the mapping between Levinasian philosophy and psychological

treatment it is important to briefly examine the contentious and often misunderstood

relationship that Levinas had with psychotherapy. It is an absolute given that in Levinasian

philosophy the ethical relation is a foundation of human existence. Further, the ethical

relation precedes the spoken word and the conscious act, such that it is said: ethics precedes

ontology. “We have called this relation metaphysical… is prior to the negative or

affirmative proposition; it first institutes language, where neither the no nor the yes is the

first word” (Levinas, 1969, p. 42). This notion is also reflected by Critchley (1999) as he

writes: “Ethics does not take place at the level of consciousness or reflection; rather, it takes

place at a level of sensibility or preconscious sentience” (p. 194).

So, for Levinas, any attempt to obscure the metaphysical relation, which is to say

ethics and the implicit understanding of truth before language, is cast into doubt as an

egology that places the self above ethics and the Other. It is this suspicion that Levinas

holds against psychotherapy: that it reinforces the self at the expense of ethics.

However, Levinas’s view of psychotherapy may be too narrow and parochial for a

true understanding of the objective of psychology, for its ultimate aim is not the

aggrandizement of an individual ego and its strength and domination over Others. Rather,

psychotherapy focuses on the ability of the patient to tolerate the discomfort of the original

trauma, that is to say, the alterity of the Other, and by extension, the obscurity of ethics by

egology. Psychotherapy enables the patient to grasp the metaphysical relation and to

experience the commandment of ethical behavior that is intrinsically a part of our humanity.

The revelation of the ethical relation results in the realization that caring for the Other is

indeed a transcendent experience that brings primal comfort to the existential angst that

plagues the unsettled patient. Psychology, therefore, is the means to a clearing such that

ethics can be discovered and experienced which leads, by manifest-destiny, to the

subjugation of egology, which is in fact the answer to the call of the Other, and opens the

door to the very ethics that Levinasian philosophy espouses.

World of the Clinic

I serve at the YWCA/Pathways Community Mental Health Clinic which primarily

serves the low income population of Snohomish County, located north of the City of

Seattle. While the clinic is contained within the YWCA (the women’s membership branch),

services are provided to men and women of all ages and includes individual, child, couple,

family and group counseling activities. Services are available on an out-patient basis, by

appointment only. Excluded are persons who present current domestic violence, drug

addition or those who, as a result of mental distress, are incapable of managing a relatively

stable living environment. While the population and problems are diverse, the patients all

have one attribute in common: poverty.

The effect of poverty is insidious and is pervasive in the lives of patients. It

exacerbates difficulties in all of life’s situations: housing, food, transportation, employment

and alike. It aggravates familial and social relationships. It diminishes self-worth and

obscures possibilities and the will to change. It fosters a desperate need to escape into

numbness using alcohol, drugs, food or other behavioral anesthetics. It instills an anger and

resentment that causes pain to others while diminishing the spirit. It exaggerates mental

illness and in some cases may even trigger and drive it. Further, it is difficult, and

sometimes almost impossible, to treat psychological issues when the patient is facing

practical problems, such as homelessness or basic living concerns, that would be daunting

even for those of sound mental health to handle. So, part of the role of the therapist in the

community clinic is to provide some level of case management, which at a minimum,

consists of referrals to other sources of social services.

The clinic is structured in an unusual and compelling way for a mental health

services organization: it is viewed as a collaborative of individual therapists, each

independently conducting intake, therapy and services, acting under the general supervision

and rubric of the administrative staff. The clinic has deep and extended roots within the

community and practices a patient-centered therapy where the health of the patient is the

primary focus. As such, obstacles that distract from this gaze are carefully managed:

bureaucratic paperwork and reporting is kept to a minimum and decisions that concern the

patient are based on the best therapeutic effect and not on the ease or benefit of the system.

For example, a patient is never refused treatment for lack of payment. There are several

funding streams including Community Service Block Grants in addition to other community

and non-profit funds that subsidizes treatment services. The therapist may select patients

from the intake process and can formulate a therapeutic strategy that is well matched to the

patient, within the context of ongoing collaborative supervision. Within this nurturing

environment, the soon-to-be-therapist can expect warm and collaborative support from their

colleagues that include paid staff, externs and fellow interns.


The sense of the clinic and the sensibility of its members make it an attractive

workplace. I admire the irreverent attitude to rigid enforcement of procedures in deference

to the care and treatment of the patient. During my introduction to the clinic two

significant impressions emerged: first, the care and health of the patient is primary; and

second, the therapist is recognized as a valued and respected care giver who receives

nurturing support and supervision. Taken with these two compelling messages, and the

expectation they induced in me, it is little wonder that I enthusiastically accepted the

internship position offered me.

World of the Patient

In the months since I first arrived at the YWCA-Pathways Community Mental

Health Clinic I have had time to experience what it is like to work in a community-based

setting serving the underprivileged and disenfranchised. Some of my illusions have been

broken with astonishing swiftness and power. Of these are the realization that when

working with patients whose basic living circumstances are precarious, therapeutic

treatment of psychological issues are sometimes, and I think I can say more often than not,

set aside in deference to the immediate pressures of housing, work and social necessity.

Driven by unending class, race and gender pressures, hyped with poverty and a constant

sense of vulnerability and exclusion, patients of the clinic require so much more than

psychological counseling.

Extended case management addresses how a person can maneuver through the rules

and policies of social service programs offering housing, medical, food and employment

safety nets. When looking at the abyss of homelessness and hopelessness, the concrete

solutions that case management provide sometimes trumps the softer issues of

psychological neurosis, depression and anxiety, all of which may be reasonable emotional

reactions to unreasonable life circumstances.

Given the complexity of this discussion, how does a therapist, whose approach can

range from the concrete to the ephemeral, choose to work with the patient in the clinical

setting? For many patients of the clinic, first addressing the most immediate crisis of

hunger, housing and safety seems the only reasonable path. While this is more a case

management task, it is unlikely that any therapeutic progress can be made until these issues

are settled. However, even when safety is not a concern, it is not often that issues of

existential enlightenment can be immediately addressed. Rather, it is the pressing issues of

emotional upset and reaction within a context of interpersonal relationships or productive

work that are likely to be tackled. Here, there appears to be two paths to take. The first

choice is a directed-focused approach where the therapist and patient work together to form

a solution, part cognitive, emotional, and intersubjective, in which to solve a specific issue,

an objective, within the trajectory of a longer held arc of life. The other path is one that

provides the patient with a clear and open space in which to explore whatever sensations,

emotions, thoughts and intersubjective feelings that are shared in the little theater of the

therapeutic dyad. This is a longer term endeavor, an act of creation from the elemental

constructs that are embedded in our basic nature and brought forward in our unique identity.

It is an effort of mutual exploration, plowing the depths of raw existence and inspirational

attainment; it presumes a breaking of the boundaries of external societal power and internal

self-imposed limitations, which more often than not, make grotesque the expectations of


A survey of patients

Table 1 presents a rudimentary evaluation of twelve patients that I worked with

during my practicum at the YWCA–Pathways Mental Health Clinic. In particular, the table

highlights various psychological dispositions patients presented, and evaluates the extent of

their commonality amongst the group. It is asserted that these psychological dispositions

reflect drives toward psychological interiority. In many cases it is the unjust or irrational

circumstances of the world that torments the individual, which include: child abuse, trauma,

societal pressures and general poverty. These worldly factors cause an intrapersonal

reaction that result in a dysfunctional focus on personality deficiencies, spiritual alienation,

and psychic annihilation, which presents in the following symptoms and behaviors: anxiety,

depression, physical illness, substance abuse, poor body image, alienation, existential crisis

and hopelessness. These psychological presentations and subsequent behavioral symptoms

are not an exhaustive list in the least; however, they are the ones that have been presented to

me during my practicum.

The key assertion is that for all these patients, worldly factors and their

psychological reaction to them result in an attachment to interiority that prevents them from

improving their cognitive, behavioral, emotive, and spiritual existential state. They are

stuck in their own interiority, desperately clinging to their dysfunctional behavior, which is

more often than not, formed by their mistaken impressions and conclusions about the world

created to explain and rationalize their very own suffering.

The demographic section of Table 1 is limited to the most general information

associated with each patient in an effort to ensure a degree of confidentiality and privacy.

Accordingly, demographic information is restricted to gender, age group by decade,

whether the person is currently in relationship with another, and whether they have had

children. In reviewing these demographic statistics one finds that: 66% of the patients are

female; 58 % are currently single (interestingly, all male patients are currently involved in a

couple's relationship); most patients are in their 40s and 50s with the average age being 47;

and 85% had children, with the average number being 2.35 children per patient. None of the

patients were a member of an ethnic minority, which may be statistically explained given

the demographics of the county is close to 90% Caucasian. The religious upbringing of the

patients was not collected though it is presumed that all of the patients come from a Judeo-

Christian heritage.

With regard to the psychological predisposition of the patients, three critical

elements that affect 75% of the group come to the forefront: trauma, substance abuse, and

depression. These three factors are not unrelated. Trauma, and most notably child abuse, is a

profound experience that impinges on the very integrity of the self and causes alienation in

various forms. Further, it drives a need for avoidance and numbing that substance abuse,

both alcohol and drugs, attempt to provide. However, there is no escaping from suffering

and depression, which is a form of psychological repression and emotional numbing, that is

so prevalent among the population.

To build the table of psychological predispositions, patient files were examined to

extract key psychological themes that were presented during therapy. To accomplish this a

qualitative research method was applied that involved the analyst’s engagement in a

hermeneutical interaction with the patient records. This process reflects a fusing of horizons

(Gadamer, 2004) between the therapist and the patient that result in an interpretive

understanding of the material. There is a cyclical flow in the hermeneutic approach such

that interpretations of the parts influences the whole and spurs a circle of ongoing

reconsideration of interpretations. The result was an ever widening and deepening spiral of

understanding and the emergence of the key psychological conditions of: child abuse,

trauma, alienation, poverty, productive work, substance abuse, health, body image, anxiety,

depression, hopelessness, and existential angst.

Having identified 12 psychological conditions, these were then clustered into higher

level groups of thematic meaning. This act of aggregation enabled a clearer understanding

of the meanings and dynamics of the lived experience. Through the process of clustering

key characteristics of super-ordinate themes emerged and the relationships between them

became evident. Clustering is an interpretative process, applied in much the same way as

described in the previous analytic steps. The analyst brings their experience to the survey

data and employs their cognitive, affective and embodied sensations as tools to identify and

interpret clusters of meaning. Analysis criteria may be varied and includes concepts such

as: abstraction, sublimation, polarization, contextualization, numeration and function. The

process used in this study was to reflect on all psychological conditions, and then organize

them into logical groupings, based on an abstraction criterion, using a spiraling hermeneutic

process of engagement with the material. What emerged as a result of this process were

three super-ordinate themes: (1) trauma and abuse, (2) power, economy in society, and (3)

the ineffable body. The super-ordinate and psychological conditions (now referred to as

sub-themes) are represented in the headings on Table 1.

The super-ordinate theme of trauma and abuse consists of the sub-themes of

childhood abuse and trauma, in addition to the experience of alienation, which is a closely

linked effect of trauma. The super-ordinate theme of power, economy and society groups

together sub-themes that are experienced by patients as a consequence of the power of the

world over the individual. The influence of power and economy bears directly on the

patient's ability to find productive work and escape poverty. Substance abuse, body image

and physical health are all influenced directly or indirectly by society’s cultural, economic,

political and moral messages that cause distortion and misinterpretation within the psychic

structure of the patient. Finally, there is the ineffable body, which refers to the sacred and

transcendent human being, too mysterious and resplendent to be expressed or captured in

words. It is this body human that contains, as a vessel, the transcendent exaltation's of life;

but this vessel also experiences the states of human suffering that is anxiety, depression,

hopelessness and existential angst. In the expression of these three super-ordinate themes

this paper looks to Levinasian philosophy to shed light on the psychologically therapeutic


Table 1: Patients and their psychological disposition


In the following sections various aspects of worldly factors and the psychological

reaction to them are examined from a Levinasian perspective. What, for example does

Levinas have to say about trauma, societal circumstances of power and economy, and the

states of the ineffable body? As each area is examined the implications of Levinasian

philosophy may bring to light a psychological approach to addressing the patient's issues

that drive them to interiority and the closing of themselves to the world.

Levinas on Trauma and Abuse

Trauma is the result of profoundly painful psychic and physical assaults. It is an

overwhelming experience that is processed by the victim in many ways. Trauma of any type

may result in devastating effects in the life of those who have experienced it, sometimes

leaving a person incapable of living a joyful and productive existence. Often deeply

traumatic events, both psychic and physical, are so overwhelming that the victim needs to

separate the cognitive and emotive memories from their awareness in order to preserve the

integrity of their very self. This defensive dissociation provides a mechanism to handle the

effects of trauma in the short term. However, as with any defense that is employed for too

long, or is too effective at maintaining an umbra of unawareness, it may develop into a

pathological condition in itself. Such is the case in treating traumatic experiences: often it is

not just the trauma that needs to be exposed and resolved, but it is the defensive

dissociation, that cocoons the memories of trauma, which need be exposed as well.

What is the defensive dissociation and what are the memories that have been

repressed? It is argued that in the wake of trauma the very nature of humanity is lost on the

traumatized: they cannot see past their own sense of distorted experience, which repeats

over and over in their daily existence.


Levinas first presents trauma as an experience of the alterity of discourse “…is thus

the experience of something absolutely foreign, a pure "knowledge" or "experience," a

traumatism of astonishment…” (1969, p. 73). However, for Levinas, trauma goes far

beyond discourse and enters into the realm of the presence of the Other. That is to say that

the very alterity of the Other, in the presentation of their face to the Same, in their helpless

and seemingly insatiable suffering, and in their so passive call for assistance in their

suffering, all this and more, this experience of witnessing by the Same is a trauma that

assaults the Same and has the potential to overwhelm and diminish. This is construe as an

original trauma. “Astonishment is traumatic because it is occasioned by, and is itself the

occasion of, the breakup of self-consciousness from within and without. The other breaches

the ego from within, in the disguise of the idea of infinity overwhelming cognition and from

without, as the abstractness demanding a response” (Roesch-Marsh, 2003, p. 310).

Simon Critchley (1999) drives this interpretation to additional clarity as he reflects

on alterity as a traumatic intercession with the Other, and goes on to assert that it is this very

trauma that serves an ethical purpose.

The Levinasian subject is a traumatized self, a subject that is constituted through a

self-relation that is experienced as a lack, where the self is experienced as the
inassumable source of what is lacking from the ego — a subject of melancholia,
then. But, this is a good thing. It is only because the subject is unconsciously
constituted through the trauma of contact with the real that we might have the
audacity to speak of goodness, transcendence, compassion, etc.; and moreover to
speak of these terms in relation to the topology of desire and not simply in terms of
some pious, reactionary and ultimately nihilistic wish-fulfilment. Without trauma,
there would be no ethics in Levinas's particular sense of the word. (p. 195)

However, what happens when we are overwhelmed by the infliction of the Other,

not just their presence, and their face, but by the deliberate and brutal violence promulgated

on the Same? Bernet (2000) writes there is a compellingly strong consistency between

Levinas view of trauma and “in the psychoanalytic sense …the event of the encounter of the

subject with something totally foreign that nevertheless irremediably concerns it and does

so right in its most intimate identity” (p. 162). So, the effect of experiencing the trauma

that is the alterity of the Other is to neutralize the Same into diminishing their self into

something disconnected from humanity, unable to recognize the Other in any sensible way,

and to retreat into a protective interiority. Further, the more violent the imposition of the

Other is on the Same, the deeper and more compelling is the drive to interiority. This

interiority may involve a psychic and spiritual sense of fragmentation, separation and

disconnection: “…the traumatized subject is thus submitted to an excessive tension, because

it remains torn between two contradictory imperatives: appropriating the foreign to itself

and rejecting it in order to preserve that which is its own” (Bernet, 2000, p. 170). Bernet

brings forward three lessons in the nature of trauma from the Levinasian perspective. First,

trauma is by its nature shocking as there is no preparing for the experience. Second, alterity

has no prerequisite to past experience. Finally, the third lesson is that profound traumas

strike a “…bodily sensibility and not in its recognitions or cognitions” (p. 173).

Childhood trauma

In her book, Trauma and Recovery, Judith Herman (1992) writes “Recovery can

take place only within the context of relationships; it cannot occur in isolation” (p. 133).

Following this observation, the intersubjective relationship is crucial in establishing a sense

of safety for the patient. Most of my efforts in the therapeutic forum focus on establishing

and enhancing a relationship of mutual respect and bidirectional dialog with the patient.

This leads to willingness on the part of the patient to access and express feelings, thoughts

and sensations that would otherwise be inaccessible or unspoken. It is an extraordinary leap


of faith, a belief nurtured in the therapeutic relationship, for the patient to face and share his

or her trauma. This is illustrated in the following case study.

Patient C, a 50-year-old male, had for the past five years been disabled and was

unable to work due to an injury. Now that his recuperation was completing he was facing

the difficult prospect of reentering the workplace. In the face of this pressure he reacted

with profound anxiety and depression, and was convinced that he would be unable to find a

job. He began to envision himself becoming alienated, homeless and despondent. Despite

our numerous attempts to address the practicality of his situation - to examine his feelings

of distress and develop a plan of small steps to help enable him in finding employment - he

was unable to make any progress. With the Christmas and New Year's holidays approaching

Patient C’s outlook took a significant downslide, with Patient C seeing the world as a

painful deteriorating place that ground inevitably to diminishment and death.

Sensing that our intersubjective relationship had reached an impasse, I decided at

our next session to conduct an intervention of sorts with the aim of stopping his emotional

backslide and to inculcate a voice of support and hope within him to counter the obsessive

self- narrative of unworthiness and hopelessness. During the session I pressed the following

key objectives: to reflect back to him that he was passively heading into an abyss; to call

out the existential conflict he was engaged in - one of life and death; to acknowledge the

difficulty and greatness of his conflict and to assure him he had resources, including the

safety and support of our therapeutic sessions; and finally, to prevail upon him to make a

choice to live and to bring a voice of life and hope into his personal narrative. It was a

somewhat dramatic and difficult session for the two of us to engage in. However, Patient C

left convinced of the genuine care and concern I had for him, which I hoped would instill a

sense of safety in our relationship and motivate him to take renewed action in his life.

In a series of extraordinary sessions that followed this intervention these hopes were

realized. On the job front, Patient C completed a resume, bought a sports coat, and made

arrangements to participate in the next job fair that was hosted in the area. More

surprisingly, however, was his ability to build on an increased sense of safety that resulted

in him disclosing a deeply traumatic event that occurred to him in childhood. This was

something he had not shared with anybody in 35 years, an event that he kept hidden in a

cage of overwhelming shame and sense of unworthiness. This traumatic event was crucial

in understanding Patient C’s current lived experience and would be further explored in

future sessions. The key lesson here was that Patient C saw the therapeutic relationship as a

partnership, as evidenced by my willingness to support him even when he felt he was

unsupportable. This realization created a deepening intersubjective relationship and instilled

a greater sense of safety that enabled him to express a deeply held childhood traumatic


Trauma and alienation

The previously cited observations lead to a possible approach for treating the

traumatized patient in a manner that is consistent with Levinasian philosophy. In particular,

the view that trauma is an embodied sensibility points to a means in which to reach the

traumatized patient. I present as an example Patient K, who had been in therapy for many

years, was freely able to describe the traumatic sexual, physical, and psychic assaults he

suffered as a child at the hands of his parents and other guardians. However, his narratives

were hollow and devoid of affect. Frequently in our sessions he would drift, in mindless

numbing or a zoning-out, and I too, through the process of projection, began to experience the

uncanny feeling of unanchored floating as we sometimes struggled to talk.

During the initial part of a particular session I tried various ways of exploring the

phenomenological experience of the patient's anxiety associated with childhood trauma. I

tried to encourage the patient to reflect on the embodied sensations he was feeling. This is

consistent with Gendlin’s focusing approach to psychotherapy in which he asserts the notion

of the direct referent. This sensing is yet another avenue of experiencing the world. “…in

addition to external objects and logic, we also have an inward bodily feeling or sensing”

(Gendlin, 1964, p. 111). I will have more to say about embodiment in the next sub-section of

this paper. At this point the patient presented a dramatic and vivid description of the bodily

sensations he felt: “In my stomach…it a lot of times feels like I'm holding something in my

stomach” (Private transcript, January 24, 2011). And again this imagery reprises a little later

in the session: “It feels like there's a really bad storm inside. [Long pause] I don't know…a

lot of emotions all tied up together I can't tell which emotion is which. That I feel like I have

to hold it or that it will all go crazy.”

This statement could not be clear: that which was repressed, the lived experience of

trauma in its raw emotional and overwhelming presence has been relegated to the body,

banished within its core, where it resides as a dissociated emotional memory. And what was

it? All of the lived experience of trauma: the sexual abuse, the horrific taunting, and the

diminishment of a child's will to grow into a happy and fulfilled person - all of this packaged

in a physiological sensation that demanded full and ongoing containment least it get out or “it

[I] will all go crazy.” Here now is an exemplar of defensive dissociation caused by trauma:

the emotional lived experience too terrible to feel, too consequential in its ramifications in all

aspects of life, are broken off into an umbra of not knowing, a distant unawareness, if only for

the embodied sensation of a knot in the core of the body that when provoked can only be

sequestered by a mindless numbing or a zoning-out.

While Patient K was unable to reach a point of full recognition of the meaning of his

trauma, the treatment plan was clear: to have the patient come to recognize the trauma done to

him and to see the Other, who so badly inflicted pain upon him, as a human being suffering

with all their flaws. And while it seems impossible, that despite his self, Patient K would be

able to find the humanity and the goodness of understanding his tormentor and to enter into a

path of forgiveness and reconciliation.

Trauma and Forgiveness

Levinas introduces the term proximity in which to approach both the spatial

positioning of the Other, presented as an assaulting alterity, coupled with a temporal

discontinuity between the past and present. Even in the break between distance and time

the overwhelming trauma, so inflicted by the Other, needs to be addressed in the most

gentle and giving of ways, despite itself:

Chosen without assuming the choice! If this passivity . . . can be conceived to be on

the hither side of freedom and non-freedom, it must have the meaning of goodness
despite itself. . . . Goodness is always older than choice, the Good has already
chosen and required the unique one. (Levinas, 1981, p. 56–57)

Yet another view is contained in the Levinasian term substitution, which represents

the idea of a drawing nearer such that the Same and the Other are both as one and as

distinct, metaphysically coupled in time and space, but seemingly suspended in dual and

complementary states. Such a relation transcends egology and selfhood, sacrifice and

burden, and enters in the frame of the immediate and implicit where the assumption of

responsibility for the care of the suffering Other is coupled with the realization that the

Same is the cause of it as well. Such a position may open the door to the impossible: the

forgiveness of the persecutor by the tormented and traumatized.

Every accusation and persecution, as all interpersonal praise, recompense, and

punishment presuppose the subjectivity of the ego, substitution, the possibility of
putting oneself in the place of the other, which refers to the transference from the “by
the other” into a “for the other,” and in persecution from the outrage inflicted by the
other to the expiation for his fault by me. (Levinas, 1981, p. 117-118)

Even in the worst inhuman and traumatic conditions, such as those described in the

Nazi death camps by Viktor Frankl, there is still a responsibility for oneself and for Others,

and the ability to overcome the suffering of extreme trauma. ”The more one forgets himself-

-by giving himself to a cause to serve or another person to love--the more human he is and

the more he actualizes himself. What is called self-actualization is not an attainable aim at

all, for the simple reason that the more one would strive for it, the more he would miss

it….in other words, self-actualization is possible only as a side-effect of self-transcendence”

(Frankl, 1963, p. 133).

The dynamics of the domestic abuse relationship is a complex one with multiple

competing psychological forces at work, making the situation difficult to live with by both

the perpetrator and victim, and clouds the ability of the therapist to map out an affective

resolution. Such was the case with Patient E, who was engaged in a dysfunctional and

abusive relationship with her boyfriend X, with whom she was living. X was an addicted

drug abuser who was thoughtless and disrespectful to Patient E at every turn. Their

relationship was three years old and had been degrading significantly in the last year or so.

Patient E reported that X was verbally abusive to her saying mean and disrespectful things

at every opportunity, and included comments about her weight, her emotional state, and her

sense of worthiness. In response Patient E would get extremely angry and enraged,

particularly when she drank, at which point she described herself as ‘mean drunk’, without

caring at all about the Other. In May of last year their fights became so bad and so intense

that the police were called to intervene and a legal restraining order was secured by Patient

E. However, their relationship continued and the abuse did not stop. When I asked Patient

E what she thought X got out of the relationship she replied she paid the rent, provided

money for him to buy drugs, cleaned the house, did the laundry and performed ‘motherly’

duties. When I asked why Patient E stayed in the relationships she said: “I love him.” She

hoped he would stop taking drugs; but later acknowledged that she knew he would never

stop. So, what did Patient E get out of the relationship? She went on to say, almost spoken

in a sad, defensive and nervous laughter that the reason she stayed in this abusive

relationship was her fear of living alone. That is to say, that her feelings of isolation, and

alienation were overwhelmingly painful for her to deal with and that in comparison the slow

cuts of verbal abuse and relationship dysfunction were a small price to pay for avoiding the

impossible feelings of loneliness.

What then is the meaning of Patient E's statements about the relationship and her

desire to stay within it? It may be too simplistic to say that she sustained the relationship in

solely in the fear of the terrifying loneliness that was sure to be felt should it come to an

end. While she could not explain her statement “she loves him” it may very well be that

what she feels, in the intensity of this dysfunctional relation, is a powerful allegiance and

connection to the idea of forgiveness: the hope and restoration of the persecuting and

predatory Other. This may be a perverse twist in the ethical relation, one based on an

internal and self-satisfying egology, a fantasy of her need for her own forgiveness, hope and

restoration. But an underlying metaphysical and ethical foundation may be at play here.

That is to say, in the suffering of both the persecutor and persecuted the desire for a

transcendent ethical relation is not lost. Is it possible for an ethical relation to be

paradoxically presented in a violent expression? It cannot, but a corrupted ethical relation,

born of an initial attempt at goodness but perverted in suffering, can and will.

Here is a possible approach for psychological treatment: the appeal to each of the

parties to recognize the humanity of the suffering Other, to disarm themselves at the

presence of the Face, and to engage in the Levinasian view of substitution. Such may be the

path of redemption for both the tormentor and the tormented. While forgiveness, the

metaphoric act of reversing time and neutralizing offenses may not happen in the absolute,

the metaphysical relation created by the intuitive understanding and amelioration of

another’s suffering, to the transcendent surprise of the Same and the Other, may be


Levinas on Power, Economy and Society

There is a paradox implicit in the nature of power and economy within society. That

is to say, the powerful and affluent are directly connected to, and cannot escape from, the

impotent and poor. The empowered and the disenfranchised are coupled together in a

dance that neither can break from. Both conspire together in a dysfunctional codependent

relationship. These paradoxes, set in context in Levinasian philosophy, are best described

by George Kunz (1998) in which he writes:

What are the paradoxes of power and weakness? The response is: power can be the
very basis of powers weakness as well as its power; and weakness, still weak, can be
the power of the weak. At the foundation of both the individual and societal
struggles of weakness against power and power against weakness we find these

unnatural paradoxes: power nurtures its own weakness and weakness possesses its
source of power in that weakness. (p. 14)

The Third, power and economy

In reflecting on society, Levinas introduces the idea of the Third, which is a

reference to all Others aggregated together into a societal whole. But while the Other has a

face, and his call is immediate and personal, the Third is anonymous and distant. How can

the Third be called to recognize justice and be heard by the Same as he would hear an

Other? Such an answer comes of the exteriority of ethics, which is to say that justice, ethics

and moral character are transcendent to life itself and affects the Third as it would any Same

or Other. “In this way, the idea of ethics, coming from outside the manageable world [i.e.

all societal organizations] with other Others, causes an awareness of, and an interest in, the

concept of justice and how this can be managed” (Aaland, 2007, p. 224). So, the idea of an

ethical stance in business or in politics, that is to say, the institutions of the Third, is not

inconsistent with Levinasian philosophy.

Of course, the whole perspective of ethics immediately emerges here; but we cannot
say that is already philosophy… It is in as much as I have not only to respond to the
face of the other, but alongside him to approach the third-party, that is necessary for
the theoretical attitude arises. (Levinas, 1998, p. 103)

According to Levinas, the transactions of money have the ability to diminish the

human encounter and enable the hiding of the face of the Other. This anonymity makes

accessible a contempt for the Other, and he goes on to state: “Expressed in monetary units –

in numbers, prices – these values give rise to homogeneity, letting themselves be compared

and totalized… homogeneity, admittedly, is immediately paradoxical: it offends, in value,

the human services that it bears – related, rightly so, to utility and profit sharing

[inte´ressement] – the unrewardable dignity of this work as human, which as such is pitted

against other principles that are supposedly incalculable” (Levinas, 2007, p. 204). The

question to be asked then is: can an economy function within an ethical standard, or is the

idea of money and its interests apart from any ethical transaction? Put another way can a

business and ethics coexist? This question is examined by Aahland (2007) who argues that

“a reading of Levinas places ethics exterior to management” (p. 225) and goes on to assert

that corporate social responsibility is as possible as a face-to-face encounter.

Likewise, Levinas holds a suspicion of the State having the power to eradicate the

face of the Other through anonymous third-party interactions. But this is not to say that

Levinas is opposed to politics, or the orderly systems in which society is managed. What he

does expect of the societal Third is as follows:

He wants to indicate how the order of the state rests upon the irreducible ethical
responsibility of the face-to-face relation. Levinas’s critique of totalizing politics
leads to the deduction of an ethical structure that is irreducible to totality: the face-
to-face, infinite responsibility, proximity, the other within the same, peace.
(Critchley, 2002, p. 24)

The key question in exerting power, such as political or economic power, is the

intentionality of its use. In a society where its constituency practices the notion of for-

oneself-above-Others, the result is an empowerment of one class over the deprivation of

another, often in an atmosphere of moral disengagement. Albert Bandura’s (1996)

noteworthy article on this topic is a chilling report on the potential for evil in any socially

configured political system, economic enterprise or cultural movement. But more than that,

it clearly describes the mechanism of how moral disengagement can be personally adopted

with the inevitable conclusion that any human being, under the right set of social and

environmental influences, can be corrupted into the complete an entire disregard for the

worth and value of another.


On the question of social justice

One can easily cite horrors of war and genocide as extreme examples, but moral

disengagement is at work in all human endeavors including capitalism and commerce. Our

society is based on a mastery of consumerism and the accumulation and spending of wealth.

Within this context all behaviors, strategies, plans and actions are seemingly available,

without regard to the impact these self-motivated endeavors has on society or the

individuals that comprise it. This can easily be extended to include any industry where

governmental or social pressures attempt to exert a moral curb on their activities. This form

of self-deceit also extends to the individuals that comprise social systems; we are after all

members of the very government we exist in and are employees of the corporations we

work for. We all too easily deny the moral effects of the work we do, but really, most of us

are dumb and blind to the ramifications of our presence and activity in the world.

Bandura (1996) asserts that there exists a power of humanization that matches moral

disengagement. As he writes on page 202: “What is rarely noted is the equally striking

evidence that most people refuse to behave cruelly, even under unrelenting authoritarian

commands, if the situation is personalized by having them inflict pain by direct personal

action rather than remotely and if they see the suffering they cause.” How does this come

about? Bandura continues: “People's recognition of the social linkage of their lives and

their vested interest in each other's welfare help to support actions that instill them with a

sense of community…the affirmation of common humanity can bring out the best in others”

(p. 202). I ask then, is this not a result of the compelling call of the Other, their face and

inexpressively exquisite and passive presence that is so compellingly described by Levinas?


For Levinas, the heart of social justice is expressed in the encounter between the

Other and the Same. While the third-party is a group, a social organization dedicated to

some achievement, social justice is made in the relation between two people; however, in

this context an intersubjective relationship is not at all private “…everything that takes

place here between us concerns everyone…..the third-party looks at me in the eyes of the

other” (Levinas, 1969, p. 212).

Patients live within a societal power structure that exerts its influence toward the

conformity of culture, the vapid promotion of wealth and possessions, and the myth of

individualism and identity. As clinical therapists we are asked to assist our patients in

meeting objectives that implicitly reflect a social expectation of what a contributing

individual is, within the context of a nominal view of societal life: productive and

repeatable accomplishments, consumable relations, and a contribution to the standards and

values of the society that are defined within its hidden framework and power structure. This

may be one overarching lesson that psychological counseling can bring to the distressed

patient in the clinical setting: that their emotional state is a natural consequence of

existence within a social structure and cultural environment that they do not fit into, either

because of personal psychologically-based predispositions, or as more often the case,

because of race, class and gender exclusions that are primarily economic or power based.

Patients within the clinic present a wide range of symptoms that refect

powerlessness: they feel de-centered, useless, isolated, incompetent and impotent (Kunz,

1998). From a cognitive point of view they are distracted, uninformed, compromising,

conceding and indecisive. Their behavior exhibits an attitude of indifference, unhelpful,

unaccommodating, defeated and ineffectual. Finally, their emotional disposition is


apathetic, deflated, relinquishing, lost and not in control. All of these factors contribute to a

rigid assumption of fatalism: that their life is predetermined to be deprived and their future

has little if any possibility.

Levinas would argue that to break from this confinement, this willful interiority, one

would look toward the face of the Other; that is to say, though the Same may appear

powerless, in service to the Other will the Same find their power. Herein lies another

overarching lesson that the therapist can give to their patient: that the way out of their

suffering, their interiority, is through the recognition and service to the Other.

Although infinitely distant from me (transcendent) and infinitely close to me

(proximate), they [Others] do not restrain my freedom, but invest freedom in me.
Their weakness limits my capricious and self-directed freedom. Others inspire me to
a more authentic freedom in the service of others…..Responsibility backs me into
insomnia by never letting me rest from that responsibility to honor the dignity of the
Other, to attend to her needs, to labor for their satisfaction, and to celebrate our
enjoyment of the goodness of the world. Humbled by the neediness of the Other, I
listen to her expressions of need, especially because of my tendency to abuse, and I
respond to her "Here I am. I am the one who has heard your call. My power is from
you to be used for your good. I cannot shirk my responsibility." (Kunz, 1991, p.

Society and the Same

The uneasy relation between the individual and the Third, in this case the Welfare

State, was exemplified by Patient L, a female in her 40’s, and the mother of multiple

children, who was divorced in unpleasant and acrimonious circumstances. The two

youngest children, ages seven and nine, were removed from her custody by Child Protective

Services and were being brought up by an aunt. Patient L wanted to get her children back,

and repeatedly said that “the kids were my life.” Patient L grew up in a dysfunctional

family, was sexually abused by her stepfather in early childhood, and was brought into child

protection and foster care at an early age. She was currently on Social Security Insurance

due to a medical disability that included asthma, pain, and seizures. She was not employed,

was not in a current relationship and, with the exception of her desire to regain custody of

her children, she had few ideas about her future. Among her psychological issues were:

depression, trauma (PTSD), recurrent nightmares, panic, distrust of family and social

systems, and poor self-esteem and identity. Most notably was her long life experience of

being, as she said, “a child of the system,” That was to say, her life experience had been to

live in a world where her possibilities were restrained and circumscribed by the Third, in

this case, by the totalizing servants of the Welfare State.

Rather than hold to the limited view that the Third pressed on her, Patient L might

have served herself better were she able to look at the Welfare State and its overwhelmed

and insensitive representatives as being inured to her suffering. That is to say, that Patient L

could see that her own humanity, in this case her very life and aspirations, had been

subjugated to the expediency of the political relation and that this was anonymously

totalizing and violent. Through the clear understanding of her world, limited to scraps and

minimal nourishment by those who have not the resources to serve the Other in respectful

commitment, Patient L could have reframed her situation from that of the victim to that of

an advocate. Such advocacy is not a belligerent counterforce to the political. Rather, it is a

statement of a caring for the Other, and by extension the Third, such that the suffering of

society caused by its inability and failure to meet the poor and disenfranchised face-to-face

can be ameliorated. In doing this, through service to the Other, Patient L could find

freedom and empowerment.

Society holds power over the population which constitutes itself; the power of the

Third is in many ways an acceptance of subjugation by the Same. This can be turned and

redirected through the exercise of ethical relation, the call from and response to the Other.

But how does the ethical act toward the Other relate to the society as a whole? And how

does the neurotic compulsion for repetition of trauma unto death, which Freud observed in

his psychological studies, relate to the metaphysical relation and the original trauma by the

Other described in Levinasian philosophy? Critchley (1999) answers it this way:

Without a relation to that which summons and challenges the subject, a summons
that is experienced as a relation to a Good in a way that exceeds the pleasure
principle and any promise of happiness (any eudaimonism), there would be no
ethics. And without such a relation to ethical experience — an experience that is
strictly inassumable and impossible, but which yet heteronomously defines the
autonomy of the ethical subject — one could not imagine a politics that would
refuse the category of totality. The passage to justice in Levinas — to the third party,
the community and politics — passes through or across the theoretical and historical
experience of trauma. No democracy without the death drive. Now, there's a
thought. (p. 195)

Substance abuse and the world

Is there no greater act of interiority than that of the substance abuser, the inebriated

alcoholic or tranquilized drug addict? Stung by the indifference of society or trapped in a

psychological disposition of unworthiness, these suffering patients devote their time and

energy in an effort to withdraw from the world and to eradicate their own temporal

existence. In the existential battle between life and death these patients pick neither, but

rather remain in an intoxicated or narcotic induced shadow land, neither living nor dying,

but rather stuck hopelessly in interiority without movement. “For Levinas, to be sure, drug

intoxication is far from an experience of alterity…” writes Nealon (1995) “… [it] can best

be understood as an attempt to withdraw from contact with and responsibility for the

other...”, and goes on to state that, “according to Levinas, intoxication brings only a greater

intensification of the subject's interiority, a refusal of "fraternity" as exterior substitution for

the other” (p. 17).

However, there is a paradox here, that is to say, the addict’s addiction is without

limit and because of this there is an imperative need to enter into the exterior world to find

the substances of their imprisonment, which is also boundless. Herein lays a Levinasian

strategy for reaching the substance abuser. First, in an awakening realization they are

indeed a member of the world and are dependent in the world for any existence they so

choose, even in substance abuse. Second, that because they are dependent on the world they

can obscure but cannot deny the fraternity of Others; that they are not singletons, isolated

and free-floating. Finally, the substance abuser can come to learn of the nature of their

internal subjectivity and its manifest desire for transcendent responsibility to Others. Thus,

Nealon (1995) speculates that this is the basis of a Levinasian oriented rehabilitation


For the "just say no" moralistic version of drug rehabilitation, the dependency of the
addict needs to be exposed and broken so the subject can be free again. If there were
a Levinasian rehab, it might proceed in exactly the opposite way -- by exposing the
dream of subjective freedom as symptom of addiction rather than a cure for it; such
a "cure" might hope to produce not a sutured subject, free again to shape its own
destiny, but rather "an ego awakened from its imperialist dream, its transcendental
imperialism, awakened to itself, a patience as a subjection to everything" (Levinas
1981, p. 164)…However, in Levinas [the calling of the Other] functions not as the
drug counselor's negative portrait of an unfree self, but as a kind of deliverance of
the self from its dreams of subjective imperialism. (p. 69)

Levinas and the Ineffable Body

Levinas asserts the role of the body in his philosophy in two distinct ways. First, that

of the apparition of the Other, the face that beckons to and disarms the Same into acting in

goodness and ethicality. Second, the body as the container of the ethical relation, preverbal

and implicit, as reflected in our sensations and exalted transcendent desires. In the first

case, the image of the body, as represented in the face and in nudity, is the catalyst for the

ethical relation between the Other and the Same (Crignon, 2004). However, it is with in

ourselves, our very body that the clarity of ethics is to be found, through profound

reflection, based on the implicit commandment towards goodness that is built into our very

nature. It is this perspective, the need for moral and ethical reflection, which is most

appropriate in psychological treatment, as this addresses the most critical psychological

dispositions that are presented in the therapeutic theater. These include the presentation by

the patient of existential angst, hopelessness, anxiety and depression of feelings.

The body as an ethical compass

The sense of the body plays a significant role in the writings of Levinas and appears

in his earliest papers, including his prophetic article entitled “Reflections on the Philosophy

of Hitlerism” published in 1934. While this article was primarily based on the major social

and political movements of that era, such as National Socialism, Marxism and Liberalism,

Levinas presents his perspective on the body: its meaning to our self, our spirituality, our

ethics and our psychology.

But the body is not only something eternally foreign. Classical interpretations
relegate to an inferior level, and regard as a stage to be overcome, a feeling of
identity between our bodies and ourselves, which certain circumstances render
particularly acute. Not only is it the case that the body is closer and more familiar to
us than the rest of the world, and controls our psychological life, our temperament,
and our activities. Beyond these banal observations, there is the feeling of identity.
Do we not affirm ourselves in the unique warmth of our bodies long before any
blossoming of the Self that claims to be separate from the body? Do these links that
blood establishes, prior to the birth of intelligence, not withstand every test? In a
dangerous sport or risky exercise in which gestures attain an almost abstract
perfection in the face of death, all dualism between the self and the body must
disappear. And in the impasse of physical pain, is it not the case that the sick man
experiences the indivisible simplicity of his being when he turns over in his bed of

suffering to find a position that gives him peace? … The body is not only a happy or
unhappy accident that relates us to the implacable world of matter. Its adherence to
the Self is of value in itself. It is an adherence that one does not escape and that no
metaphor can confuse with the presence of an external object; it is a union that does
not in any way alter the tragic character of finality. (Levinas, 1990, p. 69)

The context of this discussion was wrapped around the idea of racism and the

perverted view that the body was the “object of spiritual worth” that was reflected in

the science of eugenics, that was held so highly at the time. What he finds so

objectionable in the philosophy of National Socialism and its perspective on the body,

in the alternative, opens the door to the view of the body as an indicator of integrity,

truth, humanity and ethics. Thus, “…by rooting his conception of our humanity, of

what makes us fully human, in the bodily experiences of Self and Other, he offers a

conception of humanity that he hopes can be taken seriously by a society that affirms

the identity between our bodies and ourselves” (Manning, 1998, p. 135). Going still

further in this vein, that the embodied self is a source of moral self-disclosure,

Zimmermann (2009) states, “Such a placing of the body as the nexus point of our

engagement with a moral universe demonstrates further Levinas’ own thinking on the

relationality of the subject – in ‘one’s own skin’ – in that it exercises an en-fleshed

moral responsibility for the other” (p. 989).

The body memory

Returning now to the psychological presentation of existential angst,

hopelessness, anxiety and depression of feelings, all of these conditions reflect a

disposition of the body, announced by an uncanny set of embodied sensations whose

cause is generally neither known nor manageable by the suffering patient. More than

that, these bodily sensations are rooted in a form of unawareness, that is to say, have no

language to describe them and are thus stuck in a pre-verbal and disturbing umbra. It

can be asserted that these conditions represent issues of ethical ambiguity, so confusing

and primal they cannot bear to be reflected on by the suffering patient. But only

through reflection can the patient uncover ethical conflict sufficiently so that the unity

of the body and the mind is achieved, not only to identify the psychological issues

involved but choose an ethical path toward resolution. It is in this sense that a

Levinasian perspective is employed in psychological treatment: not just the compelling

pull from exteriority, the face of the Other, but the push toward ethical conduct as

reflected in the embodiment of our very being.

The therapeutic experience is replete with mystery, and it falls upon the therapist to

establish their practice, explicitly and consciously, based on a clear philosophic foundation.

In her article entitled “What difference does philosophy make?” Marion Hendricks (2002)

presents a person-centered view of the therapist-patient relationship, as articulated in the

work of the noted partnership between E.T. Gendlin, a philosopher, and C.R. Rogers, a

psychologist. At the core is a description of a therapeutic process that is at once applicable

to both the therapist and patient. For the therapist it enables a means of understanding the

patient through an empathic experience of their existence, as reflected in the bodily

sensations and thoughts that occur in the therapeutic rapport. The same dynamic applies to

the inward looking patient in drawing out their own pre-reflective and unaware feelings and

hidden experience into a conscious understanding.

The basis for this process is founded on the idea of congruence between feelings and

words. That is to say, congruence is the representation of feelings in words, and more

abstractly, the ability to experience feelings, and the representations they induce, with

conscious awareness. Congruence poses a significant paradox as it asks the individual to

experience that which they might not be aware or conscious of. The therapist might ask

“How can I understand the experience of the patient when a representation of their

experience is not explicitly expressed by them?” On the other hand, the patient may ask:

“How can I feel experience that I ‘m not aware of and may even be taking great pains to

keep hidden in the shadows?”

In both cases the resolution is the same. Experience may be consciously

inaccessible but that is not the same as being absent. Other means are required to detect it,

and herein we look to the body and its attuned network of sensations to provide insight into

that which is not consciously available. This concept is called the felt-sense and is the

starting point of a process that results in congruence of experience. The felt sense is

expressed as a bodily sensation that appears without definitive clarity or meaning. It is an

abstracted message from the shadows of the pre-reflective and non-verbal subconscious. It

is an inchoate sensation, the barest seed of an experience, from which the individual can

explore and study in an effort to apply a representation of it in the form of words, images

and gestures. These representations add meaning and color to the sensation, building

toward a growing articulation of understanding. The representations establish an

approximate, though not necessarily exact description, and bring the experience to light,

resulting in a carry-forward, a “re-presentation” of experience that was hidden. What was

“not there” is now transformed into something that now “is there”, and is exposed in the

present moment.

The embodiment of emotion and experience is a strongly held belief in the practice

of the Existential-Phenomenological viewpoint and is based on the notion that the mind and

body are not distinct. To the contrary, they are one in the same; the person is a whole, mind

and body. All aspects and realms of their existence is a singularity and what the mind

forgets the body may sense. As stated in Halling (1989): “…we want to emphasize how

attentiveness to another’s bodily being, and to our own bodily reaction to him or her, is

crucial for developing understanding of the other, whether the other is normal or ‘abnormal’

” (p. 188).

However, the recovery of lost experience through the technique of embodied

sensations does not guarantee an end to suffering; what it does is it presents a starting place

for continued reflection in the hopes of an ethical and psychological resolution. As I stated

with Patient K at the end of a particularly meaningful embodied experience:

But what I'm wondering, what I'm probing at, is how can we approach things a little
deeper for one. And if your tendency is not to probe things deeper, but rather to stay
on the surface because if you get too deep it becomes overwhelming, than I'm
wondering what the consequence of this is in your life? And how can we work
together to improve this in your life…to improve your relationships? Because there
may be things that you're not saying, not facing. Like not facing with your parents,
not facing with Z [his significant other], not facing with the existential
characteristics of your life … This is progress, but it is an initiating progress. How
do you face the un-faceable is where we’re at. (Private transcript, January 24, 2011)

The encased body

There is a different point of view that maybe taken with regard to the body: that

embedded in its very structure and musculature, its sinews and ligaments, a physical

memory and bodily familiarity exists that can result in a paralysis of an emotional state.

Such is the case with many patients who cling to a self-destructive emotional affect that is

reinforced by their physical stature. Such is the case with Patient C, who struggles with an

overwhelming sense of self unworthiness, which is reinforced by its very familiarity in his

body. So familiar is this physical and affective state that he works significantly harder to

maintain it than it would be for him to accept change. In a letter sent to me Patient C wrote:

It takes work to stay out of depression, even more work to get out of depression, yet
even more work to feel paralyzed in depression. I don’t even like the word “work”;
therefore, I need to do an awful lot of work in order to do the least amount of work.
As I’m sure of all, I would like to “enjoy contributing” for the good of all kind and
make a living doing it. (Private correspondence, May 5, 2011)

One way to break this deadlock is through “movement of the muscles”, meaning a

program of bodily exercise designed to change the very physiological memory that

reinforces a dysfunctional emotional familiarity and an ethical alienation. However, this is

just a first step, a means by which the tolerance for accepting exteriority can be achieved. It

is by far a much bigger step to realize one's worthiness, as for example, in this statement by

Patient C: “Others would do better with my bodily parts”, that reflected his existential wish

for death., to which I replied “You mean to say you are not worthy of your own organs?”

(Private transcript, December 16, 2010). In mirroring his pathetic statement back to him

Patient C realized the extreme implication of his rumination and entered a state of primal

and overwhelming emotive affect. This state could be construed as the Levinasian

description of the metaphysical relation, in this case focusing on his own intrinsic worth as a

living human being, endowed with the ethical responsibility and power that life intrinsically

extends, as reflected, and in this case perversely so, by his overwhelming egology and

compulsion to negate and obliterate his very being.

Many of my patients suffer from a lacking of the ineffable body, that is to say, their

inability to process sensations and open up to feelings that bridge toward the transcendent.

Instead, they seem stuck in an emotional gridlock, a confused and unclear set of feelings, or

an atomized or sometimes even repressed set of sensations. Such are the conditions of the

suffering patient. They suffer from deep distress and anxiety that can barely be controlled.

When presented with a cascade of complex and contradictory feelings they lock themselves

in a state of depression and anxiety, a form of hiding. They convince themselves that their

feelings are facts, that these facts are immutable and will never change. They turn into a

state of deep and isolated existential angst and are locked in a cognitive, behavioral,

emotive and spiritual prison, situated in ceaseless interiority. These ideas are illustrated by

the following two case studies.

Patient G was a bereft woman in late middle-age who was stuck in a hopeless

depression unable to initiate any agency despite the approaching possibility of homelessness

and destitution. Patient G presented herself as being tired and unhappy; her life was joyless

and she felt that there was no future for her. While being a parent of teenage children, she

had no authority or control over them. Rather, she presented to her children a person that

was stuck, depressed and was more in need of their parenting. Her life she felt was a bleak

series of failures: her inability to be a good wife and parent, her inability to build a

constructive and accomplished career, and her inability to develop an attitude of self worth.

However, the most difficult part of Patient G’s life revolved around what Søren

Kierkegaard describes as an effort of repetition. “Repetition means that a past actuality

becomes actual once again: someone who repeats is renewing actuality” (Carlisle 1986, p.

525). Repetition implies a striving, insistence and resoluteness of the patient to existence: to

bring themselves back to their self. This notion is worthy of additional expaination that is

presented as follows.

Kierkegaard asserts several basic existential themes in his philosophic work. First, he

observes that day-to-day life can be deeply unfulfilling. The fact of our birth does not

endow our life with an entitlement of satisfaction and contentment. Kierkegaard’s second

claim is that existence is a tension between facticity and transcendence. In this he means

we struggle in the grasp of our complacency and we are lulled by our possessions and

predispositions. However, as conscious entities we are also endowed with a longing desire

for higher meaning. We are pulled in both directions. The third theme states that a meaning

in life comes through struggle, choices and commitments. Here Kierkegaard presents a path

toward overcoming the burdens of the previous two themes; that through struggle and

attention we have the ability to transcend. Finally, he asserts that certain decisions are more

fulfilling than others. He is clarifying and extending the third theme, that as beings we are

the composition of the decisions we make and the choices we follow. We are our own

construction. It is the first two of Kierkegaard’s existential themes that most reflects

psychological pathology.

The reaction to suffering and dissatisfactions of life can take many maladaptive and

dysfunctional forms, especially those identified as clinical disorders that affect emotional

and physical states. This is a direct reaction to the trials of existence and the seeming

inability to transcend them. While we are endowed with the desire to overcome, many do

not possess the belief or skills to do so. Here lies a hope of the therapeutic process: our

state of existence is in our own hands, we can change ourselves through diligence and hard

work, with a deliberate movement toward fulfillment. And this daily effort is called

repetition. From a Levinasian perspective, repetition can be construe as the sustained desire

to hear the call of the Other, to see the suffering face of the Other and to deliberately choose

to respond in ethical goodness.


Tired of the repetition, of the constant demands of life, Patient G deliberately, with

malice of forethought, accepted the notion that she would no longer show diligence and

hard work, but rather, let life overwhelm her. So she withdrew into an inactive state of

interiority, showing no agency or involvement in the exterior world, freely letting the will of

the world control her while she withered into a shadow land state that hovered in the

ambiguity between death and life. In doing so she lost connection to the fraternity of

community, the warmth of family, and the responsibility toward the Other. What she had

and what could not be let go is her enduring suffering that she carried, as a cross,

throughout her body.

Yet another example of a patient who was dissuaded from her ineffable body by the

will of her own intention was Patient F. Here was a woman in her 50s who described

herself as religiously faithful with high morals and ethical standards. As a child she grew up

in a dysfunctional and alcoholic family. Her parents were emotionally and physically

abusive to her. She had multiple children and was married for several decades to a man

who was verbally abusive and who continually diminished her abilities and self-esteem.

Some time ago, after wrestling with a deeply conflicted sense of marital duty and religious

faith, she divorced her husband. As a result of this Patient F felt she was on her own, with

no one to help her in living a life. In reflecting on the divorce Patient F reported that she felt

the following effects: a low level depression, a lack of joy, a sense of unworthiness, and a

rejection by the world and her children who believed that the failure of the marriage was

caused by Patient F who was committing a mortal sin by divorcing. Patient F repeatedly

expressed a desire to find a relationship with a worthy man, but was discouraged and stated

she did not have faith that she would meet someone. For many sessions Patient F and I

worked on exploring her feelings. It was apparent that feelings were hard for Patient F to

experience. Patient F stated that her feelings were private. I found that her feelings were not

only private to others, but they were private to her self as well, which is to say she

deliberately chose to be unaware of them. She repeatedly stated “My feelings are not my

friends.” which was a belief she arrived at in early childhood as a defense of the abuse and

suffering about her. We talked about this and the impact on her life of not wanting to

experience feelings, how she shut them out and shunted them aside. In the past Patient F

said she felt there was something wrong with her, that there was something missing in her

self and in her life. We discussed how life events were influenced by feelings, resolved by

feelings, and that feelings were a major component in the ability for a person to have a clear

identity, sense of self, and a connection to the world. However, she remained adamant to

not allowing the experience of embodied sensations and their subsequent generation of

feelings and emotions. These were just too much for her to bear. While her life felt hollow

and disconnected her psyche refused to allow feelings in. Without feelings she had no

compass in which to evaluate her desires. She could not experience the revelation of the

Other that stood before her. And while she was deeply religious and behaved in a deliberate

moral attitude, practicing generosity and assistance to others, she could not feel the deep

sense of ethical relation and transcendent goodness that is a basis of Levinasian philosophy.

What she did possess was a synthesized view of emotion, driven by intellect and

accomplishment, but devoid of embodied feeling. Thus, the notion of the ineffable body

was beyond her ability to conceive, let alone experience.

The body resplendent


The body is a source of sensations that express our pre-reflective and unaware lived

experience, in a way that precedes language and the formation of conscious thought the

accumulation of which defines our very world view. Aggregated together these sensations

establish the foundation of feelings and emotions that facilitate and enable the

transcendence into the exalted state of the ethical relation, that which binds all living things

into an emergent stream, a living force.

My own heritage extends well beyond my Yiddish speaking grandparents and reaches

past each preceding generation, past Australopithecus and Neanderthals, past the birth of

mammals and reptiles, into the creation of single celled life, headlong toward the first

strands of proteins that were able to replicate themselves at the beginning of biology. This

is my DNA, and I feel it in my body, the influence it has over me as I am propelled to live

each day in the best measure I can, toward some unknown and never to be discovered end,

with the faith that there is a manifest-destiny to life but one that I can never even begin to

conceive of, for in my current state of evolutionary being that awareness is an impossibility,

just as an ant cannot conceive the beauty of a Shakespearean sonnet. Yet, even with these

limitations, I know the transcendent and the resplendent ethical relation, because they are

embodied, feelings before words, and ethics before ontology.




In this section the role of the therapist is examined in the context of an ethical

Levinasian perspective. The therapist serves the patient by providing their gifts, which

includes the idea of radical intersubjectivity, a form of ethical practice that is also a

metaphysical relation. The relationship between philosophy and psychology is discussed; it

is argued that both fields of thought are required for the therapeutic encounter to be


Levinas and Ethical Role of the Therapist

Levinasian philosophy has much to say about the ethical practice of psychology and

the principles of the therapist: to hear the call of the patient in their suffering, to recognize

their alterity by not totalizing them, and to meet the ethical responsibility by responding to

their needs, in such a way that no violence is done to them. Edward Gantt in his well written

article (1994) concisely describes the ethical relation of the therapist as follows.

In providing a non-totalizing context wherein the therapist can responsively attend

to the Other as Other, dwelling-with occasions a genuine opportunity for desire to
find ethical expression in the primordiality of the face-to-face encounter. In order to
be such, however, it must be a "moment of un-concern" (Halling, 1975) in which the
therapeutic situation ceases to be composed of a dialectical or authoritarian totality:
the one to heal the one in need of healing. For, to approach the therapeutic situation
armed with a presumption of disease or disorder in the client, which is to be
overcome through the transformative powers of the therapist, is to engage in
needlessly totalizing utopic speculation. Dwelling-with is a moment in which, rather
than dogmatically pursuing a pre-established mode of therapy with a particular
client-type in order to realize a particular utopic dream, we stand open to the being
of the other person who reveals a world of mystery as they bear witness of
themselves; a world which cannot be appropriated in terms of preconceived
categories or totalizing systems. It is that moment in which we give up the vain
justifications of a self indulgent utopic idealism and, in its stead, offer ourselves up
as a "being-for" in ethical response to the call of the other person whom we find here
before us: the stranger, the widow, and the orphan. (Levinas, 1969, p. 55)

Levinas’s principles of ethics are applicable to the therapeutic encounter which places

a level of awareness, sensitivity and responsibility on the therapist. In this forum the patient

in their suffering is openly exposed and vulnerable. In the face of the appeal from the patient,

the therapist is called upon to act in ethical conduct, to leave the trappings of opinion and

judgment at their home, and surrender themselves to the excruciating neediness of the patient.

The therapist is cautioned not to dominate the patient, to keep them fixed in the highest

position with complete respect to their alterity. The therapist approaches the patient in a desire

to respectfully participate with them, in goodness and passivity, on their journey of realization

and actualization. In the therapeutic relationship the patient acts in freedom, openly exploring

possibilities in a creative and welcoming environment, such that they not only can care and

tend for themselves, but they are also able to be responsible to Others.

Therapeutic practice is based on a mutual exchange between the therapist and patient,

the medium of which is discourse, and the act of which is a gift.

To recognize the Other is therefore to come to him across the world of possessed
things, but at the same time to establish, by gift, community and universality.
Language is universal because it is the very passage from the individual to the
general, because it offers things which are mine to the Other. To speak is to make
the world common, to create commonplaces. Language does not refer to the
generality of concepts, but lays the foundations for a possession in common. It
abolishes the inalienable property of enjoyment. The world in discourse is no longer
what it is in separation, in the being at home with oneself where everything is given
to me; it is what I give: the communicable, the thought, the universal. (Levinas,
1969, p. 76)

What are the gifts of the therapist? It is suggested that there are two levels of giving,

both of which are found within the face-to-face dialog of the therapeutic encounter. The first

gift is the communion and comfort of radical intersubjectivity, which includes the gentle,

passive unilateral offerings of surrender, acceptance, acknowledgement, patience and


tolerance of the suffering patient. This gift is founded on language. “The calling in question

of the I, coextensive with the manifestation of the Other in the face, we call language”

(Levinas 1969, p. 171). In a sense, the first statement of the therapist is an apology, an

expression of humility before the Other, but in recognition of the infinite otherness of the

patient that they will never fully know, “Apology does not blindly affirm the self, but already

appeals to the Other” (Levinas 1969, p. 252).

The second is the gift of teaching. In the therapeutic forum teaching is an engaging

dialog in which the therapist shares their educated knowledge and experience of

psychological practice with that of the suffering patient.

To approach the Other in conversation is to welcome his expression, in which at each

instant he overflows the idea a thought would carry away from it. It is therefore to
receive from the Other beyond the capacity of the I, which means exactly: to have the
idea of infinity. But this also means: to be taught. The relation with the Other, or
Conversation, is a non-allergic relation, an ethical relation; but inasmuch as it is
welcomed this conversation is a teaching [enseignement]. Teaching is not reducible to
maieutics; it comes from the exterior and brings me more than I contain. (Levinas
1969, p. 51)

However, this teaching is not a one way dialog; to be so would reduce the therapeutic

encounter to domination and violence. The patient in their presence also teaches the therapist,

such that: “The first revelation of the Other, presupposed in all the other relations with him,

does not consist in grasping him in his negative resistance and in circumventing him by ruse. I

do not struggle with a faceless god, but I respond to his expression, to his revelation”

(Levinas, 1969, p. 197).

Levinasian Aspects of the Therapist Attitude

How does the therapist help the patient move from their interiority to exteriority, and

do so within the Levinasian framework of ethical responsibility? Three themes are here

suggested: (1) the therapist’s self disclosure to the patient; (2) allowing the patient to teach

the therapist; and (3) the enactment of the ethical relation in the practice of radical


Therapist self disclosure

The very presence of the patient in the therapeutic encounter is their first opening.

In this forum the call to exteriority begins. In the face-to-face exchange, a radical

intersubjectivity is established, which by its very nature breaks the barriers of interiority and

exteriority. The gift of psychological technique further advances the opening. This is based

on an ongoing dialog, wherein the patient and therapist openly expose themselves to one

another in mutual surrender. The discourse is bidirectional, which is implicit in the

movement from interiority to exteriority. While their histories, roles and skills are notably

different, both therapist and patient are engaged in a vulnerable exposure and an open

available exchange. The therapist is not a “blank slate” as was asserted by the Freudian

analysts at the beginning of the era of psychological practice. Rather, the therapist conducts

an open exchange, to the limits that the patient’s psychological state can tolerate. The

degree of therapist’s disclosure to the patient has long been a focus by Karen Maroda, a

noted clinical psychologist, who writes:

But within this small theater, where only certain acts can be played out, there is no
such limitation on the world of emotion, which is at the heart of the therapeutic
enterprise. All manner of emotions can be expressed, by both analyst and patient,
even though the analyst must take greater responsibility for finding constructive and
helpful ways to express herself. For example, rather than simply disclosing every
strong feeling the analyst has, feelings should be expressed at the patient's direction
and behest, allowing him to be in control of the emotional action between them. If
the analyst discloses primarily when the patient asks for it, either overtly or through
repeated projective identifications, then the patient is less likely to be victimized by
the analyst's need to relieve herself at the patient's expense. (Maroda, 1999, p. 138)

The therapist is thus called upon to follow an ethical practice of engagement,

presenting an attitude of cognitive and emotional participation in the radically intersubjective

relationship, with the realization that “the order of developmental progression dictates that the

interpersonal necessarily occurs first, with the intrapsychic following” (Maroda, 1999 p. 84).

This is another way of saying that celebrating the patient’s alterity in a relation of open dialog

is the start of psychic healing. “Mutual surrender is not an expression of the analyst's love,

though the analyst may love her patient very much….Rather, mutual surrender constitutes an

emotional opening up, a falling away of the analyst's resistance to being known by the patient

in the deepest way possible… as such, the analyst's surrender is both an intrapsychic and an

interpersonal event” (Maroda, 1999, p. 58). Maroda goes on to state: “The key ingredients

to successful disclosures center on affective responses and on the therapist's willingness to be

open about his or her own experience… is the therapist's willingness to be forthcoming and

to show emotion that is curative and stimulates emotional honesty in the patient” (Maroda,

1999, p. 103).

Allowing the patient to teach the therapist

The therapeutic dyad works because the relationship and dialog runs both ways, a

mutual surrender, wherein the therapist and the patient open themselves in an intimate

exchange. For the patient this surrendering is transformational, as Maroda (1999) writes:

“Based on my own clinical experience, I would take this one step further and state that

surrender is the self-altering process. In the moment that a person surrenders he or she is

irrevocably changed” (p. 54). While the act of surrender is therapeutic, it is also recognized

as a gift to the therapist from the patient: an offering of the other’s lived-experience and an

opening into their very essence.


Says Halling (1975): “Maybe the "good therapist" is the person who remains

willing to let the other person reveal himself to him” (p. 223). It is an honoring of the Other

for the therapist to accept the patient’s gift of teaching. The therapist is called upon, within

their commitment to the ethical relation, to receive this offering with interest and grace.

The ethical therapist is aware they are not the sole owner of truth and knowledge, for that

would be totalizing. In the field of human interaction we are all inadequate experts. We all

grope along in intersubjectivity, often in innocuously idle conversation, but at other

moments, we reach the heights of ethical relation in the act of teaching one another.

The ethically responsible therapist celebrates the separation and alterity of the patient

and places them above all: “First, we need to remember that the coming into question of one's

own freedom is simultaneously the welcoming of the Other, the Other over whom I can have

no power” (Halling, 1975, p. 215). This notion of learning from the patient is also supported

by Brent Robbins (2000) who writes: “Levinas (1969) shows us that all learning comes from

the Other. To uphold the ethical responsibility of our call to be psychotherapists, our learning-

to-be-psychotherapists must ultimately come from the patient. We learn from our patients….it

is the patient who teaches us how to put ourselves out of business” (p. 2).

Treating the patient within the practice of radical intersubjectivity

Interiority to excess is by its very nature a loss of ethical responsibility to the Other.

This is a concept lost in the ipsiety of suffering in the patient. However, by treating the Other

in the highest Levinasian ethical relation, and by maintaining the notion of radical

intersubjectivity, the therapist is able to teach the patient, through the ongoing ethical

relationship within the therapeutic encounter, to view themselves in the activities of the

world, and to act in ethical responsibility to the Other.


“First, if ethics is first philosophy then therapy is an ethical event. It is ethical not

simply because ethical principles govern the relationship and the ongoing process. It is ethical

because the client as Other presents a claim on me” (Dueck, 2006, p. 279). In saying this, the

therapist is called to meet the ethical principles set by Levinasian philosophy within the

relation of radical intersubjectivity. Thus the therapist serves the patient by conducting a

relationship that is the very embodiment of the ethical relation.

Paul Marcus describes the role of the therapist in this endeavor as follows: “In this

context, the role of the analyst is to expand the analysand’s awareness and understanding of

what conscious and unconscious personal factors (e.g., thoughts, feelings, wishes, and

fantasies) and, especially, valuative commitments impede, diminish, or take the place of an

ethic of responsibility for the Other” (Marcus, 2007, p. 523).

Another view of ethically enabled treatment is described by George Sayre, who after

considering the well meaning but ultimately flawed person-centered approach to therapy,

states “… it seems to me to be profoundly dehumanizing to deny one of the most profound

aspirations of those we work with, namely, to be good…in rejecting the ego-logical ethic of

therapy and moving toward a de-centered understanding, we are better able to understand

people within the reality of their lives” (Sayre, 2005, p. 46).

So, what is the realization of radical intersubjectivity? There is no “handbook of

relations” that exists for the therapist: the ethical relationship is higher and more elusive than

any set of therapeutic methods, techniques and skills known to the well educated practitioner.

It may be said that radical intersubjectivity reflects a state-of-being, reaching beyond facticity

and knowledge, beyond empathy and altruism, and enters into the realm of the transcendent.

Radical intersubjectivity is an implicit understanding of the infinitely distant and the infinitely

close; a state where time itself spans the dimensions of past and future and are embodied in

the very present. It is a metaphysical relation. Radical intersubjectivity is a state where the

patient is seen in their resplendent apparition, where the therapist bears witness, with utmost

passivity and humility, with the unknowable being of the Other that sits before them. In

radical intersubjectivity the therapist extends his hand in grace, which precedes his language.

This is a presence that is ineffable but is palpably felt. It is a state “of before”, a primordial

being-connected to the wellspring of the profoundly ethical commandments that is our human

nature. This view may contain the highest aspirations of Levinasian philosophy: a profound

relation of goodness beyond goodness.

Reflections and Conclusions: On the Synthesis of Philosophy and Psychology

It is my perspective that philosophy is the underpinning of psychology. While

psychology addresses the suffering of the human condition, and the resulting cognitive,

behavioral, and affective outcomes, philosophy teaches us a way of existing in the world.

Philosophy is more than a subjective and relativistic psychological world view; that is, an

intellectual or emotional coloring of the perception of living. Rather, philosophy provides a

direct anchoring and sensibility that holds existence, human life, in an abiding, orderly and

coherent belief. While psychology addresses the internal and external behavioral and

emotive affects, the symptoms of a distorted view of existence, philosophy directly

addresses, head-on, the meaning of existence, and provides a guidepost for the

transformation of how a patient can exist in the world.

This paper examines the notion of interiority and exteriority, as defined within the

Levinasian philosophy and presents a perspective for working with the suffering patient in the

therapeutic encounter. It is asserted that when the patient is encapsulated in their interiority,

to the exclusion of the world, the consequence is psychological dysfunction. Such a patient is

chained to their suffering. By denying themselves of exteriority, they are imprisoned in two

ways. First, they are stuck mute, in laryngitis of a sort, are unable to issue a call to the Other

and to be able to receive the gifts of their assistance and grace. Second, by not being in the

world they are not present to hear the Other’s call. They have denied themselves the

transcendent exaltation of service to the suffering Other. Such is the highest goal of the

therapeutic encounter: to enable the patient to not only attend to themselves, but to recognize

and serve the suffering Other and to be responsible for them.

In the therapeutic encounter the therapist is called into an ethical practice: to establish

a non-totalizing relation where the patient is recognized and honored for their infinite

otherness, yet is helped with the gentle passivity that only the gifts of discourse and teaching

enable. This paper suggests three means for the therapist in achieving an ethical

psychological therapy: the therapist’s disclosure to the patient, allowing the patient to teach

the therapist, and the practice of radical intersubjectivity. It is posited that radical

intersubjectivity is more than a set of carefully practiced approaches. Rather, for the therapist

it is a state of being, a metaphysical relation of gentleness and grace beyond judgment, where

the infinitely unknowable Other is so passively honored, and is received with transcendent



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