The role of embodiment and intersubjectivity in clinical reasoning

Abstract

Embodied approaches to cognition have been recently challenging standard views in philosophy of mind and the cognitive sciences. We propose that these embodied cognition views hold implications for clinical reasoning. This article examines the role of embodiment and intersubjective interactions between patient and therapist in clinical reasoning in psychotherapy. It offers a phenomenologically informed enactive conception of clinical reasoning and characterises it as an ongoing embodied, embedded and intersubjective process, rather than a strictly mental process ‘in the head’ of the therapist.

Keywords::

• embodied cognition
• enactivism
• body-as-subject
• intersubjectivity
• phenomenology

Notes

^1. Consider, also, recent concerns about the status of the physical exam in medical practice. Apparently physicians have adopted practices that minimise physical contact with patients, and this has been a growing point of debate in the medical disciplines. There are even positive recommendations for this approach – the following one for psychiatrists:

Fortunately, it is possible to examine patients without having to touch them. In fact, the physical exam, which is often done without any specialized medical equipment, can be performed while standing in the hall and observing the patient through the doorway. (Madan, 2002, p. 1356)

To be fair, Madan is describing a technique that might be used if a psychiatrist is not able to do a hands-on physical exam of the patient, and the recommendation comes with certain qualifications. Yet, there is something that approaches established knowledge in this regard:

Despite a long and storied tradition, a physical exam is more a habit than a clinically proven method of picking up disease in asymptomatic people. There is scant evidence to suggest that routinely listening to every healthy person's lungs, or pressing on every normal person's liver, will find a disease that wasn't suggested by the patient's history. (Ofri, 2010, p. D5)

On the one hand, Dr Ofri goes on to emphasise the non-medical importance of touch. On the other hand, others have had to argue that the physical exam is of some medical benefit (e.g. Verghese & Horwitz, 2009).

^2. In this regard, and specifically in regard to the practise of body psychotherapy, Röhricht, Gallagher, Geuter and Hutto (2014) suggest novel ways of designing clinical settings using virtual (and mixed) reality (VR and MR) technology. For example, symptoms of boundary loss and somatic depersonalisation can be addressed with creation of virtual ‘homes’ with the ability to open or close the space as required within a virtual therapy room. One can also use such technology to re-enact the virtual lived experience of a conflict or problem constellation.

^3. We use the term ‘body schema’ to mean ‘a system of sensory-motor capacities that function without awareness or the necessity of perceptual monitoring’ (Gallagher, 2005a, p. 24). We distinguish it from the concept of body image, ‘a system of perceptions, attitudes, and beliefs pertaining to one's own body’ (Gallagher, 2005a, p. 24). For more on this distinction, see Gallagher (2005a, 2005b).

Additional information

Notes on contributors

Shaun Gallagher

Shaun Gallagher is the Lillian and Morrie Moss Professor of Excellence in Philosophy at the University of Memphis, Research Professor of Philosophy and Cognitive Science at the University of Hertfordshire and Professorial Fellow in Philosophy at the University of Wollongong.

Helen Payne

Helen Payne is Professor of Psychotherapy in the School of Education at the University of Hertfordshire. She is the Founding Editor-in-Chief of this journal.