Psychotherapies - it is often said - are unlike other medical interventions. Where most medical procedures are targeted at bodies and their sub-personal mechanisms, psychotherapies happen to people. We can get up a debate about how consistently this is true. Some psychotherapists target only specific behaviors, and many medical interventions have profound rippling effects on persons, but there is something to the distinction. After some experiences of therapy people make all sorts of unpredictable changes. Relationships are ended, jobs are left, and entire patterns of living might shift. The hope is that these changes will be positive but that is not always the case. There is an emergent literature (example here) on the negative side effects of therapy. Additionally some (this letter being an example) have questioned the shift in role that takes place in the creation of psychotherapy patients, making them "psychologically dependent on their therapists and their therapists [...] financially dependent on them." Psychotherapy changes us in all sorts of ways - some of them dramatic.
The philosopher L.A. Paul raises an interesting problem for what she calls Transformative Experiences. In a nutshell the problem is this: when you make decisions about your life, you are choosing for a future version of your self whose preferences you can broadly anticipate. I decide to book a holiday in the mountains because I know myself well enough to know that I will enjoy the scenery, the walking and so on. But this is not true, Paul argues, for all the decisions we make. Some experiences are transformative, meaning that our entire preference structure is altered when we have them. This makes some decisions radically different in type. Among other examples Paul raises the experience of having a baby. When you decide to become a parent you make a decision that may make you into a version of yourself you could not have anticipated. You don't just have to reckon with the question "what will it be like?" but also "what will I be like, and will the future me be happy?"
If psychotherapy ever fits the bill as an example of one of Paul's transformative experiences, then there is a special problem in the vicinity, because it is a process that is subject (in some jurisdictions) to the provision of informed consent. Informed consent is an important way of respecting the autonomy of people who enter into psychotherapy. a person cannot meaningfully agree to something they haven't had the chance to understand. The Wiley Encyclopedia of Clinical Psychology (linked to a few sentences ago) sets out part of the obligation thus: "psychologists should inform clients at the earliest possible point in time about numerous aspects of the treatment, including its nature and expected course." Expected course? What should you say to someone embarking on a process that could change not only their lives but also their self? The person entering therapy might welcome the changes, but will that also be true of the person left over when the changes have been made?
Psychotherapy presents many of the same ethical worries as more straightforwardly medical interventions. It's outcomes will never be completely predictable, and it can do harm as well as good. But it is unusual among clinical activities in that its aims sometimes include changes to whole personalities. L.A. Paul's work on Transformative Experiences illustrates the way that psychotherapy presents both a personal dilemma ("should I embark on psychotherapy given I can't predict my preferences once it has finished?") and a professional one ("should a clinician recommend psychotherapy given the limits on the possibility of informed consent?")
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