What is the problem with psychotherapy and how to replace it?

Abstract

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This paper argues that contemporary psychotherapy suffers from a fundamental conceptual vagueness: it lacks publicly identifiable criteria for what counts as therapeutic practice. This becomes visible through the Nonchalant Therapist Thought Experiment, which shows that psychotherapy can disappear in meaning while remaining identical in behavior. The root of the problem lies in the historical centering of the therapeutic relationship as an invisible, defining essence of psychotherapy. To overcome this, I propose Radically Embodied Therapy (RET),  a framework that redefines psychotherapy as a transparent, procedural, and embodied clinical science. RET rejects the idea of a separate psyche, situates human problems within lifelong developmental and socio-environmental trajectories, and unites medical and psychotherapeutic interventions under a single embodied logic.

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Introduction: The Paradox of Psychotherapy

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Psychotherapy occupies a curious position within the human disciplines. It is at once a vast professional enterprise and a theoretically fragile practice. Thousands of schools, orientations, and methods coexist under its name, yet there is little agreement about what renders any of them psychotherapeutic. A cardiologist who refuses to perform surgery can be said, uncontroversially, to have ceased doing medicine, but can a therapist, while maintaining the same setting, language, and gestures, cease to do therapy? This question, deceptively simple, reveals a deeper uncertainty about the ontological and epistemic status of psychotherapy itself.

To make this uncertainty explicit, imagine a experienced and expert clinician who, after decades of competent practice, all of a sudden decides one morning to “abandon” psychotherapy. He does not cancel his sessions or mistreat his clients. He continues to meet them, listens, and converses with the same attentiveness as before, yet privately decides that he will no longer conduct “therapy.” If no external observer, indeed, not even the client can tell the difference, what has actually disappeared? I call this scenario The Nonchalant Therapist Thought Experiment. Its force lies in the fact that it is perfectly coherent, since it is possible, perhaps even plausible. If the difference between therapy and ordinary conversation depends on a hidden intention, or “hidden” something else, then psychotherapy lacks a publicly identifiable criterion of practice.

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This thought experiment exposes a conceptual paradox. On one hand, psychotherapy is regulated, taught, and licensed as a profession, it presupposes reproducible methods and ethical standards. On the other, its defining element is typically located in an invisible quality, the “therapeutic relationship,” the “healing alliance,” or the “corrective emotional experience.” These terms, however valuable clinically, fail to specify what differentiates therapeutic action from any other benevolent interaction.

The consequences are not merely semantic. A practice without observable boundaries cannot ensure accountability, cumulative knowledge, or even internal coherence. Research programs proliferate, yet their empirical comparisons presuppose what none can define, that all participants are “doing therapy.” Philosophically, this undermines psychotherapy’s claim to belong among the “disciplines” of the mind, whereas ethically, it complicates the notion of professional responsibility. If a therapist’s private attitude is constitutive of the practice, then malpractice becomes almost undecidable except for some extreme and obvious ethical misconducts.

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The present essay responds to this paradox by proposing a reconstruction of psychotherapy on radically different grounds. I introduce Radically Embodied Therapy (RET), a framework that replaces hidden relational essences with explicit, observable, and revisable procedures. RET treats human persons as an embodied, developmental, and socio-environmental system, organization or more simply organism. It integrates the procedural rigor of medicine with the contextual sensitivity of the human sciences. In doing so, it aims to restore psychotherapy’s conceptual and ‘practical’ legitimacy without sacrificing its humanistic core.

The argument proceeds as follows. Section 2 formalizes the Nonchalant Therapist Thought Experiment and clarifies the problem of demarcation it reveals. Section 3 traces the historical evolution of the “therapeutic relationship” as the central explanatory construct in modern psychotherapy. Section 4 examines why diagnostic taxonomies such as the DSM fail to supply the missing procedural foundation. Sections 5 and 5.1 develop the ontological shift from psyche to embodiment and to socio-embodied context. Section 6 articulates the core principles of Radically Embodied Therapy followed by sections 7-10, which address ethical, institutional, and critical implications. The concluding section argues that RET transforms psychotherapy from a private interpretive art or ‘craft’ into a publicly intelligible, embodied clinical science.

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The Nonchalant Therapist Thought Experiment

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The Nonchalant Therapist Thought Experiment serves as an analytic device for clarifying what, if anything, makes psychotherapy a distinct kind of practice. Thought experiments in philosophy function by isolating the minimal conditions under which a concept retains or loses coherence. In this case, the concept in question is psychotherapy itself. If a scenario can be imagined in which all observable features of therapy persist while its therapeutic nature vanishes, this would indicate that the concept lacks operational grounding.

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Let us restate the scenario carefully. Imagine a psychotherapist who is competent, respected, and ethically unimpeachable ad who has practiced for decades. One morning, for some unknown reason, all of a sudden he decides that he will no longer conduct psychotherapy, though he continues to meet his clients as usual.What happens in such a case? Nothing dramatic, perhaps. The style of talk may shift, or it may not, the tone may become more casual, the focus less structured. But crucially, there is no clear criterion by which we could determine that psychotherapy has ceased. There is no set of procedures, techniques, or linguistic markers whose presence or absence would conclusively decide the matter. Some clients might still feel helped, others not, an observer might describe the interaction as friendly conversation or as supportive counseling. The situation is indeterminate, not because we lack introspective access to the therapist’s mind, but because psychotherapy itself lacks operational boundaries. The point is not that therapy is a “private” act hidden in consciousness, but that, as currently conceived, it is procedurally undefined. Between a meaningful conversation and a psychotherapeutic one, there exists no rule of demarcation comparable to that which separates medical procedures from informal care. In surgery, omission or error can be identified, an incision was not made, a dosage misapplied. In psychotherapy, by contrast, no observer, and indeed, no professional body can specify the exact threshold at which therapeutic practice begins or ends.

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This indeterminacy produces both epistemic and ethical consequences. Empirically, if there are no clear operations, then claims of efficacy rest on unstable ground. What, exactly, is being tested when studies compare “therapy” to “no therapy”? Ethically, a practice that cannot specify its procedures cannot clearly define malpractice. The nonchalant therapist violates no formal rule, commits no observable negligence, yet may have entirely abandoned the essence of his profession. The problem does not end there. Psychotherapy’s conceptual vagueness also results in a social and institutional vulnerability. In many countries, it remains an expensive, inaccessible, and publicly contested practice viewed by some as unscientific and by others as a cultural luxury. Its high cost and limited availability combine with its lack of procedural transparency to damage public trust. It is difficult to defend a form of care that is at once economically exclusive and epistemically opaque. The result is a crisis of legitimacy. Psychotherapy risks appearing less as a reproducible, evidence-based profession than as a private service sustained by interpretive ambiguity.

The thought experiment thus demonstrates that the problem is not one of hidden intention but of absent procedure. Psychotherapy, as it is currently practiced and theorized, cannot provide a concrete set of acts, operations, or decision-rules that make it distinct from other forms of structured conversation. This is the paradox of psychotherapy; a highly institutionalized practice with no procedural identity.

The following section traces how this situation emerged historically, how psychotherapy, beginning with Freud and evolving through humanistic and relational schools, came to define itself not by what practitioners do, but by the kind of relationship they believe they are in.

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Historical Roots: The Therapeutic Relationship as Essence

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The present ambiguity in defining psychotherapy did not arise accidentally, it is the product of a long historical development. From its earliest days, psychotherapy has been organized around the idea that what heals is not a particular procedure or technique, but a certain kind of human relationship. This emphasis on the relational dimension originating in Freud’s analytic setting and amplified through later traditions has gradually displaced any clear procedural foundation, leaving the practice defined by atmosphere, attitude, and interpretive context rather than by identifiable operations.

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Freud’s original project was not a theory of relationships but of “mechanisms”, repression, conflict, and symbolic meaning. Yet to access these mechanisms, he invented a distinctive situation: the analytic setting. The patient lies on a couch, the analyst sits behind, silence alternates with interpretation. The point of this arrangement was to encourage free association while minimizing social feedback. Over time, however, the analytic situation itself came to be seen as curative, not merely instrumental. Already in Freud’s later writings, the transference, the repetition of earlier emotional patterns in the analytic relationship became central to the therapeutic process. What began as a complication of analysis was reframed as its core mechanism, patients must relive their past attachments within the analytic bond to resolve them. The clinical focus thus shifted subtly from interpreting psychic content to managing the relational field. Yet even here, Freud kept a sense of procedural order, interpretation, working-through, maintaining neutrality. There was still a recognizable practice, however loosely defined. The decisive transformation came with the generations after Freud. Analysts such as Ferenczi, Balint, and Winnicott reimagined the analytic encounter in more personal and emotionally involved terms. The therapist was no longer a neutral observer but a participant who could provide corrective emotional experiences, empathy, and care. The relational atmosphere became the treatment. By mid-century, this sensibility spread far beyond psychoanalysis. Humanistic psychology, most famously in Carl Rogers declared that the essential therapeutic conditions were not interpretation or insight, but empathy, unconditional positive regard, and congruence. Healing was now grounded in the quality of interpersonal connection itself. The therapist’s authenticity replaced technical expertise as the foundation of efficacy. This move was ethically progressive, it humanized therapy, democratized it, and rejected authoritarianism but it also introduced a deep epistemic cost. Once psychotherapy’s effectiveness was defined by the “therapeutic relationship,” the practice lost any clear operational distinction from ordinary forms of supportive conversation. Empirical research since the 1950s has repeatedly confirmed that “common factors” such as empathy and alliance predict outcomes better than any particular method. Yet this finding, rather than clarifying the field, reveals its conceptual instability. If everything depends on relationship quality, then psychotherapy has no unique procedural identity.

The profession that emerged in the second half of the twentieth century thus institutionalized a paradox. On paper, psychotherapy is a highly regulated clinical practice, requiring certification, ethical codes, and continuing education. In essence, however, its defining mechanism, the therapeutic relationship, remains inherently unstandardizable and unobservable. Training programs teach attitudes more than techniques, supervision evaluates “presence” more than procedure, and research instruments attempt to quantify qualities that resist specification. The result is a professional field whose legitimacy depends on an essentially interpretive construct. The Nonchalant Therapist thought experiment gains its power precisely from this history. It is plausible only because the discipline has long accepted that therapy is defined not by what therapists do but by how they are with their clients. A therapist who continues to “be with” clients in roughly the same way may therefore appear unchanged, even if he has silently abandoned any therapeutic intention.

By grounding its identity in the therapeutic relationship, psychotherapy achieved moral warmth but lost methodological clarity. The analyst’s neutrality gave way to authenticity, and authenticity cannot be operationalized without paradox. The field thus entered the twenty-first century as a domain of immense experiential wisdom but limited procedural transparency and a ‘theoretical’ understanding and grounding of that said experiential wisdon. This historical trajectory explains why psychotherapy can be empirically successful yet conceptually fragile. It is not that therapy “doesn’t work”, it seems that it often does, but that we cannot specify what is working, or when it is absent. These criticisms might be mistaken for an endorsement of a false dichotomy between psychotherapy and psychiatry. Yet that is not the case. The following section will address how psychiatric diagnostic criteria themselves have contributed to this conceptual vagueness. Although the broader epistemic problems of psychiatry cannot be treated in detail here, they remain an essential part of the background against which this argument unfolds.

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Diagnoses and Their Discontents: Why the DSM Cannot Save Us

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If psychotherapy has long lacked procedural identity, one of the reasons is that diagnostic psychiatry has failed to supply one. The expectation that diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) would bring clarity to psychological practice has proven misguided. Instead of resolving conceptual vagueness, the DSM institutionalized a new kind of ambiguity one based on baseless description without explanation. The result is that psychotherapy, when tethered to psychiatric diagnosis, inherits a classificatory framework that is neither mechanistic nor coherent.The modern DSM arose from a historical desire for standardization. By the mid-twentieth century, the pluralism in the field was producing crisis, psychiatrists could not agree on what constituted a disorder, let alone on how to treat it. The DSM-III (1980) introduced a pragmatic solution, defining disorders descriptively, through lists of symptoms observable by clinicians, while remaining agnostic about underlying causes. The result was an atheoretical nosology, a taxonomy of appearances designed to improve inter-rater reliability. The move succeeded in its narrow aim in that psychiatrists could now agree more often about what to call a case. But in abandoning etiology and mechanism, the DSM also severed the link between diagnosis and understanding. Its categories are empirical aggregates rather than explanatory constructs, they describe surface regularities without specifying why those regularities exist.

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For psychotherapy, this descriptive turn created a deep mismatch. The DSM’s categories often combine symptoms that have no clear causal or functional relation. A single diagnosis such as “major depressive disorder” may include both insomnia and hypersomnia, both agitation and retardation, both weight gain and weight loss. In practice, two individuals with the same diagnosis may share no symptom in common. This internal heterogeneity makes it impossible to design interventions that are specific to the disorder rather than to the individual. Moreover, diagnostic categories frequently overlap, anxiety, depression, trauma-related disorders, and personality syndromes coexist and blend, yielding “comorbidity” rates that approach totality. In such a context, diagnosis ceases to demarcate anything real, it becomes an administrative convenience. For the psychotherapist, it provides neither a conceptual map of the problem nor a procedural plan for change.

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Despite these limitations, psychotherapy often relies on DSM categories as its external scaffolding. Insurance systems require diagnostic codes, training programs teach treatments “for” specific disorders, and research trials compare standardized therapies matched to diagnostic groups. Yet this structure offers only an illusion of scientific grounding. The categories to which treatments are attached are not “natural kinds” -in the sense that they are non theoreticall/logically grounded in something else than mere convention- but negotiated clusters of human distress, assembled through consensus rather than discovered through investigation. As such, any procedure claiming to treat “depression” or “anxiety disorder” is parasitic on a classificatory fiction. What appears here as empirical rigor -manualized treatments, symptom checklists, outcome measures- is therefore built on conceptual sand. A therapist treating a DSM-defined condition cannot specify what causal process is being modified. The relation between diagnosis and mechanism remains opaque, and the relation between mechanism and procedure remains undefined. Psychotherapy’s procedural vagueness thus mirrors psychiatry’s categorical vagueness.

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The failure of diagnostic psychiatry also represents a missed opportunity to unify mental health practice under a common clinical logic. In principle, a diagnostic system could have provided what psychotherapy lacks which is an ontology of mechanisms linking symptoms, causes, and interventions. In practice, the DSM’s agnosticism about causes prevented such integration. By focusing on symptom description rather than developmental or physiological trajectories, it isolated psychiatry from the broader biological and cognitive sciences. The irony is striking. The DSM was meant to modernize psychiatry by making it more scientific, yet it effectively de-scientized the field by divorcing it from theory. As a result, psychotherapy and psychiatry now share the same foundational weakness, namely, both are professionalized practices lacking clear procedural correspondence to identifiable mechanisms.

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For a reconstruction of psychotherapy to succeed, it must therefore abandon the DSM’s descriptive model. The relevant unit of analysis is not the disorder but the trajectory the individual’s embodied history of adaptation, learning, and change within specific social and physiological contexts. A viable clinical science must explain how certain patterns of interaction between organism and environment become rigid, maladaptive, or self-reinforcing, and how those patterns can be reorganized. This shift from categorical diagnosis to mechanistic formulation is central to Radically Embodied Therapy (RET).

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The next section develops this ontological reorientation in detail. RET begins by rejecting the assumption that there is such a thing as a separate “psyche.” What we call “psychological phenomena” are, in this view, patterns of embodied adaptation unfolding over a lifetime of organism-environment interaction. Understanding these trajectories, and their physiological and socio-environmental dimensions, provides the basis for a truly scientific and humane clinical practice.

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Before proceeding to the next section, an important emphasis is in order again. The framework of Radically Embodied Therapy (RET) rejects the traditional division between psychotherapy and psychiatry, as well as the broader distinction between psychology and medicine. These separations are historical conveniences rather than ontologically justified boundaries. Both disciplines address the same human phenomena -patterns of adaptation, regulation, and breakdown in living organisms- but through different conceptual languages. Psychotherapy tends to psychologize, psychiatry tends to medicalize, yet neither approach captures the full picture of how embodied organisms interact with and are transformed by their environments.

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Beyond the Psyche: Embodiment and Lifelong Trajectories

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Up to this point, I have outlined the historical and conceptual problems that have shaped psychotherapy, its reliance on the notion of a “therapeutic relationship,” its dependence on ambiguous diagnostic frameworks, and the way these constructs emerged within specific twentieth-century intellectual and institutional contexts. We have seen that these problems are not accidental but deeply historical. Now, let us imagine a different point of departure. Suppose that psychotherapy, as a profession or even as a concept, had never been invented. Suppose that we knew nothing of the “therapeutic relationship,” of the DSM, or of the clinical vocabularies that grew around them. Standing here, in the present, how might we begin to construct such a discipline from scratch? As a cognitive scientist, it is natural for me to take cognitive science itself as the point of orientation. Any attempt to build a theory of therapy must draw upon the interdisciplinary field that studies mind, the domain most directly concerned with how organisms perceive, act, and change. Yet my framework aligns not with the computationalist traditions that have dominated much of cognitive science, but with its radically embodied currents (Chemero’s radically embodied cognitive science, the enactivist tradition, Gibsons’ ecological psychology, Maturana and Villalobos’s autopoietic theory and) especially the radically externalist account of cognition I developed in my own master’s thesis. The reasons for I didn’t take computationalist views as my starting point are manifold. But a detailed critique of computationalism lies beyond the scope of this paper, the literature on this topic is already substantial. Curious readers can easily find thorough discussions of the limitations of computationalist and representationalist paradigms. What matters here is the positive orientation, that any reconstructed form of therapy should take seriously the view of cognition as an embodied, environmentally extended process rather than as symbol manipulation inside a head.

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Before turning to the therapeutic implications of this view, let me briefly summarize the core argument of my earlier thesis, since it provides the epistemological foundation for what follows. In cognitive science, whether computational or embodied, nearly every tradition begins by offering a philosophical definition of mind and then constructs hypotheses and methods to fit that definition. This, I argued, leads to theoretical inflation and conceptual fragmentation, instead of converging on shared phenomena, research programs develop around competing ontologies. This is essentially parallel to the distinction that Paul Cisek describes in the attention and action-selection literature as the difference between the analytic approach and the synthetic approach. I proposed something similar but with somewhat different arguments that are justified by more philosophically and metaphysically. Accordingly, rather than defining “mind” a priori, cognitive science should begin from empirical regularities of organism-environment interaction -patterns of action, perception, and regulation that can be directly observed- and only later, a posteriori, relate these patterns to whatever we choose to call “mental.” Drawing inspiration from the New Mechanism school’s idea of inter-field integration, I suggested that cognitive science should function as a bridge between biology and the social science, a domain that investigates phenomena lying across their interface. On this view, the appropriate unit of analysis, the epistemological ground zero, is the organism-environment interaction itself. Different theoretical traditions may interpret such interactions differently, but they can still agree on what is being studied and on the mechanisms that mediate it.

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The discussion that follows builds directly on this framework. From this perspective, therapy can be re-envisioned not as a conversation between minds but as an embodied process of adaptive reorganization, a form of intervention situated within the same organism-environment continuum that cognitive science seeks to understand.

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Hence, if the previous section questioned the utility of diagnostic categories, the present one questions the conceptual domain in which both psychiatry and psychotherapy have traditionally operatedthe “psyche” itself. The assumption that there exists a distinct mental realm, separable from physiology and environment, has silently structured the entire field of mental health. From this perspective follows the division of labor between “mental” and “physical” illness, between psychological therapy and medical treatment. Radically Embodied Therapy (RET) begins by rejecting this ontology. It does not deny that humans think, feel, remember, and suffer, it denies only that these activities belong to a special ontological domain called the psyche. In the RET view, what we call mental life is basically synchronically and diachronically distributed upomn the organism’s continuous engagement with its environment. Cognition, emotion, and behavior are not inner events but embodied adaptations, or trajectories of flexible adaptiveness/adaptation, patterns of regulation distributed across brain, body, and world. The human being is not a container of psychological processes but a living system whose functioning extends into the spaces, tools, and relationships that sustain it.

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This view obviously draws on insights from contemporary embodied and enactive cognitive science. Organisms do not passively receive information from the world but actively construct relations through movement, perception, and action. Each act of sensing is also an act of doing, each pattern of behavior reorganizes the physiological and neural substrate that supports it. In this dynamic, the boundary between organism and environment is functional rather than absolute. Emotional regulation, for instance, often depends on environmental scaffolds, social support, material stability, rhythmic habits, just as much as on internal neurochemical balance. Psychological suffering can therefore be understood as a breakdown in the organism-environment coupling. What is commonly called “depression” may not be a chemical deficit or a cognitive distortion per se, but a loss of adaptive regulation across multiple levels, metabolic, neural, behavioral, and social. The problem lies not “in” the person but in the system of relations through which the person has come to being. Thus RET places the individual’s lifelong trajectory at the center of analysis. Each person’s current organization, physiological, emotional, behavioral, is the cumulative product of continuous adaptation to changing environments. Experiences are not stored as abstract memories but sedimented as embodied dispositions, postural tendencies, affective reflexes, hormonal patterns, habits of attention and avoidance and maybe all at once. These embodied traces form the background from which behavior and experience arise.

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For this reason, therapy cannot begin from static diagnostic categories, it must begin from a reconstruction of the developmental history of adaptation of a particular person. How did the organism/person learn to respond to stress, to threat, to care throughout their lives not just their childhood? What configurations of bodily arousal and social expectation became fixed through repetition? How have work, family, culture, and physical environment shaped these patterns? RET approaches each of these questions not as psychological curiosities but as entry points into the embodied history of the person. Crucially, embodiment in RET is not a synonym for biological reductionism. The body is not a machine with malfunctions, it is a historical record of interactions. Physiological processes are ‘historical,’plastic and cumulative in that endocrine responses, immune function, and neural connectivity all change with experience. Chronic stress, trauma, malnutrition, or social deprivation literally inscribe themselves in bodily systems, producing persistent patterns of reactivity. Thus, when RET speaks of “physiological causes,” it does not mean isolated mechanisms detached from higher-order regularities, rather it means the biological residues of events that a person lived through.

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This perspective allows Radically Embodied Therapy (RET) to integrate medical and psychotherapeutic interventions without subordinating one to the other. Every phenomenon involves some form of organism-environment coupling, there is no purely “internal” or purely “external” dysfunction. Physiological interventions such as pharmacological treatments become appropriate when the system’s current trajectory is so rigid, so dynamically inert, that altering its course requires a stronger perturbation. It is akin to changing the orbit of a fast-moving object, the greater its velocity, the greater the energy needed to redirect it. In other cases, the same coupling can be reorganized more gradually through verbal, behavioral, or relational processes that operate over time. Which mode of intervention is suitable, and under what conditions, remains an open empirical question, one that lies at the heart of the integrative ambition of RET. In every case, the question is the same, that is, what pattern of regulation has become rigid, and how can it be reorganized?

Abandoning the psyche also entails abandoning the dualism between inner and outer, mental and somatic, subjective and objective. RET replaces these binaries with the language of (mechanistic) process. To say that a person “feels anxious” is to describe a system-wide state, all sustained by neural, hormonal, and social feedback. There is no need to posit a separate mental entity called “anxiety.” The term instead refers to an adaptive configuration of the whole organism, one that may have served a purpose in earlier contexts but now restricts flexibility. Therapeutic work, accordingly, is not about interpreting inner meanings but about modifying patterns of regulation. RET treats therapy as a disciplined attempt to identify maladaptive couplings and to design interventions that create new, more viable ones. This process unfolds within the practical constraints of each person’s material and social environment, acknowledging that change is not merely psychological but ecological.

Reframing therapy in these terms yields several consequences. First, it dissolves the opposition between “biological” and “psychological” treatments. All interventions, pharmacological, behavioral, relational, or environmental, operate on the same embodied system, albeit at different levels of organization which themselves interact with each oter. Second, it grounds clinical reasoning in lifelong history rather than emphasizing a certain period of life. Each case is understood as a trajectory of adaptation rather than as an instance of a disorder type. Third, it redefines healing as reorganization rather than insight. This ontological shift from psyche to embodiment, from category to trajectory, provides the foundation for a unified clinical science. Yet embodiment does not end at the boundaries of the individual organism. Every human body lives in social, cultural, and political environments that shape what forms of regulation are possible. The next section expands the concept of embodiment into this broader terrain, showing that Radically Embodied Therapy is, at its core, a non-individualistic (in the sense that individual itself is constituted by the environment, but it’s also individualistic in the sense that every individual constituted in a unique way to some extent, cause no two people are identical in their lifelong trajectories) and socio-ecological approach to human suffering.

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At this point, two predictable objections arise. The first is pragmatic: “Experienced clinicians already know all this.” Indeed, many skilled therapists already attend, in practice, to bodily cues, developmental trajectories, and social or economic circumstances. They ask about work, about family pressures, about living conditions. They intuitively sense that distress is not confined to the mind but distributed across the person’s life. Yet these insights remain largely dependent on the individual therapist’s intuition rather than on a coherent theoretical framework. They exist as good habits, not as methodological commitments. RET aims precisely to lift such clinical intuitions to the level of “real” theory to provide a conceptual architecture within which these sensitivities can be articulated, taught, and systematically developed. The goal is not to replace practical wisdom but to anchor it in a shared explanatory language, so that what is currently idiosyncratic can become communicable and cumulative across practitioners.

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The second objection is comparative: “But other schools already say similar things.” That is true, at least superficially. Systemic and family therapies emphasize relational context, community psychology points to social structures, the “third wave” of behavioral therapies links some phenomena to environmental contingencies, and even some psychoanalytic or existential approaches recognize the historical and cultural embeddedness of experience. RET differs, however, not in content but in ontological starting point. Where most frameworks add context to an already presupposed “psychological core,” RET denies that such an isolated core exists at all. It does not say that psychological processes are influenced by the environment, it says they are organism-environment processes. In other words, context is not an addition to mind but its very condition of existence. This distinction, subtle as it may seem, changes the unit of analysis. In most traditions, the individual remains the primary object of inquiry, while contextual factors enter as modifiers or background conditions. In RET, by contrast, the fundamental unit is the organism-environment interaction itself. Assessment, formulation, and intervention are organized around this interactional field rather than around the individual as an isolated entity. This shift is methodological, not merely rhetorical, it demands that every therapeutic hypothesis specify the mechanisms of coupling that sustain or disrupt adaptive regulation. RET also differs in how it conceives integration. Other approaches sometimes combine medical, behavioral, and relational tools in eclectic fashion, RET integrates them on principled grounds. Since every phenomenon of distress already involves a pattern of coupling, interventions differ only in the scale or intensity of perturbation they introduce. A pharmacological treatment and a conversational reorganization are not ontologically distinct kinds of action but different ways of reshaping the same dynamic system. Choosing among them is not a matter of allegiance but of empirical adequacy a question of what sort of perturbation can most effectively redirect the system’s momentum toward some desired new kind of stability.

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In this sense, RET’s distinctiveness lies not in its clinical sentiments -many of which resonate with existing traditions- but in its theoretical position and methodological clarity. It relocates the foundation of psychotherapy from the inner life of the individual to the dynamic interplay between organism and world, and in doing so, transforms therapeutic wisdom into a coherent science of embodied change.

In addition to these ontological and methodological distinctions, RET also diverges in the core principles that guide its practical conduct, principles that the following section will elaborate in detail. First, RET institutionalizes transparency as a defining criterion of therapeutic work. The therapist must make their reasoning, hypotheses, and procedural choices explicit and revisable. Second, RET redefines the long-standing taboo against offering life advice. Finally, RET introduces a principle of temporal flexibility. Different phenomena demand different temporal scales of reorganization, some maladaptive couplings can be altered within weeks, while others -such as long-standing depressive or relational patterns- may require years of iterative change. Therapy, in RET, is not bound to a fixed duration but adapts to the temporal dynamics of the system it seeks to reorganize. In this sense, RET’s distinctiveness lies not just in its clinical sentiments -many of which resonate with existing traditions- but also in its theoretical position, procedural rigor, and ethical transparency all together.

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Principles for a Radically Embodied Therapy

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The previous sections have argued that psychotherapy, as conventionally conceived, lacks a procedural identity and remains trapped within obsolete conceptual divisions, between psyche and body, individual and environment, psychology and psychiatry. Radically Embodied Therapy (RET) seeks to overcome this condition by redefining what it means to conduct clinical work. Its core proposal is that therapy must become a transparent, embodied, and procedural practice grounded in the same developmental and ecological logic that underlies life itself.

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RET does not only offer a new “school” or technique but also a framework for clinical reasoning -a way of understanding what therapeutic action is, how it can be specified, and how its effectiveness can be evaluated. This framework rests on four interdependent principles: Embodiment, Procedure, Transparency, and Integration.

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Embodiment

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The first and most fundamental principle is embodiment. RET treats human functioning as a set of interlocking regulatory processes that link brain, body, and environment. Distress arises not from “mental contents” but from patterns of regulation that have become rigid, self-reinforcing, or misaligned with current environmental demands. Accordingly, therapy aims not at symbolic insight but at the reorganization of embodied patterns. This may include modulating arousal, altering habitual movement or breathing, reconfiguring social participation, or establishing new material conditions that support regulation. RET thus views emotional and cognitive change as embodied skill acquisition, a gradual process through which the organism learns new ways of existing in its world.

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Procedure

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If embodiment supplies RET’s ontology, procedure supplies its epistemology. A therapy without procedure is indistinguishable from ordinary conversation, as the Nonchalant Therapist thought experiment revealed. RET therefore defines therapy as a structured experimental process, an iterative cycle of hypothesis, intervention, monitoring, and revision.

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1. Hypothesis formulation. The therapist begins by constructing a working model of the client’s issue in terms of embodied mechanisms and developmental trajectories. This model specifies what patterns of regulation are maintaining the problem.

2. Intervention design. Based on this hypothesis, the therapist designs a concrete procedure - behavioral tasks, bodily practices, environmental modifications, or pharmacological support, or all at once if need be - aimed at reorganizing the identified pattern.

3. Monitoring. The effects of the intervention are tracked through observable change, shifts in physiology, behavior, and social functioning.

4. Revision. If the expected changes do not occur, the hypothesis is revised and a new procedure tested.

 

This cyclical process mirrors the logic of scientific experimentation at the level of human phenomena. It transforms psychotherapy from an interpretive dialogue into a practical science of adaptive change. By insisting on procedure, RET restores accountability. A therapist can now specify what they are doing, why they are doing it, and how success will be evaluated. The boundary between therapy and conversation becomes clear, therapy here is defined by its procedural structure.

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Transparency

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The third principle is transparency. RET holds that therapy must be epistemically open both to the client and to the broader community of practitioners. The therapist should articulate, at every stage, what they believe to be happening, why they interpret it that way, and what procedure they intend to follow. When new evidence or understanding arises, this reasoning must be revised in conversation with the client. Transparency performs several crucial functions. It transforms therapy into a collaborative inquiry rather than a hierarchical interpretation. It establishes informed consent not only ethically but epistemologicall, the client becomes a co-investigator of their own patterns of regulation. And it enables intersubjective accountability, different practitioners can evaluate whether the reasoning and procedures are consistent with RET’s principles. In this sense, transparency is not merely an ethical idea,; it is a methodological necessity. Without it, therapy reverts to the interpretive mystique that the Nonchalant Therapist experiment exposed as untenable.

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Integration

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Finally, RET rejects the disciplinary fragmentation that divides mental health into psychotherapy, psychiatry, social work, and behavioral medicine. These separations are administrative, not scientific. If human problems are embodied and developmental, then interventions at multiple levels -biological, behavioral, social, and environmental- must be seen as integrated components of a single clinical process.

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Integration in RET occurs along two axes:

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1. Vertical integration across levels of organization (from cellular to interpersonal). A medication that modulates neurochemistry and a behavioral routine that reshapes daily rhythms both aim at restoring systemic regulation. They are not opposites but complementary levers.

2. Horizontal integration across professional practices. RET envisions collaboration among physicians, therapists, physiotherapists, and community practitioners, all contributing distinct procedural tools within a shared embodied framework.

 

This integrative stance prevents reductionism. Biological interventions do not erase the social, and narrative interventions do not float above physiology. Each level of intervention becomes a way of influencing the same embodied system from a different point of entry.

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The practical synthesis

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Taken together, these four principles transform psychotherapy from a practice defined by invisible intentions into one defined by explicit, testable, and ecologically grounded procedures. A session of Radically Embodied Therapy begins with collaborative formulation, proceeds through the design and monitoring of interventions, and evolves through cycles of revision. The therapist’s expertise lies not in interpreting hidden meanings but in identifying which configurations of the organism-environment system can be modified and how. This reconstruction does not abolish empathy, narrative, or meaning, just like all these must be included in any other therapeutic contexts like medical treatments or phsicotherapy, it repositions them as parts of the therapeutic ecology rather than as its core. Empathy becomes an instrument for gathering embodied information, narrative becomes a tool for restructuring self-regulation across time, meaning-making becomes the experiential trace of systemic reorganization. RET thus provides a framework that is at once humane and empirical, conceptual and practical. It restores therapy’s procedural identity without reducing it to technique and situates clinical practice within the same ontological continuity that unites life, mind, and environment.

The next section addresses the ethical dimension of this reconstruction -how RET rethinks responsibility, directive honesty, and the role of the therapist in guiding concrete changes in the client’s life and environment.

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Directive Honesty and the Ethics of Advice

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Among the many norms inherited from twentieth-century psychotherapy, few have been as enduring -or as philosophically confused- as the idea that the therapist should avoid giving advice. Rooted in the humanistic reaction against psychoanalytic authority, this norm sought to protect client autonomy by eliminating directive influence. The therapist was to provide empathy, reflection, and presence, but not guidance. The client was to discover solutions internally, through self-realization. While this stance carried an important moral intention -to prevent manipulation and preserve agency- it also reinforced the very conceptual vagueness that plagues psychotherapy. In a practice without clear procedures, the avoidance of advice becomes a way to conceal the absence of method. Radically Embodied Therapy (RET) challenges this tradition by proposing a model of directive honest. Here the therapist must be willing to make explicit, conditional, and evidence-based recommendations when maladaptive patterns are identifiable and modifiable.

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RET rejects the notion of “therapeutic neutrality” inherited from classical analysis. If the therapist understands, say, distress as the outcome of embodied, historical, and environmental coupling, then they also recognize that certain couplings perpetuate dysfunction. To remain neutral in the face of these patterns is not ethical restraint but clinical negligence. When a person’s lifestyle, occupational context, or interpersonal environment maintains physiological dysregulation, the therapist has a responsibility to identify and communicate this fact clearly. For instance, when chronic exhaustion and anxiety arise from long-term overwork, the RET framework requires the therapist to state that the problem is sustained by the client’s daily life structure not simply by inner beliefs or cognitive distortions. To recover, the client must modify their environment and bodily routines. Such guidance is not an imposition of values, it is the transparent communication of causal understanding, just as a physiotherapist might tell a patient that recovery from a knee injury is impossible without changing the way they walk, or as a physician might insist that treating hypertension requires altering diet and sleep rather than prescribing medication alone.

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Directive honesty does not entail paternalism, as might be suspected. RET distinguishes between imperative and conditional guidance. The therapist does not dictate action (“You must do this”) but formulates explicit conditionals like “If your goal is to restore physiological stability in such and such context, then this pattern of behavior should change.” The client remains free to accept, reject, or negotiate these conditions, but the therapist’s duty is to articulate them truthfully. This conditional form of direction aligns with RET’s epistemic transparency. Both therapist and client share the same informational space, both understand what mechanisms are hypothesized and what procedures are proposed. Autonomy, in this context, is not the absence of influence but the presence of informed choice. True collaboration depends on mutual clarity, not on silence.

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Avoidance of advice often functions, unintentionally, as avoidance of responsibility. By treating every problem as a matter of subjective discovery, non-directive therapy can implicitly endorse the social and environmental structures that produce the problem. A therapist who refuses to comment on exploitative labor conditions, toxic relationships, or material deprivation risks tacitly legitimizing them. RET identifies this as an ethical failure of omission, the refusal of clinical and moral responsibility under the guise of neutrality. Directive honesty, by contrast, situates the therapist as a participant in the client’s ecological system as someone who not only observes but also names the constraints that shape possible forms of life. This naming is not moralistic but diagnostic, it describes the conditions under which certain forms of regulation can or cannot be sustained. It also recognizes the limits of individual change when environments remain hostile. RET thus aligns with a relational ethics that acknowledges both agency and constraint.

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Traditional objections to directive practice assume that guidance necessarily involves authoritarianism or manipulation. RET redefines authority not as domination but as competent transparency. The therapist’s authority derives from their ability to formulate clear hypotheses about the mechanisms sustaining the phenomenon and to communicate them in a way that invites collaboration. The client’s trust, in turn, arises not from deference but from the therapist’s willingness to expose their reasoning to scrutiny. This reframing transforms the therapeutic relationship into a form of epistemic partnership. The therapist offers procedural knowledge, the client offers experiential knowledge, and both work together to reorganize the system. Directive honesty is the practical manifestation of this partnership, it keeps the dialogue anchored in reality rather than in interpretive ambiguity.

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Finally, directive honesty expresses RET’s broader moral vision. If human phenomena are the product of embodied and socio-environmental processes, then moral responsibility cannot stop at empathy, it must include truthful articulation of constraints. The therapist’s ethical task is to help the client see not only what is within their power to change but also what is not. Sometimes this means guiding action, other times it means naming the external conditions -economic, cultural, political- that perpetuate the phenomena at hand. RET’s ethics thus combine compassion with clarity. It replaces the passive virtue of “non-judgment” with the active virtue of responsible disclosur, saying what must be said, even when uncomfortable, and doing so in a way that sustains autonomy. Healing, in this sense, requires truth not as interpretation, but as procedural guidance grounded in an understanding of how life sustains itself.

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The next section turns from individual ethics to institutional implications. If RET is to serve as a model for clinical practice, it must also reshape how we train, evaluate, and regulate therapeutic professions. Only when these structures reflect the principles of embodiment, procedure, and transparency can therapy truly become a public, accountable science of human change.

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The Institutional and Epistemic Implications

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The reconstruction proposed by Radically Embodied Therapy (RET) cannot remain at the level of theory or individual practice. The vagueness of psychotherapy and the fragmentation of psychiatry are not only conceptual problems, they are institutional ones. Training systems, research paradigms, and professional regulations have all been built upon the same unstable foundations that RET seeks to replace: the myth of the psyche, the fetish of diagnostic categories, and the romanticism of the “therapeutic relationship.” To restore coherence, the reform must therefore reach into the very epistemic and organizational structures of mental health care. RET envisions a transformation along three interrelated axes: training and competence, evaluation and accountability, and integration within health systems.

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Current psychotherapy education privileges theoretical allegiance over procedural expertise. Trainees are socialized into “schools” or “modalities”-psychoanalytic, cognitive-behavioral, humanistic, systemic- each defined more by interpretive vocabulary than by empirically grounded operations. The result is a professional culture that values discourse and identity above clinical reasoning. In the RET model, training would instead focus on principled procedural reasoning. Rather than learning fixed schools of thought, students would learn how to formulate mechanistic hypotheses about the relevant issue, design and test interventions, and revise them in light of embodied and socio-environmental data. A RET-based curriculum would integrate physiology, developmental science, and cognitive neuroscience with anthropology, systems theory, and ethics. The clinician would emerge not as a specialist in one modality but as a clinical scientist of adaptation, fluent across multiple levels of explanation.

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Supervision, too, would change in nature. Instead of evaluating “therapeutic presence” or “rapport,” supervisors would examine the soundness of procedural reasoning. Are the hypotheses coherent with the client’s embodied trajectory? Are the interventions logically derived from those hypotheses? Are their effects being monitored in transparent ways? This shift from relational mystique to procedural accountability would mark a fundamental cultural change in how therapeutic competence is defined. The absence of clear procedures in psychotherapy has made systematic evaluation difficult. Evidence-based paradigms have attempted to fill this void through randomized controlled trials (RCTs) and manualized protocols, yet these rely on the same categorical assumptions that RET rejects. They test interventions against DSM-defined disorders rather than against mechanistic hypotheses. RET proposes a new evaluative framework grounded in procedural validity rather than categorical reliability.

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Under this framework, a therapeutic procedure is considered valid when:

1. Its underlying mechanism is specified in embodied and developmental terms.

2. Its proposed effects are observable and measurable within the client’s “cognitive ecology”.

3. It is subject to revision through iterative feedback and transparency.

 

Evaluation, in this sense, becomes less about statistical generalization and more about systematic articulation and public scrutiny. Documentation of hypotheses, interventions, and revisions provides an empirical record that can be compared, replicated, or challenged by other practitioners. Clinical reasoning itself thus becomes a public epistemic process, similar in spirit to scientific peer review. Such transparency also strengthens ethical accountability. Clients and institutions alike, when ethically appropriate and required permissions are granted, can examine what was attempted, why it was attempted, and how outcomes were monitored. The opacity that once shielded therapeutic practice from scrutiny would be replaced by a culture of open reasoning.

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RET also implies a reorganization of institutional boundaries. The current separation between “mental” and “physical” health, between psychotherapy and psychiatry, is both scientifically untenable and practically inefficient. Human phenomena is embodied and ecological, therefore, care must be organized along functional rather than disciplinary lines. In a RET-informed health system, collaboration would occur through interdisciplinary clinical units rather than hierarchical referrals. A person presenting with chronic anxiety, for instance, might work with a team including a physician, a therapist, a physiotherapist, and a social worker -each addressing different dimensions of the same regulatory system. Shared conceptual language (embodiment, adaptation, regulation) would replace the fragmentation that currently characterizes mental health care. Such integration would also extend beyond medicine. Because RET recognizes the social and economic determinants of health, it demands closer coordination with public policy, education, and labor institutions. The ultimate goal is not only to treat individual issues but to modify the environmental conditions that produce and perpetuate it. Therapy, in this vision, becomes one node in a wider ecology of care.

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