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The current paper discusses the use of formal inductive reasoning in the description of cognitive dysfunction. Formal philosophical frameworks can provide a way to conceptualize the fundamental nature of mental health in terms of the static rules and dynamic processes of the mind, and in a way that can be verified through empirical investigation. The paper begins by overviewing the object of inquiry for counselors, which is described in terms of the interaction of mental rules and processes that systematically break down and require repair in order to promote client wellbeing. A symbolic computational framework for representing these rules, processes, and their pathologies is introduced, called Formal Symptoms Analysis. Obsessive Compulsive Disorder is then taken as a case study to illustrate how the system works, before discussing the potential benefits for counseling researchers and practitioners in gaining the insights that a detailed formal analysis of mental health affords.
Lou Marinoff
Reviews Editor
Leslie Miller
Associate Editor
Dena Hurst
Technical Consultant
Greg Goode
Legal Consultant
Thomas Grifth
Journal of the APPA
Volume 12 Number 3 November 2017
ISSN 1742-8181
Kristof Van Rossem
Socrates in Prison: Socratic Dialogues with Prisoners
Oliver Boxell
On the Utility of Introducing Formal Theory to Counseling
Michael Noah Weiss
With Life as Curriculum: On the Relevance of the
Socratic Method in Norwegian Folk High Schools
Resources for Teaching Mindfulness
reviewed by Leslie C. Miller
Ethical Loneliness: The Injustice of Not Being Heard
reviewed by Helen Douglas
The Beacon of Mind: Reason and Intuition
in the Ancient and Modern World
reviewed by David M. Wolf
Biographies of Contributors
Nemo Veritatem Regit
Nobody Governs Truth
On the Utility of Introducing Formal eory to Counseling
O B
U  R
e current paper discusses the use of formal inductive reasoning in the description of cognitive
dysfunction. Formal philosophical frameworks can provide a way to conceptualize the fundamen-
tal nature of mental health in terms of the static rules and dynamic processes of the mind, and in
a way that can be veried through empirical investigation. e paper begins by overviewing the
object of inquiry for counselors, which is described in terms of the interaction of mental rules and
processes that systematically break down and require repair in order to promote client wellbeing. A
symbolic computational framework for representing these rules, processes, and their pathologies is
introduced, called Formal Symptoms Analysis. Obsessive Compulsive Disorder is then taken as a
case study to illustrate how the system works, before discussing the potential benets for counsel-
ing researchers and practitioners in gaining the insights that a detailed formal analysis of mental
health aords.
Keywords: Formal theory; counseling practice; obsessive compulsive disorder
1. Introduction
Albert Einstein once wrote that “knowledge cannot spring from experience alone but only from the
comparison of the inventions of the intellect with observed fact,” (Einstein, 1954, p.266). In order
to make practical use of this description of scientic discovery, one must rst identify the object
of inquiry. Second, one must develop a theoretical framework in which to formulate a philosophy,
or “the inventions of the intellect.” Finally, one must compare those “inventions” (or theories) with
observed fact.” is latter part refers to conducting appropriate empirical verication of the theo-
retical stipulations, such as with experimentation, clinical trials, or case studies. e main objective
of the current paper is to identify the object of inquiry for counselors and discuss the use of a for-
mal philosophical framework for theorizing about it. We will use Obsessive Compulsive Disorder
as an example to illustrate the framework, called Formal Symptoms Analysis (FSA). e benets
for practicing counselors and researchers will be reviewed as far as identifying the nature of their
particular clients’ problems and how to remedy them, as well as for developing a rich understand-
ing of mental disorders and dysfunctions. In short, the paper argues there is a great utility in teach-
ing counselors to be formal philosophical theorists.
2. What is the Object of Inquiry for Counselors?
e Enlightenment philosopher John Locke was one of the rst to suggest that experience aects
human understanding (Locke, 1690). He argued for the idea that the human mind is a tabula rasa
or “blank slate” to be molded by the environmental stimuli around it. According to this view, the
structure of the mind is formulated through associations of multiple ideas that co-occur in the en-
vironment frequently. Such associations could be promoted through rewards, while others could be
ISSN 17428181 online © 2017 APPA
Philosophical Practice, November 2017, 12.3: 1992-2004
avoided through sanctions. Over time, new sustained behaviors and memories emerge. To Locke,
this is what learning looked like. Indeed, we now know that experiences aect the way mental
structures are constrained (e.g., Bandura, 1977; Goldberg & Suttle, 2010; Ibbotson, 2013; ierry,
Athanasopoulos, Wiggett, Dering, & Kuipers, 2009), navigated in real-time (e.g., Gibson, Bergen,
& Piantadosi, 2013; Levy, 2008), and how mental models of our own and others’ minds are con-
structed (e.g., Baron-Cohen, 1991; Gordon, 1996). In turn, this aects the social relationships de-
veloped between individuals and groups of people (e.g., Hughes & Leekam, 2004; Lecce & Hughes,
2010). While information from the environment undoubtedly inuences the way our minds work
substantially, the school of “behaviorism” typied by Locke does not traditionally acknowledge the
innate infrastructures of the brain that enable the mind to make sense out of environmental stimuli
in the rst place. is is, in fact, a huge oversight since the innate biological underpinning of the
mind also plays a substantial role in shaping what it can and cannot ultimately do.
is point was not lost on another Enlightenment philosopher, Jean-Jacques Rousseau. He was
amongst the rst to argue that one’s experiences must be fed through the biologically determined
structures of the mind in order to formulate any cognitive, behavioral, or social outputs (Rousseau,
1792; see also Marcus, 2004). He argued that information from the environment incrementally
becomes accessible to children as their brains mature following a biological template. is is not
to say that Rousseau believed environmental stimuli played no role whatsoever in shaping our
minds. On the contrary, he accepted that the mind interprets environmental stimuli. Indeed, he
thought experiential stimuli were so inuential over human development that he argued parents
frequently transmit cultural norms to their children, which actually deprives the children of being
able to evaluate such norms with their own critical faculties as and when they biologically mature.
To Rousseau, this made “society” a corrupting system of indoctrination within the environment to
which children are exposed. He argued that children needed to be protected from it as they grow,
until their biological maturation is such that they can interpret it with their own critical objectivity.
All this is to say, then, that biology and the environment—or nature and nurture—shapes the way
the mind works.
Experiences of the world interact with the brains genetically endowed structure to set up a nite
system of static rules or mental “schemes” (e.g., Anastasi, 1958; Boxell, 2016; Marcus, 2004; Piaget,
1952; Pinker, 1997, 2002). We know this to be the case since humans’ thoughts and behaviors are
not limited to mimicry of the thoughts and behaviors to which they have been exposed. Rather,
humans can adapt the inputs to which they have been exposed, and, in so doing, produce innitely
creative outputs. Such adaptation requires a rule-based system to determine how the transforma-
tions of information should occur. In other words, constituent elements of information can be
combined in a multitude of dierent ways using a simple rule (or set of rules), each time producing
new novel outputs. e rule(s) can be recycled over and over with dierent constituent elements
being added in or removed, thus producing an unbounded range of possible thoughts, including
conceptualizations and language (e.g., Chomsky, 1986). To put this more simply, human thinking
is not restricted to thoughts that are memorized based on exposure. Instead, we can create new
thoughts and new internalized models of the world around us, and we have an unbounded capacity
to do so ad innitum.
e static rules that underwrite cognition do not exist in a vacuum, however. ey require cogni-
tive resources to enact them. ese resources include the capacities to activate relevant information
Oliver Boxell
whilst suppressing irrelevant information (executive control), to make predictions about upcom-
ing information structures and direct attention to relevant information sources, and to use work-
ing-memory to transmit information across mental structures to make a coherent whole, amongst
others. ese neocortical capacities for thinking and broader cognition, combined with the more
primitive and hormonally driven “ght or ight” instincts of the limbic system and brainstem, ac-
count for human thought and behavior (e.g., Marcus, 2004; Pinker, 2002). All told, this is the nature
of the mind, and therefore, it is a fundamental part of the object of inquiry for counselors.
Counselors are, of course, particularly interested in how the mind’s outputs become dysfunctional
as a reection of the ways people think, learn, and interact. We seek to remedy dysfunction and
improve quality of life for our clients. erefore, it is of fundamental importance that we know
how the mind formulates its functional capacities, and in turn how these can systematically break
down. To understand human dysfunctions, and what one can do to remedy them, one must under-
stand how these capacities work in the healthy mind, and how this compares with the symptoms of
dysfunction. Formal Symptoms Analysis is a theoretical framework in which one can stipulate the
functions and dysfunctions of the human mind and the behaviors to which it gives rise. As such,
Formal Symptoms Analysis identies underlying erroneous rules and processes, which can then
be targeted and corrected through counseling therapy. Hence, it is the conviction of the current
paper that such an approach would be of great utility for counseling researchers and practitioners
3. What is Formal Symptoms Analysis (FSA)?
Formal Symptoms Analysis (FSA) describes human thoughts and the resultant behaviors in terms
of the mind’s static rule-based systems and real-time dynamic processes. It is a representational
framework based on certain axioms of mathematical philosophy, notably rst-order and proposi-
tional logic (e.g., Whitehead & Russell, 1910). One could also think of it as a way to conceptualize
the mind’s capacity for symbolic computation. Note that the form of logic used here is primarily
inductive, as it seeks to describe mental capacities that interact with environmental stimuli. us,
truth feeds into the model from real world data, and cannot be established with deductive proofs
(e.g., Mill, 1843). e idea is to use the system rst to establish the “healthy” rules and processes
that result in mental wellbeing, and then to contrast these with “pathological” rules and processes
that are responsible for mental dysfunction. FSA is, in fact, an extension to a broader symbolic
formal theory of how human cognition and behavior work called Formal Cognitive eory (FCT).
FCT seeks to describe the smallest units of information processing in the human mind, including,
for instance, conceptual and linguistic structures and their interactions with executive function,
prediction, and memory processes. e rules and processes described in FSA do not operate at
such a “micro-level,” although each rule or process stipulated using FSA could in principle be fur-
ther decomposed within the FCT paradigm for maximal theoretical explanatory adequacy. Mean-
while, the FSA paradigm itself focuses only on describing the rules and processes that constitute
clinical symptoms.
In FSA, a “healthy” rule is called the “α function” whilst a “pathological” rule is called the “β func-
tion.” e broad objective for counseling is to turn β functions into α functions. In the remainder
of the current section, I will take Obsessive Compulsive Disorder as an example to illustrate how
FSA works.
On the Utility of Introducing Formal eory to Counseling
3.1. A Brief Sketch of Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is characterized with obsessional thoughts and associated
compulsive behaviors. e obsessive thoughts are mostly “ego dystonic” (i.e., they are contrary to
the patient’s internalized constructs of themselves). As such, patients, especially adults, typically
recognize the irrationality of their obsessions, and are consequently distressed by them. e obses-
sions are reoccurring anxieties, oen relating to contamination, death, aggression, doubt, orderly
patterns, and sex, amongst others (e.g., Allen, King, & Hollander, 2003). Meanwhile, the compul-
sions are physical or mental behaviors that are thought to be designed to alleviate or neutralize the
stress and anxiety caused by the obsessive thoughts, and might include the repetition of soothing
thoughts, washing and cleaning, re-checking, ordering, and other repetitive actions, all of which
are time-consuming and can themselves become a source of distress (e.g., Okasha, 2002).
3.2. Dening the Static Rules of OCD
FSA denes static rules and processes using principles adapted from propositional logic (e.g.,
Whitehead & Russell, 1910). Before the “pathological” rule for an obsessive anxiety can be encoded
into a β function, the “healthy” baseline equivalent is rst needed to set up a contrast, called the α
function. e proposed α and β functions are given in (1) and (2).
(1) α [P  Q (  A, where A is a perceived negative outcome)]
(2) β [P  Q (  ¬A, where A is a perceived negative outcome)]
e variables denoted by letters (e.g., PQA) are “atomic propositions.” ese are simple non-de-
composable assertions that are either true or false. Lower alphabetical letters (PQR, etc.) are “vari-
able propositions,” such that the counselor will change their exact meaning from client to client,
dependent on their particular anxieties. Higher letters (ABC, etc.) denote “constant propositions”
whose meaning holds exactly across all clients, and should be dened in the formula itself. “Atom-
ic propositions” are combined together using “logical connectives” that reect their relationships
with each other, creating “complex propositions” and ultimately, the denition of a rule or process.
Connectives include symbols such as  (if… then) and   (if and only if, abbreviation “i”). A
statement in circle brackets is a “contingent” that creates conditions that must be true in order that
the immediately adjacent antecedent proposition also holds true.
To summarize (1) in plain English, it says “if P is true, then Q is true i A is also true, where A is
a perceived negative outcome.” To give an example, assume P is “ere might be questions on my
nals that I don’t understand,” and that Q is “It is more likely I will fail my nals.” If P is true then Q
is true (P  Q), which would meet the denition of a rational α function anxiety i Q contingently
results in A, “a perceived negative outcome.” For example, if Q occurs in a context where passing
the nals is necessary to graduate, keep a job, start a dream career, or the like, then an increased
likelihood of failing (Q) would entail a perceived negative outcome (A). Note that if an individual
does not perceive a negative outcome from Q (for instance, if the nals will not aect any aspect of
their future whatsoever), then the contingent proposition A is not met, and thus, the denition of
a rational anxiety is not upheld.
Oliver Boxell
Indeed, (2) captures the fact that irrational β function anxieties are contingent on Q not triggering
a perceived negative outcome (A). is is denoted by the ¬ symbol, which negates proposition A.
Note this is the only single dierence between (1) and (2). As in the example above, then, if P is
“ere might be questions on my nals that I don’t understand,” and Q is “It is more likely I will
fail my nals,” the irrational anxiety will hold i the nals are being taken in a context where an
increased likelihood of failing (Q) does not result in a perceived negative outcome (¬A). Typical
OCD obsessions, like contamination, for instance, meet this denition. Assume P is “Restrooms
collect a lot of bacteria” and Q is “I might contract some bacteria.” Q triggers the contingent ¬A
rather than A (i.e., the β function rather than the α one is upheld) since the anxiety occurs in a
context where the kind of bacteria that might be contracted will not result in a perceived negative
outcome. Namely, contracting the kinds of bacteria found in restrooms will not typically cause
disease that could have perceived negative outcomes like sickness or death.
Crucially, the dierence between α and β already suggests a key objective for a counselor in the
eld who is trying to treat irrational anxiety disorders, including OCD. Namely, such counseling
is likely to focus on setting up the contrast between healthy anxieties that do result in perceived
negative outcomes, and are legitimate anxieties, versus those that do not result in perceived nega-
tive outcomes, and are therefore illegitimate anxieties.
Many typical OCD anxieties, however, are not fully captured by (2). e truth of atomic propo-
sitions may be objectively dierent in the real world than in the client’s mind. As such, another
iteration of β is needed to capture this fact, given in (3). Note that dierent iterations of a rule are
denoted by superscript numbers.
(3) β1 [P (=0)  Q (=0 (  ¬A, where A is a perceived negative outcome))]
In β1, a contingent proposition is added for each of the propositions P and Q that states they are, in
fact, empirically false in the real world. In FSA, “(=0)” means the antecedent proposition is false,
whilst “(=1)” would mean it is true (though this is typically assumed unless otherwise stated). As-
sume an OCD patient believes P, where P is “Touching the four corners of light switches keeps my
family alive,” and Q is “My family will not continue to stay alive if I do not touch the four corners
of all light switches.” e assumption of P is clearly incorrect in the real world. If, however, an “in-
correct” P is posited by a client, it will imply an equally “incorrect” Q. Note the implication relation
P  Q remains true; it is the real world status of the constituent propositional assumptions that is
at fault. Note, also, that the very fact β1 anxieties are made up out of false propositions inherently
ensures there cannot be a perceived negative outcome since the real world will not produce per-
ceptible negative outcomes from false information. In other words, false propositions project their
own context in which the anxiety cannot have a real perceived negative outcome. e fundamental
inaccuracy of the atomic propositions in β1 anxieties may explain why many OCD patients have
some overall perception of their anxieties being irrational (e.g., Allen et al., 2003), even though
they are presumably unlikely to consider the source of it in these detailed terms.
In this successive FSA analysis, moving from the healthy α baseline to β and, nally, to β1, we have
now encoded two separate sources of irrationality found in OCD anxieties. First, we encoded the
lack of a perceived negative outcome (β), and, second, false propositions (β1). Addressing such
comparisons is key for any practicing counselor with an OCD client. Two important outstanding
On the Utility of Introducing Formal eory to Counseling
questions, however, are the following: Why do β and β1 anxieties become obsessional for patients,
and how are they linked to compulsive behaviors? In the current analysis, the answers to these
questions are to be found in the dynamic processes involved in obsessive-compulsive behavior.
erefore, with the static rules of OCD now established, we turn to the real-time processes.
3.3. e Dynamic Processes of OCD
In considering the role of dynamic or real-time processing, we must rst dene the relevant pro-
cesses for the phenomenon under discussion, and then we must describe the way in which they
are activated to operate over specic variables or pieces of information. To dene the processes, we
use similar notation as for the denition of rules (i.e., a form of propositional logic). In (4-6), three
relevant processes are dened for the present discussion.
(4) PREVENT α V β V β1 [R ((P Q) (P (=0) ¬Q))]
(5) FIGHT α V β V β1 [B, where B is aggression towards P ((P Q) (P ¬Q))]
(6) FLIGHT α V β V β1 [C, where C is evasion of P ((P Q) (P ¬Q))]
e PREVENT process in (4) applies over any of the denitions of anxiety given above (α or β or
β1). It stipulates a proposition R that searches for a complex proposition (P Q) within those de-
nitions of anxiety, and if it nds one then it will become (P(=0) ¬Q). In other words, R transforms
“if P then Q” to mean “if P (which is now marked as false) then not Q.” at is, P, which has become
false, no longer leads to Q. If P were “ere might be questions on my nals that I don’t understand”
and Q were “It is more likely I will fail my nals,” then R might be “Hiring a tutor will reduce the
number of questions on my nals that I don’t understand.” is means that the context in which P
occurs is transformed (e.g., made untrue, or less true) such that Q is consequently negated.
e processes in (5) and (6) work in a similar way to (4), with two notable dierences. Fundamen-
tally, they still transform “if P then Q” into “if P then not Q”. However, FIGHT and FLIGHT both
do this using a constant proposition, either B or C respectively, while PREVENT above had used a
variable proposition (R). Second, unlike PREVENT, FIGHT and FLIGHT do not change the truth
status of P in order to negate Q. For example, in FIGHT, B (“aggression towards P”) might be “De-
stroying the exam hall will mean I won’t be able to take my nals.” is means P (“ere might be
questions on my nals that I don’t understand”) remains just as true as before B was applied to it,
but it does nevertheless negate Q (“It is more likely I will fail my nals”) by virtue of the fact that
the anxiety now exists in a context where the nals cannot be taken, and therefore cannot be failed.
Meanwhile, in FLIGHT, the constant proposition is C, meaning “evasion of P.” C might be “If I run
away from home then I won’t need to take my nals,” meaning that P (“ere might be questions on
my nals that I don’t understand”) remains true, whilst Q (“It is more likely I will fail my nals”) is
negated since the anxiety exists in a context where the nals cannot be taken, and therefore cannot
be failed.
e reason why R changes the truth value of P, whilst B and C do not, presumably relates to the
fundamentally dierent nature of R on the one hand, and B and C on the other. R transforms P
using sophisticated cerebral cogitation, with the objective that this transformation will negate Q.
Meanwhile, B and C are instinctual—hormonal—limbic responses that are “last resort” options,
eliciting behavior that crudely forces Q to be negated even though P remains true, using aggression
Oliver Boxell
or evasion. Not only do neurocognitive models place R-type cognition in a dierent part of the
brain from B and C-type instincts, psychological models going back to Freud (1949) distinguish
between the id (or instincts) and the ego (or thinking underpinned by cognition).
At this point, the current analysis has dened rational anxiety (1), two iterations of irrational OCD
anxiety (2-3), and three processes that will be applied to those anxiety denitions. e nal part of
the analysis is to describe usage of the real-time processes themselves. e ordering and systematic
real-time activation of processes is described using an adapted form of rst-order logic that ex-
plains how each process works on the variables that activate them.
(7) α (x) x(PREVENT) = 1 V x(PREVENT) =0 Λ x(FIGHT V FLIGHT)
(8) β(1)(x) x(PREVENT) Λ x(FIGHT) Λ x(FLIGHT)
To paraphrase (7) in plain English, it says something like “If the α function is applied over any
variable x—that is, any specic anxiety a client might happen to have—then the PREVENT process
will be applied to it. If this application works as described in (4), it will be ‘true’ (=1), or if it fails,
its application to x will be ‘false’ (=0). If PREVENT fails, FIGHT or FLIGHT will then be applied to
x.” Meanwhile, a paraphrase of (8) might be “If the β or β1 denition of anxiety is applied over any
anxiety x, then the PREVENT and FIGHT and FLIGHT processes can all be applied to it simulta-
neously.” In sum, there are crucial dierences between healthy α and pathological β or β1 anxieties
in terms of processing. PREVENT will initially be used to combat a healthy anxiety in (7), and
feedback is used to conrm whether it has worked or not. Only if it has not worked, will a choice
be made to enact FIGHT or FLIGHT. Meanwhile, PREVENT, FIGHT, and FLIGHT can all be acti-
vated simultaneously to combat pathological anxieties in (8), and such activations are not aected
by feedback generated by any of them.
For an OCD client with a β anxiety like “Restrooms collect a lot of bacteria” (P) and “I might con-
tract some bacteria” (Q), the PREVENT process involves behaving in whatever way is necessary to
negate the anxiety. For example, R in (4) might be “Cleaning the restroom removes the bacteria.
R will thus falsify P and in turn negate Q. Meanwhile, clients with β1 anxieties already have false
propositions, so applying R will not change the truth status of P since it already meets the denition
of “P(=0),” as in (4). In such cases, R would simply placate P directly in order to negate Q. For exam-
ple, if P is “Touching the four corners of light switches keeps my family alive,” and Q is “My family
will not continue to stay alive if I do not touch the four corners of all light switches,” then R might
be “Touch the four corners of light switches.” P is already false, so it simply remains so, and Q is
negated since the four corners of the light switches were touched, meaning that P has been placated
and so no longer leads to the family not staying alive (Q), but to (¬Q) instead.
e use of PREVENT with β or β1 type anxieties is similar to suggestions that compulsive behavior
(e.g., ritualistic cleaning or touching objects in certain ways) is in fact an attempt to alleviate the
anxiety caused by obsessive thoughts (e.g., Okasha, 2002). PREVENT would be used regularly—
i.e., compulsively—to placate β or β1 type anxieties that apply to commonplace objects, places, or
people, like light switches, restrooms, and family members, since the anxiety would be triggered
regularly. is is further compounded by the fact that PREVENT cannot actually “prevent” an ir-
rational anxiety. “Preventing” an irrational anxiety will not involve preventing a perceived negative
outcome, since they do not really have perceived negative outcomes, as we saw in (2) and (3). Irra-
On the Utility of Introducing Formal eory to Counseling
tional anxieties may also involve behavior that attends to false propositions, as we saw in (3), which
obviously cannot be “prevented,” since they are not real. In other words, the acts of “preventing”
irrational anxieties have no real impact on the real world (e.g., touching the four corners of all light
switches will not have a causal link with keeping the client’s family alive). Unlike pathological anx-
ieties, healthy anxieties are grounded in true real world properties and are contingent on perceived
negative outcomes that PREVENT can be demonstrated to work on with positive feedback, as we
saw in (7). For example, hiring a tutor may improve understanding of exam questions, and doing so
will tangibly alleviate nals anxieties. For OCD patients, since PREVENT cannot generate feedback
for “preventing” false propositions and/or perceived negative outcomes, it appears to form a “emp-
ty feedback loop” instead—i.e., PREVENT fails, and so is reactivated in a futile bid to get a result,
whilst the anxieties themselves cannot be terminated. To demonstrate the nature of this recursive
empty feedback loop,” the process described in (8) could be revised as (9).
(9) β(1)(x) x(PREVENT (x(PREVENT)) = ? Λ x(FIGHT) Λ x(FLIGHT)
In (9), the application of PREVENT to anxiety x has an embedded contingency that refers to itself.
PREVENT can now only be applied to x if another iteration of PREVENT is applied to x, and that
second iteration can only be applied to x if a third iteration of PREVENT is applied to x, and so on,
with each iteration failing to generate feedback, denoted by “ =?” To put it another way, the stipu-
lation will continue into an innite regress—the “empty feedback loop” that gives rise to unabated
obsessions and compulsions. In eect, this gives us a formal denition of OCD itself.
Since β or β1 type anxiety results in an empty feedback loop, FIGHT and FLIGHT can be applied to
x too, just as they might be for failed attempts at PREVENT (i.e., negative feedback) for an α anxiety.
Clients may, for example, experience anger or other impulsive emotions towards themselves and
their irrational anxieties, or the objects that are the focus of them. is may explain why OCD can
be characterized by impulsive as well as compulsive behaviors (e.g., Allen et al., 2003). Clients may
avoid the objects of their anxieties altogether, which would be very debilitating behavior, given the
commonplace items involved like restrooms or light switches. Together with an innitely repeating
PREVENT procedure, it is not hard to see why OCD is oen cited as being time-consuming and
comorbid with depression and suicide (e.g., Hollander & Rosen, 2000), forms of the FLIGHT and
FIGHT procedures.
4. Utility for Practicing Counselors
e FSA analysis in §3 suggests that OCD anxieties are irrational in two ways, as follows: (i) they do
not result in a perceived negative outcome; (ii) for many OCD anxieties, the propositions are false
in the real world. It also suggests that obsessions and compulsions arise from an “empty feedback
loop.” Taken together, practitioners can use this analysis to formulate specic counseling goals for
their clients, such as the following:
• to train their clients to distinguish anxieties with perceived negative outcomes—which are
legitimate—from those with no perceived negative outcomes;
• to train clients to check through the constituent propositions of their anxieties to see if they
are each true in the real world;
for clients to understand how placating their obsessions causes an innite “empty feedback
loop” and cannot be successful in negating obsessive anxieties, in contrast to healthy anxieties.
Oliver Boxell
ese goals provide practitioners with a highly targeted trajectory for a client’s counseling pro-
gram. is may help identify a specic set of techniques that are appropriate to reach these goals.
For instance, these goals fall under the broader objectives of Cognitive Behavioral erapy (CBT),
which are to disconnect obsessive thoughts from feelings of anxiety, challenge the irrationality of
OCD, and model healthy and unhealthy thoughts (e.g., Hill & Beamish, 2007; Foa, 2010). A CBT
counselor might, for example, ordinarily ask their OCD clients to keep a daily journal of their irra-
tional anxieties, and challenge them to rationalize each entry in a separate column of the journal.
However, if counselors were to base their sessions on the above FSA analysis and train clients to
break down each anxiety into its propositions (i.e., the premise and the consequence involved in
each anxiety), then clients may be able to assess the real world truth value of each proposition in
their journal, and therein identify a key source of irrationality in their thinking. Likewise, instead
of merely using the objective of separating obsessive thoughts from feelings of anxiety as in regular
CBT, a counselor could adapt CBT techniques to help clients establish whether an “anxiety” has a
perceived negative outcome or not. e clients’ metacognitive realization that an anxiety is discon-
nected from possible negative outcomes could become a key part of the process of removing the
feeling of anxiety from the actual obsessive thoughts.
Since CBT has been demonstrated to be highly eective in reducing OCD symptoms (e.g.,
Abramowitz, 1998; Homan, Asnaani, Vonk, Sawyer, & Fang, 2012), it would be particularly inter-
esting to test whether CBT, when administered with the more restricted set of goals based on the
current FSA analysis, would reach still higher levels of ecacy. Indeed, running an intervention
study to compare CBT with—and without—the restrictions of the current analysis would be one
way to verify this proposed theoretical account of OCD empirically. Such empirical work would
not only help counselors to identify accurate theoretical analyses on which to base their prac-
tice, but would also help to verify correct theoretical understanding amongst researchers. For now,
however, these remain questions for future research. More broadly, note that formal philosophical
accounts of clients’ problems are independent of any particular therapeutic paradigm or counsel-
ing orientation, meaning that clinicians can apply whatever insights might be gained from such
an analysis to whatever treatment methods are most appropriate and have been shown to be most
eective. Note, however, that the insights gained from an FSA analysis are intended to be useful
for counselors in rening their understanding of clients’ problems, and for rening the goals and
applications of therapeutic interventions over the course of treatment. One should not necessarily
assume that clients will overtly be able to understand or accept the logic in an FSA description of
their situation, especially if their thinking is highly entrenched in the irrationality of their disorder.
Clients’ own realizations of their awed reasoning may oen emerge during a course of treatment,
as they participate in therapeutic interventions designed to tease them out.
e abstract detail with which mental rules and processes can be stipulated in formal symbolic
theory aords twofold advantages. On the one hand, the account can be adapted to any client’s
given situation, including their particular experiences, personality, and background. Taking the β(1)
functions in the above analysis as an example, one can apply any possible obsessive anxiety in the
world to propositions P and Q. is means that an FSA analysis can be used to provide a somewhat
idiographic, or constructivist, description of a client’s problems in that the description will pertain
exactly to the individual concerned and their circumstances. e practitioner can follow such an
analysis through to the counseling goals listed above, applying them for each client specically.
On the Utility of Introducing Formal eory to Counseling
Having said that, however, the second advantage of the abstract detail involved in formal theory
is that it should be able to apply universally over all clients with the condition. e static rules
imply relationships with each other and with a series of real-time processes in order to work. All
of this needs to be stipulated in the formalization. In short, formal theory requires one to state all
assumptions and inferences—nothing can be le implicit in a formal system, since they are inher-
ently literal and everything must be dened from the ground up using the terms of the system. No
theoretical details can hide behind metaphor, imagery, rhetoric, the implications of certain words
or phrases, or any other common language devices that may result in oversimplication. is gives
rise to rich universal theoretical principles that, following empirical verication to ensure the valid-
ity of the account, can provide a detailed scientic understanding of the phenomena. In turn, this
approach has the potential to form the basis of a strong system of classication and corresponding
diagnoses for clinicians. In short, formal analyses of dysfunctions can also provide a general nomo-
thetic description that captures the nature of the psychopathologies themselves. However, unlike
many of the current classication systems based on statistically prototypical symptoms, FSA aims
to give a detailed account of the causal rules and processes for each pathology. Of course, to develop
FSA or any other formal system into a clinical nosology for use in the eld, additional empirical
work would be needed to ensure the diagnostic classications being oered can be reliably used
across dierent practitioners. At the same time, researchers should aim to test the empirical validity
behind the postulated components of each analysis of a dysfunction to ensure the abstract proto-
typical descriptions t real-world observations, and can be standardized. For now, these remain
questions for future research.
Finally, it has long been known that the process of counseling itself is inherently grounded in the
interpersonal dynamics between counselor and client. For instance, Strupp (1973, p.29) remarks as
follows in his book, accompanied by a range of studies that attempt to tease out the impacts of client
and therapist attitudes, expectations, and other personality characteristics (see also, Bilbring, 1937;
Freud, 1949; Stone, 1954, amongst other early work, and Buining, Kooijman, Swinkels, Pisters, &
Veenhof, 2015):
It is a truism by now that the objectivity of information gathered about a patient in the so-
cial interaction of psychotherapy is at best relative, because it is ltered through and aected
by the social interaction that is partly a function of the therapist’s underlying personality
Oentimes, it is asserted that the huge variance in counseling outcomes that results from the in-
terpersonal dynamics of counselor and client is a problem best met with better theories of the
dysfunctions and their treatment (see, e.g., Strupp, 1973). is makes sense, since ne-grained
theories of dysfunctions and treatment aord the counselor precision, both in assessing symptoms
and diagnosing clients, but also in guring out how to proceed with the therapeutic intervention
itself. Use of veriable and detailed theoretical accounts in counseling means the nature of the
client’s problems can be spelled out and treated in the terms of the theory, and not only under the
terms and restrictions set down by whatever social relationship emerges between counselor and
client. In other words, the precision of good theory is thought to mitigate the interpersonal vari-
ance in dierent counseling relationships. In the case of formal theoretical accounts in particular,
the terms of description are inherently detailed, since every rule and process has to be stipulated.
is should, in principle, optimize the possibility for counselors to arrive at clear understandings
Oliver Boxell
of their clients’ problems and the causes thereof, less dependently on the roles of either counselor
or client personality. Whether or not this hypothesis is accurate also remains a question for future
empirical research, however.
In sum, formal approaches like FSA help researcher-practitioners to develop more precise coun-
seling goals for their clients, whilst at the same time developing precise denitions of the psycho-
pathologies themselves. is simultaneously idiographic and nomothetic strategy results from the
use of abstract formalism to spell out details that can apply both across the whole population and to
individual cases. In this way, it is feasible that FSA accounts of mental health, educational, or social
dysfunctions could be developed into a clinical nosology that would provide a detailed account of
the rules and processes involved in causing pathological thinking and behavior. In turn, the pre-
cision that results from such a system may mitigate the well-known eects of client and counselor
personality on therapy outcomes by guiding diagnosis and use of treatment frameworks in highly
specied terms.
5. Conclusion
Counselors are interested in the dysfunctions that give rise to problems with mental health, inter-
personal and tribal relationships, and educational and career outcomes, amongst others. More-
over, they are interested in remedying such problems to improve the wellbeing of their clients. To
understand such dysfunction, and how it might be alleviated, detailed theory is required. Formal
Symptoms Analysis is a theoretical framework in which the theorist can postulate how rules and
processes work in the healthy mind, and how this diers in cases of dysfunction. Taking OCD as
a case study, the current paper has demonstrated usage of the framework. e analysis created
specic counseling objectives for practitioners, for which appropriate counseling techniques may
be identied. e formal symbolic detail of such accounts has the potential—with verication—to
provide a highly rened diagnostic classication system, better scientic understanding of the phe-
nomena described, and its detailed guidance for diagnosis and therapy may help plug the variable
treatment outcomes caused by dierent counselor and client personality types. Meanwhile, the ab-
stractness of the framework means it is adaptable to dierent counseling orientations, as well as the
dierent circumstances of individual clients. All these researcher-practitioner benets considered,
it seems there is much to be gained by teaching counselors to be formal philosophical theorists.
Abramowitz, J. (1998). Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A
meta-analytic evaluation of clinical signicance. Behavior erapy, 29, 339–355.
Allen, A., King, A. & Hollander, E. (2003). Obsessive compulsive spectrum disorders. Dialogues in
Clinical Neuroscience, 5, 259-271.
Anastasi, A. (1958). Heredity, environment, and the question “how?” Psychological Review, 65, 197-
Bandura, A. (1977). Social Learning eory. Englewood Clis, NJ: Prentice Hall.
Baron-Cohen, S. (1991). Precursors to a eory of Mind: Understanding attention in others. In A.
Whiten (ed.). Natural eories of Mind: Evolution, Development and Simulation of Everyday Min-
dreading. Oxford, UK: Basil Blackwell, 233-251.
Bilbring, E. (1937). Symposium on the eory of the erapeutic Results of Psychoanalysis. Inter-
national Journal of Psychoanalysis, 18, 170-189.
On the Utility of Introducing Formal eory to Counseling
Boxell, O. (2016). The place of Universal Grammar in the study of language and mind. Open Lin-
guistics, 2, 352-372.
Buining, E., Kooijman, M., Swinkels, I., Pisters, M., & Veenhof, C. (2015). Exploring psychothe-
rapsits’ personality traits that may inuence treatment outcome in patients with chronic diseases:
A cohort study. BMC Health Services Research, 15, 558.
Chomsky, N. (1986). Knowledge of Language: Its Nature, Origins, and Use. New York, NY: Praeger.
Einstein, A. (1954). Ideas and Opinions by Albert Einstein. New York, NY: Crown Publishers, Inc.
Foa, E. (2010). Cognitive Behavioral erapy of Obsessive Compulsive Disorder. Dialogues in Clin-
ical Neuroscience, 12, 199-207.
Freud, S. (1949). An Outline of Psychoanalysis. New York, NY: Norton.
Goldberg, A. & Suttle, L. (2010). Construction Grammar. Wiley Interdisciplinary Reviews: Cognitive
Science, 1, 468-477.
Gibson, E., Bergen, L. & Piantadosi, S. (2013). e rational integration of noisy evidence and prior
semantic expectations in sentence interpretation. Proceedings of the National Academy of Sciences,
110, 8051-8056.
Gordon, R. (1996). 'Radical' simulationism. In P. Carruthers & P. K. Smith (eds.). eories of eories
of Mind. Cambridge, UK: Cambridge University Press.
Hill, N. & Beamish, P. (2007). Treatment outcomes for obsessive compulsive disorder: A critical
review. Journal of Counseling & Development, 85, 504-510.
Homan, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). e ecacy of Cognitive Behavioral
erapy: A review of meta-analyses. Cognitive erapy and Research, 36, 427-440.
Hollander, E. & Rosen, J. (2000). Obsessive compulsive spectrum: a review. In M. Maj, N. Sartorius,
A. Okasha, & J. Zohar (eds.). Obsessive Compulsive Disorder. New York, NY: John Wiley & Sons.
Hughes, C. & Leekam, S. (2004). What are the links between eory of Mind and social relations?
Review, reections, and new directions for studies of typical and atypical development. Social
Development, 4, 590-619.
Ibbotson, P. (2013). e scope of usage-based theory. Frontiers in Psychology, 4, 255: doi: 10.3389/
Lecce, S. & Hughes, C. (2010). ‘e Italian Job?’ Comparing eory of Mind performance in British
and Italian children. British Journal of Developmental Psychology, 28, 747-766.
Levy, R. (2008). Expectation-based syntactic comprehension. Cognition, 106, 1126–1177.
Locke, J. (1690). An Essay Concerning Human Understanding. London, UK: e Baet.
Marcus, G. (2004). e Birth of the Mind: How a Tiny Number of Genes Creates the Complexities of
Human ought. New York, NY: Basic Books.
Mill, J.S. (1843). A System of Logic: Ratiocinative and Inductive. London, UK: John W. Parker.
Okasha, A. (2002). Diagnosis of Obsessive Compulsive Disorder: A review. In M. Maj, N. Sartorius,
A. Okasha, & J. Zohar (eds.). Obsessive Compulsive Disorder. New York, NY: John Wiley & Sons.
Piaget, J. (1952). e Origins of Intelligence in Children. New York, NY: International Universities Press.
Pinker, S. (1997). How the Mind Works. New York, NY: W. W. Norton & Company.
Pinker, S. (2002). The Blank Slate. New York, NY: Viking.
Rousseau, J. (1792). Emile. Trans. A. Bloom. (1979). New York, NY: Basic Books.
Stone, L. (1954). e widening scope of indications for psychoanalysis. Journal of the American
Psychoanalysis Association, 2, 567-594.
Strupp, H. (1973). Psychotherapy: Clinical, Research, and eoretical Issues. New York, NY: Jason
Aronson, Inc.
Oliver Boxell
ierry, G., Athanasopoulos, P., Wiggett, A., Dering, B., & Kuipers, J. (2009). Unconscious eects
of language-specic terminology on preattentive color perception. Proceedings of the National
Academy of Sciences of the United States of America, 106, 4567-4570.
Whitehead, A. & Russell, B. (1910). Principia Mathematica. Cambridge, UK: Cambridge University
Oliver Boxell has a Ph.D. in Cognitive Science and is currently working towards becoming a li-
censed Clinical Mental Health Counselor. His main interests concern understanding the cognitive
rules and processes that underpin human thoughts and behaviors and how these can become dys-
functional in psychopathologies. He is currently based out of the Department of Counseling and
Human Development in the Margaret Warner School of Education at the University of Rochester,
On the Utility of Introducing Formal eory to Counseling
Lou Marinoff
Reviews Editor
Leslie Miller
Associate Editor
Dena Hurst
Technical Consultant
Greg Goode
Legal Consultant
Thomas Grifth
Journal of the APPA
Volume 12 Number 3 November 2017
ISSN 1742-8181
Aims and Scope
Philosophical Practice is a scholarly, peer-reviewed journal dedicated to the growing
eld of applied philosophy. The journal covers substantive issues in the areas of
client counseling, group facilitation, and organizational consulting. It provides a
forum for discussing professional, ethical, legal, sociological, and political aspects
of philosophical practice, as well as juxtapositions of philosophical practice with
other professions. Articles may address theories or methodologies of philosophi-
cal practice; present or critique case-studies; assess developmental frameworks or
research programs; and offer commentary on previous publications. The journal
also has an active book review and correspondence section.
APPA Mission
The American Philosophical Practitioners Association is a non-prot education-
al corporation that encourages philosophical awareness and advocates leading
the examined life. Philosophy can be practiced through client counseling, group
facilitation, organizational consulting or educational programs. APPA members
apply philosophical systems, insights and methods to the management of human
problems and the amelioration of human estates. The APPA is a 501(c)(3) tax-ex-
empt organization.
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The American Philosophical Practitioners Association is a not-for-prot educa-
tional corporation. It admits Certied, Afliate and Adjunct Members solely on
the basis of their respective qualications. It admits Auxiliary Members solely
on the basis of their interest in and support of philosophical practice. The APPA
does not discriminate with respect to members or clients on the basis of national-
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Nemo Veritatem Regit
Nobody Governs Truth
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IntroductionCompulsivity and ImpulsivityImpulse-control DisordersSomatoform and Eating Disorders ClusterNeurological DisordersSummaryReferences The Obsessive-compulsive Spectrum: Promises and Pitfalls. Authored by Katharine A. PhillipsUnderstanding the Obsessive-compulsive Spectrum: A Four-factor Model of Obsessive-compulsive Symptoms. Authored by David Watson and Kevin WuExtremes of Impulse Control and Serotonin/Frontal Lobe Pathophysiology. Authored by Walter KayeThe Obsessive-compulsive Spectrum: Fact or Fancy? Authored by Donald W. BlackBlurry Spectrum Disorders. Authored by Neal R. SwerdlowSpectrum Disorders: Utilitarian Concepts or Utopian Fantasies? Authored by James W. JeffersonCarving Nature at Its Joints: Different Approaches to the Obsessive-compulsive Spectrum of Disorders. Authored by Dan J. SteinThe Challenge of Deconvolving the Obsessive-compulsive Disorder Spectrum into Its Component Diseases. Authored by Mark GeorgeObsessive-compulsive Spectrum Disorders: Are Opposites Related? Authored by Rocco CrinoThe Spectrum of Obsessive-compulsive-related Disorders: State of the Art. Authored by Donatella Marazziti
Counselors in the 21st century must not only respond to the pressures of managed care but also support the best interests of their clients. Criticism from consumers and professionals about the lack of empirical evidence of the efficacy of counseling as well as pressure from managed care companies have prompted a focus on evaluating treatment outcomes. This article provides a framework for developing standards of care by highlighting issues in outcome research in general and by reviewing treatment outcomes for obsessive‐compulsive disorder.