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The European Legacy


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A postmodern metaphor: Psychotherapy as rhetoric


Tanya DiTommaso a a Department of Philosophy, University of Ottawa, Canada K1N 6N5 Online Publication Date: 01 July 2005

To cite this Article DiTommaso, Tanya(2005)'A postmodern metaphor: Psychotherapy as rhetoric',The European Legacy,10:4,349

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To link to this Article: DOI: 10.1080/10848770500116481 URL: http://dx.doi.org/10.1080/10848770500116481

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The European Legacy, Vol. 10, No. 4, pp. 349357, 2005

A Postmodern Metaphor: Psychotherapy as Rhetoric


Tanya DiTommaso

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Abstract What is the non-objective/non-empirical nature of the psychotherapeutic discourse that heals? In general, to what extent must non-objective and non-empirical strategies be used in psychotherapeutic dialogues? In particular, to what extent must rhetoric be used to alleviate the symptoms of depression and anxiety? We shall examine the various rhetorical strategies in psychotherapy, and question the nature of the therapistpatient relation that pervades psychotherapeutic discourse.

I. Postmodern Depression and Anxiety


It is not a coincidence that the prevalence of depression and anxiety in North America comes at a time when philosophy itself has reached a desperate point of uncertainty. In the age of postmodernismwhere here foundationalism/essentialism/ realism are rejected, the sovereignty of reason is critiqued, the notion of an autonomous and objective subject is destroyed, and all metanarratives are questionedwe are continually advised to focus on the language-game character of all thought and action. All the while we try to understand the particular language-game of this theory or that practice, nestled within this exercise is the realization that upon accepting the deconstruction of core identities, metaphysical truths, and normative values, we have ushered in a frustrating and anxious state of uncertainty. This unsettling awareness may or may not be conducive to our particular theoretical and practical goals. In the case of psychotherapy, the prognosis is mixed. While the goal of psychotherapypatching together a disintegrated, disharmonious, demoralized self1is thwarted by the predominant postmodern ideas that promote the very disharmony and disintegration that psychotherapy tries to mend, psychotherapy has successfully integrated postmodern ideas into its practice by focusing on the non-objective language games inherent in discourse. To succeed, however, the psychotherapeutic enterprise must work within the postmodern glorification of ambiguity and uncertainty, and find new ways of healing the selves that consist of and exist within this uncertainty.

Department of Philosophy, University of Ottawa, Canada K1N 6N5. Email: tditomma@uottawa.ca


ISSN 10848770 print/ISSN 14701316 online/05/043499 2005 International Society for the Study of European Ideas DOI: 10.1080/10848770500116481

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While psychotherapy has largely accepted a more de-centered, deconstructed, non-objective interpretation of the self, little emphasis has been placed on the role of rhetoric and metaphor in psychotherapeutic discourse. While the role of rhetoric in psychotherapy has been noted,2 we find only the faintest of suggestions that this might be an appropriate topic of research when, for example, in the final pages of Persuasion & Healing: A Comparative Study of Psychotherapy, it is suggested that as a type of persuasion, psychotherapy might be more closely allied to rhetoric and its close relative, hermeneutics, than to behavioral science.3 In philosophy, on the other hand, the postmodern move away from the language of metaphysics has translated into the acceptance of rhetoric and metaphor as the foundation of human thought and practice. Current continental theories of the self are commonly interpreted as only one interpretation that emerges in the course of dialogue; a dialogue where conflicting ideas compete for dominance or acceptance. Any current and dominant theory of the self is dominant only insofar as it has risen to power by persuasion and force (linguistic or otherwise). What is more, the postmodern recognition and endorsement (and perhaps condemnation) of any thought or practice as inherently otherthan-self encourages us to anticipate the day when our current notions or practices will be overthrown by other, more persuasive, notions or practices. It certainly seems that we live on the brink of anticipation, where we have come to expect that our thoughts and practices will sooner or later be modified or replaced. But what becomes of our sense of self when we learn to speak or act with this anticipation in mind? How can we ever speak and act with confidence? Can we still take our own, or anyone elses, ideas or practices seriously, or will we quietly withdraw from dialogue because it only leads to endless possibility? Will we tremble with anxiety before this uncertainty, fearing the never-ending kaleidoscope of change? Little attention has been placed on the paralyzing psychological effects of the postmodern agentthe interpreter who speaks and acts. In response to this, I shall suggest that we reconsider the current psychotherapeutic dialogue from within this general state of uncertainty, and consider the possible remedies that a postmodern world-view might present. With this in mind, I suggest that rhetoric and metaphorthe foundations of hermeneutic interpretationbe acknowledged by psychotherapeutic practice as vital keys to understanding and healing depressed and anxious selves.

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II. Rhetoric and Metaphor in Psychotherapy


Curiously, while the postmodern emphasis on rhetoric and metaphor in interpretation plays a central role in the cognitive-behavior therapies and linguistic therapies of psychoanalysis, there has been little overt acknowledgment of the use of metaphor or rhetoric from within psychoanalysis, and what is more, there has been no recognition of a need to train therapists in this art. This inattention hinders attempts to interpret and treat depression and anxiety. Without an acknowledgement of the central role that metaphor and rhetoric play in self-interpretation, and without an emphasis on training therapists in this art, therapy cannot succeed in interpreting, translating, and healing the anxious and depressed selves who populate the postmodern world.

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Rhetoricthe art of persuasionis a powerful tool that allows interpreters to transcend rational boundaries by merging together what reason would dismiss as a logical paradox. Through rhetoric, therapists in effect accomplish what is logically impossible; they can create something from nothing, good from bad, happiness from depression, and peace from anxiety. In other words, to transform the perception of something (e.g. the patients perception of a burden) into nothing (e.g. the lack of a burden), to turn the perception of nothing (e.g. the patients perception of a lack of love) into something (e.g. the presence of love), and to turn the perception of what is bad and painful (e.g. a disturbing event or idea) into that which is good and pleasant (e.g. a helpful event or idea), the psychotherapist must engage in the practice of rhetoric. Metaphor underlies all our attempts to communicate. In using metaphors, we transfer, transform, and translate the meanings of our existence and the world around us. To interpret a troubling event or feeling into one more pleasant or meaningful, metaphor is essential. To interpret something as, is to invoke the use of metaphor, and thereby to alter the meaning of that something. Not surprisingly, metaphor and rhetoric hold a central place in contemporary hermeneutic philosophy. What is surprising is the diminished role that metaphor and rhetoric continue to play in the theory and practice of psychotherapy.

III. Narrative Therapy: Cure or Care?


The self conceived as a linguistic being who creates, establishes, and breaks its own linguistic boundaries is precisely the idea behind narrative therapy.4 The practice of psychotherapy hinges on the idea that an ongoing discourse between therapist and client is necessary to understand the maladies which plague the self. In general, narrative therapy and cognitive-behavior therapy both aim at developing a trusting dialogue between the therapist and patient where the therapist attempts to talk through the patients problems and establish or restore the patients sense of worth, self-love, balance, and self-possession. In talking to the patient, the therapist must translate and replace the patients troubled interpretation with another more workable one. Essentially, our self-narratives attain workability in the dialogical setting of narrative therapy. The workability, or lack thereof, of ones narrative is judged against the expectations and interpretations of the therapist.5 The power of the word is a presumption that guides the great care our society takes in choosing the very words used to describe psychotherapy. The move to replace the words analyst and patient with therapist and client, illustrates the commonly held belief that words evoke powerful messages and affect how we perceive ourselves. This linguistic shift signals the move away from the medical model of analystpatient toward a less objective, less scientific, and less authoritative therapistclient dialogue. More recently, and perhaps more disturbingly, the word cure has come under attack. This shift towards describing the dynamic that occurs in psychotherapy as a caring and healing through love, rather than as a cure,6 is premised upon the assumption that the word care (as opposed to cure) places the therapist on an equal footing with the patient-as-client and, further, that the activity of therapy consists of a mutual empowerment in which power-with replaces power-over or power-under.7 This change signals a rejection of the conception of the passive patient and the analyst as expert

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who asserts critical authority over the former. Freuds characterization of the psychoanalyst as a mirror has dominated contemporary psychotherapy to the extent that therapists of psychoanalytic and other nondirective types of therapy have claimed that they do not influence the patient.8 Psychotherapy is increasingly regarded as a joint effort where the therapist, no longer the master of the dialogue, is now a co-contributor, among other possible contributors, in the reconstruction of the patients self.9 This move towards replacing the notion of cure with care is unsurprising given the postmodern dissolution of certainty and authority. If the goal of diminishing the symptoms of depression and anxiety is thought of as a result of care, as opposed to a cure, then how are we to understand the notion of an ill or unhealthy self? If we forego cure for care, should we then replace ill with careless when describing the self who suffers from depression and/or anxiety? We could say that it is the selfs adaptabilitythe sense of ease with which one modifies ones narrativethat is the essential aspect of a healthy self. The ill self, the self who clings to sad, troubling, and anxious thoughts, is helped by the therapists suggestions for new narrative configurations and less troubling thought patterns. In other words, the therapist works to modify the patients self-defeating narrative. How is it that such a troubled self, a self who cannot adapt itself with ease and efficiency, could be thought of as an equal and co-creator in the psychotherapeutic dialogue? Certainly while the patients efforts and participation in change are necessary for this dialogue to occur, it is equally necessary that the therapist play a dominant role as healer. The postmodern watering-down of authority effectively undermines the authority of the analyst as a specialist who can offer something above and beyond what others can provide. Essentially, the linguistic implications of care undermine the efficacy of psychotherapy by ignoring the powerful rhetorical dynamic that grounds the discourse between analyst and patient. Within postmodernismwhere the self is taken to be a linguistic narrative that can be altered and reconstructed through conversationwhat concerns the psychotherapist is the self who cannot make an ordered sense or workable narrative out of her conflicting ideas and feelings. When these conflicting ideas and feelings are left unordered (because, for example, they might be too overwhelming or painful for the patient), they fester and create feelings of inadequacy, frustration, anger, anxiety and dread. Depressed and/or anxious individuals interpret their lives with disruptive and demoralizing self-narratives.10 The process of transforming these self-narratives requires addressing the particular narrative events, feelings, and ideas that, for one reason or another, the patient has not been able to organize without troubling her larger narrative self. If the object of dialogical therapy is the patients narrative-linguistic self, then aiming at a new interpretive organization of a self which is mediated through narration requires that the therapist alter the selfs narrative by asking different questions and, thereby, changing the ill story into a healthier one.11 What is evident in this description of dialogical therapy, we should note, is that the role of the analyst is not depicted as a co-contributor. The tendency in psychotherapy today is to infer from the deconstruction of permanent and identical truths and realities a paralysis where therapists who care are unable to exercise power and persuasion, and are unable to turn false narratives into true ones. In understanding that the re-ordering of the patients ideas, feelings, and values is always only one possible ordering, the talking care operates under the illusion that very little, or no, power or persuasion should be exercised by the therapist, while the

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patient is prompted to revise for herself an interpretation dialectically until an internally consistent picture emerges.12 While postmodernists in general are convinced that the self has no altogether unified or true narrative, what is not generally agreed upon is the extent to which some self-interpretations can be more persuasive and powerful than others.13 The dissolution of authority and certainty need not entail powerless and non-authoritative therapy. Even within the realm of care, some small amount of authority and persuasion must be used in order to prompt the patient towards changing troubled thought patterns. The fact that the patient seeks out the services of a therapist already suggests the patients readiness to submit to an authority. In fact, within psychotherapy, it is widely acknowledged that a patients simple readiness to enter into therapy generates a placebolike effect for that patient. On this, Frank writes:
We shall start with a universal feature of successful psychotherapies, their ability to arouse the patients expectation of help. Humans are time-binding creatures, so assumptions about the future have a powerful effect on their present state. . . . Physicians have always known that their ability to inspire expectant trust in a patient partially determines the success of treatment. . . . Placebos exert their effects primarily through symbolization of the physicians healing powers . . . [A] placebo is itself a form of psychotherapy . . . [P]sychotherapeutic success depends in part on patients confidence that the therapist possesses healing knowledge and skills.14

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As is evident in Franks research, the therapists power extends beyond the therapeutic session, and it is precisely this power that is an invaluable dimension of the psychotherapeutic discourse.

IV. The Patients Desire and Belief


Logically prior to the activity of narration is the impulse to narrate. What is expressed in narration is the self as a linguistic impulse, a self that seeks to express itself, order itself, and find meaning for itself. The primordial search for meaningthe meaning and sense of ones self, existence, history, and purposeis what drives our desire to narrate and re-narrate our selves. Viktor Frankls Logotherapy recognizes this point, and focuses on the patients underlying quest for finding and creating meaning. In perhaps the most explicit example of the close relation between rhetoric and psychotherapy, Frankl argues that the therapist should focus on the meaning of human existence as well as on mans search for such a meaning . . . [for] this striving to find a meaning in ones life is the primary motivational force in man.15 We could say that the healthy self desires and continually believes in the possibility of future meaningful narrations. In contrast, the depressed self may not see her current narrative as entirely meaningful and may no longer believe in the possibility of future meaning. An anxious self, furthermore, might be overwhelmed with her role as a meaningful self; she may believe that too many narrative details rest on her shoulders. For the anxious self, too many insignificant events, ideas, or feelings may spill into her self-narrative, creating the sense that she cannot escape the demands and noise that the world places on her. In both cases, these patients need to reorder their narrative stories with the goal of transforming and creating new meanings which can in turn be attributed to aspects (small or large, real or imagined, hidden or

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obvious) of their narrative stories. To alleviate both anxiety and depression, the therapist must focus on modifying the patients narrative self, so that current events, ideas, feelings, memories, and goalswhich might seem hopeless, burdensome, or traumaticcan be woven together into a new narrative story which alters both the color of these events or feelings and also their meaning. As Frankl astutely notes, emotion, which is suffering, ceases to be suffering as soon as we form a clear and precise picture of it.16 While the art of reconfiguring anothers narrative story depends upon a reasoned discourse, the postmodern disintegration of objectivity signals that desire and belief have overthrown the tyranny of reason. The postmodern therapist cannot search for the uncontested ultimate and objectively true meaning of the patients actions, thoughts, and purpose in life. Any search for meaning cannot rest solely upon an appeal to reason. When we ask the question: what is it exactly that makes people feel happy? we find no absolute or universal answer. The goal of helping people feel happy or content is not objective, but rather it is an aim that lies within the realm of subjective fancies, beliefs, dreams, and desires. The object of psychotherapy is not the true or objective self, but rather the imagined or believed self. While reinterpretations of a narrative self are neither true nor false in a metaphysical sense, they are nonetheless believable or unbelievable. Indeed, a condition for the very possibility of narration is the belief that meaning, order, and sense can exist. The authority of belief is a necessary authority in a world where deconstruction has taken its toll. In effect, the matter of a person feeling happy, content, or satisfied rests upon the single authority of that persons subjective belief. In a recent workWhat is a Relevant Translation?Jacques Derrida addresses the lack of an objective authority in determining the relevance of an interpretation. Here, the good interpretation is described as one that is believable and satisfying, rather than one that is true and real:
What is most often called relevant? Well, whatever feels right, whatever seems pertinent, apropos, welcome, appropriate, opportune, justified, well-suited or adjusted . . . [A] relevant translation would therefore be, quite simply, a good translation, a translation that does what one expects of it, in short a version that performs its mission, honors its debt and does its job or its duty.17

In an earlier interview, Derrida also states: I would not say that some interpretations are truer than others. I would say that some are more powerful than others. The hierarchy is between forces and not between true and false.18 What Derridas deconstruction highlights is the rhetorical force that underlies the interpretations that we believe and take-to-be-true.19 The effective therapist is one who recognizes this subjective contingency of truth, and in this light, reconstructs a narrative self that is both persuasive and convincing. In effect, the therapist should be a master of rhetoric. Rather than speaking of elusive truths, the therapist must construct a reinterpretation of a narrative self that is believable. The therapists ability to construct a persuasive and believable re-interpretation of the patients memories, thoughts, feelings, and goals is the means through which narrative therapy is successful. To be effective, the therapist must not only construct a new sense and narrative order for the patient, but more importantly, these constructions must be provided in such a way as to make them believable by the patient.

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V. Some Implications of Rhetoric in Psychotherapy


The trend to see the therapist and patient on an equal footing is, when taken to its extreme, debilitating. While it is true that the therapist must always care about what happens to the patient, and while it is necessary that the patient actively participate in the recreation of a new narrative self, focusing solely on care would spell the demise of psychotherapy. We can, after all, receive care from just about any person willing to talk to us. To go so far as to remove the cure from therapy would amount to pulling the plug on the rhetorical effectiveness of dialogical therapy. In order to interpret and modify a linguistic self who is comprised of ideas, dreams, wishes, beliefs, and desires, psychotherapy must rely on the use of metaphor and fully exercise the art of rhetoric. Only with metaphors and through rhetoric can a therapist convince the depressed self of a new meaningful and optimistic narrative or convince the anxious self of a new narrative order that makes events, feelings, and ideas appear less burdensome. The use of metaphor consists in making things become other than what they seem. The art of rhetoric consists in the power to persuade others. Combined, powerfully presented metaphors can succeed in convincing the patient to believe in and adopt a new narrative story. If the act of reconfiguring a patients narrative self is to be effective and fruitful, a therapist must be convincing. To be convincing, the therapist must exercise the power of persuasion. Frankls therapeutic goal of confronting the patient with things which sometimes are very disagreeable to hear,20 and the ability to reorient a patient toward a new meaning, is impossible if the therapist does not persuade by steering the conversation, asking particular (often leading or rhetorical) questions and offering connections. To reach through to, and to modify, a self who is embedded within a web of disorganized and troubling beliefs, the therapist must practice the art of persuasion by presenting compelling, authoritative, and believable narrative connections. Another important reason to emphasize the rhetorical power of the therapist is the fact that patients not only anticipate, but want to believe, that therapists can remedy their problems. As Freud recognized, expectation colored by hope and faith is an effective force with which we have to reckon . . . in all our attempts at treatment and cure.21 Patients implicitly look to therapists as specialists, experts, and authorities who can put an end to their symptoms. Patients seek the advice of therapists with an optimistic willingness to believe both what the therapist says and that what he or she says will be instrumental in affecting their depression/anxiety. While patients will choose to believe one particular narrative story over another, a patient is unlikely to accept a narrative presented by a therapist who lacks credible authority. While the therapists impressions must remain fluid, open, and sensitive to the nuances in a patients narrative re-telling, it is counter-productive to think of the therapist merely as a co-narrator. The vulnerability of the patient, often accompanied by a distorted perspective and impaired judgment, is characteristic of psychotherapy in general and is what originally places the patient in the therapists charge. While therapy involves an exchange or convergence of the therapists and patients perspectives, this dialogue involves a greater shift in the values of the patient than in those of the therapist.22 With this in mind, we could say that the goal of the therapist is to respect the patients vulnerability as well as his or her possibly impaired judgment. . . . [T]he therapist must be paternalistic, but only to maximize the patients potential for autonomy.23

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As disagreeable as it might be to speak of authority and power in a postmodern age, we must admit that to be successful in narrative therapy, the therapist must exercise power, persuasion, and influence over the patients narrative self. Only as a metaphori.e. a person as an authoritative specialistdoes the therapist possess the persuasive position necessary to succeed in a discourse that is directed towards convincing a patient (a patient who is already willing to believe the therapist) to believe in a new, less troublesome, narrative self. In listening to and weeding out the troubling connections or lack of connections within a patients story, the therapist cannot help but exercise power. If a new set of narrative connections is to be accepted by the patient, it must be made in and through the analysts authority and conviction. Even if the patient is schooled in postmodernism, she nevertheless accepts her current meaningful or meaningless fate as being true and real. Patients cling to their problematic and troubling narratives precisely because they believe these stories to be true and real. The patient will not willingly adopt what she considers to be a fabrication of her situation. Instead, the patient will only replace what she believes to be her true and real situation with another perspective (another metaphor) that she believes to be true or real. It is the responsibility and goal of a psychotherapist to present new narrative perspectives (transformative metaphors that alter the patients reality) in such a persuasive and believable way that these new perspectives become true and real for the patient. To be persuasive, then, the therapist must present a new narrative order to the patient metaphoricallyas if it were true. While Frank did not offer an answer to his question: If the therapists healing powers depend more on personal qualities such as persuasive talent . . . how should therapists be selected and trained?,24 we can provide a partial answer here by suggesting that in addition to their current curriculum, therapists must also be schooled in the art of rhetoric. Therapeutic success will depend on the degree to which new narrative orders are presented with confidence, believability, and authoritativeness. If the new narrative order is not presented in such a fashion, and if the patient is left to wander in through merely potential and marginally possible narrative suggestions, then the therapist does nothing to cure the patients condition, and may inadvertently contribute to prolonging the postmodern malaise and ambiguity that currently grips our society.

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Notes
1. See Jerome D. Frank & Julia B. Frank, Persuasion & Healing: A Comparative Study of Psychotherapy, 3rd edn (Baltimore: The Johns Hopkins University Press, 1991). 2. S. Glaser, Rhetoric and Therapy, in Psychotherapy Process: Current Issues and Future Directions, ed. M. J. Mahoney (New York: Plenum Press, 1980), 31334. 3. Frank and Frank, Persuasion & Healing, 300. 4. See Daniel C. Dennett, The Origins of Selves, in Metaphysics: Classical and Contemporary Readings, ed. R. C. Hoy and L. N. Oaklander (Belmont, CA: Wadsworth Publishing Co., 1991), 35564. 5. See Michel Foucault, Madness and Civilization, A History of Insanity in the Age of Reason (New York: Vintage Books, 1988); and Thomas Szasz, The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement (New York: Harper & Row Publishers, 1970).

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6. See James H. Olthuis, The Beautiful Risk: A New Psychology of Loving and Being Loved (Michigan: Zondervan, 2001). 7. Ibid., 37. 8. Frank and Frank, Persuasion & Healing, 178. 9. See Roy Schafer, Narration in the Psychoanalytic Dialogue, in On Narrative, ed. W. J. T. Mitchell (Chicago: University of Chicago Press, 1981), 2549. See also Roy Schafer, Retelling a Life: Narration and Dialogue in Psychoanalysis (New York: Basic Books, 1992); and Roy Schafer, Authority, Evidence, and Knowledge in the Psychoanalytic Relationship, Psychoanalytic Quarterly 65 (1996): 23653. 10. See Frank and Frank, Persuasion & Healing. 11. See Schafer, Narration in the Psychoanalytic Dialogue; Schafer, Retelling a Life; Schafer, Authority, Evidence, and Knowledge in the Psychoanalytic Relationship. 12. Paul Fairfield, Truth Without Methodologism: Gadamer and James, American Catholic Philosophical Quarterly 67 (1993): 28597. 13. See Tanya DiTommaso, Contradiction and Confirmation: Validity as Persuasiveness, Symposium 6 (2002): 2335. 14. Frank and Frank, Persuasion & Healing, 1329, 155, 176. 15. Viktor E. Frankl, Mans Search for Meaning (New York: Washington Square Press, 1984), 121. 16. Ibid., 95. 17. Jacques Derrida, What is a Relevant Translation? Critical Inquiry 27 (2001): 174200. 18. An Interview with Jacques Derrida, The Literary Review 14 (1980): 21. 19. In his latest writings, Hans-Georg Gadamer also made a significant point of emphasizing the rhetorical underpinnings of all that we take to be true in the natural and social sciences. See, for example, Hans-Georg Gadamer, A Century of Philosophy: Hans-Georg Gadamer in Conversation with Riccardo Dottori, trans. Rod Coltman and Sigrid Koepke (New York: The Continuum International Publishing Group, 2003). 20. Frankl, Mans Search for Meaning, 120. 21. S. Freud, From the History of an Infantile Neurosis, The Complete Psychological Works of Sigmund Freud, ed. and trans. J. Strachey, vol. 7 (London: Hogarth Press and Institute of Psychoanalysis, 1953), 289. 22. Frank and Frank, Persuasion & Healing, 184. 23. Ibid., 180. 24. Ibid., 300.