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Why All Therapies Can Be True at Once: Toward an Agency-Centered Understanding of Mental Health. 

 

How can a Thousand Things Be One Thing?

Contemporary mental health practice includes a wide range of therapeutic approaches that often show comparable, limited effectiveness, despite ongoing debates over which models are most correct or scientific. These debates persist because the field has not clearly identified what mental health intervention is actually working on. I say, simply, they are working on mental health, and agency is its closest psychological analogue. Rather than treating therapies as competing explanations of discrete disorders, the paper shows that all therapeutic and psychiatric practices implicitly address disruptions in human agency—the lived capacity or ability to act, choose, relate, and make sense of experience. Therapeutic diversity reflects the layered, situational, and embodied nature of agency itself. By making this implicit orientation explicit, the paper clarifies why multiple therapies can coexist without reduction to only one and reframes mental health care as the practical and ethical support of agency rather than the treatment of reified disorders. 

Agency Centered Understanding of Mental Health

Introduction: The Problem Beneath the Therapy Wars

Modern mental health practice is characterized by a paradox. On the one hand, there exists an enormous proliferation of therapeutic modalities: cognitive-behavioral therapies, psychodynamic approaches, humanistic and existential therapies, trauma-focused models, family systems interventions, mindfulness-based approaches, somatic therapies, pharmacological treatments, and so on. On the other hand, decades of outcome research repeatedly suggest that many of these approaches produce broadly comparable results when delivered competently and in supportive contexts; in other words, one does not show significantly better results in general than another. They all quite commonly show that they mostly and somewhat often work, but not really. The reaction to retort by reciting empirical statistics merely reveals the insecurity under this reality. 

The conundrum of statistical criterion has nonetheless generated persistent debates over which approach is correct, scientific, evidence-based, philosophically justified, and so on. What is not often talked about or realized is that these debates typically assume that therapies are competing explanations of a single underlying phenomenon, and that eventually one should emerge as the most accurate account of mental disorder. Further aggravating these theoretical battles is the medical model, which tends to emphasize that the ‘one thing’ that mental issues are stemming from is biological; if we listen to the rhetoric that abounds through the psychological studies, even into the rooms of therapy, neurochemistry specifically is often touted as the main reason why mental challenges exist and the theories of interventions are commonly stacked against proving a correlation between the brain, body chemicals, and expressed behaviors to the specific therapeutic concept and correlated practice as though we are getting somewhere in discovering source cause of mental issues. 

While the studies and results are interesting, this expectation has not been fulfilled. And the really interesting methodological narrative that is never questioned is that indeed the method will one day find it —and we are close! To toe the line of this modern empirical narrative the field has to keep coming up with more theories about why we are indeed not finding this elusive medical causal unicorn of mental issue so they responded with meta-theories: the biopsychosocial model, common factors theory, process-based therapy, contextual behavioral science, and pluralistic or integrative frameworks. It makes sense this would happen in a phenomenological-based oriented methodology. 

Nonetheless, while these models help explain why different therapies can coexist without one clearly dominating, they indeed do reflect the general ethical stance of therapy practitioners, namely that none of us really know; we respect one another and try to learn from one another while we try our best. Nonetheless these meta-theories remain, as critics often note, more theories of theories. When we take a moment to really look at what is happening, it becomes plain that the field becomes more and more reflective of idealisms with each new proposal. They explain how multiple approaches can work simultaneously, but not why each of them could make sense against the others, again, at the same time — and it seems they are oblivious to this. The biggest faux pas is that none of them, outside of their own theoretical argumentative framework, address why there is something for therapy to work on in the first place. It is like a dance of the intentionally blind; the music is playing and people are doing things, saying things, discussing things, and that’s about it. Strangely enough, they never get to talking about what they are actually talking about. In other words, they describe coordination among methods without addressing the deeper ontological question: What is the object of mental health intervention as such? 

I say that this cannot be corrected, but only accounted for. Reductive argument accords with the somewhat recent philosophical discussion around what some called the end of philosophy, that we have reduced all we can, so any progress cannot not be found by further reduction, and meta-theory is just reduction in a different guise. As Edmund Husserl said and our contemporary philosopher Graham Harman now implores: To the things themselves! Or for our case, to the person itself ! The suffering person themselves. But even humanism has become a psychological idealism. Nonetheless, As we should know by now: it is just reality, not an indictment. So it is, this essay argues that the proliferation and partial effectiveness of diverse therapies is best understood not as a failure of theory, nor as evidence of relativism, but as a reflection of a deeper and more fundamental feature of human life: agency, and its proper descriptive name, mental health. 

My central claim is this:

All psychotherapeutic and psychiatric interventions, taken together, are working—implicitly or explicitly—on the restoration, stabilization, and expansion of human agency under the phenomenological notions that interpret appearances of when it has been disrupted in their particular ways. In other papers I have labeled the disruption itself as subjectivity, and specifically in the realm of mental health, psychology. Psychology is thus the activity which bases itself not only on the attempt to solve a problem, but in doing so tends to reiterate the problem in different terms, what the postmodern philosopher Jean-Paul Lyotard called phrase universes. I simply say that they are also subjects and behave like all subjects do. It is not wrong or incorrect; it is just an accurate description. Mental health philosophy promotes returning to the thing itself (the person, psychology, mental health, epistemology) with renewed awareness and attention toward what is actually happening, to ground and account for everything that is involved with mental health. 

From the perspective of agency, which I say is at the core of mental health itself and fills the epistemological gap which informs theories of a psyche, therapies do not need to compete as rival explanations of disorder. Instead, they address different layers, constraints, and failures of agency within a complex, embodied, relational, and meaningful world. I call this orientation upon things disciplinary knowledge, while the individual therapies are oriented upon proposing ontological arguments about the being of maladies within a unified world of meaning and idea, which they also propose within the basis of their argument about what to do given a specific phenomenology of mental issue. The difference articulated here thus frees the various theories to be able to coalesce their meaning to substance and greater effectiveness, contains psychology to its usefulness, and brings effect around phenomenological features of a person, rather than what is essentially a disembodied disorder that the person somehow ‘caught’. 

The Implicit Assumption Shared by All Therapies

Despite their differences, all therapies presuppose something remarkably similar. Whether framed in biological, cognitive, behavioral, relational, existential terms, spiritual, or what have you, all therapeutic practice assumes that a person has become unable to live as they otherwise might want. Mental Health Philosophy suggests that this inability is not merely due to the presence of symptoms, as though they are reflecting some invading item that effects an individual, but rather opens knowledge up to a broader comprehension to place symptoms in their proper epistemological and thus nosological junctures. Symptoms of mental issues are reflections of a disruption in the person’s capacity to act, choose, feel, relate, or make sense of their life in ways that sustain them. 

The Psychological Disorders (for the majority part, with some caveats discussed elsewhere) are phenomenological clustering of symptoms. Then by some methodological sleight of hand which has its roots in the depths of philosophy some 300 years ago (think Descartes and then Kant), because we can justify a clustering of features, such a thing that is constituted by the cluster must likewise (as it is implicitly argued) have or represent a Being itself. This is phenomenology at work, what the 20^th century brought us by the subject of ideology. This method for procuring real things supports why I say modern psychological science is an idealism, again, not to suggest it is wrong, but to contextualize it in the way that indeed we know things, to then bring to notice that there is other valid knowledge that we have access to that is not subjective. The inference is that by including all relevant knowledge and not just approved, methodological ethical knowledge, into the approach for treatment is more sensible and responsive to real conditions.  

In everyday language, an infringement on agency can appear as complaints such as:

“I can’t stop doing this even though I want to.”

“I know what I should do, but I can’t bring myself to do it.”

“My thoughts don’t feel like they belong to me.”

“I don’t feel present in my own life.”

“Nothing I do seems to matter.”

These statements point to something deeper than malfunctioning cognition or neurochemistry. In fact, there is no way to prove any particular line of efficient causality; we cannot know whether the chemistry or biology is causing the malady or merely reflecting the state of things because of the malady. Any proof we might offer in necessarily skewed by the method assumed proper; to be more responsive and attentive to what is happening, we simply need to recognize this fact. When we do so, the simpler notion is they indicate a breakdown in what late phenomenologists might call authorship—a diminished sense that one is the source of one’s actions, experiences, and meanings. We need be mindful then and work in aspiring awareness; note, while we might be tempted to call this a existential approach to mental health intervention, and indeed one would not be incorrect in making such a connection, it is likely that such a conclusion would be off, since even though it indeed can be viewed as making an argument about the being of mental issue (an Existentialist or Humanist ontological argument), it is more that this is the inevitable conclusion when we consider everything that is happening in mental health that we have access to and are able to know of.

There is a difference occurring here that I feel is best grasped through the notion of orientation. So it is that this ‘argument’ is less about proving what something is offering or something we should do, and more about showing that all the theories are already telling us what the various ‘Beings’ are and what is best done for them. I say orientation is the significant issue here because of course the medical criterion of mental disorders has a certain sense, but the interventions are not really treating a biological condition any more or less than a spiritual condition, say. So, as I said earlier, recognizing what is actually happening frees theories to be able to notice which theory is helping with what situation of disorder, rather than aligning the theory with a disorder that is oddly affecting a person that gains their mental health exclusively by brain-correlated, neurochemical states, for example. So see, this is what therapy already does on the ground, and amounts to why I say I am not offering anything new but merely offering a common philosophical ground for what is already happening. 

Yet agency is not absolute in the empirical sense, and is not properly reduced to its correlated ontological claim. It is always embodied, situated, historically shaped, and relationally mediated, yes, but because it has to do with mental health as an object that presents material processes. This step out of the action of psychology moves mental health into its own domain which is more concerned with what is happening than it is with Big Picture systems of Reasons why something we might be knowing should appear in whatever way according to a priori material, semantic organizations. Agency is greater than a psychological capacity or faculty because it can be constrained or disrupted without being destroyed; one can have agency and be yet still suffering from mental issues. Agency in this way is not a cure or another theory of how we should frame psychological issues and their solutions. Rather, mental health problems could be said to arise because agency disappears by being subsumed (somehow) in psychology, but better said it is because it takes a different shape, for example, becomes unreliable, fragmented, or inaccessible under certain conditions.

This is why I distinguish between veracity and ethics; it is only under real conditions determined by the person themselves in the universe that constitute whether anything that is happening is good or bad, desired or not, well or sick. For sure psychology and society says something about sickness and wellness and so on, but agency is not determined by them and indeed exceeds them. This framing thereby helps clarify why mental challenges can be experienced as uniquely distressing; there is no knowable absolute criterion for “anxiety”, say, that has it be bad for anyone in particular, and often, indeed, anxiety is not a problem, just as being depressed is not always inappropriate to circumstances, nor wanting to end one’s own life, strange or offensive as that might sound to some. Psychology enacts an ongoing attempt to reframe disorders in contexts that will establish an absolute Being of the named disorder, but its keeps failing, so we are right then to notice its activity for what it does offer in the effort for helping, rather than the reverse, which wants to hide the embarrassment of its methodological failure behind structures of positive economic and political appearances. 

As well, agency here should not be confused with simplistic notions of willpower or personal responsibility. Rather, it refers to the lived capacity to participate in one’s own life as a responsive, choosing, meaning-making being within a world that offers possibilities and constraints. In therapy, this is exactly what the application of theory responds to — not the reverse —but each in their own way and depending on the actual person in their subjectivity, their phenomenology, showing up in specifically the way that they are. 

Mental Health, the one thing, as the Psychological Object: Agency

To say that therapy works on agency is to make an ontological claim about what mental health treatment is fundamentally addressing, yes. This just admits that human beings are not merely organisms reacting to stimuli, nor isolated minds processing information, nor passive recipients of social forces. They are agents whose lives unfold through action, interpretation, relationship, and commitment over time. 

Mental health has greater explanatory ability when agency is centered, and accords with how things actually operate in the real world. For example, a broken bone limits movement, but it does not typically threaten one’s sense of being a Self. Then also, seemingly by contrast, panic attacks, severe depression, dissociation, psychosis, or trauma disrupt the very mechanisms by which a person orients themselves in the world and initiates action. While the person could be said to remain present in distress to no longer feel at the helm, agency remains as the object that every theory of intervention and interaction in therapy works with, whether explicitly or not. Whatever psychological or medical posed mechanism, all such knowledge works with the same object of mental health in mind. 

Why So Many Therapies Exist

If agency were a single, unitary faculty, one might expect a single, comprehensive therapy to restore it. But from a phenomenological orientation, agency is layered. It depends on multiple interlocking conditions that can fail independently or in combination.

At the biological level, extreme mood states, psychosis, or severe anxiety can overwhelm the nervous system, making reflective choice temporarily impossible, but whether it is the nervous system of not is almost incidental. Similarly, at the autonomic level, trauma can lock the body into defensive states that bypass conscious intention, and at the behavioral level, habits and avoidance patterns can narrow life until few options remain. Further, at the cognitive level, rigid beliefs can foreclose perceived possibilities; at the relational level, attachment injuries can undermine trust and co-regulation; at the narrative and existential level, loss of meaning can render action pointless even when capacity remains — and so on and so on. 

What one believes is actually the case is less important that how we approach it, that is, how we correlate phenomena (subjects). I tis this conceivable that each of these constraints on agency gives rise to a corresponding therapeutic approach; it is not the psychological disorder which coordinates application, but what is actually happening circumstantially, situationally, on the ground. For sure, medication exists to help because sometimes the agency that is occurring cannot be accessed until biological parameters are stabilized. This is valid, but again, not necessarily because of some psychological disorder. Exposure therapies likewise exist because avoidance patterns imprison behavior despite conscious desire; is avoidance patterns indicate a mental disorder? The most accurate answer is maybe, but for sure mental health is in play. Psychodynamic therapies exist because relational and emotional patterns operate outside immediate awareness, but there is no psychological requirement to come at the issue in that way. Existential therapies exist because action requires meaning, not merely skill or insight, but sometimes gaining skills catalyze a person to find purpose. 

The diversity of therapies in the context of psychology thus appears very accidental. Mental health, on the other hand organizes our disciplines to reflect into the many ways by which agency is being constituted by a juxtaposed situation of subjectivizes, i.e., the person and the theory, locally while remaining globally intact.

What Therapy Does When It Works

When therapy is effective, the most salient change is not merely symptom reduction, though symptoms often diminish. Rather, the person experiences an expanded sense of possibility. They can do things that previously felt impossible, tolerate experiences that once overwhelmed them, relate differently to others, and make choices with greater coherence. This is a shift of one’s relationship with agency. The expansion of agency may appear subtle or dramatic depending on the context. A person with obsessive-compulsive disorder who resists compulsions is reclaiming agency over simple (re-) action. A trauma survivor who remains present during emotional activation is reclaiming agency over experience. A depressed person who begins engaging in daily activities is reclaiming agency over time and effort. A person in existential despair who recommits to a valued project is reclaiming agency over meaning. Symptoms recede not because they were attacked directly, like having a cold and blowing one’s nose, but because the person is no longer organized entirely around avoiding or managing them. Agency is the reorientation toward one’s Self.

Integration Without Reduction

Mental Health Philosophy resolves a persistent tension in practice. Integration, whether across the whole domain of clinical work or as an approach to individual practice, risks collapsing distinct therapies into a vague eclecticism or reducing them to disembodied techniques. Conversely, strict allegiance to a single model often ignores dimensions of suffering that lie outside its explanatory scope. The object oriented mental health, which accounts for the subject-oriented psychology (the psychodynamic theory of object-relations is a phenomenological, and thus actually subject oriented, theory), allows integration without reduction because, philosophically speaking, all subjects reduce to themselves; this is the case with every argument and proposal, so Mental Health Philosophy accounts for all theories of intervention without demand upon individual organizations of ontology and correlated practice. Therapies, of course, are not specifically interchangeable, but neither are they mutually exclusive. Each forms their address around specific constraints on agency, which is to say, by particular phenomenological correlations that psychology as an explanatory vehicle thus far has been blind to and methodologically has rejected. The clinician’s task, as always, is thus not merely to select the “correct” theory, but to open unto the subject(s) at hand, to the person themselves for example, and to intervene accordingly. This orientation could also help in appropriate sequencing of help efforts. Medication may be necessary before insight is possible; relational safety may be necessary before exposure can occur; existential meaning may be necessary before skills are used. 

Ethical Implications

Understanding therapy as oriented in agency carries significant ethical implications. It resists both ideological moralism and medical determinism. Clients are neither blamed for their suffering nor treated as passive objects to be fixed. Instead, they can be regarded as agents whose capacities have been constrained by forces beyond their control because they are unaware them. This stance fosters confidence and humility in clinicians. No single method can claim total authority over a mental disorder even while certain ones might be more applicable, but all the while no model exhausts the person. Mental Health Philosophy holds greater automatic capacity for upholding dignity to clients, whose recovery is understood less as compliance with treatment than as the reemergence of a relationship with themselves they often didn’t know what possible.

Why This Is Not Merely Another Meta-Theory

Unlike common factors or biopsychosocial models, an agency-involved Mental Health Philosophy does not simply reconcile existing approaches to another argumentative theory. Rather, it identifies the ontological target that makes every therapeutic approach meaningful in the first place, the object that is already making mental health meaningful for everyone involved — there is no argument to make, to believe in, or be convinced about because Mental Health Philosophy is just taking account of what we already do. It explains why techniques matter, how and why theories arise, why relationships heal, why meaning transforms, why interventions work, including why biology and medicine has any ability to have a relationship to mental health at all; in fact, everything that can be said to be involved with mental health is contextualized to a cogent explanation. 

This is not a theory about which therapy is best, but about what therapy is. It is also not about entirely about what agency represents. Mental health exists because human agency is real, powerful, fragile, omnipresent, and recoverable. In other words, true. Therapies proliferate because agency can appear to be disrupted in many ways, to bring about sense in various forms. Improvement occurs because of the presence of agency while problems persist when oriented in psychological representations. 

Conclusion: Mental Health as the Care of Agency

Seen through this lens, mental health is less about eliminating pathology, correcting cognition, or normalizing behavior. These are needed and valid approaches. But it is really about supporting human beings in regaining the capacity to live as participants in their own lives. We already know this. 

All therapies—biological, behavioral, relational, somatic, cognitive, experiential, existential, spiritual—are various ways of seeing what is there under the appearance, all are attempts to inscribe meaning of agency under specific subjective conditions by which it has become constrained. Interventional theories reflect the phenomenological plurality involved with the complexity of the real human life. But moreover, agency is that which inscribes, that by which phenomena are able to be known and experienced as the dynamic process. We are not concerned for mental health because of psychology, rather, through the disciplinary rather than the ontological lens, it is due to mental health that psychology is able to exist. 

Team, Agency, Idealism and Philosophy

Agencymatters.org

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