Abstract

The aim of the article was to develop the thesis that patient’s decisions about truth and responsibility are central to the process of psychotherapy and yet they are rarely explicitly articulated. In the first part of the text, I outlined the anthropological context of the thesis, according to which human intentionality and psychological mechanisms have the status of domains of objective reality that are ontologically separate, although in the patient’s experience they combine with one another. Next, with reference to the classical opinions of psychotherapy, I identified two aspects of patient decisions related to her/his psychopathology: adaptive (more pronounced in childhood) and moral (more pronounced in adulthood). I went on to isolate groups of psychological operating mechanisms involved in both truth- and responsibility-avoidance choices and, using clinical illustration, showed how the therapist can support alternative decisions. Finally, I further clarified the understanding of the proposed working model by indicating the different therapeutic consequences of revealing psychological mechanisms vs. decision-making based on the type of patient disorder and the anthropological-moral character of his/her choices.