An ontology of difference: Speculations on psychotherapy, mental health work, difference, and ethical realism

In mental health and substance use, assessment and the resulting diagnosis determine the choice of treatment or therapy to be used with the individual client. In health policy today, treatment should be evidence based and standardized. Health care thus draws on New Public Management principles, where only those methods and practices considered to be evidence based are accepted in the “market” of public health care. However, we view psychotherapy and mental health work as a meeting between persons that in the spirit of standardization might well be labelled “an individual case.” Psychiatric diagnoses are subject not only to standardization but also to a focus on identity and similarities, as more generally seen in Western science and philosophy. Difference arises when comparing identities; difference is secondary to identities. In this article, we draw on the philosophy of Deleuze and Guattari to explore whether an ontology of difference could be helpful in therapy. An ontology of difference speaks to our experience as therapists, researchers, and teachers that there will always be difference, and that identities are secondary to difference. Rather than providing standardized answers, knowledge is useful for speculating, experimenting, and bringing forth innovative suggestions as to what could be helpful therapy in the individual case. We do not know what psychotherapy and mental health work can become and we need tools for experimentation, suggestions, and visions of what could be helpful. This must be based on collaborative relationships with those who seek help and support. The central question is, then: What can therapy become?