Pyrrhonian suspension

1. Introduction

Version followed: Pyrrhonian practice as Sextus Empiricus sets it out in Outlines of Pyrrhonism (PH) Book I, with PH III 280–281, using section numbers as reported in the Stanford Encyclopedia of Philosophy entry "Ancient Skepticism" (Winter 2008 archive), Bowden 2024 and Maddox 2016; Diogenes Laertius, Lives IX.61–108, in R. D. Hicks's 1925 Loeb translation, is the public-domain text quoted. Every therapy adaptation below is marked [synthesis].

Pyrrhonism is an ancient philosophical way of life, not a psychotherapy. No current certifying body for Pyrrhonian practice is known [uncertain: not verified]. Psychotherapists use it in two ways: as a set of philosophical exercises integrated into therapy, and as a frame of meaning for clients drawn to scepticism. Non-clinical philosophical counsellors may also use it, within the scope limits given in section 3. [source: SEP Ancient Skepticism; APPA Code of Ethics]

Core idea of change, as Sextus describes it: people who are troubled by the conflicting appearance of things go looking for the truth, hoping it will calm them (PH I 12). The sceptic sets opposing appearances and arguments against each other until they seem equally weighty (equipollence, isostheneia). Judgement is then held back (epoché), and freedom from disturbance (ataraxia) follows. In Hicks's Diogenes, it comes as "suspension of judgement, which brings with it tranquillity like its shadow" (IX.107). For pains that cannot be avoided, Sextus aims at moderate feeling (metriopatheia), not their absence. The sceptic still feels them, but drops the added belief that they are bad by nature (PH I 25–30). [source: SEP; Bowden 2024; Maddox 2016; Diogenes Laertius, Hicks trans.] Patrick's 1899 summary calls the goal "repose and tranquillity of soul". [source: Patrick 1899]

Evidence status: no controlled evaluations of Pyrrhonian exercises as a mental-health intervention are known [uncertain: not verified]. Bowden treats whether a Pyrrhonian outlook is psychologically possible as an open empirical question. [source: Bowden 2024, n. 1]

2. Framework

The Pyrrhonian sequence (Sextus). The sources give a sequence of moments, not timed sessions. [source: SEP; Bowden 2024; Maddox 2016]

Disturbance and inquiry. Anomaly in things troubles a person, who inquires in the hope of tranquillity (PH I 12). Sextus calls the sceptic someone who is still investigating (PH I 1–3, 7).
Opposition. The sceptical ability is to set appearances against appearances, thoughts against thoughts, and appearances against thoughts (PH I 8, 31–35). The Ten Modes (PH I 35–163) and the Five Modes of Agrippa (PH I 164–177) are standard ways of producing such oppositions.
Equipollence. The opposed accounts come to seem equally persuasive.
Epoché. Judgement is suspended. Bowden stresses that Sextus presents this as something that happens to the sceptic, who finds himself held back, rather than as a deliberate decision (PH I 9–10). Sextus does not promise that it always occurs (PH I 193).
Ataraxia. Tranquillity in matters of opinion follows, by chance and not by method. The illustration is Apelles, who failed to paint a horse's foam until he threw his sponge at the picture in frustration (PH I 28–29).
Moderate feeling and continued life. In unavoidable affections such as cold, thirst or pain, the sceptic seeks moderate feeling (PH I 25–30). Life goes on by appearances in four ways (PH I 23–24, below). Inquiry continues.

Typical session count and format. Neither the ancient sources nor the modern sources give one. Do not promise a number. [uncertain: not verified]

Clinical adaptation [synthesis]. For a psychotherapist using the exercises within therapy:

Phase A, assessment and suitability. Goal: establish what the client is seeking help with, rule out conditions where systematic doubt is likely to harm (section 5), and judge whether the problem is partly a problem of belief and judgement. Move on when there is a formulation, consent, and no contraindication.
Phase B, orientation. Goal: introduce the sceptical stance in plain language as a philosophical tool, not a treatment. Move on when the client can state the stance in their own words and wants to try it.
Phase C, locating dogmatic evaluations. Goal: find the beliefs that something is good or bad by nature, which Sextus links to constant disturbance (PH I 27). Move on when one or two target beliefs are clear.
Phase D, opposition and suspension practice. Goal: build balanced oppositions with the modes, and practise reporting appearances rather than asserting natures. Move on when the client can loosen a target belief in session and notice any change in distress.
Phase E, living by appearances. Goal: keep everyday action, duties and safety intact through the fourfold observance, and stop suspension from becoming avoidance. Move on when action is stable or improving.
Phase F, consolidation and ending. Goal: the client applies the stance alone, including to the stance itself.

3. Guiding principles

Remain an inquirer. The sceptic is still investigating (PH I 1–3). Practical meaning: keep questions open; the aim is never to win the argument. [source: SEP; Maddox 2016]
Report, do not assert. Sextus treats sceptical phrases as reports of how things appear, not claims about how things are. Hicks's Diogenes gives the formula "We determine nothing" (IX.74). Practical meaning: model and invite first-person, present-tense phrasing ("it seems to me now"). [source: Diogenes Laertius, Hicks trans.; SEP]
Balance, not refutation. The method aims at equally weighty opposed accounts, not at swapping one dogma for its opposite. Practical meaning: when the client's belief starts to crumble, do not install a new certainty; build the other side to equal weight. [source: SEP; Bowden 2024] [synthesis for the clinical point]
Tranquillity cannot be forced. It arrives as the Apelles story shows (PH I 28–29). Practical meaning: do not set calm as homework; treat its arrival as a by-product. [source: SEP; Massie 2013 abstract]
Feel the unavoidable; drop the added belief. Sextus's surgery example: bystanders may faint while the patient bears up, because believing that something bad is happening can be worse than the event (PH III 235–238). Practical meaning: never ask a client to stop feeling pain, grief or fear; work only on the extra judgement laid on top. [source: Bowden 2024]
The phrases apply to themselves. In Diogenes, a sceptical statement removes itself as well, "like a purge which drives the substance out" (IX.76; cf. PH I 206). Practical meaning: "nothing is certain" must not harden into a new creed such as "nothing matters". [source: Diogenes Laertius, Hicks trans.; Maddox 2016]
Live by appearances. The criterion is what appears: "the apparent is the Sceptic's criterion" (Diogenes IX.106). Life proceeds through nature, the pressure of feelings, laws and customs, and the arts and crafts (PH I 23–24). Practical meaning: everyday action and obligations continue while judgement about ultimate natures is suspended. [source: Diogenes Laertius, Hicks trans.; SEP; Patrick 1899]
Suspension covers truth claims, not ordinary conduct. Diogenes reports the dogmatists' charge that a sceptic would do monstrous things on command, and the reply that suspension applies to questions of truth, not to matters of daily life (IX.108). Practical meaning: scepticism never licenses harm, neglect of safety or of duties of care. [source: Diogenes Laertius, Hicks trans.]
Proportion the argument to the person. Sextus compares the sceptic to a doctor with remedies of different strengths, the stronger for more serious cases (PH III 280–281). He calls this philanthropic. Practical meaning: use the lightest opposition that loosens the belief; do not demolish what the client does not bring for examination. [source: SEP; Bowden 2024; Maddox 2016]
Client authorship and voluntariness. The APPA Code asks practitioners to encourage clients to reach their own conclusions (Standard II.ii) and to obtain freely given consent throughout (II.xii). Practical meaning: the client chooses which beliefs are examined. [source: APPA Code of Ethics]
Scope. The APPA Code requires referral when a problem is not primarily philosophical (Fundamental Canon iii) or exceeds competence (II.xi). It bars presenting oneself as a mental-health counsellor or psychologist (II.viii) and using psychological interventions without qualification (II.ix). Practical meaning: a philosophical counsellor does not treat mental disorder. A psychotherapist offers Pyrrhonian exercises as an adjunct inside a clinical formulation, never as treatment for a disorder in itself. [source: APPA Code of Ethics] [synthesis for the psychotherapist's side]
Concepts attributed. That suspension yields tranquillity is the Pyrrhonists' claim. Practical meaning: present it as a claim the client can test in their own experience, not as a fact. [synthesis]

4. Intervention inventory

The ancient sources describe a philosophical practice, not clinical procedures. Exercises 4.3–4.17 follow Sextus's and Diogenes' structure, in this guide's own words. The clinical steps inside them, and the assessment, consent, meaning-making, integration, collaboration and ending procedures (4.1–4.2, 4.18–4.21), are [synthesis]. All example language is illustrative.

4.1 Suitability and scope assessment [synthesis]

Purpose / when: Before any sceptical exercise. Decide whether Pyrrhonian work fits the client and the problem, and whether it would be harmful.
Steps: (1) Complete your usual clinical assessment, including risk. (2) Screen for conditions where systematic doubt can worsen symptoms: obsessive-compulsive doubt and reassurance-seeking, depersonalisation or derealisation, psychotic-spectrum experiences, and depressive hopelessness. (3) Ask whether the distress is partly carried by fixed evaluative judgements ("this is a catastrophe", "I am worthless"). (4) Ask what draws the client to philosophy, if they raised it. (5) Record the rationale and any contraindication.
Example language (illustrative): "Before we use anything from ancient scepticism, I want to be sure that doubting would help you rather than add to a doubting you already struggle with."
Watch for: A client who already doubts compulsively, or who hears "nothing can be known" as confirming that nothing is real. Either one is a reason not to proceed (section 5). It is working if a clear formulation names the judgement the exercises will target.

4.2 Informed consent and framing [synthesis; source: APPA Code; APA Ethics Code]

Purpose / when: At the start, and again whenever the work changes direction.
Steps: (1) Describe Pyrrhonism as an ancient philosophical practice that you are adapting, not an evidence-based treatment. (2) State its claim, attributed: that suspending judgement brings calm. (3) Explain that the client chooses which beliefs to examine and can stop at any time. The APPA Code likewise asks for honest, complete information about the service (II.x) and consent throughout (II.xii). (4) If you also teach or practise philosophy with this person in another setting, consider multiple relationships under APA Ethics Code Standard 3.05. (5) Document consent.
Example language (illustrative): "This comes from a Greek philosophical school, not from a tested therapy manual. Its authors claimed that holding back judgement brings peace. We can try it as an experiment, and you decide what we look at."
Watch for: Expectations of a cure, or deference to you as the authority on truth. It is working if the client can say in their own words what the exercise is and is not.

4.3 Mapping the anomaly (PH I 12) [source: Maddox 2016; SEP]

Purpose / when: Early. Identify the conflict of appearances that troubles the client, which Sextus names as the start of inquiry.
Steps: (1) Ask the client to describe a situation where things seem to conflict: people disagree, the evidence points both ways, or two of their own values pull apart. (2) Write down each side as it appears to the client. (3) Ask what they hoped settling the question would give them. (4) Note how much distress comes from not knowing, and how much from what they believe would follow.
Example language (illustrative): "Where does it feel as if the world won't add up? What would finally knowing give you?"
Watch for: The client treating the mapping itself as a demand to find the answer. It is working if the client can name the conflict and the hoped-for calm.

4.4 Locating "good or bad by nature" judgements (PH I 27–30) [source: Bowden 2024; Maddox 2016]

Purpose / when: Phase C. Sextus holds that whoever believes things are good or bad by nature is constantly disturbed. Use this when distress is driven by absolute evaluations.
Steps: (1) Take a recent distressing episode. (2) Separate what happened, what was felt, and what was judged about its nature ("bad", "unbearable", "must not be"). (3) Mark which judgements are about ultimate value rather than observation. (4) Choose one judgement, with the client's agreement, for later exercises.
Example language (illustrative): "There's what happened, there's how it hit you, and then there's the verdict that it was terrible in itself. Shall we look at the verdict, and leave the rest as it is?"
Watch for: Abuse, danger or injustice. Do not invite suspension of judgement about whether harm happened, or about the need for safety (4.13). It is working if the client distinguishes the event from the verdict.

4.5 Separating the unavoidable affection from the added belief (metriopatheia; PH I 25–30, III 235–238) [source: Bowden 2024; SEP]

Purpose / when: Pain, grief, illness or bodily symptoms that cannot be removed. Sextus seeks moderate feeling here, not its absence.
Steps: (1) Acknowledge the unavoidable feeling plainly. (2) Use Sextus's surgery image in your own words: onlookers may faint while the patient bears up, because believing something bad is happening adds its own weight. (3) Ask the client to name the added belief. (4) Invite them to notice the feeling with and without that belief. (5) Ask what changes, without expecting the feeling to go.
Example language (illustrative): "The pain is real and I'm not asking you to argue with it. I'm curious about the extra sentence that comes with it: that this is ruining everything."
Watch for: Any implication that the client should not feel grief or pain, and invalidation. It is working if the distress about distress falls while the original feeling is accepted.

4.6 The three oppositions (PH I 8, 31–35) [source: SEP; Bowden 2024]

Purpose / when: Phase D. This is the core sceptical ability, to set up opposing accounts.
Steps: (1) State the target judgement. (2) Appearance against appearance: find how the same thing appears differently at other times, from other places, or to other people. (3) Thought against thought: find an argument for the opposite conclusion. (4) Appearance against thought: set what is observed against what is reasoned, or the reverse. (5) Write each opposition beside the original.
Example language (illustrative): "You've told me how it looks from here. How did the same thing look a year ago, or to your sister? And is there an argument you'd find just as convincing for the other conclusion?"
Watch for: One-sided 'balancing' that only builds the comforting side. Sextus aims at equal weight, and a lopsided pair invites a new dogma. It is working if the client is genuinely unable to say which side is stronger.

4.7 The Ten Modes as perspective-variation prompts (PH I 35–163) [source: Diogenes Laertius, Hicks trans.; SEP; Patrick 1899; clinical selection = synthesis]

Purpose / when: To generate oppositions when the client is stuck on one view. The modes in Hicks's order are: differences among living creatures; among individual people; among the senses; in conditions and states; customs, laws, myths and dogmatic beliefs; mixtures; distances, positions and places; quantities and qualities; frequency or rarity; and relation. Sextus's order differs slightly.
Steps: (1) Pick the modes that fit the judgement. Clinically the most usable are individual differences, conditions and states (mood, tiredness, illness), position and place, frequency or rarity, relation, and customs [synthesis]. (2) Turn each into a question about the target. (3) Collect the answers as oppositions (4.6). (4) Do not run all ten mechanically.
Example language (illustrative): "Does this seem as certain when you're rested as when you're exhausted? Would it seem as shocking if it happened every week? What does your community take for granted about this that another wouldn't?"
Watch for: Relativism used to excuse harm, or cultural and religious commitments treated as mere custom against the client's wish (4.18). It is working if the client produces variations for themselves.

4.8 The Five Modes of Agrippa as a justification check (PH I 164–177) [source: SEP; Diogenes Laertius, Hicks trans.]

Purpose / when: When a client demands certainty before acting ("I have to be sure"). The five modes are disagreement, infinite regress, relativity, hypothesis and circularity. SEP describes the trap they set: any claim either lacks justification or leads to regress or circularity (PH I 178–179).
Steps: (1) State the certainty the client wants. (2) Ask whether informed people disagree (disagreement). (3) Ask what would justify the justification, and so on (regress). (4) Ask whether it holds only in relation to a viewpoint (relativity). (5) Ask whether it rests on an assumption taken without proof (hypothesis). (6) Ask whether the proof presupposes the conclusion (circularity). (7) Ask what it would mean to act without the certainty, by appearances (4.12).
Example language (illustrative): "If the certainty you want can't be had by anyone, not just by you, what would it be like to act on how things seem today?"
Watch for: In obsessional doubt this can become another checking ritual. Stop and see section 5. It is working if the demand for certainty loosens and action resumes.

4.9 Building equipollence [source: SEP; Bowden 2024; steps = synthesis]

Purpose / when: After oppositions exist. Aim for the state in which opposed accounts are equally persuasive.
Steps: (1) Put the two accounts side by side. (2) Ask the client to rate how persuasive each seems now, informally, without a validated scale. (3) Strengthen whichever side is weaker with more appearances or arguments. (4) Stop when neither side clearly wins. (5) Ask what it is like to hold both.
Example language (illustrative): "Right now neither side is winning. Let's just notice what it's like to leave it there for a moment."
Watch for: Anxiety rising rather than settling. Some clients feel unsafe without a verdict, so slow down or return to grounding. It is working if the client reports relief or curiosity rather than a frantic search.

4.10 Sceptical phrases as self-reports (PH I 187–208) [source: Diogenes Laertius, Hicks trans.; SEP; Patrick 1899]

Purpose / when: Phase D onward. Sceptics use set phrases to report their state, not to assert truths. In Hicks's Diogenes these include "not more (one thing than another)", "We determine nothing" and "Every saying has its corresponding opposite" (IX.74–76). Diogenes glosses the first as "no single thing is in itself any more this than that" (IX.61).
Steps: (1) Pick one phrase that fits the client's target. (2) Practise converting an assertion ("It is hopeless") into a report ("It appears hopeless to me today"), and then a sceptical phrase ("no more hopeless than not, as far as I can determine"). (3) Ask the client to try the phrase in a real moment between sessions. (4) Review what happened.
Example language (illustrative): "Instead of 'it's ruined', can you try 'it seems ruined to me right now, and I'm not settling whether it is'?"
Watch for: Phrases used as magic formulas or as a way to dismiss feelings. It is working if the client spontaneously reports appearances in the first person.

4.11 Applying the phrases to themselves (the purge image) [source: Diogenes Laertius IX.76, Hicks trans.; Maddox 2016 on PH I 206; Patrick 1899]

Purpose / when: Whenever scepticism risks becoming a new doctrine ("nothing matters", "nobody can know anything, so why try").
Steps: (1) Notice the new certainty. (2) Recall the image in your own words: the sceptical statement removes itself along with what it removes, like a purge leaving with the substance. (3) Ask the client to apply the sceptical phrase to the new certainty too. (4) Return to living by appearances (4.12).
Example language (illustrative): "'Nothing matters' sounds like a verdict as well. Can we hold that one as lightly as the others?"
Watch for: Hopelessness. "Nothing matters" with low mood calls for risk assessment (section 5). It is working if the client stops treating scepticism as a belief to defend.

4.12 Living by appearances: the fourfold observance (PH I 23–24) [source: SEP; Patrick 1899; Diogenes Laertius IX.106–108, Hicks trans.; planning steps = synthesis]

Purpose / when: Phase E, and whenever suspension threatens action (the ancient apraxia objection). Sextus says the sceptic lives by the guidance of nature, the pressure of feelings, laws and customs, and instruction in the arts. In Diogenes, sceptics observe "rules and customs".
Steps: (1) Take a decision or task the client is avoiding. (2) Go through the four guides: what their nature and capacities suggest; what their feelings press for (hunger, tiredness, need for company); what custom, law or their role expects; what skilled practice, including professional and medical advice, recommends. (3) Choose an action that follows these appearances without requiring certainty. (4) Plan it concretely, using behavioural-activation methods where relevant (cross-refer II 040). (5) Review.
Example language (illustrative): "You don't have to settle whether this job is right in some ultimate sense. What do your energy, your commitments and the advice you trust suggest doing this week?"
Watch for: Withdrawal relabelled as suspension. It is working if action and routine continue or increase.

4.13 The boundary: truth questions versus daily conduct (Diogenes IX.108) [source: Diogenes Laertius, Hicks trans.; clinical boundary = synthesis]

Purpose / when: Always. It matters most when a client uses sceptical reasoning about harm, safety, ethics or care duties.
Steps: (1) Recall the ancient reply in your own words: suspension concerns claims about how things really are, not the conduct of ordinary life. (2) Mark clearly with the client which matters stay out of the exercise: safety, medical treatment, legal and safeguarding duties, the reality of abuse. (3) Never use sceptical exercises to cast doubt on a client's account of victimisation. (4) Follow your usual safeguarding and risk procedures regardless.
Example language (illustrative): "We can question big verdicts about life's meaning. We won't use this to question whether you are safe at home. That stays solid."
Watch for: Abusers' or coercive groups' "you can't know what really happened" rhetoric echoed by the client. It is working if the client holds the boundary themselves.

4.14 The Apelles reflection: not forcing calm (PH I 28–29) [source: SEP; Massie 2013 abstract; Patrick 1899]

Purpose / when: When the client strains to reach tranquillity, or judges themselves for failing to.
Steps: (1) Tell the story briefly in your own words: the painter could not depict a horse's foam, gave up and threw his sponge, and the mark it left made the foam. (2) Ask where the client is straining for calm. (3) Invite them to keep inquiring and stop demanding a result. (4) Notice afterwards whether anything settled by itself.
Example language (illustrative): "The painter got what he wanted only once he stopped forcing it. What if calm isn't the task this week, just looking is?"
Watch for: Disappointment when relief does not come. Sextus does not promise that it will (PH I 193; Bowden 2024). It is working if self-pressure drops.

4.15 Pyrrho anecdotes as discussion texts (Diogenes IX.62–68) [source: Diogenes Laertius, Hicks trans.; use = synthesis]

Purpose / when: Optional, for clients who like stories. Diogenes reports Pyrrho on a ship in a storm "pointing to a little pig in the ship that went on eating". He also reports that Pyrrho's friends followed him to keep him from carts and precipices, and that he passed the fallen Anaxarchus without helping.
Steps: (1) Offer one anecdote. (2) Ask what the client takes from it. (3) Discuss its limits: the friends who kept Pyrrho from danger, and the bystander who did not help, show what not to copy. (4) Link back to 4.13.
Example language (illustrative): "The pig wasn't caught up in what the storm meant. And yet Pyrrho's friends still had to pull him out of the way of carts. Which part speaks to you?"
Watch for: Indifference idealised as not caring, or neglect of self or others. It is working if the client takes calm, not carelessness.

4.16 Proportioning the argument (PH III 280–281) [source: SEP; Bowden 2024; Maddox 2016]

Purpose / when: A therapist-side procedure, throughout. Sextus's doctor uses milder remedies for mild cases and stronger ones for serious cases.
Steps: (1) Judge how strongly the client holds the target belief and how fragile they are. (2) Start with the gentlest opposition, such as a single alternative appearance. (3) Escalate to stronger arguments only with consent and if the belief is still causing distress. (4) Stop as soon as the belief loosens.
Example language (illustrative): "I'll offer just one other way of seeing it. Tell me if even that feels like too much."
Watch for: Debating to win, or dismantling beliefs the client values (faith, love, core commitments) uninvited. It is working if the client feels lighter, not attacked.

4.17 The inquiry log: continuing zētēsis (PH I 1–3, 7) [source: Maddox 2016; SEP; log format = synthesis]

Purpose / when: Between sessions. It keeps the stance of an inquirer who has not concluded.
Steps: (1) The client notes moments when a fixed verdict appeared. (2) For each, they write the appearance as a report, one opposing appearance, and whether judgement was held back. (3) They note any change in distress and any action taken by appearances. (4) Review it together, without grading.
Example language (illustrative): "Jot down when a big verdict showed up, one way it could look different, and what you did next. No need to get it right."
Watch for: The log becoming rumination or checking. Shorten it or stop. It is working if entries get briefer and calmer.

4.18 Meaning-making when scepticism touches faith, identity or tradition [synthesis; source: ICD-10-CM Z65.8]

Purpose / when: The client's interest in scepticism comes from loss of faith or conflict with family religion, or sceptical exercises collide with their beliefs.
Steps: (1) Explore what the sceptical stance means to the client and to their family. (2) Use the Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions [uncertain: DSM-5-TR wording not verified]. (3) Do not aim sceptical arguments at a faith the client wants to keep. (4) Where the difficulty centres on loss or questioning of faith, the DSM-5-TR condition "Religious or Spiritual Problem" can be recorded as Z65.8. ICD-10-CM Z65.8, "Other specified problems related to psychosocial circumstances", lists religious or spiritual problem among its inclusions. (5) Offer collaboration with a religious leader if the client wishes.
Example language (illustrative): "Some people come to doubt as a relief, others as a loss. Which is it for you, and how is your family taking it?"
Watch for: The therapist's own views on religion steering the work. It is working if the client feels free to keep, revise or leave their commitments.

4.19 Integration with cognitive therapy [synthesis]

Purpose / when: In CBT-informed work. Sceptical oppositions resemble examining the evidence and decatastrophising, but the aim differs. CBT usually seeks a more balanced or accurate belief, while Pyrrhonism seeks suspension of the verdict. No published protocol combining Pyrrhonism with CBT is known [uncertain: not verified], so this integration is the clinician's own.
Steps: (1) Use a thought record as usual. (2) At the alternative-thought stage, offer the client a choice between a balanced alternative and holding judgement back with a sceptical phrase (4.10). (3) Where a value judgement about something's nature drives distress, try suspension. (4) Where a factual error can be checked, ordinary evidence-testing may be simpler. (5) Track which option helps.
Example language (illustrative): "We could look for a more balanced thought, or simply not decide whether this is a disaster. Which feels more useful today?"
Watch for: Mixing aims in ways that confuse the client. It is working if the client can choose the tool that fits the thought.

4.20 Collaboration and referral both ways [synthesis; source: APPA Code of Ethics]

Purpose / when: A client sees a philosophical counsellor alongside you, wants one, or was referred from one.
Steps: (1) With consent, clarify roles: the philosophical counsellor offers philosophical examination. Under the APPA Code they refer problems that are not primarily philosophical (Fundamental Canon iii), do not present themselves as mental-health practitioners (II.viii) and do not use psychological interventions without qualification (II.ix). (2) Check the counsellor's credentials, and whether they are certified by the APPA or a comparable body. (3) Refer to philosophical counselling when the client wants philosophical exploration and has no clinical need, or after treatment ends. (4) Accept referrals of clients whose problems turn out to be clinical. (5) Agree consent for information sharing. Background: Lou Marinoff founded APPA; City College of New York ordered a halt to Marinoff's on-campus counselling (his own account dates the order to November 2000; a 2004 New York Times Magazine article reported it) [uncertain].
Example language (illustrative): "Your philosophy sessions and our work can sit side by side. I'd like your permission to agree with your counsellor who covers what."
Watch for: A non-clinical practitioner treating depression, trauma or risk. It is working if roles are clear and the client is not caught between the two.

4.21 Consolidation and ending [synthesis]

Purpose / when: Phase F.
Steps: (1) Review which exercises helped. (2) Have the client run one full sequence alone: anomaly, opposition, suspension, living by appearances. (3) Apply the stance to the therapy itself: the client need not hold a final verdict on what changed. (4) Plan for relapse, with early signs and which exercise to use. (5) Discuss further philosophical reading or practice if wanted.
Example language (illustrative): "Let's watch you take one verdict from start to finish without me. Then we can talk about what you'll do when the old certainties come back."
Watch for: Dependence on the therapist as the source of counter-arguments. It is working if the client generates oppositions on their own.

5. Handling problems

The ancient sources address only the apraxia objection, the objection that a sceptic would do terrible things, the claim that suspension may fail to occur, and the risk of the phrases hardening into doctrine. Everything else here is [synthesis].

Obsessional doubt or reassurance-seeking appears [synthesis]. Stop Pyrrhonian opposition work, especially the Agrippan modes (4.8): systematic doubt can feed checking and rumination. Bowden uses door-checking only as an analogy and explicitly does not equate Pyrrhonists with people who have OCD [source: Bowden 2024, n. 5]. Move to an evidence-based OCD treatment such as exposure and response prevention, or refer.
Derealisation, depersonalisation or psychotic-spectrum experiences [synthesis]. Doubting appearances can destabilise. Stop, ground the client in shared ordinary reality, reassess, and refer to psychiatry where indicated.
"Nothing matters" with low mood or hopelessness [synthesis]. Treat this as clinical, not philosophical. Do a structured risk assessment following your service's standard practice. Use safety planning and lethal-means counselling (storage and removal) where indicated. Give crisis resources: 988 Suicide & Crisis Lifeline (US), Samaritans 116 123 (UK and Ireland). Then use 4.11 only once risk is managed.
Suspension becoming avoidance or apraxia [source: SEP on the apraxia objection; Diogenes IX.106–108; response = synthesis]. Return to 4.12. Make one appearance-guided action the week's task, and use behavioural activation (II 040).
Ataraxia does not come [source: Bowden 2024 on PH I 193; SEP on Apelles]. Normalise this: Sextus does not promise it. Drop calm as a goal (4.14) and check whether the target was an unavoidable affection, which calls for 4.5 rather than suspension.
Intellectualisation and debating [synthesis]. The client argues philosophy to keep feelings away, or tries to out-argue you. Name it gently, slow down, and return to a concrete episode and its felt sense (4.3, 4.5). Use the lighter remedy (4.16).
The client wants answers, not suspension [synthesis]. Respect this. Some problems need a decision, information or a values clarification. Offer standard decision-making or values work, or Socratic or other philosophical approaches if they fit.
Faith, culture or identity feels attacked [synthesis]. Repair at once. Acknowledge, apologise if needed, and agree which commitments are out of scope (4.16, 4.18).
Using scepticism about abuse, danger or ethics [source: Diogenes IX.108; response = synthesis]. Hold the boundary (4.13), follow safeguarding duties, and do not suspend judgement on safety.
Non-adherence to between-session practice [synthesis]. Shorten the inquiry log (4.17) to one line, or do the practice in session. Explore whether the practice itself has become a new 'should', which Pyrrhonian language can help loosen (4.11).
Rupture: the client experiences the therapist as relativising their pain [synthesis]. Validate the reality of the pain explicitly (4.5). Ask what felt dismissive and return to the client's agenda.
The therapist's own dogmatism [synthesis]. Watch for attachment to the Pyrrhonian claim itself. Apply the purge image to your own enthusiasm, and take the case to supervision.
Political and ethical critique [source: Bowden 2024, n. 25, reporting Nussbaum]. Some critics hold that Pyrrhonism is politically harmful. If a client worries that suspension means abandoning justice or commitment, discuss this openly. Where it matters to them, help them keep moral and political commitments outside the exercise.
Dual roles and competence [synthesis; source: APA Ethics Code, APPA Code]. If you also run philosophy groups or teach a client, consider Standard 3.05 on multiple relationships. Do not present philosophical exercises as a validated treatment. Check that your professional insurance covers adapted philosophical techniques within your licensed practice.

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