Monday, 28 January 2019

Emerson

The sentiment from which it sprung determines the dignity of any deed, and the question ever is, not, what you have done or forborne, but, at whose command you have done or forborne it. - Emerson, Experience

Monday, 3 September 2018

A Freudian Look at the Feature Film, Jackie

Last night I watched the feature film, Jackie (2016), on Netflix. I go to the cinema rarely so as usual I am about two years behind what is currently on release. 
Having read nothing about the film beforehand I was expecting to half-enjoy an up-market, soapy bio-pic. 
About that I was completely wrong. 

Jackie is a film about the elemental experience of unexpected death. One moment life is one thing. The next moment it is something entirely different. It is an experience as unanticipated as birth, & perhaps as terrifying. 

This is Natalie Portman's most disturbing film since she played the twelve-year-old Mathilda in the controversial Leon (1994).
The two films are connected. Both portray sudden bereavement as the result of extreme violence. Portman excels in the depiction of grief that is kept, or not kept, under iron control.  

For those of us of a certain age the death of JFK marked indelibly a particular moment in our lives. 
As a child of seven-and-a-half I remember the dark November evening in 1963. I cannot recall how the news arrived. It was maybe eight o'clock, winter bed-time for me. Staring blankly at the patterns in my bedroom rug I could not understand why any men (we assumed at first there must have been several) would want to destroy this cheerful father figure to us all. A light had gone out for no apparent reason other than someone's sheer meanness. 

Jackie recreates that moment of loss & disorientation that everyone who was alive & sentient on that day felt. 
More particularly, it creates terribly & brilliantly the chaos that ensues following the sudden death of someone close to us. The earth seems to roll without an axis. 
The white light that forms a backdrop to many of the scenes in the film, & the brightly illuminated public rooms that recur over & over, create the feeling that one is close to drifting out of reality into another world.

In the hours after her husband's death Jackie floats through the crowds of officials & security men that are pressed into Air Force One, cut off from communication with all those around her. 
Her isolation & confusion is broken at last by the wife of Lyndon Johnson, "Lady Bird", played by Beth Grant, who takes her in hand & calms her. Lady Bird seems to be the only person who remains in command of herself during this crucial period, unembarrassed by the shame of the half-acknowledged emotions that inhibit everyone else.  
Lady Bird subsequently intervenes a second time a little later at the news of Oswald's death to pacify her husband, now the President, who bristles at receiving instructions from Bobby Kennedy. 

This memorable brief performance is a reflection of how expertly & persuasively all the characters in the film are sketched. 
Peter Sarsgaard as Bobby is also perfect. Genuinely shattered by his brother's death & by the plight of his sister-in-law, he yet struggles to conceal from himself his own satisfaction at it, not least through a long recital of the failures of their shared administration. 

In his last film appearance before his own death, John Hurt gives a characteristically hypnotic performance as an Irish priest seeking to console Jackie.
But then we notice something odd. 
The long wispy white beard that Hurt wears was surely not seen on any Catholic priest in 1963, least of all one who was acting as spiritual guide to the Kennedys. 

And at this point the key to the abiding power of this whole drama becomes clear. 
In the guise of a priest the character Hurt is really playing is Teiresias, the old blind prophet of the Oedipus legend. 
Here we have the source of the fascination of the tragedy of JFK. It is yet another iteration of the Oedipus fantasy at the heart of human action & experience.

Understood in this perspective the figure of Jackie emerges in its true light as Jocasta, the mother who is both desired & forbidden.
The secret appeal of this terrible moment in modern history is our excitement, no less than our horror, at our own impulses. We are transfixed by the image of Jackie-Jocasta because her terrifying widowed state threatens to reveal so much about ourselves. We so much want to see this & we so much don't want to see this. 
All this is encapsulated in the historically accurate moment when on leaving Dallas she refuses to change out of her blood-stained clothing. "Let them see what they have done," she says. 

Over the years there have been many conspiracy theories about what happened at Dallas. Perhaps the Russians had some involvement. Perhaps the mafia had some involvement. Presumably we shall never know. 
But the real engine of these events was the human unconscious & our need to re-enact in each generation the sacrifice of fathers. 

And the sacrifice of sons too, for this is also central to the legend of Oedipus. 
JFK was both a sacrificed father & a sacrificed son. This is what is so poignant about his tragedy & why he still haunts us. For a brief time he was the good father to us all: cheerful, vigorous, self-deprecating, giving us trust in ourselves. 

But he was also the victim of his own father's ambitions, & driven by the need to atone for his father's sins, which ranged from the appeasement of Hitler in the 1930s to the arranging of a lobotomy for his eldest daughter Rosemary in 1941 (long after the psychoanalytic revolution had reached America), who did not recover. 

As we did not know at the time but as we know now, JFK paid for all this with chronic illness for much of his life. 
In Jackie it is the unrelenting focus of the filmmakers on this underlying emotional reality, ignoring the superficial political detail, that makes the film so true & so powerful. 

Thursday, 12 April 2018

Therapy Through the Looking Glass


Last month (March 2018) the Minister for Health announced that he had acquired approval from the Oireachtas (Ireland's Parliament & Senate) to recognise officially within the field of psychological therapy two professions: that of "psychotherapist" and that of "counsellor". The aim is that everyone working in the field of talk therapy will have to register with the authorities under one or other of these two headings. 

It is not clear in what way the Minister thinks enshrining this distinction in law will help the general public to find assistance for emotional problems or in what way he thinks it will improve the mental health of the nation as a whole. It will in fact do neither of these things.

Every skilled and conscientious therapist who uses talk therapy with her clients modifies continuously the approach she takes, reflecting her perception of the unique needs of each person she works with. She has a hundred kinds of response ready in her therapeutic toolbox, and she knows when to deploy each one.

Sometimes she will listen quietly, sometimes she will speak, sometimes she will make suggestions, sometimes she will give guidance, sometimes she will carefully leave the client to find the solution to a problem himself. Sometimes she will confront her client with hard truths, sometimes she will offer sympathy and support. Sometimes she will laugh at a client’s jokes, sometimes she will suggest how he is using humour to evade issues he finds emotionally difficult. Sometimes she will point out how a client is neglecting his responsibilities to others who depend on him. Sometimes she will draw his attention to how he is using a sense of duty to others as a way of neglecting his responsibilities to himself. Sometimes she will encourage a client to forget immediate daily concerns to take a look more carefully at how his life is shaped by longer term trends that have their roots in the distant past. Sometimes she will tell him to stop dwelling on the past as a pretext for not making as much as he can of his circumstances here and now.

This is a description of the daily work of the psychotherapist.

This is also a description of the daily work of the counsellor.

So how is it then that we have arrived at the point where the Minister for Health is proposing to make two distinct professions that go by these names?

It is a good question, and not easy to answer. The proposal is so manifestly impractical and so obviously divorced from reality that one can only speculate as to how it was derived.

What the Minister has failed to grasp, or perhaps is simply unwilling to acknowledge, is that the terms “psychotherapist” and “counsellor” are conventional rather than substantive. They reflect not practical realities in the therapy world but rather differences in how therapists have traditionally described themselves and the schools with which they identify.

For example, in twenty years working as a therapist I have always felt more comfortable with the label “psychotherapist”. Largely, this is because I have a long-standing interest in psychoanalysis, which is where the talk therapies began over a century ago. I am not a card-carrying member of any psychoanalytic association, however, so I prefer not to call myself a psychoanalyst. But my thinking on therapy has always been informed by psychoanalytic ideas. Traditionally, the term “counsellor” has carried the implication, however vague, of a therapist who is more focused on practical matters in the present and who gives less emphasis to the unconscious roots of problems than one would expect, conventionally, from a psychoanalyst. For this reason, especially when dealing with professional colleagues, I generally do not use the term for myself.

Nevertheless, most of my day-to-day work is indistinguishable from counselling and most of my clients refer to me as their “counsellor”. This is simply because, to the general public, this is the term that is most familiar. For this reason also, on my business cards I, like many of my colleagues, offer “psychotherapy and counselling”.

Most people have a reasonably clear idea of what a “counsellor” does. He, or she, is someone who talks through personal problems in confidence with a client. But this is as much as the term means to people who are not specialists in the therapy field. They would find it much harder to describe what a “psychotherapist” does, or how what she does differs from what a “counsellor” does.

And so would I.

It is true that if I were challenged in an academic argument I could make a distinction between the two terms, but not without recourse to a lot of technical language about unconscious processes that only a handful of specialists with an extensive knowledge of the literature would be able to follow or would have any interest in. Furthermore, the distinction I made would still be conventional, and other specialists might well prefer alternative definitions. The point is that the terms of the distinction are not those upon which specialists are agreed. They are still debated, and they always will be. The distinction here is qualitatively different in kind from that, for example, between a cardiologist and a neurologist, where the lines of demarcation are clear-cut and accepted by everyone in the profession.  

In short, the distinction between “psychotherapist” and “counsellor” is one that could keep a small number of experts innocently entertained for a long time, but as far as the general public is concerned has absolutely no practical reality at all.

However, if the Minister of Health has his way this distinction is one we are all now going to have to make routinely, whether we are therapists trying to explain our work to clients, hard-pressed GPs trying to decide to whom to refer patients in emotional distress, or bewildered members of the general public looking for help.

The result will be confusion throughout the therapy field on a scale we have not seen before. It will be much harder for therapists to explain themselves to the general public and it will be much harder for the public to understand what services therapists have to offer.

It is impossible to say whether the Minister simply does not comprehend this and has been misled by very bad advice, or whether he does comprehend it and is cynically hoping to use the resulting confusion as a way of increasing the bureaucratic grip of the Department on the therapy field in general. After all, the more confusion there is, the more paperwork we need, the more everyone is entangled in red tape, and consequently the bigger the budget the Minister’s Department can demand. And the bigger the budget a minister has at his disposal, the greater becomes his importance vis-à-vis his colleagues in government.

Whatever may be the truth of this matter, the Minister cannot claim that he has not had ample opportunity to acquire an understanding of the consequences of his decision, had he chosen to take it.

In the autumn of 2016 the Department of Health invited suggestions on how best to legislate for the therapy field. At this time, many of us made detailed submissions, pointing out that to think of the therapy professions as simply subordinate branches to medicine is a mistake and leads inevitably to the creation of what are in important respects artificial categories like, for instance, that of “psychotherapist” and “counsellor”.

To these submissions we received no response.

Then in May 2017 the announcement came from the Department that the field was to be split anyway into these two professions.

No explanation was given for how this decision was reached, who had been consulted, or what was the rationale behind it.

It is clear the consultation process was from the outset a fiction. There was a careful exclusion of anyone who had raised an objection to what, evidently, the Minister had already decided to do.

Dividing the profession in this way is either an act of simple ignorance or it is an exercise in raising a political smokescreen. In the latter case, it is designed to bamboozle people, to give the impression that somehow something significant must have been done, when in fact nothing has been done, apart from making the world of therapy even more confusing to the public than it already is.

Imagine the reaction we would have if the Minister for the Arts were to propose licensing artists on the basis of whether they use oil or water colours, or licensing writers on the basis of whether they write novels or short stories. Yet the distinction between psychotherapists and counsellors lacks even this degree of reality. A profession for therapists who wear blue socks and one for therapists who wear yellow socks would be as helpful, indeed probably more so.

This decision is a very bad one, for the public and for those who work in the therapy profession. Its effects will be regressive and damaging. It should be put on ice. 

And while it is on ice we should have what we have not yet had, which is a serious discussion about the complex nature of therapy, its place in modern Irish society, and the best way to ensure that it remains vital and creative in the years to come.   

Tuesday, 27 March 2018

Presentation to What is the Future for Counselling & Psychotherapy in Ireland?, City Colleges, Dublin, March 25th 2018

Some Comments on Proposed Regulation for the Therapy Professions

Presented at City Colleges in Dublin on March 25th 2018
as part of the conference on
What is the Future for Counselling & Psychotherapy in Ireland?
Chaired by Dr Finian Fallon

Marcus Bowman PhD

I am going to make just a few brief comments on the question of regulation for the therapy professions. This is a very complicated subject that needs to be given a lot of thought, but I will keep my remarks short & hopefully to the point.

I know that my remarks may seem surprising to some people but I want to stress that my intention in making them is not to cause upset or to shock anyone. My hope here only is to make a few points that can be used as an opening for discussion. My concern is that we have not to date had a proper debate about regulation & that given the potentially significant & long-term consequences of legislation we need to remedy this lack.

-

I want to preface my remarks by saying that I am using the terms therapist & therapy here purely in a generic sense to refer to anyone who uses talk therapy as a way of assisting people with emotional problems, whether they call themselves counsellors or psychotherapists or anything else. I am not here concerned to draw any distinctions within the field of the talk therapies in general.

Also, I need to stress that I am speaking here only of therapy with adults. I have nothing to say about therapy with children, who obviously need special safeguards. Adult therapy involves a dyadic relation between two people, either of whom is free to end the therapy at any time. Child therapy in contrast involves a triadic relationship, because a parent or guardian is always included, & consequently the dynamics of the process are quite different.

Indeed, my essential objection to the current proposals for regulation of the therapy profession is that they would turn adult therapy into a variant of child therapy by establishing an external authority to oversee the patient-therapist relation. In my view this is incompatible with the practice of therapy in a secular democracy.

-

The first thing we need to understand is that in designing legislation for any profession we confront two fundamentally distinct options.

Our first option is to erect entry barriers into that profession. This approach starts from the assumption that a candidate for entry into the profession is not competent to practice that profession until he or she has proven otherwise. This proof of competence is provided by the candidate passing certain prescribed tests & examinations.

This is how for example medicine is regulated, & also its ancillary professions like nursing & physiotherapy, & so on.

By & large this approach to regulation is the one adopted in the case of any profession that is based on the practice of the physical sciences. Alongside medicine we could mention professions like engineering & architecture, & also trades that have traditionally required apprenticeships like that of the plumber or the electrician.

The reason this approach of setting up entry barriers is taken in professions like this is that it is easy to establish tests in the physical sciences that are objective & that will give rise to results that command a high degree of consensus. There is doubtless an element of luck in being admitted to any profession, but in general you won’t become a hospital consultant unless you have been able over many years to demonstrate a high degree of technical skill in your specialty.

-

Now, our second option in regulation is to start from the opposite assumption, namely to assume de facto that all candidates – or virtually all candidates – for entry are competent to practice, unless they clearly prove themselves unfit to do so.

This is the approach that is taken to most of the professions based on the human sciences, that is to say, the non-physical sciences. It is taken here because with these sciences it is not possible to establish objective tests of competence that will command broad consensus.

This is why anyone is free to practice as, for example, an historian, or an economist, or a social scientist, or a journalist, & to describe herself professionally in such terms.

This family of professions based on the human sciences have certain characteristics in common. For instance, forms of employment within them tend to be quite diverse. Some practitioners work in education, some work for government agencies, some are employed in industry, & some are self-employed. Those who are employed by formal organizations will of course have to meet the particular requirements stipulated by those employing organizations. But entry into the profession as such is open to anyone, irrespective of their formal qualifications.

Another characteristic of these professions based on the human sciences is that they tend to form within themselves informal schools of thought, reflecting the fact that influences & approaches are diverse. There is, in other words, not a high degree of agreement on what standards, or priorities, or approaches are crucial for inclusion in the profession as a whole. This again reflects the fact that in the human sciences, unlike the physical sciences, it is not possible to set up tests of competence or ability that will give results that command wide consensus.  

-

My contention is that, with certain qualifications, it is to this latter family of humanities that our profession belongs, & not to the former family of professions based on the physical sciences like medicine.

Like the other professions based on the human sciences our field is fragmented into multiple schools reflecting the fact that there is not broad agreement on many significant aspects of the philosophy underlying the work we do, & therefore on what particular values & aims we should prioritize. 

I contend therefore that an attempt to treat the talking therapies as if they belonged to the former group rather than to the latter will not work. What is being made here is what the philosopher Gilbert Ryle long ago called “a category mistake”.

-  

The current proposals for legislation for therapy are explicitly formulated in the first way, not in the second. They expressly treat therapy as an ancillary discipline to medicine & propose to provide a legislative framework based on that assumption.

In other words, the assumption is being made that we have an objective basis for establishing within the profession a system of hierarchy & authority that will be able to command general consensus, when in fact this crucial element for the successful functioning of such a system is absent.

-

If we legislate as if we have the basis for a consensus on such matters, even though we don’t have this, I suggest that certain undesirable consequences will inevitably ensue.

First of all, the arena will be set for an intense power struggle between the various associations, groups & factions that constitute the therapy profession as a whole as each one fights to acquire authority in the hierarchy that the law will create.

Since we have no objective measure of who is qualified to exercise authority in our field this will be decided by which groups are the most effective & ruthless at political lobbying on behalf of their own members. In the absence of an objective test of the right to exercise authority, such as we have in medicine for instance, there is no other way the matter can be settled.

Second, & following on from this, an arbitrary line will be drawn through everyone who now & in the future is practicing as a therapist. Those who are lucky enough to fall on the right side of this line, who have membership of the groups that successfully seize power, will be legalised. Those who happen to fall on the wrong side of this line will be criminalised, or at the very least strongly disadvantaged in their work as therapists. This line won’t make any distinction between good therapists & bad therapists. On both sides of the line there will be some therapists doing good work, & some doing mediocre work.

Thirdly, under the proposed system, some therapists will become wealthy at the expense of others. Privileged groups within the profession will become enriched, because they will be granted effective monopolies in the most lucrative aspect of therapy, which is the training of other therapists. Those dependent on these privileged groups for legitimation & accreditation will be impoverished at their expense.

-

I suggest therefore that the problem of the design of legislation for our profession needs to be thought through very carefully – something that clearly did not happen before the current proposals were first made, over 10 years ago, & so far as I can see, has not happened since.

The aim of legislation in this area should be not arbitrarily to empower certain groups at the expense of others within the profession but rather to empower the general public vis-à-vis the profession as a whole.

The aim should be to make the market for therapy as efficient & transparent as possible by providing as much information to the public as we can about therapists & the profession of therapy.

In my view, we should not place major restrictions on any adult person who wishes to work as a therapist. Possibly the minimum qualification of holding a degree & having spent a couple of years as a client in therapy would be sufficient. I think a minimum age of perhaps 30 or 35 for registering as a therapist would not be inappropriate. I don’t know. These are things that need to be mulled over & discussed by all of us & not just by a self-appointed minority.

But I would require anyone who chose to enter the profession to appear on a register of therapists, which should be available to the public. On this register each therapist would be free to outline her education & qualifications, membership of organizations if any, general background & experience, general philosophy of therapy, & any other information she wishes to give about herself.

Everyone on the register would be bound by a general code of ethics. Any therapist found to have infringed that code would be subject to suspension from the register, either temporarily or permanently, & the reasons for this suspension would be noted.

Each member of the public would thus have access to all relevant information about any therapist he or she chose to attend, & it would be up to each client to decide whether he or she wished to attend that therapist.

In addition, there should be a concerted attempt to educate the public in general about what therapy is, what it can realistically achieve, what it cannot realistically achieve, & what a member of the public should expect if they choose to enter therapy.

Such a system would not be perfect. No system of legislation for such a complex field as ours can be perfect. But it would reflect the reality of the world of therapy as it actually exists now & as it will continue to exist in the future.

-

In conclusion, it needs to be acknowledged that there are many personal stresses that are unique to the profession of therapy. We all have to deal with these as best we can, & I think if we are honest we all manifest symptoms of these stresses to some degree.

For people of a certain temperament however, this stress manifests itself in the form of a wish to try to control the work of other therapists & to deny them full legitimacy. From the inception of our profession a century ago – in Vienna – this exclusionary neurosis, if I may call it that, has been the main blight on it. It is rooted, of course, in unconscious fantasies of sibling rivalry & a sense of insecurity about parental love & approval.

Our focus, I suggest, should be on developing institutional structures that minimize the scope for this kind of symptomatic behaviour. My concern is that the current proposals, which were not designed with any reference at all to the very unusual characteristics of our profession, will have exactly the opposite effect, causing us to hand on to the next generation of therapists a damaged profession, lacking in honesty about its own motives & distorted by its own anxieties.

Thank you for your attention.