The French essayist Montaigne once said
that before we know what a word means we must take a look at the man who uses
it. In the same spirit the great German philosopher Nietzsche remarked that every
word is a pocket into which we can put a hundred different things.
Nowhere is it more important to remember
this open meaning of all our words than when we come to consider titles like “therapist”,
“psychotherapist”, “psychoanalyst”, “counsellor”, and so on.
One of the most important things we learn
from therapy is that the meaning of words – all our words – is fluid & continually
changing. We do not know what any word means until we examine how it is used because
each word means something slightly different in each context in which it is
employed.
Sometimes, “I hate you” can mean, “I want
to kill you.” But sometimes it can mean, “I love you”. And sometimes it can
mean, “I love you and I want to kill
you.”
What we learn from therapy, or certainly
what we should learn from therapy, is never to take words at their face value. Always
think about what is going on behind the words.
All the professions & vocations that we
now call “therapy”, or “psychoanalysis”, or “psychotherapy”, or “counselling”,
& so on, derive ultimately from the work of one man: Sigmund Freud. Freud
was a medical doctor & a specialist in neurology in Vienna. His work in
this area began in the early 1890s & lasted up to his death, when he was
living as a refugee from the Nazis in London, in 1939.
As a young doctor trying to help patients
suffering from hysterical symptoms, Freud was impressed with the work of one of
his senior colleagues, Josef Breuer. Breuer had found that with one patient – a
famous case now referred to as “Anna O.” – he could help to alleviate her
symptoms by getting her to recount the circumstances in which each of them had
first appeared. As it happens, all her symptoms first appeared while she was
caring for her father during his last illness.
Breuer himself does not seem to have tried
to apply this approach to any other patient. But taking this case as his
inspiration, Freud went on to formalize a treatment for mental disturbances that
focused exclusively on talking with the patient. Freud discovered a way of
translating the symptoms of mental illness so that they became intelligible in
the life history of his patients. He showed that no matter how irrational &
crazy the behaviour patterns of the patient may seem there are ways of
interpreting them so that they make sense. And the way to interpret them is to
talk to the patient in a particular way & to ask the patient particular
questions about his experiences.
Every form of therapy today that relies
predominantly on talking with the patient is derived ultimately from this
pioneering work of Freud. Freud’s theory & practice are the beginning point
for all modern talking therapies.
To describe his new technique for treating
mental disturbances Freud coined the term “psychoanalysis”. According to its
etymology this literally means analysis of the mind, or analysis of the soul. He
also occasionally in his early work refers to himself by the slightly more
generic term “psychotherapist”. This means according to its etymology one who
cares for the soul, or guards or shepherds the soul.
Freud was a genius at figuring out how the
unconscious processes of the mind work & it would be fair to say that his
interest in the mind as an object of scientific exploration always predominated
over his interest in applying his insights to curing the mind. Freud enjoyed
life & he had many interests but he was not an optimist about the human
condition overall & he was sceptical that much can be done to improve human
beings or make them better in a general sense.
Among Freud’s successors in the technique
of talking therapy some have continued to call themselves “psychoanalysts”, if
they feel that their way of translating the symptoms of their patients is still
in essentials – or in spirit – the same as that pioneered by Freud.
Around the world there are now many
associations whose members call themselves “psychoanalysts”. However, there is
often rivalry between these groups & frequently one association will say
that its claim to use this professional title is more legitimate than its
rivals & that they should not be using the title. To the layman all this
will seem rather silly. And indeed it is rather silly.
Other practitioners of the talking therapy
call themselves simply “psychotherapists”. They may prefer this title for a
variety of reasons. It may be only because they do not belong to a professional
association that uses the word “psychoanalyst” & therefore they see no
particular reason to bother using the title for themselves. This is often the
case in the country in which I work, The Republic of Ireland. Here, few
therapists regularly describe themselves as “psychoanalysts”, & it is no
particular professional help to do so since it is not a title that the general
public widely recognizes.
I myself use the appellation
“psychotherapist” for this reason & also because, like many of my
colleagues, although I feel a great sense of indebtedness to Freud as a
pioneer, my own approach to therapy, my own ways of making sense of what my
patients say to me, has come over time to be influenced by too many other writers
& thinkers in addition to Freud for me to feel entirely comfortable using the
title “psychoanalyst”.
I do however also sometimes refer to
myself as a “psychoanalytic therapist”, to make explicit my reliance on Freud’s
precedents while stressing my willingness to depart from him when I think this
is appropriate. The term “psychoanalytic therapist” is widely used &
recognized in Britain, but somewhat less so in Ireland.
Without a doubt the most frequently
encountered title in the therapy world at the moment is that of “counsellor”.
This is the one that is most widely recognized by the public in general &
many people who are attending a talk therapist of whatever kind will say they
are “in counselling”.
Like all the other titles in the therapy
field the term “counsellor” is conventional. Ultimately, its meaning is
whatever people take it to mean.
Traditionally, the title “counsellor” has
been used by therapists who stress the emotionally supportive aspects of their
work, over the deeper psychological inquiry that is associated with Freud &
with those who call themselves “psychoanalysts”. This is still broadly true.
But some therapists who use the appellation “counsellor” will have a deep
knowledge of Freud’s practice & theory & will consciously be applying
his insights in their work.
Another title in the therapy world that
has gained some currency in the last twenty years is that of “life coach”. This
term originated in the US where it has been adopted by practitioners who stress
the advisory nature of their relationship with their clients. They aim to give
practical advice & guidance on matters of career & personal relations
& they downplay the therapeutic function of their work.
But again, terms are very fluid in this
field & there are currently people who call themselves “life coaches” who
seem to be doing work that is not easy to distinguish from much that happens
under the label of “counselling”.
Another important nomenclature in the
current therapy field is that of “cognitive behavioural therapy”, or “CBT”.
“CBT” derives from the work of
“behavioural” psychologists in the 1950s. These “behavioural” psychologists
were overtly hostile to Freud & were determined to show that treating the
symptoms of mental distress as essentially bad habits, or bad forms of
adaptation, could be a more effective form of treatment than Freud’s way of
trying to interpret them as expressions of the patient’s unconscious needs.
In its originating philosophy “CBT” does
represent something quite at variance with “psychoanalysis”. The fundamental
difference between them is that “psychoanalysis”, in its original form,
stresses that the most important meanings of the patient’s symptoms are those
that are unique to that patient, while “CBT” stresses & seeks to uncover
those aspects of the patient’s symptoms that are universal to everyone. “Psychoanalysis”
in its original form strives to help the patient by putting him in closer touch
with himself. “CBT” strives to help the patient by putting him in closer touch
with others. In a nutshell, “psychoanalysis” says: “become who you are”; “CBT”
says: “become normal”.
For those therapists like myself who work
in the “psychoanalytic” tradition the goal of “becoming normal” is problematic.
While every good therapist will emphasize how much we all have in common with
each other, the “psychoanalytic” tradition stresses that each of us has a unique
destiny to live out & that the path to health is to accept & embrace
that destiny.
Most “CBT” practitioners today will still
stress that first & foremost they are not “psychoanalysts” & are
opposed to its basic principles.
The truth however, as with everything in
the world of therapy, is much less black & white than this, & much more
shades of grey.
If you go nowadays to a therapist who
describes herself as practicing “CBT” you are not at all unlikely to end up
discussing with her your family background, your childhood, your relationship
with your parents, your sexual experiences, & so on. The focus on all these
topics, as a way of making sense of symptoms, originates of course with Freud. It
is more than possible that you will get benefit from these discussions &
the chance to explore your emotions in an honest way. The “CBT” therapist, however,
is likely to claim that this is another example of how “CBT” methods are
superior to those of “psychoanalysis”.
It is small wonder the public are so
confused as to what actually goes on in the world of therapy when the
therapists themselves are often so confused.
But again, we see how lacking in practical
utility are most of the labels we encounter in the therapy world. On their own they
give us almost no information on what we really need to know about a therapist.
The golden rule in choosing &
assessing a therapist is therefore to attend not to what professional label he
happens to use, nor to what he says is his philosophy of therapy, but to what
he actually does in practice.
Whether your therapist calls himself a “psychoanalyst”,
or a “psychotherapist”, or a “counsellor”, or a “CBT” therapist, or anything
else, the most important question to ask yourself is, is he or she focused on
you as an individual, & focused on what is special & particular about the
circumstances you have to contend with, & the problems you have wrestled
with in your past? Or, on the contrary, does your therapist seem to want to fit
you & your circumstances into some pre-existing theoretical framework that
he happens to prefer? Does your therapist look at you, & respond to you, as
a unique individual? Or does he or she look at you as a particular instance of
a general theory of how human beings are, or how they should be?
The rule is that every good therapist,
whatever professional label he may use to distinguish himself in the therapy
marketplace, will be sufficiently at ease with his own individuality to be comfortable
with your individuality as his client. Whatever school he may have trained in,
& whatever is his favoured theoretical tool kit, he will always use these
in a pragmatic way, subordinating them to the needs of his client.
