tag:blogger.com,1999:blog-24904231689908177322024-03-05T05:47:06.250-08:00Pangur CottageNotes by a Psychoanalytic TherapistMarcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.comBlogger57125tag:blogger.com,1999:blog-2490423168990817732.post-52498691809350074902019-05-13T06:24:00.002-07:002019-05-14T06:14:25.340-07:00Freud's Unforgiven Error: On the Development and Consequences of the Seduction Theory <!--[if gte mso 9]><xml>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">The following is the text of my talk <u>On the
Development and Consequences of Freud’s Seduction Theory</u>, given at <u>The
Irish Psycho-Analytical Association Conference 2019</u> - <i>The
Budapest School of Psychoanalysis: Ferenczi, the Balints and Beyond</i>.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Saturday, 11 May 2019</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><i><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Introductory
Remarks</span></i><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">IPAA President Fergal Brady has asked me to
give a short introduction to the seduction theory to give some background
context to the relation between Freud and Ferenczi as it developed in later
years.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">So I have tried to put together a brief history of the
events surrounding it, being as objective and as fair as I can.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">This is quite a tricky task because the seduction
theory has always been a highly contentious issue, and has provoked strong
feelings in everyone who has commented on it, from Freud onwards.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">There are two reasons for this.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">First, the question of childhood sexual abuse is
always emotive, as it awakens strong and primitive feelings in all of us. There
are few subjects on which human beings find it harder to think clearly and
dispassionately.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Second, some of the key facts in the story are missing
and can never be known to us.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">For instance, we don’t know how many of the patients
Freud was treating when he developed the theory actually had experienced abuse.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Gaps in our knowledge like this mean that on some
vital questions we are forced to speculate. And the way we speculate inevitably
will be coloured by what kind of person we think Freud was, and how we believe
he was motivated, in other words, by our own transference feelings towards him.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">As a result, everyone tends to arrive at their own
version of what happened with the seduction theory. I don’t pretend my version
is any different. </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">However some writers have speculated quite extensively
beyond the agreed facts.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">I have tried to avoid this, keeping as close as I can
to what can be established with a fair degree of objective confidence.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><i><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Development of the
Seduction Theory</span></i><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">To understand the seduction theory we have to consider
the historical context in which Freud developed it in the mid-1890s.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">As Ellenberger (1970) and others have shown, Freud
found the basic components for his ideas in a huge range of 19<sup>th</sup> century
sources. (cf., Sulloway 1979, McGrath 1986, Schwartz 1999, Makari 2008, et al.)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">But the two most important personal influences on
Freud’s thinking on psychotherapy during this period were Jean-Martin Charcot,
with whom he had studied in Paris in the 1880s, and Josef Breuer, from whom he
had learnt about the cathartic cure and with whom he wrote <i>Studies On
Hysteria</i>, published in 1895.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">From Charcot Freud inherited the supposition that
hysteria was determined in part by hereditary predisposition and in part as a
result of traumatic experiences.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">From Breuer’s cathartic method he inherited the idea
that the way to cure hysteria was to get the patient to recall accurately the
memories of the traumatic experiences that had originally caused it.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;"><span style="color: #999999; font-size: 14pt;"><br /></span></span></div>
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<span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;"><span style="color: #999999; font-size: 14pt;">Freud’s seduction theory can be seen as a development
out of, and a response to, the influence on him of these two men.</span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud was always more interested in the role of trauma
in hysteria than in that of hereditary predisposition. The main reason for this
was that only trauma seemed to offer the possibility of psychotherapeutic
intervention. </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">From the early 1890s Freud became increasingly
convinced that it was specifically <i>sexual</i> traumas that were at
the root of the neuroses in general.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">The relationship between sex and mental illness was
widely discussed by specialists at the end of the 19<sup>th</sup> century.
But it particularly interested Freud because it seemed to offer the solution to
a puzzle raised by the cathartic cure.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Catharsis seemed to work by uncovering repressed
memories of traumatic experiences. The puzzle this raised was how the <i>memory</i> of
an experience could have greater psychic power than <i>current</i> experience.
Sex seemed to offer a solution here because it is something that can be
experienced, so to speak, prematurely. Sex is paradoxical in that one can
experience it before one is ready to experience it.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud’s hypothesis was that at the time of sexual
maturity premature sexual experiences became retrospectively active
emotionally. “In every case of hysteria,” he writes, “there lies in the past
one or several premature sexual experiences.” (1896c) “What happens is,
as it were, a posthumous action by a sexual trauma.” (1896a)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">If, as Freud believed was usually the case, these
premature experiences were subject to psychological </span><span lang="EN-GB" style="font-family: "georgia" , serif; font-size: 14.0pt;">defence</span><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;"> at
the time of maturity then they resulted in the formation of neurotic symptoms.
In the case of hysteria the memories were converted to physical symptoms. In
the case of obsessional neurosis they were transformed into compulsive thoughts
and actions. From 1894 Freud refers to these two illnesses as the
neuro-psychoses of defence.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Hysteria and obsessional neurosis he distinguished
from the so-called “actual” neuroses of neurasthenia and anxiety neurosis. These
he suggested were rooted in current disorders of the sexual life, that is,
either excessive masturbation, leading to neurasthenia, or sexual excitation
that was not fully discharged, leading to anxiety.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud’s thinking on the seduction theory reached its
highest point of development in 1896. In this year he published his ideas on it
in three important papers in which he uses the term psycho-analysis for the
first time. The first is “Heredity and The Aetiology of the Neuroses”,
originally in French, in February of this year (1896a). The second is “Further
Remarks on the Neuro-Psychoses of Defence”, also in February (1896b). And the
third is “On the Aetiology of Hysteria” (1896c), which was read by Freud
in April of that year at a meeting in Vienna of the <i>Society for
Psychiatry and Neurology</i>. This meeting was chaired by the eminent
psychiatrist Richard von Krafft-Ebing, who had made his name cataloging the
different forms of sexual perversion and deviation.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">In these three papers Freud’s emphasis is on the
emotional impact of sexual seduction, or what we would now call sexual abuse,
on children under the age of about 8 to 10 years. He writes as follows:</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">“These sexual traumas must have occurred in early
childhood (before puberty), and their content must consist of an actual
irritation of the genitals.” (1896b) </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud identifies three types of case: in the first are
attacks mostly on female children by adult strangers; in the second, much more
extensive, group, children are seduced into sexual relations sometimes lasting
years by adults entrusted with their care such as nursemaids, governesses,
servants, teachers and so on; in a third group there are sexual relations
between children, usually siblings. And, he adds, also “unfortunately
all-too-often close relatives”. This last reference is evidently a euphemism
for fathers who have seduced their daughters. (1896c)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud is aware from the outset of the objections that
are likely to be raised to his hypothesis. He writes:</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">“The most immediate objections to this conclusion will
probably be that sexual assaults on small children happen too often for them to
have any etiological importance, or that these sorts of experiences are bound
to be without effect precisely because they happen to a person who is sexually
undeveloped, and further, that one must beware of forcing on patients supposed
reminiscences of this kind by questioning them, or of believing in the romances
which they themselves invent. In reply to the latter objections we may ask that
no one should form too certain judgements in this obscure field until he has
made use of the only method which can throw light on it - of psycho-analysis
for the purpose of making conscious what has so far been unconscious.” (1896b)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Note that from the remarks at the start of this
passage we see that the idea of infantile sexuality which Freud is to develop
explicitly in a few years’ time is already implicit in the seduction theory.
His point is that children experience sex as sex, not as something else, even
though they do so in an immature way.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">It is important to note also that right from the
beginning Freud privileges the position of psycho-analysis, as developed out of
the cathartic cure, as a means of establishing the truth of these suppositions.
No other existing method, he is saying, is capable of deciding the truth or
otherwise of this theory. This is a fateful assertion, and one which he was
never really to relinquish in later years. I suggest that this has been the
source of significant but essentially unnecessary problems for psychoanalysis
as it has developed over the decades. I shall return to this again in a moment.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud nevertheless does not hide how difficult it is
even with the psychoanalytic method to establish the facts as he sees them. He
remarks:</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">“Patients know nothing of these scenes before the
application of the analysis. They tend to take offence if one warns them of the
emergence of these things; only through the strongest compulsion of the
treatment can they be moved to concede to the reproduction of them, they suffer
under the most violent sensations, of which they are ashamed and which they try
to hide while calling these infantile experiences into consciousness, and
still, after they have gone through them again in such a convincing way, they
try to deny the belief by stressing that they have no sense of memory as in
other instances of forgetting.” (1896c)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">The conclusion is inescapable, I think, that in some
cases at least Freud received no corroboration at all from the patient that he
or she had actually been sexually abused as a child.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Considerations such as these seem to have weighed
heavily with his audience in April 1896. According to Freud in his letter to
Fliess of 26 April he received an “icy reception” and Krafft-Ebing he says
remarked that, “it sounds like a scientific fairy tale.” </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud had been expecting a strong reaction to the
seduction theory. In February he had remarked: “I am quite sure this theory
will call up a storm of contradictions from contemporary physicians.” (1896a)
So there is undoubtedly an element of wish-fulfilment in the response he
received and in his reporting of it. Nevertheless it is clear that no one apart
from Fliess found the seduction theory plausible.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">We see from his letters to Fliess that Freud went on
wrestling with the theory in his own mind until the end of 1897, that is about
18 months after the fateful April meeting. But he never publicly
advocated the theory again after the three papers of 1896.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><i><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Aftermath
of the Theory </span></i><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span lang="EN-US" style="color: #999999; font-family: "georgia" , serif; font-size: 14.0pt;">Over the next ten years Freud went on to develop the
key ideas of psychoanalysis. These stress the importance of internal psychic
events, and the conflicts between wishes and drives, rather than particular
external events. In other words, Freud concluded that the most important factor
in the development of neurosis is not the particular experiences that the
individual undergoes, as he argued in 1896, but how he or she deals with those
experiences.</span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">It is not until 1905 that he returns explicitly to
address the seduction theory in the <i>Three Essays on the Theory of
Sexuality</i>. At first sight it seems his position has changed little in the
intervening years. He stresses the importance of sexual seduction in the
etiology of neurosis and insists that in 1896 he had not overestimated either
the frequency or the significance of this as a contributing factor. He concedes
however that a strict causal link between seduction and neurosis does not hold,
though he justifies this with the somewhat surprising claim that some children can
experience sexual seduction without developing neurosis. (1905a; SE7 190;
Studienausgabe V 96)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">However in a paper written in the very same year
[though published in 1906], entitled “My Views on The Role of Sexuality in the
Aetiology of the Neuroses” Freud takes a completely different position, saying
that in the 1890s, chance had brought him a misleadingly large number of cases
in which sexual seduction had played the main role. This he says caused him to
overestimate the frequency of its occurrence in hysteria generally. (1906a; SE7
274; Studienausgabe V 152)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud was evidently dealing with many serious cases of
sexual abuse in the 1890s and this is doubtless why the seduction theory came
to seem so plausible to him. At the same time, however, it seems very likely
that Freud had also refused to believe at least some patients who accurately
reported that they had not been abused. My own guess is that it was mainly his
continuing unease about this in later years that prevented him from thinking
clearly on the matter and led him to make such inconsistent and confusing
claims about the whole seduction question.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">For instance in 1917, in the 23<sup>rd</sup> of
his <i>Introductory Lectures</i> (“The Paths to Symptom-Formation”),
Freud writes as follows: “Phantasies of being seduced are of particular
interest, because so often they are not phantasies but real memories.
Fortunately, however, they are nevertheless not real as often as seemed at
first to be shown by the findings of analysis. Seduction by an older child or
by one of the same age is even more frequent than by an adult; and if in the
case of girls who produce such an event in the story of their childhood their
father figures fairly regularly as the seducer, there can be no doubt … of
the imaginary nature of the accusation … You must not suppose, however, that
sexual abuse of a child by its nearest male relatives belongs entirely to the
realm of phantasy. Most analysts will have treated cases in which such events
were real and could be unimpeachably established …” (1916-17; SE16 370;
Studienausgabe I 361) [Similar remarks in <i>New Introductory
Lectures</i>, lecture 33, “The Feminine”. Here he attributes the phantasies to
the female Oedipus complex. (1933a; SE22 120-1; Studienausgabe I 551-2)]</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">After reading a passage that veers as erratically as
does this from one position to another one could be forgiven for asking, well,
does Freud believe in the reality of childhood seduction or does he not? It is
small wonder that so many psychoanalysts did not know what they were meant to
think on the issue.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Later in 1931, only a couple of years before his
unhappy final disagreement with Ferenczi, he comments: “Actual seduction is
frequent enough, it proceeds either from other children or from carers who wish
to calm the child, put it to sleep, or make it dependent. Where seduction takes
effect it regularly disturbs the natural course of developmental processes;
often it leaves behind </span><span style="font-family: "georgia" , serif; font-size: 14.0pt;">far-reaching and lasting consequences.” (“On
Female Sexuality”; 1931b; SE21 232; Studienausgabe V 282) </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">As we see from comments like these it is not the case,
as some of his critics have alleged, that Freud denied the prevalence or the
etiological significance of seduction after 1896.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Nevertheless, there is no question that his remarks on
the issue are contradictory and badly unresolved. On the one hand, he
acknowledges the reality of childhood seduction. On the other, he clearly
believes that it is common for patients to have conscious recollections of
seduction that never actually happened – something that most of us I think
would now dispute.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span lang="EN-US" style="color: #999999; font-family: "georgia" , serif; font-size: 14.0pt;">His tendency to go on asserting this I suggest
reflects how painful the failure of the seduction theory had been for him and
how difficult he found it to accept that in the 1890s he had in fact pressed
patients to admit to memories of abuse they had never actually experienced. In
my view he needed to believe that he had been misled by the unconscious of his
patients, rather than by his own over-hasty judgment.</span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">However the aspect of Freud’s position on the
seduction issue that I suggest did the most long-term damage was the assumption
he bequeathed to psychoanalysts that they can, and should, give us certainty on
this question.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Reaching reliable conclusions about the patient’s past
history was an implicit goal of the cathartic cure but it does not occupy the
same place in psychoanalysis.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Recall that the aim of catharsis is to recover <i>memories</i>.
By implication, it claims that the <i>accuracy</i> of a memory is
established by the removal of the symptom with which it is connected. Turn this
claim around and it amounts to the assertion that the capacity to remove
symptoms demonstrates that the associated memories accurately reproduce past
events.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Psychoanalysis in contrast doesn’t work in this way.
Its objective is to uncover hidden <i>intentions</i> – or wishes,
drives, desires – and especially hidden conflicts between them. Psychoanalysis
in other words shifts its attention from testing the <i>accuracy</i> of
memories to elucidating <i>the emotional significance</i> of
memories. It remains much more agnostic than does the cathartic cure on the
always difficult question of how accurately a subjective memory may reflect
actual events.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">In psychoanalysis, an improvement in the condition of
the patient allows us to say that we are accurately, or reasonably accurately,
describing his previously unconscious intentions. But it doesn’t allow us to
say whether his memories are true or false in some objective sense.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">When Freud took the decisive step of moving away from
discovering memories to discovering motives he should also have acknowledged
what follows from this and have explicitly contented himself with making
statements of <i>probability</i> about what had happened to his
patients in the past. Unfortunately he didn’t do this. By the implication of
what he said on the seduction theory in later years he allowed to continue the
idea that uncovering unconscious wishes is still as reliable a guide to
reconstructing the patient’s past as is uncovering his memories. But of course
it cannot be this.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">As a result of Freud’s failure in this regard too many
analysts over the years have felt under an obligation to reach a conviction
about what happened to their patients in the past for which there was never any
need. It is out of this misguided sense of obligation that have arisen too many
dogmatic denials of abuse that actually happened, and too many dogmatic
assertions of abuse that actually did not happen.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">There is nothing shameful in admitting that one knows
things about a patient’s past not with certainty but only with some degree of
probability. It is not weakness to say, “On balance, I think this happened, but
I cannot be completely sure.” On the contrary, such an attitude of skeptical
open-mindedness is the mark of the scientific spirit.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;"><br style="mso-special-character: line-break;" />
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<span style="color: #999999;"><i><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Conclusion</span></i><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Virtually every biography of Freud and every history
of psychoanalysis will tell you that psychoanalysis begins when Freud gives up
the seduction theory.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">It is however more accurate to say that psychoanalysis
begins when Freud gives up asking the question to which the seduction theory is
meant to be an answer.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">The question Freud was trying to answer with the
seduction theory is this: what is the essential condition without which the
development of hysteria in an adult is impossible?</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">All of Freud’s work after 1897 is geared to showing
why no such condition can exist, beyond the basic condition of being human.
What he goes on to demonstrate as he develops the ideas that define
psychoanalysis is that we are <u>all</u> in some measure hysterical,
anxious, phobic, melancholic, traumatised, neurasthenic, infantile, perverse,
paranoid and, in our dreams, we all spend much of our lives in a state of
psychosis.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">In other words these states are not, as he and the
other psychiatrists of the 1890s had thought, like physical illnesses with
specific aetiologies, but rather just different aspects of the general
condition of being human.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">As he writes in the <i>Introductory Lectures</i> of
1917: “‘Being sick’ is in essence a practical concept. From a theoretical
point of view however … you may quite well say that we are <u>all</u> sick
– that is, neurotic – since the preconditions for the formation of symptoms can
be demonstrated in normal people.” (Lecture 23, 1916-17; SE16
358; </span><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Studienausgabe I 350)</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">In my judgment, Freud’s insight here, and his
development of its implications, was the most humanising influence of the 20<sup>th</sup> century.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">But it is also another way of saying that the question
underlying the seduction theory was radically misconceived. This was the
problem with the seduction theory from the outset. It was a question rooted in
the assumption that mental illness can be understood on the analogy of physical
illness and that psychoanalysis and psychotherapy generally are just
sub-departments of medicine, with its easy distinctions between health and
sickness. In this larger sense it reflects an error from which we have still
some significant way to go to set ourselves free.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999; font-size: 10.0pt;"><o:p><br /></o:p></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999; font-size: 10.0pt;"><o:p><br /></o:p></span></div>
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<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">-</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Key to Freud’s 1896 papers (all these are to be found
in SE3): </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">(1896a) “Heredity and The Aetiology of the
Neuroses” (originally in French), February. </span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">(1896b) “Further Remarks on the Neuro-Psychoses of
Defence”, February.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">(1896c) “On the Aetiology of Hysteria”, delivered in
April.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span><br />
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Bibliography, apart from works by Freud cited in the
text:</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Ronald W. Clark (1980), <i>Freud: The Man and The
Cause</i>. London, Jonathan Cape.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Henri F.
Ellenberger (1970), <i>The Discovery of The Unconscious: The History and
Evolution of Dynamic Psychiatry</i>. London, Allen Lane.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span style="font-family: "georgia" , serif; font-size: 14.0pt;">Peter Gay
(1988), </span><i><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Freud: A Life For Our
Time</span></i><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">. London, J.M. Dent.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Ernest Jones (1953), <i>Sigmund Freud: His Life
and Work. Volume One. The Young Freud</i>. London, Hogarth Press.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">George Makari (2008), <i>Revolution in Mind: The
Creation of Psychoanalysis</i>. London, Duckworth, 2008.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Jeffrey Moussaieff Masson (1984), <i>The Assault
on Truth: Freud and Child Sexual Abuse</i>. London, Harper Collins.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Jeffrey Moussaieff Masson (1985), Translator and
Editor. <i>The Complete Letters of Sigmund Freud to Wilhelm Fliess,
1887-1904</i>. London, Harvard University Press.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">William J. McGrath (1986), <i>Freud’s Discovery
of the Unconscious: The Politics of Hysteria</i>. New York, Cornell University
Press.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Paul Robinson (1993), <i>Freud and His Critics</i>.
Oxford, University of California Press.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Joseph Schwartz (1999), <i>Cassandra’s Daughter:
A History of Psychoanalysis</i>. Harmondsworth, Penguin.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Frank J. Sulloway (1979), <i>Freud: Biologist of
the Mind. Beyond the Psychoanalytic Legend</i>. London, Basic Books.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><span lang="EN-US" style="font-family: "georgia" , serif; font-size: 14.0pt;">Richard Webster (1996), <i>Why Freud Was Wrong</i>.
London, Harper Collins.</span><span style="font-size: 10.0pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><br /></span></div>
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<span style="color: #999999;"><br /></span></div>
<div class="MsoNormal" style="line-height: 15.0pt; margin-right: 55.25pt;">
<span style="color: #999999;"><br /></span></div>
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<!--EndFragment--><br />Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-40329573367818623212019-01-28T02:25:00.001-08:002019-01-28T02:25:45.700-08:00Emerson <font size="4">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</font>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-42504633275085271642018-09-03T09:53:00.000-07:002018-09-04T05:06:26.155-07:00A Freudian Look at the Feature Film, Jackie<span style="font-size: large;">Last night I watched the feature film, <i>Jackie</i> (2016), on Netflix. I go to the cinema rarely so as usual I am about two years behind what is currently on release. </span><br />
<span style="font-size: large;">Having read nothing about the film beforehand I was expecting to half-enjoy an up-market, soapy bio-pic. </span><br />
<span style="font-size: large;">About that I was completely wrong. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><i>Jackie</i> 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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">This is Natalie Portman's most disturbing film since she played the twelve-year-old Mathilda in the controversial <i>Leon </i>(1994).</span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">For those of us of a certain age the death of JFK marked indelibly a particular moment in our lives. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><i>Jackie</i> recreates that moment of loss & disorientation that everyone who was alive & sentient on that day felt. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">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.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">This memorable brief performance is a reflection of how expertly & persuasively all the characters in the film are sketched. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">In his last film appearance before his own death, John Hurt gives a characteristically hypnotic performance as an Irish priest seeking to console Jackie.</span><br />
<span style="font-size: large;">But then we notice something odd. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And at this point the key to the abiding power of this whole drama becomes clear. </span><br />
<span style="font-size: large;">In the guise of a priest the character Hurt is really playing is Teiresias, the old blind prophet of the Oedipus legend. </span><br />
<span style="font-size: large;">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.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">Understood in this perspective the figure of Jackie emerges in its true light as Jocasta, the mother who is both desired & forbidden.</span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">But the real engine of these events was the human unconscious & our need to re-enact in each generation the sacrifice of fathers. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">And the sacrifice of sons too, for this is also central to the legend of Oedipus. </span><br />
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">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. </span><br />
<span style="font-size: large;">In <i>Jackie</i> 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. </span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-27165824858562602662018-04-12T09:40:00.000-07:002018-08-20T08:20:42.586-07:00Therapy Through the Looking Glass<div align="center" class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-align: center;">
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<span style="font-family: "georgia"; font-size: large;">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. </span></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">This is a description of the daily work of the
psychotherapist. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">This is also a description of the daily work of the
counsellor. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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? <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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”.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-outline-level: 1;">
<span style="font-family: "georgia";"><span style="font-size: large;">And so would I. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: large;"><span style="font-family: "georgia";">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. </span><span style="font-family: "georgia";"> </span><span style="font-family: "georgia";"><o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-outline-level: 1;">
<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia";"><span style="font-size: large;">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”. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%; mso-outline-level: 1;">
<span style="font-family: "georgia";"><span style="font-size: large;">To these submissions we received no response. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">Then
in May 2017 the announcement came from the Department that the field was to be
split anyway into these two professions. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">No
explanation was given for how this decision was reached, who had been
consulted, or what was the rationale behind it. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: large;"><span style="font-family: "georgia";">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.
<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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.</span></span><span style="font-family: "georgia"; font-size: large;"> </span></div>
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Name="index 9"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 1"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 2"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 3"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 4"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 5"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 6"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 7"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 8"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" Name="toc 9"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="header"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footer"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index heading"/>
<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of figures"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope return"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
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<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia";"><span style="font-size: large;">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. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><o:p></o:p></span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com1tag:blogger.com,1999:blog-2490423168990817732.post-16184313870868755832018-03-27T03:52:00.000-07:002018-03-29T12:33:36.212-07:00Presentation to What is the Future for Counselling & Psychotherapy in Ireland?, City Colleges, Dublin, March 25th 2018<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<u><span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Some Comments on
Proposed Regulation for the Therapy Professions<o:p></o:p></span></span></u></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Presented at City
Colleges in Dublin on March 25<sup>th</sup> 2018 <o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">as part of the conference
on <o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: large;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "georgia"; line-height: 150%;">What is the Future for Counselling &
Psychotherapy in Ireland?</span></i><span style="font-family: "georgia"; line-height: 150%;"><o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Chaired by Dr
Finian Fallon<o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Marcus Bowman PhD<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span><br />
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The first thing we need to understand is
that in designing legislation for any profession we confront two fundamentally
distinct options. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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 <u>not</u> 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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">This is how for example medicine is regulated,
& also its ancillary professions like nursing & physiotherapy, & so
on.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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 <u>are</u> competent to
practice, unless they clearly prove themselves unfit to do so. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">I contend therefore that an attempt to
treat the talking therapies <u>as if</u> 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”. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">- <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">-<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">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. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Thank you for your attention. <o:p></o:p></span></span></div>
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Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-13105582389189936222017-08-28T06:19:00.000-07:002017-08-30T06:12:16.187-07:00The Freud Wars Revisited: A Response to Louis Menand’s “Why Freud Survives” in The New Yorker<div class="MsoNormal" style="line-height: 150%;">
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Nietzsche once remarked that there
is a joke concealed within Kant’s philosophy: that he set out to prove what the
man in the street already believes, but in a language so obscure that the man
in the street would find it completely dumbfounding. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">One might say that there is a joke
concealed in Freud’s work too, though it is roughly the opposite of this: that he
set out to show how little the average educated man actually understands
himself, but in a language so clear that the average educated man is convinced
he now really does understand himself, but is convinced at the same time that
Freud was deluded. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">I exaggerate, of course. But
perhaps not greatly. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It came to my mind while reading
<a href="https://www.newyorker.com/magazine/2017/08/28/why-freud-survives" target="_blank"><span style="color: #f4cccc;">Louis Menand’s recent essay on Freud</span></a> & his critics in The New Yorker
magazine (28<sup>th</sup> August 2017). Although boldly titled “Why Freud
Survives”, it is not at all clear why Menand thinks he does survive. There is
no accusation that has been levelled against Freud in the last fifty years
against which Menand shows the slightest inclination to defend him in even the
most qualified degree. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The specific occasion of the essay
is a new book by long-time Freud critic Frederick Crews helpfully reminding us
again in case we had forgotten what a monster the founder of psychoanalysis really
was. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Menand raises an urbane question
mark over the intensity of Crews’ personal obsession with Freud & he is
ironically aware that Crews ends up trying to debunk the founder of
psychoanalysis by subjecting him to a version of psychoanalysis of his own. But
it is clear nevertheless he largely agrees with him that Freud was in essence a
fake. <o:p></o:p></span></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Menand records again much of the
criticism Freud has been subject to in past decades, though most of this is now
over 30 years old. At the same time he signally fails to note how much of this
criticism has been shown to be unjust & misconceived. Evidently the
assumption is that if you go on repeating a charge long enough eventually you
will persuade yourself it is true. <o:p></o:p></span></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">According to Menand, for instance,
“historians like Henri Ellenberger & Frank Sulloway pointed out that most
of Freud’s ideas about the unconscious were not original, & that his
theories relied on outmoded concepts from nineteenth-century biology.” This is
simple nonsense & reveals Menand to understand nothing about psychoanalysis. In focusing specifically on <u>conflict</u> within the
unconscious, which is the key innovation that makes psychoanalysis what it is & distinguishes it from
everything else, Freud had no predecessors in the clinical study of the
unconscious, & among the philosophers only Nietzsche anticipates him in
this regard. As to biology, Freud uses this always as a general backdrop for
his thinking & as a source of metaphor but his characteristic ideas in no
way depend on abandoned biological theory. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">Menand goes on to repeat without
any caveats the assertion by Peter Medawar, described as is now traditional in
this kind of literature as “the Nobel Prize-winning medical biologist” so that
he can serve as a kind of all-purpose genius, that psychoanalysis is “the most
stupendous intellectual confidence trick of the twentieth century.” As for Adolf
Gr</span><span lang="DE" style="font-family: "georgia"; line-height: 150%;">ü</span><span lang="EN-US" style="font-family: "georgia"; line-height: 150%;">nbaum’s often
cited <u>The Foundations of Psychoanalysis</u>, Menand judges this to be “a
dauntingly thorough exposition designed to show that, whatever the foundations
of psychoanalysis were, they were not scientific.” And so on. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Menand
either does not know or does not care that all these attacks have long ago been
subject to penetrating criticism. Anyone seriously interested in studying the
problems with these writers & many other of the Freud critics could do
worse than to start with <a href="https://www.amazon.com/Freud-Adler-Jung-Alder-Discovering/dp/0887383955/ref=sr_1_3?s=books&ie=UTF8&qid=1503936733&sr=1-3&keywords=Walter+Kaufmann+discovering+the+mind" target="_blank"><span style="color: #f4cccc;">Walter Kaufmann’s Discovering The Mind: Freud,Adler & Jung</span></a>, <a href="https://www.amazon.com/Freud-His-Critics-Paul-Robinson/dp/0520080297/ref=sr_1_1?s=books&ie=UTF8&qid=1503936870&sr=1-1&keywords=Paul+Robinson+Freud+%26+His+Critics" target="_blank"><span style="color: #f4cccc;">Paul Robinson’s <u>Freud & His Critics</u></span></a>, & my
own <u><a href="https://www.amazon.com/Last-Resistance-Psychoanalysis-Alternatives-Psychology/dp/0791454525/ref=sr_1_1?s=books&ie=UTF8&qid=1503936929&sr=1-1&keywords=Marcus+Bowman+The+Last+Resistance" target="_blank"><span style="color: #f4cccc;">The Last Resistance</span></a></u>. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">For Menand however the notion that
Freud brought about a genuine revolution in the way we understand ourselves was
always an illusion. “For many years,” he remarks, “even as writers were
discarding the more patently absurd elements of his theory – penis envy, or the
death drive – they continued to pay homage to Freud’s unblinking insight into
the human condition.” To which the obvious response is: which writers does he
mean? Apparently for Menand anyone who has found Freud’s ideas to be fruitful can
only be the bamboozled member of a mindless cult, incapable of looking for anything
other than confirmation of the master’s pronouncements. <o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-size: large;"><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">
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<!--StartFragment-->
<span lang="EN-GB">I
first began to read Freud when I was a teenager & Penguin Books began to
publish most of the Standard Edition in paperback form, starting with the
Introductory Lectures. I remember at this time, in the mid 1970s, wise adults
gravely explaining to me that Freud had now been superseded by more recent
advances in scientific psychology & that his theories </span><!--EndFragment--></span><span style="font-family: "georgia";">were being abandoned by serious
scholars & thinkers. I made little protest at this, because I did not
believe it. The extraordinary clarity of thought in Freud’s writing & the clear
applicability of the ideas to everyday experience seemed to me then the work of
genius. More than forty years later they still do.</span></span><br />
<span style="font-size: large;"><span style="font-family: "georgia";"><br /></span></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Over those years I have continued
to study & reflect on Freud, first informally for my own interest, later as
a doctoral student & in several years of personal analysis, &, for the
last twenty years or so, as a psychotherapist doing what I can to help my own
clients. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">After all these years I am not
sure, by any means, that Menand’s examples of penis envy & the death drive
are not mistaken hypotheses. But I know for sure they are not “patently absurd”.
Anyone who imagines these ideas are not profoundly compatible with a great deal
of what we observe in human psychological life is simply unaware of the
evidence, or doesn’t want to look at it. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">What is so revealing is that such
a supposedly sophisticated commentator as Menand should experience not the
slightest need even to attempt to justify dismissing these complex &
difficult notions. Menand, because he regards himself as a literate man, assumes
therefore he must also know enough to know these things are not worth taking seriously.
<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The great bulk of writing on Freud
in our culture is of this nature. The clarity of Freud’s words &, above
all, the fact that he writes on things that touch us all most intimately –
childhood, parents, siblings, the sexual life, anxiety, envy, death – persuades
almost every educated man & woman who approaches this work that he or she
must in some inherent way, & without the need for much careful reflection,
be in a position to know on what matters Freud was right & on what he was
wrong. On the validity of quantum mechanics, or even on the validity of the
theory of evolution, most of us are conscious enough of our ignorance of the
evidence to maintain an agnostic silence. But on the validity of the Oedipus
Complex we are all born experts. Or so we assume. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Menand goes on to write, with a
further display of psychological expertise: “It can be useful to be made to
realize that your feelings about people are actually ambivalent, or that you
were being aggressive when you thought you were only being extremely polite. Of
course, you shouldn’t have to work your way through your castration anxiety to
get there.” <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Menand knows that “of course” we
shouldn’t have to do this because – well, because he is a literate & scholarly
man. <o:p></o:p></span></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;"><br /></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">But in truth, there is no “of
course” about it. Castration anxiety is a symbolic expression for the fear of
parental, & later societal, punishment for trying to be true to one’s own
nature. None of us can start to come to terms with our ambivalence & none
of us can contain it until we have addressed & tried to be honest about
this most basic of all human fears that lies at the root of it. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Freud has been very controversial
from the beginning. But what are now referred to as the “Freud wars” began in the late 70s & early 80s around the time Jeffrey Masson, who had been given the
task of editing the definitive version of Freud’s letters to Fliess, claimed
that Freud had deliberately concealed sexual abuse among his patients, &
with Frank Sulloway’s bizarre charge that he had concealed the biological basis
of his psychological theories. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">At the time both were sensations, in
the book review sections at least, because they satisfied a craving for
evidence that Freud must have “concealed” something. We accept as a matter of
course that genius by its nature is never transparent. But we find this very
hard to accept in the case of Freud who seems so skilled at uncovering our own
secrets. We resent this. And this is why the literature revealing all the ways
Freud was a moral monster has flowered so vigorously. We want his secrets out,
just as he has forced our secrets out. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Despite some cooling down in
recent years the wars have continued on & off in this vein pretty much ever
since: eccentric & ambiguous accusations are made, framed in sensational
terms, relating to Freud’s abuse of the evidence, or his abuse of his patients,
or his abuse of his colleagues, or his misunderstanding of science, or his
personal sexual life, that turn out always to have no relevance to his substantive
ideas. And this is why the Freud critics – by which I mean here those who have
turned attacking Freud into a career or vocation in itself – have had no impact
on the development of psychotherapy. Their work is animated not by a serious
engagement with Freud’s thought but reflects rather an intense emotional transference
to his <u>figure</u> that they cannot overcome in themselves. The ironical
thing is that nothing has done more to keep Freud alive in the mind of the
educated public than the extraordinary love, we cannot call it anything else,
these critics have for Freud. <o:p></o:p></span></span></div>
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<br /></div>
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<!--StartFragment-->
<span lang="EN-GB">A case
in point is Adolf Gr</span><span lang="DE">ü</span><span lang="EN-US">nbaum’s </span><u><span lang="EN-GB">The
Foundations of Psychoanalysis</span></u><span lang="EN-GB"> from the 80s. Though
described by Menand as designed to show that the foundations were not in fact
scientific, a closer reading of the work shows that it is much more ambiguous
than this. Supposedly questioning Freud’s scientific credentials, Gr</span><span lang="DE">ü</span><span lang="EN-US">nbaum in
fact fiercely defends him against any other philosophers, like Karl Popper for
instance, who have questioned his </span></span><span lang="EN-US" style="font-family: "georgia"; line-height: 150%;">understanding
of science. The true story of the book is </span><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">Gr</span><span lang="DE" style="font-family: "georgia"; line-height: 150%;">ü</span><span lang="EN-US" style="font-family: "georgia"; line-height: 150%;">nbaum’s intense
possessiveness of Freud, who he sees in a father & son rivalry with himself
alone for the deeper understanding of science.</span></span></div>
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<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Subscribing to what is now the
conventional wisdom on this subject Menand writes in his casually dismissive
way that “from the beginning, Freud was a lousy scientist.” Poor old Freud, bottom of the class again. </span></span><br />
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;"><br /></span></span>
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">At the same time
however Menand is too canny not to realize that there is throughout the critical
literature of psychoanalysis an idealization of what science is & what it
does. Here, for once, he identifies something genuinely significant. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The ultimate origin for this
idealization is the philosophy of Kant, where it serves the purpose of leaving
a space free in the universe in which moral dogma can live unchallenged by
scientific questioning. What we have learnt from Freud is that when science
finally invades that formerly sacrosanct moral space it no longer looks the way
classical mechanics suggests it should look. Things get messy, & they get
emotional. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">At the deepest level, this is what
the Freud wars have always been about. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">They are not about whether Freud
was sometimes economical with the truth, or whether has was having an affair
with his sister-in-law, or whether he made a hash of understanding scientific
method. They are about the fact that Freud showed us how to criticize our moral
presuppositions. They are about the question of how we are going to live, &
how we are going to organize the often conflicting inclinations within us in a
world in which moral certainties have given way to ethical dilemmas. The Freud
wars are just one expression of the crisis that has been brought about in modern
life as a result of the disappearance of that ethical space in which motivation
seemed certain & transparent, & right & wrong seemed absolute. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The deepest artists &
philosophers before Freud could see that this ethical space would not survive
the end of Christianity. But it was Freud who did the demolition work in public
view when the time finally came. Some people have been able to adapt to this
fundamental change in cultural life but some have found it very difficult,
& among these are the Freud critics. They cannot make peace with the man
who has become the symbol for the coming of the age of moral ambiguity. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The argument therefore is not an
intellectual one that will be resolved eventually through some new piece of
evidence about Freud or about psychoanalysis. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It is on the contrary a debate
between two different kinds of human temperament. It is between those for whom
the most important & rewarding thing in life is now the challenge of
mastering the self in a world that has become essentially uncertain, of
acquiring ever deeper insight & access to ourselves & to whatever resources
Nature has given us, and, on the other hand, those for whom such a challenge is
alarming & repugnant, who, in our post-Christian world, cannot come to terms
with being morally orphaned & who, in spite of themselves & to their
own distress, cannot stop looking for a formula that will tell them <u>how</u>
to live – whether this be in religion, or in some idealized notion of Science,
or in Marxism, or in Feminism, or indeed as many of them previously did, in Freudianism
itself, and who cannot live without someone to blame for the fact that life
forever leaves them dissatisfied with their fate because it now refuses to give
them certain answers.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">But for those of us who now
believe that moral uncertainty & ambiguity are the price of emotional
maturity Freud was a genuinely great man & he is one of the great
provocations & inspirations to personal autonomy. We are perfectly aware of
his flaws as a man, & we are very clear on which aspects of his theorizing
we think doubtful or certainly mistaken. But because we do not need him to be a
god, we are not in a perpetual state of rage because he fails to be one. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Those who have made careers out of
attacking Freud have missed the message Freud leaves our whole culture, because
they are unable to respond to it. And that message is this: <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">“I have tried to be as honest as I
can about the disturbing emotions I have discovered in the depths of my own mind
& in the minds of others. In spite of the mistakes I have made, as every human being who has the
courage to attempt something new will inevitably make, I have tried to be as honest as I can with myself without
losing control of myself & without ceasing to work to form myself into the kind
of human being I think Nature wants me to be. - Now, can you show me that you are
strong enough to try to do something similar with your own life …?” <o:p></o:p></span></span></div>
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</style>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com6tag:blogger.com,1999:blog-2490423168990817732.post-47706881098219807522017-06-17T07:14:00.001-07:002017-06-19T01:04:27.927-07:00What is the Difference between a Psychoanalyst, a Psychotherapist & a Counsellor? A Guide for the Perplexed. <div style="margin-bottom: .0001pt; margin: 0cm;">
<span style="font-family: inherit; font-size: large;">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.</span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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.<o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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.<o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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 <i style="mso-bidi-font-style: normal;">and</i> I want to kill
you.” <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">Like all the other titles in the therapy
field the term “counsellor” is conventional. Ultimately, its meaning is
whatever people take it to mean. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">Another important nomenclature in the
current therapy field is that of “cognitive behavioural therapy”, or “CBT”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">“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.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;"><span style="mso-spacerun: yes;"><br /></span></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">Most “CBT” practitioners today will still
stress that first & foremost they are not “psychoanalysts” & are
opposed to its basic principles.<o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">The truth however, as with everything in
the world of therapy, is much less black & white than this, & much more
shades of grey.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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”. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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.
<o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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? <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-GB"><span style="font-family: inherit; font-size: large;">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. <o:p></o:p></span></span></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0cm;">
<br /></div>
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Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-43344162798991845482017-03-24T10:36:00.000-07:002017-03-24T10:45:13.034-07:00Submission to The Minister of Health on Regulation of Psychotherapies: October 2016 (4 of 4)<div class="MsoNormal" style="line-height: 150%;">
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<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 24px;">Mental health is an objective that each of us can set only for himself. No one else can give us instructions on how to achieve a good life, & no one else can make the journey to a better life on our behalf. A builder can make me a house, a plumber can repair my domestic pipes when they break, an electrician can install lighting in my study, an engineer can design for me an environmentally friendly motor car, a surgeon can heal me when I fracture a bone. All these things can be done <u>for</u> me. And this is why the professions of builder, plumber, electrician, engineer & surgeon can all be regulated by statute with success. If I feel any of them has not done a proper job for me I can appeal to what society has formally stipulated they should be able to do for me, & I can seek redress under the law.<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 24px;">But no one, no father or mother, no church, no priest, no government, no government minister, no psychotherapist, can make me well in an emotional sense. That journey is one I must make myself. And if I decide to make it then it will be a unique journey, for me alone, & it won’t resemble the journey to health for anyone else. And if I further decide to enlist the help of a psychotherapist, by employing her to challenge me & get me to see in myself what I cannot see by myself, & encourage me & support me when the anxiety of confronting myself is hard to handle, if I do that then only I can judge whether she has given me the help I need. Because only I can know where I need to get to & only I can know when I am there. I cannot resort to some societally sanctioned criteria of what she is supposed to do for me, because no such criteria are possible, because society cannot decide for me how to be healthy.<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 24px;">In short, we cannot “regulate” psychotherapy without damaging it in a fundamental way, because we cannot specify beforehand what constitutes success, or failure, in psychotherapy. No one else but I can decide whether my therapist has been successful, or helpful, or worthwhile. The suggestion that a third party should step in & decide this for me, by vetting beforehand whom I may call on for psychotherapeutic help, is misconceived in the most profound way. It is an attempt to infantilize a process that exists precisely to assist in the enriching & deepening of adult responsibility.<o:p></o:p></span></div>
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<span style="font-size: large;"><br /></span></div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"></span><br /></span>
<br />
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<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 24px;">*</span></div>
<span style="font-size: large;"><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><br /></span>
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">The proposal to “regulate” psychotherapy leads to an
incoherent result because it is not what it purports to be. Like a neurotic
symptom, which in essence it is, it is lying to itself, & to us, about what
it is trying to achieve. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The wish to see psychotherapy “regulated” is motivated
by an unacknowledged shame & an unacknowledged resentment. The shame
reflects an anxiety about not being able to regulate one’s own life & a
fear that the signs of this weakness may become visible. The resentment is of
those who are strong enough to discover what health means for them & to
decide how they are going to live, of those, that is, who are strong enough to
regulate themselves. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">There is much occasion for shame in modern Ireland. In
recent times a spirit of greater emotional honesty than has characterised most
of our history has forced us to look into what is an unflattering mirror. Psychotherapy
has become a target for “regulation” because it represents & symbolizes this
mirror. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Things have been brought to light that for generations
we have tried to keep hidden. For instance, the fact that the emotional &
physical abuse of children has been an intrinsic part of our culture,
sanctioned by the highest authorities; that we have for long been supine in the
face of religious doctrine & prejudice; that we are timid when it comes to confronting
authority in general; that alcoholism & private violence are a routine part
of our lives; that incest is common in our families; that we make daily use of
illegal drugs; that we make daily use of pornography; that the delight we take in
the misfortune of our neighbour is equalled only by our fear of his disapproval;
that we resent anyone who we think has got something we don’t have; that we are
deeply suspicious of the stranger in our midst; that we are deeply suspicious
of each other. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">This is not the Ireland we promote abroad but it is
the real Ireland we all know. This is the foul rag & bone shop of the heart
where we all start, every day, again. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Our relative honesty about these things is very newly acquired.
Only a few years ago we still enjoyed one of the lowest suicide rates in Europe.
We achieved this because we lied about the true figures. We lied, because at
the time suicide was “regulated”, it was a criminal offence. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The spirit of this old “official” Ireland, where “regulation”
ensured that messy unpleasant things were not talked about, is not yet dead. It
is this Ireland that is calling now for the “regulation” of psychotherapy &
for a new culture of hypocrisy about mental health. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In psychotherapy we refer to this kind of self-deception
as resistance. Resistance is a response to the challenges of psychotherapy that
is rooted in an anxiety that one will not be strong enough to govern oneself. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In the relative privacy of the consulting room
resistance tends to show itself in the form of anger or moral outrage. In
public discourse it is usually more careful to dress itself in the respectable
tones of concern for the public good. In this arena, it generally involves an
appeal to some authority that it hopes people will be too frightened to
question. In days gone past this might have been the Church. In totalitarian
societies it is the Party. In more liberal open societies it tends to be more
vague, abstract notions like Science, or Public Safety. But in every period
& context it betrays its true nature by the attempt to place in question
either the validity or the possibility of the emotional & intellectual
autonomy of the individual self. It is regressive, because it refuses to accept
the only authority which in the present age now has final legitimacy: the
exercise of personal autonomous adult judgement. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">*<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">It is not only those outside the immediate world of
psychotherapy who suffer the pressure of all this revelation. Those of us who
work within that world suffer it too. Exploring the unconscious is a fascinating
& rewarding discipline. But it is also, at times, stressful, & it needs
strong nerves. Often it can result in a kind of emotional vertigo, when the
ground under one’s feet seems to sway, & when one wishes dearly for greater
stability & firmer points of guidance. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">There are moments when all of us working as
psychotherapists wish we had some assurance from authority that all this
uncovering of its nakedness were not going to leave us without a guide. As much
as we all wish to be free of the old gods, there are moments of confusion &
fatigue when we wish back again the reassurance they seemed to provide. This
anxiety, this fear of paralysis & retribution for challenging ancient
authority <u>within ourselves</u>, is scarcely acknowledged even to ourselves,
because we are ashamed of it; it is incompatible with our image of ourselves as
toughened explorers of the unconscious. But it too is an important source of the
appeal of “regulation” & it is why calls for it can be heard within
psychotherapy also.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Sometimes, too, this moral anxiety on the part of
psychotherapists mixes with other, less noble motives. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Within the profession of therapy there are some older
& better established practitioners who feel it is in their interest to try
to establish a greater control of entry into it. This is less about diminishing
competition from new entrants than it is about establishing a monopoly on
training, which, because it can last so long, can be very lucrative. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Training therapy always involves some compromises with
the principles of therapy. This is unavoidable. A client who is attending a
therapist purely for personal reasons can terminate the therapy any time she
feels she is not getting value for her money. In contrast, trainee therapists are
often required to attend for thousands of hours of educational therapy
extending over several years, irrespective of whether they genuinely need this
in any personal sense. When a therapist is working in a training capacity
therefore she has significantly more power than she has with other clients. As
everyone in the profession is aware, courses of training therapy are often
unsatisfactory from a purely therapeutic point of view for this reason.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">A monopoly authority for “regulation”, however, would
deepen these known problems rather than alleviating them because it would give
even more power to the training therapist than she enjoys under the present comparatively
open system. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The method of therapy hinges upon the freedom of the
client to challenge & to criticise the therapist, including in personal
terms. Emotional honesty is not possible if the client is not assured he has
this freedom. But how many new candidates would have the confidence to
challenge a training therapist who potentially, through the submission of a
negative report on the candidate’s progress, had the power at the least to
delay his acquisition of a licence to practice, which in practical terms might
mean denying it altogether? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The essentially corrupt system proposed by the
“regulators” would gradually squeeze out from the profession the maverick &
the outsider, those who have the greatest capacity for independence of mind,
& who constitute the life & soul of psychotherapy. They would be replaced
by the timid, the conforming, & the politically ambitious. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">*<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Grandiose schemes to “regulate” psychotherapy reflect,
among other things, out-dated & superficial analogies between psychotherapy
& medicine. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In the past, the practice of medicine relied significantly
on the personal relation between the physician & his patient. Over time however
this aspect has been transferred out of medicine into psychotherapy, &
medicine has changed as a result. Modern medicine relies now as far as possible
purely on the disciplines of the physical sciences & on the principle of
what is “evidence based”, which means the assumption that what works in one
case will probably work in another. The ideal now in medicine is to minimise
the divergence that patients with the same condition receive from different
doctors. The aim is to minimise the personal element as much as possible. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In psychotherapy such an approach is quite useless. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In psychotherapy, we start from the assumption that
what works in one case will certainly not work in another, because what we are
treating here is precisely what makes the patient different from everyone else.
The notion of “regulating” such a process externally is a contradiction in
terms. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The purpose of psychotherapy is to educate the
individual in her own nature, so that she can then continue her life in a way
that is more creative, in whatever way she has potential to be creative.
Whether other people in society then approve or disapprove of the life she goes
on to live can never be a legitimate concern of psychotherapy. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Any legislation for psychotherapy therefore, if it is
to be of genuine value & not merely a pretext for undermining the challenge
it represents, can never concern itself with the attempt to make the outcome of
therapy more acceptable from the point of view of society as a whole. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">What legislation for psychotherapy should aim for is an
objective that is honest, modest & realistic. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The aim should be to make the market for psychotherapy
as efficient & transparent as it can be & to see that the public has as
much information as possible about particular psychotherapists & about
psychotherapy in general. The profession should be made not more closed, as the
“regulators” would like, but more open. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">It should not be made more difficult than it now is to
enter the profession. A multiplicity of schools & viewpoints should be
cultivated & protected. No school of therapy should be given legal
privileges over others, & no therapist should be obliged to join a school.
Information about therapists should be made readily available to the public. A
register of therapists, outlining educational qualifications, contact details
& any other biographical information each therapist wished to give, would
be useful. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Also useful would be more general education for the
public, outlining what they should expect from psychotherapy & what they
should not expect from it. Rather than being encouraged to complain when they
find psychotherapy is not what they anticipated, the nature of psychotherapy
should be better explained to them. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">People should be taught that psychotherapy is a
process of learning & discovery about the self. Like all genuine learning it
involves hard work & sometimes it will be stressful. In psychotherapy you
must expect to be challenged, it is not the task of the therapist always to
agree with you. It won’t always be plain sailing. There will be times when you will
feel confused, & there will be times when you will feel angry. This is what
you must expect in psychotherapy. It is not easy. It is not comfortable. However,
your therapist should also be supportive of you through this process, &
should be sensitive to how much confrontation you can handle. If after a
reasonable time with a therapist you feel you are not being properly supported,
then you should discontinue, & possibly consider an alternative therapist. But
the decision either to stay with a therapist or to leave is ultimately your
responsibility alone. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Psychotherapy is not for children. It does not offer a
sugar-coated world of easy alternatives & peace & love & happy
endings. It is an engagement with real grown-up life, with all its tragedies
& terrible dilemmas & conflict & responsibilities & unfairness
& uncertainties & mistakes & imperfections. If you feel you cannot
handle such an engagement, then don’t enter psychotherapy, this is not something
for you. <o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">*<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The essence of modernity is the recognition that we
don’t know what man is in a spiritual sense. We cannot say where man is going. Modern
psychotherapy is one reflection of a new phase of human culture, one in which
we acknowledge that we do not in fact have the answers to life that religion
told us we did have. We now understand that trying dogmatically to impose
solutions on ourselves, where there is in fact only ignorance, diminishes our
humanity & diminishes our faith in man. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">In a culture that has given up religious dogma, man
has become an experiment again. Each of us is an experiment to see what health
for the animal man might mean. And each course of psychotherapy is an experiment,
to explore, very tentatively, what health for one particular individual might
mean. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">This requires courage. It requires faith in ourselves
& faith in the future that we are creating. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Calls for the “regulation” of psychotherapy spring
from a lack of this essential faith. They arise from an anxiety that we do not
have within us the resources to deal with an unpredictable future, one that may
not be like the past. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Good psychotherapy is premised on the faith that we do
in fact have the resources within us to deal with this future. We are creative,
we can meet the uncertainties of the future, we are not just passive dependent
children at the mercy of events. Tomorrow does not have to be the prisoner of
yesterday. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Essentially, we have to decide what it is we as a
society wish from psychotherapy. Nothing would be easier, of course, than to turn
the profession into just another form-filling adjunct of the swollen bureaucracy
of health. This would be a great shame, & a great opportunity lost. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Alternatively, however, we could work to make psychotherapy
a vital & challenging part of the cultural & spiritual education of the
people, helping us to question our prejudices & comfortable assumptions,
& helping to re-open those deeper springs of our creativity which we have,
for the moment, in our timidity, shut down.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<br /></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-48639061543788672522017-03-24T10:35:00.001-07:002017-03-24T10:44:26.496-07:00Submission to The Minister of Health on Regulation of Psychotherapies: October 2016 (3 of 4)<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Consider for a
moment what would be the result of such an arrangement.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Those
candidates who were able to cultivate favourable connections with the governing
cadres within the profession & who were able to meet their demands in terms
of fees & training would be granted the right to practice. Those who were not
able to do so would be denied the right to practice. The final result would be
the drawing of an arbitrary line between those psychotherapists who were
favoured by the hierarchy, & thus legally allowed to practice, & those
who were not so favoured, who would be criminalised. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The
“regulators” defend these proposals on the grounds that the monopoly authority they
want to see set up would be able to process complaints from the general public
about particular psychotherapists. Again, this claim betrays a lack of acquaintance
with the most elementary aspects of psychotherapy. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Any assessment of the technique & general
abilities of a psychotherapist requires making a retrospective judgement about
private conversations, conversations that dealt with very intimate &
emotive subjects, between two people, the therapist & her client, of which
no verbatim record exists, & at which no witnesses were present. Under the most
favourable of circumstances this is an exercise fraught with difficulty. No
matter how carefully you conduct such an assessment you can never be sure you
have not made mistakes. In fact you can be sure you have made mistakes, because
you are forced to re-create in your imagination a series of events at which you
were not present. You can never reach more than a tentative, subjective &
problematic judgement. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Furthermore, at some point every serious course of
psychotherapy must involve challenge & disagreement between therapist &
client. There will, at times, be upset & anger on the part of the client,
& some degree of emotional stress also on the part of the therapist. It is
a part of the responsibility of the therapist to ensure this happens. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Now let us put ourselves in the place of the Committee
of Wise Men & Women proposed by the “regulators” who are to ensure that
only “qualified” psychotherapists are to practice. Suppose we have to consider
a complaint from a therapist’s client & are now faced with the task of
assessing the course of psychotherapy in question. What objective basis do we, necessarily
excluded from that course of therapy, have for distinguishing between justified
challenges made by the therapist to the client, that the client will, inevitably,
have found in some degree upsetting, & criticisms or verbal attacks that
reflect only the therapist's own insecurities or technical failings? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The answer is: we have none. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">If a client makes a formal complaint to us, how then are
we to judge to what extent the complaint is justified? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">How are we to know, for instance, to what extent we
are simply looking at a poor match between therapist & client, a clash of
incompatible personalities, in fact? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">How are we to know to what extent the therapist was just
tired or stressed & doing poor work at the time? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">How are we to know to what extent the client was
simply too lacking in self-critical abilities to respond to what were in fact good
& insightful interventions on the therapist’s part? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">On the other hand, how are we to know to what extent the
problems that the client was bringing to the therapy were particularly upsetting
to the therapist’s personal insecurities & anxieties, & caused her to
react to them too much from a personal point of view & with not enough professional
detachment? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">From yet another point of view, how are we to know to
what extent the freedom the client experienced to express his anger with the
therapist acted in fact in a liberating way for him from things that were
holding him back? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">What grounds do we have for assuming the conclusion of
good psychotherapy should be mutual congratulation between therapist &
client, rather than, for instance, a deepened mutual scepticism? <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The short answer is, we don’t have any. A therapist
who is producing disciples & converts is a therapist who is failing in her
job. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">We cannot answer questions of this nature in any other
than the most tentative & uncertain way. They remain always a matter of
subjective judgement, & every good psychotherapist is perfectly aware of
this. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Yet it is on the basis of such unreliable answers that
the “regulators” propose either to allow candidates to practice as therapists,
or, it might be, to disbar them. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">How things
would work in practice, of course, is that complaints against well-established
& well-connected therapists would, in the main, be set aside. No one is
going to cause professional embarrassment to a friend, still less vote her of a
job. But, in order to reassure the Minister that the authority was energetic in
fulfilling its responsibilities, complaints made against those therapists less
established, more distant from, & less favoured by, the ruling elite would,
in the main, be acted upon. Such an outcome as this is inevitable because, to
repeat once again, we have no objective basis for assessing the competence of a
psychotherapist as a psychotherapist. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">Other problems
would be created too. Given such an authority as the “regulators” propose, the
internal politics of the profession would come under the sway of the larger
politics of the State itself. An authority that relied for its mandate on the
Minister for Health, who is elected by the public, would not be in a particular
hurry to endorse candidates for psychotherapy who were known to hold unorthodox
views on mental health, or views that might not run well if reported in the
tabloid newspapers. The discussion of mental health by professionals in general
would start to be compromised by what was politically acceptable in the larger
sense. Psychotherapists & candidates for psychotherapy would learn to
self-censor their views to stay politically correct. The very spirit of
psychotherapy, which depends on the courage to speak uncomfortable truth to
complacent power, would weaken & fade. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; font-size: large; line-height: 150%;">The
establishment of such an authority would in short make the profession of
psychotherapy as a whole more corrupt, more bureaucratic, & less responsive
to the needs of the public.</span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-49262108488939835162017-03-24T10:35:00.000-07:002017-03-24T10:35:27.752-07:00Submission to The Minister of Health on Regulation of Psychotherapies: October 2016 (2 of 4)<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">In recent times I have noticed a tendency on the part
of some public representatives in Ireland to try to politicise the issue of psychotherapy.
Some, not confined to any one party, have made a habit of calling for the “regulation”
of psychotherapy, & have criticised past & present governments for not
having done this. Invariably, these calls are accompanied by reference to one
or more of the many ills in our society – suicide, or depression, or addiction,
or whatever. The implication is that the occurrence of such problems is unacceptably
high somehow <u>because</u> psychotherapy has not been “regulated”. We are to
understand that “regulation” will in some unspecified way ensure these ills are
no longer aggravated unnecessarily. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">These exercises in popular rhetoric are ill-judged
& they are unhelpful. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The purpose of psychotherapy is not to minimise any of
these well-known social ills. Any legislation we introduce for psychotherapy,
whatever form it takes, will have no impact on the rate of suicide, or sexual
abuse, or drug misuse, or domestic violence, or addiction to pornography, or alcohol
dependency, or depression, or divorce, or single-parent families, or days lost
to psychosomatic illnesses, or any other of the many ills that can be
associated with emotional instability. These problems are part of living in a
modern secular society & psychotherapy neither can, nor does it aspire to,
diminish them.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">So what then is the task of psychotherapy? <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The task of psychotherapy is, first of all, the cultivation
of greater emotional honesty. This is very difficult. Anyone who thinks that it
is not should undertake a year or two of serious psychotherapy & see how he
finds it. Such a course of educational therapy should be a minimum requirement
for any politician or civil servant who has ambitions to contribute to the
framing of legislation for it. Only someone who has made a committed personal
engagement with psychotherapy, & has genuinely tried to clarify his own
motives, can begin to grasp just what a remarkable capacity we all have for lying
to ourselves, & how ingenious we are at dressing up our narrowest
self-interests in the guise of respectability & altruism. If we can achieve
any degree of honesty with ourselves, we are achieving a very great deal. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The first thing we need to be honest about in the
context of the present discussion is that none of us has the capacity to
improve the mental health of society overall. Responsible governments do have some
influence to see that people with manifest mental illness & disability are
treated humanely & well. But they do not have the power to improve the
mental health of society as a whole. Politicians who encourage the public at
large to believe that they do have this capacity, & that we can as a
society legislate ourselves into mental health, will only provoke false
expectations. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Let us take one concrete example that illustrates this
point. In principle, much the most effective contribution any government could
make to overall mental well-being would be to increase the duty on alcohol to a
level where consumption was significantly reduced. At the stroke of a pen,
overnight, the mental stability of society would begin to improve. The
incidence of serious accidents, domestic & public violence, depression,
unemployment, divorce, & suicide would all, almost certainly, decline. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">But this isn’t going to happen. It isn’t going to
happen because every government fears the electorate. Any political party that
was complicit in an increase in the price of alcohol sufficient significantly to
impact on these social problems could comfortably forget about returning to government
for the foreseeable future. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Here then is our first lesson in mental health, &
it is an awkward one. Taken overall, society has no inclination to recover from
its emotional illnesses. And it will not do so. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It will not do so, because what you regard as the signs
of my mental instability I will defend (even if I do not entirely believe it) as
the chosen style of life that best suits me. And, so long as we are living in
an open democratic society, there is no way you can impose your view of the
matter on me. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">This is the flaw in the proposal to “regulate” psychotherapy.
We all agree what physical health is. But we don’t agree what mental health is.
Mental health, in a society that adheres to the principles of liberty &
free inquiry, will always be a matter of personal judgement & taste. What
it is, & where it exists, will never be subject to general agreement. And
if we cannot agree how something is to be defined, then we cannot make a law
for how it is to be achieved. We cannot regulate a process if we cannot specify
what the outcome of that process is supposed to be. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">To legislate for mental health, so as to make people
more mentally healthy in a general sense, is as pointless as to legislate for
personal happiness, & for the same reason. What is health & happiness
to me might be hell on earth to you. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It is true there are circumstances when mental illness
is unequivocal, in the form for instance of the kind of manifest psychosis that
Shakespeare gives to Ophelia after the death of her father. In a case like this,
there will be no dispute that the sufferer needs to be protected from herself
& taken into care. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">But in only a tiny percentage of cases is the decision
about mental health like this. Most of the time it is impossible to decide, in
any kind of objective way that will command general consensus, whether an
individual is generally well or generally unwell. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">For instance, many people suffer from occasional or even
frequent delusions, in the form of visual hallucinations or imagined voices,
& yet they lead perfectly “normal” lives, raising families & holding onto
productive employment. Should we say such people are mentally ill? Perhaps we
should. But who is going to decide? And what of the much larger number of
people who do not suffer delusions but who suffer still all the neuroses, &
anxieties, & depressions that are the everyday human lot? Should they be
classified as sick too? Or should they be regarded as well? Or should just some
of them be viewed as sick & others well? Should you be regarded as well?
Should I? What criteria are we going to use for such a distinction? And who is
going to decide? <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The truth is that it is impossible to draw a line
between the mentally healthy & the mentally unwell in a way that will
command general agreement. This is because as a culture, once we gave up
adherence to religious authority & doctrine, we also gave up the capacity
to define mental health. We lost this, because our conception of mental health
was derived from the moral presuppositions, underpinned by religion, that told
us what was the purpose of life & therefore what a man & a woman should
be. It is because we can no longer define mental health that psychotherapy
exists. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">To anyone with a passing acquaintance with the issues raised
by psychotherapy this is all common knowledge. If it is not familiar to the would-be
“regulators” then the question is: why is it not? <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">What these confused people propose is to use the law
to prescribe certain outcomes for psychotherapy, & to proscribe certain others.
A psychotherapist is to be allowed to help a client to achieve some conceptions
of health, but she is to be forbidden to help him to achieve others. We are to legitimise
some forms of mental health, & delegitimise others. The law, in short, is
to be made a substitute for religious & moral doctrine. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">In a society that adheres to open democratic principles,
this simply won’t work. It is a fantasy. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">We need to be clear here. If any psychotherapist is
behaving in an abusive way towards a client or, for instance, if a
psychotherapist is encouraging a client to commit an act that is itself
criminal, then he or she is already in breach of existing laws, & should be
dealt with under existing laws. Every psychotherapist is & should be bound
by exactly the same laws as every other citizen. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">What is proposed by the “regulators” is something quite
different. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">What they want is to specify laws for psychotherapy as
such, & therefore for mental health as such. They want to establish an
authority, sanctioned by law, with the power to determine what the end goal of
psychotherapy may be, & what it may not be. They want an authority with the
power to demand what a psychotherapist must be & must do & must say,
not as a citizen, but as a psychotherapist. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">Since however we cannot define what mental health is,
& therefore cannot define what the outcome of psychotherapy should be, it
would be an impossibility for any </span><span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;">such authority to
do what it was nominally supposed to do. It would, therefore, do things it was
not nominally supposed to do. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The establishment
of such an authority would, in effect, grant monopoly power to certain privileged
individuals within the profession to determine who was & who was not
allowed to practice. And since the desired result in psychotherapy cannot be
determined beforehand, & since therefore we have no objective measure of
the ability of a psychotherapist, the decision to grant the right to practice,
or deny the right to practice, would have to be based by these privileged
individuals on something else. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It would be
based, of course, on the internal politics of the profession itself. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">No candidate for
psychotherapy can be assessed on the basis of what she knows, because no one
can say what a psychotherapist should know. Therefore, in any assessment of a
candidate, of her ability & of her qualification to practice, the crucial
question is always who she knows, that is to say, who is willing to vouch for
her & endorse her. This is how candidates for psychotherapy have always
been assessed since the profession originated at the end of the nineteenth
century, in the work of Freud & his associates. There is no other way they can
be assessed. And this is why since its inception the profession has been
characterised by the generation of multiple factions & rival schools. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">As long as such
a selection process does not have the force of law, it remains relatively
benign. A candidate who is unacceptable to one school will usually, if she has
any potential at all, find a place in another. This is why preserving a
multiplicity of independent schools is so important to the well-being of the
profession as a whole. We must have free, competing schools of psychotherapy, because
there is no other field in which the knowledge of everyone working in it is so limited
& so imperfect & so subjective. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">This cannot be
emphasised enough. Psychotherapy is wrestling with the core problem of our
species, the one that the decline of religion has made manifest & urgent
again: What is man? This is the oldest question, & it is the last question
we shall be able to answer, if indeed we ever can. <u>No one</u> knows what man
is. Every culture has been an attempt to answer this question & every
culture has failed to answer it; that is why culture keeps changing. Psychotherapists
are the ones who are aware of this. They are distinguished from other men &
women not by some specialist expertise but rather by an awareness of how <u>little</u>
we know of ourselves & how most of our energy is expended in trying to hide
from how little we know. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
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<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">It is
disturbing to see how little appreciation of these fundamental problems the would-be
“regulators” of psychotherapy seem to have. First, they propose to give certain
schools absolute power within the profession. Second, they want to give to what
of necessity can never be more than an informal & highly imperfect selection
procedure the force of legal statute.</span><span style="font-size: 10pt;"><o:p></o:p></span></span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-43219377405757206442017-03-24T10:34:00.000-07:002017-03-24T10:34:35.586-07:00Submission to The Minister of Health on Regulation of Psychotherapies: October 2016 (1 of 4)<div align="right" class="MsoNormal" style="line-height: 150%; text-align: right;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-family: georgia; font-size: large;"><i>In the autumn of 2016 the Irish Minister for Health asked for suggestions regarding the best way to design legislation for the psychotherapy professions in Ireland. I made the following submission in October 2016: </i></span><br />
<span style="font-family: georgia; font-size: large;"><br /></span>
<span style="font-family: georgia; font-size: large;"><br /></span>
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Dear Minister, <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">You have asked for submissions & suggestions
regarding the proposal to legislate for the profession of psychotherapy. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">First of all, you need to give some thought to what is
the nature of psychotherapy & what is its place in society. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Psychotherapy has become a part of everyday life &
there is a tendency to assume we all now know what it is, & what it does,
& what it is for. In fact, its nature is not generally understood. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Initially, we are all are drawn to psychotherapy for
reasons we grasp only vaguely. A deep understanding of why it is such a
compelling part of contemporary life & what we should expect from it only
comes later, after much work & learning. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The first thing to underline is that the advent of
modern psychotherapy throughout the developed world is a cultural event. This
means, in particular, that it is not a scientific event & it is not a
medical event. To compare psychotherapy with an innovation in medicine is misleading.
The problem of emotional health is different from the problem of physical
health. It is different not just in certain details but in fundamentals. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Above all, psychotherapy needs to be seen in the
relatively recent historical context of the decline of structured religious
faith. In no country has this been more apparent than in Ireland. Here, the
rapid expansion of the world of psychotherapy from the 1990s onwards has coincided
exactly with the collapse of the authority of the Church in society.
Psychotherapy is, in its essence, a new kind of expression of faith, a secular
faith that in the rational evolution of the individual lies the best hope for
what man is. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">One might well ask if psychotherapy is not more usefully
considered under the heading of education, rather than health. Good psychotherapy
is a deeply educative experience. But whether it makes us more healthy is a different
question. Even to ask this question is indicative of a certain naiveté. Good psychotherapy
leaves us less sure rather than more sure about what health really means. It
challenges the prejudices we all enter therapy with as to what health is, &
our sureness as to why we lack it, or, worse, our sureness as to why we possess
it. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Although we are generally not conscious of this, these
assumptions about health that we all begin with are derived for the most part
from religious teaching. Even the most secular of us carry these assumptions around
with us, because we are all the children of a culture that was, until very
recently, shaped by religion. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">In contrast to religion, however, which purports to
tell us what health is, psychotherapy is a journey of gradual discovery of how
much of what we initially dismiss as illness may actually have rich seams of
new life concealed within it. We learn that insisting on how healthy we are, or
demanding to be made healthy, are both kinds of delusion, reflecting a lack of
insight into the nature of the human condition, & a lack of faith in the life
it contains. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Going back to its original derivation in Greek, the
term psychotherapy literally means, the care of the soul. This describes its
nature well. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">We should however carefully distinguish here between care
of the soul, & cure of the soul. Cure of the soul is essentially a
religious notion, with the implication of coming closer to God through faith
& through renouncing sin. Many people expect psychotherapy to give us a
secular version of this, on the grounds that religion told us how to live, so
psychotherapy should do the same thing. This reflects the unconscious
assumption that in a society no longer governed by religious teaching we should
still be able to achieve consensus on what a healthy state of the soul is. In
fact, in the absence of religion (or some enforced totalitarian substitute for
religion) no such consensus is possible. The notion of a cure for the soul
therefore has no place in psychotherapy. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Psychotherapy comprises a set of intellectual &
emotional disciplines for tending & cultivating the individual, in a
context where the dogmas & certainties of religion & morality are
pointedly excluded. We are particularly watchful here for the tendency to try
to transfer certainties derived from religion into secular dress, in an attempt
to disguise their dogmatic intent & conceal them from critical examination.
<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Psychotherapy is a unique development of modernity
& cannot be understood outside of this historical context. It reflects the most
recent evolution of Western culture, the culture that emerged in the early
Middle Ages out of the confluence of the traditions of ancient Greece &
Rome with those of ancient Judaism & Christianity. Contemporary psychotherapy
reflects the development of these interwoven historical matrices into the
modern world. It contains within it elements of Western science & elements
of Western art & elements of Western religion & philosophy. If you wish
to be a serious psychotherapist you should know something about all these
things. And yet it is not exactly a science, & not exactly an art, &
not exactly a religion. It is, in fact, like only itself – & its purpose is
to help individuals to develop who are like only themselves. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Modern psychotherapy reflects the fact that for a long
time now Western culture has been moving slowly towards the evolution of one overriding
ethical imperative: the cultivation of autonomous individuals who live beyond
any unconditional morality. This is the new faith of the West. We cannot in any
sense “prove” that this is a better or more justified faith than the more
dogmatic & less individualist cultures associated with the East. But it is <u>our</u>
faith, the modern faith of men & women who belong to the Western tradition.
It is in the greatest possible autonomy of the individual that we now place our
highest hope for man. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">No other civilisation has evolved in quite this way. To
the extent that other cultures have adopted forms of psychotherapy this is
because they have also adopted in some measure the ideas & ideals of the
West. The emotional & intellectual autonomy of the individual is the supreme
ethical imperative of modernity, & the practice of psychotherapy is this
modern imperative made manifest.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">Psychotherapy is a development out of modern culture
as a whole & it is the property of that culture as a whole. It is practiced
by certain people within that culture, but it is not the exclusive possession
of any particular profession, or caste, or elected priesthood, or privileged
church. If legislation attempts to turn it into such a possession, it will
fail. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">The philosophy, ideas & practices that underlie
modern psychotherapy are accessible to anyone who is receptive to the
appropriate authors & texts, who acquires the habit of reflecting carefully
on himself & on others, & who, above all, has the emotional capacity
continually to shape & reform himself in a way that increases his creative
potential in life. If you possess these qualities you may make a good
psychotherapist, irrespective of what paper qualifications you may also
possess. If you lack these qualities you will not make a good psychotherapist,
irrespective of what paper qualifications you may also possess. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; vertical-align: middle;">
<span style="font-size: large;"><br /></span></div>
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<span lang="EN-GB" style="font-family: "georgia"; line-height: 150%;"><span style="font-size: large;">If legislation attempts to restrict the practice of
psychotherapy to those in possession of particular paper qualifications, the
work that characterises it will migrate elsewhere under a new guise (in the
same way as a few decades ago it migrated out of medicine). People will seek
out & find good psychotherapy, whatever name it bears, & whether or not
it is sanctioned by the State. </span><span style="font-size: 10pt;"><o:p></o:p></span></span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-23895424681032377712017-03-18T03:30:00.000-07:002017-03-19T05:24:57.978-07:00The web of our life <span style="font-size: large;">The web of our life is of a mingled yarn, good & ill together. Our virtues would be proud if our faults whipped them not, & our crimes would despair if they were not cherished by our virtues. - Shakespeare, All's Well That Ends Well - 4.3.71</span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-35236354234629714152016-06-19T10:56:00.000-07:002016-06-19T10:56:16.745-07:00We do not cure with reasons <span style="font-size: large;">The psychotherapist can address the illness of his patient never with arguments & reasons, but only ever with what he is in himself. It is not what the therapist does & says that matters, but what he is. </span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-14066343016102249272016-04-26T05:20:00.003-07:002016-04-26T05:20:56.873-07:00Polonius in psychotherapy<span style="font-family: georgia, 'times new roman', serif; font-size: large;">In Polonius Shakespeare created a type we meet rather more often than we would like in modern psychotherapy. He thinks he possesses self-knowledge & yet lacks it. He is an expert on everyone else's life, yet is clueless on his own & on the lives of his children. He meddles & interferes in the affairs of others compulsively. </span><span style="font-family: georgia, 'times new roman', serif; font-size: large;">He loves being on stage & has no sense of when to keep silent. Instinctively he takes the side of whatever is the authority of the day. He cannot think for himself. He extols the virtue of autonomy in his speech - "This above all: to thine own self be true," - yet he is unable to manifest it in his life.</span><span style="font-family: georgia, 'times new roman', serif; font-size: large;"> </span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-52325787573873700652016-04-23T07:08:00.001-07:002016-04-23T07:08:41.390-07:00Freud & Courage<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Central to everything Freud did was courage. It was his most ingrained habit. The men he revered - Joseph, Moses, Hannibal, Cortés, </span><span style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Cromwell, </span><span style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Goethe - were all men for whom courage was instinctual & inevitable. Freud showed us that for anyone who would explore the human heart & spirit courage is the first requirement. You will face resistance, in yourself & in others, & you must be prepared to confront this. </span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-91532324825208117392016-04-22T10:36:00.001-07:002016-04-22T10:36:31.027-07:00The first task of the therapist
<!--StartFragment-->
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<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">The first
responsibility of the therapist is to speak for that which now has no one else to
speak for it. It is to cut against the grain of consensus & what is thought of today as "good". The therapist is at war with every today, helping tomorrow to be born. </span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-733474534537681542016-04-22T10:30:00.001-07:002016-04-22T10:30:16.719-07:00Nestor to Telemachos <span style="font-size: large;">"Be brave too, so that men unborn may speak well of you." - The Odyssey, III, 200 (Richmond Lattimore translation.)</span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-10675946567806065512016-04-20T02:13:00.001-07:002016-04-20T02:13:28.791-07:00The problem of autism & moral chaos
<!--StartFragment-->
<!--EndFragment--><br />
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">How much
of what is currently diagnosed as autism or its near equivalents is actually
the result of a defence mechanism against the moral chaos of modernity? How
much of it is a veiled or displaced moralism, in the sense of an inability or unwillingness to encompass moral dilemmas & uncertainties? It may be, for instance, a
defence against "attention deficit", simply a refusal to acknowledge
value choices which the ego is not able to make? </span></div>
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Whatever the truth of this may be, we need to consider carefully within the modern context the inability of the individual to empathise with the other. </span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-3567139610462407652016-04-18T09:50:00.000-07:002016-04-18T09:50:09.246-07:00Everything merges into its opposite.
<!--StartFragment-->
<!--EndFragment--><br />
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">Everything
in human life is bound up inextricably with its apparent opposite. No life
without death, no beauty without ugliness, no civilization without barbarity. </span></div>
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;"><br /></span></div>
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: Georgia, Times New Roman, serif; font-size: large;">We deal with experience by opposing different parts of it. So why do we have this psychological need to create oppositions? Why do we allow ourselves to admit that we desire one part of the opposition but not the other? </span></div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-32611610158232652112016-04-15T03:43:00.000-07:002016-04-15T03:45:47.059-07:00A recurrent danger for the psychotherapist<!--StartFragment-->
<br />
<div lang="en-GB" style="margin: 0in;">
<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;">There is a recurrent danger that psychotherapy may provide for the practitioner an escape from a personal moral chaos he cannot deal
with. In such cases the therapist may easily come to treat his patient as a simplified two-dimensional version of
reality, & in that way attempt to
retreat to a more manageable reality than the one he must inhabit himself.
Psychotherapy can thus too readily become a highly
intellectualised defence for the therapist. And the elaborated institutions of
therapy all too easily shore up this defence. </span></div>
<div lang="en-GB" style="margin: 0in;">
<br /></div>
<!--EndFragment-->Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-85978666582472144052014-09-27T03:27:00.000-07:002014-09-27T03:27:04.575-07:00On Psychodynamic Therapy & Its Relation with Medicine - Part Four (of Four)<div align="center" class="MsoNormalCxSpFirst" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">IV<o:p></o:p></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">After it adopted a psychoanalytic approach </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">in</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">middle</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> 20<sup>th</sup> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">century
psychiatry needed to become </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">a new kind of </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">ethical</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">scientific</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> profession. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">But</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">rather than doing
this & developing into an autonomous discipline governed by its own
principles it reverted back again to being the dependent child of </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">medicine</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. As a profession psychiatrists
lacked the understanding & the self-confidence to persuade their colleagues
that mental illness is different from physical illness. As a consequence
psychiatry lost its way & it </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">remained</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">trapped in competition with </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">rest</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">medicine</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> for prestige & for funding. Instead
of doing what it needed to do to be true to its own problems & challenges it
confined itself to reacting to what was going on in the rest of medicine. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">So,</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">as</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> medicine made ever more
impressive progress in the decades after The Second World War </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">psychiatry</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">felt</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">it</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">had</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> show that it could make progress
too. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">As</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">a</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">result</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> the pressure on psychiatrists
who had adopted a psychoanalytic approach became ever greater. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">In</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">general terms </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">it</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">easy to state what is the final objective of
physical medicine. It is to extend the time frame over which the physical
machine that is the human body functions in an efficient & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">effective</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> manner. This is a simple, straightforward
objective. It presents no conceptual complexities or ambiguities because the
health of one part of the body does not conflict with the health of another
part. A weakness or injury in one part weakens all parts. As a consequence
everything in medicine is subordinate to this one overall objective. All the
subsidiary aims of particular medical interventions can be subsumed directly under
this larger aim. This objective gives us also our definition of physical
ill-health: it is any development within the body that diminishes the physical
efficiency of the body or is likely to shorten the time span over which the
body will function efficiently. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">What this means is that objectives in
medicine are profoundly stable. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">We</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> always </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">know</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">what</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> endgame </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. It has never changed at any
time in history & it never will. In any sphere of medicine we are either
moving closer to the larger aim of extending the duration of physically healthy
life or we are not. Throughout the treatment of any physical disease or injury our
specific objectives are contained always within this larger objective. As any
given intervention proceeds we may of course consider more effective means of
reaching the larger objective than those we considered at the beginning. But the
objective itself does not change. It is the same at the end of the treatment as
it was at the beginning. Assessing the progress we are making therefore
presents no conceptual problems. We are all agreed what progress means, we can
measure it, & we can achieve it. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-IE" style="font-size: large; mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The treatment of
mental illness is nothing like this. Here, we have no idea at all what the
larger aim is, i.e. what is the purpose of human life. So we have little idea
before the treatment begins what the subsidiary aims of this particular intervention
should be. Every human life is an experiment; it is an adventure in discovering
new possible meanings that life can take for itself. The objectives in the
treatment of mental illness are therefore profoundly unstable. In the treatment
of physical illness we always know where we want to go. In the treatment of
mental illness we are never sure where we want to go. At every step we face
dilemmas & doubts. And indeed acknowledging this lack of certainty is a
large part of what being mentally healthy means. <o:p></o:p></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-IE" style="font-size: large; mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">And it is here that
the perennial attempts to apply the principles of physical medicine to the
treatment of mental illness come to grief. They look scientific & rigorous
& objective & modern & enlightened. They seem to promise us a
freedom at last from the tiresome subjective complications those old-fashioned
un-scientific psychoanalytic therapists are forever introducing. They appeal to
public policymakers who want to be seen to be “doing something” about mental
health. They attract what limited public funding there is for mental health.
And they always fail.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The claim that we
are ever making </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">“progress”<i style="mso-bidi-font-style: normal;"> </i>towards mental </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">health, like the
claim that we are failing to make “progress” towards mental health,</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> meaningless, </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">because
it implies that the goal is something fixed, & not, as it actually is,
something forever evolving. Mental health is not a state that we ever reach, it
is a process of development that we maintain. It is a creativity that requires
a </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">continual
questioning & review of </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">our</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">goals &
objectives. The first step in emotional health is the recognition that the
objective is moving & uncertain. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">We don’t know what an emotionally healthy
state for man is. Each of us has to wrestle with this puzzle every day for
ourselves. Exactly where we are going is </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">subject</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">all</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">time</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">re-examination</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. It is therefore never clear
when we are being successful at achieving it & when we are failing. Indeed
it is just when we are congratulating ourselves on a success that we are most
likely to be creating the conditions for new self-deception. And it is just
when we are agonizing over a failure that unknown to ourselves we have set the
scene for new discoveries about ourselves. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">whole</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> thing far more closely resembles
a <i style="mso-bidi-font-style: normal;">Bildungsroman </i>by Goethe or Dickens
or Proust, with misunderstandings, wrong turnings, mistakes, reversals,
disappointments, fresh starts, surprise successes, chance developments, &
so on, than it does anything that happens in a medical operating room. If you
set out in this endeavour with the aim of competing with </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">physical</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> medicine you </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">have
profoundly misunderstood</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">what</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">it</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">you</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">have</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">do</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Among the most important of </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">patient</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">’s symptoms to attend </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">in psychotherapy </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">are</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">his</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> initial assumptions &
assertions on entering </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">treatment</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">about what being cured & being healthy </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">will</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> look like </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">for</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">him</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. If we are not at the least
questioning those assumptions then whatever we are doing it is not psychodynamic
therapy. At every stage we question again what progress means. The patient,
& the therapist too, should always unlearn some<i style="mso-bidi-font-style: normal;"> </i>of what they thought at the outset health would mean. Ideally,
every psychoanalytic session should involve some overturning of our ideas about
health. We should always be thinking afresh about where we are going. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In the context of mental health, development
is marked always by this abandonment of former goals & aims for new ones. We
must be able to leave behind less fruitful objectives for more fruitful
objectives. Anything other than this is dogmatism, or what Freud calls defence.
But clearly of course, seen from the perspective of the objectives given up,
such a process is not going to look like progress. The objectives given up
never relinquish their power over us without a fight & they will struggle
as hard as they can to persuade us that our work represents failure. Mental
illness always has an army of propagandists working on its behalf, both in the
mind of the patient & in the wider society. And they are subtle &
powerful propagandists, very adept at recruiting the forces of respectability
& good sense to their side & at persuading us that we should be more
moral, or medical, or scientific, or God only knows what. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Progress in short is what other people like
to see us making. But development is something we do for nature within us,
& it represents a higher & healthier imperative. This is where our true
responsibility as human beings lies, not in organizing our lives to try to
maintain the approval of others. So long as we are intent on demonstrating progress,
& so long as our support for others is conditional upon them demonstrating
progress, we are still the slaves of aims & values inherited & acquired
from those around us. Emotionally, we are still children. In such circumstances
we have nothing of real value to offer other people since we are simply
reflecting their own prejudices back to them. When we begin to develop, on the
other hand, & begin to think critically about the aims of our life, then we
do start to have something genuine to give them, because we are showing by our
own lives the essential vitality & creativity of nature that is in them
also. You do not help another by sacrificing your individuality to his foolish
anxieties & superficial preconceptions.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">This is why there is no genuine development in
psychotherapy in which the patient does not become more indifferent to the
immediate approval of those closest to him. He would of course like their
approval tomorrow if that is possible; but to achieve that he may well have to bear
with their irritation today. It will in any case be a short-lived irritation
because it is founded on short-sightedness.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Often the parents, families & partners
of patients undergoing psychotherapy are unhappy with the course of development
taken by the patient. This is the reason we make every effort to insulate
knowledge of the therapy from other people in the patient’s life – something
that is quite unnecessary in physical medicine. What everyone close to the
patient wants – inevitably – is for the patient to become more co-operative
with what they take to be their own present needs today. It is always very
difficult for the patient to resist this pressure. And it is the therapist’s
first responsibility to <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">help him to do so. Therefore the therapist
must always be indifferent to any pressure he himself may feel or come under to
make progress with his patient. When third parties like parents or employers
are involved directly in sponsoring & funding the therapy this indifference
can be difficult for the therapist to maintain. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Of course, that part of the patient that
resists demonstrating </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">progress</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> is unlikely to meet with much favour from an overworked doctor or an
ambitious & insecure psychotherapist who is keen to chalk the patient up as
another “cure”. The therapist who lacks confidence in himself can readily fall </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">into</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the trap</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">becoming</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">irritated by </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">such resistance & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">dismissing</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">it</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> as obstructive & childish.
On the contrary, this resistance, however it manifests itself, must be attended
to with the </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">greatest</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">care</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> because
it has things </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">first</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">importance</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> to teach us about how <i style="mso-bidi-font-style: normal;">this </i>patient must find autonomy &
maturity. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">We don’t have an objective measure for how
much progress any individual is making with life & we will never have one
because we will never have a definition of mental health that we can finalize
& all agree on. The most we can achieve in this respect are broad anodyne
notions such as the famous criteria attributed to Freud by Erikson of the
capacity to love & the capacity to work. Not many people are likely to
disagree that an <i style="mso-bidi-font-style: normal;">in</i>capacity to love
& work is compatible with health. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">But</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">even</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">this</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">formulation</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">can</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">be</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">questioned: what if I
find that a life of leisure & abstract speculation free of personal
distractions is the best for me? Who is to say I am sick because I do not find
attractive the hypocrisies of career & relationships? W</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">e can argue about mental health,
but we can never define it.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Confronted with this assertion most people
get a little restless. The general reaction is, Surely there must be <i style="mso-bidi-font-style: normal;">some</i> way we can define it? But what they
really mean by this is, Surely the kinds of life that seem to <i style="mso-bidi-font-style: normal;">me</i> to be healthy must be correct? Is it
possible that <i style="mso-bidi-font-style: normal;">I</i> could be mistaken
about what is healthy? Everyone would like to see his own<i style="mso-bidi-font-style: normal;"> </i>ideals for life adopted as the standard, & if this is
impossible then at least secured from doubt. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">In fact, neither of these things is
possible. So in practice the attempt to set up standards of mental health means
falling back on those that enjoy the most popularity, or the least
unpopularity, or the ones that people are most afraid to question in public. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> DSM criteria </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">are</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">a</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">perfect</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">example</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">formalization of
this process. Definitions of mental health – as opposed to the reality of
mental health – are what we can get away with, at any given point in history,
without so many people raising objections that they become unworkable. </span><span lang="EN-US" style="mso-bidi-font-family: Didot;"><o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">But such definitions are always shifting
because they paper over our essential ignorance </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> what is good for </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">man</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. No matter how often we set up such
definitions as authorities, in the long run they end up proving unworkable
& have to be revised or scrapped. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">In contrast, although the progress of physical
medicine all the time results in the scientific re-categorization of particular
illnesses, illnesses are never re-categorized at a later time as health. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">For example,
contracting</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">plague</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">as serious</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">a</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> physical </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">condition</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">now</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">as</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">it</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">was</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">in</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Athens</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Pericles. Pericles
himself died of it. Although we know a great deal more now about the causes of
various plagues & how to prevent them & how to treat them, their
conditions & consequences are the same now as they were in the fifth
century. You can die of them now in just the same way & with just the same
symptoms as you would die of them then. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">On the other hand, suffering
the emotional traumas of combat, which we now regard as serious &
debilitating illness, was, in a society in which everyone had direct &
immediate experience of war, & faced the immediate danger of enslavement,
just another everyday experience. We can see many clear references to combat
trauma in ancient literature like the works of Homer & the Greek tragic
dramatists. These great writers knew that war shreds minds. But their world did
not recognize this as a specific illness or syndrome. Are we right to classify
it as such & the Athenians wrong? The question is meaningless. Conceptions
of mental health are inseparably bound up with ethical views on what human life
is about & what human beings should expect to have to handle in the normal
course of events. And these views change between communities, between one
historical period & another, & between different individuals. </span><span lang="EN-US" style="mso-bidi-font-family: Didot;"><o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">This</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">however</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">not</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">accepted</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Precisely</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">because</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> we </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">are</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">unable to define
what</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">mental</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">health</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is,</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> public views on the matter </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">swing</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">from</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">one</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> untenable & unquestionable
extreme </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">another</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. The changes we have seen in the
attitude to homosexuality illustrate this well. Only a few generations ago
homosexuality was a </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">hideous</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">crime</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">which</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">no one could speak</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of in public
discourse</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. Then for
a relatively brief period some saw it as an illness to be cured. Now no one
dares suggest it is anything other than a perfectly healthy form of sexual
behaviour. Some jurisdictions have even outlawed the treating of it as an
illness. All these unthinking positions stem from an essential ignorance & the
fear that arises from essential ignorance. Homosexuality should certainly not
be a crime. But no more than heterosexuality should it be treated as a form of
sexuality that is always & everywhere healthy & beyond scientific
analysis & ethical criticism. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Modern attitudes towards trauma have
traversed the same mindless extremes. In The First World War men who were
physically unable to function as a result of combat stress were shot, on the
grounds they lacked “moral fibre”. Now, if someone suffers a fatal accident at
work or even outside work many employers feel compelled to send in “trauma
counsellors” to minister to their colleagues. Just as every manifestation of
homosexuality is now assumed to be beyond reproach, no matter how socially
disruptive or upsetting other people may find it, so every fatality is assumed to
send shock waves of trauma through the surrounding population, no matter how
tenuous their connection may have been with the deceased person. Underlying
these fashionable attitudes to emotional health you will search for any ethical
or moral coherence in vain. We have no idea what we are doing or what we are
trying to do with them. They are the societal equivalent of the involuntary
movements & obsessional symptoms of an over-anxious patient who does not
know what it is he is anxious about. And just like such a neurotic individual
we are as a culture too frightened of ourselves to be able to think
intelligently & critically about them. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">As a culture we are very resistant to the
fact that assessing mental health requires the exercise of ethical judgement &
a sensitivity to human context. We are so because this is the kind of thinking
that human beings have always found the most difficult. We just don’t like
doing it. With science & technology we are superb in our reasoning. The
steady improvement in all aspects of physical health reflects this. But with
understanding & mastering our emotional make-up we are for the most part
quite lost. This is why our ever greater technological sophistication makes no
impact at all on our tragi-comic history. And it is why the problem of mental
health is immune to developments in medicine. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Attempts to set up <i style="mso-bidi-font-style: normal;">general</i> definitions of or propositions about mental health,
precisely because they inevitably ignore context, are always based on
self-deception & the projection of personal prejudices & fantasies.
Until you know, & know well, the particular individuals involved in any
given case, & are therefore in a position to discipline your own
assumptions in the light of empirical facts, you know nothing of importance on
which to base a judgement of emotional health or well-being. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But as a culture we are profoundly dishonest
about this. We don’t want to confront the fact that each of us must figure out
what health means for us, each day, afresh. There is no formula that can be applied.
We have continually to question our assumptions about what is good & right.
There is no pattern of life that we regard as healthy today that might not have
to be revised tomorrow. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In modern life we are not encouraged to
consider time-consuming & difficult ethical questions such as these. If a
question doesn’t have an obvious way of answering it we try to pretend it isn’t
there. So, as far as possible, we keep busy & tire ourselves with overwork
& when not working we prefer those distractions that help us evade the
tedious burden of reflecting on ourselves. Taking time for reflection &
contemplation on how we should be living is regarded at best as something that
may be forgiven if it can be shown to make us more socially productive & at
worst as a sign of weakness & ill-health. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">And of all the professions none has signed
up more enthusiastically to these modern prejudices than medicine. Now
completely governed by the principles of technology, it has squeezed all
ethical questions about what the meaning of human health might be out of its
field. Psychiatry did start to explore these questions with psychoanalysis but
it then abandoned them again. In the longer run, its dependence </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">on</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> medicine proved stronger than
its identification with the problems of its patients. Slowly it </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">dawned</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">on</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">psychiatrists</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">that</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">better</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">a patient is doing</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> in psychoanalysis </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">less</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">likely is he to
reflect a model of health that is suitably demonstrable to other doctors. In
physical medicine good patients become more co-operative with the doctor; they
come literally to embody his values. In psychodynamic therapy by contrast good
patients become more independent of the doctor; they come to reflect more &
more their own values & they care less & less about demonstrating
health to anybody else, perhaps especially to their doctor. Disturbed by this
trend, psychiatrists pulled back & gave up on psychodynamic therapy. It
just didn’t generate the kind of patients that a discipline dependent on
medicine for its self-image could handle. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">To try to </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">justify this abandonment of its
patients psychiatry attributed the failure of psychoanalysis to sign up to the
ideals of medical progress as a failure in it as a science. Psychiatrists
gratefully accepted the arguments, promulgated widely by many critics of Freud
in the last decades of the 20<sup>th</sup> century, that their colleagues in
the rest of medicine were being more rigorous at applying scientific methods
than were they.<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[1]</span></span><!--[endif]--></span></span></a>
In consequence psychiatry went back to notions of science that look respectable
but miss the point of mental illness. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The models of mental illness endorsed by
modern psychiatry don’t acknowledge the essential ambiguity of most forms of
mental distress, whether we are speaking of depression, anxiety, phobias,
traumatic flashbacks, nightmares, or addictions. They regard all such
conditions as if, like physical illnesses & injuries, they did not pose fundamental
conceptual & ethical questions about what is the best way for a man or
woman to live. Rather than offering us a serious engagement with this question
psychiatry leaves us with the promise that one day, somehow, if we persist long
enough with nervous science, we will successfully divorce mental illness from the
problems & dilemmas we all face as human beings, the inevitable conflicts
we experience & the difficult choices we must make between different people
& values & aims. In the meantime, however, for those of us still living
in the real world, the marriage continues. <o:p></o:p></span></div>
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<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">It would be remiss of me here not to note
that some forms of psychotherapy have gone out of their way to provide an
alternative model to that of psychodynamic therapy. The most important here is
“cognitive behavioural” therapy, or CBT.<span style="mso-spacerun: yes;">
</span></span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">In</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">my</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">experience</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> this is now the only form of
psychotherapy </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">which</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">
psychiatrists are willing to refer their patients. They favour CBT not because
it is remotely compatible with neurophysiology but because it has developed in
the decades since The Second World war specifically as a rival to psychodynamic
therapy. What brings psychiatry & CBT together is this common enemy. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">The defining characteristic of CBT, the
thing that it shares with psychiatry & that distinguishes it from
psychodynamic therapy, is that it refrains from engaging with the patient in a critical
dialogue about the idea of health that he brings to the therapy. It does not
regard the health of the patient as something that he himself must come to </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">define</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">through</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">an</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">engagement</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">with</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">his</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">own</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">emotional</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">history</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">It</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">does</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">not</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> look at the place of the
symptoms in the developmental history of the patient & it discourages him
from thinking about what his symptoms mean to him. It </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">ignores</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">the struggle of the patient to individuate, refusing
to see his symptoms as what they are: injuries sustained in the course of his
attempts to work out which values are healthy for him.<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">With CBT the</span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;"> emphasis is on
efficiency & speed. The focus of the therapy is on the attempt to </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">remove symptoms through the
inculcation of new </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">habits</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">behaviour</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">thought.</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> Where it succeeds in this it is,
effectively, sacrificing the future to the past, because it acts in such a way
as to suffocate the generative things in the patient that are seeking to be
heard through the symptoms. Where it fails in this it is because </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">what</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">original</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">in</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">patient</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> too strong. When this happens
the presenting </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">symptoms</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">either</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">persist
in their initial form </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">or
</span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">conflicts</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">underlying</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">them</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> find expression in some other
symptomatic pattern. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The fundamental aim of CBT is to cure the
patient by weakening his emotional autonomy. It discourages his critical
reasoning & encourages him to conform to the standards of health that
others are most comfortable seeing him adopt. In effect, it aims to purchase
the appearance of health today, at the price of genuine health tomorrow. The
philosophy of CBT is that it is better for the patient to be happy &
adjusted to whatever appears to be the conventional view of health now, rather
than develop a unique & personally developed pattern of health that will be
strong enough to stand when that conventional view starts to alter as the
constellation of relationships in his life evolves. <o:p></o:p></span></div>
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<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">CBT lacks a historical perspective. It tells
us we should accept the consensus about what is healthy, whatever that might be
at any given time or place, & it gives assurance it will not cause trouble
for those who have most to gain from that consensus & most to lose from
seeing it challenged. For this reason it is </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">popular</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">with</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">everyone</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">who</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> has some reason to </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">want</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">therapy</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">be</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">useful</span></i><span lang="EN-US" style="mso-bidi-font-family: Didot;"> – </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">parents</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> who are trying to cope </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">with</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">disobedient </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">children</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">wives</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> having to deal </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">with</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">uncommunicative </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">husbands</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">employers</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> handling potentially recalcitrant
</span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">staff</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, & politicians
hoping to be re-elected by bad-tempered </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">electorates</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. This is why it styles itself as
an “evidence based” therapy. All this means is that the course & outcome of
the therapy are determined by someone other than the patient. It is not the
evidence that the patient himself sees of the success or otherwise of the
treatment that matters, it is the evidence that someone outside the therapy
sees of this. The patient is not to be trusted as the best judge of his own
emotional well-being.<o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The ostensible</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> attraction of CBT </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">that</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> it promises to be cheap &
quick. But </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> real source of its appeal is that it does not raise awkward questions
about what emotional health actually is. It reassures us we don’t have to think
about the meaning of mental health because such a question is old-fashioned
& unscientific &, anyway, we already know what it means for all
practical purposes, don’t we? There are always so many people who want to hear
this that any therapy that says it in a convincing manner will do well. <o:p></o:p></span></span></div>
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<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Of course, sometimes</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">CBT is </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">effective in its
aims</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, because each
of us is to some degree frightened of greater autonomy. A part of us would
always rather not have to face it. If you encourage that fear then </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">learning</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">conform</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">conventional</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">expectations</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> may well feel like </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">as</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">good</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">a</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">solution</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">life’s</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> complexities </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">as</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">any</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. Furthermore, for some people it
will be the best solution to life’s complexities. For some people, greater
personal autonomy will always be an unvisited country. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But for all that CBT is not benign. It is
not offered in a pragmatic way as an additional or supplemental approach to be
used where appropriate in place of other treatment perspectives, or in the
treatment of particular kinds of patient, but as something we can expect to be
more effective than other psychotherapies in most cases. It is portrayed as the
treatment of choice. Its advocates do not have a fair-minded attitude to
therapies other than their own, they are dismissive of other approaches, &
casually misleading in the claims they make for their own therapeutic efficacy.
Their appeal is not to people who are in emotional distress but to those who
are dealing with the impact of people in emotional distress. It is the only
form of psychotherapy that regularly seeks government funding. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Essentially, CBT is a reactive therapy, not
one that springs from its own inner resources. It lacks faith in the generative
powers of man. It sees the value of men & women not in themselves as unique
expressions of nature but solely in how far they efficiently serve existing
societal goals. It was born originally out of an antagonism towards the ideal
of emotional autonomy established by psychoanalysis & it remains dependent
on psychoanalysis for its self-definition. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Those who possess the potential to cultivate
greater autonomy within themselves & who are fighting to do so provoke
complicated feelings in those who possess this potential too but who have shied
away from the challenge it represents. They don’t want to be reminded of what
they have run away from in themselves, & yet something in them won’t let
them forget it. Those who have evaded the difficult war of self-conquest suffer
a mixture of fascination & revulsion, of fixation & resentment, towards
those who have not been able to evade it. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">People who become emotionally unwell do so
precisely because they have not been able to escape this war. A combination of
their innate character, their history, & the traumas they have experienced
has generated a conflict around autonomy inside them & it cannot now be
quenched. Something inside them is pushing them towards greater emotional
independence, & something inside them is frightened of greater emotional
independence. Those who because of this internal conflict can no longer fit in comfortably
with whatever is the dominant ethical perspective of any group, whether it be a
neighbourhood, a church, a profession, a school, or a family, will not only
have to cope with the pain of their internal divisions but will also have to
contend with the unhappy reactions on the part of those around them to what
they are going through. They will encounter hostility, of course, but always
also in some measure there will develop an intricate co-dependence in which
those of the surrounding ethos both condemn them & start emotionally to
feed off them. The one who is seen not to fit in may be an object on the part
of others of envy, or an object onto which self-loathing is projected, or a
convenient lightning rod for sadism that would otherwise be hard to control, or
indeed he may be viewed as a saviour or redeemer of the group as a whole.<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_edn2" name="_ednref2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[2]</span></span><!--[endif]--></span></span></a> And he
may be many other things besides all this at the same time. For the one who is
the object of such feelings they will of course offer a difficult but
nevertheless often addictive mixture of attention & punishment. We see
profoundly unhealthy co-dependencies like this in all fields of human activity
& they can sustain themselves for many years. But such feelings, especially
in small intimate groups like families, are naturally expressed only ever
indirectly. “Why must you always cause trouble for the family? How often have
you rejected the help we have arranged for you? Why can’t you just brace up
& get on with it, like the rest of us who are all working so hard to help
you?” Such is the typical refrain in the household where someone is emotionally
unwell. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The objection to CBT is that instead of
working to analyze & help resolve these convoluted & difficult
attitudes of dependent resentment towards the best in human beings – the best
being that which compels them to be original & creative – it merely
re-iterates them & gives them a gloss of clinical justification. In the
guise of healing it perpetuates pathology. Under the surface, the cultivation
of CBT, with its facile certainties & its unresolved ambivalence towards
what is unique in each of us, is only another part of the perennial war that is
waged in culture by those who have run away from themselves against those who
are unable to run away from themselves. What we need in the field of
psychotherapy is a new honesty about this war, not a further articulation of
it. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">To sum up. There are two cardinal but
interrelated mistakes that have been made about psychoanalysis &
psychodynamic therapy over the last hundred years. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">The first & most obvious </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">mistake is
that of looking at psychoanalytic therapy as a discipline within medicine. The
history of the failure of psychiatry over the last century illustrates the
folly of this approach unequivocally. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Ultimately however
this mistake is only a particular instance of the second, broader mistake of
expecting psychoanalytic therapy to be functionally subordinate to aims
assigned to it from outside itself. This is the real error, & it is
constantly repeated in all sorts of different ways, by patients, by therapists,
& by those not involved in the therapeutic </span><span lang="EN-US">relationship</span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-IE" style="font-size: large; mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">Psychoanalysis,
& any psychotherapy that seriously applies a psychodynamic perspective, is
a sovereign discipline, one which explores in the case of one particular individual
what spiritual & emotional health may mean for the animal man. Its purpose
is the enrichment of the life of one human being only. It is animated by the
faith that the deepening of one life & the maximising of the emotional
autonomy of that one life will ultimately benefit all life. But it can never be
a servant to anyone or to any external interest. If it begins to be this it
ceases to be what it is & it becomes something else, no matter what it may
call itself.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-IE" style="font-size: large; mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">The greatest danger
to genuine psychodynamic therapy at the present time comes from the
perpetuation of this mistake of trying to make it the useful servant of some
purpose emanating from outside the therapeutic process itself. This mistake is
being made both by those within psychotherapy & those without it. Many
therapists would like to see their professional & financial position given
greater security in exchange for making promises that they will only do certain
specific things with therapy that society deems to be valuable. And many
political & bureaucratic interests seek to justify & extend their own
power by presenting therapy as a potential danger to society unless they are
given a hand in regulating it & specifying what interests it may serve in
society. To the extent all this is not driven by simple material greed it stems
from the fear of the cultivation of the personal conscience within society
& an unacknowledged anger towards those who work towards this. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-IE" style="font-size: large; mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">We live at a moment
in history when man has perhaps less faith in himself than he has ever had. He
no longer believes in himself as a creature in whom the gods have an essential
interest, indeed any interest at all. But he hasn’t outgrown this need for what
the gods once gave him. He waits still to be <i style="mso-bidi-font-style: normal;">given</i> his value by some source external to himself that can make use
of him. For this reason a process like psychoanalytic therapy that has no end
other than the cultivation of faith in the self, & in life, is hard for him
to understand. It seems strange & alien, & he keeps trying to
understand it in terms that are more familiar to him – specifically, in terms
of a world where what is <i style="mso-bidi-font-style: normal;">good</i> &
what is <i style="mso-bidi-font-style: normal;">justifiable</i> is assumed to be
what is necessarily <i style="mso-bidi-font-style: normal;">useful</i> to
something external to itself.<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_edn3" name="_ednref3" style="mso-endnote-id: edn3;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-IE" style="font-family: Georgia;">[3]</span></span><!--[endif]--></span></span></a> <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Religious faith has not disappeared from
contemporary life but it has retreated from the centre of civilization to the
periphery. Behind it, it has left a backdrop of moral chaos. This chaos is
generated by our fear of our underlying urge to greater personal autonomy,
which the retreat of religion has enhanced in us, & our uneasy awareness of
the repeated demonstration of just how difficult autonomy really is. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">To try to deal with this moral chaos we have
become addicted as a culture to attempts at ever more minute regulation of daily
life. Modern ethics are less & less about what a man or a woman should <i style="mso-bidi-font-style: normal;">be</i> & more & more about what he
or she should <i style="mso-bidi-font-style: normal;">do</i> – that is to say,
what he or she should <i style="mso-bidi-font-style: normal;">not</i> do. Our de
facto morality – the ethics of everyday life – is not about the cultivation of
creative & autonomous individuals but about the regulation of specific acts.
We mistrust ourselves. We fear man not as something formidable but as something
incompetent. We see man not as a promise to be cultivated but as an idiot to be
controlled. We speak not of health & resourcefulness, or of health &
courage, or of health & initiative, but of health & <i style="mso-bidi-font-style: normal;">safety</i>, as if the two terms were
synonyms. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In this atmosphere of moral panic the
pressure has grown for psychotherapists of every kind to demonstrate that they
too have signed up to our modern ethic of regulation & measurable progress.
This all sounds very reasonable & scientific & humane. But in fact it
is just a respectable-sounding way of saying that the task of therapy is not to
cultivate individuals, but to make them less likely to question the need for
external regulation in the rest of life. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">As I have tried to show here, in physical
medicine, where there is no difficulty in measuring progress & where there
is no conflict between the well-being of the patient & the immediate
benefit to society, this emphasis on external measures & standards presents
no problem. The less physical illness there is in society, the more we all
benefit in easily measurable ways. What is important here is not that the physical
health of any given individual impacts at once on the well-being of society, it
is that it is <i style="mso-bidi-font-style: normal;">recognized</i> at once as
doing so. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But in mental health, where the well-being
of the patient always involves the capacity to depart from the prejudices of
others, things are much more complicated. One of the fundamental criteria of
mental health is the ability to question what others perceive to be good for
us, & for themselves. The mental health of one individual impacts on the
well-being of the rest of society immediately, but it is only ever acknowledged
as having done so <i style="mso-bidi-font-style: normal;">after an interval of
time</i>. The emotional health of tomorrow is always engaged in a war to free
itself from the emotional health of today, because tomorrow always has
different tasks from those of today. Trying therefore to impose external
measures & aims on this process, which means trying to impose the measures &
aims of today onto those of tomorrow, is fundamentally mistaken. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Nevertheless, in many countries now there
are moves afoot to give the State greater control over all forms of
psychotherapy. This includes the country where I practice as a psychotherapist,
The Republic of Ireland. Here in Ireland, the current proposal is that all
psychotherapy should be controlled by The Department of Health of the
Government. It is painfully clear that almost no one has thought through what
the implications of such an arrangement would be & that as it stands it is
simply another iteration of the ancient mistake of seeing psychotherapy as
subordinate to the objectives of medicine. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Essentially, those of us living in
democratic societies have to make a fundamental decision about what we want
from psychotherapy. Is it to be treated as an autonomous sphere whose value to
society lies in the cultivation of the individual conscience? Or is it to be a
subordinated function with its aims & means prescribed for it by the State?
<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">If we choose the latter course then our
definitions of mental illness, the criteria we use for treating it, the
legitimate aims of treating it, & the specification of who may treat it,
will all be determined by the political process. In other words, they will be
determined by the outcome of a struggle for ascendancy between those sectors of
society that are able to claim an interest in them: medical doctors,
psychotherapists as a profession, school teachers, employers, & the
pharmaceutical industry, among others. Each of these groups will seek to define
things in a way that serves what they take to be their own best advantage. And
the criteria that are given the final stamp of the authority of the State will
be decided ultimately by those groups that are best able to manipulate the
political process in their own interest. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Inevitably, the politically weakest
constituency of all, & the one that will have the least say in the process,
will be those who have the deepest interest: the patients themselves. Though,
of course, everyone else will claim loudly to know best what their interests
really are. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">If however we do choose to go down this road
of trying to control psychodynamic therapy by subordinating it to the political
process only two outcomes in the long run are possible. Either the State will
successfully impose the political aims of today, in which case psychodynamic
therapy will disappear in all but name. Or – much more likely in my view – the
State will be unsuccessful in this attempt, & genuine psychodynamic therapy
that takes as its primary objective the increased emotional autonomy &
independence of the patient will indeed continue, but as an essentially covert
& perhaps quasi-illegal activity. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But I hope & indeed I expect to see a
happier outcome than this. The aspiration for personal autonomy, though it
always has to contend with contrary forces – anxiety, on the part of those who
feel it, & resentment on the part of those who have denied it in themselves
– is in fact very strong in human beings. It can be delayed certainly but it
cannot I think in the long run be arrested. There is, in short, no reason we
cannot make a recognized place within a civilized society for a psychotherapy
that is liberated both from the illusions of misplaced medical analogies on the
one hand & the relics of a religious morality that seeks an authority over
itself on the other. Let us begin now to work to construct that place. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">July 2014.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
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<!--StartFragment-->
<!--EndFragment--><br />
<div style="mso-element: endnote-list;">
<!--[if !supportEndnotes]--><span style="font-size: large;"><br clear="all" /></span>
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<br />
<div id="edn1" style="mso-element: endnote;">
<div class="MsoEndnoteText">
<span style="font-size: large;"><a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span lang="EN-US"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[1]</span></span><!--[endif]--></span></span></span></a><span lang="EN-US"> On the question of the scientific status
of psychoanalysis, see my own <i style="mso-bidi-font-style: normal;">The Last
Resistance</i>, SUNY Press, 2002. <o:p></o:p></span></span></div>
</div>
<div id="edn2" style="mso-element: endnote;">
<div class="MsoEndnoteText">
<span style="font-size: large;"><a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_ednref2" name="_edn2" style="mso-endnote-id: edn2;" title=""><span class="MsoEndnoteReference"><span lang="EN-US"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[2]</span></span><!--[endif]--></span></span></span></a><span lang="EN-US"> Anyone who doubts this may be unaware how
frequently one member of an unhappy & disturbed family enters therapy
essentially as the proxy for the family as a whole. <o:p></o:p></span></span></div>
</div>
<div id="edn3" style="mso-element: endnote;">
<div class="MsoEndnoteText">
<span style="font-size: large;"><a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_ednref3" name="_edn3" style="mso-endnote-id: edn3;" title=""><span class="MsoEndnoteReference"><span lang="EN-US"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[3]</span></span><!--[endif]--></span></span></span></a><span lang="EN-US"> </span></span><span style="font-size: large;">This way of thinking about what is morally good owes
its long history above all to the influence of Plato. </span><span style="font-size: x-small;"><o:p></o:p></span></div>
</div>
</div>
Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-15502386800916791202014-09-26T09:50:00.001-07:002014-09-26T09:50:49.928-07:00On Psychodynamic Therapy & Its Relation with Medicine - Part Three (of Four)<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">III<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">People who have histories of significant
personal loss but who never suffer from depression may be emotionally healthy,
or they may not. But they cannot, without further examination of the case, be
described as more healthy than those who do. Yet this is what modern psychiatry
has come dangerously close to doing. In an attempt to emulate the surface <i style="mso-bidi-font-style: normal;">forms </i>of scientific thought, psychiatric
evaluation of mental illness has tried to stop taking human reality into
account.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">And here we come to the crucial point, the
point on which all modern debate about mental illness hinges, & which
constitutes the underlying source of all the self-deception that plagues this
debate. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">We cannot make a judgement about what is or
is not healthy in the human mind without making an ethical judgement about how
human life <i style="mso-bidi-font-style: normal;">ought </i>to be lived. What
the medical perspective on mental illness conceals is that the question of what
is or is not mentally healthy is the same as the rather old-fashioned-sounding
question of what is or is not morally good, only approached from a secular
point of view. But because the decline of religious faith has made it
increasingly hard to reach agreement on the question of what is morally good,
we don’t feel comfortable asking it. So as a culture we have tried to persuade
ourselves it is really a medical question. The covert appeal of medicine in the
sphere of mental health is the hope of using science to reach consensus &
agreement on what are essentially ethical problems. The result of this
self-deception is what is misleadingly called the “therapy culture” where
illness is used as a pretext for failing to exercise personal responsibility.
The syndrome is misnamed however because it is not the psychotherapy profession
but the medical profession that has been responsible for encouraging the view
that moral problems can be solved in medical ways. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">That being said, however, the fact is that
with the decline of religion & the advent of a secular culture the nature
of moral & ethical problems <i style="mso-bidi-font-style: normal;">has</i>
changed. It is no longer legitimate to talk of unconditional moral rules as it
was in a time of general religious faith. That era is gone. We do now have to
look at ethical issues in the context of emotional health. But two things need
to be born in mind here. First, when we speak of illness here we are speaking
of something fundamentally different from physical illness & it cannot be
cured in the same way that physical illness is cured. Second, a recognition of
the ethical or moral dimension of emotional illness does not mean we expect to
derive a code of answers as to how men should live but rather that we recognize
that man, as a matter of fact, does not know how to live. It is quite true that
moral problems have become problems of health, but this is not health in the
sense that one is taught to use that term in medical school. And it is equally
true that problems of mental illness have become problems of morality, but this
is not morality as it was ever taught by the priests. Because, in a secular
world, questions of morality & questions of health can no longer be kept
separate but have fused with each other, each has fundamentally altered the way
we understand the other. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Every civilization has developed codes &
rules of morality of one kind or another because, as Nietzsche remarks, man is
the sick </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">animal</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">In</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">other</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">words</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, man does not know what kind of
life is optimal for his nature so he is always trying to patch up his ignorance
with the scraps of moral teaching. This is an unstable & dangerous
condition </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">for</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">any</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">animal</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> to be in. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">And</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> this is the source of </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">our</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> turmoil. What we see in human
history is the perennial re-awakening of ethical debate about how man should </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">live</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, alternating with the perennial
attempt to shut such debate down. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">We</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">are</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> always on
the way to finding out yet again just how divorced </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">we</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">are</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">from</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> ourselves, or on the way yet
again to trying to forget it. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Man is in an impossible position because not
only does he not know how to live, he also cannot bear the anxiety of knowing
that he does not know how to live. So he tries all the time not to know it. The
history of ethics & morality is thus the history of an animal essentially
frightened of itself, trying bravely to confront itself, but always
compromising this attempt with hypocrisy. And it is into this quagmire of
half-truths & self-delusions that one perforce ventures as soon as one
makes any serious attempt to address the problem of mental health &
illness. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">For instance, the diagnostic categories in
the <i style="mso-bidi-font-style: normal;">Diagnostic & Statistical Manual </i>of
the American Psychiatric Association constitute a catalogue not of types of
physical malfunction but rather of ethical judgements </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">about</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> what are healthy & what are
unhealthy patterns of human life. It is just that here, instead of being made
by one individual, they are made by a committee that has sifted a large number
of individual judgements. As such, there is absolutely nothing wrong with this.
It helps to clarify diagnostic categories, it gives coherence to debate, &
it gives us a picture of consensus thinking on these matters among
professionals at the present time. A problem arises only if we are encouraged
to </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">think</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">of</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> these categories as having been
derived in some way other than as a consequence of ethical judgements about
what a healthy life should be. In fifty years from now some of these diagnostic
categories will still be useful. But quite a few will merely be quaint
reminders of what some people thought life was about fifty years ago.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Anyone who is engaged in helping someone in
mental distress faces the responsibility of having to make an evaluation of
just how far that person deviates from some ideal of health. If a patient is
behaving in a wildly destructive manner, or is clearly prey to delusions, or is
completely unable to cope with everyday things, such an evaluation is easy. But
most people who come seeking help with their unhappiness are not behaving this
way. Most are suffering a vague but persistent sense of unease, or anxiety, or
hopelessness. More often than not they cannot express clearly what it is they
feel wrong. This is when judging the degree of illness the patient is suffering
becomes hard, & the likelihood of achieving consensus starts to diminish.
And this is where the clinician must be able to exercise personal judgement. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">This is challenging & potentially
stressful because to make such judgements consciously & rationally the
therapist must </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">have a good awareness of </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">his <i style="mso-bidi-font-style: normal;">own
</i>values. He must be able to view them critically. And he must be comfortable
with the fact that that they are not absolute or God-given but are particular
to him & are the outcome of his own history & his own evaluation of
things. They </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">can</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> never be entirely appropriate for others. At this point the therapist,
if he is any good, is on his own. Under this pressure, the temptation for the
therapist to seek an escape in a consensus view of the matter may be strong.
But for him to do so is to abnegate responsibility, because no such consensus
exists. He is now dealing with the human soul in its living solitude. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">To ask the question, what is the best way
for <i style="mso-bidi-font-style: normal;">this</i> patient to live? (not all
patients, but <i style="mso-bidi-font-style: normal;">this </i>patient), is </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">necessarily</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> to become aware that our own
values are specific to us. But each of us is limited in our ability to look at
our own values dispassionately. In some measure, all of us are fearful that if
we give up the assumption that our perspective on things is somehow the right
one, right not just for us </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">but in some ultimate</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> way for everyone else too, our sense of isolation
will become intolerable & our sense of self will start to unravel. We can
accept that some of our views on things may be personal to us & have no
authority other than our own private judgement. But it is an exceptionally
strong individual indeed who is happy with the idea that all of his views are
without any sanction other than his own judgement. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">This anxiety about emotional isolation is
the professional neurosis of psychotherapists & is at the root of the
insecurity & mutual irritation that is such a prominent characteristic of
them. Unconsciously those of us in the profession seek support for our own
judgements among other therapists. But then, when inevitably we don’t find
this, or find it in less than complete degree, we try to hide from our sense of
shame over our dependence in an attitude of paranoia towards our colleagues.
Professional associations of psychotherapists are notoriously unstable &
prone to faction, for just this reason. And they always will be. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">And this same anxiety over emotional
isolation is why psychiatrists as a<span style="mso-spacerun: yes;">
</span>profession, & many psychologists & psychotherapists also, cling
with such irritable tenacity to the supposed authority of “science”. The
perennial appeal of “science” in the field of mental health –whatever “science”
is conceived to be – derives from the hope that it will give us an objective
basis for evaluating mental health </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">that</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">is</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">
independent of our own judgements. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">It is one of the characteristic dogmas of
modernity that science gives us access to a world that is purified of human </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">prejudice</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">value</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. Nothing could be further from
the truth. Science is as free of human prejudice as the claw of a cat is of cat
prejudice. Our devotion to science reveals only how many of our most powerful
prejudices it confirms. And it is precisely because it confirms so many of our
prejudices that we need to pretend to ourselves it is free of them. Our own
interests will not allow us look at how riddled with our own interests it
actually is. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In psychiatry we have bamboozled ourselves
into believing that science holds out an escape from having to make the kind of
value judgements that arise everywhere in treating mental illness, & thus
offers an escape from the stress of having to achieve a sufficient degree of
critical self-mastery to be able to make such judgements in something
resembling a balanced & rational manner. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">For it may be true that a man can have a
chaotic emotional life & be prey to a whole menagerie of personal neuroses
& complexes & still be a first-rate physicist, or chemist, or surgeon.
But without a significant degree of self-knowledge & a mastery of the self
a man certainly cannot be a scientist or therapist of the soul. </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">This kind
of </span><span lang="EN-US" style="mso-bidi-font-family: Didot;">science makes
demands on the character of the investigator that science elsewhere does not
make. And this is why the sciences of elsewhere are repeatedly called upon in
mental illness. They look like a respectable escape route from the central frightening
challenge that understanding mental illness poses: know who you are & how
you differ from other people. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">For instance, if we could convincingly show
that depression, or even a particular kind of depression, were caused by a
malfunctioning of particular neuronal circuits in the brain then we could
without hesitation classify it as an illness. The need to make an ethical
appraisal would be overcome because we could point to a simple distinction
between a circuit that functions normally & one that functions abnormally.
It would cease to be a mental illness in the same way, for instance, that
Down’s Syndrome & dementia have ceased to be mental illnesses. Like them,
it would be a physiological illness with certain associated mental impairments.
We would be released from the difficult task of making an ethical assessment as
to whether a particular case of depression was an essentially healthy response
to difficult circumstances or a difficult history, or on the contrary whether
it should be more usefully classified as an illness, as a pathological
inability to deal with a reality that a healthy person should be able to cope
with. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">And this, essentially, is the most important
driver behind the search for physical causes of mental suffering. It is a wish
to escape from the fundamental ethical ambiguity of mental illness. It is the
wish for a certainty that would take out of our hands the responsibility for
making difficult, uncertain decisions. It is a regressive wish & in the
very difficult field of emotional pain it has unfailing appeal. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Science is genuine science so long as we
handle it as our intellectual servant & take responsibility for how we
apply it. Once we start to fetishize it & treat it as our emotional master,
as some kind of intellectual equivalent of the categorical imperative, it
becomes merely a neurotic symptom of denied anxiety. And in large measure
psychiatry, & those regions of psychotherapy that crave scientific
respectability, have done just this. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Psychiatry has lost the habit of thinking
ethically, contextually & historically. But when we stop thinking in this
way we lose sight of the mind. To keep the mind in focus we must ask, what is
the cause of emotional distress in the past of <i style="mso-bidi-font-style: normal;">this </i>patient? How is the distress symptomatic of <i style="mso-bidi-font-style: normal;">this </i>patient’s attempts to create a
better future out of the past? To what extent is the patient failing, & to
what extent succeeding, in developing a future that will be creative &
fruitful for <i style="mso-bidi-font-style: normal;">him</i>? Until we place the
patient’s distress in the context of <i style="mso-bidi-font-style: normal;">his </i>past
& <i style="mso-bidi-font-style: normal;">his </i>future we are wandering
without a compass, however scientific we may flatter ourselves our procedures
are. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But I wish not to be misunderstood here. The
correct application of physical science is a vital part of our war against
destructive formations in the human mind. The mistake psychiatry has made is
not in trying to get a better grasp of the functioning of the brain &
nervous system. We need to know much more about these things than we do at
present, & we will. Anti-depressant & anti-psychotic medication are
saving lives & releasing people from intolerable suffering every day. This
is not the problem. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The mistake psychiatry has made has been in
endorsing the view that it is okay to give up the treatment of patients first
& foremost as <i style="mso-bidi-font-style: normal;">unique life histories</i>:
that is, as people who have had to make unique choices, who have faced, &
who still face, unique dilemmas, & who have to try to create unique
futures; & for whom there will be <i style="mso-bidi-font-style: normal;">uniquely
healthy solutions</i>, with no parallels in the life of any other human being.
By excluding this essentially ethical perspective on mental illness psychiatry
has misled public perception of what it is & it has distorted public policy
on how it is best treated. In its wider responsibility to the public debate on
mental health psychiatry has lost its nerve. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Every aspect of physical health can be
expressed in terms of a healthy norm. Each part of the health of the structure
& functioning of any human body can be described in terms of its degree of
deviation from an ideal numerical ratio. Mental health in contrast is nothing
like this. We suffer mental distress because for each of us there is a unique
state of flourishing, fruitfulness & creativity, & because to achieve
this state we have to overcome our fears of not being quite like anyone else.
You can be a paragon of physical health & still be a worthless individual.
This is not possible in mental health. Without at least a modicum of honesty
& courage in confronting oneself mental health cannot be said to exist.
Mental health is ethical health. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
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Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-28270507015769312592014-09-25T01:07:00.000-07:002016-07-22T06:57:01.782-07:00On Psychodynamic Therapy & Its Relation with Medicine - Part Two (of Four)<div align="center" class="MsoNormalCxSpFirst" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">II<o:p></o:p></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Freud is often dismissed nowadays as
unscientific or outdated, or out of touch in some fundamental way with
modernity. But all that such unthinking attitudes reflect is that as a culture
we are not able to get into perspective the scale of our debt to him. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">We assume that by now we must know Freud
& have assessed what is of value in him. But in fact, he is very difficult
to know properly. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Freud’s thought is intricate, complex &
subtle, it evolved & changed with the years, & it was developed against
the background of an intellectual culture with which only a handful of
specialists now have real familiarity. Over 45 years working as a psychoanalyst
he wrote a great deal. The <i style="mso-bidi-font-style: normal;">Standard
Edition </i>of his writings in English consists of 24 volumes, the German <i style="mso-bidi-font-style: normal;">Gesammelte Werke </i>contains 18 volumes.
Some of the most familiar terms associated with him, like the <i style="mso-bidi-font-style: normal;">Id</i>, the <i style="mso-bidi-font-style: normal;">Ego</i>, & the <i style="mso-bidi-font-style: normal;">Superego</i>,
he never used & are mistranslations of the terms he did use. As a result
most people, including most psychotherapists & also a surprisingly
significant number of people who call themselves psychoanalysts, have no more
than a glancing or second-hand acquaintance with him. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In the past psychiatrists evidently believed
that after the demanding years of medical school they could pick up Freud’s
essential ideas in a couple of years of practice almost as an afterthought. But
to master Freud’s thought is as difficult as acquiring a proper training in
medicine, perhaps more so. It certainly takes many more years of experience
& maturation. And much of the training available for psychodynamic
therapists, undermined as it is by rivalry & often petty-minded competition
between different therapeutic factions, is poor. In reality the fashion for
Freud’s ideas in the middle decades of the 20<sup>th</sup> century was as
superficial & was based on as many misconceptions as is his unpopularity
now. As a culture Freud has always been largely unknown to us, & all the
more so because we assume we do know him. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Freud’s achievement was to show us how to
translate the language of madness into the language of everyday experience.
This was his great legacy. Nothing in human history has had such a humanising
influence on the treatment of mental distress as this. Before Freud everyone
was frightened of insanity because they could not understand it. It was as
incomprehensible to them as is Ophelia’s state of mind to us after her
breakdown in <i style="mso-bidi-font-style: normal;">Hamlet</i>. The result was
shame, incarceration & cruelty. Freud showed how to understand mental
alienation & pointed out how its expressions can be found everywhere else
in our lives. To learn the language of mental illness is to learn how to
interpret our own everyday neurotic symptoms & how they express in an
indirect way our personal divisions & anxieties. Even the world of outright
psychosis is not alien to us; we are all familiar with it & enter it every
night in our sleeping dreams. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">By showing how to translate the language of
insanity Freud took a lot of the fear of mental illness away. But at the same
time he made plain that the price of overcoming this fear is acknowledging how
indistinct in all of us is the line between illness & health. In the sphere
of the human mind – as opposed to the human body – there is not a clear
distinction between the healthy & the sick. It turns out that to understand
madness is to understand ourselves. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">We are all sick to the extent that we are
all divorced from ourselves & misunderstand ourselves. We are all
struggling to make sense of a self that we only very imperfectly understand
& which is all the time developing & evolving beyond the little
understanding we do have of it. And we are all healthy, to the extent that we
all continue to evolve & develop throughout life & are always
discovering new things about ourselves & about our relation with the world.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">This does not mean we can make no
distinction at all between mental illness & mental health. But it does mean
we need to be aware of the underlying human context within which mental illness
occurs. This context is different from that of physical disease. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The strange co-existence of sickness &
health within us draws attention to just how unusual an animal we are. The
physical structure & function of the human body are similar to the body
structure & function of many other animals. One can learn a great deal
about human physical health from the study of other animals. But the emotional
life of the human animal is unlike that of any other. In this regard, between
man & that of even our closest relatives there is a gulf. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Most of the important mistakes that are made
in psychology & in psychiatry are rooted in an unwillingness to accept how
large this gulf is, how strange is human life when viewed from the perspective
of the other animals, & how difficult it is to be honest & accurate about
this strangeness. It is intriguing when we find other creatures behaving in
ways that seem reminiscent of ourselves. But all this does is remind us of our
fundamental animal heritage. As far as the serious study of human emotional
life is concerned, from the other animals we have learnt nothing. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Down through the centuries of course this
was taken as grounds for exempting man from total immersion in nature on the
basis of his powers of reason. Now we have gone to the other extreme of
pretending there is nothing unusual about us at all. Both positions show how
difficult it is to keep a clear view of how we fit into nature. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">One thing that clearly sets us apart is the
scale of our savagery & our strange addiction to cruelty. The deep &
intense gratification we achieve in inflicting pain as an end in itself, on
others & on ourselves, has, apparently, no parallels among other species. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">All our knowledge of ourselves has come from
the study not of other animals but of the artefacts of human culture. And all
of these are made possible by the more, or less, regulated & sublimated
exercise of this cruelty, this strange human passion for sacrifice, of
ourselves, of others, & of parts of ourselves. What we know of the mind
comes from the study of what the conflicts within our nature have made
possible: our religion & philosophy, our science & technology, our
poetry, literature & music, our visual art, our perverse sexual lives, our
family life, our political & economic structures, our laws & our prison
camps. There are no animal analogues of any of these. The divisions within us
have made us the most creative thing that nature has given birth to, & the
most destructive.<span style="mso-spacerun: yes;"> </span>Nothing, as Sophocles
says, is more terrible than man.<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: "georgia";">[i]</span></span><!--[endif]--></span></span></a> <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">What distinguishes the animal man is his
suspension between the past & the future. He is the perpetually unfinished
animal. Possibly this is the root of our terrible cruelty, because to live
suspended in this way is constantly to have to sacrifice things that we value.
A creature cannot make a future that is significantly different from its past
unless it is prepared not just to accept loss but is actively excited by loss.
Let us bear in mind that depression too is a kind of excitement at loss because
it is a refusal to let the experience of loss go.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The emotional life of man is the struggle of
the future to be born out of the past. No other animal lives even vaguely like
this. No other animal is constantly losing its way & constantly having to
correct its errors in this perpetual condition of war with itself. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In this suspended state between past &
future, & between health & sickness, we all experience throughout our
lives times of distress & trauma & despair, as well, hopefully, as
times of fulfilment & joy. With an animal in such an unfinished state how could
it be otherwise?<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But coming to terms with this is very hard.
None of us ever completely does so. This reluctance to accept our condition is
indeed one of the things that makes us human. It means accepting that all our
views on how life should be lived & what is a healthy state of existence
are of necessity provisional. We always have to be ready to question &
explore them again. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In understanding mental distress therefore
& in trying to help those suffering from it we are immersed in making
ethical judgements about what is good & healthy, & what is bad &
sterile. This work is so difficult intellectually & so demanding
emotionally because there is no book of rules we can fall back on in making
such judgements. To try to help those in mental turmoil is to come face to face
with the fundamental uncertainty of the human condition. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Accepting this uncertainty in our condition
& being able to live creatively without taking flight from it are as close
as any of us can come to health. Other than this there is no way mental health
can be defined.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The acknowledgment of this unfinished state
of the human animal, & consequently the essentially problematic nature of
cure & health in its mental life, is the defining characteristic of
psychoanalytic therapy & is what distinguishes it from all other
psychotherapies & all other treatments for emotional distress.
Psychoanalytic therapy is an education in scepticism & in irony. What seems
bad today often seems good tomorrow. Many of the things that we think at first
are healthy for us turn out not to be so, & many things we have feared turn
out to nurture us. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Should such a widely experienced condition
as depression, for instance, be regarded as an illness? There is no simple
answer to this question. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">The experience we call depression can be
associated with many different underlying mental states. It can come & go
throughout a person’s life for no obvious reason, or it can appear for what
seems the first time in response to a significant traumatic event such as a bereavement
or unemployment. It can be moderate & episodic, or severe & chronic, or
alternating with periods of mania where everything seems possible. But it is
always distressing &, usually, it drives the person who suffers it to seek
for a resolution to it. However it is not an illness in the way that mumps
& chicken pox & cancer are illnesses. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Depression can be a sign of weakness &
poor health. But it can also be the response of an essentially healthy
individual to distressing & unhealthy circumstances. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Hamlet </span></i><span lang="EN-US" style="mso-bidi-font-family: Didot;">for instance is the portrait of a
man suffering depression. But is he sick? Or is he a man of integrity sickened
by pathological & corrupt circumstances? These questions are famously
impossible to answer. And this is why the play is a centrepiece of Western
literature: in the ambiguity of his condition Hamlet is a symbol for us all. We
all experience distressing loss at different times in life. To be human is to
develop & to develop is to be always vulnerable to loss. To respond to such
experiences in an emotionally appropriate & fruitful way may well involve
periods of depression, & sometimes these may be severe, resulting in
significant incapacity. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Like Hamlet, King Lear too suffers
depression. Should we regard him as sick? His history is more complex than that
of Hamlet & we have to guess at a lot of it – just as we have to do in
psychotherapy. Initially he seems reconciled to old age & to handing over
the kingdom to his daughters. But as the action proceeds his behaviour shows he
is anything but reconciled. Everything he does ensures that the one daughter
who genuinely cares for him, Cordelia, will renounce her inheritance. He wants
to deny her the world, about which, as we quickly see, he feels deeply bitter
& resentful. He manoeuvres like a bad-tempered child so that Cordelia is
left with no choice but to come with him into death. Is this illness on Lear’s
part? It is very hard to see how it is anything other than illness. Death &
destruction triumph everywhere in this story – or almost so. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">And yet, for all its extraordinary drama, <i style="mso-bidi-font-style: normal;">King Lear </i>is nothing more than everyday
life viewed through a powerful magnifying glass. Sibling rivalry, parents who
are over-dependent on their children, wars over inheritance, opportunists
driven by envy exploiting the misfortunes of others, & well-meaning
intervention on the part of people who have no understanding of what they are
dealing with – what is all this but daily life? <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Whatever form depression takes it is always
the reflection of divisions within the individual between different needs.
Hamlet is notoriously divided & driven back & forth by different
inclinations & tendencies. Lear’s actions are a constant contradiction of
his expressed wishes & intentions. And so it is in real life.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">A deeply upsetting event like the death of
someone close to us (as Hamlet has experienced), or being made redundant from
the role that has defined us (as Lear has experienced), will provoke intense
divisions within us; for instance, those between the profound needs that are
satisfied by love & work, & the quite different need to come to terms
with a new reality that is unfamiliar & disorienting. Only someone with no
imaginative grasp of the reality of human life would expect a person who had
experienced events such as these <i style="mso-bidi-font-style: normal;">not </i>to
go through a period of emotional distress. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But often the events determining the
conflicts underlying the depression are less manifest than this because they
didn’t happen last week but in the more remote past. People who have
experienced the death of a parent while they were children, for example, or who
have been unloved as children, are likely to be prone to periods of depression
throughout the rest of life. Why would they not be? They have suffered
important losses & have been denied important needs. These losses are a
part of what defines them. But at the time of such experiences the pressures of
growing up & trying to deal in a practical way with the rapid series of
challenges that childhood & adolescence bring are intense. At this period
in life the brain & the mind are still rapidly developing & there is
little time for integrating these experiences in a developed way into emotional
life. Often, it is only when a later upsetting experience intervenes to disturb
the fragile balance that has been established that the fault lines of older
conflicts are opened again. This kind of case, where depression is caused by
the combined emotional effect of contemporary events & events from years in
the past, is the typical one & the resulting distress will be more severe
& harder to resolve than one caused by present upsets only. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Nevertheless, the point at which depression
becomes sufficiently severe or destructive to be classified as an illness
rather than as an appropriate response to loss is impossible to determine with
precision. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">However, when we do decide that the degree
of emotional dysfunction in depression is such as to constitute an illness it
is still not an illness like a physical illness. The historical events to which
the depression is a reaction are integral to the identity of the person
suffering it. They have significance for the patient because they represent
crucial battles in his war to achieve autonomy. To try to resolve depression by
pretending that the historical events of loss or trauma underlying it lack this
significance is to pretend that the patient is just another animal without a
history & without a future. Yet, to the extent that contemporary psychiatry
encourages the view that the roots of depression are to be found <i style="mso-bidi-font-style: normal;">exclusively </i>in biochemistry, this is
what it is doing. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But what is the logic in studying &
treating man as if he were something other than what we know he is? What would
we think of a science that insisted on studying a bird as if it were a species
of fish? Is not this determination to distort the human subject itself
symptomatic of something deep & unacknowledged? <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In most cases, anyone with good empathetic
skills can understand the causes of conditions like depression & anxiety.
This is not the difficult part of psychotherapy. What is much more difficult is
identifying correctly the particular drives & conflicts in play. This is
demanding & intricate work because, curiously enough, we expend a great
deal of energy in trying to hide these from ourselves. Human beings have a
strong propensity not to know, not to wish to know, the causes of their own
distress. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Why might this be so? <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">In the case of depression caused by reaction
to bereavement for instance, our feelings for those we love & who are
closest to us are always complicated. Love, even in the strongest of us, always
involves some measure of dependence, & therefore some measure of resentment
& anger. And dependence is something we are all ashamed of. We do not like
seeing it in ourselves. So we try not to see it in ourselves. And so when we do
lose someone we love we usually get very confused about why we feel the way we
do & what it is we really feel. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Freud suggests for example that Hamlet’s
confusion & his inability effectively to take revenge for the murder of his
father can best be understood as reflecting the mixture of love & hate he
feels for his father. The irony is that, in spite of all his insight, Hamlet is
not able to acknowledge the resentment he feels towards his father other than
in an indirect manner, in his condemnation of everything in the world <i style="mso-bidi-font-style: normal;">except </i>his father. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">As a result of this propensity to hide from
things we feel ashamed of in ourselves we often fail to identify traumatic
& significant events in our past. It is not that we forget that such events
took place, it is that we don’t recognize their full emotional significance for
us. Patients in psychotherapy will often report they have suffered periods of
depression throughout their adult lives for no obvious reason they can identify.
When it is pointed out to them that they lost a parent in childhood, or that a
parent was brutal & unloving towards them, they are, at first, often amazed
that events this far in the past should still have significance for them. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">By & large this is the rule with memory.
Human emotional life is so complex & entangled that we are never aware of
more than a fraction of the whole significance of any given event in our past
(& still less so in our present). But with events that are especially
charged with difficult emotional significance – that is, those involving
emotions we are ashamed or frightened of – this is particularly true. We do not
wish to understand fully our reaction to such experiences. To do so means
having to question assumptions about ourselves that we don’t want to question.
This is why we so often react with anger towards someone who tries to explain
how such events are still shaping our lives. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">To understand the history of psychoanalytic
therapy & its place in psychiatry & in the world of psychotherapy
generally we must bear this underlying anger in mind. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">Those who object to psychodynamic therapy in
the treatment of mental illness generally claim that it is unscientific or too
time-consuming. The implication is that there is some truly scientific, &
quick, & inexpensive, & lasting therapy just around the corner; as if
it were the most reasonable thing in the world to expect a treatment for mental
illness that will combine all these qualities. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">But underlying such arguments is the
unacknowledged wish to find a justification for treatments that don’t ask
awkward questions & don’t require us to be more autonomous as individuals.
Every alternative treatment that has been proposed for mental illness is less
demanding on the patient in terms of the honesty & courage it requires from
him than is psychodynamic therapy. This is the true appeal of these therapies.
Everyone wants to be well, provided getting well doesn’t require too much
effort or too much time or too much honesty with oneself. It is as if living
the best life one can were somehow not the most important task every human
being faces. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Every </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">other</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> serious attempt to help patients
with mental illness, whatever philosophy it may espouse, turns out in practice
to be long, slow, at best partially scientific, & of an uncertain outcome.
Rather like psychoanalytic therapy, in fact. But with the difference that
difficult questions about the ambivalence of the patient towards the past &
the future & to the prospect of being cured are avoided if at all possible.
Every effort is made not to challenge the patient </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">by</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> carefully not asking what it
means for <i style="mso-bidi-font-style: normal;">him</i> to be cured. Cure is
taken to be either what the patient initially says it is – “I want to get over
the breakdown of my relationship & move on with my </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">life</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">be</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">free</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">to</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">have</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">more</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">affairs</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">,” – or what the therapist
initially says it is – “You must stop having these trivial relationships &
settle down & get married.” The working assumption is that one or other of
them must know </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">from</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">the</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">outset</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">without</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">further</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">ado</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> what health means. Psychodynamic
therapy alone acknowledges the fundamental problem here: before we have
explored the divisions within the </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">patient</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">before</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">both</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">patient</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> & </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">therapist</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">have</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">learned</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">something</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">about</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">these</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> divisions, we cannot say what
kind of an outcome represents a cure for the </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">patient</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">. Only through a dialogue between
patient & therapist, with each learning important things from the other,
can we arrive at a legitimate notion of health for any patient. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><span lang="EN-US" style="mso-bidi-font-family: Didot;">Sometimes despair & grief are
appropriately viewed as illnesses & sometimes they are not. We always have
to make a judgement of an ethical & indeed an aesthetic nature as to what
is fundamentally healthy & what is fundamentally not. But in either case </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">such</span><span lang="EN-IE" style="mso-bidi-font-family: Didot;"> </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">experiences</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> are a part of our humanity. We
cannot be fully human </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">without</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> experiencing </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">such</span><span lang="EN-US" style="mso-bidi-font-family: Didot;"> emotions, without processing them & integrating them &
transcending them. We cannot cure ourselves of these things unless we cure
ourselves of what it means to be human. We need our love & our hate &
these will always inflict collateral damage on </span><span lang="EN-IE" style="mso-ansi-language: EN-IE; mso-bidi-font-family: Didot;">us</span><span lang="EN-US" style="mso-bidi-font-family: Didot;">, & on others too. As long as
we live we will suffer harm & we will inflict harm. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">There are no easy, quick or simple cures for
mental illness because there are no easy ways of being human. Life is complex
& difficult & painful. It is not impossible that at some time in the
future we shall contrive ways of using science to deaden in a fundamental way
our emotional responses to the vicissitudes of life, & thus change in a fundamental
way what it means to be human. But unless & until we give up the fight of
being human in some such way, life will continue to be complex & difficult
& painful. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">It is said that we face a modern epidemic of
depression & mental illness. But all that is really happening here is that
we are for the first time waking up to just how disturbed an animal we have
always been. In our initial attempts to confront this we have been trying to
comprehend it in terms of our pre-existing sciences. These sciences work very
well for other things, so why not for ourselves? This attitude is not without
value. But the way we have tried to apply science to ourselves has been
premature & rather clumsy, & the motivation behind it has been
ambivalent. True, we want to understand ourselves better. But also, we don’t
want to understand ourselves better. Let’s be honest: looking at ourselves is
often uncomfortable. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">We cannot simply<i style="mso-bidi-font-style: normal;"> </i>take the science of physical disease & apply it dogmatically
to mental turmoil. That won’t do. We must go about our work with greater
ingenuity. We must shape our inquiry to the thing we are inquiring about.
Dismissed so often as outdated, Freud in fact still has a great deal to teach
us about how to do this. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span style="font-size: large;"><br /></span></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-size: large; mso-bidi-font-family: Didot;">*<o:p></o:p></span></div>
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<!--[if !supportEndnotes]--><span style="font-size: large;"><br clear="all" /></span>
<br />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<br />
<div id="edn1" style="mso-element: endnote;">
<div class="MsoEndnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span lang="EN-US"><span style="font-size: large; mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: "georgia";">[i]</span></span><!--[endif]--></span></span></span></a><span lang="EN-US"><span style="font-size: large;"> <i>Antigone</i>,
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Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-18327467633150701942014-09-20T04:43:00.000-07:002014-09-26T09:47:16.438-07:00On Psychodynamic Therapy & Its Relation with Medicine - Part One (of Four)<div align="center" class="MsoNormalCxSpFirst" style="line-height: 150%; text-align: center;">
<br /></div>
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<i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">There are creative manners, there are
creative actions, & creative words; manners, actions, words, that is,
indicative of no custom or authority, but springing spontaneous from the mind’s
own sense of good & fair. <o:p></o:p></span></span></i></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; mso-add-space: auto;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">– Emerson
<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In 1893, in the very early years of
psychoanalysis, Freud remarked that hysterical symptoms behave as if the
nervous system did not exist.<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_edn1" name="_ednref1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span style="mso-special-character: footnote;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[i]</span></span><!--[endif]--></span></span></a> In
pointing this out he was on the way to changing not just the treatment of
mental illness but our entire framework for thinking about it. And he was doing
so in a way that was more radical than most doctors at the time or later realized.
<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Psychiatrists in the first few generations
after Freud mainly did not see that this new discipline of psychoanalysis took
the treatment of mental illness outside the bounds of medicine as these had
been conceived up to that point. Psychoanalysis represented a dilemma for
psychiatrists, but one they were reluctant to acknowledge. If they were
properly to practice psychoanalysis they would have to re-think what it meant
to be a doctor of mental illness. They would have to re-examine the meaning of
mental illness, & they would have to re-evaluate what it meant to cure
mental illness. Many psychiatrists were attracted by the possibilities of
psychoanalysis but they were not prepared for this reassessment of their own
professional role. So for several decades the incompatibility of psychoanalysis
with the wider assumptions underpinning the profession of medicine was fudged. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In the longer term the fault lines between
psychoanalysis & the rest of medicine became increasingly difficult to
ignore. As the years went by psychiatrists to a large extent gave up on
psychoanalysis. In the end, faced with the choice between taking a
psychoanalytic approach to things & retaining their self-identification as
medical doctors, psychiatrists chose the latter. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">To continue to take a psychoanalytic
approach meant for psychiatrists having to abandon important assumptions
learned in their medical education about the nature of illness. Unwilling to do
this, they tried to rationalize their decision to abandon psychoanalysis on the
grounds that a psychoanalytic approach was an unscientific approach. This, they
hoped, would justify unlearning the interesting things psychoanalysis had
taught them about their patients. Accordingly, they gave up thinking in a
psychoanalytic way about their patients. Or at least they tried very hard to
give up thinking in this way. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">*<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Freud began his medical career in neurology
& made important contributions to this field before beginning his own
private medical practice in the mid-1880s. In this, he specialized in treating
patients suffering various kinds of mental illness which at the time, by &
large, were assumed to be caused by malfunctions in the nervous system. Throughout
his working life he maintained close connections with the medical world in
which he had been trained. Most of the early psychoanalysts were medical
doctors. But Freud was consistent in holding the view that psychoanalysis
should be independent of medicine & should not be subordinated to it. He emphasised
that a medical education, as such, was not a particularly good preparation for
psychoanalytic work. And he encouraged many people who were not trained as
medical doctors but whose background was in the humanities to become
psychoanalysts. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In the generations immediately after Freud
psychoanalysts without a medical background, like Anna Freud & Melanie
Klein, had a prominent place. Nevertheless up until perhaps about 1980 or
thereabouts probably most people practicing psychoanalysis or some form of
psychodynamic therapy were medically trained. They qualified in medicine &
then trained as psychiatrists by becoming specialists in nervous diseases,
& only then did they undertake training in psychoanalysis. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">And in important respects most psychiatrists
who became psychoanalysts continued to see themselves as doctors in a
traditional sense. They behaved as if psychoanalysis was not essentially
incompatible with the rest of medical science; they did little to discourage
the view that they could cure people of mental illness in the same way that
their colleagues in the rest of medicine cured their patients of physical
disease; & they claimed for themselves the professional rewards of income
& status that went with being doctors.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Eventually however, the attempt to keep
psychoanalysis largely under the control of the medical profession & to
treat it as just another branch of medicine broke down. Over the last forty
years or so fewer & fewer psychiatrists have undertaken training in
psychoanalysis. And the position now in the second decade of the 21<sup>st</sup>
century is that the great majority of people who practice some form of
psychoanalytic therapy have not been trained as medical doctors. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">*<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">What can we learn about the nature of
psychoanalysis & psychodynamic therapy from these events? Why did the
enthusiasm for psychoanalysis that psychiatrists at one time showed turn into
such an unequivocal rejection of it? And is it more realistic to see these
events as psychiatry giving up on psychoanalysis, or as psychoanalysis giving
up on psychiatry? <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The expectations that psychiatrists had in
the first half of the 20<sup>th</sup> century that they could adopt
psychoanalysis without a fundamental re-assessment of their own place in the
broader profession of medicine were misplaced.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Why were they misplaced? <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The underlying problem here is that
psychoanalysis approaches the questions of illness & health in a different
way from physical medicine. Psychoanalytic therapy treats these issues as
problematic; it subjects them to critical examination. That is why it is called<i style="mso-bidi-font-style: normal;"> </i>psycho<i style="mso-bidi-font-style: normal;">analysis</i>. It assumes that in the case of each patient who undergoes
a course of therapy, illness, health & cure will turn out to mean something
unique, they will have no exact parallels in the life of any other individual.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The first task of psychodynamic therapy
therefore is to figure out in each particular case what these things might
mean. It specifically rejects the suggestion that knowing what is healthy for
one individual will give you knowledge of what is healthy for someone else.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Physical medicine does not proceed in this
way. A doctor of physical disease who went about his work with such an attitude
would be negligent. In physical medicine the distress of the patient & the
malfunctioning of his body are treated as things to be rectified as quickly
& as completely as possible, given the existing state of medical knowledge
& its technical capacities. It is not the task of the doctor of physical
illness to inquire whether it is <i style="mso-bidi-font-style: normal;">desirable
</i>to cure a patient of a fractured arm, or high blood pressure, or cancer.
His task is only ever to inquire whether it is technically <i style="mso-bidi-font-style: normal;">possible </i>to do so, & to do so without harming the patient in
some other more serious way. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In psychoanalytic therapy however this is
not what happens. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In psychodynamic therapy, in the first
instance, we approach the distress of the patient & his presenting symptoms
& the unhappy aspects of his life as things to learn from. They are trying
to say something to us & our first objective is to understand something of
what they are trying to say to us. We want to discover from these things as
much as we can about the patient & his life & his circumstances. We
take them as signs & symbols of conflict within the patient & we use
them to try to understand as well as we can <i style="mso-bidi-font-style: normal;">what
</i>is in conflict within the patient. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">It is not just the fact that the patient is
emotionally divided that is causing his distress. Mainly, his distress is
caused by the fact that he is divided in a unique way that no one else can properly
understand, indeed often in a way so unique that no else can even recognize it.
Because of this, he cannot communicate its dimensions to other people, he
cannot even articulate them to himself. The language to describe these
divisions does not yet exist; that is why the patient is forced to fall back on
the language of his symptoms. And it is this isolating aspect of mental
illness, this resistance to communication, that makes it so painful. The
patient does not wish to know what forces are fighting inside him because he is
running so hard from the isolation that such knowledge entails. And those
around him do not wish to know either, because they fear this isolation too. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Our physical illnesses reflect our
similarities with everyone else, they reflect the fact we are subject to the
same physical vulnerabilities & frailties as them. But our emotional crises
& distress reflect the fact that we are unlike anyone else. When we are
born we are autonomous individuals only potentially. It takes many years to
mature into a healthy individuality, much longer than it takes to become mature
physically. And we have to fight to achieve this. We have to struggle to sort
out in what ways we are like those nearest to us & from whom we acquire our
first perspectives on things, & in what ways their perspectives are not
beneficial for us. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Mental illnesses are the emotional injuries
we sustain in the course of this long fight for independence & autonomy.
Some people achieve a happy maturity without great emotional turmoil, though
often their understanding of life can be relatively superficial because of
this. At the other extreme some people succumb to their injuries & never
overcome them & become bitter & destructive. Some of the most
destructive men in history have been of this type. In his great geniuses of
envy, like Iago & Edmund, Shakespeare loved to portray them. And many
people lose their nerve in this struggle for autonomy & more or less
successfully suffocate their individuality.<span style="mso-spacerun: yes;">
</span>They become the pillars of whatever is regarded as proper & correct
in the age. But some people come through the fight, overcome their injuries,
& eventually achieve a fruitful & happy level of emotional freedom
characterized neither by anxious conformity nor by envy & resentment. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The war within the patient will be between
some tendencies that are good & healthy & which it is desirable for him
to develop in his life, & some tendencies that are inhibiting & which
it is desirable for him to let go. Another way of thinking of this division is
that between the past, which is an essential part of the patient’s identity but
is in some way holding him back, & the future which the patient must move
towards if he is to go on living in the world but which may have distressing or
destructive things within it. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">In psychodynamic therapy the symptoms that
the patient presents are treated as the expression of the struggle between
these things. There are good things that we want to cultivate & bad things
that we want to allow to atrophy. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">At the outset of the analytic process
however we cannot know exactly which aspects of the patient’s life & habits
are the good things & which are the bad things. Again, this is because they
will be unique to each patient, who is living out a life story no one has lived
before & no one will live again. Only when we have acquired quite a
detailed knowledge of the history & circumstances of the patient will we
begin to get some idea of which trends are desirable & which are
undesirable in his life. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Psychodynamic therapy is often caricatured
as an endless re-working of the remotest years in the patient’s past in an
effort to dredge up his most distant memories. Such a procedure is not
psychodynamic. The exploration of memories, on the assumption that repressed
memories are the cause of the illness, is the characteristic of what was once
called the cathartic cure. The cathartic cure, as the name indicates, aimed to
dissipate emotions provoked by past events that the patient supposedly had not
been able to express at the time of those events. The memories associated with
the emotions were thought of as locked in the unconscious. The aim of the
therapy was to get the patient to remember these events & allow the
emotions into consciousness. The belief was that the patient would be cured of
his symptoms simply by experiencing the emotions. If the symptoms persisted it
was assumed this was because the emotions associated with the memories had not
yet been experienced deeply or fully enough. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Historically, the cathartic cure preceded
psychoanalysis, although variants of it are still widely practiced today. It
regarded the memories themselves, & the question of whether they were
unconscious or conscious, as the causal factor in mental illness. The purpose
of cathartic therapy was to break through to the unconscious memories &
release the emotions associated with them. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Initially Freud worked with this theory too.
But right from the beginning, in his <i style="mso-bidi-font-style: normal;">Studies
On Hysteria</i>, he was in the process of replacing this early theory of mental
illness with a much more sophisticated framework. Freud’s innovation was to
regard neurotic symptoms not as the outcome of repressed memories &
emotions but as the result of conflict between two different tendencies in the
mind. On this view, distortions of memory, so far from being the causal agency
of neurotic illnesses, are merely another symptom of them. In the psychodynamic
theory of the mind that Freud went on to develop the causal mechanism in mental
illness is viewed as the presently existing conflicting trends within the
patient. The aim of therapy is not to make memories as such conscious but to
help the patient be more aware & less afraid of the emotions at war inside
him. This involves both intellectual & emotional development, but it does
not aim, as such, for the kind of display of affect that is associated with
catharsis. In the psychodynamic framework, being able to remember things well
& being open to the emotions associated with the past can be important
indicators of strength. But by themselves they won’t be enough to get you well.
<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">All memory is subjective. Psychodynamic
therapy emphasises that memory is always uncertain, always distorted, &
always partial & limited by perspective. The memories that recur to the
patient in the course of the therapy simply furnish us with another set of
symbols & symptoms from which to make sense of the forces & drives the
patient is struggling with here & now, today. The focus of psychodynamic
therapy is not on memory as an end in itself but only insofar as the critical
examination of memory assists us in the articulation & resolution of
present internal divisions. This is where the patient’s fears lie & this is
where the illness must be resolved if it is to be resolved. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The whole art of psychodynamic therapy is
that of distinguishing what within the patient is most likely to be helpful for
the future from what is most likely to be sterile. This is very difficult. And
this is where most of the mistakes in psychodynamic therapy are made. It cannot
be reduced to a formula. When it is successful it is the outcome of a happy
interaction between the therapist & the patient. Some of the time it
involves discovering things that have been there already. And some of the time
it involves cultivating things that have only existed in an inchoate form. It
is immersed in uncertainty & ambiguity. You can never be sure it has been
done in the best possible way. It will always have an indeterminate outcome. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The skill of the psychoanalytic therapist is
being able to draw out what is unique in the divisions the patient is
suffering, being able to explore & discuss these with him in a way that
reduces his fear of them, & being able to interact with the patient at a
personal level in such a way that what is valuable & healthy within him is
encouraged to take greater strength in its fight with what is destructive &
repetitive. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The primary requirement of such a
psychotherapist therefore is that he should be sufficiently aware & in
control of his own<i style="mso-bidi-font-style: normal;"> </i>conflicts &
with what makes them unique that he is not frightened of what makes those of
his patient unique. It is well established that the crucial factor in the
success of psychotherapy is the capacity of the therapist to establish a
personal relation with his patient. But to be able to do this the therapist
must have achieved a good relation with himself. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Every good therapist works in a way that
reflects his own personality & experience. He is sufficiently at ease with
what is novel in his own make-up that he is not frightened of what makes his
patient isolated. The relationship between patient & therapist will contain
within it metaphors of other relationships in the patient’s life. The therapist
needs to be aware of this because it can be an important source of understanding.
But to be able to do this the therapist must first be sufficiently at ease with
his own individuality to allow a personal relation to develop with his patient
while at the same time remaining sufficiently detached to be able to observe it
in a critical & objective manner. None of this is easy. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The therapist who is less at ease with his
own individuality will generally seek to reduce the process of therapy to a
formula of some kind. In effect, he will be looking outside the therapeutic
process itself for sanction & authorization. The easiest way to identify a
poor or inexperienced therapist is by the over-emphasis he gives to the school
of thought he adheres to or by the fact that he puts so much stress on the
formalities of treatment that a personal relation with the patient never
properly develops. The better therapist does not take flight to theoretical
formulas but brings himself & the experience of his own development to the
process. If the autonomy of the therapist is not sufficiently developed he will
be unable to establish a relationship with the patient that is personal &
real but at the same time is contained by critical reflection, & the
therapy will fail. And the therapy will fail also if the therapist’s own
experience & imagination are too remote from those of his patient. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">The first task of psychoanalytic therapy
then is not to try to remove as quickly as possible the symptoms of the patient
but rather to understand what things are fighting with each other & finding
expression in the symptoms.<o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Psychodynamic therapy is the only form of
psychotherapy that emphasises that we cannot know in any <i style="mso-bidi-font-style: normal;">final </i>sense what mental health is. We will always debate it &
we will always have to return again to figure out what it means for us here
& now. This is not so as to give sanction to the lazy attitude that madness
& sanity are the same thing or that there is no such thing as mental
health. Quite the contrary, it is to recognize that making these distinctions
in a responsible way requires difficult, sustained, rigorous intellectual work
that is never finished. If we could define mental health in a final sense none
of this would be necessary. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">And it is to recognize also that the
assessment of mental health always requires us to take the responsibility for
making an ethical judgement, though always of course a provisional one, on how
life should be lived. It is this ethical aspect in the assessment of mental
illness that is the most difficult for us to accept. We live in a world that
has become frightened of ethical puzzles because it feels it no longer has a
confident basis for solving them. This is why so much of modern intellectual
life is devoted to attempts to evade the ethical. Such attempts include our
excessive reverence for the idea of science, our excessive devotion to trying
to regulate the minutiae of social life, & our excessive faith that
majority or consensus views are the most reliable guides to action. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">And it is this discomfort with ethical
problems, essentially, that is the reason the attempt to keep psychoanalysis
within the sphere of medicine eventually broke down. Medical doctors are not
taught to be sceptical about what they understand by health. They are taught
that their professional status depends upon appearing to know what health is. A
good psychotherapist of course knows a lot more about health than does his
patient, & it is often his responsibility to reassure an anxious patient
that this is the case. Nevertheless, he uses this reassurance not as a basis
for instructing the patient on what he should do to get better but rather to
open a discussion with his patient as to what health might mean now for him. A
doctor treating physical illness does not proceed in this way. <o:p></o:p></span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 150%;">
<span lang="EN-US" style="mso-bidi-font-family: Didot;"><span style="font-size: large;">Psychodynamic therapy is always asking, what
is health? What is healthy, not for all time, but for <i style="mso-bidi-font-style: normal;">this </i>person, here & now & in the future? It introduces into
the treatment of mental illness attitudes & questions formerly associated
with philosophy & ethics. Medical science as it is currently understood
cannot contain within it a discipline that proceeds in this way. This,
fundamentally, is why medicine & psychoanalysis parted company. <o:p></o:p></span></span></div>
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<div style="mso-element: endnote-list;">
<!--[if !supportEndnotes]--><span style="font-size: large;"><br clear="all" />
</span><br />
<hr align="left" size="1" width="33%" />
<!--[endif]-->
<br />
<div id="edn1" style="mso-element: endnote;">
<div class="MsoEndnoteText">
<a href="https://www.blogger.com/blogger.g?blogID=2490423168990817732#_ednref1" name="_edn1" style="mso-endnote-id: edn1;" title=""><span class="MsoEndnoteReference"><span lang="EN-US"><span style="mso-special-character: footnote;"><span style="font-size: large;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span lang="EN-US" style="font-family: Georgia;">[i]</span></span><!--[endif]--></span></span></span></span></a><span lang="EN-US"><span style="font-size: large;"> In a paper of 1893 Freud wrote: “The
lesion in hysterical paralyses must be completely independent of the anatomy of
the nervous system, since in its paralyses & other manifestations hysteria
behaves as though anatomy did not exist or as though it had no knowledge of it.
… Hysteria is ignorant of the distribution of the nerves.” <i>Standard Edition</i>, I, p. 169. </span><span style="font-size: x-small;"><o:p></o:p></span></span></div>
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Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0tag:blogger.com,1999:blog-2490423168990817732.post-7659481103018446862013-01-19T23:13:00.000-08:002013-01-20T01:31:13.862-08:00On the Training & Registering of Psychotherapists<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">In <i style="mso-bidi-font-style: normal;">The Irish Times </i>last month Dr Paul O’Donoghue emphasized the
importance of training in the practice of the psychological therapies &
looked forward to a day when all psychological therapists would be registered
on the basis of training. (13<sup>th</sup> December 2012, <i style="mso-bidi-font-style: normal;">Training is a requirement for being a psychologist</i>) <o:p></o:p></span></span><br />
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Dr O’Donoghue suggests
that when deciding which therapists to register the choice we face is a simple one
between carefully backed scientific psychology, represented by psychologists
like himself, & the kind of therapy he illustrates with the example of a
little known school called “Energy Psychology”, which he reports has six
practitioners in Ireland & apparently is based on an unorthodox application
of Einstein’s equation between matter & energy. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">In fact, it is not
entirely clear exactly what Dr O’Donoghue would like to see done here. If he is
proposing only that we should deny groups like the Energy Psychologists official
registration it is difficult to see what practical difference this would make,
since being unofficial is presumably a quality that they & their clientele
value. On the other hand, if his proposal is that groups like this should be
outlawed from offering their services to the public at all it is hard to see
how this could be reconciled with the democratic right of citizens to consult
with whomever they wish. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Nevertheless, the fundamental
problem with Dr O’Donoghue’s position is not his call for registration as such but
rather the way he uses Energy Psychology as a cypher for all therapy that is
not undertaken by clinical psychologists like himself. <span style="mso-spacerun: yes;"> </span>In effect, he portrays the field of
psychotherapy as falling neatly into two schools: the school of Sense – his own
one – & the school of Nonsense – all the others. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The reality of
contemporary psychotherapy is much more complicated than Dr O’Donoghue is
willing to acknowledge. His endorsement of “scientific” psychology & his
implicit rejection of any therapy that does not qualify as science raise many central
questions he chooses to ignore. So far from being widely accepted, the idea of
a scientific psychology is one of the most contentious & fiercely argued
over in modern thought. For over half a century now there has been an extensive
& often very technical debate as to whether psychotherapy is, or can be, or
should be, a science, &, if so, then what kind of science we are talking
about. As yet no consensus has been reached on these matters. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The truth is that the
area of therapy confronts us with a host of technical & moral questions to
which there are no easy answers. The nature, status & aims of therapy are
all subject to debate.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Certainly, it is true
that there is no good therapy that is not based, in part, on science. But there
is no agreement on exactly how therapy should be based on science. And there is
no good therapy that is based on science alone. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">In recent years there
have been rumblings about legislation for psychotherapy in Ireland. But a
debate on what therapy is, what role it should play in society, & what it
is we hope & expect legislation to do, we have not yet begun. We cannot
regulate something if we don’t know what it is. The problem is that most people
not involved in therapy understand little about it, while each faction within
therapy strives to present itself to the public as better than all the others.
The result is a state of general confusion. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">From the point of view
of legislation there are two essentially distinct categories of therapy &
it is necessary to separate these out from the beginning.<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">First, there are those therapists
who work in private practice, with adult patients, & who engage in a
private contract with their patients. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Second, there are therapists
working for third parties. These further subdivide into two major sub-groups.
There are those who are employed by either governmental or non-governmental
agencies to work with patients on their behalf. And there are therapists
employed by parents or guardians to work with children & minors. <o:p></o:p></span></span><br />
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The first category of
therapy is therapy in its primary form. Here, the client, the person who pays
for the therapy, & the patient, the person who attends the therapist, are
one & the same person. Both parties, therapist & patient, are working
to maximize the personal autonomy of the patient. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The second category is
therapy in a more derivative form because client & patient are not one
& the same person. As a result there are implicit limits on the degree of
autonomy of the patient that the therapy is aiming to achieve. Therapy of this
type will cease at any point that the client, whether this means the parent or
guardian of a child patient, or the employing agency in the case of an adult
patient, judges that it has run its course or feels dissatisfied with its
progress. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Therapy of this secondary
or derivative type does not present any issues of principle in regard to
registration & licensing. Therapists working with children should be
registered in any event.<span style="mso-spacerun: yes;"> </span>And if the
client paying for the therapy is an agency of some kind, whether it be
governmental or semi-governmental or a wholly private enterprise, it is in any
case free to stipulate any criteria & credentials it wishes for the
therapists in its employ. This is the case as it stands now & no likely
kind of registration or licensing would make any essential difference to this. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Registration &
licensing only become problematic in the case of primary therapy, that is,
therapy with adults, in the self-employed sector. Furthermore they only become
problematic here to the extent that they attempt to restrict who may enter the
market as a therapist. Here, therapist & client are engaged in a purely
private arrangement in which, provided the law is being obeyed, no third party
has any right to interfere.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Put simply, a
registration or licensing system that does not recognize the basic right of
adults in a democratic society to discuss their private concerns with whomever
they choose will be rendered irrelevant. If I choose to discuss my personal
life with Mrs Murphy down the road because I find her sensible & helpful,
even though she has no more formal qualification than a Leaving Cert, that is
no business of anyone apart from her & me. If we arrange to meet once a
week & I agree to pay her for her time, this again is a matter purely for
us alone. The government has no legitimate role in it. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But of course, as Dr
O’Donoghue stresses, there is a generally held assumption that some kind of
formal training is necessary to make an effective therapist. Like many
important generalizations in therapy this is difficult to demonstrate & one
can always find exceptions. But there is little doubt that most of the time, in
general terms, it is true. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The main benefit
training confers is a sense of security & confidence in the trainee by
providing her with a support network within which to work & an intellectual
framework that helps make some sense of the often very confusing data one
encounters when working with disturbed & unhappy people. As she becomes
more experienced the therapist may well discard both of these supports, but
they are undoubtedly very helpful at the start of one’s career. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">However two things need
to be stressed about training for psychological therapy.<o:p></o:p></span></span><br />
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">First, we have not been
able to show clearly exactly what kind of training is required to produce good
& effective therapists. In the absence of such clear demonstration, of
course, everyone has their own opinion. This is why there are so many divergent
schools within psychotherapy. But no one particular course of training has been
shown to be clearly better at producing effective therapists than any other. Nor
for that matter has any particular course been clearly shown never to produce
effective therapists. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Second, every kind of
training that we currently have places into the system every year a significant
number of therapists (impossible to say how many) who probably should not have
been qualified. The most significant shortcoming of all our current training
programs, including the most prestigious, is that they do not systematically eliminate
candidates who turn out to be not all that happy in the work of therapy &
consequently not all that good at it. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But we must remember
nevertheless that the worst therapists probably save some lives, just as the
best & most experienced therapists sometimes fail. Therapists like to tell
the public that the profession divides into the experts & the amateurs, but
this is a distortion. Every therapist, except the very worst, is in part an expert
& in part an amateur. The good ones are those who have the self-knowledge
to recognize this, the bad ones are those who do not. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Almost everyone (with
the possible exception of those who have the most fanatical faith in strict
“scientific” method, whatever they conceive this to be) agrees that the most
important factor in the making of a good therapist is temperament &
character. Every good therapist is unique, of course. That is why she is good.
Nevertheless every good therapist has a high degree of self-control, is good at
thinking critically about her own motives, is able to tolerate conflicting
feelings within herself, & has a sufficiently firm grasp of her own
preferences & values not to need to have these confirmed by others, i.e. by
her patients. She must in addition have a lively imagination & be able to
put herself in the position of others who may be very different from herself.
She must in sum be strong enough in her own individuality to be able to connect
deeply in imagination with others without fearing to lose herself in them. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Can training impart any
of these vital qualities? <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">My own view, & I
don’t believe I am in a minority here, is that an individual who is largely
lacking in these qualities at the outset is unlikely to acquire them as a
result of training. Training helps the trainee become familiar with the “mechanics”
of therapy – how people generally behave in therapy, the kind of responses they
make, the questions they are likely to ask, the problems that most often crop
up, & so forth. And it helps the trainee acquire the professional habits
for dealing with the typical therapeutic situations one encounters. If a
trainee already possesses the vital temperamental qualities of a good therapist
then training helps her to become more practiced & self-confident in
exercising them. But that is all. If the essential therapeutic temperament is
not present from before the training commences, it won’t be acquired as a
result of training. <o:p></o:p></span></span></div>
<span style="font-size: large;">
</span><br />
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The crucial problem we
face however is that we don’t have any objective test for who may possess these
essential temperamental qualities, or who may lack them. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"></span></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">In selecting candidates
for training therefore we perforce fall back on proxies for such a test. </span></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Acceptance for training
depends on a subjective judgment made by the senior members of the school to
which a candidate applies. This judgment is based on things like academic
qualifications & work experience, but above all on whether the school members
feel comfortable with the candidate, feel in other words that her perspective
is reasonably close to theirs or can be made reasonably close to theirs. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">For instance, a
candidate who expresses an admiration for Freud is unlikely to be accepted by a
school that is strongly Christian in outlook; or indeed one that believes Freud
was essentially unscientific. Equally, a candidate who expresses a faith in the
healing power of the Holy Spirit is unlikely to be accepted by a school of
orthodox psychoanalysts. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The problem here is that
acceptance for training is not decided by the patients of therapy. It is
determined rather by existing therapists who view the candidate from their
point of view, i.e. as a potential pupil, a potential adherent of the school
& a potential source of income for it, & ultimately as a potential
professional colleague &, it may be, as a potential professional rival.
None of these things has anything to do with how good a therapist the candidate
will one day be. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Success as a therapist
depends upon personal temperament & upon the possession of a knack, upon a
capacity to connect with those in emotional turmoil. At the early stages of a
therapist’s career this knack is difficult to identify, because everyone who
genuinely possesses it goes on to develop it in a way that is unique to
themselves. In candidates who initially seem doubtful it can sometimes flower
in unexpected ways. Equally, those who initially seem full of promise can
sometimes flounder & never seem really comfortable in the work. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But those therapists involved
in training other therapists are usually reluctant to reject candidates if it
emerges in the course of training that they seem unsuited to the work. There
are several reasons for this. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">First, such a judgment
is always subject to error & uncertainty in the first years of a
candidate’s career & supervisors don’t like to hurt the feelings of
candidates who may have already invested a lot of time, & a lot of money,
in becoming trained. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Second, no one likes
having to admit to themselves they may have made a mistake in taking a
candidate on in the first instance. </span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">And third, the income
& professional prestige of supervisors generally depends upon the number of
candidates they have for training. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The upshot of all this
is that training is of no practical help as a system for screening out unsuitable
candidates. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">So right here we have a
major problem for any scheme that proposes to make training the basis of
registration or of the right to practice. Training can give a general
indication of a therapist’s theoretical orientation. But, as such, it tells us
nothing about the effective skill of a therapist. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Those who are keen to
see licensing of therapists introduced gloss over this. Instead, they try to
support their argument by suggesting parallels between psychotherapy & the
profession of medicine, which of course does have a licensing system.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Psychotherapy however is
not like medicine. Psychotherapy has become an important presence in Irish
society not as the result of any innovation in medical science. On the
contrary, it has become important because of the decline in power of the
Catholic Church & the advent of a secular society. As a consequence of
these cultural changes people are looking for ways of making sense of the
suffering of life & of coping with it, outside of a religious framework.
This is what people look to psychotherapy to provide. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">To become a little more
technical for a moment, psychotherapy is one of the <i style="mso-bidi-font-style: normal;">ethical sciences</i>,<i style="mso-bidi-font-style: normal;"> </i>rather
than one of the physical sciences. It is a science, that is, in the sense, for
instance, that economics, or history, or anthropology are sciences. It is not
however a science in the way that cardiology is a science. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Like these other human
disciplines it requires a good solid background knowledge & mastery of the
intellectual tools involved to be practiced properly. But, like them, it also
requires unorthodox views, critical assessment & freedom of expression.
Without these things, like them, it quickly stagnates into a sterile orthodoxy
wherein no one dares to challenge the conventional wisdom. <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
</div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span style="font-family: Times New Roman; font-size: large;">
</span></div>
<div class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;">
<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The catch, however, is
that psychotherapy is able to pretend not to be one of these ethical sciences,
because its history enables it to masquerade as an off-shoot of medicine. The
grand illusion that governs the field of psychotherapy in general, & is
much the greatest danger to it because it is so widely shared, is not that the
various fringe therapies around it are scientific (generally speaking they
aren’t), but that the field itself somehow can be made a part of the medical
sciences. This is the classical error in discussions about psychotherapy.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Of course, psychotherapy
is<i style="mso-bidi-font-style: normal;"> </i>connected with medicine.
Therapists generally work closely with doctors. Some therapists are doctors,
though this is less often true now than it was in the past. But this is not
because therapy is a sub-discipline of medicine. It is because psychotherapy picks
up just at the point where medicine leaves off. The problems of therapy begin
where the solutions of medicine end. Therapy & medicine are like two
adjoining countries with a common border. But they are separate countries, with
different laws, customs, traditions & values. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Sometimes, therapists
cure their patients of their presenting symptoms. But when they achieve this it
is essentially incidental to their principal object. Their principal object is
to help their patients come to terms with the pain, the loss, the tragedy of
their circumstances &, with time, turn these experiences from being
something negating of life into something affirming of it. This is no small
achievement. But it is not what you go to any kind of medical doctor for. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">As I have said, the
success of therapy depends primarily upon the personal rapport between
therapist & client. Licensing therapists on the basis of training would
therefore not improve the quality of therapy available overall. Nor, as such,
would it be any help to the public in finding a therapist. Members of the
public seeking effective therapy would still have to rely on recommendations by
friends & GPs, & simple trial & error. There is no other way you
can find a therapist that is right for you. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">What restrictive
licensing would do, however, is increase the cost of therapy to the public
overall (possibly bringing insurance companies into the market too), make therapists
who train others wealthier, & make those holding unfashionable &
dissenting viewpoints a little more reluctant to speak out. A vocal minority
within the profession who enjoy dabbling in politics would, liaising with
government agencies, determine the accepted line on such things as the family,
sexuality, religion & moral questions generally. Anyone who diverged from
the officially sanctioned line would potentially risk having her license
revoked. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">If then licensing –
licensing that is designed to restrict entry into the market – is clearly such
a bad idea for psychotherapy, where is the suggestion coming from? What is
behind the calls for licensing? <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">In part of course it is
simply a commercial response to the growth in competition we have seen in the therapy
sector over the last twenty years. No doubt, there are some practitioners who
would like to control further entry into it, & secure an income from those
who do enter it. Inevitably, these are the therapists who are most eager to
persuade the public that their brand of therapy is rigorously scientific &
ethically pure & that everyone else is just messing around, representing a
potential menace to public health. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But in fact most
therapists are not mercenary & I do not believe that, within the
profession, this is the most important source of the current push for registration
& licensing. That is to be found, in my view, at a deeper & more
interesting level, in the anxiety & guilt that is an inherent part of being
a therapist. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Working as a therapist
involves very particular emotional demands, & these are not always easy to
meet. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The psychotherapist has
to confront in a very direct & uncompromising way the essential moral
uncertainty & ambiguity of our age. The only categorical imperative the
therapist should recognize is the autonomy of her patient. She works all the
time to uncover the layers of unconscious consensus that have accreted to the
instincts of her patient, entrapping & suffocating the true identity beneath.
But to obey that imperative, the therapist must not be intimidated by moral
consensus herself. She must be able to suspend her own moral preferences if,
& to the extent that, she perceives it to be in the interests of her
patient to do so. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Let no one pretend this
is easy. It requires a great autonomous strength on the part of the therapist
which, inevitably, sometimes she can summon up & sometimes she cannot. As I
have said, the best & most experienced therapists sometimes do poor
therapy. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But, because she is
being asked to suspend her own moral preferences, the work always involves for
the therapist in some measure moral anxiety, shame, the fear of alienation,
& guilt. These are primeval reactions to questioning consensus views &
values, bred into all of us over millennia of prehistory when diverging from
consensus was the only sin, & we all have less control over these reactions
than we like to imagine.</span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Every therapist deals
with these feelings by trying to hold on to something that feels secure &
congenial. For some therapists, including myself, this is Freud & his
general perspective. For some of a more religious temperament it is faith in
God. For others it may be something more abstract, like the Correct Scientific
Method. But every therapist has her preferred fallback position, the
intellectual & emotional position she retreats to, in the face of the
inherent moral uncertainty of the work she does. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">All therapists hanker
after tangible symbols of belonging to something that feels authoritative &
protective. We are all drawn to symbols that reassure us we will not face
attack by the community in spite of the essentially subversive work we do,
which always involves questioning the assumptions of the community. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">For, as therapists, we
need to remember that we are not here to serve the community, as such. That is
not our vocation. Our starting premise, as therapists, is that we do not know
enough about human nature to be sure what the interest of the community is. Our
assumption is that all human beings lie to themselves & that what the
community takes to be in its interest contains much that is mistaken. Working
on that assumption, we are<i style="mso-bidi-font-style: normal;"> </i>here to
serve, as best we can, the interest of the individual. Our faith is that what
strengthens the individual will, ultimately, strengthen the community. At any
rate, we hope so. But don’t ask us to prove or demonstrate this, because we
cannot do so. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">And in the interim, much
that we learn about the patients we work with will inevitably be in conflict
with conventional values. Our patients are ill because, in their fear of
conventional & community values, they will not let themselves face certain
vital truths about themselves. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">We must remember how
much of what we now take for granted about mental health was regarded only a
few years ago as sinful & heretical. And this was so nowhere more than in
Ireland which as a society can still be surprisingly intolerant of minority
views. The conventional view of what is good in the emotional life always lags
behind what we as therapists are discovering. To do our work properly we must
have the courage of our own insights & not be intimidated by consensus. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">But it is in the
emotional pressure of maintaining this independent stance, I believe, that we
find the root of the wish for a public licensing system. We therapists feel
that if we were licensed, if, in other words, we could point to something that
reassured us we were <i style="mso-bidi-font-style: normal;">legitimized by an
authority </i>to do what we do, then the guilt & anxiety of our work would
be lessened. An essential part of that legitimation, of course, would be to see
our sibling rivals (the Energy Psychologists, perhaps?) denied societal
approval. The good can only ever be defined in contradistinction to the bad. It
would be reassuring, we feel, to have a bit of paper that certified that <i style="mso-bidi-font-style: normal;">we</i> are truly scientific, while <i style="mso-bidi-font-style: normal;">they</i> are merely crackpots. </span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"></span><span style="font-family: Times New Roman; font-size: large;"></span> </div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">The contrary is the
truth: every good therapist is scientific enough to be at ease with the
crackpot in herself. Rather than running away from it by projecting it onto
others she uses the crazy part of herself to deepen her understanding of life. </span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">A licensing system
would, in essence, externalize the professional neurosis from which all
therapists, in greater or lesser measure, suffer. Like all neurotic responses
it would at best be an irrelevant waste of resources & at worst be destructive
of diversity & alternative viewpoints. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">What then is the
practical alternative to restrictive licensing? <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">I have proposed a
straightforward register of therapists, which it would be obligatory for anyone
who practices as a therapist to join, & which would give the general public
background information on education, training, memberships & general
theoretical orientation for each therapist. This would bring much needed
transparency for the public & make the market for therapy more efficient. </span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;"><o:p></o:p></span></span> </div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Everyone on this
register would be bound by a basic code of ethics.<span style="mso-spacerun: yes;"> </span>This code would also include basic standards
for advertising, in particular precluding anything that could reasonably be
expected to mislead the public about training, expertise, or likely therapeutic
outcomes. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">A system of sanctions
should be provided in the event of infringement of the code. In cases of
serious offences such sanctions should include removal from the register & thereby
disbarment from the right to practice. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Such a system would be
straightforward & inexpensive to administer, & it would solve all the
outstanding problems a restrictive licensing system has been proposed to
address, without any of the inevitable problems such a system would bring with
it. Its underlying assumption is that as far as possible it is best to leave it
to the public to decide whom they wish to attend for therapeutic help, rather
than trying to decide this for them. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">Good psychotherapy
depends, ultimately, upon a willingness to confront the complexity of the
truths that make up our human condition. In the investigation of these truths
we do not need to fear viewpoints that diverge from our own. If they are of no
value they will fade as a result of their own sterility. If they have something
useful to say, we should listen to them. At the very least, we should welcome
diversity & competition in the marketplace of therapeutic ideas. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif"; line-height: 200%;"><span style="font-size: large;">People who challenge our
assumptions are good for all of us. They are especially good for us therapists,
for whom dogmatic slumbers, induced by fear of uncertainty, are always a
danger. We should think carefully before we decide to outlaw them.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-family: "Georgia","serif";"><o:p><span style="font-size: large;"> </span></o:p></span></div>
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<span style="font-family: Times New Roman;"><span style="font-size: large;">
<o:p></o:p></span></span></div>
<span style="font-size: large;">
</span>Marcus Bowmanhttp://www.blogger.com/profile/06758225024777060758noreply@blogger.com0