Night thoughts of a sceptical psychotherapist (extract)

 

Cause yet we continue. All of our lives. This is what we do, we continue. We really have to keep on being alert to this fact, because this is what it is, an actual fact.
It makes yer head go. (Kelman, 1998, p.72)

If the construction of the future and the putting things to right for all time is not our business, it is all the more clear what our present task is. I mean the uncompromising criticism of everything that exists, uncompromising in the sense that it does not fear its own results and just as little fears conflicts with the powers that be.(Marx in Kovel, 1981, p 30)


Many years ago, at a time when psychotherapy was being subjected to one of its periodic attacks in the media, I spent some time trying to write a piece called ‘In defence of therapy’. The article came to nothing but it was some time before I realised what was wrong. The problem was and is that one cannot defend something called ‘therapy’, any more, indeed, than one can really criticise it. The beast of therapy is hydra-headed and one has to be specific, whether in criticism or defence. Ultimately I can defend and stand up for only what I do, what I think, not for what others may do, unless of course I have chosen in some way to associate with them. Even then differences in thought, style and approach are quickly and easily apparent. This chapter, which borrows its title from Russell McCormmach’s dark and elegiac novel, Night Thoughts of a Classical Physicist (Penguin, 1983), sets out not a sustained thesis about therapy or even a linear argument. It is rather a sequence, almost an alphabet, of observations written under the sign of scepticism.
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An aesthetics of therapy?
A therapy that wishes to renew itself might well look to some writings on art for paths to follow. In his book The Intimate Philosophy of Art, John Armstrong argues that what helps us to get more out of works of art - pictures, buildings and so on - what aids a genuine appreciation is not information or knowledge, the traditional art historical approach whereby one learns about artists, periods, styles, methods and so on. Rather it is our own resources, in particular our capacity for contemplation, reverie and sensitivity. If we allow these to inform our engagement with a painting, say, our appreciation will be deep and authentic: ‘..it is in the quality of our engagement that the human worth of art is apparent - art matters in virtue of the kind of experience it invites the spectator into. There is no access to art except in private - in looking, thinking, feeling as we stand before an individual work. Cultivation requires that we draw upon our own resources of sensitivity, reveries and contemplation, our capacity to invest our ideals and interests in the process of looking. Without these we can only know about art as detached observers who look on without being able to participate ...’ (Armstrong, 2001, p.195)
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Bad behaviour

The therapeutic relationship is not, as some claim, an inevitably abusive one. If it were no one could in good faith be involved in it. But it is surely beyond doubt that it is a relationship that can become abusive, and very easily so. All this has been well-documented. What more is there to say about such things? When therapist and patient engage in a sexual relationship whatever is going on it is no longer therapy. It is no longer a talking about things but an enactment of them.

What concerns me more in a sense, because it is more widespread, are other forms of questionable behaviour. There are simply too many stories of such things - of therapists who hold on to patients long after the therapy seems fruitful, of therapists who seem unable or unwilling to engage in any real dialogue, particularly where it involves them being questioned or challenged. (Herein lie the dangers of dogma, of therapists who think they are the ones who really know what is going on. See for instance Gordon, 2003) Here I want to address a couple of other issues.

Among the stories are those of therapists who seem distracted or bored or who go to sleep. Now we are here on difficult ground. Of course as therapists we are affected by the people we are in the room with and these affects can be strange indeed, especially to people outside the world of therapy. To speak of someone falling asleep sounds terrible, a gross dereliction of duty if you like. And yet all therapists must be familiar with the urge, or something similar. It is, after all, what theories of countertransference are all about, that one person can affect another, quite wordlessly, quite profoundly. These feeling states can be crucial communications from the patient, I do not doubt it for an instant. Indeed, the longer I work the more I trust these silent, sometimes bodily communications. And yet, when we hear such stories and maybe too if we are really honest in thinking about our own work, how often do we sense that ‘countertransference’ is just part of what is going on, that it might even be just a therapeutic excuse for, well, bad behaviour, not being in a fit state of mind for the work. (Counteransference, Lacan remarked, in the ‘coded language we wallow in’ is what we call ‘being an idiot’, Lacan, p 228) Therapists frequently work far too much, putting in hours that they would rightly question if a patient said they were doing the same. A certain omnipotence, a self-importance hide behind the offered excuse of financial uncertainty. But maybe therapy isn’t something you can do in this way, that the intensity of the encounter is just too much hour after hour after hour.

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Coming to terms
A great many of people’s difficulties in life arise from an inability to accept who they are. We berate ourselves for not being something we feel we are not - attractive, successful, intellectual, younger, slimmer, gregarious - whatever. The list is probably endless. And people who have significant emotional or psychological difficulties berate themselves for these too, something therapy can play into with its confused talk of people ‘taking responsibility’ for their problems. The idea of a ‘coming to terms’ highlights a process of acceptance, an acceptance of who one is, of one’s experience, both of what one has done and what one has suffered. The process is, of course, by no means easy. The idea that we are not, after all, masters of our fate is one most people find hard too accept. Coming to terms is not a surrender, nor a resignation nor a quietism -‘There is nothing to be done.’ - but a modest aim which can make a difference.

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Ethics
‘The other does not exist: this is rational faith, the incurable belief in human reason. Identity=reality, as if, in the end, everything must necessarily and absolutely be one and the same. But the other refuses to disappear, it subsists, it persists; it is the hard bone on which reason breaks its teeth.’ (Antonio Machado quoted in Paz, 1990, p. 5)

The ‘other’ (usually capitalised) has undoubtedly become a fashionable word of contemporary discourse, a word without which no contribution is complete. Indeed, sadly it may be falling into that category of words which are being emptied of content, which will be impossible to use with any real conviction. Yet what it speaks of continues to matter. It may sound paradoxical but there is a sense in which most psychotherapy has lacked any re al sense of the other. Theories of therapy are based on concepts of an atomised individual, isolated from any context. Moreover, these theories place the individual at the centre of things, as a sun around which other entities must revolve. Even those theories which seem to grant more place to the other, primarily the mother, still depict the individual as centre stage, with others standing in adjunct, albeit important roles. The other is not only other but secondary. The great achievement of the philosophy of Emmanuel Levinas is to put this into question. For Levinas, ethics is my responsibility for the Other and this responsibility precedes any knowledge I may have of that Other and it is this ethical responsibility to and for the other that makes me a human being; it constitutes me as a subject (see Gordon, 11999 Chap 2)

Levinas's work is a sustained and radical questioning of the preoccupation in Western thought with knowledge in which even other human subjects are treated as phenomena - objects - to be known and to be understood. In this process their essential and fundamental otherness is lost. Levinas's conception of ethics also goes against the grain of thought which sees in the other only a version of my self, which appropriates the other through some assumed knowledge or claimed understanding. Against this Levinas argues that 'there is no exceptional place for the subject'. For Levinas the important question is not ‘To be or not to be?’ but, rather, how being justifies itself.

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Gap
‘Between the experience of living a normal life at this moment on the planet and the public narratives being offered to give a sense to that life, the empty space, the gap, is enormous. The desolation lies there, not in the facts.’ (Berger, 2001, p. 176) A psychotherapy that wishes to be meaningful must dare to step into that space.
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History
‘History throws its empty bottles out the window. (Chris Marker, Sans Soleil)
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Kindness
‘Kindness is what matters, all along, at any age - kindness, the ruling principle of nowhere!’ (Morris, 2001, p 186)

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Language
‘A political economy of the sentiments has developed in mimicry of all the sacralised marketings elsewhere. When interrogating our profoundest relationships, we ask, "What’s in it for me, is it a good emotional investment, what do I get out of it, what is the pay-off, where is the bottom lime?" "I gave you everything", cry the debtors of psychic economics, "and I was conned, swindled, taken in, cheated". A language of pecuniary fraud is deployed to describe our broken bonds and ruined attachments. Will it pay dividends, will I get a good return for love or friendship, how high is my stock right now. I staked everything, and I came away empty-handed. A bankruptcy of the soul and heart that is filed in no court.’(Seabrook, 2002, p.21)
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Music
Music may be the one cultural form that evades the psychotherapeutic grasp to understand and to subjugate. Psychoanalysis for example, George Steiner remarks, is almost helpless in the face of music (Steiner, 1989, p. 46. This may be, as the saying has it, the exception that proves the rule. Freud famously did not like music. ‘I am almost incapable of obtaining any pleasure’ from it he said in the first page of his essay on Michelangelo’s statue of David (Freud, 1914, p. 211) Is this not astonishing? Even Lenin, now one of the most vilified figures of the modern world, found Beethoven's Appassionata sonata unbearable, that such beauty could exist in such a terrible world. But he could hear it for what it was. In music as in no other art, Oliver Sacks suggests, we find expressed a whole range of emotions, some of them not even nameable, and their resolution. Maybe it is this unnameability that is so problematic for therapists, ‘Why it circles and returns/ instead of giving a straight answer/ as the Gospel demands.’ as Adam Zagajewski puts it in his poem, ‘Late Beethoven’. (RD Laing once remarked that music told him, a lonely child, that other people had the same thoughts and feelings as he did, that he was not alone in this. It was ‘a connection to the heart of humanity’.) For some time I wanted to write a story about a character, the music healer, who would advise people on music they might listen to accompany them in difficult (indeed not always difficult) periods in their lives. ‘Maybe,’ he might say, ‘you should listen to Miles Davis’ Kind of Blue every evening for a while, or Shostakovich’s Preludes and Fugues for piano or try Arvo Part’s Fratres ....’. (Incidentally, as the musician and writer David Toop remarks sharply, the music produced by men in popular genres surely gives the lie to the nostrum that men cannot express what they feel.)

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Ordinary
What is ordinary is pathologised - loss, grief, ageing, illness, jealousy, obsession, anxiety, redundancy. Psychotherapy becomes part of the process of what Tana Dineen calls ‘manufacturing victims’.(Dineen, 1999) Having started out as an attempt to normalise the pathological, or at least place it on a continuum with the normal, therapy has ended up making the normal a problem. What is called for, as Peter Lomas has consistently argued for a long time, is a return to the ordinary, to the everyday ways of being and thinking that are too easily dismissed by the professional. Indeed, the further the therapist moves from the ordinary and everyday, in the speculation and investigation of fantasies for instance, which are in any case unprovable, the further he may disable the patient from being ordinary and living an ordinary life (Lomas, 1999)
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‘Oh my body, make of me always a man who questions.’ (Fanon, 1968, p. 165) 

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Recognition
Despite all the criticism and qualifications therapy matters, or can do. It is certainly not the most important thing in the world and there are many types of work that are more beneficial to the world. But, in small ways, and maybe not so small ways at some times, it is important and can help people to lead lives that are less disturbed and more creative, more alive.

In therapy we do what? We listen to another and in doing so we recognise her as another human being. We put into practice the idea of the Roman poet that ‘Nothing human is alien to me’. This is not something other to me but this is also me, at least in possibility. This may be the first time that someone has ever taken this stance in relation to this person.

We listen to the people who come to see us and we listen in a way that other people do not listen to them and maybe never have listened to them. We engage with them. We reflect with them and we offer a space in which such thought and reflection might, against the odds, take plae. We are interested and if we are not we are interested in thinking about why not. We help to clarify and demystify. We offer, as David Smail puts it, a form of solidarity. We show people that they are not alone. ‘Do not leave me in my solitude’ as the philosopher Emmanuel Levinas puts it, is the cry of the other to me (Mortley, 1991, p. 15). We offer our thoughts drawn from our own experience in life as much as our work. We help people come to terms with who they are, to accept who they are with all their faults and limitations and, in so doing, maybe help to open up new possibilities of who they might become. Recognition is not about some phony niceness, although there is nothing whatsoever wrong with tact and manners, something too many of us have forgotten in our professional (de)formation. ‘I would meet you upon this honestly.’ as Eliot puts it, an honest meeting, an attempt at one, where everything can be talked about. And if I experience someone as arrogant or mean or self-obsessed I have a responsibility to articulate this in a manner that is appropriate to the occasion and I must be prepared to hear difficult things about myself also.


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Scepticism
Scepticism is not be confused with cynicism - to know the price of everything but the value of nothing, as Oscar Wilde put it. Nor is it to be confused with a posturing, usually associated with a certain kind of post-modernism, which appears to hold that we can know nothing or that all positions and perspectives are of equal value. Scepticism holds rather that we are entitled, indeed enjoined, to question. ‘What is the basis of your belief or assertion? How do you know that?’ If we are unable to ask these questions we might as well give up whatever it is we are doing. ‘Language’ says the philosopher Emmanuel Levinas, ‘is already scepticism’. The very fact of language enables us to put things in question, not to take things for granted. This is part of the responsibility of being a human, speaking being.

Whether it is an epistemological position valid for all seasons is debatable. That it is a valuable, even necessary position for the psychotherapist seems less so. Scepticism is not some easy option, an excuse for mental laziness. Far from it. A sceptic has to work a lot harder, think a lot more for herself. Like the agnostic in the field of religion there are no easy dogmas to follow, to fall back on. (‘It’s in the Bible/Koran/Torah’; ‘It’s God’s will’, ‘Jesus/Moses/Mohammed decreed.....’) Life is a lot harder when you have to think for yourself.



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Therapisation (of everyday life)
The growth of therapy has contributed also to what one might call, if rather inelegantly, the therapisation of everyday life, the ways in which the language and culture of therapy have infiltrated spheres of life outside of the clinical encounter as well as the ways in which people have come to see themselves. In some ways, this is no bad thing. It is right, for instance, if institutions such as prisons and the criminal justice system become less punitive and more understanding of what it is in people’s lives that lead them to do the things they have done. It is right that we increasingly recognise that the experience of learning is a profoundly emotional one as well as an intellectual one. But there are other ways in which therapy affects the culture which are much less welcome, indeed which ought to make us rather worried.

At an everyday level there is the way in which therapy is proffered as a solution for almost everything - bereavement, redundancy, illness, separation and divorce. It is shocking how quickly therapy or counselling will be offered or suggested to someone who has suffered in some way. Moreover, the suggestion, ‘Maybe you should think about seeing someone?’ can, all often, be a way of saying, ‘Actually I don’t have time for what you are going through’. In this sense the culture of therapy can justly be accused of contributing to the weakening of more ordinary bonds, especially those of family and friendship. In the same vein, there is the terrible language of therapy that has invaded the culture. People don’t talk to or with one another, they ‘share’; people don’t cut or burn themselves, they ‘self-harm’; people don’t refuse to do things, they are ‘resistant’ to them; people do not disagree about things but are ‘in denial’; people are not oppressed or exploited but have low self-esteem.

There are more far reaching ways in which therapy has invaded the public culture in ways which are far from welcome. There is the way for instance in which the provision of therapy is seen as the answer to deprivation which is material. The denial of material resources to schools, for example, which prevents them doing the job they are supposed to be doing, not to mention the vilification and denigration of teachers that has become a regular feature of public discourse, is not going to be set aright by the provision of psychological help. This is not, it must be emphasised, an argument against therapy. It should go without saying that schools should have access to whatever help they need, psychological or otherwise.

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Universalisation
One of the most regrettable tendencies in psychotherapy is the tendency to universalise, to make general statements from specific situations. Practising therapists fall into this trap all the time when they use a highly specific clinical example as proof of a general theory. More fundamentally Freud generalised hugely from his own experience or, rather, his thoughts about his own experience. He assumed, for instance, from his own love for his mother and jealousy of his father a universal syndrome, the Oedipus complex. What was true for Freud had to be true for everyone at all time, a pretty narcissistic view of things (Heaton, 1993, p.116). Not only that but Freud drew from his own experience of an authoritarian father-son relationship the conclusion of an inevitably authoritarian politics. This helps us to understand, although not forget, Freud's dedication in 1933 of a copy of Why War? (his exchange of letters wth Einstein) to the Italian dictator Mussolini with the inscription 'with the respectful greetings of an old man who recognises in the ruler the cultural hero' (Brunner, 2001, p.170).

 

 

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Virtue
In his attentive and thoughtful reading of the writings of Primo Levi, Robert Gordon argues that what makes Levi meaningful to millions of readers who have never experienced a fraction of the horror that Levi endured, what can make him seem almost like a friend, are his ‘ordinary virtues’. These are the virtues of listening, of common sense (not really that common of course), of friendship, of wit, of discretion. From every page exudes ‘a practical, engaged sense of living, working and writing’ along with an unceasing commitment to various forms of practical intelligence (Gordon, 2002, p. 89). It is this practical wisdom which through intelligent engagement with the world can clarify or humanise experience.

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Wonder
There is a predictability of intellectual life, a deadness even in the therapeutic culture. Nothing surprises. Nothing cannot be explained or understood. The book, the film, the play and, of course, the person, none can escape the grasp of psychotherapeutic theorising. But let us be honest. How often does one really want to read that book or article or attend that lecture or seminar, particularly after formal qualification? Very rarely in my experience. The reason is simple. Before one has even opened the book or gone to the lecture one knows what one is going to hear. It is all so predictable, so lacking in any kind of freshness, let alone excitement. (Of course there are exceptions; there always are. But all too often the exceptions are less illuminating in themselves than as signifiers serving to point up what is wrong with all that is not exceptional.)

Wonder, Peter de Bolla writes, is not the same as awe, or rapture or surprise, each of which can involve a paralysis of other senses. By contrast wonder requires us to acknowledge what we do not and indeed may never know, to acknowledge the limits of our knowledge: ‘It is ... a way of knowing that does not lead to certainties or truths about the world or the way things are. It is a state of mind, of being with the world and oneself that, like being in love, colors all that we know we know. (de Bolla, 2001, p. 143)

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‘Because everything connects in the end, or only seems to, or seems to only because it does.’ (DeLillo, 1998, p 465)

 

 

 

 

From Between Psychotherapy and Philosophy: papers from the Philadelphia Association, edited by Paul Gordon and Rosalind Mayo (Whurr, 2003)