The Hope of Therapy


The argument of this book can be stated simply. Therapy is inherently an ethical endeavour, both in the sense that the therapist is called upon to be responsible to and for people who seek her help, and in the sense that therapy is inevitably bound up with ideas about how we should live and how we should treat one another.   People suffer emotionally because of their experiences in the world and it is one task of the therapist to address this experience to help people make sense of it, to come to terms with it.   This endeavour takes place within a particular form of time and space whose function is to make possible a particular kind of conversation, a conversation with no predetermined limits or ends.   Therapy is not a scientific or technical process.   It is rather an art or craft requiring a particular sensibility or disposition.   As such it has much to learn from other forms of art and craft, such as painting and the visual arts, fiction and poetry.   Finally, I believe, therapy inevitably carries within it an idea of hope, hope both for the individual who seeks help and hope for a better world.   In this sense it is, to me at any rate, part of the great unfinished, indeed unfinishable, project of the Enlightenment and of humanism, that we can be more truthful to ourselves and therefore more free.

There is, of course, a great deal that is wrong with therapy. Its beliefs can be seriously wrong-headed, as in its ideas of penis-envy among women or its beliefs of repressed memories of trauma waiting to be recovered.   The damage done by such nonsense is impossible to calculate. Therapy can be almost religious, like a cult with its beatified figures, holy texts, sites of pilgrimage, lines of succession, not to mention the need to expel deviants who threaten the purity of the cause.   (When Freud spoke of 'the narcissism of small differences' he did not know he was describing the future of the movement to which he had contributed.)   Therapists themselves can be unbearably smug while the therapeutic encounter is, of course, a situation open to abuse, to be used for the gratification of therapist, personal, financial or even sexual, or even just the confirmation of preconceived ideas.   The accounts of inconsiderate or even bad behaviour are many, too many to be dismissed out of hand.   Time and time and time again one hears the stories of men and women who are vulnerable, in distress, who turn to a therapist for help and who find not compassion but arrogance, not open-mindedness but dogma, not an open conversation but one whose terms have been fixed by one side in advance.   Nor are they   just stories one hears for therapists too have their own experiences of therapy and these are far from universally good.

But these 'specialists without spirit, sensualists without heart' (Weber) are only part of the story.   If they were not no one could possibly be a therapist in good faith. Most people one comes across who have been in therapy have been helped by it, found a place where they have been listened to, perhaps for the first time in their lives.   Most therapists do not seek personal aggrandisement, do not take advantage of the people who come to see them   but are content to dwell in that zone of humility in the face of so much human suffering and endurance.

I took the decision to write this short book - or rather the decision took   - in June 2005.   It was early morning, summer seemed finally to have arrived, and I was on a high speed train, going to Kendal to an exhibition by the painter Sean Scully that I had wanted to see for some time.   It was one of those days, too rare, when everything   seems possible, or at least a great deal,   A few days earlier I had spent a day with people involved at a local counselling project in Oxfordshire who had invited me to talk about the ethics of therapy.   Not for the first time I had been impressed at the difficult and completely unsung work such people were doing in their locality. At the same time, and again not for the first time, I had been taken aback, dismayed at some of the beliefs held by the people that I met.   They clearly saw counselling and therapy in terms of technique, in which there are right and wrong things to say, correct and incorrect ways of doing things.

At the same time I was touched by people telling me how much they had got from my book Face to Face: therapy as ethics , and from other pieces I had written since.   Published in 1999, Face to Face had clearly touched a chord in the world of therapy and counselling and over the years many people told me how it had articulated something for them.   This was pleasing indeed - it is what writers want to hear - but the book had been unavailable for some time and, in any case, did not quite represent where I stood now.  

Much of what I have written before has taken the form of critique or questioning of psychoanalytic theory or the practice of psychotherapy.   This is important.   One of my favourite remarks by Marx is from a letter he wrote where he says that it's not up to us to set out blueprints for the new society but rather to engage in uncompromising critique of what is, uncompromising in the sense that it doesn't fear its own results or the conflicts with authority it may bring about.    And I have been concerned to put in question some of what seems to me wrong in this field.   The first chapter of Face to Face was called 'What's wrong with psychotherapy?',   and elsewhere I have asked questions about, among other matters, the racism of psychoanalysis and the absence of a radical politics in psychoanalysis.   Explicit critique is not however my central concern in this book.   Inevitably, any statement of position is implicitly critical of others but the principal point of this book is to put forward my own thoughts on matters that seem to me to be central to therapy.

I first started seeing people for therapy almost 20 years ago .   I never really felt happy with the eclectic melange of object relations thought, with a sprinkling of critical social theory, with which I emerged from my first training. It somehow just didn't sit right with me and the sorts of things I said to people who came to see me under the sign of that approach never really felt authentic. They were not truly my words.   I found my way subsequently to the Philadelphia Association, partly through hearing about the workings of some PA therapists, partly through the book of essays from the PA, Thresholds Between Philosophy and Psychoanalysis , published in 1989, which I thought then (and indeed continue to think) was like a sea breeze on a muggy day.   There was, it seemed to me, at least in some of the contributions, an enviable freedom of thought in evidence here, a genuine scepticism about many of the things that therapists too easily take for granted, combined with a rigorous philosophical thinking about matters that struck me as pretty central to the practice of therapy - the meaning of subjectivity, the nature of language, the significance of dwelling and community, the contours of the erotic and so on.   There was, it was clear to me, a very different kind of conversation about therapy going on here, one that I wanted to be part of.  

As I argue in this book I have come increasingly to see therapy   as a conversation, a particular type of conversation perhaps, but a conversation nevertheless.   But writing is also a contribution to a conversation of ideas and I hope this short book is read in that spirit.   Psychotherapy is full of schools and methods and I have no wish to add to them.   One of the dismaying things about writing a book is finding oneself being put in this position, of being slotted into a particular framework.   This is dismaying not only because I am not trying to found a new school but because I am trying to question the whole idea of frameworks (at least in this field) and to open up - and keep open - spaces for thought and for creativity.  

This book is written as a plea for therapeutic freedom of thought and action, an 'affirming flame' (in Auden's wonderful words from a time of unimaginable horror) in the face of an increasing technicisation of such care.   Therapy has for many years managed to stay outside of external interference and, on the whole, it has been the better for it.   Now those days seem numbered.   At the time of writing the British government has made clear not only its intentions to bring psychotherapy within the realm of state regulation but to do so under the rubric of 'health professionals',   a denomination which seems to me and to many others singularly inappropriate.   Except in the loosest sense possible, and therefore a meaningless sense, what I and others do has nothing whatsoever to do with health.   We stand in a different area altogether, in a completely different relation to those who consult others such as speech therapists, physiotherapists and occupational therapists.   Nevertheless if the state regulators and their many allies within the world of therapy have their way, psychotherapy will soon become subject to the hyper-regulation that has come to dominate - and suffocate - many other areas of social life.

One of the arguments of this book is that therapists have a great deal to learn from the creative arts and creative artists. Art can flourish only if it is free but this freedom is as much to do with a free-spiritedness, an attitude of mind, a position on the part of the artist, as it is do with a context.   (Great art has always managed to emerge from the darkest of times.)   The intention of this book is to encourage this free-spiritedness along with the immense responsibility that it inevitably carries.