Democratize Psychotherapy

Democratize Psychotherapy

You might think a solution to the mental health crisis is making therapy universally accessible.  This is dangerously wrong.  The function of psychotherapy is to tell people that societal failures are actually private problems. Bernie Sanders’s entire campaign message, both in 2016 and in 2020, was about uncovering and repudiating this lie. This warped understanding—that our collective problems are really personal failures—is a key feature of both the current practice of psychotherapy and the function of uninhibited capitalism. At its core, psychotherapy is an oppressive tool of capitalism that we need to move beyond if we are to achieve a fully collective society. 

Psychotherapy as an Oppressive Practice

Psychotherapy has a sordid history as being a profession that keeps people in line and upholds an unjust social order. For much of the twentieth century, for example, psychotherapy served as a voice of authority that kept women in their place and upheld the existing social order. 

Betty Friedan’s Feminine Mystique, which is widely credited with sparking the beginning of second-wave feminism, makes this explicitly clear: “Freud’s followers could only see woman in the image defined by Freud—inferior, childish, helpless, with no possibility of happiness unless she adjusted to being man’s passive object—they wanted to help women get rid of their suppressed envy, their neurotic desire to be equal. They wanted to help women find sexual fulfillment as women, by affirming their natural inferiority” (186). As Friedan fiercely concludes in the opening paragraphs, psychotherapists taught women “that truly feminine women do not want careers, higher education, political rights—the independence and the opportunities that the old-fashioned feminists fought for” (2).

What did this kind of psychotherapy look like in practice? Susie Orbach gives an example in her essay, “Beyond the Fear of Intimacy,” when she describes therapy sessions in the UK in the 1980s:

Returning to live and work in the United Kingdom (in 1984 in the heyday of Kleinian practice) I discovered that the patient—for much of British analysis—had become not so much an individual to be engaged with, as someone whose defense structure needed to be excavated…I got the feeling that there was a maddening kind of “gotcha” operating. The patient, who invariably didn’t know the rules of therapy, would somehow transgress them. He or she would comment on the books on the therapist’s shelves (envy of the analyst’s knowledge or distrust of the analyst’s capacity to think without props), say hello on bumping into the therapist in the street (invading and inappropriate), talk too much (controlling the space), talk too little (not allowing anything to penetrate), feel too much (being unable to think), or not have sufficient affect (defending against desperation, devastation, depression)…all of which were inevitably interpreted as evidence of [patients’] defenses against being in therapy in the way the analyst wanted them to be (398).

These kinds of interactions, multiplied billions of times over across several decades, have played an important part in maintaining an oppressive social order—an order in which those who know “the rules of therapy” are placed above those who do not know the rules. More often than not, those who don’t “know the rules” are already oppressed in some way, whether due to their race, class, gender, or education level.

Peter Levine, the creator of Somatic Experiencing body therapy, best describes the effect psychotherapy has on people today: psychotherapists are experts at calming people down, but that’s generally the only change that happens. And when people are calm, they are less likely to seek real, meaningful change in the wider world.

When explaining his own approach to psychotherapy in a 2008 book, Relational Theory and the Practice of Psychotherapy, Paul Wachtel discusses this “calming down” effect, though he doesn’t use that exact phrase:

One consideration that has shaped a good deal of how I work derives from an experience that I have had on surprisingly numerous occasions. As a teacher and therapist, I regularly get into conversations with people (apart from my own patients) about their therapy experiences. In these conversations…I have noticed…a pattern that has troubled me. The person describes how wonderful his therapist is, while it seems to me, from all I hear or know about the person, that he is still living his life in the same painful and self-defeating way. From what I can discern, the relationship to the therapist has improved. There is a vitality, aliveness, and genuine connection in the room that perhaps was not there when they began. Consequently, the therapist too has probably felt that good work was being done. But the patient’s life outside the sessions is not nearly as different. He continues to live in a way that is painful or constricted. The therapist becomes a wonderful oasis, but the patient still lives in the desert (283).

I’ve been a client with eight different individual therapists, as well as in two long-term groups, and this was my experience every time, both for myself and for the other people in my therapy groups. Every time, we were unaware of it. I was unaware of it myself until I read the above passage. No one in my graduate program for counseling ever mentioned that this was a possible problem, and none of my therapists ever seemed to be aware that it was a problem they should look out for. The entire field of therapy seems to be willfully ignoring this extremely common problem, likely because it’s a problem that can’t be overcome.

I suspect that many clients accept this because therapy is engaging and mentally stimulating, even if it’s not effective at changing their lives. This mental stimulation can provide some fresh ideas about how to live, but these can also be found in self-help books, and talk therapy promises much more than that. 

If there’s trouble substantiating the idea that talk therapy functions as a subtle form of oppression, it’s not because therapy is helpful to most people but because of the dynamic Wachtel details: many clients like the calm of the oasis and don’t realize that they’re still in the desert. If people understand that they’re still in the desert and that their therapist isn’t helping them out of it, they’ll start to see the ways in which psychotherapy is subtly oppressive. 

The Therapist-Client Relationship

One of the chief sites for psychotherapy’s oppression is in the therapist-client relationship.

The fact that clients are expected to be vulnerable and share intimate aspects of their personal lives, while therapists are allowed to remain invulnerable and not reveal anything about themselves creates a subtle power imbalance. In addition, clients are generally supposed to see therapists as authorities, while therapists do not—despite what some say—see clients as authorities, further emphasizing this imbalance and hierarchy within the therapist-client relationship. The fact that clients willingly submit to this and pay for it doesn’t change this dynamic. 

When one person comes into a relationship declaring that they’re the problem, it takes responsibility away from the other person for their side of the interaction. Therapy does not work because, in therapy, therapists do not take full responsibility—or any responsibility, really—for addressing and rectifying the relational problems between therapist and client that they have a hand in creating and perpetuating. Therapy allows therapists to stand at a distance from and analyze clients because the therapist-client relationship is a cross-class one. There’s no way to heal such relational problems in the context of therapy. They can only be solved outside of therapy.

It’s well-documented that therapists are not necessarily any better at interacting with people outside the therapy session than clients are. Paul Wachtel makes this point in his 2014 book, Cyclical Psychodynamics and the Contextual Self, saying, “[I]n their own lives outside the consulting room, there is little indication that therapists interact with their friends, children, or intimate partners any more effectively or benignly than anyone else” (81). This strains and undermines the notion that therapists are authorities on human relationships and emotions. In this context, the power imbalance between therapist and client seems more artificial and designed to oppress than to help. 

Today, it is conventional wisdom among therapists that psychoanalysis was bad in the past but isn’t now. In 2020, therapists of all stripes emphasize warmth, collaboration, and the idea that the client is an expert on themselves. This leaves many people with the belief that the inherent power imbalance and resultant abuses of power in psychotherapy have been overcome by better ideas about what’s therapeutic. However, a closer look reveals that problematic aspects of psychotherapy still exist and can’t be eliminated because they’re inherent in the therapist-client relationship. 

To draw a rough analogy, this is similar to how many white people have approached race relations and racism since the end of the Civil Rights Movement: by declaring that they don’t “see” race and that racism has largely been solved. However, power imbalances still exist between races, and no amount of collaboration or heartfelt expressions of care can paper over them. Unfortunately, acknowledging the need for respect cannot replace actual respect, both in society and in the therapy room. Actual respect is what counts, and in order to actually respect clients, the power imbalance must be eliminated. The only clear way to do that is by eliminating therapy as a practice altogether.

Psychotherapy as a Tool of Capitalism

In our society, the dominant mode of thinking is that anyone who has a problem caused by capitalism—such as depression, anxiety, and the struggles neurodivergent people experience simply trying to live within narrow, capitalistic structures—just needs to go to a therapist who will tell them that they’re actually the problem. If the individual is the problem, not the system, there is no need to “fix” the system. Just fix the individual instead.

Mark Fisher writes about mental health and capitalism in his 2009 book, Capitalist Realism:

[There is] a correlation between rising rates of mental distress and the neoliberal mode of capitalism practiced in countries like Britain, the USA and Australia…it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill? The “mental health plague” in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional, and that the cost of it appearing to work is very high (23).

In this context, it’s no surprise that Sigmund Freud’s ideas were the building blocks for the highly capitalistic public relations industry. Adam Curtis examined this deftly in his 2002 film, The Century of the Self. Throughout much of the twentieth century, large corporations used the tools of psychotherapy and public relations, as Elizabeth Fones-Wolf explains in Selling Free Enterprise, to redefine the meaning of Americanism to emphasize individualistic, as opposed to collective, ways of dealing with inequality. They instituted massive propaganda campaigns, which included community organizations such as schools and churches. The National Association of Manufacturers put their aims succinctly in a December 1950 bulletin: the business community was characterized as fighting an “everlasting battle for the minds of men” (52).

These two fields of thought control—psychotherapy and public relations—were mutually reinforcing in the American capitalist society. Just as the public relations industry fought for control over Americans’ consciousnesses outside the therapy room, psychotherapists did the same thing inside the therapy room. 

In the US, our institutions make it easy for us to lead solitary, individual lives. At the most basic level, the majority of workers are told what work they’ll be doing, and they don’t negotiate with others on how to divide up tasks, as has happened throughout most of human history. At an institutional level, corporations, the institutions that have the largest effect on our daily lives, are extremely secretive. We don’t know what they’re planning to do until they decide it’s in their interests to tell us. They don’t have to respond to FOIA requests or even polite requests from middle management. 

Since humans across all societies have spent thousands of years controlling production and resources, the fact that we no longer can means we’re separated and atomized in the workplace, where we spend most of our waking hours. When that happens, it can be difficult to build a collective life outside the workplace. We have become too used to the structures of competition, privacy, and secrecy that we are raised in from our earliest schooldays to our working days in corporate America.

There’s nothing inherently wrong with competition, privacy, and secrecy on an interpersonal level, but when they come to dominate a society and a culture, mental and emotional health suffers. As Adam Curtis explains in his 2007 interview in The Register, “What people suffer from is being trapped within themselves - in a world of individualism everyone is trapped within their own feelings, trapped within their own imaginations.”

A recent, well-documented society that operated very differently was the one made up by kibbutzim in Palestine in the early twentieth century. These societies were colonial, but that doesn’t mean there aren’t things we can learn from them and adapt to the decolonized world we want to build. In The Kibbutz, Daniel Gavron writes about how kibbutz members shared not only their possessions but also their psychic materials. Gavron quotes one kibbutz member, “Everything was shared: not just accommodation, food, and clothing but doubts and fears, pain and joy, anger and ecstasy…[N]othing was off limits; there were no secrets, and the members shared their most intimate feelings with the whole group. All members disclosed their thoughts, exposed their anxieties, and laid bare their character. If two members made love, they were expected to share the experience with the entire community” (45). I’m not sure I’d like to share my sex life with everyone, but it is clear that this collective society was able to support individuals’ emotional and psychological needs without the help of therapists.

In another passage from The Kibbutz, Gavron quotes Shulamit, one of four girls in a twenty-six member group, who says, “Oh, how beautiful it was when we all took part in the discussions…Nights of searching for one another—this is what I call those hallowed nights. During the moments of silence, it seemed to me that from each heart a spark would burst forth, and the sparks would unite in one great flame penetrating the heavens” (45). Shulamit is describing a mutually supportive society that is not only deeply fulfilling for individuals but also incredibly exciting. It also sounds much better than being calmed down in a therapy session. 

The kibbutz members’ discussions and sharing of their most intimate feelings were connected to the ideas that animated their politics, economics, and vision for society. Collective discussions likely seemed natural not only because of their political ideas but also because the institutions they created supported their desire to have collective encounters. It’s likely easier to share your intimate thoughts and feelings when you’ve built up a level of trust with others by making decisions collectively at work and at bimonthly political meetings. In the United States today, therapy doesn’t support that kind of collective group work, and capitalism actively discourages it. Both only reinforce the trend toward social isolation.

A Collective Future

We don’t need to wait for a revolution to talk to one another. Neighborhoods can form groups in the same way people form book clubs. That’s actually how many movements have started. The second-wave feminist movement began in part when women got together in book clubs and began to talk about their lives. They quickly realized that what they were experiencing was common to all of them. That’s something therapy, with its secretive nature, can’t provide. There’s no reason why these neighborhood get-togethers can’t be replicated for other issues, including economic ones. They could be a basis for people to launch tenant unions or mutual aid groups.

I would also suggest that we use psychotherapists’ insights to liberate ourselves. I first learned about the idea of using the knowledge you’ve gained in oppressive institutions to liberate yourself from those very institutions while watching a 1970 debate between Noam Chomsky and Michel Foucault. At one point, Foucault asked Chomsky how Chomsky could work at the Massachusetts Institute of Technology (MIT) when he so vehemently opposed the Vietnam War, and MIT was involved in creating the very weapons used in that war. Chomsky replied:

“[A]s to how I tolerate MIT, that raises another question. There are people who argue, and I have never understood the logic of this, that a radical ought to dissociate himself from oppressive institutions. The logic of that argument is that Karl Marx shouldn’t have studied in the British Museum which, if anything, was the symbol of the most vicious imperialism in the world, the place where all the treasures an empire had gathered from the rape of the colonies were brought together.

But I think Karl Marx was quite right in studying in the British Museum. He was right in using the resources and in fact the liberal values of the civilization that he was trying to overcome, against it. And I think the same applies in this case.”

I would agree, and I think the same applies in this case. Countless books by psychoanalysts have provided us with an enormous amount of information about how to resolve interpersonal conflicts and to trust ourselves. There is no good reason for us not to democratize what these therapists have found and apply it in a context that can actually help us. Allowing a specialized caste to hoard insights about human relations is a recipe for societal dysfunction. Instead, let’s use psychotherapists’ best insights to overcome psychotherapy and other oppressive institutions so that we can start building a more collective society. Let’s stop thinking an occasional visit to the oasis is satisfactory. Let’s get out of the desert.