Something's fishy, things aren't adding up
Something’s fishy, things are not adding up
Over the years, as both a therapist and client, I’ve noticed that some things about therapy don’t make sense. I’ve written a few of them down below so that you can get a sense of what’s propelling me to write this essay. I think as a big a problem as any of these questions, though, is the problem of why other therapists aren’t talking about them all the time and trying to find answers to them. That’s very concerning to me as well.
As a client I noticed many unusual things which didn’t make sense about therapy and the culture surrounding it. For example, I learned that my therapists are not necessarily any better than I am when they interact with people outside of the therapy session. Wachtel makes this point in Cyclical Psychodynamics (CP), saying “in 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,” (p. 81n1). Why isn’t the general public’s assumption--that therapists are masters at relationships--correct?
Therapists’ conventional wisdom is that therapists need to go to therapy in order to be effective with clients. If (1) most therapists are currently in therapy or have been in therapy and (2) therapy isn't helping therapists "interact with their friends, children, or intimate partners any more effectively or benignly than anyone else", then (3) when is anyone getting better? Does talk therapy not resemble a racket?
Why is it that therapists are interested in and intent on analyzing what clients say, but they don’t have any systematic understanding of what to say themselves? In Therapeutic Communication, Wachtel elaborates on this point, writing, “It is by now widely recognized that, when listening to a patient, it is at least as important to notice how the patient communicates as to hear what he says—indeed that very often the ‘how’ is the most important ‘what’ that the astute listener can pick up. But a corresponding literature on the how of the therapist’s communications is scarcely to be found,” (p. 23). Later, in graduate school, I learned that therapists-in-training are often intensely interested in what they should say, and their teachers respond most often by telling them that the right thing to say will come to them when they understand the relationship.
As a client in many therapies, including group therapies, I learned that therapy is often ineffective, and that therapists are either unaware of it or uninterested in it. To wit, Paul Wachtel writes in RTPP:
“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—with acquaintances, colleagues, students—I have noticed with some frequency 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,” (p. 283).
Why is it that in all my years of therapy and my three years in graduate school no therapist ever mentioned this common problem? In all of my many therapeutic relationships both I and my therapist thought I was making progress because I had a good relationship with my them—not because I was getting better. Yet none of us recognized that until the therapy’s end. Only after a long time with each therapist was I able to realize that I hadn’t changed much at all, and though some therapists recognized my lack of change, others defensively refused to accept it.
After reading the passage above from Wachtel about the oasis and the desert and realizing no one had pointed out this common problem to me before, I began to believe there’s a lot of self-deception involved in being a therapist and, at times, a conspiracy of silence among the entire profession. To be sure, as Wachtel’s passage notes, there also seems to be a lot of self-deception among clients about what they’re getting out of therapy. If therapy is as ineffective as I’m claiming, it couldn’t continue to exist if clients were entirely aware of it. For many therapists, self-deception is not hard to permit. Therapy is a private practice after all. Therapists who say they’re successful are operating on the honor system. No one but the therapist and the client knows what’s happened behind closed doors.
If the cyclical psychodynamic view Paul Wachtel has developed is correct, why do therapists use the terms transference and counter-transference? Why is the starting point of our understanding what the patient/client is doing and we say then that the therapist is just reacting to that? My view is that we use those terms because therapists are deceiving themselves about what's happening. Many relational theorists say that the terms like “bidirectional”, “reciprocal”, and “interactive field” better capture what happens in therapy than the terms transference and counter-transference. If therapy is bidirectional and reciprocal, though, why in every relational therapy does the client think about the therapist more and more intensely than the therapist thinks about the client? Why too, if the relationship is bidirectional and reciprocal are there so many problems with therapist self-disclosure but not with client self-disclosure? Finally, even if therapy sessions eventually become reciprocal and bi-directional (a dubious proposition) don’t therapy sessions begin each time still with what the client is doing? Even if we think of the beginning of each therapist-client encounter as happening outside of the therapy room, the beginning is the client showing up to the therapist's office, right? Or if we go back even further, therapists advertise on Psychology Today while clients come to them because they’ve developed problems which predate those ads. The therapist is the beginning becaue the therapist has to have an office for clients to go to and advertisements for the clients to respond to. If we go all the way back, did people have interpersonal neuroses before Freud decided to become a therapist to cure them (recall what Ogden, tweaking Winnicott’s phrase about mothers and babies said: there is no analysand without the analyst; RTPP, p. 38). Whatever terms we use to describe the interaction, there’s no doubt that therapists have on their minds clients’ problems and clients know they’re expected to talk about their own problems. From a cyclical psychodynamic view, there’s no reason the client should be focused on more than the therapist.
Why did Freud say that “what is advantageous to our therapy is damaging to our researches,” (quoted and discussed in RTPP, pp. 44, 47-50)? Relatedly, in The Limits of State Action Wilhelm von Humboldt made a statement I think is self-evidently true: “Every human being . . . can act with but one force at the same time: or rather, our whole nature disposes us at any given time to some single form of spontaneous activity.” If both Freud’s and von Humboldt’s statements are true, what aim was Freud pursuing in therapy? What aims are therapists pursuing today?
Why do therapists constantly note that, more than any theoretical orientation, what’s healing about therapy is the relationship clients have with their therapists, and yet therapists constantly vouch for each other as great therapists without having seen how the person they’re vouching for creates a relationship with their clients? Therapists seem to be judging each other’s competence, if not their own, by how intelligently they can talk shop with one another. It seems that for many therapists talking shop—in a casual, personable way—is how they establish relationships with their clients.
It also seems that one way to understand if people are being treated fairly is if their failings are seen as due to a context as opposed to who they innately are. I learned that very quickly when, for example, trying to understand why some people are poor. If understanding context is central to treating people fairly, what does it say about therapy that it began with a one-person point of view about patients, and it required therapists to engage in decades of painstaking work to arrive at a two-person point of view? Moreover, what should we conclude about the fact that for decades therapists excused their own bad behavior on the thinnest of pretexts by calling it projective identification?
In Psychoanalysis, Behavior Therapy, and the Relational World, Wachtel writes, accurately in my view, that a primary goal of therapy is to help people become more responsive to the world. In light of this, what does it say about psychotherapy that over the history of talk therapy, clients have seemed to be much more responsive to their therapists than vice-versa?
Why did even relational theorists praise Wilfred Bion’s idea of approaching clients “without memory, desire, or understanding” even though if anyone on the street was asked about the idea they’d find it ludicrous, and no one outside of psychoanalytic circles thinks it’s possible, less a good idea? (Wachtel, RTPP, p. 140).
In Cyclical Psychodynamics Wachtel writes clients’ problems are not theirs or anyone else’s alone but due to the relationships they have with other people: "Indeed, one might even argue that the process whereby others are continually recruited into a persisting maladaptive pattern is the neurosis." That's correct in my view, and if therapy is ineffective, does it seems probable that therapy—the relationship—is a process by which clients try to recruit therapists as “accomplices” (to use Wachtel’s terminology) to maintain their neuroses. It seems though that due to the nature of the therapeutic relationship, therapists can never be fully roped in to clients’ lives as accomplices. If it isn’t possible for therapists to become full accomplices in clients’ lives and vicious circles with clients, why—besides the fact that it’s convenient—do we think it’s possible for them to create virtuous circles with clients?
Why, according to Wachtel, did the first-wave behavior therapists have a more personal touch with their patients than psychoanalysts, even though psychoanalysts were concerned with patients’ intimate thoughts and feelings (CP, p.46n8)? And why did first-wave behavior therapists have a more personal touch than psychoanalysts when behavior therapy is grounded in a theory which analogizes humans to pigeons and dogs?
Why did trauma expert Peter Levine, the creator of Somatic Experiencing therapy, say in an interview that the thing most therapists are experts at is helping people calm down but therapists often struggle to do more? Being calm is not a bad state to be in but why are all therapists from all theoretical orientations good at this? Further, what is making—and keeping—people calm in therapy if it’s not the resolution of their problems? Is there something in the nature of the therapy session which keeps people calm? And doesn’t this calming effect contradict the idea that the purpose of therapy is to be more alive? (Levine interview: https://www.psychotherapy.net/interview/interview-peter-levine)
Why has there never been a seminar or conference about the incredible damage one-person theorists inflicted on people for decades? Why did therapists move on like nothing had happened? Isn’t it natural for people who want to help to acknowledge the harm they’ve done, own it, and periodically reflect on it so that it doesn’t happen again?
To help therapists empathize with their clients, Wachtel quotes Leston Havens’ comment that “In the current interpretive climate of much psychotherapeutic work, patients sit waiting for the next insight with their fists clenched. Small wonder, for it is rarely good news,” (see RTPP: p. 173 for source). I think most clients, if not the general public, would agree that that was an accurate depiction of therapy at least at a time not too long ago. Wachtel doesn’t write for the general public, though. He writes for other therapists. Is it not telling then that Wachtel introduces Havens’ comment by describing it as “provocative” so as to express an attitude toward Havens’ comment that therapists are likely to accept? I don’t think Wachtel would need to imply that Havens’ comment is controversial to get members of the general public to accept it. I think that would actually turn a fair number of people off. Why is it then that members of the general public are less threatened by an accurate description of the therapeutic relationship than therapists are? Are therapists protecting something?
Did the relational or two-person point of view develop by therapists having epiphanies in session about what works with clients? Or did therapists develop the relational and two-person points of view by having epiphanies about what works with people in their personal lives and then applying that knowledge to clients in session? I think the answers to those questions are crucial.
Why are there very few citations for theory of cyclical psychodynamics, and they’re all from Wachtel? Why is no one else writing about this theory that’s obviously true?
Does confidentiality serve the therapist in addition to or with greater force than it serves the client? Does confidentiality shame clients, making it less likely that they’ll talk about or even notice what went wrong in their therapy sessions? Does confidentiality create a taboo which makes it so that people feel uncomfortable listening to clients talk about their negative experiences in therapy?
Why have Freud’s insights largely not penetrated the consciousnesses of those in the lower class? That seems very funny to me. Any time a dominant social or economic class relegates to itself a domain of study or body of knowledge—for example, economics—I presume that what they’re doing with it reinforces, or at least doesn’t threaten, their class’ dominance. The same domain of study or body of knowledge can often liberate people, but only when it’s employed in a different way than the dominant classes are employing it. It’s further unclear to me why, if psychotherapy is liberatory, it wouldn’t threaten to end class divisions. People who are more fully realized understand naturally that class divisions are artificial and oppressive.
Why are therapists calling therapy a special situation which can’t happen anywhere else? It seems unlikely that after 100,000 years of modern human history, people discovered a brand new way to be with each other in the last 80 years. And while many therapists 80 years ago said that therapy was the way for people to get the lives they wanted, pretty much everyone in the field has had to walk that claim back. That’s interesting, isn’t it?
My understanding of all of these problems is that they’re caused by a relational theory which isn’t fully contextualized. I intend to contextualize that theory.