Category Archives: Psychotherapy

Notes on the Psychotherapeutic Relationship: 1

The whole of the psychotherapeutic enterprise rests on the psychotherapeutic relationship. It strikes me that attempts to describe or define it have to overcome the difficulty that this mostly subconscious process takes place in private settings. Who is in a position to observe it? For this reason I intend to investigate it largely on the basis of my own personal experience, and using clues and pointers from others that ring true to me.

My first observation is that the psychotherapeutic relationship belongs to the class of human relationships that we call conversation, using this to include both verbal and non-verbal transactions. Here we can make use of the valuable observations of Theodore Zeldin. From Zeldin I draw a clear distinction between genuine and false conversation. In the genuine conversation each party enters in a generous spirit, prepared to emerge from the process having learned from it, having been altered. The fences are down; one is willingly risking that one may be wrong or mistaken, and may have one’s views transformed.

Conversation loses its genuine function when a power play is operating. This neurotic pseudo conversation is exemplified to comic effect in the one-upmanship books of the humorist Stephen Potter.

When the sufferer, client, analysand, patient, comes to psychotherapy, he is thirsty for genuine conversation but expecting to be thwarted, as his experience and his world view instructs him.

The psychotherapeutic relationship is a conversation in which power play is negated and a generous engagement in the sufferer’s interest on the part of the psychotherapist is felt by the sufferer. For this to be possible it is obvious that two conditions must be met: Firstly, the psychotherapist has to be capable of setting aside or overcoming any need on his part of showing or feeling superiority. Secondly, the psychotherapist has to demonstrate that the sufferer’s interests are paramount. Both these conditions must be met and be genuinely felt.

By negating the struggle for power the psychotherapist models a way of conversing, which opens up a dispassionate search for truth.

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Hope, Utopia, Heimat

Essential to meaningful psychotherapeutic intervention in the life of another human being is an understanding of human nature. It is often outside of academic psychology that we find the deepest springs of insight.

In particular I value a massive three-volume work that I acquired when I lived in Germany during the 70s: Ernst Bloch’s Das Prinzip Hoffnung. On the face of it what this Marxist philosopher deals with is the utopian and social-revolutionary current running through history and culture. At its base, however, there is more. This is evident in the poetic and prophetic tone, especially of the opening passages.

Mankind begins empty, and is in restless pursuit of fulfilment. This is not so much Marx as Hegel. Our waking dreams are of improvement, of harmony, of a life worth living, of a home-coming to a society entirely humane: Heimat.

It is when this most basic desire is thwarted that humanity is bitterly disappointed in the world, and feeling rejected by it in turn spitefully rejects the world. Mankind is then ashamed of its own impotent being.

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Thomas Nagel’s Case Against Reductionism

The currently most widely held view of the world is materialist. According to this view phenomena which appear immaterial have, or could only have, a materialist explanation. These phenomena could, in other words, be reduced to causal chains as physics and chemistry present them.

If we accept that view, mind, consciousness, intentionality, meaning, purpose, thought and value are mere appearances. And of course the only sciences that could legitimately deal with humanity would be physical sciences. And only medical therapeutics could deal with mental health problems. There would be no place for a psychotherapy which operated mind-to-mind.

There has always been a stubborn belief that such reductionism does not hold water and in 2012 there was published a cogent work of philosophy which revisited this ancient philosophical territory, Thomas Nagel’s Mind & Cosmos: Why the Materialist Neo-Darwinian Conception of Nature is Almost Certainly False (Oxford University Press).

Quoting from page 13: The conflict between scientific naturalism and various forms of antireductionism is a staple of recent philosophy. On the one side there is the hope that everything can be accounted for at the most basic level by the physical sciences, including biology. On the other side there are doubts about whether the reality of such features of our world as consciousness, intentionality, meaning, purpose, thought, and value can be accommodated in a universe consisting at the most basic level only of physical facts – facts, however sophisticated, of the kind revealed by the physical sciences.

And from page 16: My guiding conviction is that mind is not just an afterthought, or an accident or an add-on, but a basic aspect of nature.

This short book is recommended as a rewarding read, revealing the gaping hole in the materialist conception of the world. Science’s great challenge is to find a conception of the world that has a place in it for the mind, and an explanation both of its existence and its emergence.

Why should psychotherapists be concerned about this argument? Why shouldn’t we leave this argument to the philosophers and the scientists? Because the materialist prejudice invades our own territory. We too are prone to reductionism. The most insidious is not actually the crass reduction to physical causes but the assumption that only psychological mechanisms are at the root of human functioning and suffering: psychologism. We are prone to omit the social-embeddedness of humans, and their connectedness with the cosmos.

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Integration in Psychotherapy

Over the past century there has been a great proliferation of approaches to psychotherapy. Each school elaborates its own theory and practice, its own concepts and assumptions, and in its own language. The terrain of psychotherapy is a patchwork of fields separated by impenetrable hedges. Each school of thought is in competition with the others but at the same time acting as if the others were not there. Each is unintelligible to the others without a dedicated effort of translation and understanding. It is very unlikely then that real advances in the art and science of psychotherapy can spread beyond the schools where they are made.

In any other field we might expect to see competing theories and practices, it is true, but we would also feel that unity was being approached stepwise as the whole field moved conscientiously and cooperatively in the direction of truth.

I do not count the effort at integration, where psychotherapy and counselling courses lump together a few of the separate traditions, perhaps hoping that the students themselves will synthesise something useful. The Integrative students I have met for the most part think that they have been given a bundle of distinct tools, that they can select from. There is no integration here.

And indeed given the sheer number of distinct traditions, it would take millennia of each talking and listening to each before common platforms could emerge.

There is a better way. By rising above the field onto a philosophical plane we could establish the parameters of a genuine advance in psychotherapy. Fundamental to this undertaking is the need to establish a clear view of human nature in its connection with the world. It would need to be able to distinguish from each other both the apithology and pathology of the soul. This is what this series of postings hopes to contribute to.

It could be objected that theory is not as important as the practice of psychotherapy. And it is quite likely that experienced and wiser psychotherapists will resemble each other over time and learn to see beyond the limitations of theory. But theory whispers so seductively and so insistently into our ears as we practice. And if the theory misleads us, is not our practice in jeopardy?

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