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The Madness in Psychotherapy
As are all things human, the craft of psychotherapy is flawed. We proceed as much by failure as by success. Given the opportunity, most of us will fail as often as we succeed. Both ends of the spectrum are productive, require one another, feed one another. Both are to be respected, anticipated. Cared about. Too often, though, we place more value on the side of success. I know that I do, even as I embrace that failure brings its own kind of success. I believe this to be true of the field of psychotherapy as well.
People do not typically visit a therapist's office with the conscious hope of not getting better. It is usually pain that brings them there, and they are full of the fervent wish to be rid of the pain. This is where one of the many bifurcations in psychotherapy dwell. There are therapists who treat pain as a sign to be read, and when read sufficiently it is held that the pain perhaps will subside. Then there are those in the business of curing pain. This is where the madness lies. It lies in the 'cure.'
Long ago, way back in the 20th century, a small group of German, Swiss and Austrian doctors were busily inventing the field we now know as psychotherapy. True to their paradigm, they viewed this as a medical, scientific enterprise. And the human difficulties they were chasing were thought of as diseases. They were diseases either searching for or fleeing from a cure.
The notion of cure is deeply embedded in the paradigm of allopathic medicine, as is the notion of normal, baseline health. Health is the absence of 'disease' process. Of course this has been adumbrated over the decades to mean not only the absence of some processes, but the presence of others. At any rate, these ideas have now spread so thoroughly into the general fund of cultural information as to be one of the supporting columns in our ideas about the world and our place in it.
The early community of originators began to split apart almost as soon as they came together. But they all still retained the basic imprint of medicine, disease, and cure. From Freud and his group came Jung(psyche, spirit, archetypes) and Adler(will to power) and Reich (orgone energy, and its modern descendant, Bio-energetics). There was another group less known to Americans, though, and these were the individuals who worked hard to create a new paradigm for understanding.
These were the Phenomenologists — psychiatrists who had read the work of Husserl and Heidegger, Soren Kierkegaard. Where the medicine men were concerned with what disease was represented by the symptom, and naming it, these men wanted to see the symptom as a sign to be read for its meaning, for that particular individual. What is the symptom saying about the individual's being in the world?
These men were Ludwig Binswanger, Henri Bergson, later in America, Rollo May. There were others as well, and as a group, they still flirted with the idea of medicine and cure, but explicitly worked to remain free of jargon and invented medicalized language. They saw the symptom in the individual as the gateway to the soul.
Carl Jung was also working at the creation of his own system. He always maintained for himself the fantasy that he was doing science. Nothing could have been further from the truth however, insomuch as science in the 20th century had become entirely empirical. Jung was a highly creative intuitive whose science was actually a form of literature and comparative analysis of textual materials from both Oriental and Western sources. Those sources, as we all know now, were from the mystical traditions of their cultures, mythological, meditative, alchemical. One of his major paradigmatic statements was the observation that symptoms were at one time called 'gods.'
They were as such working with a bigger frame of reference than were the experimentalists, the reductionists, the behaviorists. This is the group I became attracted to when beginning my undergraduate studies at University of Dallas in the early 70s. It is to Jung and this group that I remain loyal to this day. Years of psychotherapy, both as patient and as provider have taught me that there is no such thing as 'cure.'
But there remain therapies that try to provide it. An example is ReDecision Therapy. This had its heyday in the 70s and 80s but still has its following. The therapist is typically a commanding and charismatic type who evinces a great deal of personal power. Therapy is conducted in group settings, with one person after another working one on one with the therapist. The question is asked, What do you want to change? and the client announces something like, 'I want to stop being so afraid all the time.'
The theory is that being afraid all the time is a decision that the person made long ago, and continues to recommit himself to on a daily basis. A variety of questioning techniques are brought to bear in which the ways the client holds on to the fear are explored, including the way that the fear actually provides protection from something even more unwieldy than fear.
At last the client is given the opportunity to retain the fear, or to only be afraid at appropriate times, or let go of the fear altogether in favor of something more desirable. Many will elect to be fearless. They will leave flush with the euphoria of having sworn off of fear. Only to find it returning again a few days or weeks later.
They might decide that their decision needs to be remade. Or, more likely, they might decide that they had failed at Re-Decision Therapy. With the idea of fearless living lurking over the horizon, just a decision away, they will try again. They will become dependant on the seemingly fearless therapist who has made up his mind to shed all of his neuroses and be healthy and rational. The RDT therapists will say they don't encourage dependancy, actually discourage it. This is true of course, as it is the paradoxical model itself that encourages this in its very structure.
I was in ReDecision Therapy for 7 years, and was never able to be good enough at it to get 'well.' I repeatedly made decisions that lasted 24 or 48 hours. And then felt miserable again. I didn't realize that what I wanted was someone who would listen to my story and try to understand. Not try to cure me, not be so married to a technique that I could not open my mouth and speak for 5 minutes without being hurried into some technique. I finally got out when I realized that I had become very sick in a dependancy on my therapist and on the technique.
There are many, many other therapies. All of them have some element of cure involved. But above all, I am thinking of the more 'radical' therapies. The ones that promise to work 'deep' -- deep in the body, deep in the soul, deep in the past. These are the therapies some begin to search out when it seems that the 'traditional talk therapies' aren't working. The individuals begin to see the Reichian or Bio-energetics therapists.
One of the problems of these therapies is a mis-imagination of 'depth.' A literalization of depth. Trauma is buried deep in the body, and must be excavated. Or there is a need for a primal experience, such as a rebirth, or a scream. There are loosely formed groups that offer experiential 'work' that is dramatic, emotional, sweaty, difficult, noisy. One after another, the patients enter into the circle of friends and associates made at the group seminar, announce their trauma, appoint their assistants from the group, and then proceed to sweat and strain and scream against piles of cushions or against masses of humanity.
What most will not find in contemporary psychotherapy is an encouragement to see psychic pain as carrying meaning and value. That it is a sign that the soul longs for change, or to express something about itself.
As James Hillman says, "In its complaints, the psyche is speaking in a twisted and misshapen language of its depths." It asks that its sign be read, and accepted. The real madness of psychotherapy is not what the patient brings in the room, but therapists' fantasy of cure and power over the symptom.
It may be that the best therapist is the one who offers the least, makes no promises. He or she will be wary of cures, will not be in a hurry. She will be most interested in coming to know you, the client, personally. He will openly express that there is nothing he can do about your fear, depression, shame, rage, etc, unless you, the client, are willing to work with him.
He will in some way show that he knows what Hillman said above, that the psyche's depths are being opened in the complaint. He will encourage healing by resisting the cure. He will be willing to allow himself to journey into the underworld of the client's depths. He will offer no struggle, will attack no demons, but instead open dialogue with them. He will acknowledge that his best weapon is his powerlessness.
We Americans pride ourselves in our 'practicality'. When we enter therapy, we are in a hurry. We want to get to the end-point. The end point being that time in psychic life when the complaint is quelled, reduced, made minimal, cured. Americans are willing to take whatever means necessary to get 'back on track.' ( The Way of Depression )
Thus, much of the initial work of psychotherapy is involved in forming the friendship necessary to help the person relinquish the need for immediate gratification. Paradoxically, as in so much of our lives, healing comes quicker when we go slow. The anguished voice crying out from psyche's depths is brought out on stage and auditioned. She is almost always cast in a future production of the individual's life, and she sheds her monstrous form when acknowledged.
I think we can agree, then, that the madness in psychotherapy is the madness for the cure. The cure is often about placing the ego back in it's position of dominance in psyche's throng, when the complaint originally sprang from something other than ego wanting to come onstage. I think this has something to do with the ancient intuitions of LaoTze and Buddha and Christ in their teachings that we must die to our desires. Because, so often, desire springs from the ego's need for aquisition. Americans naively want their therapy to get them back on the path of conquest and aquisition, even while the soul is saying, No, that is what needs to change.
To come back again to the notion of cure, I want to add that the most precarious moment in psychic life is that time when the individual pronounces himself cured. A wise appraisal knows there are no cures for the psyche, only a widening of the container of psychic life. This may indeed necessitate a change in the way one lives. Of course, this can be accomplished without the outward shape of one's life being observably changed, but the inner landscape will have a different set of markers, boundaries, settings. Where once you were intolerant of changes to your schedule, you now accept them as the rythm of life.
If you fled from pain with overwork or drugs, alcohol, TV, etc. you now make time, not to confront and conquer the pain, but to sit with it and let it be. You recall Hillman's statement regarding the psyche's twisted language and its depths. You acknowledge that indeed you may need to change your life outwardly as well. But again, this can mean no more than taking the time to be a loving spouse, an attentive friend, an encouraging parent.
We have the capacity to 'cure' ourselves by our willingness to put out what we are longing to take in. We are then actively engineering an escape from our pains by surrendering passivity in our waiting for the cure, and accepting that our real duty is to be the cure for others.
This may sound dangerously like the disease described by Bradshaw and others as 'co-dependance.' but truly it is not. This is because the addiction of codependancy is to the satisfaction of one's own compulsions by attempting to satisfy or manage them in others. What it really is is acknowledgement: My wife longs to be loved, so I give it. My son longs for encouragement ,so I give it. My friend needs my attentive ear, not my advice (my ego), so I give the ear. etc etc etc.
This is why I say: Madness lessens as we abandon the cure.
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