Therapy Beyond Modernity: deconstructing and transcending profession-centred therapy
by Richard House
Richard House publications
...certain crucial factors exist in therapy that have not been sufficiently considered by many therapists, [which], in remaining ill-considered, are likely to increase the likelihood of negative or abusively-interpreted experiences.... therapists have incorrectly placed their ‘faith’ in various principles and assumptions that are questionable and unnecessary.
(Spinelli, 1995: 157, 160)
A quarter-century ago now, in the Introduction to his acclaimed primer A Complete Guide to Therapy, the radical therapist Joel Kovel wrote:
[T]herapeutics necessarily involves ideology.... therapy seems true to nothing but uncertainty. The proper approach is that of critique, by which I mean an inquiry that reveals the hidden assumptions of a phenomenon, grounds it in history and does not pretend that the observer stands separate from the thing observed.
(Kovel, 1976: 13-14, original emphasis)
That the history of therapy since the mid-1970s has notably failed to follow Kovel’s precept is testimony to both the uncritical, non-reflexive stance that ideologies tend to take towards themselves, and also to the illusion of reflexiveness and self-interrogation that therapy has been able to perpetrate. The latter feature surely stems, at least in part, from the highly peculiar nature of the therapeutic project, whose very essence is typically that of self-interrogation and awareness - but which typically and uncritically takes the pursuit of that very process itself as an unproblematic given. Thus, only the means by which such awareness is pursued have been open to ‘critique’ and the battle of theoretical ideas (in turn manifested in the proliferation of types of therapy and the enormous growth in the literature of therapy); but the possibility that this very project might itself be suspect is hardly given a passing thought within the ideology of therapy or what in this book I term therapy’s ‘regime of truth’ (borrowing from Nikolas Rose’s terminology).
What has tended to happen, then, is that the content of therapy has been subjected to the most stringent interrogation and critique (often stemming from the internal competitive jostling for ‘market’ position of the various approaches), while the very project of therapy per se has typically escaped any similar level of problematization (for notable exceptions see Cloud, 1998; Masson, 1988; Smail, 1996).
In this book I attempt to redress this woeful lack of balance by following Kovel’s recommendations - that is, by teasing out and laying bare the hidden assumptions of therapy as a modern(ist), increasingly professionalized healing practice, and the ways in which those assumptions constitute an ideology which, like most if not all ideologies, inevitably takes on a self-serving nature, being surreptitiously more concerned with preserving its own hegemony than with an honest authenticity of procedure and practice.
I write as a ‘semi-retired’ counselling practitioner, having been practising as a therapist since 1990, with seven years of training, first in Counselling and Groupwork and then in Body-Oriented Psychotherapy; as a General Practice Counsellor doing strictly time-limited counselling within the NHS; as a former group supervisor for a Westminster Pastoral Foundation affiliate, and experienced individual supervisor; and as a trained Steiner Waldorf class and kindergarten teacher, currently working in Steiner Waldorf early years settings.
I am aware that the content of what follows will challenge in a quite fundamental way the very foundations of the therapy project; and for that reason it may well be received with affronted hostility in some quarters, and welcome relief in others. Extant critiques of therapy have tended to be pretty long on rhetoric and emotional charge, and, concomitantly, rather light on intellectual rigour and coherence. In this book I attempt to rectify this lack by setting out a fully articulated argument which questions at root the status of some of ‘professional’ therapy’s most hallowed and taken-for-granted assumptions.
As will become clear, I believe that as the age of modernity wanes and the flawed and distorting Enlightenment project becomes progressively exposed, we will inevitably begin to enter what I call a post-professional, even post-therapy era, soundly rooted in an emancipatory, participative New Paradigm philosophy; and I hope that this book will prove to be just one early harbinger of these momentous historical movements in the evolution of the Western mind (Tarnas, 1991).
Despite initial appearances (particularly in Part II of the book), it is important to stress at the outset that Therapy Beyond Modernity is not a Massonian/Eysenckian/Gellneresque wholesale rejection of the very project of therapy - though I do view therapy as just a transient and culturally specific phase in the evolution of the Western mind and human consciousness more generally. But equally, in today’s Western culture, therapy both exists and continues to burgeon; and to the extent that it does have a future, I feel passionately committed to influencing that future as far as possible in a ‘post-professional’, ‘postmodern’, participative direction - a direction which, not least, privileges creative ‘human potential’ development and a spiritual, New Paradigm focus over a remedial psychopathologizing and infantilizing ontology (Mowbray, 1995; Parker et al., 1995). If this book succeeds at all in this somewhat ambitious aim, then it will have more than served its purpose in the evolution of ideas - ideas to which we all continually contribute in our different ways in our day-to-day vocational beliefs and healing practices.
Summary of contents
Part I is concerned with those defining features of the therapeutic experience for which I have elsewhere coined the term ‘Professionalized Therapy Form’ (House, 1999b), and which I refer to in this book variously as ‘professionalized therapeutic practice’ or discourse, professionalized therapy’s ‘regime of truth’, the ‘protocol’ of professionalized therapy, and the like. In Chapters 1-4 inclusive, I begin to problematize the very project of therapy per se - certainly in the conventional form that it typically takes in mainstream therapy culture.
Following a broad contextualizing introduction to the broad themes addressed in the book in Chapter 1, Chapter 2 draws heavily upon the important work of Ian Parker and Nikolas Rose on discourse and power to show how conventional therapy typically functions as a ‘regime of truth’ which in turn acts as a self-serving and ethically questionable ideology. My central thesis in this book has been greatly influenced by the important work of Nikolas Rose, Professor of Sociology at the London School of Economics and Political Science, and Ian Parker, Professor of Psychology at Manchester Metropolitan University - most particularly, the former’s seminal books Governing the Soul (1989) and Inventing Our Selves (1996), and the latter’s masterful multiply-authored deconstruction of the notion of ‘psychopathology’ (Parker et al., 1995), his many works on discourse, power, and social constructionism, and his recent edited volume, Deconstructing Psychotherapy (1999), the theme of which I would like whole-heartedly to endorse and be aligned with in the views expressed in this book. The intellectual debt which I owe to Parker and Rose will become especially clear in Chapter 2.
My central argument is that, in its professionalized, commodified form, therapy can and sometimes does become routinely and intrinsically abusive to the extent that it self-fulfillingly constructs a framework - professionalized therapeutic discourse and practice - which serves to guarantee the legitimacy of its own existence within a discursive regime of truth, and outside the confines of which it can become very difficult for clients and therapists even to think.
In Chapters 3 and 4, I then examine in detail a number of hallowed concepts from the therapy lexicon - namely, resistance, boundaries and ‘the frame’, holding, confidentiality, safety, abuse and ethics - to illustrate the way in which these arguably ideological concepts have far more to do with a therapist-driven self-interest than they do with an authentic and meaningful characterization of the therapeutic experience. My main conclusion is that, in order to avoid these intrinsic abuses, therapy should aim to be ongoingly and processually deconstructive of its professional ideologies and clinical practices - giving an approach to therapy which is postmodern, deconstructive, and unavoidably hermeneutic in both philosophy and practice.
In Chapters 5-8 inclusive, I examine three detailed reports that have appeared in the literature of actual client experiences of therapy, in order to ‘test out’ the propositions developed in the preceding chapters. I focus in particular on the work of ‘Rosie Alexander’, ‘Anne France’, and ‘Anna Sands’, each of whom have written insightfully and in considerable depth about their often extremely harrowing experiences of one-to-one therapy. Chapter 5 includes detailed discussions of why there is such a dearth of studies of actual client/patient experiences of therapy, and of why it is so hard to rely on subjective-report data to assess the efficacy of therapeutic interventions. My principal finding is that there is indeed ample confirming evidence from these experiential data to support the formulations in Chapters 2-4 about therapy’s ‘regime of truth’ and the self-serving ideology of professionalized therapeutic practice.
In Part III I take the argument further still, outlining the features that a New Paradigm, ‘post-professional’ approach to therapy might take. In Chapter 9 I give a detailed account of the pioneering work of the healer-analyst and contemporary of Freud, Georg Groddeck, whose extraordinary therapeutic work can, I maintain, serve as a prototype for the kind of therapeutic approach that will obtain in the postmodern world which is fast supplanting the outmoded positivist legacy of modernity’s Enlightenment project. Chapter 10 outlines the case for a ‘post-therapy era’, in which therapy, in its professionalized commodified form, is systematically exposed as being part of the problem rather than a solution to the cultural and spiritual malaise of modernity.
Finally, Part IV considers at length the implications of the book’s analysis for the praxis of therapy in what I call (following Ivan Illich) a ‘post-professional era’. Chapter 11 summarizes and further discusses the critique of professionalized therapy developed earlier in the book; and Chapter 12 elaborates upon the possible nature of a mature, viable post-professional framework for therapy, and the specific form that what I call a New Paradigm, ‘deconstructive therapy’ might plausibly take.
Following a brief synthesizing conclusion, entitled ‘Who would be a therapist?’, there is an exhaustive reference section, together with a Select Bibliography of the literature on critiques of therapy and therapy professionalization, which I hope the interested reader will find to be a useful ‘mining’ resource for pursuing critical perspectives in and on therapy.
A final ‘editorial’ note. The original draft of this book contained an additional part, with three chapters on critical perspectives on therapy professionalization. Length constraints unfortunately meant that they had to be excluded from the current book, so my many critical and sceptical references to the professionalization question that recur throughout this book might appear to need more detailed substantiation. My published writings on this question are many and varied, and are quoted in full in the References and the Select Bibliography at the end of the book. The three chapters in question will appear in my forthcoming collection of critical papers, With an Independent Voice (House, forthcoming).