Therapy Beyond Modernity: deconstructing and transcending profession-centred therapy
by Richard House
Richard House publications
Forthcoming in Ipnosis magazine, 8 (Winter), 2002
Therapy Beyond Modernity...
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.... The proper approach is that of critique, by which I mean an inquiry that reveals the hidden assumptions of a phenomenon….’. 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’.
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. 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 am aware that the content of this book 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 the 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 taken-for-granted assumptions. I believe that as the age of ‘modernity’ wanes, we will progressively and 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.
It is important to stress at the outset that Therapy Beyond Modernity is not a 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, and the ‘over-professionalized’ ideology that sustains that ontology.
In Part I draw upon the 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 argument is that therapy can be 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 their 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.
I examine 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.
I then 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. My principal finding is that there is indeed ample confirming evidence from these experiential data to support my formulations about therapy's 'regime of truth' and its self-serving ideology of professionalized therapeutic practice.
In Part III, I outline the features that a New Paradigm, 'post-professional' approach to therapy might take, with a detailed account of the pioneering work of 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 deeply flawed Enlightenment project. I also outline 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.
ELABORATING ON THE ‘POST-PROFESSIONAL’ ERA
Until we reach a position where individualized therapy is simply not needed within modern culture, then, perhaps the best we can do is to embrace an explicitly deconstructive therapeutic practice - and trust that the new millennium will bring new cultural forms for supporting people with their difficulties of living. Clearly such an approach requires striking a delicate balance between fearless critique, on the one hand, and offering constructive suggestions as to the specific nature that a less self-serving and abusive therapy might take, on the other. I would describe a processually deconstructive therapy (which is not one, as Luce Iragaray might have said) as having a goodly proportion of the following distinguishing characteristics (some of which do, of course, overlap with each other).
ü noughth, it would achieve a 'state' (or, better, way of being) in which all theoretical or classificatory devices such as the one I am about to present would be redundant and transcended;
ü first, it would essentially eschew preconceived theoretical frameworks - having an inclusive, pluralistic approach to diverse, 'local' 'knowledges' which values (for example) intuitive, spiritual, and feminist 'knowing' at least as highly as rational-empirical knowledge; and would follow Wilfred Bion's suggestion that, as far as possible, the therapist enter the consulting room free of memory, desire, or understanding
ü second, it will tend to embrace a postmodernist, deconstructionist epistemology, rather than the essentially positivistic, modernist agenda that dominates so much of the therapy world and the psychology discipline more generally;
ü third and relatedly, it will tend to gravitate towards a so-called New Paradigm, spiritual, transpersonal, or even mystical ontology which recognizes the ultimately ineffable nature of human life and existence, eschewing the overtly egotistical individualism that professional therapy typically embraces and encourages; recognizing that healing practices from every culture and epoch are of value; that therapy and ‘healing’ might well be commensurable practices; and that we should be open to locating and contextualizing the therapy phenomenon within the broader evolution of human consciousness;
ü fourth, it would tend to be essentially hermeneutical, with a phenomenological/existential focus;
ü fifth, it will accommodate seminal critical, post-structuralist perspectives on the so-called 'invention' of contemporary subjectivity and the hegemony or 'regime' of the (modern) self (Nikolas Rose) which increasingly holds sway in Western culture - and couched within the wider question of the evolution of human consciousness;
ü sixth, it will tend to pay more attention than conventionally to the interface and cross-fertilization between psychology and philosophy, and the recent development of 'philosophical counselling'. Under this category I include the fundamental question of 'victimhood', and the tension between environmental determinist and responsibility-taking conceptions of human experience;
ü seventh, it will tend to have a de-professionalized, devolved structure along the lines of the ‘self-generating practitioner community’ concept outlined by John Heron, the nearest current equivalent of which is the UK’s Independent Practitioners Network; and a non-institutional, responsibility-embracing, and participative approach to ethical conduct ;
ü eighth, it will tend to sympathize with the project of critical and feminist psychological perspectives;
ü ninth, it will typically challenge the 'myth of normality', and reject the ideologically driven language of 'abnormality', or any kind of medical-model focus (tacit or otherwise) on so-called 'psychopathology';
ü tenth, it will tend to problematize, and certainly not take for granted, the ideology of 'developmentalism' within developmental psychology;
ü eleventh, it would advocate and achieve a radical transparency, openness, and 'power-with' way-of-being with clients (as in the Person-Centred tradition) minimizing the exploitative power dynamics that so saturate the conventions of professionalized therapy;
ü twelfth, it will be ordinary and quite specifically non-mystifying in terms of both theoretical affectation and procedural minutiae, with a 'friendship' rather than a clinical focus, and eschewing pretensions to therapist 'expertise';
ü thirteenth, its focus will tend to be more on taking care (David Smail) than on a medical, 'assessment-diagnosis-cure' model - in other words, it will privilege human love over technique or clinical 'treatment' ideologies;
ü fourteenth, it would lay stress on ‘play’ (Winnicott), 'the dance', and creativity, rather than the 'deficit' ideologies of 'psychopathology' and '(ab)normality' - a move well characterized by anthroposophist Georg Kuhlewind in his phrase 'from normal to healthy';
ü fifteenth, it will more likely embrace a (social) constructionist rather than a positivist/objectivist framework; and it will tend towards being conversational, narratival, story-focused, and dialogical;
ü sixteenth, and relatedly, it will tend to privilege notions of the indissolubly co-creative intersubjectivity of human relationship in its therapeutic ontology, rather than an intra-psychic, subject/object, observer/observed ontology;
ü seventeenth, it would tend to be time-limited or of relatively short duration, thereby minimizing the possibility of infantilizing dependency issues being triggered and exploited within the emotional cauldron of the professionalized therapy milieu - and yet being able to stay true to Person-Centred, humanistic values;
ü eighteenth, it will tend to be flexible rather than rigidly and obsessively 'boundaried' in nature, both in terms of working contracts and periodicity of meeting;
ü nineteenth, it will consider the so-called 'extra-therapeutic' dimension - the social, the cultural, and the political - at least as much as it does the intra-psychic, with its associated individualistic ideology - and including a greater engagement with community psychology;
ü and twentieth and finally, it would tend to have an open view about the nature of 'change', and would by no means slavishly follow the old-paradigm (and professionally self-serving) view that therapeutic change necessarily has to be a long-winded and painful process.
Clearly, this brief sketch cannot remotely do justice to the detailed form that an explicitly post-professional deconstructive therapy might take: the articulation of that task has already been started in Ian Parker's important recent anthology Deconstructing Psychotherapy (Sage,1999), and no doubt it will be picked up and developed in different forums and in diverse ways in the coming years. However, no matter how assiduously we might strive to create a non-self-serving therapeutic culture that is maturely post-professional, and which responds to the concerns expressed in this book, at least some the inherent contradictions nestling at the very heart of the therapeutic project will surely remain.
It may be as well to reiterate what I have not tried to do in this book. First, I have not attempted to locate the cultural phenomenon of 'therapy' within an evolutionary or an historical context (e.g. in terms the decline of organized religion and 'community', and the concomitant rise of 'ego', individualism, narcissism, and the technocratic mentality of modern science). Nor have I attempted to account for therapy as clinical practice in a quasi-Marxist, 'historical materialist' analysis of 'late capitalism' (e.g. exposing the alienating commodity form of capitalist social exchange relations, and the 'fetishizing' social-relational effects of such on the private-exchange relationship of therapy itself). Such analyses are, I believe, of crucial importance in helping us to locate ourselves far more accurately and knowingly in terms of the meaning and wider relevance of individualized therapy as cultural healing practice at this point in the evolution of consciousness. I hope to address these complex questions in depth in future writings.
Neither should the arguments developed above necessarily be seen as applying to 'therapy-in-general' (not that I believe there is necessarily any such valid ontological category anyway!). Thus, I personally know several therapists who work in ways that coincide with many of the twenty-one post-professional criteria I have outlined above, and who in the process do everything they can not to collude with and encourage the profession-centred tendencies inscribed within professionalized therapy. Yet I also know practitioners who in my judgement do very little if anything to respond to the potential abusiveness of professionalized therapy’s regime of truth; and my strong hunch (based admittedly on personal anecdotal experience) is that the latter type of practitioner may substantially outnumber the former. And hence, the strong need I have felt to write this book.
My main concern, then, has been with private-sector, individualized (one-to-one) psychotherapy and counselling. This is not to say, of course, that at least some of my concerns might not be applicable to therapy in settings other than private practice, or that other, potentially less problematic forms of therapy are not subject to their own particular, 'local' regimes of truth (for example, time-limited therapy, group therapy, and family therapy). It is for others more conversant with these other modalities than myself to assess the degree to which either the substance of my critique, or the methodology I have adopted in developing it, might be useful in their own particular fields.
Of course, thinking about therapy within a 'regime of truth' perspective can itself all too easily become another regime of truth! - which of course I wish to avoid, lest I be hoist by my own critical petard. What I have tried to do in this book, then, is to offer a perspective on contemporary one-to-one, professionalized therapy: a way of trying to think about and understand this peculiar cultural phenomenon (just how peculiar I don't think we begin to realize as it has become so commonplace and culture-saturating), which has rapidly diffused throughout Western culture in recent times. I hope the perspective I have offered may be useful and illuminating for those - both practitioners and clients - who might have uncritically taken 'therapy' to be some kind of universal, unchallengeable 'given' of modern culture. Certainly, whether what I have written proves to have any credence will surely depend upon whether it finds a resonance within the evolving culture of therapy and the history of ideas, and not on whether it is in some sense ‘objectively’ accurate in any naive 'correspondence-theory-of-truth' sense.
I concur with the Derridean view that it is a fundamental error of the (ironically named) 'Enlightenment' project to expect humanly built systems of Truth to lead to reliable and complete accounts of the real. And as a consequence I do not claim anything more than a local 'truth' for the foregoing analysis. Nor from within my own world-view can I claim any more than this with any coherence or authenticity. Moreover, I do not believe that views such as those set out in this book are anyone's personally owned property or creation, but rather, they happen to have been 'channelled' through me from the culture - or from we know not where....
I do not want to 'psychopathologize' the therapy field, not only because I am myself still a part of it, but more importantly because such a pathologizing world-view is, I believe, not only epistemologically unsustainable, but can easily amount to little more than ad hominem abuse which obscures far more than it reveals. Yet I do hope that before launching the counter-attack - or heading for the bunkers - therapy practitioners will feel able to consider closely and relatively undefendedly the challenges I have mounted to professionalized therapy in this book - challenges whose careful consideration can, in my view, only lead to less self-serving and more enabling therapeutic practices.
WHO, THEN, WOULD BE A THERAPIST?
My hunch is that, notwithstanding the force of argument developed in this book, there will continue to be a veritable stampede of people wanting to enter the therapy world as practitioners - certainly if the wildly proliferating number of training courses that have mushroomed in the past decade is anything to go by. And one has only to read Sussman's excellent book A Curious Calling: Unconscious Motivations for Practicing Psychotherapy (1992), to see clearly why this should be so. For in our individualistic, narcissistic culture, therapy has so easily become a 'profession' or activity upon which people can 'project' or 'act out' (to use the language of therapeutic discourse) all manner of personal difficulties, within a carefully structured, culturally sanctioned environment that confers 'permission' and respectability upon their behaviour. Like the little boy entering the city I have fingered the 'Emperor's-clothes-ness' of modern therapy in pretty uncompromising terms - not least to provide some kind of counterweight to the uncritical treatment that therapy receives from the vast swathe of proliferating (and predominantly profession-centred) therapy literature.
Following Cushman, perhaps the increasing cultural ascendancy of 'the therapeutic' parallels deeper processes in the evolution of individualized consciousness and ego/self-hood, of which the vast majority of us are unaware… and yet which it may be crucial to identify and understand if we are to fashion a therapy which is facilitative of a healthy human evolution, rather than it being just one more ideological trapping of late modernity. Under these circumstances, I want to ask: Just who would want to be a therapist? Certainly, I find myself gradually relinquishing my erstwhile chosen occupation of counsellor and therapist, and in recent years there have been signs of others leaving the therapy field because they no longer feel able to work as therapists with integrity and authenticity. Anne Schaef, in a book that should surely be on every therapist's reading list, describes in graphic detail her own personal journey through the therapy 'profession', and into a 'post-therapy' way of helping people with their problems of living (she revealingly refers to herself as a 'recovering psychotherapist'). And Robert Sardello, drawing upon the anthroposophical vision of Rudolf Steiner and the latter's early lectures (1912-21), which devastatingly criticized the newly developed practice of psychoanalysis, has similarly left the world of psychotherapy for what he calls ‘adult education into soul-wisdom’ and ‘spiritual psychology’:
[B]y sequestering it in a private room, therapy removes soul from the world.... Symptoms... do not belong to the individual but to the culture as a whole.... Psychotherapy is an abstraction, culturally sanctioned in a world of materialist abstractions… [P]sychotherapy… seems to me a deviation contributing to the destruction of culture.... [These] conclusions… have led me, a practicing psychotherapist, to the necessity of relinquishing this practice.
(Sardello, 1990, my emphases)
The work of erstwhile therapists like Georg Groddeck, James Hillman, Robert Sardello, and Anne Schaef certainly inspires in me the hope that there are at least signs of a qualitatively different kind of post-professional, New Paradigm therapeutic practice beginning to emerge.
I leave the final word to the late Ann France, author of the excellent client book-length testimony Consuming Psychotherapy (1988), with a memorable quotation which eloquently captures the core of this book’s most central concerns:
The stress in psychotherapeutic theory and practice needs, I think, to shift from the idea that this is a treatment meted out by a specialist to a sick person, who has no right to question it, to the attitude that this is a co-operative venture between two equals, with the same goal of effectively enhancing the life of the consulter, and freeing him or her from the temporary bond created with the therapist.
Richard House is an NHS counsellor, a publishing editor, a Steiner Waldorf Kindergarten teacher, and an academic writer, living in Norwich. He co-founded the ‘W.A.S.T.E.’ (Welfare Action for Surviving Teachers and Ex-teachers) web site in the summer of 2001 (at www.wasteedu.org). His book The Trouble with Education: Stress, Surveillance and Modernity is to be published through Education Now Books in mid-2003; and an anthology co-edited with Yvonne Bates, Ethically Challenged Professions: Enabling Innovation and Diversity in Psychotherapy and Counselling, will be published by PCCS Books in 2003. Address for correspondence: email@example.com