[Changes, 10, 274-281, 1992]

Psychotherapeutic theory and wishful thinking*

DavidSmail

There’s a lot to be said for anarchism. But, as with any word, concept, or indeed person, that threatens to point a way through the ideological fog in which we habitually move and have our being, towards ways of thinking and living together less saturated with the brutal exploitation of self-interest, ‘anarchism’ has become almost solely associated with terror and misrule of the most chaotic and dangerous kind. It is certainly extremely threatening to the status quo if people start to speculate what the world might look like if we managed to create a society in which the coercive use of power - even the democratic power of majorities over minorities - were cut to a minimum. As it stands, our entire society and just about every aspect of its culture is held together by coercive power. On the whole only anarchists (my personal favourite being Leo Tolstoy) have seriously questioned whether we could construct a society on anything other than coercive power. (Tolstoy, inspired by none other than Jesus Christ, suggested love as a possibility, and though his ideas caused quite a stir at the time - not least in the heart of Mahatma Gandhi - they tend these days to provoke embarrassment or scorn.)

If, then, you are to achieve a critical purchase as uncontaminated as possible by coercive power on whatever section of our cultural apparatus you happen to occupy - and let’s concentrate henceforth on the world of psychotherapy - you are going to need to be a bit of an anarchist. That is, you are going to have to step beyond the immediate preoccupations, concerns and rules of your discipline and begin to take note of the part it is playing in the more general scheme of things.

Psychotherapists, for example, need to raise their consciousness above the familiar questions of therapeutic outcome and process, professional credibility, accreditation and training, etc., and begin to reflect about what role they may be filling in smoothing the way for the application of coercive power. Not, I suspect, that psychotherapists are very far up the power hierarchy, but arguably, they are quite a way up the hierarchy of those who mediate power these days. In any case, only if you are right at the bottom of the heap, without economic or indeed any of the other kinds of capital (educational, cultural, etc., see Bourdieu, 1986) which give access to the markets, or if you have been totally marginalised, or put in prison, etc., only then can you safely assume that you might not be implicated in the transmission of coercive power. I don’t think it’s an affront to my colleagues, or a disqualification of my own right to speak about such matters, or an indication of inadmissible hypocrisy, if I suggest that psychotherapists may be implicated in activities which contribute to a savagely unfair and exploiting society. The point being that there is no way of avoiding being so implicated. You can’t swim around in a cesspool without getting covered in shit. But maybe you can begin to contemplate a rather more anarchic posture, i.e., one which reflects a refusal of some of the implicit rules which guide our activities.

Don Bannister was a bit of an anarchist (and I’m pretty sure he would not have felt dishonoured by the label). His very considerable achievement was, with a little help from his friends, to rescue British psychology from the oppression of Power in the guise of ‘science’ (in fact a juggernaut of dogmatic privilege having nothing whatsoever to do with, for example, the passions of Galileo) and open up to it spaces in which it could be contemplated with a degree of intellectual freedom. However, oppressive power never takes long to regain the advantage, and knows better than to scorn good ideas; it will appropriate, make use of them, and finally turn them to the disadvantage of their originators (look, as the most obvious example, at what the Church did with Christianity). Anarchic thinkers need to be quick on their feet and ready to dodge out of the way when a new juggernaut comes trundling towards them decked out in their own ideas.

The words which follow could, I suggest, just about have been written by Don Bannister:

The use of the term ‘science’ does not imply some restricted view, derived from a caricature of 19th century physics, in which all salient variables are rigorously controlled and in which the experimenter has dictatorial power over events. Many contexts in which the psychological scientists work allow for only partial control of the multitude of variables and sources of measurement error which operate within them.

But they were not. In fact, they form part of the text of The future of the psychological sciences: Horizons and opportunities for British psychology, put out with pride by the BPS (April, 1988) as its corporate statement of the art. In view of this I suggest it might be wise to place a rather different valuation upon them than if they had been written by Don Bannister. Actually, the real clue to the reason for their occurrence in the said document is stated almost unambiguously in another section of it (p.45):

A fair proportion of the submissions to the Working Party noted that while psychology may have established its credibility on the basis on its scientific approach, an over-reliance in the future on such an approach may serve to lessen the impact in the public domain. Nevertheless, other submissions coherently argued that the scientific approach has served psychology well and that it should remain the dominant model.

In other words, the criterion is not truth, but interest.

The truth is only of interest to Power if it can keep a monopoly of it. The old juggernaut of ‘science’ was the monopolised truth of established power, and those of us who remember it well certainly do so for its oppressive force rather than for any enlightenment that it shed. But times have changed, power has shifted a bit, interests have flowed here and there into different channels, and truth is no longer quite such a useful commodity as it was.

In about the time it has taken for the NHS to bloom and wither, established power in the west has recovered from the challenges to it which were mounted following the Second World War. A mere 40 years or so is but a microwave in the tides of history which erode ever more efficiently the ability of the weak to withstand the strong. It’s not, I’m afraid, just that Victorian Values are making a brief reappearance, a last fling before the contradictions inherent in capitalism finally cause its disintegration and usher in a Marxian dream of equality and brother/sisterhood; it’s more that power, privilege and ruthless advantage have taken up where they appeared for a moment almost to have left off, but with far more refined machinery and control of almost all the means whereby protest and resistance could be mounted. ‘Truth’ has become too crude and too limiting a concept with which to further the interests of power, which now appropriates for its own ends the very critique of ‘Scientific Truth’ which was formerly deployed against it. As I’ve indicated, potential paradigm shifts don’t threaten power for long; they are simply pragmatically absorbed by it.

I’m sorry to write in this apocalyptic and apparently paranoid way about Power with a capital ‘P’. I can’t say anything very coherent and measured about it because I’m not acquainted with it closely enough to describe it more accurately (not, that is, at the very highest levels of its operation). Rather, I infer its presence from glimpses of things seen or sensed in the far distance. Huge houses hiding in sculptured woods a mile back from electronically operated wrought iron gates; yachts that look like ocean liners anchored at night in Mediterranean bays, ablaze from stem to stem with electric light; extraordinarily beautiful, burnished women alighting from enormous cars outside Harrods; the very possibility of an international trade in illicit plutonium, transnational big business. C. Wright Mills must have been right about the power elite, but, whether in personified or corporate form, it’s a long way beyond my experience - in the same way, perhaps, that the nature of say, classical scholarship is beyond the ken of the average Sun reader. In any case, I get a strong sense that there’s something up there that’s pretty instrumental in determining what happens down here.

I am of course able to be a little more coherently explicit about those powers and privileges available to the social stratum (and those below it) which I occupy. I become aware of the relative amount of my educational capital, for example, when I find myself editing my vocabulary so as to make it comprehensible to one of my patients, or when another of them, struggling to express her awe of my ‘braininess’ by guessing the newspaper I read, lights on the Daily Mail. My world is as inaccessible to her as the Duke of Westminster’s is to me. One of the ways in which anxiety is related to power is laid bare when this same woman recounts the frantic worry attached to choosing lamb chops from a supermarket freezer. Her sister chooses the ones she likes the look of. My patient searches for those she can afford while trying with a desperate appearance of casualness to make it look as if she’s the better judge of value for money by discovering chops which, though lighter, are leaner. By no means all power is distributed on the basis of social class, of course. At the most basic level, for example, most men have readier access to the power of violence than most women, and all adults are almost unimaginably more powerful than their children. We are precipitated at birth into a situation in which the way power is used is crucial for our survival and development.

In order to shape and control a society structured by self-interest as the principal medium of the transmission of power, I don’t suppose you have to maintain any very highly explicit, precision-engineered system; rather, the application of power would be a bit like tipping a bucket of water down the side of a hillock - by one route or another it will find its way to the bottom, facilitated by (and so deepening) available channels, cutting some new ones, swamping small obstructions, flowing round (and thereby isolating) little islands of resistance, and so on. This is of course not very far from Adam Smith’s metaphor of an Invisible Hand as the means whereby markets are controlled; market influences don’t have to be obsessively calculated at any point, but rather self-interest can safely be left to operate the system more or less automatically.

psychotherapy in society

In order to give an indication of how psychotherapeutic ideas are shaped by the flow of interest, I need first to make a rather impressionistic sketch of the kind of society in which psychotherapists are located.

A lot has been written recently about the ‘postmodern, post-Fordist’ society, and various millennial stirrings seem to be taking place, unsurprisingly, no doubt, in the intellectual imagination. Such stirrings range from the excited euphoria of Tofflerian ‘third-wavists’ who see the amazing possibilities of electronic communications, etc., opening up undreamt-of vistas, to the unnerving, almost incoherently autistic despair of visionaries such as Jean Baudrillard, who (in my view more convincingly) see the world as we have known it vanishing into ‘an endless enwrapping of images’ (Baudrillard, 1984, p.28), a kind of nightmare hall of mirrors in which even the mirrors are imaginary, and where ‘reality’ has become transformed into a theme park, more unreal than the unreal.

Though by no means averse myself to a bit of dramatic overstatement (especially on the doom-and-gloom front) this kind of thing seems a bit over-the-top even to me. (Though from time to time one does come across ghastly confirmations of these apparently highly abstract speculations.) In the matter of reality becoming secondary to image, witness the mother seen on TV news (itself some kind of irony) who forked out £2,000 to stage a video remake of the wedding of her daughter, who had spent an impatient honeymoon anticipating viewing the original video, only to have her heart broken by the discovery on her return home that it had been spoiled by technical faults. But despite such indications of changing times, I can’t myself see what’s happening as the dawning of an incredible New Age, either as a Caprian ‘Turning Point’ towards a holistic gambolling in a renewedly verdant Gaia or as a plunge into a vortex of illusion and meaninglessness. Rather, it seems a much more familiar story of how the social fabric is adjusted such that the status quo in terms of the distribution of power and privilege is maintained as stably as is consistent with (in particular) technological developments.

Some of the themes of this story are very familiar indeed, like for example using developments in the sophistication of machinery to put people out of work and keep the profits for yourself. Nor, of course, has sweated labour disappeared - it’s merely been transported to parts of the globe where most of us can’t see it. Of course there have also been new developments of a kind; as far as people in the developed world are concerned, more find themselves coerced into mass consumption than into mass production, and the trick of creating, maintaining and financing the purchasing power of markets has become all-important. It’s no good having machines turning out endless loads of plastic junk if there are too few people around who can afford to buy it; but even that may not be as new as it seems - perhaps the main thing that’s changed over the past few decades is who (what sections and classes of the global population) and what (what kinds of machines) are consuming and producing, and where the mass-produced rubbish is dumped.

The pursuit of ‘growth’ and the limitless development of markets (not least the academic markets of the social sciences in which ‘new’ ideas and fashions are at least as important as they are in the clothing industry) does mean that an element of unreality becomes necessary for progression. It’s a truism of the modern market that needs have to be created and all kinds of ‘necessity’ invented. We have to be made eager participants in the business of stuffing ourselves with rubbish, in being battery-people maintained at the optimum level of consumption. There’s little to choose, as an example of engineered, consumption-oriented uniformity, between a supermarket display of frozen chickens and an average European beach where one is confronted (as also in the mirror) by the Standard Euro-Belly, rounded out to a point just below that at which further consumption would be hampered by undue strain on the organism.

The type of culture needed to support such levels of consumption has to be formidably dependent upon make-believe. Hence the importance of marketing managers and advertisers in the present-day world; hence the maddening but nevertheless irresistible ubiquity of the language they use. Hence the down-grading of truth. And hence, to a degree I think we need seriously to reflect upon, the booming of the therapy industry.

We have become so accustomed to the hyped-up language in which advertising clothes its bare-faced lies that it is perhaps with a kind of defeated resignation that we find ourselves talking of the ‘importance’ of trivia, the ‘uniqueness’ of the uniformly indistinguishable, the ‘newness’ of the utterly familiar; our sense of logic no longer protests at the representation of so much as ‘major’ and so little as ‘minor’. Miller Mair (1988) has written powerfully of the invasion of our conceptual space by the ruthless language of marketing which seeks to intimidate us into abandoning the entirely legitimate moral foundations of care. But even if we manage to extricate ourselves from a managerial/marketing takeover, do we - psychologists and psychotherapists - not still stand in danger of being the mediators of an essentially wishful world, i.e., one in which market opportunities are opened up through the seductions of wishful thinking?

The more I think about it the more it seems to me the case that therapeutic psychologies of almost all varieties have tended to construct plausible rhetorics that hold out the promise of erasing damage or transforming misery both of which are ineradicably inflicted by a society which thrives on the exploitation and oppression of the weak by the strong. I have not, I think, come to this view through some prior commitment to bloody-minded intellectual anarchy, but because my experience as a psychologist and psychotherapist of sorts stubbornly refuses to fit into the theoretical accounts that have been designed to anticipate it.

When I compare what is supposed to happen to people as the result of therapy with what actually does, and I don’t mean here merely my own therapy, I am forced to the view that most therapeutic theories are indeed little other than magical systems of wishful rhetoric. They gain plausibility by describing accurately enough the nature of much psychological suffering and they are often able to offer enlightening observations of how such suffering is generated. But it is not my experience, and neither have I encountered convincing demonstrations of it, that techniques of change which most therapies claim to be effective really are. I am not convinced that the base metal of id can be transformed into the gold of ego (though 1 can see the attraction of the project to a rather repressed Victorian moralism). I have often experienced people gaining insight, but I have never known it change them there and then in any significant way. Again, I’m not really sure what’s meant by ‘personal growth’, but 1 have not seen much of it taking place simply as the result of therapy. The whole idea of ‘cognitive restructuring’ seems to me so mechanistically naive as to be beyond serious consideration. I know at first hand that psychotherapy is very often an extremely warm and moving experience, but I have never known anyone be transformed by therapeutic love alone. Comforting ideas like the ‘corrective emotional experience’ or the therapeutic finishing of ‘unfinished business’, the notion that one can ‘work through’ neurotic conflict, analyse ‘transference neurosis’ or provide ‘re-parenting’ experiences in ways which somehow deliver people from their past seem not only counter to a rational account of human nature and development, but also actually not to happen.

May I say in capital letters and underlined at this point that:

I AM NOT SAYING THAT THERE IS NO SUCH THING AS CHANGE FOR THE BETTER.

I am saying that such change comes about, when it does, in ways not yet adequately understood in psychology and psychotherapy, and certainly not reliably able to be mediated by any psychotherapy currently practised. Again:

I AM NOT SAYING THAT PSYCHOTHERAPY IS WITHOUT VALUE.

I am saying that therapeutic theories have on the whole failed to give an accurate account of wherein their value lies, and would say further that most overstate their value, or at least make claims concerning their ability to bring about change which cannot in fact be substantiated.

This state of affairs arises not because of some special wickedness in the individual souls of psychotherapists, but because of societal (largely market) pressures which, among other things no doubt, (a) render a mythology of personal change almost irresistibly attractive (without it the barbarity of our world becomes almost unbearable to contemplate) and (b) push us in the direction of a professional model in which a one-to-one therapist/client contact calls for a foundation on the technical expertise of the therapist. In my view both these elements are instructively apparent in the development of Freud’s career. His detachment from the trauma theory of neurosis and his development of a one-to-one practice on the model typical for physicians of his day are explained less by any moralistic references to failure of courage (à la Jeffrey Masson) than by an utterly understandable vulnerability to economic necessity.

And it is still, I believe, economic necessity which plays a large part in leading us to overlook the lessons of our experience. We may comfort our patients and, where they have access to some of the currencies of power in our society, we may be able to encourage them at least to try to affect their worlds. Very often we may help them to become less confused and distraught about the nature of their difficulties. But we don’t erase the scars of a brutalised childhood or render innocuous the inhumanities of the circumstances in which people live. We can neither conquer pain nor transmute desire, for ourselves or for our patients, and we should not seek to normalise the forms in which their pain and their desire are lived. We should not because we cannot. We cannot change the forms of our patient’s pain or desire because they are almost never held in place by anything we can touch. What we can do, and it is no mean achievement, is explicate our patients’ pain and desire in ways that might help them to feel that they are human.

As far as we succumb to the temptation to mediate the postmodern ideology of make-believe, to help construct, that is, a world of relativities and imaginary possibilities where what is thinkable is what is real, where history is reconstructible and pain transformable to pleasure, we run the risk of relegating the understanding of truth to terrorism; for where we do not attend to each other carefully, closely and sympathetically, where we do not struggle to understand each other on the ground of our common embodiment as human animals located in actual space and time, we allow our world and our lives to be manipulated by those with a much cruder understanding of our nature. If we do not call ourselves back from a Baudrillardian fantasy world of ‘endlessly enwrapping images’, of advertising hype and wishful thinking, we render ourselves utterly at the mercy of those who know that our bodies are vulnerable to pain, and who are only too prepared to exploit their knowledge.

An adequate theoretical psychology leads, I believe, away from the kinds of models of therapeutic healing which have tended to dominate the scene throughout most of this century. There have in fact been versions of, movements towards, such a psychology leading an uneasy existence rather at the margins of respectability, but they seem now almost to have dropped out of sight. There is, for example, an ‘alternative therapeutic psychology’ to be traced to the work of Alfred Adler and through that of Sullivan, Horney and Laing. The central theme of these approaches is of course people’s relation to the social/societal context in which they find themselves, the genesis of their experience in a social world. The failure of this theme to thrive in psychology and psychotherapy can no doubt be attributed to the kinds of market forces I’ve referred to. In particular, I suspect, its unpopularity stems from its tendency to direct us towards social practice rather than individual therapy, the external world as much as internal worlds, public as much as private space; it invites political involvement as well as therapeutic concern, strategies of prevention rather than technologies of cure.

It is not part of my aim to attempt to chasten or dishearten people who earn their living by the practice of psychotherapy. I do wish, though, that we would be more modest and measured in our claims than we sometimes are, more aware that our entirely understandable and necessary instinct for survival may at times cloud our judgement and colour our view of our role and purpose in ways which do not make for a better society. Above all, I wish that we would more often and more boldly make use of our extremely privileged position as people who have access to knowledge of the harmful ways in which the world can inflict itself on individual men and women to articulate a psychology which emphasises care more than magic.

references

Baudrillard, J. (1984) The evil demon of images. Power Institute Publications

Bourdieu, P. (1986) Distinction. London: Routledge & Kegan Paul

Mair, J.M.M. (1988) Recent rhetoric in the NHS: reflections on the language of marketed care. Newsletter of the Psychotherapy Section of the British Psychological Society

* This paper was first presented at the PPA conference organised in honour of Don Bannister.

Homepage