|
|
|
BadTherapy
 TO THE POINT
- by Rosie Alexander
Behind the closed consulting room door the client talks, at length, and the therapist's voice is little heard. At the other side of the door the situation is reversed.
In bookshops the therapy section shelves groan under the weight of words written by professionals. The contribution of psychotherapy clients is scant, and almost without exception adulatory. And yet, psychotherapy clients are not invariably satisfied with services rendered.
Wilson and Barkham, in their contribution to The Handbook of Psychotherapy, while suggesting that "the average client receiving psychotherapy is better off than 80 per cent of a control population", admit that a possible eight per cent of clients are harmed by it.
Whatever the actual percentage, the fact that a proportion of clients are harmed by therapy is undeniable. One need only attend a meeting of one of the support groups for victims of bad practice or read one of their newsletters for evidence of this.
But, despite the longstanding controversy raging around psychotherapy there is no proper dialogue between practitioners and critics. Indeed, there is a kind of Catch 22 idea put about that if you criticise therapy it simply means that you need therapy. As Polly Toynbee wrote in the Radio Times in May highlighting some of the aberrations of psychoanalysis "... if you challenge the value of any of this, it is a sign of your deep need for more analysis". Some of the criticism directed at the various therapies concerns relatively trivial matters and, if valid, would mean at worst that clients were wasting their time.
A much more serious problem, however, is summed up in the words of Joel Kovel who, in A Complete Guide to Therapy, balanced the view that therapy "can touch the human heart and promote freedom" with the observation that it "can just as likely mechanize, enslave and drive a person crazy". I believe it is this 'enslavement' which is at the root of so much that can go wrong in therapy. It manifests itself as a combination of excessive dependency and obsession, the object of both being the therapist. It affects patients to varying degrees, with some people experiencing virtually nothing of such feelings and others finding that their lives and minds have been taken over by them to the exclusion of all else.
Work is neglected, social life is neglected, existing relationships are neglected. The week is staked out by the schedule of visits to the therapist. Between visits the client's thoughts veer back and forth from reruns of the previous session to projects for the next one to outright fantasies, all involving the person of the therapist. The pain of unrequited attachment can be intolerable.
Although this might seem to be a bizarre state of affairs it has always been considered not only part and parcel of the psychoanalytic process but essential to the success of the treatment. As Denise Saada wrote in L'Heritage de Freud, "Le transfert est indispensable a la reussite d'un traitement psychanalytique".
Freud himself, in describing transference in Introduction to , refers to patients who become morbidly obsessed with their analysts and alienate friends and family by talking about them incessant. But so necessary did he consider transference that he believed that narcissistic personalities, who remained impervious to the phenomenon in much the same way that some subjects cannot be hypnotised, could not be treated by psychoanalysis.
In theory it all seems quite simple. The relationship with the analyst is a recreation of the patient's infantile relationship with his parents. Problems unresolved in infancy are finally resolved in the course of the adult's relationship with his analyst. When this is achieved the patient's feelings towards the analyst evaporate and he not only returns to his normal state of mind, but finds himself psychologically fitter as a result.
In a Panglossian world such would invariably be the outcome. But we are not in a Panglossian world and the outcome is often either "no change" or serious emotional or psychological damage.
The state of mind engendered by transference is ill-understood, especially by those who have never experienced it personally. Even therapists, for whom it is a working tool, often have little idea of the emotional powder keg they are handling.
The feelings of extreme dependency are compounded by a regression to an infantile state with the overall result that the client becomes more or less detached from reality. The effect is similar in some ways to that procured by LSD. (I speak as one who has experienced both). And just as LSD can have profoundly disturbing effects, so too can transference. As French psychiatrist Edouard Zarifian says in his book Les Jardiniers de la Folie, psychoanalysis is only for the psychologically fit; for others it can lead to madness or suicide.
It might seem that the obvious solution for therapy seekers who fear such consequences is to choose a treatment which is not psychoanalytically based. But although the transference phenomenon is an integral and necessary part of psychoanalytic process it is not brought about by any specific psychoanalytic techniques which can be implemented or not as the therapist sees fit. It seems, rather, that the phenomenon can arise spontaneously in any therapy which involves two people meeting regularly on a one to one basis for one to help the other.
For some people this can result in a truly devastating mental condition for which there is practically no help available Although many psychotherapists and professionals in related fields appear to appreciate that a serious degree of mental disturbance is involved they are impotent when it comes to offering a solution. A patient struggling to free himself from a fruitless, agonising and psychologically destructive relationship with a therapist will, if he seeks help, be told either that this is just a phase of the therapeutic process which he must work through, or that he should simply stop seeing the therapist - the latter option of course being a virtual impossibility for a patient held powerless in Svengali-like thrall.
A further complication of such emotional bondage is that it renders the client very vulnerable to the various forms of abuse - particularly sexual and financial exploitation - which are increasingly giving therapy a bad name. MIND, in fact, in one of its advisory booklets (Getting the best from your counsellor or psychotherapist) describes the encouraging of dependency in itself as a form of emotional abuse.
The controversy surrounding psychotherapy has always tended to polarise at two extremes, with the pros fanatically defending the theories of the chosen guru, be it Freud, Jung, Klein, Lacan or any one of a host of others, on the one hand, and the antis shrieking about psychobabble on the other. This does no service either to those who benefit from therapy or to those who find that it merely aggravates their mental suffering.
The problem of excessive dependency and unresolved transference is crying out for attention but no solution will be found unless practitioners are prepared to recognise that a problem exists.
I do not attempt to answer questions, only to raise them. And some questions practitioners might like to consider are the following.
Is there any way of identifying those susceptible to extreme dependency before they start therapy? Some therapists have suggested that "borderline cases" are more prone to this kind of thing. Perhaps there are others. What alternatives to one-to-one therapy can be offered to these people? Group therapy? Family Therapy/ Co-counselling? Drug treatment?
What precisely are the iatrogenic elements of the treatment that trigger off the excessive dependency and other undesirable psychic phenomena associated with transference?
What precautions should therapists take to minimise the risk of this kind of thing? In view of the need for a therapist to remain as neutral as possible the problems associated with receiving clients at home are worth looking at here.
What warning signs that transference is getting out of hand should a therapist be on the alert for?
Finally, given that there will always be a chance of things going wrong even if every effort is made to screen out vulnerable patients, what can be done to help those who fall through the safety net and end up in the state of extreme distress which I and so many others have experienced?
As regards the last question, the answer for me lay in a self-help group where I found understanding and empathy, but without the risk of again being caught up in a prison of dependency.
It is true that my book, in which I recount the process of psychological disintegration which accompanied a course of therapy, conveys a very negative message but I do not speak for those who benefit from therapy. There are already plenty of people who speak for them. I speak only for myself and for those who, like me, have had negative experiences. If such experiences are heard and admitted as valid testimony along with the more positive ones, in an atmosphere free of the mudslinging and hyper-sensitive defensiveness which usually surrounds these debates, a more balanced picture may be obtained.
Rosie Alexander is the author of the book Folie a Deux: An Experience of one to one therapy , London, Free Association Books. (1995)
|
