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A consideration of psychotherapy as an ethical discipline and how this impacts the issue of professional regulation.
“Government regulations all carry coercion to some degree, and even where they don’t, they habituate man to expect teaching, guidance and help outside himself, instead of formulating his own.” – Wilhelm von Humboldt
“They think society wiser than their soul, and know not that one soul, and their soul, is wiser than the whole world.” – Ralph Waldo Emerson
“My discoveries are not primarily a cure-all. My discoveries are a basis for a very grave philosophy. There are very few who understand this, there are very few who are capable of understanding this.” – Sigmund Freud
“The fact is that a vice was revealed that went well beyond the local circumstances that triggered off this conflict. The mere fact that one could claim to regulate the training of psychoanalysts in so authoritarian a fashion posed the question as to whether the established modes of this training did not produce the paradoxical result of maintaining them perpetually as minors.” – Jacques Lacan
A few weeks ago I posted some incidental comments to the Therapists For Change group on Facebook (https://www.facebook.com/groups/2950609755168535/?ref=share) on the position of psychotherapy in Ireland. I expressed the view that the advent of psychotherapy is connected with underlying changes taking place in our culture as a whole. I maintained that we are still coming to terms with these changes and that we have not yet absorbed their full significance.
A couple of people told me they did not understand the point I was trying to make. So let me now attempt to amplify what I said then and see if I can make my remarks a bit more explicit and comprehensible.
The kind of issues that come up for regular discussion in the Therapists for Change group include regulation, training, professional representation and recognition, and fee structures.
It is important to see that issues such as these have not suddenly sprung up from nowhere. They represent only the current outcomes of the interaction of social and psychological forces that have been at work for some time, and will continue to be at work into the future.
We need to cultivate a better awareness than we presently have of what these forces are and how they have evolved and how they are still evolving. In the absence of this it will not be possible to make a proper distinction between those things in the world of psychotherapy it will be relatively easy to change, those things it will be relatively hard to change, those things it may be impossible to change, and, finally, those things it may be possible to change but which it may, in the larger scheme of things, be unwise to change. In turn, without making some such distinction as this it will not be possible to develop clear strategies and policies for addressing the issues that are of concern to us. In the absence of this we will only be reacting to events in an impulsive and ineffective way.
Psychotherapy tries to deepen our insight into the forces shaping us in the present that have their origins in the past. Our aim in doing this is to make possible a more creative and fulfilling future. If we are not prepared to apply this principle of analysis to the work of psychotherapy itself we betray ourselves. The first duty of the psychotherapist, as Freud showed us, is to be ready to analyse one’s own behaviour and motives. Without this capacity for systematic self-critical reflection there is essentially nothing to distinguish us from the legions of pundits, interferers and advice-givers with which the modern world teems. The first and last mark of the true psychotherapist – the psychotherapist by vocation and not merely by profession – is this capacity, indeed passion, for self-analysis.
(Note that throughout this essay I shall in general refer simply to “psychotherapists” and “psychotherapy” because it saves me having to write repeatedly “psychotherapy and counselling”. Nevertheless I am assuming throughout that these two words are synonymous.)
The most significant failing in the debates currently taking place about psychotherapy in Ireland is the relative weakness of this habit of self-analysis. This in turn is reflected in a lack of acknowledgement of how unique is the place that psychotherapy occupies in contemporary society. Confronted as we currently are with the endlessly repeated assertion of its supposed status as a health care profession it cannot be stressed sufficiently that psychotherapy is something sui generis. It does not fit into any existing professional genus.
Yes, indeed, it is true that it has some similarities to medicine and some of the other health care professions. But it has more similarities with the pastoral work we associate with the established religions. It is also deeply influenced by the traditions of critical moral philosophy that run from Socrates to Nietzsche. Furthermore, in its origins and in its continued inspiration it owes profound debts to the work of the great poets, dramatists and novelists through the ages. At the same time, it is in crucial respects not like any of these things. It has roots in many things and yet, just because its origins are so diverse, it is significantly unlike any of the things from which it is descended.
Psychotherapists are uneasily aware of their anomalous position in society. But for the most part not clearly understanding why they are anomalous and where the intellectual roots of their work lie they feel guilty and anxious. They have an uncomfortable sense that they dare not allow quite to cross the threshold of consciousness that they might be doing something wrong, even perhaps something sinful. They have a feeling that if only they could get the rest of society to recognise them as part of a profession just like any other this would take away this underlying sense of insecurity – this sense that civilisation is not quite content with them. Rather than acknowledging this problem honestly however and exploring and clarifying its dimensions, they for the most part try to take flight from it, afraid that if they were to be open about the things that are unique to their work civilisation might decide to do away with them altogether.
The aim of the present short essay is to try to reassure them on this point, to show that their flight to the externals of professionalisation, in the form of greater degrees of institutionalisation and regulation, is essentially a neurotic response. Like all neurotic response, because it is motivated by unacknowledged fears that do not come into view and are not discussed, it ends only in sterility and repetition. It doesn’t solve the problems it is ostensibly intended to solve, because the problems it is ostensibly intended to solve are not the real problems driving it. The true solution, as is the case with all neurosis, is a deeper degree of honesty, more respect for the self, the courage to be more autonomous, and an overcoming of the fear of seeming anomalous. It is in fact by highlighting why and how our work is unique that we can attain the best position from which to defend its legitimacy and gain the confidence of the rest of society. We have our own rules and principles of work and it is essential for us to stress to the rest of society that in important respects these are not like those of any other specialist profession.
Psychotherapy in the Republic of Ireland
The first thing to be noted is that psychotherapy came to Ireland, at least to the Republic, later than possibly any other comparable Western society (“Western” defined here as any society that has been predominantly shaped by the heritage of Judaeo-Christian and classical Greek and Roman cultures). Prior to the 1990s, it is true, there was some psychotherapy in Ireland. But it was rare, it was available to few people, and it was provided for the most part either by medical practitioners, in which case it was subordinated to the goal of achieving some medically conceived notion of “cure”, or by members of religious orders, in which case it was subordinated to the pastoral goals of one or other of the established churches. It was only in the 1990s that a genuinely secular psychotherapy profession emerged as a significant feature of Irish social life, one provided by lay therapists who were neither medical doctors nor clerics, and who were therefore free to treat the goals of therapy as autonomous and important aims in their own right, independent of medical or religious concerns.
One consequence of this late advent of an independent psychotherapy in Ireland is that most of the oldest generation of therapists in this country are, with some exceptions, now in their sixties, and they have professional memories that for the most part do not go back further than the 1990s. By way of contrast, in most other Western countries the most senior generation of therapists may be as much as twenty years older than this and will have professional memories that in some cases reach back to the 1960s.
In these other societies this oldest generation of therapists entered on their careers in a time that was, in some ways, culturally, politically and technologically different from the present. Nevertheless in some countries at this period, for instance the United States, significant parts of the general public were already familiar with a diversity of therapeutic styles and approaches, and the “therapy culture”, in the cities at least, was already recognisable. (And had been named as such; see Philip Rieff, The Triumph of The Therapeutic, 1966) In contrast, in the Republic of Ireland at this time the great majority of people had never encountered a psychotherapist, or knew anyone who had, and few people could have told you with any precision what a counsellor was or did.
In 1951, writing of the United States, Carl R. Rogers remarked (in the opening sentence of the first chapter of his Client-Centred Therapy): “Professional interest in psychotherapy is in all likelihood the most rapidly growing area in the social sciences today.” It would be at least another forty years before anyone could have accurately made a comparable assertion about psychotherapy in Ireland.
In several European countries psychotherapy was well established as a distinct profession by the 1920s. In some countries it was a growing presence even prior to The First World War and before the Republic of Ireland was an independent state. In this context it should be remembered that it is now well over a century since Freud, in 1909, made his visit to lecture on psychoanalysis in the United States, travelling in the company of Carl Jung, from Switzerland, Sandor Ferenczi, from Hungary, and Ernest Jones, from the United Kingdom.
In the countries from which these men came, as well as in the United States, the oldest living generation of therapists at the present time will have been already the third or fourth generation of therapists when they began their careers in the 1960s and 1970s. In contrast, the oldest living generation of therapists in the Republic at present is in essence the first generation of therapists that this country has had.
All this is to underline the fact that the professional institutions of therapy in Ireland are of significantly more recent origin than in most equivalent countries, their place in society is by any comparable standard new, and their structures and traditions and the relations between them have had shorter time to become established than have those elsewhere.
This relative youthfulness on the part of the therapy profession and its institutions in Ireland has significant implications. It impacts, among other things, on the way the profession negotiates with other important players in society, most consequently of course with the political class and the agencies of government generally. These other institutions are either much longer established or are, like CORU for example, the regulatory body for the health care professions, the offshoot of much longer established institutions. This is doubtless one reason why in its dealings with these institutions of societal authority the therapy profession in Ireland, taken as a whole, has been notably passive. Had the government of the Republic proposed to regulate a therapy profession whose institutions stretched back, for instance, to the 1930s, it would have had, one hopes at least, a serious argument on its hands. As it is, the profession has acquiesced in the idea of governmental regulation with scarcely a murmur, indeed with many signs of enthusiasm.
What is so concerning here is the apparent assumption among therapists – or at least among those therapists whom the government has been willing to accept as speaking for the profession as a whole – that the most important issues facing the profession can only be solved by agencies ultimately subject to an authority external to the profession itself. That the therapy profession has acquiesced in this extraordinary suggestion betrays a striking lack of belief on the part of its members in their capacity for self-regulation.
By way of contrast, to the end of his life Freud made clear his opposition to the attempts by the American medical establishment to control psychoanalysis through monopolisation by psychiatry. This was, in part, why he wrote The Question of Lay Analysis, in 1926. He was frustrated in his hopes on this score and American psychiatry went its own way. But several decades after his death, following a decision by the US Supreme Court, the monopoly the medical doctors had established over psychotherapy was dismantled. Meanwhile, the reputation of psychoanalysis in America has never recovered from the years when it was made so expensive by the doctors that only a privileged elite could afford it, and when its failure to live up to the repeated claim that it was a medical specialty had become manifest for everyone to see.
What is disappointing is that so few psychotherapists in Ireland appear to be aware of these historical facts and problems, or can see their relevance to present developments. Whether or not they agree with the position he took on this, how many therapists in Ireland can honestly say they have reflected on why Freud, himself a highly trained medical man, was so opposed to the medicalisation of psychotherapy?
In discussions among contributors to the Therapists For Change group I have seen it suggested that therapists in Ireland may be held in lower esteem than they are elsewhere. I don’t myself believe that this is the case. Few things are a more personal matter than psychotherapy and the views of individual members of the public on therapists and therapy in general, here as elsewhere, will depend almost entirely on what has been their private experience of therapy and whether it has personally been a satisfactory or an unsatisfactory one.
What seems to me to be indisputable, however, is that therapists here, when dealing with institutions of authority or with anyone within the profession who makes claims to authority, speak with a marked lack of assurance, and are, in general, reluctant to assert their professional rights. In part, this is probably a reflection of Irish culture itself, which does have a strong tradition of rebelliousness and non-co-operation with authority but does not have a well-developed tradition of open dialogue with authority with the aim of asserting legitimate claims and privileges. Since the process of psychotherapy is all about learning how to engage constructively with authority – first of all inside one’s own mind – and how to assert oneself in a way that is not destructive, we begin perhaps to get an inkling of why it is that therapy was so late in establishing itself within Irish culture.
Therapists here too often lack the self-confidence and firm readiness to assert themselves that comes from being the conscious inheritors of a well-established professional tradition. Whether this lack of a confident sense of belonging to a tradition is a cause or a consequence of the fact that therapists in Ireland so often do not have a good knowledge of the history of their profession is not so clear.
Either way, this lack of historical knowledge and awareness matters. It does so not just because not knowing how psychotherapy has developed into the thing that it now is weakens a therapist’s sense of identity and his understanding of his professional place in society. It matters also because, as is the case with all the human sciences – all the Geisteswissenschaften, the sciences of the human mind and spirit – if you do not have a knowledge of the history of the ideas you are using you will not be able to apply those ideas with nuance and discrimination.
The Essential Components of Psychotherapy
The first thing to stress in the context of the history of psychotherapy is that all modern psychotherapy and counselling has its origins in the work of Sigmund Freud at the turn of the nineteenth and twentieth centuries and in the psychoanalysis that he created at that time. Summing up the essence of what distinguishes his work is not difficult because he did so himself with great clarity on several occasions.
Psychoanalysis stresses above all the importance of paying attention to unconscious conflicts in the mind between different impulses and drives and how these conflicts express themselves in symptomatic experiences and behaviour. Because of this underlying propensity to emotional conflict, human beings always have motives and feelings that they are not comfortable acknowledging. This discomfort with certain parts of ourselves Freud referred to as psychological defence. It is not just that we do not know what our nature is. We do not want to know what our nature is, because that nature is perpetually at war with itself.
Defence manifests itself in the displacement of our impulses and intentions. More often than we like to recognise, what we desire brings with it something that we fear. When this happens we disguise what we desire as something else. For instance, psychotherapists desire the approval of society as an officially recognised profession. They do so because they do not trust themselves and fear that, without the oversight of authority, they might do something destructive or punishable. But this is a shameful desire, so it is disguised, for instance, as a concern to protect the public from the potential danger of therapists who may not be properly qualified. It is not I who might do the bad thing, it is the other. This is one of the most familiar forms of psychological defence, to be found at the root of so many destructive human behaviour patterns, from inter-familial violence and abuse to racism and sexism in all their forms. What is disappointing, however, is that a profession that claims to specialise in an understanding of unconscious motivation should be so slow to consider its own actions from this point of view.
Apart from defence, Freud also stressed a developmental perspective on the mind, emphasising that our deepest and most long lasting conflicts more often than not have their roots in inclinations that first make their appearance during childhood. This origin of our conflicts in drives that have been shaped in childhood is reflected also in our anxiety about deviating from what we take to be the wishes of authority, initially impinging on us of course in the form of our parents. The achieving of mental health, therefore, is seen by psychoanalysis as a process of emotional maturation, a process in which our fear of breaking with the paths we take to be indicated by authority is replaced by a greater degree of psychological autonomy, that is to say, a state in which we are able to live comfortably with the values and preferences we have developed as a result of our unique abilities, temperament and experience. In the case of the professional neurosis of psychotherapists themselves, this maturation is achieved in the autonomous exercise of professional judgement, without an anxious dependence on the approval of the particular school or institution to which one belongs, or, behind that, on the state itself, both of which unconsciously symbolise parental authority and sanction.
These core concepts of defence, displacement and development, all of which, in this combined form, originate in Freud’s psychoanalysis, are the foundation of all contemporary psychotherapy and counselling and remain central to our work up to the present day.
Psychotherapy and the Legacy of Christianity
As I have remarked, psychotherapy draws its inspiration from many cultural traditions. But the most important thing to understand is that psychotherapy is an ethical discipline, rather than a discipline, like medicine for instance, within the physical sciences. To say that it is an ethical discipline is to say that in a systematic way it examines the values, choices and decisions that operate in human life, considers their origins, looks at how they play themselves out, and suggests how they may be modified so as to make life better.
Other ethical disciplines include economics, politics and education. Freud once famously referred to these as the “impossible professions”. (The remark occurs in Analysis, Terminable and Interminable, 1937.) They are impossible in the sense that no matter what conclusions they reach they never achieve a consensus. They never achieve a consensus, because all these disciplines, like psychotherapy, are concerned ultimately with the question of what should be the aims of human life, what should be the purpose of human life, what ought human life to be about. And this is the question on which human beings never agree.
The best way to make the essentially ethical nature of psychotherapy clear is to contrast it with what has up to recent times been the dominant ethical perspective of the West, namely Christianity. Nothing is more illuminating of the fundamental nature of psychotherapy than to consider the core values that animate it against the backdrop of the core values that animate Christianity. Viewed from this point of view modern psychotherapy emerges as the most significant anti-Christian movement in modern culture.
We should remember that Christianity is the oldest authority in our culture that still exercises significant power over our attitudes, feelings, thoughts and reactions. Although it is often said now that we live in a post-Christian world, the fact remains that the world we inhabit has been ineradicably shaped by Christianity. It is impossible to conceive of European civilisation without considering Christianity. We have all, including those of us who regard ourselves as non-Christians, internalised its values. And as long as we see ourselves as being in revolt against Christian values we are also implicitly acknowledging that for us nothing comes closer to symbolising the pure idea of authority than does Christianity. For many people who have never read The New Testament, indeed especially for those who have not read it, Jesus remains the ideal of the best that a man can aspire to be.
Contemporary psychotherapy however represents a set of ideas that are not compatible with this ideal. Psychotherapy, at its core, is therefore inherently subversive. This is a disturbing idea, including to many psychotherapists. If you do not understand this about psychotherapy however, you do not understand its essence.
To grasp this point is especially important when it comes to a consideration of the place of therapy in Ireland, because Ireland has traditionally so deeply and for such a long time been dominated by Christian doctrines. No doubt there are several reasons why psychotherapy developed as late as it did in Ireland. But by far the single most important one is the long dominance of Irish culture by the Catholic Church.
Throughout the 1980s the Catholic Church still exercised a decisively intimidating influence over the political class in Ireland and in the determination of social policy. This was reinforced by the remarkable scenes of enthusiasm that greeted John Paul II on his celebrated visit to Ireland in 1979. Over the next ten years, whatever their private views and practices may have been, politicians of all stripes dared not institute any social policies that they felt might meet with the disapproval of the Catholic hierarchy. To all outward appearances The Republic of Ireland remained attached to its Catholic traditions and beliefs.
Then, in the following decade of the 1990s, two things of historical significance happened in Irish society.
The first was that the ancient authority of the Catholic Church imploded. Priests and nuns, who had been a commonplace sight on the streets of Ireland for centuries, disappeared from view. For as long back as history has any record clerics had been figures of reverence and at least outward respect in the predominantly rural culture of Ireland. Now, suddenly, in a society that had become urbanised, wealthy and closely connected with the rest of both Europe and the English-speaking world, they became objects at best of popular comedy and at worst of vilification as defendants in cases of sexual abuse. Almost overnight, so at least it appeared, Ireland had transformed itself from a rigidly Catholic society into a modern secular state.
At the same time a second thing happened in Ireland. During these same years in which the ancient authority of the Catholic Church collapsed there was what can fairly be described as an explosive development in the professions of psychotherapy and counselling.
When I was leaving school in the 1970s I didn’t tell anyone about my hope of one day being a psychoanalyst because I knew people would regard it with incredulity. Twenty years later most of the third level colleges in the country offered some kind of course in therapy or counselling, and most were inundated with many more applicants than they could accept. There can scarcely have been another country that took to psychotherapy so suddenly and dramatically from a virtual standing start.
These two social developments of the demise of the church and sudden advent of psychotherapy did not merely happen to coincide in time. They were on the contrary intimately linked to each other: the second was a direct result of the first and without it would not have happened, without it in fact did not happen.
The professions of psychotherapy and counselling are in short the inheritors of the spiritual and emotional problems that people formerly took to their priests and religious confessors. This is true everywhere. But in no society has this been more vividly illustrated than it has in Ireland. In places where the transition from religious faith to therapy has been more gradual there may be some excuse for not appreciating the intimate connection between the two social developments. In Ireland, there is none.
When I use the phrase “spiritual and emotional problems” I am referring to those most personal and fundamental questions that all of us as human beings must resolve, whether we do so consciously and with careful reflection, or unconsciously, reactively and without thought and attention. Questions such as: Who am I? How should I live? What are my priorities in life? What is important to me as a human being? What am I prepared to do? What am I not prepared to do? With whom should I have sexual relations? To whom do I have responsibilities? Whose example should I follow?
In the age of faith this is the kind of question that was answered by religious precept and teaching. In the age after faith, that is to say after the institutionalised religions have ceased to determine what is or is not regarded as acceptable in society, and which is the age we now live in, the people in society whose role it is to help us resolve these questions are the psychotherapists and counsellors.
They do so however in a very different way from that of the clerics before them, or at least they should do. This is because their basic working assumptions are very different from those of the clerics.
The Basic Assumptions of Christianity
So let’s see if we can help clarify the real nature of psychotherapy by first clarifying the features of the ethical system to which it is most directly opposed. Point for point, we shall see that each of the pivotal features of Christianity is challenged by psychotherapy.
The defining feature of Christianity is that it looks to a world beyond the one we experience with our waking senses. The core imperative of Christianity is that we should renounce all our attempts to flourish within this known world. Such things as: taking thought and learning not to act on impulse but only after reflection, acquiring an education, investing in activities that will yield benefits in the longer-term, cultivating the arts and the sciences, cultivating the art of living and the ways there are to make life enjoyable and rewarding, engaging in sexual relations, raising children and teaching them the advantages of maturity – all such things, all the things that define adult life and make it worth living, are systematically condemned in The New Testament. They are so, because Jesus, clearly, was horrified by the world of adulthood and its hypocrisy. Evidently, he believed it is not possible to become an adult and to live well in the adult world without becoming spiritually corrupted. Children on the other hand he saw as representing something more honest and decent, a view most of us would now view with some scepticism. Furthermore he was convinced that God disliked the adult world as much as he did, so much so in fact that he was about to bring it to an end. (Matthew, 16.28; 24.34; Mark, 9.1; 13.8; 13.30; Luke 9.27) If we can take what he is reported to have said as even roughly accurate, Jesus was convinced that a new and completely different order of things was about to be instituted by God, one in which “the last shall be first and the first last”. (Matthew 20.16)
Over the centuries, when the world did not come to an end as Jesus had predicted it would do, Christianity, in order to survive, had to evolve into an organised social movement, and it had to adjust to the experienced world. In doing so however it was compelled to adopt all sorts of worldly aspirations, some charitable and some not so charitable. The various Christian churches were, in effect, institutional attempts to reconcile Jesus’ conviction that the world was going to pass away soon with the experienced reality that it appeared set to continue for the foreseeable future. While Jesus however was personally indifferent to exercising power in the world, just as he was indifferent to improving it, convinced as he was that a power greater than himself was about to sweep it away, the churches that established themselves in his name became, inevitably, deeply ambiguous institutions, striving on the one hand to maximise their influence in the world, while at the same time committed to a profound war with the values of the world. (James, 4.4; John I, 2.15) The result of this fundamental contradiction of attitude was that the churches set about making the violence and cruelty that for Jesus had remained confined within the fantasy of an imagined future, into a part of everyday human reality. A bizarre mixture of genuine charity and extreme savagery, not recorded before in history, thus became the hallmark of the Christian churches around the world. We have seen plenty of this in Ireland.
In contrast to Christianity, psychotherapy is rooted in values and perspectives that go back to the Enlightenment of the eighteenth century with its emphasis on rationalism, scepticism and secularism. Beyond that, its roots can be traced both to the Classical world of Greece and Rome, and to the traditions of Judaism, with their focus on this world and the absence of interest in any life beyond the one we know. Drawing on these traditions, it is quite aware of the manifest failings and imperfections of the world, but unlike Christianity it values the world as something good, not something bad. It aims therefore to shape the world – that part of the world that is constituted in our own self – so as to make it as fruitful as it can be.
The most important point of disagreement between modern psychotherapy and Christianity is that psychotherapy sees in the challenges of adulthood an adventure of interest and of value, in fact of the highest value, and it takes the hallmark of achieved adulthood to be the capacity to balance divergent inclinations within the self. It does not look to any agent external to this world to either reward or punish us for our actions. Rather, it regards the highest reward that life can offer as being the consciousness of having overcome destructive conflicts within ourselves and having turned these into sources of generation and creativity. The ethical core of psychotherapy, and its central point of conflict with Christian doctrine, is the belief that one can indeed live in the adult world as an adult, and do so with a basic level of honesty, decency and integrity.
For Christianity, because the world we know is condemned by God, and because the self is so constituted as to live in a world that is condemned by God, love is defined logically as the sacrifice of the self, the destruction of the self. This idea has been such a foundational one for moral discussion and thought for so long that we have difficulty in becoming aware of it, let alone questioning it. It is almost an automatic response in us to assume that giving preference to the needs of the other over those of ourselves is morally “good”, without ever asking ourselves whether there might be something questionable with the assumption that we actually know what the needs of the other really are, or know what our own needs really are.
For psychotherapy in contrast, because it works on the contrary assumption to Christianity that the world though full of imperfections should be made as fruitful as possible, love is defined in the opposite sense to this, namely as a deepening of our understanding of the needs of the self in order to achieve something closer to its true creative potential, so that in turn it may maximise what it has to offer to the world.
Because its central principle is the belief in another, unknown world, Christianity relies on the idea of faith or, in other words, on unconditional authority (unconditional because it emanates from outside the knowable world of conditions). Jesus claims that faith in him is the path to eternal life in this other, coming world and that anyone who lacks such faith will be condemned. (e.g. Matthew 19.28-30; 25.31-46; Mark, 9.42; Luke 12.8-12) A Christian therefore is not primarily someone who does good works. Notwithstanding the parable of the Good Samaritan (Luke 10.29 ff.), Christianity (unlike Buddhism for example, or Confucianism) is not defined as a code of conduct or a morality for governing action in, or attitudes to, the world. It is, rather, a system of faith in one particular individual, Jesus. “He who denies me before men will be denied before the angels of God,” Jesus is quoted as saying. (Luke 12.9) This is the primary assertion of authority upon which Christianity ultimately rests.
Because it argues that God condemns the world and will, at some point, institute a great judgement on us all, Christianity maintains that each of us is in need of salvation, and that only through accepting the authority of Jesus is that salvation possible. This is developed into the claim that it is therefore only through his agent, the social institution of the church, that one can be forgiven for being a human being, for having human attributes, and for wishing to be a human adult.
In place of this ideal of salvation and forgiveness modern psychotherapy offers that of personal formation and autonomy. Assuming no world other than the one we experience day-to-day it maintains that our salvation can lie only in ourselves. None of us is responsible for what we have inherited from the past. But we are each responsible for what we do with that inheritance. We should make life as good as we can.
In psychotherapy therefore there is no claim made to authority analogous to that in Christianity. Each individual is assumed to be seeking a unique solution to the puzzle of life. The therapist is a facilitator or catalyst in the striving of the individual towards achieving a greater degree of self-formation, an acceptance and celebration of one’s unique nature and destiny, through a deepening knowledge of oneself and of what makes one creative. Psychotherapy emphasises the importance of an ever-diminishing emotional dependence on any authority that is acting in one’s life in a destructive or inhibiting way; in short, in an ever greater understanding and mastery of the self.
The Fudging of Values
At the beginning of the Christian era the various Christian churches were attempts to reconcile the irreconcilable, that is to say, their aim was to keep alive in the world an ideology whose fundamental premise is that nothing in the world is worth keeping alive. In essence, this is what they have remained down through the centuries, in each era shifting and modifying their positions so as to stay as far as possible compatible with the current prejudices and objectives of the most powerful players in society.
It is often said nowadays that the Christian churches corrupted the message of Jesus. This of course is true, but not in the sense that is usually meant, namely that the views of an essentially kind-hearted and peace-loving man were used to justify institutions of political power and violence. The only evidence we have – which is the evidence contained in The New Testament – presents a consistent portrait of a man who was animated mainly by disgust at the world he saw around him, and who hoped and expected that world would soon suffer a general retribution for being as corrupt and hypocritical as we all know it to be. The problem for those who wished to use the message of Jesus as the basis for a religious movement was that there was no way that Christianity could exist as an established religion except by effectively ignoring what was his key assumption, that God was about to take action and exact that retribution.
Jesus himself was essentially passive in the face of the world, while the churches established in his name have been essentially active. While serious Christian scholars have always been quite aware of what Jesus is reported to have said, in practice, as a working religion, it has never been able to transcend this basically counterfeit position, and every new generation that has subscribed to Christianity, because Jesus’ key assumption turned out to be false, has had no choice but to distort his message into something other than what it actually was. As a consequence, in general, each succeeding generation has projected onto the figure of Jesus whatever it took to be its own “best” inclinations and instincts, whether these were, for instance, the felt duty to colonise and convert “less civilised” peoples around the globe, the felt duty to persecute anyone whose sexual life deviated from monogamous heterosexuality, or, as in our own day, the felt duty to be tolerant and unassuming in the face of all kinds of racial and sexual difference and diversity. Down the ages Christianity has shown a remarkable capacity to follow the exhortation of St Paul and has been “all things to all men”. (1 Corinthians, 9, 22)
This ancient propensity on the part of the Christianity to twist and turn to every prevailing cultural trend has also had an extensive influence on the course of psychotherapy over the last hundred years, sometimes distorting the figure of Jesus to portray him as some kind of proto-Freudian, more often distorting the nature and aims of psychotherapy to make it conform more closely to what is taken to be the Christian position.
The fact that psychotherapy represents a rejection of the central tenets of Christianity has not been an easy one to accept for societies whose foundations have assumed the truth of Christian ideas. The idea of Christianity as the spirit of authority as such – in other words as what is “good” as such – is still deeply embedded in the unconscious of our culture. The appetite therefore for some kind of fudge – for variants of psychotherapy that would seem not to be at odds with the major principles of Christianity – has been enormous.
The earliest significant attempt to reconcile psychotherapy with Christianity is Carl Jung’s Analytic Psychology which he developed in the decades after his break with Freud prior to The First World War.
Jung devoted much energy to trying to reconcile religious ideas in general with the principles of psychotherapy and to blurring the distinctions between them. In the particular case of Christianity this required a distortion both of it and of psychoanalysis. The latter he was prone to portray as an attempt to reduce man to something less than his full humanity. “I must admit,” he writes of Freud’s psychoanalysis, “that a purely sexual aetiology of neurosis seems to me much too narrow. I base this criticism not on any prejudice against sexuality but on an intimate acquaintance with the whole problem. I therefore suggest that psychoanalytic theory should be freed from the purely sexual standpoint.” (“Psychoanalysis and Neurosis”, 1916, quoted in Anthony Storr, ed., Jung: Selected Writings, Fontana, 1983, p.50).
The problem with this is that psychoanalytic theory as developed by Freud never assumed a “purely sexual aetiology of neurosis”. On the contrary, it is based on the assumption of a psychic conflict, sometimes involving sex, and sometimes not. The point of psychoanalytic therapy is to achieve a reconciliation between the conflicting forces within the mind, so that both sides in the conflict are recognised, and neither strives to extinguish the other. Where sex is involved in psychic conflict the aim of therapy is to be more honest about this so that it can be integrated in a harmonious way with the rest of the personality. This is what autonomy and mature emotional individuation mean.
Jung is distorting also of Christianity, suggesting that, properly understood, there is no real conflict between it and psychotherapy. “The development of personality means … fidelity to the law of one’s own being. For the word “fidelity” I should prefer, in this context, the Greek word used in The New Testament, pístis, which is erroneously translated “faith”. It really means “trust,” “trustful loyalty.” Fidelity to the law of one’s own being is a trust in this law, a loyal perseverance and confident hope; in short, an attitude such as a religious man should have towards God.” (“The Development of Personality”, 1934, quoted in Anthony Storr, ibid., p.197) This implies that Jesus’ demand that one have faith in him, and in the coming other world, is actually the calling to become who you are in this one. Like Jung’s portrayal of psychoanalysis, this is simply historically incorrect.
Another influential fuser of the therapeutic and the religious is Jacques Lacan. Lacan is master of the art of being, if not all things to all men, then at least all things to all psychotherapists. It is possible to quote him in support of most positions, and indeed I have used a remark of his with which I agree as one of the epigraphs to this essay. Nevertheless in spite of his endless gyrations it is not difficult to trace the main thrust of his thinking.
Unlike Jung, Lacan abandons the basic principle of psychotherapy, which is to learn about and reform the self. He pointedly rejects the key Freudian concepts of defensive conflict between drives and the aim of reconciling such conflicts, expressed in the idea of the organizing ego. In their place he enshrines the notion of the “absolute Other” as our goal. Like all his notions, this idea of the “absolute Other” has a studied vagueness about it; it is not explicitly the old God of traditional theology, but at the same time Lacan is not going to gainsay anyone who chooses to take it in that sense.
By claiming that he represents some kind of “return” to Freud, in other words, by claiming implicitly that if Freud had understood himself as well as Lacan does he would have been a Lacanian, by repeating that the unconscious is “structured like a language”, which is in essence a way of suggesting once again the old Christian duality of body, the world of nature, and spirit, the world of language (Lacan quotes approvingly, John, 1.1: “In the beginning was the Word …”), and by spicing his writings with arbitrary references to philosophers like Hegel and Heidegger who are full of difficult abstractions, Lacan has won a widespread following in contemporary academic circles. He has been particularly popular in recent decades in traditionally Catholic societies, including Ireland.
A third example of the inclination to draw psychotherapy closer to traditional Christianity is “existential” therapy. This is Christian insofar as it displaces the focus on the fear of individuation and the assertion of the self, which Freud believed was the most fundamental fear that results in psychic conflict, with the fear of death. The most impressive instance of this is perhaps the work of Irving Yalom (see his Existential Psychotherapy, Basic Books, 1980). Existential therapy, through its positing of the primacy of the fear of death represents a regression back towards Christianity. Fear of death, let us remember, is the primary fear as far as Christianity is concerned and its central promise is that it offers a way of overcoming death – hence the resurrection – and achieving eternal life.
A fourth example of the attempt to blunt the conflict between modern psychotherapy and Christian teaching will surprise some people, yet in many ways it is the most interesting of all, because it is the most veiled. This is cognitive behavioural therapy, or CBT as it is now usually called. How does CBT show the influence of Christian teaching? Well, it does so by positing as the goal of psychotherapy not the deeper personal autonomy of the self but rather the drawing of the behaviour and responses of the self closer to some supposed normal standard. In other words, the central ethical imperative of psychotherapy, according to CBT, is not the cultivation of the habits and conditions that as far as possible maximise the fruitfulness and creativity of the individual, who by definition is an exception, but rather the approximation of the individual as closely as possible to those patterns of action and feeling that, supposedly, are manifested by the majority of other people. It is, in other words, a denial of the unique imperatives of the self, but presented in the guise of science. It is an attempt to justify, so to speak, the blunting of the self. In classic CBT that is undiluted with psychoanalytic influence (something nowadays rarely encountered), the essential uniqueness of each individual and therefore the ethical imperative for each of us to understand ourselves as best as we can are ideas that are not entertained. It is a reflection of the continuing power of Christian attitudes, and the unconscious guilt felt as a consequence of departing from them by asserting the unique rights of the self, that CBT has become the most popular choice of psychotherapy around the globe.
These are just four examples, prominent at present or in the recent past, of the different ways in which contemporary psychotherapy has been shaped by what are ultimately Christian traditions and attitudes.
Debate in Psychotherapy is Ethical Debate
In examining the impact of Christian ideas on psychotherapy my point is not to argue that one approach in psychotherapy is preferable to another.
It is true that I am more sympathetic to the traditional psychoanalytic position than I am, on the whole and with some exceptions, to that of Jung, Lacan, Existential therapy or CBT. But I know well that there are fine therapists in each of these schools doing important work helping people in distress and keeping people alive. Furthermore each of these schools has made vital theoretical contributions to psychotherapy without which the field would be much poorer than it is. If psychotherapy had remained a Freudian monopoly it would have become sterile long ago.
But that is not the point I want to make here either.
What I am concerned with here is to underline the nature of debate in the field of psychotherapy: debate here revolves around human values. In all psychotherapy we find in the background the same fundamental, eternal questions: What is human nature? What are the basic needs that must be met for the human animal to be well? How should human beings live? And in each particular case of psychotherapy there is one central specific question that comes to the forefront: How should I live now?
Debate in psychotherapy is ethical debate, it is not medical debate. In medical science disagreements are settled, sooner or later, by the results of empirical research, and empirical research that can nowadays almost always be measured and expressed with great precision in mathematical terms.
We psychotherapists do not argue with each other in this way. We argue about what are in essence moral questions, we argue about what are the hidden aims and motives of human life. Each age and each culture has tended to delegate the formal evaluation of this kind of argument to particular specialist groups or classes within society. The ancient Hebrews delegated it to the priests. The ancient Greeks delegated it to the philosophers. The Christian age delegated it to the clerics and intellectuals of the Church. And our age has delegated it, more than any other, to the psychotherapists.
We are not just the inheritors of the questions formerly answered by the Christian churches, we are the inheritors of the entire moral debate of the West that begins with Heraclitus, Socrates, Plato and Aristotle in Greece, and the writers of Genesis in ancient Israel. This is the tradition to which we belong. It is a fundamental mistake to place us within the medical tradition and that of the physical sciences.
It is instructive in this context to return to 1951 and Carl R. Rogers’ Client-Centred Therapy. There, Rogers makes plain that he expected a rigorous scientific approach to psychotherapy to reduce what was by that time an already proliferating number of therapy schools, and to lead gradually to greater unanimity. At the time Rogers evidently thought of “client-centred” therapy as a particular technique of therapy which, by its successful results, would demonstrate the essential psychological autonomy of the therapy client. He seems to have regarded alternative schools of therapy as somehow not quite believing in this fundamental autonomy and therefore as bound over time to be gradually superseded as a result of empirical research.
Rogers writes: “In the accumulation of recorded case material and in the prosecution of research in therapy, client-centred therapists have thus far carried the major burden. Yet there is encouraging evidence that workers with other views are now recording their cases, and it is only a question of time before research studies will be made by Freudian analysts, hypnotherapists, Adlerians, and eclectic therapists. It is these research studies of the future which will help to remove the labels and unify the field of psychotherapy.” (ibid, p. 13, emphasis mine)
This of course is exactly what did not happen. What we have seen over the last seventy years is not the greater unification of the field of psychotherapy but its ever greater diversification.
In essence, in 1951 Rogers was confusing a scientific hypothesis of the kind we find in the physical sciences, and which the evidence would show to be correct, with an ethical attitude that he believed the therapist ought to adopt towards the client.
Treating the client on the assumption that he will have a better quality of life if he learns to behave with a greater degree of personal autonomy is, in my view, usually the best way to proceed in therapy. I happen to share this ethical attitude with Rogers. But there is no way that we can demonstrate scientifically that it is the correct way, destined to supersede all the others. There is no conceivable outcome to psychotherapy that would somehow demonstrate that the client possesses psychological autonomy. Any more than one can prove, for example, that the Christian view that this life is of no value is a mistake. These are ethical positions, not testable hypotheses of the form that can result in consensus. Whether one adopts them or not depends on one’s temperament, experience and judgement. On this kind of question, no one can show that one position is more correct than another. There will always be those who disagree with every ethical position. And every question in psychotherapy rests ultimately on an ethical problem, however it may have been dressed up in the garb of rigorous science.
Seventy years after Rogers, however, we are, in effect, repeating the same mistake that he made of confusing ethical positions with demonstrable propositions. The arguments that have been made for the greater state institutionalisation of the psychotherapy profession in Ireland assume that we have at our disposal objective tests that can establish which approaches in psychotherapy are effective, valid and true, and therefore which therapists, by demonstrating their capacity to utilize such approaches, may be judged as fit to practice. That this ancient mistake is being repeated reflects the lack of historical awareness in Irish psychotherapeutic circles.
In the professional disciplines that are based on the application of the physical sciences we have always agreed beforehand on what it is we want to accomplish. For instance, we want to build a bridge that can safely support a particular weight of traffic, or we want to rid the oceans of plastic waste, or we want to put a satellite in orbit around Mars, or we want to increase crop production on a given acreage of soil, or we want to find a vaccine for a particular virus, and so on. We always know beforehand what it is we want to accomplish. (I am speaking here of the applied sciences, not pure research which may have no particular end-point in view.)
In the case of medicine and the health care professions the overriding objective is to prolong the life of an individual in as physically healthy and active a state as possible. The performance of anyone engaged in professions like this can readily be assessed. Either their intervention achieves this aim, taking into account all the initial conditions of the patient, in which case the intervention is judged a success, or it does not, in which case it is judged a failure. To be admitted to the membership of one of the institutions of such a profession, and to retain that membership, a practitioner must be able to demonstrate a sufficiently high number of successful interventions. There is no conceptual difficulty in assessing the qualifications for membership of such professions.
In psychotherapy, however, we cannot agree on what is the ultimate aim of the intervention. We don’t have agreement on where we should be going in psychotherapy. The splintering of the field into so many schools is simply a reflection of this inability to agree. Should we be aiming for the strengthening of the ego, as the Freudians traditionally maintain? Or should we be aiming for a deeper sense of faith, as the Jungians suggest? Or should we be helping the client in therapy to recognise the absolute Other, as the Lacanians would say? Or should we be assisting the client in overcoming his fear of death, as the Existentialist school claim? Or should we be trying to modify the responses of the client so that they are as close as possible to what is normal, as the CBT school insists? Who knows? Who can say?
Well, the only person who can say is the client himself. It is what he or she wants from the therapy that is the only legitimate authority we have in this matter. A therapist is of course justified in challenging what the client says he wants, on the quite legitimate grounds that the client may not be seeing his own best interests and might be wiser to modify what he wants. But ultimately, no therapist has the authority to go against what his client says he wants to achieve. If client and therapist cannot agree on this, the therapy has broken down.
But the fact that we cannot agree beforehand what is the ultimate goal of our work means that we cannot, beforehand, establish any objective measure to assess the success or failure of that work. At the outset we literally do not know where we are going with any course of psychotherapy. This is why the history of all psychotherapeutic institutions is one of fragility. Constantly, they splinter and fragment
The danger we are currently drifting into in Ireland is that this natural propensity to fragmentation in the institutions of psychotherapy will be inhibited by the actions of the state.
The result will not be higher standards of therapy – for the simple reason we have no measure by which to judge whether standards are higher or lower – but the suffocation of debate and the self-censoring of divergent viewpoints, with a resultant loss of diversity and choice available to the general public.
I have already suggested an alternative framework for developing institutional supports for the psychotherapy profession which would get around this problem of self-censorship and be based on a proper recognition of the status of psychotherapy as an ethical discipline engaged in the investigation and discussion of what are the best and most fruitful aims of human life in a modern, democratic, secular society. You can find the link to those proposals here: http://pangurcottage.blogspot.com/2018/03/presentation-to-what-is-future-for.html
But what we need at the moment above all is something we have not yet had: a proper open debate about the alternative possibilities for structuring and clarifying the aims of the therapy profession.
I hope that the present essay may go some small way to stimulating at least a few interested people to think again about the unique place of psychotherapy in our society, and about what might be the best ways of maintaining its vitality into the future.
The classical analysts got one thing right: you cannot “cure” people by merely sympathising with them on their misfortune. Beware pity & Mitleid.
But they got one thing wrong: you cannot “cure” people if you withdraw from them emotionally. The therapist has to be an incitement to them to achieve a higher state of harmony & repair. Pace Freud, the task of the analyst is not to be a “mirror” to the patient. Nor is this what Freud himself did. It is to show that a higher unification is possible.
Physician heal thyself, said Nietzsche, because by doing so you give your patient the courage to heal himself.
Shame exists wherever there is a “mystery”; but this is a religious concept, which in the older times of human culture had a wide extent.
… Sexual relations, for example, which as a privilege and adyton [this was traditionally the most sacred place within a Greek temple, reserved for the priests and priestesses] for adults were to be withheld from the view of children, for their advantage.
… In the same way, the whole world of inner conditions, the so-called “soul”, even now for non-philosophers [let’s include depth psychologists here among philosophers] is a mystery, because this has been believed to be, for countless ages, of divine origin and of being worthy of divine intervention: as a result it is an adyton and arouses shame.
Nietzsche – Human, All-too-Human, section 100
Das Leben sei so hübsch, daß man völlig für gleichgültig achten könne, wem man es zu verdanken habe: denn es schriebe sich doch zuletzt von Gott her, vor welchem wir alle gleich wären.
Life seemed to me so beautiful that I thought one should regard it as completely a matter of indifference to whom one owed it. And in the end it was in any event to be ascribed to God, before whom we were all equal.
Dichtung und Wahrheit, I 80
“When I am asked how one can become a psychoanalyst, I answer, through the study of one’s own dreams.” (DP 76)