The field of psychotherapy has become a confusing one for the general public on account of the large number of names and titles now being used in it.
If you are looking for therapy for chronic physical aches and pains your task is relatively straightforward: you only have find a reliable professional who uses the title of physiotherapist.
But if you are looking for help with stress and strain of an emotional kind your task is a bit more complicated: you have to decide whether you need a professional who calls himself a counsellor – or a psychotherapist, or a psychoanalyst, or a psychoanalytic therapist, or a cognitive behavioural therapist, or an existential therapist, or a gestalt therapist, or a life coach, or … several other things besides.
[Note that throughout this essay I shall refer to any therapist, and any member of the general public, as “he”, “him” and “himself”. This is of course to be understood as a convenient stylistic shorthand for “he or she”, “him or her” and “himself or herself”. It makes no assumptions about the likely gender of either therapists or their clients.]
As a general statement, most of these labels mean less than they seem to mean, in the sense that for the most part there is more that the people who use them have in common than there is that sets them apart.
The fact that it can be difficult to distinguish between the different schools of therapy that use these professional titles helps explain the irritability that so often arises between them. A market square full of stall-holders who are selling similar goods to passers-by is unlikely to be the most tranquil and even-tempered part of town.
To try to offer a little clarity in this confusing picture I want to consider here the general meaning of what is one of the oldest and most widely accepted labels in the field: psychoanalytic therapy. This is also the one which I happen to use for my own work.
This term originates in the oldest tradition in psychotherapy, which is psychoanalysis. Psychoanalysis has a relation with every other professional title now used in the field, because every other title can largely be defined by how much or how little of traditional psychoanalysis is still endorsed by the people who use that title. Almost all modern psychotherapies rely heavily on the ideas that first emerged with psychoanalysis, though they don’t always acknowledge this. One important school, cognitive behavioural psychology, owes its origins to the work of psychologists who were often strongly motivated to prove psychoanalysis wrong. In spite of this, today most therapy that goes by the name of cognitive behavioural borrows a significant amount of theory and practice from psychoanalysis. Because the influence of psychoanalysis can be found in virtually all modern psychotherapy, by clarifying psychoanalytic therapy we should be able to go some way towards clarifying the field as a whole and showing where the meaningful alternatives are to be found within it.
At the same time it is important to stress that this account is a personal one and that it reflects my own views. This is inevitable. Strange as it may seem to those not involved in the world of psychotherapy, we don’t have objective definitions for any of the terms used in it, if by objective is meant enjoying universal agreement. In this respect, and not only in this respect, psychotherapy is more like a branch of literature or the arts than it is like a branch of the physical sciences. In psychotherapy, just as when we are learning to understand a work of literature or of art, we are engaged in debate about what things mean. And just as with literature and art, although one interpretation can be better informed and based on more experience and insight than another, there is, ultimately, no definitively right answer that everyone will agree on.
Psychoanalysis and psychotherapy have been pretty much the central interest of my life since I was a teenager in the 1970s. This was when I first read Freud’s Introductory Lectures which were published in easily available paperbacks at that time. These lectures gave a glimpse of what seemed to me a magical world in which it would be possible to discover the hidden meaning of our dreams and our little everyday habits and neurotic symptoms.
In later years, after many vicissitudes, I have been privileged to be able to make a small contribution to that world. And it has been as rewarding, and moving, as I expected it to be.
The years however have also taught me the sadder lesson that the profession of psychotherapy as a whole is in danger, as indeed it always has been, from professional insecurity, political in-fighting, unnecessary mystification, and general neuroticism. The work of exploring the unconscious mind is always fascinating. But the professional institutions that have grown up around that work are plagued by territoriality and by spurious claims to precedence and authority.
Contemporary psychotherapy reflects the dawning of the era in which the individual conscience begins to achieve primacy over the morality of the group and community. But because this deep cultural change frightens us more than we like to admit, the work of psychotherapy has stayed, for the greater part, within competing professional groups. Each of these communities of therapists represents, so to speak, a half-way house on the road to achieving the complete, ideal individual autonomy of the therapists who comprise it. The imperatives of therapy, because they are pushing all the time in the direction of this personal autonomy, are therefore themselves always at work corroding the structure of these groups. This is why they are all so prone not just to often bitter rivalries with each other but no less so to internal splitting and faction. At one level, each psychotherapeutic group is trying to break down into its constituent individuals. But the legitimate need of those individuals for learning, co-operation and mutual support, in addition to their conscious and unconscious personal anxieties, work always against this tendency. The outcome of this is that every institutional group in psychotherapy is a more or less uneasy alliance of the individuals who constitute it.
Each new generation of therapists has to do what it can to keep the threats that arise from this factionalism and over-politicisation at bay and try to ensure that psychotherapy remains as far as possible what it should be: a learned, rational and humane approach to overcoming our fears and to finding the courage to be honest with ourselves and to make the best and most fruitful lives that we can.