The Intellectual Roots of Psychoanalytic Therapy: Nietzsche and The Theory of Displacement

What is Psychoanalytic Therapy? – A Personal View, Part 6

Freud’s development of psychoanalysis did not happen in a vacuum. He drew for inspiration on a wide range of predecessors in 19th century medicine, psychology and philosophy, as well as the great dramatists, poets and novelists of the past. As he himself was the first to acknowledge, the idea of the unconscious mind, the idea of unconscious conflict, the idea of defence against unpleasant and disturbing thoughts leading to their repression from consciousness, the idea of infantile sexuality, and other ideas that characterise psychoanalysis, had all been anticipated in one form or another before him. Freud’s importance is not that he was the first to think of any of these ideas but that he was the first to combine them together to create a viable form of psychotherapy.

As it has developed after Freud, modern psychotherapy has followed Freud’s example by continuing to draw inspiration from these older, pre-Freudian sources.

The philosopher and psychologist who is the most important anticipator of Freud’s thinking and who is closest to him in intellectual spirit is Friedrich Nietzsche (1844-1900). Nietzsche has had a deep impact on many areas of modern thought. His influence on the development of psychotherapy in particular, though not always acknowledged, has been profound. Freud once called him the first psychoanalyst.

When Freud was developing psychoanalysis in Vienna at the end of the nineteenth century he was working in an intellectual environment where there was widespread discussion of Nietzsche’s ideas. Though he was too ill to write any more after 1890, and died in 1900, during this period Nietzsche became an inspiration to the modernist intellectual movement that emerged throughout Europe in the years before the First World War.

Modernism has many strands in the humanities and sciences and in the arts and literature. It is characterised by an awareness that the religion and morality that guided European civilisation for centuries has burnt itself out, and that modern culture will be dominated by the ideals of science, technology and rationalisation, but that these developing trends will nevertheless collide and interact with, and at the same time come to reflect, the underlying irrational nature of human beings.

Joyce, Proust, Mann, Kafka are representatives of this modernist sensibility in literature; Mahler is in music; Munch is in the graphic arts; Max Weber is in social science. And there are countless other pivotal figures that could be mentioned here. Psychoanalysis is another part of this modernist movement, a movement that continues to shape all our thinking in the arts and humanities today.

Freud said he refrained from reading Nietzsche too closely because he wanted to develop his ideas as independently and as much in the light of his own clinical experience as he could. But there is no doubt he was influenced by this atmosphere of discussion of Nietzsche’s ideas. As a medical student he also had a friend, Joseph Paneth, who had met Nietzsche, and who discussed his ideas with Freud. [cf Ronald Lehrer, Nietzsche’s Presence in Freud’s Life and Thought, 1995, pp.44-51] And many of those who later became Freud’s followers, including those who subsequently broke with him to form their own schools, like Alfred Adler, Carl Jung and Otto Rank, made no secret of how important Nietzsche was to their own thinking. After Freud himself, Nietzsche is much the most significant shaper of the contemporary world of psychotherapy.

Nietzsche was especially interested in the psychology of religion and morality and in uncovering the unconscious roots of the emotions associated with these things. This is where his strengths are to be found, just as Freud’s are in the psychology of the family and of childhood and of sexuality.

Nietzsche is, in particular, the first thinker systematically to explore the notion of unconscious displacement. Displacement refers to the shifting of an emotion from the person it was originally aroused by and directed towards, through symbolic connections and associations, and as the result of conflict with other emotions and interests, onto a different person.

For instance, Nietzsche was the first psychologist to trace clearly the psychological mechanisms behind masochism, the inflicting of suffering on the self, making plain that it is a displaced form of sadism, the inflicting of suffering on someone else. Masochism can be as gratifying as sadism to the subject’s wish for cruelty, in fact it may be more gratifying; all that happens, from a psychological point of view, is that the self has been substituted for some other person as the object of the sadistic emotion. Masochism is accompanied by the unconscious thought, “I cannot make him suffer, but I can make myself suffer, and make him watch my suffering and feel uncomfortable and guilty because of it. I may also be able to stir up the anger of others, more powerful than me, towards him, through their identification with my displayed distress.”

An important point stressed by Nietzsche is that masochistic behaviour towards the self is every bit as much a reflection of self-assertion as is sadism towards another. Try as we may to evade it, egotism, the assertion of the interests of the self, animate everything we do.

Along with this insight into masochism and sacrifice of the self goes of course the corollary that caring for others, looking after them, tending them, healing them, protecting them, and so forth, may be, through identification with them, a displaced way of caring for ourselves. At the same time, caring for others can also, through the exercise of greater control over ourselves, be a displaced and sublimated way of gratifying our wish for power over them.

Nietzsche points out that our sense of identity is never clear-cut and precise, and that we identify one person with another person, and ourselves with others, and others with ourselves. As a result of this we can never be completely certain about where our most powerful emotions and feelings are directed. Love of others is always entangled with love of ourselves; hatred of others always goes hand in hand with hatred of ourselves.

These are revolutionary insights, because they undercut the ancient assumption (it can be traced back at least as far as Plato’s Republic in circa 400BC) that there is a fundamental moral difference between caring for someone else and caring for oneself, and between hurting oneself and hurting someone else, and therefore that the basis of morality is putting the interests of others ahead of one’s own.

In overturning this assumption Nietzsche lays the foundation for modern psychotherapy. Psychotherapy in the contemporary sense is only possible in a moral world in which the care of the self is regarded as being at least as important, and sometimes more important, than care for others. The idea that our moral duty to others can be isolated from our moral duty to ourselves is simply no longer tenable. To neglect ourselves is to neglect others, and to neglect others is to neglect ourselves. We are rediscovering here the ancient wisdom of the Jewish talmudist Hillel (circa 50BC) who famously remarked: “If I am not for myself who will be; and if I am for myself alone, what am I?”

If we had to identify the single most important insight in psychoanalytic therapy, and in the whole of modern psychotherapy and counselling, it would be this mechanism of unconscious displacement. In psychoanalytic therapy we are considering all the time how we shift our attitudes and feelings from one person to another, and from other people onto ourselves, and from ourselves onto other people.

This is how, for instance, we transfer our feelings that originate in our relations with our parents onto our adult partners, and onto our children. It is how our love and our anger get turned on people who apparently have had no objective role in provoking such emotions, how we come to persecute other people because they reflect things we don’t like in ourselves, and how we come to punish ourselves for things that were done by other people. This mechanism of displacement is the key to understanding the universe of irrationality that characterises human life and action.

The displacement of emotions plays such an extensive part in human life because we live so much by symbols and metaphors. This is another way of saying that, more than any other animal, we experience one thing as like or similar to, or associated with, or a substitute for, another thing. This makes us a very creative animal but it also amplifies, to an extent that is unparalleled in the rest of the animal world, the scope for both conscious and unconscious conflicts between our wishes, impulses and drives. Our wishes are continually getting entangled in each other, trying to achieve objectives that they feel are like an objective they cannot reach, and in the process forming alliances with each other, and at the same time pursuing aims that are incompatible with those of others.

It is because it takes the part played by symbolism and metaphor in human life so seriously that psychoanalytic theory has consistently outperformed in sheer fruitfulness every other model for human psychology that we have seen. These other models, invariably, have tried to mimic the sciences of other things, especially the psychology of others animals. But in doing so they have let slip from their grasp the essence of what makes us human.

Tomorrow: (7) The Notion of “The True Self” in Psychoanalytic Therapy

Psychoanalytic Therapy is a Psychodynamic Therapy

What is Psychoanalytic Therapy? – A Personal View, Part 5

The second distinguishing characteristic of psychoanalytic therapy, after its rooting of the symptoms of emotional distress in the history of our personal lives, is that it considers the human mind as a place of conflicts between different wishes and drives, and it treats the symptoms of emotional suffering as expressions of these underlying conflicts.

Life all the time presents us with painful choices and dilemmas. For instance, we often feel we should behave in a caring and considerate way towards people whose behaviour may be hurting or injuring or confining us.

To return to our previous example, a man might feel under an obligation to care for his ailing mother, even if he has himself never received much genuine love from her. He might spend years looking after a difficult, selfish woman for whom he feels little real affection. And the price he may pay for this is having to put on hold the development of relations that are important to his own long-term wellbeing.

In dilemmas like this, which arise in one form or another all the time in life, discovering just where is the correct balance between doing our duty to a parent, or a partner, or a child, and fulfilling our duty to ourselves, can be very difficult.

The emotional conflicts produced by this kind of problem are not trivial; often they make people anxious and depressed, and they can cause physical illnesses in addition.

Freud was very skilled at tracing the different ways in which we can get caught in personal conflicts like this. Such conflicts often take unexpected forms, or forms that we do not like to acknowledge. Freud said that we, in his term, defend ourselves against acknowledging many such conflicts in ourselves, because we feel ashamed of some of the impulses in ourselves that generate them, and we don’t know how to resolve them. When we defend ourselves against conflicts like this they are said to be repressed out of our conscious awareness. Freud regarded overcoming this defence as the main aim of psychotherapy. He believed the most important thing in life is to have the courage to face the truth about our real motives. All modern forms of psychotherapy that place an emphasis on being honest with ourselves show Freud’s influence.

Because it is focused on personal conflicts like these between emotions, we say psychoanalytic therapy is concerned with the dynamics of the mind. For this reason psychoanalytic therapy is often also referred to as psychodynamic therapy. These two terms mean the same thing.

Tomorrow: (6) The Intellectual Roots of Psychotherapy: Nietzsche and The Theory of Displacement

Psychoanalysis and Psychoanalytic Therapy

On the relation between Psychoanalysis and Psychoanalytic Therapy

What is Psychoanalytic Therapy? – A Personal View, Part 4

Freud’s therapeutic work and his writings are correctly described as psychoanalysis, because this is the term he coined for them. The first one or two generations of his adherents and followers are also rightly described in the history books as psychoanalysts. This is what Freud called them, unless they made a formal break with him, as some of them did, and it is what they called themselves.

Some psychotherapists today still call themselves psychoanalysts. But it is now over 80 years since Freud’s death and if the term psychoanalysis is today intended to mean a psychotherapy that is shaped exclusively by the ideas and practice of Freud, such a thing no longer exists. Everyone who now calls himself a psychoanalyst is, in practice, implementing a form of therapy that is influenced by Freud and also by other people in addition to Freud. In other words, he is practicing a form of psychotherapy that can be accurately described as more, or less, psychoanalytic.

For this reason many psychotherapists like myself who acknowledge a major debt to Freud’s work, but who wish to emphasise at the same time that other influences are also important to their idea of therapy, call themselves simply psychoanalytic therapists.

In cutting our way through the jungle of terms that has come to plague the contemporary field of psychotherapy, the attempt to draw a distinction between psychoanalysis and psychoanalytic therapy is no longer of value. From the point of view of a member of the general public trying to figure out what kind of therapy he can expect from a given practitioner, psychoanalysis and psychoanalytic therapy may be treated as the same thing. Some therapists using these terms will try to adhere more closely to a model of therapy associated with Freud, and others will be less concerned with this. But until you meet the therapist you will not be able to tell from the title he chooses what is his practice in this regard. Except when referring specifically to historical events and the development of psychotherapy in the past, I shall therefore for the remainder of this essay ignore any distinction between the two terms.

The most important distinguishing characteristic of psychoanalytic therapy is that it places emphasis on treating emotional problems by looking at the biography of the person as a whole. The symptoms of the individual are taken to be the outcome of his whole history, development and life circumstances.

One of the words that regularly occurs in Freud’s writing is context – Zusammenhang, in German. Freud is looking for contexts within which the symptoms of the patient make sense. In other words, he is looking for connections within which the symptoms form part of a comprehensible story. What this means in practice is that we connect symptoms with events and experiences in the individual’s life by postulating emotions and motives that plausibly link them.

For example, if a young man falls physically ill with chronic debilitation, headaches and vomiting, and it emerges that he has spent the last several years caring for a mother who has been suffering from a terminal illness, then it is possible he has fallen ill, at least in part, because he has had to deal for so long with the conflicts between his feelings that have arisen as a result of such a demanding way of life.

Furthermore, if, when we speak in confidence to the man, he tells us he has had to postpone for some years his marriage to his fiancée, then we may have further reason for believing the man’s physical symptoms are in part at least a reflection of the stress he has experienced. His symptoms, in other words, are the way that the emotions he may have not been able to admit to himself, or convey to his mother, have found to express themselves.

Freud writes, in Studies On Hysteria, from 1895:

I am struck by the fact that the case histories I write read like short stories and that they dispense with what one might call the serious stamp of the scientific … However, a searching presentation of the mental processes that one is used to getting from the creative writer permits me, with the application of a few psychological formulas, to achieve a degree of insight into the development of a hysterical illness. [SH 131]

The work that Freud regarded as his most original and significant contribution was his book on dreams. This he entitled the Interpretation [Deutung] of Dreams, rather than the Explanation [Erklärung] of Dreams. Psychoanalytic therapy, and this is true of psychotherapy and counselling in general, is an interpretive discipline, we are concerned with the meaning of symptoms. And “meaning” here refers to the connections that a symptom has with the lived experiences, intentions, concerns, anxieties, hopes and aspirations of the patient.

This is why narrative is such an important part of psychotherapy. We treat symptoms by making stories that make sense of them. And, surprisingly enough, because we are creatures who live so much by stories, making good narratives out of our emotional problems has a powerful therapeutic effect on them.

What the work of psychotherapy reveals to us is that removing symptoms often turns out in practice to be less urgent a matter than discovering what is their meaning in the narrative flow of our lives. It turns out that we develop emotional symptoms not, as with symptoms arising out of our physical nature, because something has gone wrong in our make-up, but because something has happened to us whose meaning we need to find out. The emotional symptoms we develop are a way of forcing us to find this meaning. In other words, unlike physical symptoms which arise because we are not well, emotional symptoms arise as an adaptive, and ultimately creative, measure for dealing with life itself.

Doctors and psychiatrists tend to disregard perspectives like this, or at best they regard them as outside their sphere. In the main, they want to treat our emotional symptoms as if they were of the same nature as our physical symptoms, that is, as signs of an underlying system failure that needs to be repaired. But this approach, although it certainly has its place in treating emotional problems, especially those that are clearly rooted in neurological malfunction, is much less helpful in addressing those of our symptoms that we develop in the course of the battle of life itself.

Freud had a lot of experience in the medical science of his own day and though he insisted that psychoanalysis was a part of science, he was not afraid to propose accounts of things that did not look the way medical science was expected to look. Freud understood, in a way that many of his critics down through the years have not, that the shape a science takes will depend on the thing it is studying.

In 1925 looking back on his development of psychoanalysis at the turn of the century, Freud wrote: “Even the psychiatrists, to whose attention came the most unusual and surprising mental phenomena, showed no inclination to examine their details and trace their contexts. They were satisfied with classifying the variety of the manifestations of illnesses and where possible with tracing them back to sources in somatic, anatomical or chemical disturbances. In this materialist or better mechanistic period medicine made great advances, but it also overlooked in a short-sighted way the most important and difficult of the problems of life.” [The Resistances against Psychoanalysis, 1925, SD 227]

Nothing could be more mistaken than the idea that Freud was trying to force the science of the mind into the pattern of a science designed for something else, like biological evolution, or physics. Yet this is what Freud’s critics – and indeed many prominent psychoanalysts also – have often claimed. For a relatively early example of this argument, out of scores of other works that could be cited, see Thomas Szasz’ famous The Myth of Mental Illness, first published in 1961. Szasz argues, rightly, that psychotherapy is an essentially interpretive discipline, rather than a medical discipline. And this is why he asserts that mental “illness” is a “myth”. But he asserts, quite wrongly, that Freud saw psychoanalysis as an application of the physical sciences that underlie medicine.

On the contrary, it is plain to anyone who takes the trouble to read him that trying to force the human mind into a scientific medical straight-jacket is exactly what Freud was not doing. Indeed this is exactly why he was so successful, where almost everyone else who attempted to develop a science of the mind ran into the sand. What he was doing was using some of the expressions of the physical and biological sciences as symbols and metaphors for mental processes. I have looked at the precedents for this in the classical German literature in which Freud was steeped in my own study, The Last Resistance, from 2002.

As Philip Rieff remarks, “Far from being a residual idea left over from his biological training, as the neo-Freudians have maintained, Freud’s theory of instinct is the basis for his insight into the painful snare of contradiction in which nature & culture, individual & society, are forever fixed.” (Freud: The Mind of the Moralist, The University of Chicago Press, 1959, Third Edition 1979, pp. 33-34)

This is exactly right. Many people both inside and outside psychoanalysis have encouraged us to jettison the metaphors Freud employs from the biological and physical sciences, on the assumption that some kind of purer or clearer discipline will result. But without these metaphors psychoanalysis is impoverished because we start to lose sight of precisely the kind of inescapable conflicts that Freud draws to our attention.

We may with as much justification regard a careful analysis of someone’s unconscious motives as scientific as we may, for instance, a careful piece of historical, biographical, social, or legal, research. All investigation like this, when it is properly conducted, involves a mixture of close attention to the empirical evidence, and the development of hypotheses that describe human motives.

But to expect the science that develops from this kind of analysis to look like physics, or animal ethology, or to regard it as a failure because it does not look like these disciplines, is purely superstition. There is more to science than the physical and animal sciences.

At the same time, one must be careful not to fall into the opposite error, which is even more widespread, of thinking that the sciences of human life are in some radical way disjoined from the physical sciences and involve some entirely different logic and reasoning. We must acknowledge the unusual place of the human mind in nature, while also recognising that its place is in nature. It was Freud’s success in doing just this that explains the continuing fecundity of his ideas.

But not everyone has been able to maintain this difficult balance. In the middle decades of the twentieth century, for instance, the medical psychiatrists of the United States embraced psychoanalysis with an enthusiasm that reflected a mistaken understanding of its true nature. In the years after World War II a training in psychoanalysis was a pre-requisite for any career in American medical psychiatry and no one was allowed to practice psychoanalysis who did not have medical qualification. What these doctors failed to see, for some decades, was that psychoanalysis could not be integrated with the rest of their medical training, because it represents a different kind of intellectual discipline. When this truth finally did dawn, particularly in the 1970s and 1980s, they abandoned it entirely, as if it had failed to keep some promise ti had made to them. Nowadays any American psychiatrist who has an interest or training in psychoanalysis and who hopes to make any kind of career will keep this quiet. And in general on this side of the Atlantic also, people with a medical training and background now no longer play any major part in the world of psychotherapy.

Tomorrow: Part 5: Psychoanalytic therapy is a psychodynamic therapy

The Origins of Psychotherapy: Freud and Psychoanalysis

All modern psychotherapy derives ultimately from the work of Sigmund Freud.

What is Psychoanalytic Therapy? – A Personal View, Part 3

To all intents and purposes modern secular psychotherapy originates at the beginning of the 20th century in the work of the Viennese neurologist Sigmund Freud (1856-1939).

In the 1880s one of Freud’s mentors, Josef Breuer, treated a young woman with emotional problems called Bertha Pappenheim. Bertha was immortalised in the literature under the sobriquet of “Anna O.” She was in great distress, suffering from various problems including occasional paralyses of her limbs, distortions in her vision, and a phobia about drinking water. Breuer got her to recount the memories of the traumatic events that had coincided with the onset of each of her symptoms. In this way he traced them to particular memories of the time Bertha had been caring for her father in his last illness.

Freud adapted and developed this approach with his own patients and gave formal shape to what Bertha herself had been the first to call “the talking cure”. Freud gave his work the name of psychoanalysis, which etymologically means “analysis of the soul (psyche)”.

Psychoanalysis began the contemporary practice that we now see everywhere in modern culture of treating people suffering from emotional problems by talking with them about their personal history and their experiences and feelings, using no other form of medical or psychological intervention apart from conversation, and without recourse to any religious frame of reference.

As Freud remarks however, there is nothing especially new in using dialogue as a way of helping people in emotional distress. Quite the contrary, words are the oldest instrument for trying to influence the spirits and demons that were for so long believed to inhabit the unhappy soul. (See for instance Freud’s essays “Psychic Treatment”, Psychische Behandlung, 1890, ERG 35, and “On Psychotherapy”, Über Psychotherapie, 1904, ERG 110) As Freud says: “Words are the essential instrument of psychotherapy. … The words of our daily speech are nothing other than faded magic.” (“Psychic Treatment”, Psychische Behandlung, 1890, ERG 17) The task of psychotherapy is to rediscover the magical power that resides in words to change our minds.

At the same time this new version of the ancient talking cure reflects a modern idea of the place of the soul in nature. For Plato and for the Christians the soul was what took us out of nature, made us go to war against nature, and ultimately, so the expectation was, enabled us to move on to a realm beyond nature after our natural deaths. Unlike this, the soul in psychoanalysis and in modern psychotherapy is treated as rooted in the nature of the body, whose task it is to interact between the needs of the body and the demands the rest of the natural world places on it.

The development of this way of treating the unhappy soul amounted to a revolution. In the immediate term this was a revolution in the treatment of mental illness. It showed for the first time that the language of mental illness, the way it expresses itself in various symptomatic behaviour patterns, feelings and experiences, is not something incomprehensible and closed to our rational understanding. It is in fact only a dialect of the everyday language used by normal people in normal circumstances.

By doing this, Freud changed the place occupied by madness in our culture. It was no longer something alien and frightening to be locked away out of sight but something in which we all to some extent partake and which, with a little sensitivity, we can all understand.

But in the longer term it was a revolution in the entire culture of the West. This is because the kernel of Freud’s achievement was that he discovered how to translate the expressions of mental illness into the language of our everyday concerns. The consequence of doing this was to make plain that a clear line between mental illness and mental health does not exist. Before Freud, people could reassure themselves, usually a little uneasily, that they were perfectly sane. Since Freud, this is something none of us can claim without sounding naive. As a result of Freud’s work we see now that human life at every level is suffused with irrationality.

“Being sick,” wrote Freud, “is in essence a practical concept. When you look at it from a theoretical point of view … you could easily say that we are all sick, that is to say, neurotic, because the conditions for developing symptoms can also be demonstrated in the case of normal people.” (Introductory Lectures, I, 1916-17 [Vorlesungen 350])

Freud stressed a number of things about human psychology in particular, for example: the role of unconscious emotions in guiding us, the unconscious transference of emotions aroused at one point in time by one person onto someone different at a later point in time, the prevalence of sexuality in our motives generally, and the fact that the mind evolves and develops, and therefore the importance of considering childhood experiences and relations with parents and family for an understanding of our emotional make-up. All of these ideas are now accepted by virtually everyone in the field of psychotherapy and counselling; their validity and importance are taken as a matter of course.

One should be aware therefore that all contemporary psychotherapy and counselling that relies on a conversation between therapist and client derives ultimately from Freud’s work.

However, it is easy for the layman to be unaware of this because as a culture we have not always been grateful to Freud for pointing out how extensive is the reach of the irrational in our lives. Many people are still upset with Freud for having done this. They find it hard to get a handle on the irrational in their own lives and feel threatened by acknowledging its extent. Even at this distance in time they continue to feel uncomfortable around Freud. A lot of the critical literature on him and his work is driven by this personal discomfort, rather than by a balanced concern to get at the truth. If you are not a specialist it can be difficult to distinguish serious scientific criticism of Freud’s work, which is essential to the continuing development of psychotherapy, from the often inaccurate accounts of what he said and did that are to be found side by side with it in the bookshops and on the websites. It is no criticism of the book industry that it relies on sales and income like every other, but the result of this is that sensational “revelations” about Freud, however fictional, will always get more publicity than careful scholarly studies of his life and work.

Freud stirs up our emotions. Therefore if you wish to think critically and fruitfully about his work it is important to try to think critically about your own feelings about him, so that you are thinking about him in a clear and objective way and not in an emotional way.

Tomorrow: (4) Psychoanalysis and Psychoanalytic Therapy

Psychotherapy and Counselling

There is unnecessary confusion between the terms psychotherapy and counselling.

What is Psychoanalytic Therapy? – A Personal View, Part 2

The first two apparently alternative titles that need to be sorted out are the basic ones of psychotherapy and counselling.

This is particularly necessary here in Ireland, where the government is currently planning to introduce a formal professional distinction between psychotherapists and counsellors.

In its original sense, the word counsellor means someone who listens in confidence and gives advice.

For instance, Shakespeare’s Pericles says to his advisor Helicanus:

Fit counsellor and servant for a prince,
Who by thy wisdom makes a prince thy servant,
What wouldst thou have me do?
Pericles, scene 2.

In this broad sense of the word, intelligent counselling is part of the work of every competent psychotherapist. Some traditions in psychotherapy frown on the idea of the therapist giving advice. This is notably true of the old classical schools of psychoanalysis which encourage the therapist to say as little as possible. But what is to be avoided in psychotherapy is the giving of bad or stupid advice, or the therapist trying to compensate for what he cannot change in his own life by trying to change things in the life of his client. All psychotherapy involves some advice and counsel, even if this is no more than the implicit advice to turn up on time for one’s appointment.

The term “counselling” was first popularised in the context of psychotherapy in the 1940s by the American psychotherapist Carl Rogers (1802-1987). He used it partly because at the time in the US the title of “psychotherapist” could only legally be used by those with a medical qualification and partly because he wanted to stress that what is valuable in psychotherapy are those things that are not specifically medical about it. (Freud had made the same point in 1926 in his The Question of Lay Analysis.)

Rogers however did not attach any particular theoretical significance to the term “counselling”. For instance he did not use it to distinguish his own brand of “humanist” or “person-centered” psychotherapy from other psychotherapy, as he might have done.

Rogers himself writes in the opening pages of his Counselling and Psychotherapy (1942): “There has been a tendency to use the term counselling for more casual and superficial interviews, and to reserve the term psychotherapy for more intensive and long-continued contacts directed towards deeper reorganisation of the personality. While there may be some reason for this distinction, it is also plain that the most intensive and successful counselling is indistinguishable from intensive and successful psychotherapy.” (Chapter 1, page 4, my emphasis)

Since Rogers’ time the term counselling has become more widely used but it has retained the connotation of emotional help that is undertaken for a shorter duration than traditional psychotherapy, or that is in some sense less deep than full-scale psychotherapy.

For instance, when the survivors of a traumatic event are offered emotional therapy they receive what is invariably referred to as counselling. They are not usually said to be offered psychotherapy, though that is in fact what it is, even if it lasts for a restricted period.

The popularity of the term counselling is undoubtedly due to one genuine advantage it has over that of psychotherapy. This is that it gets us away from the implicit assumption that emotional distress is an “illness” to be “cured”, rather than an inevitable part of the human condition that we all must deal with at some point or another.

As a result counselling is now the most popular general term for what specialists have traditionally called psychotherapy. Nowadays, most people who are in psychotherapy even for several years will say they are attending their counsellor, not their psychotherapist. In all modern contexts now it has in fact become impossible to make any consistent distinction between the terms psychotherapy and counselling.

For this reason, many practitioners, including myself, now regularly describe themselves as psychotherapist and counsellor. This is the clearest and most accurate way to describe to the general public what we are and what we do. In practice, the two words are merging into a single professional title.

These two terms now refer to the same thing, and they are offered by the same people. Throughout this essay I shall therefore treat the terms psychotherapy and counselling, when referring to the contemporary scene, as synonymous.

Tomorrow: What is Psychoanalytic Therapy? – (3) The Origins of Psychotherapy: Freud and Psychoanalysis