DEMYSTIFYING

THERAPY
Praise for Ernesto Spinelli’s Demystifying Therapy

… this is a brilliant book, which I unreservedly recommend to anyone in

the counselling field … It will most surely provoke fertile, enlightening and
constructive engagement within our profession for years to come.
Richard House, Counselling

[Ernesto Spinelli’s] argument is that theory-led approaches … tend to

reinforce the mystique of therapy and increase the likelihood of therapists
misusing their power and of … clients having a negative experience of
therapy. As an alternative, he puts forward an existential-phenomenological
model of therapy, which requires that the therapist attempts to bracket out
his or her biases, assumptions, and so on … and try to enter the patient’s
own meaning world in order to enhance their self-clarification, challenging
the person, as it were, from within.
Dr S J Ticktin, Newsletter of the GP Psychotherapy Association of
Ontario

Spinelli thinks therapists are in philosophical terms too naïve and do not
examine their models critically enough. Instead they focus on techniques,
and influence their clients in ways of which they are unaware. He believes
that being with the client in relationship is philosophically the most moral,
the safest and, in fact, the only justification for therapy … He implies that
self-awareness, humility and a critical approach are fundamental to working
in any therapeutic model. … Perhaps some work on philosophy should be
part of all therapy trainings, so that self-awareness and self-monitoring
could be achieved at a greater depth of understanding.
Courtenay Young, Self and Society

[Demystifying Therapy] is a book that raises many questions which merit

extensive discussion. I hope it will receive it. The author has the gift to lend
even the most elusive elements of his argument a transparency which opens
it up for understanding and critique.
Hans W Cohn, Journal of the Society for Existential Analysis

Dr Spinelli has written an extremely thought-provoking and enlightening

analysis of the dangers inherent in most of the current therapies.
His primary concern is the potential that exists for client abuse, not just
sexual or emotional maltreatment but, more importantly, misuse of the
power a therapist has within the therapeutic encounter.
Spinelli eruditely … elaborates on the importance of the therapeutic
relationship and how working within a descriptively focused encounter can
help ensure that interpretations are made within the client’s own experience
and not imposed from outside.
Alison Strasser, Psychotherapy in Australia
DEMYSTIFYING
THERAPY

ERNESTO SPINELLI
Other works by Ernesto Spinelli
published by PCCS Books

Tales of Un-knowing
Therapeutic encounters from an existential perspective
ISBN 978 1898059 79 0

Republished in 2006 by
PCCS Books
Wyastone Business Park
Wyastone Leys
Monmouth
NP25 3SR
UK
Tel +44 (0)1600 891509
www.pccs-books.co.uk

First published in Great Britain 1994

by Constable and Company Ltd

© Ernesto Spinelli, 1994

The right of Ernesto Spinelli to be identified as the author of this work has been asserted by
him in accordance with the Copyright, Designs and Patents Act 1988

All rights reserved.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as
permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced,
stored or transmitted in any form, or by any means, only with the prior permission in writing of the
publishers, or in the case of reprographic reproduction, in accordance with the terms of licences
issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms
should be sent to the publishers.

Demystifying Therapy

A CIP catalogue record for this book is available from the British Library

ISBN 978 1898059 89 9

eISBN 978 1910919 12 5

Cover The Psychologist by Zoltán Gábor (Private collection)

CONTENTS
Introduction

PART ONE
Demystifying some fundamental ideas about therapy

PART TWO
Demystifying the issue of power in the therapeutic relationship

PART THREE
Demystifying therapeutic theory:
1. The Psycho-analytic model

PART FOUR
Demystifying therapeutic theory:
2. Cognitive-behavioural and humanistic models

PART FIVE
Demystifying the therapeutic relationship

Conclusions

Bibliography

Index
For my father
Who thinks that therapy is a load of nonsense,

For my mother
Who takes the opposite point of view,

And for my students and clients

Who have had to put up with the divided loyalties
Of yet one more dutiful son.

Professor Ernesto Spinelli, PhD is a Fellow of both the British

Psychological Society (BPS) and the British Association for Counselling
and Psychotherapy (BACP) as well as a UKCP registered existential
psychotherapist. In 1999 he was awarded a Personal Chair as Professor of
Psychotherapy, Counselling and Counselling Psychology. His authorship of
numerous specialist articles and several highly respected and widely read
books dealing with the theory and practice of existential psychotherapy has
earned for Ernesto a BPS Counselling Psychology Division Award for
Outstanding Contributions to the Advancement of the Profession, and an
international reputation as a leading figure in the advancement of
contemporary existential psychotherapy. As well as maintaining a private
practice as a psychotherapist, executive coach and supervisor, Ernesto is
Director of Ernesto Spinelli Associates (ESA).
INTRODUCTION

We’re playing those mind games together

John Lennon

Try to imagine a world where psychotherapy or counselling do not exist.

Imagine that not only are there no more private practices for those who can
afford to pay specialists to listen to and assist them in dealing with their
problems, nor are there any similar services provided by local authorities,
community groups and educational or religious establishments, but also that
there are no longer any telephone help-lines such as the Samaritans,
Childline, and so forth, nor are there any problem pages in your newspaper
or magazine, nor any radio station ‘agony aunts’ and ‘uncles’, nor any self-
help books, or ‘pop’ psychology manuals, to help you cope with stress or
sexual problem or to teach you to live more suitable or hedonistic or caring
or fulfilling lifestyles. And consider, as well, how much less ‘psychobabble’
there would be for morning television hosts to endlessly chat on about or to
find ways of having you reveal, live, on the air, the various concerns and
dilemmas you face each day or can no longer live with. Consider as well the
nature of the everyday conversations you might engage in with your
colleagues, friends, children, spouse or partner, and how much of their
content would now be bereft of notions and ideas that would be derived
from popular usage of therapeutic terminology. How great would be the
gaps in people’s thinking and communicating about themselves and others?
How would people cope with the myriad variety of problems that
psychotherapists and counsellors (both trained and self-made) are experts in
dealing with? How would they even recognize them or discern their
existence?
A colleague of mine once pointed out to me that the basic premise of
Woody Allen’s film A Midsummer Night’s Sex Comedy lay in its attempt to
present a world of social and intimate relations which existed prior to the
advent of Freud’s psychology and the dramatic, lasting cultural changes it
would bring forth. Perhaps it was the very ‘strangeness’ of this world, and
the irksome naïveté of its characters, which invoked in me, and in a great
many others who saw the film, a sense of disgruntlement that made the
cinematic experience seem so disappointing. Like Adam and Eve, it would
seem, once we have eaten of the tree of knowledge, we can never return to
that prior state of innocence. Nor, perhaps, can we fully re-experience it.
Whatever the case, it would appear that, at the close of this century,
Western culture and society (and, increasingly, a great many other cultures
and societies that have been influenced for good or ill by the West) have
succumbed to the ‘triumph of the therapeutic’ to the extent that vast
amounts of our understanding about our desires and motives, our
explanations of our behaviour and perceived needs, our aspirations and
desires, even our very sense of ourselves as human beings, are largely
derived from notions and hypotheses gleaned from theories that have either
originated from psychotherapeutic assumptions or have been extrapolated
from more general theories of psychology, philosophy, the social, biological
and physical sciences and so forth, in order to amplify, clarify or
substantiate therapeutic claims.
However much the majority of lay individuals who employ such ideas
may have overextended, trivialized or even misunderstood a great many of
the terms employed in order to explain or make sense of their own, or
others’, beliefs and behaviours, it remains the case that these ideas have
entered common parlance, and, in so doing, have shaped, and continue to
shape, fundamental views we hold about ourselves. It would be surprising,
for instance, for most of us not to assume such things as the existence of an
‘unconscious mind’, or to disavow the notion that experiences and
‘traumas’ from an individual’s infancy and childhood provide the key to the
understanding of his or her adult personality. We speak authoritatively, if
not glibly, about archetypal individuals such as ‘the archetypal’ hero, sex
goddess, or football player; we recognize the hidden (often erotic or
aggressive) meanings of all manner of symbolic images and verbal allusions
employed by novelists, film directors and advertising agencies; we would
find it surprising if one were to suggest that each of us does not harbour
seemingly forgotten (or repressed) memories which, nevertheless, continue
to exert their psychic hold upon us.
As we approach the end of the twentieth century and begin to assess and
stamp it with an instantly identifiable label which seeks to capture its
fundamental ‘essence’, we are immediately presented with the wide
selection of candidates available to our consideration: the ‘Communication
Revolution’, the ‘Nuclear Age’, the ‘Electronics Explosion’, to mention just
three. During this century we have seen the creation of technological
marvels and monstrosities, we have witnessed the sudden rise, spread, and
even more sudden fall of political ideologies, we have toyed with genetics,
our reproductive systems, subatomic quanta, and we have invented a form
of music whose popularity and adaptability appears to be worldwide. But,
most ‘essential’ of all, I would suggest, in that it has fundamentally shifted
the very means by which we think of and try to understand ourselves, and,
therefore, has set the parameters of our objectives, aspirations and
achievements, has been the birth, steady rise and ever-increasing reliance
upon, and use of, therapeutic thought and practice. Like it or not, we
(particularly we in the West) are the ‘children’ of Freud and all his many
and diverse followers, re-interpreters, rivals and detractors. Even if we,
ourselves, have not been in, nor practised, psychotherapy or counselling, it
would be surprising if we did not know or were unable to name someone in
our circle of family, friends and acquaintances who has.
I have been a practising psychotherapist and counsellor for some
fourteen years. My name appears on the register of psychotherapists of the
United Kingdom Council for Psychotherapy (UKCP) and on the list of
accredited counsellors of the British Association of Counselling (BAC).
Over the last decade, I have devised, directed and taught various academic
and professional training programmes in psychotherapy and counselling. I
have been employed as a counsellor for the NHS and for an international
college and continue to maintain a private practice working with adult
individuals and couples. I state all this not in order to elevate myself, or to
prove my credentials, but, rather, in order to present a paradox. While I
have clearly dedicated a large part of my life to therapeutic practice and to
the dissemination of therapeutic thought, and while I can truthfully state
that my enjoyment—even love—of my work has not diminished over time
(if anything, I have grown even more entranced and engaged with the
nature of my chosen profession), nevertheless I hold a high degree of
scepticism for many of the claims made for psychotherapy and counselling
—particularly with regard to the specialist (some might say ‘quasi-
magical’) ‘skills’ or ‘powers’ of psychotherapists and counsellors, the
specific and unique outcome characteristics of therapeutic encounters, and,
perhaps most importantly, the unnecessarily mystificatory assumptions and
near-tenets underlying the theoretical underpinnings and practices held by
most practitioners.
Increasingly, a number of authors have pointed out the potentials for, as
well as actual incidents of, physical and sexual abuse of clients by their
therapists (Masson, 1989; Rutter, 1990; Russell, 1993). While I share these
authors’ concerns, I am convinced that there exists a much more subtle and
prevalent problematic area that has not been sufficiently analysed.
Generally speaking, it has to do with the distinct form of subtle (and
sometimes not so subtle) potentially debilitating influences engendered by a
variety of assumptions held by psychotherapists and counsellors regarding
their role and function, their employment of specialist skills and their
(sometimes unquestioning) reliance upon, and belief in, the ‘truths’ of their
theories. Over time, I have increasingly questioned the significance of these
assumptions and have tended towards a conclusion that their principal
function is not to provide the means of alleviating the various forms of
human misery with which clients present their therapists, but rather to
invest therapists, and the therapeutic process, with a sense of special and
unique authority and wisdom which serves as a distinguishing hallmark of
both the profession and its practitioners. I have felt this tendency to be
increasingly disturbing and problematic not only because of the potentially
abusive expressions of power that it offers to therapists, but, just as
significantly, because of its inclination towards the unnecessary
mystification of therapy.
I readily admit that I am not the first to voice such concerns, but it is my
intent, in writing this text, to present them from a point of focus that I hope
will be seen to be both novel and instructive. As I have written elsewhere
(Spinelli, 1989), I subscribe to an existential-phenomenological orientation.
This approach, I believe, readily lends itself to a sceptical stance—by which
I don’t mean to suggest a stance of closed-mindedness, but rather its
opposite—which seeks to counter-balance those tendencies mentioned
above by its attempts to avoid reliance upon seemingly fixed or
unshakeable ‘truths’ or universal ‘facts’ in order to imbue its arguments
with the stamp of authority, and which takes its fundamental project to be
that of clarification and, hence, demystification.
I feel that I should be clear from the outset that this will be an
opinionated and critical text. But, just as I hope that the opinions expressed
will be viewed by readers as being balanced and worthy of their
consideration, so, too, is it my hope that the criticisms expressed will be
seen to have constructive, rather than destructive, intent.
Readers will have noticed by now that I have employed the terms
‘psychotherapy’ and ‘counselling’ synonymously. While each exists as a
separate professional body, it is fair to say that a great deal of overlap exists
in the theoretical foundations of the various approaches associated with
each, and, also, in their applications at the consultative, or therapeutic,
level. I have taken this stance in order to clarify that my concerns and
interests lie in the analysis and examination of all approaches that take as
their main area of concentration a structured therapeutic focus. While I am
aware that many colleagues would prefer (if not insist upon) a clear line of
demarcation, I am not entirely in agreement with them for reasons that will
be made clear in Part 1 of this text. But this issue raises a far more
fundamental problem—that of defining the terms ‘psychotherapy’ and
‘counselling’ themselves. This issue, too, will be considered in Part 1.
Nevertheless, for the time being at least, rather than continue to employ
both these terms throughout the text (which seems to be rather an unwieldy
and irksome exercise for both writer and reader!), I will, instead, employ
the lexicons ‘therapy’ or ‘therapeutic process’ as overall, inclusive terms for
both psychotherapy and counselling and the theories, practices, skills and
assumptions underlying both, and will employ the separate terms only when
considering their avowed distinction or in deference to other authors whose
texts and/or personal preferences refer explicitly to one or other label.
In a similar fashion, I will employ the term ‘client’ rather than ‘patient’
throughout the text. Although I remain dissatisfied with the former, the
medical implications of the latter make it, to me at least, an even more
disingenuous term. There is, I think, much to be said for the term
‘analysand’ which is employed by a number of psycho-analytically
influenced therapists. However, as these seem to be the only therapists to
employ this label, my use of it would run the risk of imposing an
unnecessary theoretical or practice-based restriction upon it. Having racked
my brain in vain for years in search of a better term than those currently
available, I have settled for ‘client’ until a more appropriate term is
suggested by someone far more capable and linguistically creative than me.
Finally, for reasons of space and added complexity of argument, I will
limit the discussion in this text to issues of therapy as practised with
individuals whose degree of felt disturbance, anxiety, inability to cope or
fragmentation falls within those boundaries that were once largely
distinguished as ‘neurotic’ rather than ‘psychotic’. Although I believe that
much of what I have to say applies equally to more serious or pervasive
instances of mental disturbance, I have elected to focus upon those
therapeutic interventions that are most prominently observable in private
practices, counselling agencies and NHS surgeries that offer consultations
with registered or accredited therapists.
As I have already indicated, Part 1 of this text will focus on questions
related to the ostensible similarities and differences between psychotherapy
and counselling, and the various attempts that have been made to define the
nature, boundaries and concerns of each in order that the unnecessarily
mystificatory tendencies that such definitions impose can be clearly
demonstrated. Part 1 will also consider a number of important critiques
made of therapy and will examine the main findings arrived at concerning
the general efficacy or ‘success’ of therapy in fulfilling its stated (or
implied) aims to ‘cure’, ‘help’ or ‘change’ clients.
Part 2 will principally consider the question of power in the therapeutic
relationship. In particular, it will focus on the existing evidence for the
serious misuse and abuse of therapeutic power as expressed in the sexual,
physical and financial abuse of clients by therapists, and via forms of
therapeutic indoctrination. It will also consider the conclusions arrived at by
critics of therapy, in particular those set forth by Jeffrey Masson, with
regard to the significance of power and its abusive potentials and argue that
such critiques, while valuable and requiring attention by therapists,
themselves add to the unnecessary mystification of the therapeutic process.
Parts 3 and 4 will focus on a variety of important elements found in the
principal theoretical models upon which most therapists rely in order to ‘do’
therapy. Part 3 will examine a number of the major ‘theory-led’
assumptions of the psychoanalytic model such as the role of the past,
unconscious processes, and the issue of transference, and will provide a
critique of these, as well as the notion of analytic interpretation. In a similar
fashion, Part 4 will consider certain fundamental assumptions found within
the cognitive-behavioural and humanistic models of therapy focusing in
particular on issues dealing with the ‘objectivity’ of the therapist and
assumptions concerning the nature of ‘the self ’. Once again, the principal
aim in criticizing these views will be to expose those implicit mystificatory
tendencies contained within them which serve to imbue therapists with
unnecessary and potentially abusive power.
Having addressed the major mystificatory concerns raised about
therapeutic theory and practice, Part 5, ‘Demystifying the Therapeutic
Relationship’, will present an alternative orientation towards therapy,
derived from existential-phenomenological investigation, which
concentrates on the potentials for a more open encounter between therapist
and client by concentrating its attention on issues surrounding the relational
qualities of ‘being’ within the therapeutic relationship. Further, it will
examine both the potentials and limitations of therapy so that more
adequate expectations, process possibilities and outcomes can be identified.
Throughout the text, my overall contention will be that, however
unwittingly, therapists have tended to mystify both the therapeutic process
and themselves as its expert practitioners. As a result, these mystificatory
tendencies have helped to promote the increasingly prominent public view
that therapy is both a special and necessary ‘cure’ for human misery and
that therapists, correspondingly, are the qualified agents of that ‘cure’.
These views demand serious questioning not least because the failure to
fulfil the expectations that clients have tended to set upon therapy and their
therapists—and which therapists, as well, have been inclined to set upon
their profession and themselves—is all too likely to create increasing
frustration and criticism. Already, the initial signs of a ‘backlash’ against
therapy are evident—paradoxically just at the moment when therapists are
stepping up their attempts to regulate their profession. Along with such
safeguards, however, therapists must be prepared to practise what they
preach in that they must be willing to look honestly at the enterprise they
engage in and confront that which they have allowed, or encouraged, to be
mystified.
It is the intent of this text to assist therapists, and their clients, in the
task of demystification. In taking these initial steps, perhaps it will become
evident to all concerned that the task has long been overdue.
PART ONE

DEMYSTIFYING SOME FUNDAMENTAL IDEAS

ABOUT PSYCHOTHERAPY

Whatever you say it is, it isn’t

Alfred Korzybski

Human beings ask questions. Our success as a species is due, in no small

part, to our quest for knowledge. Underlying a great deal of both what we
ask and how we formulate our queries has been our attempt to arrive at an
increasingly adequate understanding of ourselves. Over time—and
especially during this century—we have gained significant skills for
clarifying and (at least partially) alleviating many forms of distress,
dissonance and disorganization that any one of us is likely to experience
either within ourselves or between ourselves and others. In this sense,
Sigmund Freud’s own evaluation of his theories as being equal in
revolutionary import and significance to those of Copernicus and Darwin is
almost certainly valid. For while there may be sufficient cause to doubt the
specific conclusions that Freud derived from his theories, it seems to me
undeniable that, in general terms at least, his ideas have provided the
impetus with which to address our questions in a manner that is
fundamentally characteristic of this century.
Freud’s ‘talking-cure’, which served as genesis to his developing theory
and technique of psycho-analysis, for good or ill, has shaped our age to the
extent that ever-increasing numbers of us turn to such forms of dialogue the
moment we are confronted with the mysteries, conflicts, dilemmas and
disruptions that intrude and impinge upon our lives no matter how mundane
or cataclysmic they may appear to be.
Therapy has never been as popular, or as available, as it is today. More
people than ever before are ‘in’ therapy or are training to be therapists. For
instance, when I first joined the School of Psychotherapy and Counselling,
in October 1989, the only programme on offer to trainees was its MA in
Psychotherapy and Counselling. Less than five years later, the school has
expanded its programmes to such an extent that it currently offers not only
the MA programme (with three annual intakes), but also a substantial
number of short courses in psychotherapy and counselling, a one-year
certificate in the Foundations of Psychotherapy and Counselling (six
intakes), a diploma in Counselling (two annual intakes), an advanced
diploma in Existential Psychotherapy (one annual intake) and, most
recently, a PhD in Psychotherapy and Counselling which is the first of its
kind in the UK. This dramatic growth in the numbers of programmes is by
no means unique; various colleges and training establishments can as easily
provide similar wide-ranging lists of their own.
In parallel to this development, public demand for therapy has increased
substantially. Dr Raj Persaud, in a recent Sunday Times article entitled
‘Talking your way out of trouble’, has stated that there are:

currently 30,000 people earning their living from counselling and a

further 270,000 in the voluntary sector. Research conducted on
behalf of the Department of Employment suggests that over 2.5
million use counselling as a major component of their jobs … The
BAC [British Association for Counselling] has over 10,000
members and receives over 60,000 calls per year … (Persaud,
1993:8).

Similarly, there exists a large number of applications for therapy through

the NHS or via private-practice contacts. In the light of such, and a great
many more examples that would amplify this contention, Dr Persaud has
suggested that ‘[p]sychotherapy is the growth industry of the 1990s—being
chic now means being in treatment’ (Persaud, 1993:8).
But the great interest in, and demand for, therapy has also created
significant worries. Most recently, serious concerns about various aspects of
therapy have been raised by a number of journalists and writers critical of
the increasing public use of, and dependence on, therapy. A notable
example of this has been the furore raised by Fay Weldon’s novel Affliction
(1994) and her subsequent highly disparaging remarks concerning the
potentially abusive and manipulative interventions of therapists (Freely,
1994). Ms Weldon’s critiques seem to have struck a responsive chord in the
British media to the extent that even the free weekly London careers
magazine Ms London recently ran an article on this topic which was cover-
headlined as ‘Psychobabble: decoding the jargon of therapy’ (Bartlett,
1994). In effect, the result of this current wave of articles and exposés has
been to inform the public of something that many ‘insiders’ have known all
along: the values and foundations of therapeutic practice are riddled with
insufficiently questioned assumptions.
Currently, anyone in Britain can call himself or herself a therapist and
offer such services since it remains the case that no therapeutic body or
organization has as yet been granted a Royal Charter or legal status (as is
the case for psychology). In their concern and desire to remedy this
situation, if only to protect the public, most of the major psychotherapy
organizations in the UK have joined together to form the United Kingdom
Council for Psychotherapy (UKCP) which, in May 1993, published its first
(voluntary) list of registered psychotherapists. In a similar fashion, the
British Association for Counselling and Psychotherapy (BACP) has, for
several years now, maintained a publicly available list of its members (both
accredited and non-accredited) and of BACP registered training
programmes. In addition, consultations with comparable therapeutic
organizations throughout Europe have been initiated with the aim of
establishing common regulations governing the practice of therapy within
the European Community.
Such developments—as time-consuming, exasperating and imperfect as
some insiders and outsiders have judged them to be—are generally
praiseworthy and, in the final analysis, necessary. However, it remains the
case that, in emphasizing such issues as what constitutes adequate training
in therapy and which rules and requirements will govern the registration of
therapists, a fundamental question is not being properly addressed. For such
has been the belief and dependence on the alleviating or curative properties
of therapy that all concerned rarely stop to ask themselves just what it is
that therapy provides, or can provide.
1. SEVERAL (FAILED) ATTEMPTS AT DEFINING THERAPY AND
ONE NOVEL ALTERNATIVE

As I will endeavour to show throughout this first part of the text, what
responses have been provided, or assumed, tend to be mystificatory in that
they impose on therapy (and therapists) an aura of ‘specialness’, uniqueness
and expertise derived from its theories, practices and training components
which, however desirable to some, clearly lack sufficient supportive
evidence from research studies.
However, just in case readers are beginning to suspect that they are in
for another round of ‘therapy-bashing’, allow me to inject a note of
reassurance: I do think that therapy offers something that is both unique and
worthwhile and I will seek to clarify and examine that which I believe
makes it so. But in doing this, I will also have to question and criticize
numerous assumptions—some of which may seem fundamental—currently
held by many therapists (and clients) which seem to me to be not only
unnecessary but also detrimental to the understanding and practice of
therapy and, more importantly, to the enhancement of its potentials. In order
to engage in an attempt to demystify therapy, the most obvious and logical
place to begin would be to describe and define what therapy is, or has been
said to be—even if, as we shall see, as is often the case with issues dealing
with human relations, obviousness and logic do not unfortunately seem to
play a governing role in the matter.

A. SOME INITIAL DIFFICULTIES

While anyone reading this text may well have a sense, or ‘gut feeling’,
either from previous readings or from his or her own experience of ‘being
in therapy’—either as a therapist or as a client—of what therapy is or means
to them, and, if pressed, might well be able to put such into a sufficiently
suitable and representative statement, nevertheless it would appear to be the
case that any such statement, while by no means incorrect, would almost
certainly remain incomplete and open to some degree of dispute.
While a common resolution to a problem of this sort would be to turn to
a suitable dictionary for definitional guidance, in this case dictionary
definitions turn out to be misleading and problematic. My copy of the
Concise Oxford Dictionary, for instance, defines therapy as a form of
medical treatment, and associates the word therapeutic with terms such as
curative, healing arts, and medical treatment of disease. Similarly,
psychotherapy is defined as a psychological form of disease (or disorder)
treatment, and while the term counselling does not appear, the word counsel
is given the meaning of consultation and giving advice professionally on
social problems, just as, similarly, a counsellor is said to be an advice-giver.
All these definitions, while not entirely incorrect, are certainly confusing
and would be rejected in whole or in part by many therapists. Further, in
their employment of terms such as disease and medical treatment, and in the
implicitly directive quality of words such as advising, they impose
unnecessary definatory restrictions that, once again, a great many therapists
(myself included) would dispute as being antithetical to both the
understanding and practice of therapy.
As if such complexities were not enough to confound and demoralize
us, Jeremy Holmes and Richard Lindley point out in their important text
The Values of Psychotherapy (1989) that the activity we call therapy has
failed to establish itself with a degree of unity of function and purpose since
its basis lies in no agreed-on theoretical foundation, and, indeed,
encompasses procedures and ideologies that range from the established and
conventional to cult-like fringe systems. The full impact of this statement is
made eminently clear when it is realized that somewhere in the region of
460 diverse forms of therapy are now claimed to be in existence (Omer and
London, 1988). Each of these has its own particular perspective on what
therapy is and what it claims to offer or promote, ranging from quasi-
medical ‘curative or symptom-removal’ stances (as might be suggested in
the literature of behavioural therapies (Corey, 1991)) to views of therapy as
a form of ‘applied philosophy’ (as advocated by British existential
therapists (van Deurzen-Smith, 1988)).
Therapies can be classified in a variety of ways—founder, orientation,
directiveness, reflectiveness, expressiveness, length, and so forth (Holmes
and Lindley, 1989), such that ‘clusters’ of therapies may be formed.
I have elected to distinguish four general models or ‘thematic stances’
of therapy. Three of these, the psycho-analytic (e.g. Freudian psycho-
analysis, Kleinian psycho-analysis), the humanistic (e.g. person-centred
therapy, gestalt therapy) and the cognitive-behavioural (e.g. Beck’s
cognitive therapy, Rational-Emotive Behaviour Therapy) are widely known
and, together, cover the central emphases and divergences within the great
majority of theories and approaches to therapy. The fourth model, the
existential-phenomenological model, is far less well known and is derived
from the writings of various existentially influenced therapists, including
the present author (e.g. May, 1983; van Deurzen-Smith, 1988; Spinelli,
1989). The fundamental ideas, practices and attitudes to therapy of the first
three models are summarized in the appropriate sections (i.e. Parts 3 and 4)
of this text; the fourth model primarily informs the last section of the book.
To complicate matters even further, the general public (like the
dictionary and, perhaps, like some therapists as well) also tends to confuse
therapy with broadly related areas of guidance, advice, socio-legal and job-
related assistance, and so forth. And, while all such enterprises may involve
some elements of ‘therapy-based skills’, it is necessary to clarify how these
differ from ‘therapy proper’. As these distinctions are by far the most clear-
cut, it would seem appropriate to begin with them and then move on to
more contentious areas.

B. DISTINGUISHING THERAPY FROM COMMONLY ASSOCIATED TERMS

Recently, the BAC (the British Accociation for Counselling) has provided a
most interesting and relevant document entitled A Report on Differentiation
between Advice, Guidance, Befriending, Counselling Skills and Counselling
which was commissioned by the Department of Employment (Russell,
Dexter and Bond, 1993). As the title of the report suggests, its principal task
is to provide the basis for clarifying the different aims and realms of
discourse contained in the above-stated terms, since their distinctiveness is
by no means clear to a great many members of the public (and possibly to a
good number of ‘service providers’ as well!)
Advice may be defined as a brief consultation the aim of which is to
provide the client with appropriate and accurate information and to offer
informed suggestions about how to act upon that information. Advice-
giving focuses on the widening of clients’ knowledge of their options and
choices with regard to their socio-legal rights, potential action programmes,
and so forth. The Citizens Advice Bureau is almost certainly the most well-
known advice-giving organization in the UK. Though advising is such a
commonly employed term, taking in a wide variety of styles and attitudes
ranging from the facilitative to the authoritarian, in this more restricted
sense it focuses particularly on areas and issues related to problem-solving
via the dissemination of accurate and appropriate information and
assistance with related practical tasks such as official letter writing,
professional telephone contacts, and so forth.
Guidance involves the use of an extended consultation or a series of
consultations the aim of which is to assist the client to explore a particular
concern via the provision of appropriate and accurate information and the
giving of both suggestions and support as to how to act upon that
information. A good example of a British guidance organization would be
Relate or, as it was known until a few years ago, the National Marriage
Guidance Council. Guidance services are often confidential and involve
specific contractual criteria setting out such parameters as the designated
time, focus and duration of the service. While the guidance-provider will
certainly apprise the client of accurate and relevant information required to
make appropriate decisions, it is equally (if not more significantly) the task
of guidance to afford clients with the opportunity to explore possibilities
and to develop various skills designed to enhance decision-making.
Guidance clearly requires the development and maintenance of a close
relationship between client and guidance-provider, but while in some cases
it may aim for a more or less egalitarian basis (as in Relate), it may also be
explicitly unequal (as in career guidance).
The term befriending involves a relationship between two individuals,
one of whom agrees (either within clearly demarcated or flexible and
negotiable boundaries) to take on the role of friend to someone who is
socially isolated and who then, in his or her capacity as a ‘befriender’,
offers practical and emotional support. Although it is the least frequently
employed and possibly least familiar of all the terms under consideration,
references to befriending appear as far back as 1879 ‘when lay missionaries
were appointed to advise, befriend and help offenders and their families’
(Russell, Dexter and Bond, 1993:3). Probably the best-known befriending
organization in the UK is the Samaritans. The founder of the Samaritans,
Chad Varah, distinguished befriending from counselling in terms of
befriending’s greater flexibility in being accessible and available to the
individual seeking help. Befriending is most accurately associated with
such services as telephone help-lines, hospice assistance, and juvenile
offender schemes which may be complementary or alternative to the
judicial system. Befriending differs from the other related approaches under
consideration in that it emphasizes its informality, it remains deliberately
non-professional in order to remain as flexible as possible with regard to its
style of assistance (so that, for instance, the term ‘client’ is avoided in order
to emphasize an egalitarian, humane form of contact), and it takes its
principal task and service to be the ‘sharing’, rather than the management or
solution, of problems.
Counselling skills focus on the employment of communication and
social skills that may benefit or enhance the offering of advice, guidance,
and befriending or which may be employed while in the process of nursing,
educating, policing, medically diagnosing, and so forth. ‘Counselling skills
do not constitute a role in themselves … but need to be identified within a
framework of values which facilitate someone’s capacity for self-
determination and a pattern of communication which flows mostly from
that person to the facilitator’ (Russell, Dexter and Bond, 1993:19).
Counselling skills focus upon the facilitative element that underlies
communication and social skills. As such, members of the ‘caring’
professions, such as nursing, for example, will employ counselling skills as
part of their task or goal-oriented work and such skills may well provide
therapeutic benefit though, clearly, the person employing such skills would
not lay claim to being a therapist.
Lastly and most pertinently, the BAC-derived definition of counselling
focuses on a specific relationship, established and maintained via clearly
demarcated and mutually agreed guidelines or boundaries, the aim of which
is to facilitate the means by which the client may initiate personal work
designed to promote a more satisfying life-experience in a manner that
respects ‘the client’s values, personal resources and capacity for self-
determination’ (Russell, Dexter and Bond, 1993:20). Since the 1920s,
counselling has been defined as the application of psychosocial care. More
pertinently, the term was initially employed by Carl Rogers in reaction to
his not being permitted to label himself a psychotherapist and practise
psychotherapy on the grounds that he was a psychologist rather than a
medical doctor (thankfully—in my view, anyway—in most instances these
restrictive criteria would no longer hold today).‘ Imported’ to the UK in the
mid-1950s, counselling today tends to assume the requirement of extensive
training for counsellors and differs from all the previous terms in its
emphasis on the exploration of the unique meaning-world of the client and
on the possibilities and limitations that such a view expresses and contains.
While the influence of Rogers’ person-centred approach on counselling
must be acknowledged, nevertheless counsellors today may be adherents of
as wide a variety of theoretical perspectives (i.e. cognitive-behavioural
counselling, psycho-analytic counselling, existential counselling) as would
be encountered in a directory of psychotherapeutic approaches.
The very fact that most practitioners distinguish ‘psychotherapy’ from
‘counselling’ further aggravates the problem of defining therapy. Can
psychotherapy be differentiated from counselling? And if so, how? Both are
broadly agreed to be ‘therapeutic enterprises’, yet in the UK (and
elsewhere) each is represented by separate ‘host bodies’ (i.e. the UKCP and
the BAC). Whether there exist more subjector enterprise-based distinctions
is an additional area of complexity and controversy that will be discussed
later in this section. Nevertheless, while acknowledging that I have not yet
made the case for such, and begging the reader’s temporary indulgence, I
have opted to employ the term therapy as a ‘generic’ one that includes both
psychotherapy and counselling. As such, the terms ‘counselling skills’ and
‘counselling’ discussed above may be equally designated—for the time
being, at least—as ‘therapeutic skills’ and ‘therapy’.

C. SOME FURTHER PROBLEMS

While the differentiation guidelines just discussed are useful in allowing a

clearer understanding of what is not therapy, they still tell us very little
about what it is. Acknowledging this same difficulty in a recent paper
entitled ‘Core skills for psychotherapy’, Ian Owen has written:

It is easy to define what therapy is not. It is not lecturing, not

moralizing, patronizing nor befriending. It is not the use of
counselling skills by non-mental health professionals in interviewing
or management (Owen, 1993:15).

This point of view, while perhaps seeming initially unhelpful, nevertheless

contains an implicit issue of substantive importance which is rarely made
explicit: both practitioners and critics tend to speak of ‘therapy’ in a
singular or all-embracing sense. While such a stance might be
understandable for the purposes of simplicity and convenience, even so it is
highly misleading. Therapy, as we have begun to see, is far more diffuse
and complex a term than we might have originally assumed it to be. Indeed,
when one considers the great variety of approaches and techniques that
refer to themselves as therapies, one is struck as much by the substantial
differences and contradictions between these as by any immediately
apparent or obvious similarities.
Freud’s now-famous description of psycho-analysis as an ‘impossible
profession’ resulting from his certainty that it could never hope to provide
entirely satisfactory results (Freud, 1937a) would seem to take on an added
and more general significance in that the statement would also seem to fit
all too accurately the current condition in which therapy in general finds
itself with regard to attempts at its definition for the purposes of both clarity
and criticism.
But if it seems impossible to define the term therapy (other than in
terms of what it is not) then perhaps there may be some value in returning
to the initial distinctions that were made—between psychotherapy and
counselling—in order to consider how these terms have been defined.
Possibly, in this way, we might gain some helpful entry-point leading to the
definition of therapy.

D. DEFINING PSYCHOTHERAPY

Eloquently taking on the challenge of attempting a definition of

psychotherapy, Jeremy Holmes and Richard Lindley have argued that one
way of approaching the possibility of extracting ‘the basic elements to be
found in all forms of therapy’ (Holmes and Lindley, 1989:3) is to consider
it from the standpoint of structure, space and relationship (Holmes and
Lindley, 1989).
The notion of structure, that is to say the basic conditions such as the
meeting-time, the location where psychotherapeutic sessions are to be
conducted, the ‘contractual’ conditions that both psychotherapist and client
agree to, and so forth, while clearly variable and distinct between one
theoretical approach and another, and, indeed, between any one
psychotherapist and another, nevertheless offers a broadly common
purpose. For the structure offers, at least potentially, a secure environment
which promotes the exploration of cognitions, affects and behaviours in a
manner that seeks to allow greater honesty and the expression of thoughts
and feelings that might not otherwise be allowed direct expression in
another structure.
This ‘safe’ structure, while clearly unusual or, indeed, ‘unreal’, may
sometimes prove to be cathartic or emotionally explosive and, in this way,
the psychotherapeutic structure may be likened to that of theatre
(particularly in the original Greek sense of the word), in that ‘as in the
theatre, there is a suspension of disbelief, which allows powerful emotions
and actions to be explored safely without the consequences that might
follow in everyday life’(Holmes and Lindley, 1989:5). Further, as in theatre,
this very ‘unreality’ may expose and clarify the underlying features of the
client’s everyday, lived ‘reality’ in a more intense and direct fashion. As
such, the psychotherapeutic structure seeks to promote and enhance the
client’s experience of being ‘held’ by and within the psychotherapeutic
process.
In so doing, however, a novel and possibly unique space is created
which seeks to enable or facilitate the clarification or discovery of
previously unconsidered or superficially examined feelings, attitudes,
assumptions, and viewpoints held by the client. In this exploratory space,
then, the possibilities emerge for greater, more honest self-challenge and
discovery. Again, however, as has been pointed out by various authors, an
important paradox emerges. For while the psychotherapeutic space is likely
to foster the client’s experience of increased autonomy, this experience
seems to require in the first instance an abdication of autonomy via the
acceptance of the structure which, however much ‘democratically
negotiated’ between psychotherapist and client, will nevertheless contain a
number of rules, restrictions and conditions that are non-negotiable and
which have been effectively imposed on the client by the psychotherapist,
or by the psychotherapist’s allegiance to a particular approach to
psychotherapy—conditions that raise crucial questions concerning the
unequal power base of the therapeutic process.
Finally, for most psychotherapists, regardless of the orientation they
represent or advocate, the relationship between psychotherapist and client is
considered to be the most fundamental element in the psychotherapeutic
process. Indeed, many would go so far as to state that the very success of
psychotherapy, however defined, is first and foremost dependent on the
quality of the relationship that has been established and the possibilities
contained within it for furthering the likelihood of productive or positively
experienced change. It remains to be asked, however, just what there might
be that is special or different about a psychotherapeutic relationship as
opposed to any other, or indeed whether differing models of therapy
promote the establishment of varying kinds of relationships.

E. DEFINING COUNSELLING

Founded in 1977, the British Association for Counselling (BAC) has

established itself in the UK as the principal organization promoting
counselling and both accrediting individual counsellors and registering
counselling training institutes. In its ‘Code of Ethics and Practice for
Counsellors‘, it is stated that:

The term ‘counselling’ includes work with individuals, pairs or

groups of people often, but not always, referred to as ‘clients’. The
objectives of particular counselling relationships will vary according
to the client’s needs. Counselling may be concerned with
developmental issues, addressing and resolving specific problems,
making decisions, coping with crisis, developing personal insight
and knowledge, working through feelings of inner conflict or
improving relationships with others. The counsellor’s role is to
facilitate the client’s work in ways which respect the client’s values,
personal resources and capacity for self-determination. Only when
both the user and the recipient explicitly agree to enter into a
counselling relationship does it become ‘counselling’ rather than the
use of ‘counselling skills’ (BAC, 1993: section 3).

While denoting a sense of offering a service, this definition avoids greater

specificity on the grounds that

While it is essential to have some consensus about counselling as a

service, it is not useful to attempt to specify in detail how the
counselling task is undertaken. This might lead to an exclusive set of
assumptions about how human beings learn, develop, and cope with
the changing needs and resources in themselves and their
environment (BAC, 1991: section 1). People become engaged in
counselling when a person, occupying regularly or temporarily the
role of counsellor, offers or agrees explicitly to offer time, attention
and respect to another person or persons temporarily in the role of
client. (BAC, 1991: section 2).
In a BAC document written by Hetty Einzig aimed at the potential
‘consumer’, the counsellor is presented as being supportive but unwilling to
provide direct advice, ‘since the aim is to help you develop insight into your
problems’ (Einzig, 1991:3). Equally, the counsellor examines and clarifies
the client’s communications so that they can become both clearer and more
direct in their meaning. Throughout, the counsellor employs such skills as
‘knowing how and when to ask the right questions’(Einzig, 1991:4) which
have been ‘developed through training and experience’ (Einzig, 1991:4).
She goes on to state:

Most of all, the counselling process can help you to feel more in
control of your life and able to do something yourself about what
isn’t right for you, about the feelings distressing you or about a
difficult relationship, rather than feeling helpless, angry or frustrated.
You don’t have to be a victim in your life (Einzig, 1991:4).

When the separate definitions of psychotherapy and counselling just

outlined are analysed in conjunction with one another, there is little that
emerges which offers a significant distinction between the two enterprises.
Other than differences in terminology (i.e. psychotherapy vs. counselling),
and a more clearly ‘service-offering’ slant in the statements concerning
counselling, it is evident that the three principal elements of structure, space
and relationship which informed the previous discussion on psychotherapy
(Holmes and Lindley, 1989) are also emphasized in the BAC literature on
counselling. Has something been left out which would clarify just what is
different between the two processes?

F. A CRITIQUE OF THE SUGGESTED DIFFERENCES BETWEEN PSYCHOTHERAPY AND

COUNSELLING

Sigmund Freud viewed psycho-analysis as a profession that was neither for

physicians nor priests but, rather, as that of professionals who minister to
the other’s needs (Freud used the word seelsorger, which has tended to be
translated into English in terms suggesting ‘secular minister of the soul’).
Similarly, Thomas Szasz has pointed out that ‘Aeschylus actually had a
name for what we now call psychotherapy. He called it the employment of
iatroi logoi, or “healing words”. In these ancient roots, then, lies our proper
term for the modern, secular cure of souls …’(Szasz, 1978:208).
While the term ‘cure’ might initially suggest that psychotherapy—as
opposed to counselling—is deeply embedded in a medical tradition, such a
conclusion would be inaccurate. Although it is true that the great majority
of the pioneers of psycho-analysis were indeed medical doctors, and that in
some countries, such as the United States, medical training was (and, to a
lesser extent, remains) a requirement for entering into psycho-analytic
training, this was never the case in the UK (among other countries), and
Freud himself (as the previous paragraph suggests) was in favour of ‘lay’,
or non-medical, analysts (Freud, 1926).
‘Cure’, in the psychotherapeutic sense, extends the meaning of the word
far beyond the boundaries set by medical diagnosis and treatment. V. M.
Axline, in her well-known book Dibs: in search of self, for instance, speaks
of psychotherapeutic cure as ‘a chance to feel worthwhile. A chance to be a
person wanted, respected, accepted as a human being worthy of dignity’
(Axline, 1964:22). Similarly, Abraham Maslow’s view that the deepest
psychological miseries encountered in living result from ‘the sin of failing
to do with one’s life all that one knows one could do’ (Maslow, 1968:5)
captures, for many psychotherapists, the essence of what psychotherapy
deals with and seeks to ‘cure’.
Such distinctions might best be understood from the standpoint of the
difference between problems and dilemmas. Problems require solutions,
while dilemmas can only be explored and lived with in a more or less
satisfactory manner. While the medical doctor deals primarily with
problems, psychotherapists’ principal endeavours focus on their clients’
dilemmas.
For all the above reasons, psychotherapy—like counselling—excludes
from its definition the more medically based approaches to the cure or
alleviation of symptoms as exemplified by drug-based or physicalist-based
interventions (such as, for instance, electro-convulsive treatment (ECT))
and, instead, typically emphasizes interventions that rely in whole or in part
on verbal and non-verbal communication.
As was stated before, the modern-day employment of the term
‘counselling’ came about when Carl Rogers found himself prevented from
practising psychotherapy in the United States because he had not been
medically trained. Rogers called what he did ‘counselling’ not because he
wished to make a distinction with psychotherapy but because he quite
simply was not allowed to label himself a psychotherapist. His agenda was
the same as that of the psychotherapist and, as such, in this instance, we
must conclude that no substantive distinction between psychotherapy and
counselling is apparent.
Clare Townsend (1993) has argued that the distinction is principally one
of status based on the questionable assumption that counselling is somehow
inferior to psychotherapy. Once again, this view probably has its origins in
psychotherapy’s (tenuous) relationship with medicine and the possibility
that the high regard in which the latter was held in some ways ‘transferred’
on to the former. It must be said, however, that today it is by no means
certain as to whether medical training necessarily infers higher status upon
a psychotherapeutic practitioner; indeed, for some, the opposite view may
well be the case!
For the general public (and, perhaps, for some psychotherapists and
counsellors), counselling clearly has a ‘populist’ appeal, while
psychotherapy, again possibly owing to its historical development, retains
an ‘elitist’ element. Particularly in a class-conscious society such as that to
be found in Britain, these distinctions may say more about social divisions
than about theory or practice-based differences, or, indeed, about
differences in the quality or effectiveness of the therapeutic process.
Certainly, there is a currently held belief that counselling ‘can be provided
to many more people than psychotherapy can and in a wider variety of
contexts’ (Townsend, 1993:252).
For many, psychotherapy suggests the idea of lengthy treatment
involving several weekly meetings, while counselling is perceived as being
relatively brief and usually requiring, at most, once-weekly meetings. For
some, the number of weekly sessions in which therapy occurs is sufficient
distinction between psychotherapy and counselling, so that whereas
counselling is seen to occur typically on a once-weekly basis,
psychotherapy sessions may take place anywhere between three and five
times per week. This purely quantitative (as opposed to qualitative)
distinction seems to me to be somewhat arbitrary and artificial in that there
exist numerous instances where psychotherapists will see clients on a once-
weekly basis and, equally, counsellors may meet with their clients for
several sessions in the same week. It would not be surprising if this
distinction (more commonly raised by psychotherapists trained within the
psycho-analytic model) were not one based once again more on perceived
status than on process or outcome effects. Though largely anecdotal,
Townsend’s point that, while professionals might be impressed by someone
who is in therapy three times per week, the general public would regard that
individual with some degree of suspicion and might go so far as to view
him or her as being mentally unbalanced, suggests, if not the truth, then at
least something approximating it. Certainly, given the requirements of
personal on-going psychotherapy for trainees on the great majority of
psychotherapy training programmes, it remains the case that a significant
proportion of psychotherapy’s clientele is made up of students of
psychotherapy. Such requirements are less common within counselling
training programmes, where, while at least some experience of counselling
from the standpoint of a client is strongly encouraged by most training
programmes as a means of clarifying the various dynamics of the
counselling relationship, it may not be required.
Some have argued the distinction between psychotherapy and
counselling on the basis that counselling tends to focus on a specific and
currently experienced life-issue and, in this sense, is focused on problem-
exploration, while psychotherapy deals with more deep-seated, less easily
definable or compartmentalizable issues, exploration of which may bring
about general, permanent and profound changes in a client’s whole attitude
to life. Translated into the language of advertising, what is being claimed is
that the psychotherapeutic process ‘reaches those parts that counselling
cannot’.
Still others have taken as their focus point for distinction the argument
that while counselling is largely ‘present-focused’, emphasizing the ‘here
and now’ aspects of experience, psychotherapy is more concerned with the
exploration of the past, focusing on infant and childhood relations with
‘significant others’(such as one’s parents) in order to expose and bring to
the client’s awareness how such relationships may have imposed negative
or ‘neurotic’ patterns of thought and behaviour. In this way, it is further
argued, while the nature of the counselling relationship is straightforward,
direct and focused on the dynamics between counsellor and client, the
psychotherapeutic relationship emphasizes and relies on the ‘subtextual
elements’ (i.e. transferential elements) in the relationship.
Finally, some have suggested that the main distinction between
psychotherapy and counselling is that while the former requires clients to
recline on a couch, the latter only provides an armchair. I leave it to readers
to decide whether this variation provides a sufficient point for demarcation.
Needless to say, all these distinctions are open to argument and are
clearly not generalizable. In all cases, examples can be presented which not
only raise significant doubt as to the general validity of a particular point of
divergence, but also provide the means for arguing the very opposite—such
that distinctive features or categories said to belong to psychotherapy can be
seen to be, in certain circumstances, central to the counselling process under
consideration, and vice versa.
It is possible that the difference between counselling and psychotherapy
has more to do with ‘image marketing’ than with revealing any genuine
process-or outcome-related differences. Equally, contextual factors may
play a role in whether a practitioner defines himself or herself as a
psychotherapist or a counsellor. In my own case, for instance, being both a
UKCP-registered psychotherapist and a BAC-accredited counsellor, I
cannot, in all honesty, say that I am aware of any differences when I say I
am being one or the other! Usually, in fact, my title is determined by my
clients’ wants or assumptions, or which referral list they selected my name
from. It is possible that, just as some might feel that the issues in their lives
merited the attention of a psychotherapist, others might be intimidated by
the perceived ‘grandiosity’ of such a title and would feel more at ease
talking to a ‘humble’ counsellor.
My own conclusion is that it is not possible to make a generally
accepted differentiation between counselling and psychotherapy and that it
is clear that, regardless of the many and varied distinctions that some have
sought to impose on them, the terms may be employed interchangeably.
Indeed, it may well be the case that the desire to impose or avoid
distinctions has more to say about the allegiance of the institution in which
a practitioner has trained, the setting in which he or she might typically
work, and the personalities involved, than about specific distinctive features
of practice.
As such, it may be more helpful to acknowledge the similarities
between the two terms:
1. Both involve methods for (primarily) verbal exploration of
psychological difficulties.
2. Both terms ‘house’ a variety of differing (even competing) theories and
methodologies the precise goals of which may vary significantly.
3. In general, both seek to assist individuals in clarifying and resolving
their own emotional predicaments and thereby gain greater clarity and
increase the possibility of bringing about change in their way of relating
to themselves, to others, and to the world in general.
4. Both share common theoretical underpinnings in that both are based on
the work of the same authors and on the same theoretical constructs.
5. Both emphasize the establishment and development of a particular and
specific relationship which is itself viewed as essentially therapeutic or
at least containing essential elements necessary for therapeutic benefit.

All in all, then, if there exist significant differences between psychotherapy

and counselling, they are not easily forthcoming. As such, my case for
employing the term ‘therapy’ as one that encompasses both psychotherapy
and counselling can be seen to have sufficient validity to merit its
continuation.

G. THE DEFINITION OF THERAPY REVISITED

Nevertheless, since both psychotherapy and counselling have each provided

their own definition, albeit a definition that seems equally applicable to the
other, can it be that our initial task of defining therapy has finally reached
its fruition?
Unfortunately, the answer must remain ‘no’. For while at first sight the
given definitions would seem to be as accurate and inclusive as one might
realistically hope for, on closer inspection they reveal assumptions and gaps
in logic which require elucidation. Not wishing to burden the reader any
more than is necessary with regard to this issue, I will endeavour to expose
these by focusing on a critique of the BAC definition of counselling
provided by Alex Howard (1992) which, hopefully, the reader will
recognize as being equally applicable to a definition of psychotherapy, or,
indeed, of therapy in general.
In considering the BAC’s definition of counselling, Alex Howard has
written:

It ought to be obvious that BAC’s definition of counselling is just

about as vague as it can be … BAC refers to the ‘task’ of
counselling; but prescribes nothing about the means and methods. It
tells you what counsellors are trying to do, but nothing about how
they do it. Such coyness is understandable, for three reasons:
a) There is very little consensus among counsellors and
psychotherapists about methods that work and don’t work.
b) Counsellors and psychotherapists, in their urge to show toleration,
warmth and humanity, don’t like to explore their differences very
energetically.
c) Counsellors, in the process of marketing their wares to the wider
world, are keen to show an underlying unity of purpose. Therefore
they are most reluctant to face, or reveal, the fundamental divisions
about methods which run, like deep fissures, through the very heart
of their activities. (Howard, 1992:90).

But how is counselling distinct from the myriad forms of ‘care’ that others
may offer? Howard points out that the

BAC does, of course, stipulate that counselling is occurring only

when people explicitly adopt the role of ‘counsellor’ and ‘client’ …
But we still end up with a circular definition. Ask: ‘What is
counselling?’ and you get the answer: ‘It is what counsellors and
clients explicitly agree to do together.’ But what do they do
together? The answer: ‘Counsellors do counselling and clients have
it done to them’! … This tells us nothing more about the nature of
counselling but it reveals a great deal about the, human enough,
search for power, status and a secure income (Howard, 1992:91).

While one might wish to take issue with the tone of Howard’s critique, its
basic argument, however unpalatable, nevertheless strikes home. It may
well be the case that a definition of therapy involves therapists’ definitions
and views of themselves as therapists (for whatever reasons and purposes)
as much as having something to say about the act and purpose of therapy.
H. A FINAL AND NOVEL ATTEMPT TO DEFINE THERAPY

As we can see, then, the various attempts to define the broad field of
therapy have not succeeded in providing an agreed-on statement. Does this
mean that the field cannot be defined? Possibly. But before entirely
subscribing to this conclusion, let us consider the possibility that there may
be something in the nature of the question itself which provokes (if not
forces) such a conclusion upon us. All the approaches and attempts to
define therapy discussed so far reveal a Socratic stance in that they seek to
ask the question ‘what is therapy?’ in the hope that an answer will emerge
which will provide the necessary and sufficient properties of this term. This
is clearly a laudable aim, and it is one that permeates most attempts to
define a realm of discourse. Indeed, for many centuries, philosophers in the
West subscribed to this approach as being the sole means of arriving at
suitable definitions.
It was only towards the middle of this century that this approach was
challenged in a substantial manner by the Cambridge philosopher Ludwig
Wittgenstein (1953). Wittgenstein forcefully argued that:

most concepts or categories do not possess a set of characteristics

shared by all members of the category. Rather, category members are
united by strands of similarity, or what are called ‘family
resemblances’ … [They] are open concepts, which possess no set of
necessary and sufficient properties but are held together by a
network of overlapping and crisscrossing similarities (Winner,
1982:5)

Wittgenstein’s famous example of this argument was the concept of games.

While it may seem, at first, to be the easiest thing in the world to define a
game, nevertheless, as Wittgenstein so ably showed, this is far from the
case. For the concept of games is an open one in that, on closer inspection,
there exist no features that are common to all games. Monopoly, poker and
football are all games, but what do they have in common? One might first
say that they all involve some sort of competition between at least two
game-players. But is competition a necessary condition to a game? Clearly
not; in recent years there has been the development of a wide range of
‘fantasy’ board and computer games that emphasize co-operation or
exploration rather than competition. Yet there is no doubt in participants’
minds that they are engaged in game-playing. Nor does a game require a
minimum of two players. Games such as solitaire, for instance, can only be
played by one person. While all games share some properties with some
other games, no games share all properties with all other games. And
further, as Wittgenstein argues, when a new game is invented, it is
understood to be a game because it is in some ways similar to some
established game, not because it is similar to all games in any exact manner.
The philosopher Nelson Goodman (1977), clearly influenced by
Wittgenstein’s line of argument, approached this same issue with regard to
our attempts to define art. While it may be justifiably argued that all art is in
some way ‘symbolic’, being symbolic is not in itself a necessary and
sufficient defining feature of art since much can be symbolic that is not ‘art-
laden’, such as Ordnance Survey maps or numbers. At the same time,
however, it is not inconceivable that an art gallery (which, one would
expect, houses works of art) might purchase an Ordnance Survey map taped
on to a piece of hardboard or a line of numbers painted on to a canvas and
promote such as examples (perhaps even exemplary examples) of
contemporary art. We can all easily think of real controversies generated by
diverse views on the issue of what constitutes a work of art. Goodman
provides an original (and, I believe, highly significant) alternative to such
controversies by arguing that, rather than ask the question ‘What is art?’, we
should be asking instead ‘When is art?’ Consider Goodman’s own example
of a stone lying in a driveway. In such circumstances, the stone is neither a
symbol nor a work of art. But consider the same stone inside a geological
museum. The stone may now, as a representative of stones of a given
geological period, be symbolic, but it is still not a work of art. Now place
the stone inside an art gallery. The stone here, under observation, may also
be seen to be symbolic, but its symbolic nature will not be the same as that
of the stone in the geological museum. Rather, it may be symbolic of all
manner of aesthetic qualities by virtue of its shape, colour, smoothness or
roughness of texture and so forth. It may also be symbolic in terms of the
‘mood’ that some observers might claim it to exemplify. Put more
simplistically, although the stone itself might be unchanged, it is the context
under which the stone is observed which provides it with its differing
meanings and classifications.
Following both Wittgenstein and Goodman, I would propose that our
concerns with the nature of therapy reveal similar issues. Therapy cannot be
fully defined in that it, too, is an ‘open concept’—the varying forms or
categories of therapy do not possess sets of characteristics shared by all
members of the category ‘therapy’. Rather, category members are united by
‘family resemblances’ the varying similarities of which overlap and
crisscross one another. Similarly, it may well be far more useful and
satisfactory for us to ask ‘When is therapy?’ rather than ‘What is therapy?’.
For in doing so we can then begin to focus on the contextual features of
therapy rather than continue with our vain attempts to eke out their
definitional properties.
Again, to return to the example of art, something is a representative of
art when it is located in a specifically designated artistic environment (such
as an art gallery), when it is labelled as art by an authoritative individual or
body (such as an art critic or the gallery’s body of governors), and/or when
an individual’s experience of, or encounter with, the said object is
experienced in such a manner that the individual labels that object-in-
context as ‘a work of art’.
Let us consider what emerges when we apply the same criteria to
therapy. Therapy is such when it occurs in a specifically designated
environment (such as the therapist’s office or the ‘psychological frame’
under which therapy occurs), and when a process of encounter occurs under
conditions that have been labelled as ‘a therapeutic encounter’ by a
designated authority (i.e. the therapist and/or the registering authority that
attests to the therapist’s credentials), and/or when the experiential features
of the encounter are defined as ‘therapeutic’ by at least one participant in
the process.
Therapy, in this sense, acknowledges the vast realm of possibilities
inherent within the term, while containing such under the limits (or
‘givens’) specified above. Equally, it focuses the term within a contextual
frame of reference within which the notion of ‘encounter’ is central. In
doing so, it shifts our focus away from ‘doing’ or ‘done to’ characteristics
to, broadly speaking, ‘being’ (or, more accurately, as I will discuss in Part 5,
‘being-for’ and ‘being-with’) variables that involve both the therapist and
client. Most significantly, perhaps, this stance exposes the mystificatory
possibilities and tendencies that are most likely to emerge when one
attempts to impose defining characteristics on therapy which are fixed on its
‘whatness’.
It is precisely this realm of definition which, I believe, has led numerous
critics of therapy to express their concerns or to polemicize against its
practice (or its practitioners). Unlike a number of my colleagues, I do not
take the position that such views are entirely misguided, or are the
expressions of the critic’s personal neurosis, or that the best means of
dealing with them is to pay them no attention whatsoever in the hope that
they will disappear or be revealed to be absurd at some future point in time.
Equally, however, I remain sceptical of the conclusions drawn by such
critics because they, too, in their critiques, reveal their allegiance to the
imbuing of therapy with quasi-magical, ‘doing-specific’ properties. For me,
it is not a question of ‘white magic’ versus ‘black magic’; it is the doing
away with the ‘magical beliefs’ themselves which should concern us.
My attempt to refocus the definition of therapy in the manner suggested
above may not be entirely satisfactory, but it would seem to be an
improvement over previous attempts at defining the term in that:

1. It allows for all the various competing (and often conflicting) theories
of, and approaches, styles and attitudes to, therapy to co-exist within the
broad realm of ‘family resemblances’ by de-emphasizing specific skills,
aims, goals and outcomes claimed to be necessary, desirable, or specific
to therapy (e.g. curing, helping and/or directly changing the client).
2. It circumvents notions of therapy that are reliant on the idea that
therapy is ‘done to’ someone (the client) and is ‘done by’ someone else
(the therapist).
3. It acknowledges the significance of the labels, or titles, of ‘therapist’
and ‘client’ as being, in and of themselves, essential defining
components of the therapeutic process.
4. While recognizing the ‘specialness’ or uniqueness of therapeutic
encounters, it nevertheless diminishes the tendency to view any events
that might emerge in seeming consequence to such encounters (e.g.
alleviation of symptoms, beneficial help, etc.) as being possible only
under the specific set of theoretical conditions and assumptions believed
in, espoused and imposed by the therapist (or the ‘school’ or approach
that he or she has been trained in and represents), or, indeed, by the
therapeutic process in general—that is to say, the ‘specialness’ of
therapy lies within the relationship or encounter that is made possible
rather than in the consequences or outcomes of such.

This last point may be seen by some as being somewhat problematic since
its intent is to redirect the emphasis of therapeutic encounters away from
such notions as might be associated with medically modelled ideas of
diagnostic intervention, alleviation and cure and towards the idea that the
object and focus of therapy is principally the formation of the relationship
and the exploration of the possibilities contained therein. This is not to say
that the experience of (and, indeed, evidence for) psychophysical benefit,
alleviation of disturbing and disorientating symptoms, and even ‘cures’ are
not possible through therapy. Such a statement would be clearly absurd! But
what is being suggested is that just as therapy cannot lay claim to be the
sole, or even established, means of producing these consequences, in the
same way it should not make the production of these outcomes its point of
focus or its ‘reason for being’.
I realize that this view will not sit well with a great many people, not
least a good number of my therapeutic colleagues. Equally, the stance I am
taking begs the question: Then why go to, or engage in, therapy at all?
What is the point?’ I will endeavour to address this question and provide
what I hope will be a sufficiently satisfactory answer. But some patience is
required of the reader; we must first consider the various critiques raised
against therapy.

2. CRITIQUES OF THERAPY

Even if the difficulties surrounding the very definition of therapy were to be

agreed as having been partially surmounted, we have still to face an equally
problematic question: Is there any evidence that therapy is effective in
alleviating distress, or even curing it? Indeed, is there any evidence that
therapy is at least as effective in these goals as any other activity that would
not be defined as therapy? And, as well, is there any evidence that would
suggest that therapy not only is not effective but might actually be harmful
or likely to increase or prolong distress in individuals?
These are fair questions to ask and, once again, as I will seek to
demonstrate, there are no straightforward answers to any of these concerns.
The harshest critics of therapy, though often focusing their attacks on
psycho-analysis (Eysenck and Wilson, 1973; Masson, 1984, 1988; Gellner,
1985), have raised serious objections to the vagueness, lack of scientific
evidence and rigour and possible inaccuracies in most (if not all) theories
that underlie therapeutic practice. Some have suggested that therapy is a
modern form of religion requiring unquestioning faith in both its ‘priests’
(i.e. therapists) and its ‘congregation’ (i.e. clients) and is thus closed to
objective criticism, measurement and scientific falsifiability. Others, on the
other hand, while acknowledging that at least some therapies are open to
scientific investigation, claim that therapy has been found to be ineffective,
or unable to substantiate its claims. Still others have attacked therapy not
from a scientific perspective but from a socio-political one, arguing that
therapy ‘may be used essentially as a palliative, diverting attention away
from the true cause of human unhappiness’ (Holmes and Lindley, 1989:13),
such that therapy degrades, mystifies and moulds individuals to accept,
even embrace, as personally tolerable, situations that should continue to be
seen as socially intolerable. Equally, these latter critics argue as
unacceptable the elevation of the individual and the ‘psycho-political’
competition that such an elevation creates or aggravates between
individuals, social classes, cultures, races and genders. Clearly, all these
separate criticisms require consideration and response if we are to remain
broadly in favour of the therapeutic enterprise.
Generally speaking, however, it must be noted that all such critiques
are, in significant ways, far from neutral. Each has as its basis an alternative
view of social vicissitudes to promote and, indeed, elevate. This is not to
say that the critiques are to be swept aside, but rather that they must be
placed into their proper context in order that suitable discussion and
analysis can proceed. I feel it necessary to make my own position clear in
this matter. While I am in no doubt that there is much to criticize therapy
for, as this text will hopefully make clear, nevertheless there is also much to
be said in its favour. While there are certainly individuals who have
suffered and been injured in numerous ways as a result of their involvement
with therapy, it is important to acknowledge that many have also found
therapy to be literally life-saving or life-enhancing. If therapy can be
accused of doing wrong to people, it must also be praised for doing
something right. If therapy, as it currently exists, is imperfect, then we are
left with two broad options: either to give up on it and seek alternative
enterprises that will fulfil therapy’s promise and avoid its inadequacies and
inconsistencies, or alternatively seek to clarify both what therapy can offer
and what ill-considered, misleading and potentially disruptive and abusive
assumptions therapy carries with it might be removed or at least minimized
from its agenda. Both approaches seem to me to be valid and worth
promoting. But just as the first alternative must acknowledge that, after
much deliberation and proposal of alternatives, as yet no entirely suitable
substitute for therapy has been found (Masson, 1993), so, too, does it
remain a possibility that the clarification of the therapeutic process may
reveal destructive assumptions that are so fundamental to its entire
enterprise that they are embedded in its definition and application. I believe
that the most honest answer we can provide with regard to this dilemma is
to acknowledge that we simply do not know as yet. As such, it would seem
sensible to me to maintain a view that promotes further exploration of both
stances. This text takes as its main focus the investigation of those issues
and concerns that arise when one adopts the second option, in that its
principal aim is to consider critically the possibilities and concerns which
emerge when one makes therapy itself the focus point of investigation. That
is to say, if it were to be the case that therapy offers unique possibilities in
understanding and alleviating at least some aspects of human misery and
disturbance, then what are its potentials, limitations and points of danger?

A. CRITIQUES LINKING THERAPY TO RELIGION

One recurring theme that arises in many discussions on therapy, in

particular the very idea of therapy, is that it is in some way linked to, or a
contemporary form of, religion. Such views have been advocated by both
defenders and critics (or, if you will, ‘believers’ and ‘heretics’) of either
therapy in general or of specific models of therapy (particularly the psycho-
analytic model). Freud himself was well aware of this tendency and, in a
now famous letter to his friend Oskar Pfister, railed against the possibility
of psycho-analysis being in any way associated with religion. Indeed, it was
his aim to find the means of protecting it from its influence (as well as that
of physicians) (Freud and Meng, 1963).
On one level, it is easy to understand why, in spite of Freud’s protests,
such analogies continue to be made. Partly as a result of the first phase of
the development of psycho-analytic theory and practice, the Freudian
legacy of which included ‘inner circles’, testaments of faith, apostates,
heroic myths, and so forth, some therapy institutes have retained (perhaps
even fostered) an aura of secrecy and mystery that suggests more the
initiation rites and ceremonies of secret societies than an academic or
professional training. But it would be unfair to suggest that this is so for
most modern-day training programmes. Nevertheless, something (at least
vaguely) akin to Christian religious practices (such as the Catholic
confessional) might be seen to have their parallels in the therapeutic
process, and for these reasons there has been some interest in considering
and promoting such potential similarities.
Halmos (1965), for instance, in considering the status of therapy, argues
that therapy is more dependent on the ‘faith’ of therapists in maintaining
their beliefs in the beneficial possibilities of therapy than on any significant
scientific bases. In this way, he suggests, therapy is best understood as a
secularized form of religion exchanging the notion of the struggle between
good and evil for that of mental health versus mental disruption.
Rieff (1979), among others, sees the therapist’s ‘own value system as
central to the therapeutic relationship’ (Holmes and Lindley, 1989:119). As
such, he argues, therapy can be understood

as a form of ‘moral pedagogy’, and therapists as latter-day priests

who wrap up their covert moral message in a pseudoscientific garb
… In his view it is only a short step from the confessional to the
couch … He characterizes Freud’s ‘fundamental rule’ of
psychoanalysis the ‘candour’ expected of the patient as a sacrament
… (Holmes and Lindley, 1989:119).

In this fashion, Rieff suggests, that which can be clearly seen as moral
discourse takes on the guise of science.
In a similar fashion, Rustin and Rustin (1960) take the view that therapy
is the religion of humanism which, in being so, emphasizes the value in the
exploration of individual experience.
Taking a more controversial stance on the issue, Dr Kenneth Calestro
observed somewhat caustically that psychotherapy is the bastard progeny of
a long tradition of neo-religious and magical practices that have risen up in
every unit of human culture (Calestro, 1972:83).
In order to provide substance to such claims, E. F. Torrey (1986) goes on to
compare therapists with those whom Westerners have somewhat
derogatorily labelled as ‘witch doctors’ and lists various points which he
sees as being of convergence. These include: symptom removal, attitude
and behaviour change, insight, improved interpersonal relationships, and
improved social efficiency (Torrey, 1986).
While these views may be appealing to some, and indeed may contain
some intriguing possibilities for exploration, they are likely to be as
misleading as they are potentially useful. I agree entirely with Holmes and
Lindley when, in addressing this issue, they write that the attempt to
reinterpret psychotherapy in terms of its potential resonances with religion

misses … the heart of what is special about analytic psychotherapy.

Interesting and illuminating parallels exist between, say, the findings
of modern physics and Taoist philosophy … but to reduce one to the
other or to conflate them would be absurd (Holmes and Lindley,
1989:122-3).

Equally, to stretch these similarities in order to suggest the lack of

distinction between therapy and religion is, ultimately, abusive to both
systems. Better then to acknowledge that, while potential points of contact
and dialogue may exist and may be worthwhile pursuing, nevertheless each
has its own unique foundational emphases and concerns which are as much
its defining characteristics as any statements or conclusions it might share
with alternate, or competing, systems.
Nevertheless, something of relevance is contained in such views. In her
paper, ‘The myth of therapist expertise’ (1992), Katharine Mair compares
the current position of therapists with that of physicians during the first
decade of this century since, in each case, their patients’ faith in their
expertise, their understanding of the nature of the problems and their ability
to remedy the complaints are far less than might be imagined or conveyed.
Equally, just as physicians undertook a specialized training which claimed
to provide a model with which to understand the illness and a methodology
for treatment they believed in because it seemed to work, so, too, does the
modern-day therapist function under similar, and equally questionable,
guidelines. While Mair accepts that therapy can be of significant value to
people, she argues that
its efficacy is not due primarily to the models and methods that it
uses (which may be as irrelevant to the patient’s problems as the
application of leeches was to the curing of a fever eighty years ago),
and that too blind a faith in them may actually interfere with
therapists’ ability to help their patients (Mair, 1992:135).

Echoing Torrey, Mair makes the point that all societies seem to designate
certain individuals as their ‘healers’ whose wisdom, authority and ability to
carry out effective interventions are accepted with little, if any, doubt. All
forms of therapy rely upon or make use of this mystique even in those
instances where the task of therapy is defined in terms of providing ways of
enabling individuals to heal themselves. ‘Psychotherapy, like medicine, is
said to be based on knowledge. Perhaps, like the medicine of eighty years
ago, its true foundation is on the myth of knowledge’ (Mair, 1992:136).

B. SOCIO-POLITICAL CRITIQUES

Socio-political critiques of therapy present quite a different area of concern

which the psychologist and counsellor, Phillida Salmon, has succinctly
summarized:

Historically, psychotherapy has been something of a special

preserve, separated off from the social world. At worst, it has
reduced social structures to inner feelings, psychologising—often
pathologising — material, political or cultural realities. Even at its
best it has tended to ignore and bypass these realities, treating them
merely as the context for its focus: individual, private worlds, intra-
personal or inter-personal processes. Psychotherapy has, in general,
affirmed the primacy of inner events, and paid little attention to the
ways in which social and cultural structures actually shape personal
experience.
This situation is surely not the outcome of a lack of awareness …
The problem, for psychotherapists, is rather the lack of a language in
which to formulate the meaning of sociocultural realities in relation
to the work they do. The need is not just for a new kind of
understanding of how the outer world may have brought about the
pain, bewilderment and suffering of therapeutic clients. A still
greater problem is that, within our available conceptual repertoire,
there is no adequate way of formulating the meaning of
psychotherapy itself as socio-cultural practice (Salmon, 1991:50).

Following this line of argument, David Pilgrim has presented a critical

perspective which posits that while it was the case that therapy from the
mid-1960s to the mid-1970s stood in opposition to the orthodoxy of mental
health and both sided with and informed progressive, even radical, social
movements, this is no longer the case. The current ‘reductionist, socially
blinkered understandings of therapy can be traced back to the sectional
interests of professionalism … What is on offer, in professional practice, is
typically elitist and self-interested’ (Salmon, 1991:50).
Pilgrim criticizes the tendency to employ forms of ‘psychological
reductionism’ that re-interpret and reduce actions that are arguably valid
within their social context to instances of (neurotic) individual motives. For
example, Chasseguet-Smirgel and Grunberger (1986) take the stance that
trade union activists may be considered to have ‘authority problems’ and
revolutionaries may be deemed to be suffering from ‘an omnipotent
infantile fixation’. In a broader manner, such approaches assume the
validity of considering parts of a system not only in isolation from their
wider context, but also in a manner that excludes all variables other than
those deemed to be ‘psychological’. In this way, for instance, ‘discourse …
has been associated with reducing social policy decisions about mental
health to psychological considerations of child care (particularly mothering)
and reducing class-derived industrial conflict to tensions in and between
small and large groups …’ (Pilgrim, 1991:53).
Further, these questionable stances tend to be validated by means of
naive invocations of individual responsibility and choice which both elevate
the individual and disenfranchize social criticism.
In a similar vein, David Smail (1991) has presented the argument that:

[p]sychotherapists … are trapped within a fundamental dilemma.

Explanations of the origins of suffering usually make reference to
the material world. But the claim to universal curative powers leads
to a formulation of therapeutic work in terms that are purely
psychological … This results in the psychological reductionism
pointed out by Pilgrim: the conversion of real powerlessness into
personal inadequacies supposedly remediable by social skills or
stress management training—or conversely, the reading of socio-
political advantage as inner strength (Smail, 1991:61).

This suggests the kind of ‘get on yer bike’ philosophy advocated by the
Thatcherite ideology that was so seemingly popular during the 1980s but
which has since been largely discredited even by those who, at the time,
were its staunchest defenders. For example, the Institute of Economic
Affairs (the free-market ‘think tank’ so venerated by Mrs Thatcher which
initiated many of her economic ideas) now acknowledges that Thatcherism
failed to address ‘the deeper questions facing any civilization’, and that,
contrary to the view attributed to the Prime Minister, there is such a thing as
a society (Guardian, 27/09/1993:3).
More extreme stances have argued that therapy can be seen as a means
of suppressing social dissent and advocating social conformity. They view
therapy as a panacea for the privileged classes which allows these to view
and deal with their problems in ways that elevate the individual and, by so
doing, strengthen the inhuman relations between classes, cultures, races,
genders, members of differing sexual orientations; in short, between the
various group classifications to be found in contemporary Western society.
Further, they argue that therapy offers false promises since the underlying
causes of human misery and unhappiness are fundamentally socio-political,
not psychological; as such, all therapy can truly offer is a conformist
acceptance of life lived in ‘quiet desperation’.
Russell Jacoby (1975), for instance, arguing the case that the humanistic
psychology of Carl Rogers provides a subtle means of making the
intolerable and unacceptable both tolerable and acceptable, writes:

Rogers in Encounter Groups writes that ‘the encounter group

movement will be a growing counterforce to the dehumanization of
our culture.’ Proposed is not the dissolution of dehumanization, but
its humanization. The brutal totality is accepted as given … The
unholy alliance between monopoly capital and the Center for Studies
of the Person is no sacrilege. The concern of the former for
pacifying its employees, like the concern of the latter, is not
malicious but is grounded in the lie of bourgeois society that they
both share: the ills are subjective …
The endless talk of human relations and responses is Utopian; it
assumes what is obsolete or yet to be realized: human relations.
Today these relations are inhuman; they partake more of rats than of
humans, more of things than of people. And not because of bad will
but because of evil society. To forget this is to indulge in the
ideology of sensitivity groups that work to desensitize by cutting off
human relations from the social roots that have made them brutal.
More sensitivity today means revolution or madness. The rest is
chatter (Jacoby, 1975:88-9).

While Jacoby’s argument may have become even more relevant to the
1990s given the rise of a substantial number of organizations that employ
humanistic and encounter-oriented techniques in order to ‘better empower’
employees to work harder and feel happier within their company rather than
question its principles or hierarchical structures, nevertheless there remains
an underlying logical error in his stance. If therapy increases an individual’s
chances of survival in an inhumane society, it does not follow that that
individual has now come to believe that society is humane. If anything, the
experience of many who have been in therapy is quite the opposite in that
they begin to recognize much that they have gone along with or merely
tolerated in the past as being no longer acceptable or tolerable. While it is
possible for an individual to emerge from therapy in a state that may be
categorized as being far more complacent, it is equally possible that another
may emerge far more socially responsible and active.
In the same fashion, it remains just as erroneous to assume that all
forms of psychic disturbance are solely the result of social forces. That
individuals from the same social group experience life at varying levels of
disturbance or dissociation would suggest that other, psychological, forces
are at work. Is it not more likely that both elements (and any number of
others) play a role in the matter? And, in the same way, it seems sensible to
consider that if therapy can at least minimize those elements of
disempowerment experienced at the psychic level, then this in itself,
however partial and imperfect it may be, is of some worth.
One of my clients, Donna, a woman deeply involved in social causes,
experienced through her therapeutic work the realization that an underlying
theme to what she sought to accomplish was an increasingly punitive and
intolerable psychic command to push herself further and further into
‘service for others’. Driven as she was, unable to consider or ‘have a say’ in
her actions, Donna had begun to lose all sense of care and concern for both
her work and for those who benefited from it. Although her actions were
socially laudable and significant, she felt herself to be lost within them to
the extent that she experienced as little choice in the living out of her life as
those who see themselves as having no option in resisting the social
injustices they perceive as prevalent in the world we inhabit. Through
therapy, Donna began to regain a sense of choice in her work; she shifted
from a position of ‘must do’ to that of ‘can do’ and, in so doing, regained
not only a sense of value in her work but also in herself. Before, she had
perceived herself as being machine-like, compelled to carry out her actions
not because they were socially just but because they were her ‘command
programme’. Her life had become as full of embitterment and helplessness
as that of many an employee working in a capitalist organization. By the
end of her therapy, her commitment to her work had, if anything, increased
—not dissolved, as Jacoby would suggest—because, as she put it: ‘it’s no
longer something that I have to do, it’s what I want to do.’ Just as
significantly, Donna had discovered that this shift restored to her a greater
sense of responsibility than she had felt for a good many years. As
liberating as this responsibility was to her, it also gave her the insight to
recognize how much more difficult it was to work from this stance than
from her previous one—and, equally, how much more human it was.
With regard to such criticisms, it seems to me fair to conclude that
therapy clearly emphasizes the significance of ‘the inner world’—the realm
of meaning, reason and imagination—that each of us brings into our private
and public relations with the world. Equally, one must acknowledge
therapists’ claims that, by means of the examination of such, therapy opens
up the possibility for mental and behavioural change that promotes the
development of increasing autonomy and self-awareness so that the
experience of living is imbued with greater responsibility, tolerance (of self
and others) and respect. In this regard, however, given the make-up of
contemporary society, the possibility exists that therapy may well have
become an essential means to examine and analyse, both within ‘its private
encounter with the patient and in its public face … a part of human
experience that, in our society, only it takes seriously’ (Holmes and Lindley,
1989:14).
I believe that we are in no position to ignore or ‘wish away’ the social
impact and existence of therapy—whatever concerns we might have about
it in its current guise and regardless of the questions it raises about itself
and the society that has become increasingly dependent on, and defined by,
its very presence. Nevertheless, there is an important note of caution to be
acknowledged from the various socio-political critiques of therapy.
In their evangelical fervour to promote the cause of therapy, individual
therapists have tended to present therapy as the principal—if not sole—
means of resolving the problems of human relations and of transforming
society. Such extremist viewpoints, while being directly opposite in their
stance to that adopted by some socio-political critics, are based on similar
errors of logic. To be fair, I have myself written from a standpoint that
argued that if socio-political relations between individuals, groups, cultures
and societies can possibly be improved or fundamentally changed, then
what appears to me to be required is an adoption of a phenomenologically
informed perspective on the issues that both unite and divide us (Spinelli,
1989). I still stand by that view, but I also want to stress that it is far from
the stance being criticized above. It is one thing to say that a particular
theoretically infused viewpoint may provide significant ways and means to
approach or clarify issues of human relations; it is quite another to state that
that particular perspective is itself the solution to the issues under
consideration.
In the same way, it is one thing to argue that therapy, in its general
sense, may provide us with significant—if not unique—means to
understand, address and seek to ameliorate many problems of private and
public social relations, but this is not the same as stating that therapy in and
of itself can resolve many—if any—such concerns. Therapy can inform the
task so that more adequate analyses and resolutions may be attempted, but
to claim that therapy is itself the means to reducing or removing social
problems is both simplistic and potentially dangerous.
I emphasize this point because I believe that it contains within itself a
fundamental misunderstanding of therapy which both its critics and many
of its advocates continue to promote. Therapy, it seems to me, can at best
provide the means to explore, better understand and reassess various issues
in one’s life so that an individual gains a more adequate means of acting
upon, accepting, or changing his or her perspectives and behaviours. It is,
broadly speaking, a means towards the acceptance and clarification of the
possibilities for change rather than the instigator or cause of change.
It is this very distinction which reveals a fundamental flaw in the
arguments raised by both the critics of therapy (including the socio-political
critics currently under consideration and, as we shall see below, the
scientifically oriented critics), as well as those who present themselves as
extreme advocates of therapy. All such groups have imposed a causal
assumption between therapy and some aspect of change (whether change is
seen as ‘cure’ or ‘panacea’) and in so doing have substantially
misunderstood or misrepresented the possibilities that therapy may offer. As
I will argue below, the main thrust of the great majority of ‘outcome
studies’ has been based on this false assumption of a causal relationship
between therapeutic intervention and (measurable) change, just as most
critiques—and defences—of therapy have also based themselves on this
same assumption. This is no moot point. In equating therapy with change,
therapists themselves have fallen into the trap of emphasizing change for its
own sake (presumably in order to give meaning to their enterprise). But this
stance, as we shall see, is itself deeply problematic, not merely because of
its implicit arrogance (is change always for the private and public good?)
but because it imposes limits and constraints on the possibilities of
relationship between therapist and client—limits that may themselves
significantly aggravate the elements of power within the therapeutic process
and which may, however inadvertently, promote various forms of both overt
and subtle abuse.

C. THE ARGUMENT AGAINST STATE-FUNDED OR ASSISTED THERAPY

Another, related, line of argument argues not so much against therapy itself
as the assumption that therapy has become an essential constituent of
modern society and that, as such, it should not be solely available to those
who can afford it but should be publicly funded in a manner similar to the
National Health Service and state education. Like it or not, here in the UK,
public opinion appears to be largely in favour of publicly funded therapy.
Increasingly, GP surgeries are making such available to their patients and
more and more patients are responding to this offer. Such developments
have fuelled various movements to lobby both Parliament and medical
agencies to make provisions for NHS-funded therapy.
Among critics of this viewpoint, Thomas Szasz, himself a therapist and
member of the American Psychiatric Association, is perhaps the most well-
known opponent of publicly funded therapy. While much of his critique is
aimed specifically at the psychiatric and psycho-analytic professions, it is
equally applicable to a state-based therapy. Szasz has argued that once
therapy comes under the governance of the state, then, like psychiatry, it
can become persecutory and a major mechanism for the imposition of moral
standards that are more in the state’s interest to promote than to the
individual’s benefit, in that such institutions then become (or, at the very
least, risk becoming) coercive and inegalitarian (Szasz, 1974b). Szasz has
presented throughout his writing a great number of historical examples to
back up his views that, in the service of the state, psychiatry and
psychiatrically related professions such as therapy become the means for
the state to define (usually through pseudo-medical language and diagnostic
terminology) and persecute ‘deviants’. In the past, such ‘deviants’ included
witches and religious heretics. In current times, they include
schizophrenics, drug-takers, homosexuals, and single parents (Szasz,
1974b, 1992b).
For Szasz, the involvement of the state places psychiatrists and
therapists in an insurmountable dilemma. For, in having become
representatives and employees of the state, they must ally themselves either
with the state—and thereby persecute the ‘deviant’—or, alternatively, must
ally themselves with the ‘deviants’—and, in so doing, find themselves
branded as irresponsible or ‘rogue’. It is only by remaining independent of
the state, Szasz argues, that both the therapist and the client can remain
protected.
Szasz’s argument is a serious one. There is abundant evidence to
demonstrate that institutionalized psychiatry has oppressed some
individuals (Laing, 1967; Masson, 1988; Breggin, 1993). Szasz’s own
encounters with the American Psychiatric Association provide testimony
for this and it is arguable that, in the UK, R. D. Laing’s critiques of
medically based theories of psychiatry ‘branded’ him as an irresponsible,
dangerous, and even ‘mad’ practitioner. As such, the question to be asked is
not can state-funded therapy be persecutory (for surely it can), but rather is
state-funded therapy inevitably persecutory?
While I have a great deal of sympathy for Szasz’s arguments, and
certainly share his concerns, and, as well, agree with him that state-funded
therapy raises specific issues that require continual monitoring and
protective measures to minimize, if not ensure against, persecution of both
therapist and client, I am not fully convinced of the inevitability of his
scenario for several reasons.
First, it is surely the case that many of those who advocate state-funded
therapy—and this includes both therapists and members of the medical
profession—do so precisely because they are both aware of and concerned
by instances of medically focused theoretical biases that might lead to the
mistreatment, abuse or persecution (whether intentional or not) of
individuals and who view the establishment of state-funded therapy both as
a beneficial complement to medical diagnosis and treatment and as a
protection against such biases and their consequences.
Second, there is a clear difference between making therapy available to
a great many people who could not otherwise afford it and imposing or
forcing it on them. I agree with Szasz that such instances can and do occur,
but it is possible to set up protective measures to prevent such. In the UK,
for instance, the British Medical Association’s vociferous stance against
forcing certain individuals to take blood tests in order to ascertain whether
they are infected by the HIV virus—a stance that remains deeply unpopular
with a substantial proportion of the British public and with a good many
Members of Parliament—suggests that the institutionalized medical
establishment is not always at the service of those who would seek to add
new categories of ‘deviancy’. Considering the argument more broadly, it is
important to distinguish between recommendation and imposition and it is
clear that such distinctions can be incorporated into those regulations which
govern the establishment or extension of state-funded therapy.
Third, Szasz himself reminds us that for psychotherapy to work the
patient must actively want it rather than just passively accept it, and be
prepared to give up something in order to achieve success (Szasz, 1992a).
Presumably, that individual bases the decision on the judgement that the
choice of being in therapy is potentially more worthwhile than another. But
what if I, as an individual, choose to enter therapy but find that I cannot
because I do not have the financial means to do so? Szasz’s stance seems to
suggest that the poor and the uneducated require jobs, money, knowledge
and skills rather than therapy (Szasz, 1974c). But does this statement differ
markedly from that of those whom Szasz criticizes? Is not Szasz also
imposing a view that restricts freedom of choice on questionable grounds? I
agree with him that the poor and the uneducated may want or require all of
the above, but are they to be dictated to as to what they require simply
because they are poor and uneducated? Can it not be the case that such
ethical discussions might also benefit the poor and uneducated not because,
as Szasz argues, they might simply reveal previously unforeseen facets of
personal freedom (Szasz, 1974c)—though that in itself might be of some
value—but because the process may well expose additional factors that
aggravate their physical and mental impoverishment? I agree with Szasz
that no amount of therapy is going to reduce or remove social oppression or
political disenfranchisement, but it may well reveal additional variables that
make an individual’s life experience even more miserable and debilitating.
If therapy can at least offer this much to the poor and uneducated, if some
of the poor and uneducated would choose it were it not for its financial cost,
and if it seems reasonable to test the hypothesis that state-funded therapy
may provide some possibly significant novel and unique personal and social
benefits which other services are unable to provide, then is not a just and
humane society duty-bound to provide the means at least to explore such
possibilities?
Nevertheless, I agree with Szasz that potentials for abuse and coercion
exist within such developments and if they were to come into being suitable
protective measures must be contemplated and established from the start.
These would focus on issues of availability versus imposition as well as on
controls designed to protect both practitioners and clients from unnecessary
and abusive institutional interference. Szasz’s critiques should not be
dismissed as extremist or unduly pessimistic. We simply do not have the
evidence as yet to conclude whether they are or not. On balance, I believe
that the enterprise is worth attempting so long as we remain cognizant of its
potential dangers and are entrusted with sufficient means to protect against
them.
I also believe that Szasz is correct in his insistence that no one needs
therapy in the sense that it is both a necessary and singular means to greater
self-awareness, empowerment, authenticity, greater autonomy or any other
of the jargon words that therapists and clients might employ. That it is
certainly a unique means to deal with all such is not being disputed, but
those who go so far as to stress that therapy is the sole means to such goals
simply overstate the matter. Even so, the fact that it is a means, and is at
least potentially a very good means, would suggest that it would be
somewhat irresponsible to make it available only to those who can afford its
financial costs. In this latter sense, I would disagree with Szasz’s argument
that public funding for therapy is a dangerous and unnecessary
development. Insofar as it might allow the state to honour and advance its
commitments to the provision of structured assistance to those experiencing
mental disquiet and ‘dis-ease’, but who cannot afford the cost of private
consultations, therapy may well be both a viable and cost-effective option
worthy of serious consideration (Holmes and Lindley, 1989).

D. GENDER-BASED AND MULTI-CULTURAL CRITIQUES

In relation to the last point raised above, numerous feminist critics of

therapy continue to point out that many of its assumptions and practical
applications are still infused with patriarchal and paternalistic tendencies—
even when practised by female therapists. Is this another unavoidable or
unresolvable dilemma for therapy? I think not. Modern feminism gained
much of its impetus and clarification of its critiques of patriarchal society
from the ‘consciousness-raising’ groups developed in the 1970s. Both the
rationale and practices of such groups were based on therapeutic models
and techniques and provided powerful means for self-challenge, critical
awareness and increased autonomy which allowed many women to consider
more honestly the roles they had adopted in their personal and public
relations, to question and challenge such roles, and to strive to find the
means to change them in whole or in part. If, as I believe, therapy is a
dynamic process, open to the exposure and re-evaluation of its tenets and
assumptions, then the challenges of feminism require critical and non-
defensive consideration which might in numerous ways influence the
development of both its theories and practices.
The same clearly holds for challenges from other cultures, both within
and outside a therapeutically influenced society. The question of whether
therapy can adapt to differing socio-cultural conditions or be seen to offer
and fulfil its promise as a valid enterprise beyond the Western milieu
remains unanswered in significant ways. For, although therapy obviously
exists in various forms and emphases in many diverse cultures, it is unclear
as to whether it has been adopted because it is a valid and capable response
to those cultures’ internally perceived concerns and dilemmas, or,
alternatively, whether therapy has become an important means to promote
and partially fulfil those cultures’ tendencies to be seen to be increasingly
‘Westernized’ through their adoption of Western ideals and aspirations,
fashion styles, popular arts such as music, cinema and television, and, as
well, those ‘Western neuroses’ that might best be explored via a Western
form of therapy.
As to sub-cultures within a dominant Western culture, as is the case in
the UK, one can observe an acceptance of the value of therapy so long as it
is in the hands of therapist-representatives from within that same culture.
The argument here runs along the lines that only therapists from the same
culture as their clients can understand and deal with the particular issues
and concerns brought to them. In this way, non-Caucasian groups within the
UK have argued the case for ‘Black Therapy’ or ‘Afro-Caribbean Therapy’
or ‘Asian Therapy’, and so forth. In turn, this has led to movements which
advocate that therapeutic encounters be segregated on the basis of sexual
orientation (e.g. gay and lesbian therapists for gay and lesbian clients),
religious affiliation (e.g. Christian therapy), or gender (e.g. female
therapists for female clients), or any combination of the above (e.g. Gay
Asiatic Christian Therapy). While the stimulus for such movements is
partially understandable given the increasing socio-cultural schisms that
currently exist in a society such as that of the UK, where change towards a
more culturally diversified community has not yet been substantially
acknowledged or accepted by its dominant culture, nevertheless the
underlying logic of these movements remains open to question. It seems
necessary to point out, for instance, that while such stances may remove or
restrict possible inter-cultural biases and assumptions that in a microcosmic
fashion reflect the aspects of the broader cultural imperialism of the West
towards other cultures, nevertheless it remains important to expose and
challenge the great variety of possible inter-cultural biases that might enter
the therapeutic relationship and thereby inhibit the exploration of individual
differences or divergent views. Is there not the possibility that similar
tendencies, unhelpful as they are to clients, might not occur in therapeutic
encounters that are segregated on the basis of various similarities between
therapists and clients? Worse than this, however, as socio-cultural critics
themselves point out, therapy can easily become employed as a means of
imposing normative standards of thought and behaviour and, just as one
group or culture can seek to impose its views and standards on another
through therapy, so, too, can it be the case that this act of imposition can be
carried out within the same group or culture so that the therapeutic process
becomes something more akin to ‘thought reform’ or the inculcation of
various forms of ‘correct’ thought and practice. This is not to say that the
very idea of segregated therapy is fundamentally erroneous, but merely to
point out that it is by no means devoid of potential dangers. The problems
encountered might be different to those that might be found when
individuals from divergent representative groups engage in therapy, but
problems are still likely to arise and must be seriously considered—just as
the possible advantages of engaging in therapy with individuals from
divergent cultures or sub-groups should also be studied.
There remain two major forms of critique against therapy to be
considered. The first, most famously argued by Jeffrey Masson (1988),
focuses its attention on the unequal distribution of power in the therapeutic
relationship, which Masson takes as being unresolvable and which, as a
consequence, turns therapy into an unavoidably abusive enterprise, and will
be left to Part 2 of this text in order to provide the fuller discussion that it,
and its implications, require. The second area, dealing with the scientific
critiques of therapy, actually contains not one general issue but several,
each of which has been of significant public and specialist interest. For
these reasons, I have chosen to address these critiques separately in the
following section.

3. SCIENTIFIC CRITIQUES OF THERAPY

With regard to a scientifically based case either for or against therapy, there
continue to be two main issues that have interested critics and researchers.
The first has focused on the question regarding the scientific status of
therapy while the second, more common, concern, concentrating on
‘outcome’ studies, has studied the effects—positive, negative and negligible
—of therapeutic interventions. I will summarize the major findings of each
individually.

A. CRITIQUES QUESTIONING THE SCIENTIFIC BASIS OF THERAPY

On considering the scientific basis or status of therapy, initial investigations
have exposed several immediate difficulties hindering any simple or
straightforward conclusions. Firstly, as ever, the very variety of currently
existing therapies has confounded discussion. Many critiques of therapy
tend to focus exclusively on the scientific status of psycho-analysis (e.g.
Farrell, 1981). Yet even here to speak of psycho-analysis as a unified field
of enquiry is somewhat misleading since there exist many diverse forms of
psycho-analysis (e.g. Freudian, Jungian, Kleinian, American and British
object-relations theories, Lacanian, etc.), all of which exemplify significant
divergences between one another both at the theoretical and applied levels
and many of which also contain within themselves differing emphases that
reveal important implications for their development of hypotheses and
practice. At the other end of the scale, cognitive-behavioural therapies have
tended to attract the least scientific challenge owing to their claims to being
direct applied off-shoots of dominant trends in academic, experimentally
focused psychology (e.g. Beck, 1976). Between these two extremes lies a
broad range of humanistic therapies which, while not immune from critique
as to their scientific status, have themselves developed critiques of
statistically oriented, quantitatively focused empirical approaches to
scientific enquiry and have played a major role in promoting scientific
investigation that is, at least initially, qualitatively oriented and focused on
the exploration and clarification of subjective experience rather than
objective measurement (Shaffer, 1978).
This latter enterprise reveals a subsidiary area of concern—namely, that
scientific evaluation can take many forms. Not surprisingly, perhaps, the
most vociferous critics of the scientific status of therapy tend to be
exponents of a view of science that is grounded in, and dominated by, a
stance on experimental findings based exclusively on quantifiable and
repeatable controlled studies best exemplified by laboratory-based research
that seeks to isolate specific variables and study their influence and effects
under strictly manipulated conditions (e.g. Eysenck,1952, 1983). While the
value and advantages of such a stance are obvious, perhaps even desirable,
it is quite another matter to suggest that these are the only acceptable or
proper means of engaging in scientific enquiry. Further, it is debatable that
such forms of enquiry can approach an area of such variable complexity as
the therapeutic process without imposing serious limitations on both the
nature, the quality or the significance of any of the available findings.
For many scientists, the essential criterion as to whether a theory can be
said to be scientific is its falsifiability. So if, for instance, I were to argue
that everything that human beings think and do is caused by invisible,
supernatural rays originating from the dark side of the Moon, my theory
might be believed to be correct by myself and any number of other
individuals, but could not be said to be a scientific theory since it could not,
at this point in time at least, be falsified. Any objection that anyone raised
against my contention would have little, if any, impact on my stance and,
indeed, I might even be able to interpret such an objection as further
‘evidence’ for the accuracy of my argument. As such, while my theory
might seem to explain everything, it actually explains nothing. An apt, if
disconcerting, example should clarify the issue. In The Interpretation of
Dreams (Freud, 1900), Freud recounts that one of his patients refused to
accept his contention that all dreams were disguised attempts at wish-
fulfilment. She produced a dream for him that seemed to prove her point.
On the contrary, Freud asserted, the dream did fulfil a wish—the wish to
prove Freud wrong! Now perhaps Freud was right and his intervention
provided beneficial therapeutic insight for his patient. But this is not the
issue: was Freud’s theoretical reasoning scientific? On the grounds of
falsifiability, in this instance, it clearly wasn’t.
Psycho-analysis has often been singled out as being an unfalsifiable
theory and, therefore, as an unscientific one (Popper, 1960). But this
conclusion has been contested not only by defenders of psycho-analysis
(Edelson, 1984) but also by theorists who remain deeply critical of psycho-
analysis for other reasons (Grünbaum, 1984). Unfortunately, as my earlier
example suggests, a great deal of ammunition has been given to their critics
by psycho-analysts themselves. For instance, Freud himself argued that
many critiques of his theories were not based on logic but on the
psychology of the critic (Freud, 1925). This view has persisted in many
forms so that genuine criticisms have been dismissed and left unconsidered
and, instead, have been ‘explained away’ as examples of the critic’s
pathology. Jeffrey Masson’s critiques of certain aspects of Freudian
psychoanalysis have tended to be dealt with in this way by the
psychoanalytic establishment (Masson, 1992). In a similar fashion, when
recently, in my capacity as Acting Chair of the Society for Existential
Analysis, I invited Masson to speak at its annual conference, I was told by
various psycho-analytic colleagues that ‘the man was clearly mad and had
nothing to say’ and that the very act of my inviting him suggested
‘disturbing destructive tendencies in my own psyche’! Needless to say, I
find such attitudes deeply disturbing and of no benefit to the status of
therapy. To dismiss what is being said solely on the basis of who says it, to
equate criticism with personality, is nothing less than intellectual fascism of
the most insidious kind. It was precisely on such grounds that individuals
were arrested, placed into psychiatric clinics or executed in Stalin and
Brezhnev’s USSR. It may well be the case that Masson’s ‘pathology’ or my
own ‘destructive tendencies’ fuel or direct our interests and criticisms, but
such explanations say nothing at all about the possible validity of the
criticism in and of itself and only succeed in giving credence to those who
would characterize therapy as something more akin to religion than to a
philosophically or scientifically infused enterprise.
Is the whole of therapy based on unfalsifiable theoretical assumptions?
The available evidence is clear that even if it were to be found that some
approaches to therapy—in whole or in part—were based on unfalsifiable
theories, there is no basis to any contention that the theoretical
underpinnings of therapy are, of necessity, unfalsifiable.
As such, the question of the scientific status of therapy, while by no
means satisfactorily answered in the eyes of its most extreme critics, seems
to be sufficiently resolved for everyone else—critics and advocates alike.
For them, the crucial question is not whether therapy is scientific or not but
whether it achieves its claims of reducing or removing a great deal of
psychic disturbance, misery and pain.

B. CRITIQUES OF THE EFFICACY OF THERAPY

How is efficacy to be measured?

Understandably, a substantial amount of literature exists on this topic with
most of the research tending to concentrate on treatment or outcome studies
—that is to say, the evidence for or against any discernible (i.e. ‘objective’)
effects (whether positive or negative) of therapeutic interventions. But here,
too, we are immediately faced with serious limitations and challenges to the
evidence obtained from such studies. How, for instance, are outcomes to be
measured? Is a client’s subjective experience of the beneficial effects of
therapy in and of itself a suitable ‘measurement’ of the efficacy of therapy?
Or must there be some observable or measurable changes in the client
which are open to quantitative analyses? And if no notable behavioural
changes following therapy are to be found, does this necessarily imply a
failure in the therapeutic process?
To aggravate the situation further, the very aims or goals that therapists
may set for therapy might, in themselves, not only vary, but also prove not
to be overly amenable to experimental research.
Freud, for instance, saw the possibilities of his technique as allowing
individuals to enhance their ability to ‘love and work’, or, alternatively, ‘to
transform hysterical misery into common unhappiness’ (Freud and Breuer,
1895).
In a similar vein, the psycho-analyst Roy Schafer takes the position that
an analysis can be said to be successful when it produces

a more united, subjective self, one which has more room in it for
undisguised pleasure, but also for control, delay, renunciation,
remorse, mourning, memories, anticipation, ideals, moral standards,
and more room too for a keen sense of real challenges, dangers and
rewards in one’s current existence. The childlike regression and
nostalgia are reduced in influence (Schafer, 1976:147).

And Owen emphasizes that

the purpose of meetings is to give clients the space in which to

unfold their problems in a professional’s presence. Therapists must
put aside their cares and needs and be ‘introverted’, that is, let clients
speak and use the time as they wish … (Owen, 1993a:15).

I am in broad agreement with all these aims and stances, but it is also clear
to me that it would be an extremely difficult task to set about measuring any
or all of these effects on the behaviour of an individual or, indeed, to
demonstrate that they were the direct outcome or result of therapeutic
intervention.
As such, the scientific evaluation of the efficacy of therapy is a
notoriously difficult enterprise which has, so far at least, provided very few
reliable and valid conclusions. Kline (1984), for example, having
scrupulously examined the available research evidence concerning the
effectiveness of psycho-analytic therapy, concludes that
it is wrong to say that psychoanalysis is an effective therapy. It is
equally wrong to say that it is ineffective. There is no evidence either
way … The criteria of success of psychoanalytic therapy are difficult
to define (Kline, 1984:19).

This assertion is echoed by Anthony Storr (1966):

[T]he view that psychoanalysis cures anyone of anything is so shaky

as to be practically non-existent (Storr, 1966:58).

Evidence for the beneficial and harmful effects of therapy

In general, however, the accumulated evidence of outcome studies at least
suggests that therapy tends to be beneficial (Luborsky et al, 1975, 1985;
Smith et al, 1980), and that some aspects of therapy seem to be more
important than others in bringing about beneficial change.
For instance, the six-year-long, ten-million-dollar study funded by the
National Institute of Mental Health concluded that therapy is as effective as
drug treatment in alleviating clinical depression. Analysing the results
obtained over a sixteen-week test period, it was found that while the drug
treatment (employing the anti-depressant drug imipramine) was initially
quicker in producing ameliorative results, therapy eventually caught up and
was shown to be equally effective in eliminating the most serious symptoms
of clinically diagnosed depression in over 50 per cent of the randomly
assigned individuals. Similar percentages of success were obtained with
individuals assigned to drug treatment. These results contrasted
significantly with those obtained from a control group of individuals who
had been prescribed placebos and were provided with regular statements of
verbal support in that only some 29 per cent of control group individuals no
longer displayed serious symptoms (Leo, 1986).
While these findings are clearly of importance in arguing the case for
therapy as a suitable, possibly even preferable, alternative to drug
treatments, nevertheless when one considers that nearly 50 per cent of the
individuals in the two experimental study groups were not helped
significantly by either therapeutic intervention or by drug treatment, and,
alternatively, that some 29 per cent of the control study group improved
somewhat ‘spontaneously’, the actual effectiveness of therapy is not as
great as one might initially be led to believe (Leo, 1986).
If there exists at least some evidence to suggest that therapy can be
beneficial, is there any that would suggest that therapy can also be harmful
or damaging? McCord (1978) traced 250 treated clients thirty years after
termination of treatment and 250 from a matched control group. Although
80 per cent of the treated group thought they had benefited from
counselling (which was person-centred supplemented by educational help
and training in social skills and lasted five years in most cases), the
employment, criminal and health records of both groups showed the treated
group to have done less well in all respects than the control group. A
number of other studies, as summarized by Mays and Franks (1985), have
also pointed out the existence of negative outcomes in therapy.

Research design problems in outcome studies

Overall, then, while a substantial number of studies dealing with the
outcomes of therapy exist, their findings, whether positive or negative, have
to be treated with considerable caution, owing to various and significant
methodological problems and weaknesses in research design which, in
some cases, render the studies essentially valueless.
Restricting himself to a review of quantitatively based outcome studies
of psychotherapy on the grounds that it is from the evidence obtained from
these that claims for the scientific basis of psychotherapy are usually made,
Paul Kline points out a number of significant problematic areas present in
all of them. These include: issues dealing with the meaning of recovery;
problems of client diagnosis; variance among therapists; variance among
clients; therapist–client interaction variables; difficulties arising out of the
need for control groups; variables dealing with instances and regularity of
‘spontaneous remission’; the validity and reliability of the psychological
tests; length of follow-up studies; biases in the research design, and so forth
(Kline, 1992). Each of these areas raises important difficulties for the
researcher. Just to take one of them as an illustrative example, let us
consider the issue of recovery. The fundamental problem here is that it is by
no means an easy task to define the meaning of recovery. Is recovery to be
understood as the remission of symptoms? Or can recovery simply mean
that clients feel more able to deal with life, or are just generally more
cheerful? Or does recovery entail some dramatic change in their behaviour?
(Kline, 1992). These, and a great many more, possibilities can be argued to
be examples of recovery. But not all therapists and researchers would agree
that any, or even most, of such instances constitute recovery. The question
of recovery, as Kline quite rightly points out,

conceals a far more formidable conceptual difficulty in the

investigation of psychotherapy. What is deemed to constitute
recovery must depend upon how psychotherapy is conceived. This
varies from the simple (behavioural therapy) to the complex
(psychoanalytic therapies) and to its virtual denial … Clearly what
constitutes recovery is no simple matter to decide (Kline, 1992:65).

If such are the difficulties to be encountered with just one variable of a

possible research design, then ‘it can be seen that the ideal research, with
proper sampling and valid measures, constitutes a massive practical
problem demanding enormous resources’ (Kline, 1992:83). And yet to
compromise ones research opens it to the risk of being judged invalid.
Perhaps unsurprisingly, given the massive problems involved, Kline
concludes that ‘the case for the effects of psychotherapy remains to be
made. This is not to say that it is ineffectual, simply that it remains
unproven, despite the weight of research findings (from experiments which
have not overcome these problems) in its favour’ (Kline, 1992:83-4). As to
the possibility that such problems may be fully overcome at some future
point, Kline remains cautious. His task, he tells his readers, was simply to
sensitize us to the problems involved. Whether we respond to these
optimistically or pessimistically ‘is perhaps a matter of personality rather
than logic’ (Kline, 1992:98).
Other researchers (e.g. Stiles and Shapiro, 1988) have also criticized a
number of important assumptions of outcome studies on the grounds that,
being a usually lengthy interaction, ‘it is by no means a clear and easy task
in therapy to separate process from outcome’. Further, they point out that
these approaches to the question of therapeutic efficacy tend to take
medically focused outcome studies of the effectiveness of a particular drug
as their model. But, while such models may be valid when it is possible to
isolate and measure the effects of a specific variable (i.e. the drug in
question), such that the researcher can obtain a linear dose-response curve
which can then be analysed and measured for its effectiveness, in therapy,
where no specific variable can be easily isolated, and where it is more likely
that the variables are both far more complex, interactive and
interdependent, then the accumulated data may be minimally significant,
seriously flawed or misleading such that a zero, or even a negative
correlation between therapeutic intervention and outcome, may still be
masking the effectiveness of the encounter.

Placebo effects
It is precisely because such issues have not been properly addressed, and
hence the distinction between specific and nonspecific variable effects has
not been properly acknowledged, that some critics have suggested that the
effectiveness of therapy is best understood in terms of a placebo effect.
To consider this argument constructively, it becomes important to
clarify firstly a distinction between an intentional and an inadvertent
placebo. An intentional placebo refers to a treatment variable that has been
designed to have no effect in itself on a particular disorder. An inadvertent
placebo, on the other hand, refers to a treatment variable that is intended to
have an effect on a particular disorder by a specified means, but which is
subsequently found to produce its effect in some other manner which
remains unknown or inexplicable to the investigator. Intentional placebos
such as sugar pills are commonly employed in medical tests measuring the
effectiveness of a new drug. On the other hand, it now seems likely that
most medical and surgical procedures before this century were in fact
inadvertent placebos and some of them may have been highly effective.
Intriguingly, Frank (1989) has argued that placebos may best be understood
as a form of therapy since a placebo is a ‘symbolic communication that
combats demoralisation by inspiring the patient’s hopes for relief … It is
therefore not unsurprising that placebos can provide marked relief in
patients who seek psychotherapy’ (Frank, 1989:97).

The relationship between theoretical models and therapeutic effectiveness

Nevertheless, it remains a possibility that should not be entirely discounted
that therapy itself may be an inadvertent placebo. This would suggest that
while therapy can be shown to be effective, the reasons for its effectiveness
are not those that we have tended to assume. Some initial evidence in
favour of this view would be obtained if it were to be shown that in spite of
the fact that each of the 400-plus approaches to therapy attributes its
effectiveness to its specific theory and methodology, in fact no evidence
exists which demonstrates that some theoretical approaches to therapy are
more effective than others (Kazdin, 1986).
As it happens, there is actually a good deal of evidence in favour of this
very contention. Smith and Glass (1977), for instance, having reviewed
almost 400 controlled evaluations of counselling and psychotherapy,
concluded, in line with other outcome studies, that, on balance, therapy was
effective. However, their research went on to argue that there were, at best,
only ‘negligible differences’ between the different schools of treatment. In
the same way, Beutler (1979) could not find any evidence to show that any
one form of therapeutic treatment was consistently better than any other.
Differing theoretical orientations produced no significant differences in
outcome.
Similarly, in the National Institute for Mental Health project discussed
above, part of the research involved the comparison of the effectiveness of
the two forms of brief therapy employed in the study (these were cognitive-
behavioural therapy and interpersonal therapy). The researchers were
unable to find any significant evidence for the greater effectiveness of one
over the other (Leo, 1986).
In line with these conclusions, the following statement by Ian Howarth,
a vociferous critic of therapy, deserves serious consideration:

It is now clear from meta-analyses of almost 500 evaluative studies

(e.g. Smith, Glass and Miller, 1980) that most forms of
psychotherapy and counselling are approximately 50 per cent more
likely to produce an improvement than would occur without
treatment, provided the outcome is assessed from the client’s
subjective reports. These same meta-analyses mostly fail to show
any difference between different forms of treatment, no matter how
different in philosophy … or how different the procedures … and no
matter what the disorder being treated … The non-specificity of
treatment is confirmed by the failure to demonstrate any effect of
training on the effectiveness of therapy (e.g. the meta-analysis of
Berman and Norton, 1985). One is driven to the simple conclusion
that psychotherapists do not know what they are doing and cannot
train others to do it, whatever it is (Howarth, 1989:150).

Clients’ views on the effectiveness of therapy

There is the strong possibility, then, that therapeutic efficacy may have little
to do with a particular theory being espoused and that therapists have
emphasized the wrong reasons for the effectiveness of therapy. Perhaps it
would be wise to turn to the statements and views of clients in order to
consider their stance on the matter. Somewhat amazingly, given the large
amount of studies dealing with therapy and therapists, there exist very few
extensive studies that focus exclusively on the client’s experience of
therapy. Recently, a text entitled On Being a Client by David Howe (1993)
has provided an important analysis of this subject area.
Howe argues that, from their perspectives, clients tend to see the
therapeutic process as one composed of three ‘movements’ or sequences:

1. Accept me.
2. Understand me.
3. Talk with me.

With regard to the last point, Feifel and Eells (1963) studied sixty-three
clients of psychotherapy and found that simply the opportunity to talk
topped the list of what clients found to be most helpful from the therapeutic
process.
A major factor which clients return to again and again in their
assessment of therapeutic effectiveness, and which seems to be a
fundamental underlying factor in all assessment ratings, is ‘the warmth and
friendliness’ of the therapist (Strupp et al, 1969). Similarly, one study
showed that clients tended to feel that therapists should be interested in
them as people, not as potential or actual cases (Sainsbury et al, 1982).
Summarizing many of these findings, Howe points out that, generally,
clients tend to prefer therapists who seem to them to have their own
personality, sense of humour and particular characteristic ‘quirks’. Clients
also typically tend to prefer engagement and dialogue with the therapists
and tend to experience the therapist’s unwillingness to engage verbally with
them, or to remain silent, as being artificial, threatening, or rejecting. Anne
France (1988), taking up this issue from the client’s standpoint, argues that
while she doesn’t want the therapist’s views to swamp and overwhelm her
own, nevertheless she does want to know them.
Similarly, clients tend to define the good therapist as one who attempts
to enter their world-view empathically and non-judgmentally. This belief
that another is able at least to partially understand them and have some
sense of their suffering, confusion or distress is, in itself, perceived as being
deeply therapeutic.
Clients also want their therapists to be interested in them. Kline et al
(1974) found that accurate insight and the perceived interest shown in them
by the therapist were variables defined as being of major importance by the
client group that had been interviewed.
As to the therapeutic process itself, clients identify the quality of the
relationship as being of central defining importance in that it fosters both
acceptance and understanding which will enable the necessary sense of trust
and security required for honest exploration, but which also seeks to avoid
rejection, criticism, ridicule, inconsistency and judgement. This view is
backed by Lomas (1981), Oldfield (1983) and France (1988) among others.
Strupp and his associates aptly sum up these issues when they conclude:

It seems that the amount of improvement noted by a patient in

psychotherapy is highly correlated with his attitudes to the therapist
… More important, the therapist’s warmth, his respect and interest
… emerged as important ingredients in the amount of change
reported … the more uncertain the patient felt about the therapist’s
attitude toward him, the less change he tended to experience (Strupp
et al, 1969:77).

As to clients’ views on factors that may impede the therapeutic process,

McLeod’s (1990) review of clients’ conclusions noted that:

First, clients felt that things went badly when they did not co-operate
with the therapist by being silent, by talking superficially or by not
daring to talk about some things. Secondly, problems in the
relationship between therapist and client were seen as a hindrance
(for example, the therapist not being warm enough, confronting too
much or too little, not valuing or accepting the client enough).
Thirdly, clients found it unhelpful when their therapists made
interventions which took them off their own ‘track’, when the
therapist said things that ‘did not feel right’ (McLeod, 1990:15).
Howe amplifies these findings by arguing that the therapeutic process itself
is impaired when therapists fail to understand, or even attempt to
understand, their clients. Worse, under such circumstances, clients’ sense of
isolation is likely to increase when therapists seek to impose their own
explanations on the client’s experience (Howe, 1993).
Noting important perceptual differences in the therapeutic process
between therapists and clients, Maluccio (1979) has shown that when
counsellors are asked to recall the first session, they typically focus on the
problems and issues presented. Clients, on the other hand, tend to remember
the feelings they had and their reactions to the therapist. In a similar
fashion, Feifel and Eells (1963) found that whereas therapists emphasize
changes in behaviour and relief of symptoms as the main indicators of
success, clients placed the accent on insight and understanding as the most
appropriate measures of satisfaction.
Oldfield (1983) presented four main aims that clients tend to want to
achieve through their therapy:

1. To change their feelings, gain relief from distressing emotional states

and increase their self-esteem and confidence.
2. To gain greater understanding, both of self and of problems to be dealt
with.
3. To regain their ability to cope with life, and be able to work effectively
again.
4. To improve their relationships with others.

Clients’ perspectives on the therapeutic process are valuable not only for
what they state but also for what is not said. Like the research findings
discussed earlier, client views do not seem to hold the therapist’s allegiance
to any particular theory as being of great significance—indeed, this issue is
rarely, if ever, mentioned by them! Once again, then, we are faced with the
possibility that the effectiveness of therapy is based on previously
unforeseen factors. But if this is so, then what other factors may be worth
considering?

Personality factors and therapeutic effects

Some researchers have suggested that variances in therapeutic efficacy may
be due to the personality factors associated with the therapist.
McConnaughy, for instance, found that a significant positive correlation
existed between the most consistent beneficial therapeutic results and
minimal emotional disturbance in the therapist (McConnaughy, 1987).
In the OPUS Report which was drawn out of a series of discussions
with forty-three therapists representing sixteen therapeutic ‘schools’ or
approaches, it was argued that there exists the distinct possibility that the
best therapists are ‘born’ rather than ‘made’ in that their ability to deal
effectively with others is ultimately more a reflection of the therapists’
personality and life experiences than of any specifically taught techniques.
Further, it was suggested that most, if not all, therapists are drawn to the
profession as much out of a personal curiosity and desire to understand and
deal with aspects of their own lives which remain unresolved or
problematic as they are by the desire to help others (Broadbent et al, 1983).
More problematically, this same report also addressed the possibility that
some may have been drawn to the profession at least partially by their wish
for power (Broadbent et al, 1983).

Training and therapeutic efficacy

These viewpoints raise significant questions concerning the value and
effectiveness of training individuals to become therapists. In recent years,
partly owing to the desire to promote the professional status of therapy, and
to enhance client protection against various forms of abuse perpetrated by
‘rogue’ therapists and to provide some suitable means of securing clients’
ability to address their complaints to the proper authoritative bodies,
therapeutic institutes and ‘host’ bodies such as the UKCP and BAC have
increasingly emphasized the necessity of suitable training for therapists.
Now while it would seem to me that, for all the reasons given above,
training is an important, not to say essential, safeguard for both therapists
and clients the value of which should in no way be minimized, the
assumption that training itself is directly related to effective therapy remains
an open question.
In addressing this point, perhaps somewhat facetiously, Mair concludes
that therapists ‘do seem to be able to help people; perhaps because they
often manage to outgrow the handicaps imposed by their training’ (Mair,
1992:152). As a back-up to this somewhat disturbing statement, she
reminds her readers of some intriguing research (Hattie et al, 1984) that
reviewed forty-three studies in which the effectiveness of the interventions
of ‘professionals’ (defined as those who had undergone formal clinical
training in psychology, psychiatry, social work or nursing) were compared
with those of ‘para-professionals’ (educated people with no clinical
training). The findings obtained from this study concluded that, on average,
the para-professionals’ interventions were significantly more effective than
those of the professionals. Not surprisingly, criticism of these findings was
sought and, to be fair, was found in that there was sufficient evidence of an
arbitrariness in designating the two groups such that, for instance, some of
those labelled as professionals had had no training in psychology and some
of the paraprofessionals had had academic training that was of at least
tangential relevance to therapy. Nevertheless, when Berman and Norton
(1985) eliminated eleven of the forty-three studies on such grounds, they
found that although the analysis of the remaining thirty-two studies
eliminated the statistically significant advantage of the para-professionals,
even so, the accumulated data now showed that both groups were equally
effective both at the end of treatment and in follow-up studies. When
further differential treatment effects were considered separately, the only
variables that distinguished the two groups were that the professionals’
interventions were more effective with older clients while the para-
professionals’ interventions had a greater beneficial impact with younger
clients, and that professionals’ interventions proved to be better in longer
treatments (Berman and Norton, 1985).
Such findings raise potentially significant, if embarrassing, questions
about the nature of therapist expertise and the inherent value of training. In
entering a training process which is likely to last a minimum of four years
(often many more) and which requires a good deal of financial and
emotional investment, the successful graduate will, in the end, gain sound
knowledge of one or more relevant theories, the ability to employ various
skills and techniques, and the status of recognition as a ‘professional’. All
these may well be of importance and value for a variety of reasons,
including those pertaining to the provisions of ‘safety mechanisms’ and
controls designed to protect both therapists and clients from various forms
of abuse and to provide the means to ensure that suitable avenues of
complaint procedures and allegiance to standards of ethical practice are
both implemented and practised. But in terms of either gauging or ensuring
the most effective therapeutic interventions, therapeutic training can make
no indisputable claims as to its merits or even its necessity.

Some preliminary conclusions

It would seem that all the points discussed with regard to the evidence for
the efficacy of therapy do not tell us very much that is either conclusive or
overly explanatory as to either the efficacy of therapy or the reasons as to
why it should be efficacious. On the basis of these studies, it would seem
fair to conclude that therapy is usually beneficial to people, at least in so far
as clients judge it to be so and as far as a term as vague as ‘beneficial’ can
be measured by means of quantitative outcome studies. Nevertheless, when
researchers have tried to identify those variables that can be identified with,
or related to, therapeutic effectiveness, none of the obvious ones—such as
theory or training—have been found to be of significance.
In the light of such failures, various sceptics such as Mair (1992) have
suggested that therapy gains its authority simply because it reflects the
attitudes of society in the guise of scientific ‘truths’. In a similar fashion,
Frank (1973) has written that differing therapies with similar levels of
effectiveness share, in common with all healing arts (both scientific and
magical), rationales or ‘mythologies’ that contain within them explanations
of illness, deviancy and normality. For Frank, therapies rely on persuasion
designed to allow or convince the client to accept and enter into the
mythological system. The relative effectiveness of therapy, then, rests not
on its scientific veracity but, rather, in its compatibility with ‘the cultural
world view shared by the patient and the therapist’ (Frank, 1973:327), and
in its ability to protect therapists’ authority and hence maintain clients’
confidence in their therapists’ ability to ‘heal’ them.
An example provided by Mair should clarify this line of argument.
About one hundred years ago, many psychiatrists claimed, on scientific
grounds, that masturbation was a major cause of insanity. These claims
were not challenged, nor, indeed, were they even properly tested.
Nevertheless, they were accepted as scientifically sound because they
‘made sense’ to them and to their society in that they accurately reflected
the attitudes, biases and fears of that society. It was only when society itself
began to reconsider its attitudes and values that such claims became open to
doubt and criticism and were subsequently rejected as false (Mair, 1992).
These views can be seen to underline the fact that all knowledge, even
‘scientific’ knowledge, cannot be isolated from its psycho-social context.
Truth is neither pure nor permanent but a more or less adequate construct
which is at the very least influenced by all manner of socially based
variables. Several writers who have focused on the history and development
of science and medicine (e.g. Koestler, 1959; Foucault, 1961; Boorstin,
1985) have arrived at similar conclusions. Nevertheless, there remains a
deep resistance to such views, not only by those whose power and authority
rest on the ‘truth’ of science, but also by those who bestow such authority
upon them. Uncertainty does not appear to be highly valued in our society.
Once again, Mair provides a further example which makes this point
somewhat obvious.
Deciding to test ‘whether an honest admission of uncertainty would
have any effect on the progress of his patients’ (Mair, 1992:137), a general
practitioner truthfully told half his experimental sample of patients that he
was uncertain as to what it was that was wrong with them; to the remaining
half he provided an authoritative, but fraudulent, hypothesis and told them
that they would be better in a few days. Two significant findings emerged.
Firstly, as an immediate response to the GP’s statement, the latter group of
patients tended to express greater satisfaction with the consultation, felt that
their doctor had understood them and voiced their sense of having been
helped. Two weeks later, 64 per cent of the second group stated that they
were now cured or at least felt better. On the other hand, only 39 per cent of
the first group claimed to be over their illness or felt better. The GP’s
conclusion was ‘that honest doubt had actually prolonged some of his
patients’ symptoms since they would normally be expected to clear up
within the two weeks’ (Mair, 1992:137).
What might this tell us about therapy? Therapists tend to both believe in
and present themselves as ‘learned experts’ whose methods depend on an
established theory (the basis of which is usually claimed to be ‘scientifically
sound’) and on the training they have received. But, as we have seen,
conclusive evidence for such views has hardly been forthcoming. Yet
therapists’ insistent beliefs in such is understandable. At a time when
dubious ‘new age psychobabble’ is capitalizing on the demand for guidance
and enlightenment, most professionally trained therapists vehemently
distance themselves from anything that smacks of charlatanism and (I
believe quite correctly) express heartfelt horror at having therapy equated
with such on the basis that it is ‘just another placebo’—however well it
works. But, equally, therapists remain on dangerous ground if their
insistence is based on assumptions and arguments, such as those discussed,
the validity of which may be minimal or even non-existent.

Alternative possibilities and the ‘Dumbo Effect’

Those of us who are prepared to accept inconclusive research findings but
do not remain entirely convinced by the alternative explanations proposed
by Mair and Frank may have yet another option to consider. It is possible
that much of the problem lies principally with the research methods that
researchers have tended to employ and their underlying assumptions.

After decades of research the amount of well-established knowledge

about what affects therapeutic outcomes is disappointingly meagre.
Research of the sort done in the last decade, although approaching
clinical relevance, still has not offered much to practising clinicians
(Greenberg, 1981:34).

Echoing this view, John Rowan has criticized the conclusion that therapists
of all persuasions, trained or untrained, obtain much the same results. He
argues that the point is dubious because, once again, it relies on outcome
research which is perhaps the weakest area in the whole field of
psychological research. Considering the findings of Garfield and Bergin
(1986) (which are generally viewed as the standard critical review of
outcome research), he notes that:

every single piece of research turns out to be minimally revealing. In

each case, whatever variable one looks at, the answer seems to be
the same either there is no effect, or the effect is very small, or the
answers are confused in some way. No clear results emerge at all
(Rowan, 1992:162).

Considering what might be done about this state of affairs, Rowan has
emphasized the distinction between outcome research and process research
(i.e. research that focuses on what takes place in therapy as it is in the
process of occurring) and advocates that more of the latter seems required.
Further, he has argued that both forms of research are mutually necessary in
that each offers different, if equally significant, emphases which only when
taken together may provide researchers with a more realistic basis for their
conclusions (Rowan, 1992). The current tendency in therapeutic research,
however, is to focus on one or the other (and usually just on outcome
studies), but rarely, if ever, on both together, and thus the derived results
are, at best, limited and more often inadequate and one-sided. The
relationship of variables in therapist intervention is both difficult and
complex. In the words of Greenberg and Pinsof, it ‘appears to be beyond
the capabilities of current research procedures’(Greenberg and Pinsof,
1986:726). Perhaps, as Rowan suggests, there exists the ‘need for new
paradigm research that does not even attempt to talk about variables, but
which talks instead about people, and to people, and with people’ (Rowan,
1992:163).
Like Rowan, it seems to me that in the current state of affairs, while it
might be rash to claim, on the basis of currently existing, if still inadequate,
evidence, that all therapists and therapeutic processes are equal,
nevertheless the fairest conclusion we can arrive at is that ‘we simply do not
have the evidence to conclude whether they are or not’ (Rowan, 1992:163).
In the light of this, a recent, highly interesting study by Aebi (1993)
considered the question of how therapeutic change is achieved. Aebi noted
that one way of approaching this question would be initially to differentiate
between specific and non-specific factors that might influence therapeutic
outcomes. Specific factors are those that are claimed to be essential
ingredients and characteristics of a particular therapeutic approach. These
are perceived to be active agents of change and are centrally related to that
therapy’s theoretical underpinnings. Examples of specific factors include
‘transference’, ‘systematic desensitization’ and so forth. Non-specific
factors, on the other hand, refers to those factors that seem common to
different approaches, or which have not been specified as active ingredients,
or which are not considered to be sufficient, or even necessary, in bringing
about change, or which are employed incidentally rather than deliberately to
achieve or promote change. In some instances, non-specific factors may
even be likened to inadvertent placebos.
Now while it is obvious that all therapeutic approaches agree that clients
are capable of beneficial change, there exists little, if any, agreement as to
how this change can best be brought about. Clients are, in most instances,
motivated to change and, arguably, prime themselves for such simply by
beginning therapy (Garfield, 1989). In a similar fashion, therapists in
general tend to expect clients to change in therapy not only because they
might be caring individuals who want the best for their clients, but also
because therapeutic change is one means of confirming that one is a good
therapist and, as well, justifies one’s advocacy of a particular theoretical
approach and its specific applications. I feel certain that all therapists more
or less adopt this stance and, in most instances, it seems a perfectly
reasonable thing to do. It only begins to become questionable when
therapists find themselves (as, I confess, I have at times found myself)
reacting angrily to their clients’ announcements of major insights or
breakthroughs brought about by dialogues or events occurring outside of
the therapeutic sessions. Having found, through discussions with my
students and colleagues, that this is not an uncommon event, it seems well
worth asking why we should react in this way. Aebi’s study points to
obvious, if unpalatable, possibilities: if clients are able to achieve such
significant therapeutic changes with others who are neither trained
therapists nor possess the deep theoretical understanding (or, indeed, any
relevant theoretical understanding) that therapists do, then both the
‘specialness’ of therapists and the ‘specialness’ of the theory they subscribe
to and believe in are called into question.
If, rather than dismiss this anxiety-provoking challenge, therapists were
seriously to examine their assumptions, then one possibility that emerges, as
Aebi suggests, is that perhaps their emphasis on and belief in the specific
factors in therapeutic models are somewhat misguided and bereft of
significant evidence since, as we have seen, although the research evidence
for outcome studies is at best partial and certainly imperfect in its
experimental procedure, nevertheless its conclusions remain consistent:
there exists no evidence to show that any one approach is any more
effective than any other. Added to that, research on named specific factors
such as systematic desensitization (a technique employed by some
cognitive-behavioural approaches which pairs anxiety-provoking stimuli
with relaxation training until the anxiety response is eliminated), while
generally agreeing that it is an effective form of treatment, also concludes
that there is currently little understanding as to how or why this procedure
should work (Aebi, 1993). Indeed, there is a singular failure of evidence
correlating specific therapeutic impact with specific factors (Aebi, 1993).
Could it be the case that non-specific factors may play a more important, if
not central, role in the therapeutic process while those factors that have
been labelled (and valued) as being specific are not, in themselves,
significant but rather, as Aebi suggests, are specified as important only
because they provide therapists with a rationale for their interventions?
In working with students, I have referred to what I have facetiously
named the Dumbo Effect. In the Disney cartoon, Dumbo the elephant is able
to fly because he has convinced himself that he possesses a magic feather
that grants him this ability. So long as Dumbo continues to believe this, the
feather takes on fundamental significance and is seen as essential to both
Dumbo’s powers and self-esteem. It is only when the feather is lost and
Dumbo discovers, much to his initial astonishment, that he can still fly
without it, that the feather is seen as an initially necessary ‘trick’ or focal
point which is, in and of itself, possessed of nothing special or magical.
This simple little allegory seems to me to encapsulate the issue under
discussion.
Consider, for example, the power of the therapeutic ‘frame’ or structure.
For example, therapists tend to believe that the physical environment in
which therapy is conducted plays a significant role in the relationship that is
generated. As such, they go about fashioning an environment that is in
keeping with the theoretical views they hold concerning a proper frame. Is
the room to be ‘neutral’ or filled with objects that belong, or have some
personal meaning, to the therapist? How should the furniture be arranged?
Indeed, what furniture should there be in the room? What clothes should be
worn by the therapist during therapeutic sessions? Should paper tissues be
provided for clients or would their availability relay the implicit message
that the client is expected to cry? (Some readers may find this difficult to
believe but this last point has generated a good deal of debate within and
between certain models of therapy!) If asked why they are concerned with
such questions, therapists are likely to respond that these (and many other)
frame issues have been shown to be of major significance to the success, or
possibility of success, of therapy. But this assertion is highly debatable as
there exists no substantive evidence which demonstrates a correspondence
between any of these frame issues and successful outcome. But to suggest
that therefore all frame-related concerns should be dismissed would be
missing a significant point. The frame issues may not be important in
themselves, but may rather have the same effect as Dumbo’s magic feather.
In other words, their importance lies in the fact that the therapist believes
them to be necessary in order for the ‘magic’ of therapy to work.
Behaviourist psychologists refer to such beliefs as ‘superstitious learning’
in that it points to unnecessary behaviour that has been incorrectly
associated with necessary behaviour leading to a desired goal. In simple
language, what is being referred to are those ‘superstitious’ beliefs which
all of us hold to some extent that allow us to ‘explain’ various successes or
failures in our lives. Where behaviourists go wrong, I believe, is when they
denigrate such beliefs and seek to find ways of expunging them from our
‘repertoire of responses’. What they forget is that one person’s superstitious
belief may well be another’s reason for living. Worse, they fail to consider
how much of what they, or anyone else, might take as ‘being non-
superstitious’ might well be so. The history of science and medicine
provides numerous examples of this very phenomenon.
In any case, the point being made here is that it is far more likely
(though far less palatable to therapists) that their concerns and beliefs with
regard to various frame-related issues reveal their dependence on the
Dumbo Effect.
But this effect extends to clients as well in that they, too, might believe
that the presence or lack of a couch, therapists’ personal objects, boxes of
tissues or whatever are necessary for the ‘magic’ of therapy to be effective
on them. For instance, some prospective clients have told me on their first
meeting that they could not consider me as their therapist because my
clothes were too casual. Alternatively, others decide to work with me
precisely because the clothes I wear reveal (to them) that I am an easy-
going and caring person who will be more interested in them than in
himself.
The problem is that, as much of the discussion has shown, there seems
to be very little in therapy that is not a Dumbo Effect.
Just like Dumbo, therapists may have found their ‘magic feather’
through their theories and, as well, have rationalized that the ‘magic’ they
are able to achieve comes from their theories and their applications.
Perhaps, as is being suggested, their powers are not derived from the
‘truths’ they hold, but from therapists’ beliefs in them, and, through them,
in themselves. If so, an examination of those non-specific factors that have
been thus far identified might initiate the process whereby therapists, like
Dumbo, might discover what is still possible without the feather.
The main non-specific factors that have been identified by Aebi include:

1. The therapeutic relationship itself.

2. The therapeutic frame (which is the term initially coined in 1952 by the
psycho-analyst Marion Milner, who took the metaphor from painting; it
refers to the ‘ground rules’, or structure, of therapy, including practical
issues such as procedure, logistics, time and duration factors, etc.);
therapist/ client protection issues such as confidentiality, taping of
sessions, etc; and process issues such as the clarification and agreement
between therapist and client as to the possibilities and purpose of their
therapeutic sessions and what is expected of each of them.
3. Therapist reinforcement (which refers to therapists’ encouragements to
their client that they are willing to listen and to attend to them (e.g.
head-nodding, summarizing, etc.))
4. Arousal (that is the expression of emotions through which there
emerges the increased likelihood of client receptivity to change).
5. Interpretation (which refers to the inclination on the part of all
therapists to present their clients with theoretically derived
interpretative hypotheses focusing on the clients’ meaning-world, self-
other relations, behaviours, and so forth).

In a similar fashion, Orlinsky and Howard (1986) reviewed 1,100 outcome

studies, spanning thirty-five years, and were able to single out what they
considered to be the crucial factor in all cases of effective therapy. As
might be expected, it was not the theory behind the therapy or on which its
practices and interventions were based, nor was it any explicit factor related
to training, nor was it the nature or quality of the therapists’ interpretations
and interventions. Rather, it was the bond that therapists form with their
clients.
For many reasons, this conclusion should not come as any major
surprise. It will be recalled that the BAC Report on Differentiation discussed
earlier emphasized the relationship itself as a central defining characteristic
of therapy, just as Aebi’s findings summarized above placed the therapeutic
relationship as a focus point of virtually unanimous agreement among
therapeutic approaches.
Nevertheless, beyond acknowledgement of its being of major
significance to the therapeutic enterprise, both the structure and meaning of
this relationship is by no means agreed on by therapists. While some
approaches (such as the cognitive-behavioural approach) emphasize the
importance of the development of a therapeutic relationship largely as a
means to a specified, goal-directed end, other approaches (such as the
person-centred approach or psycho-analytic models) view the properties or
the possibilities or this relationship as themselves being the ‘essence’ or
catalyst to beneficial change, conflict resolution, growth, ‘making the
unconscious conscious’, and so forth. But, even in this latter grouping, the
meaning, function, essential defining characteristics, and the therapist’s role
or task within the relationship differ widely. So, for instance, while the
person-centred therapist emphasizes such features as the therapist’s aim of
providing or expressing congruence, empathy and unconditional positive
regard within the relationship, psycho-analytic therapists emphasize the
transferential possibilities contained within the therapeutic alliance.
It would seem essential, then, to examine the therapeutic relationship in
order to expose its possibilities and limitations and to discover what there
may be about it which allows or encourages the beneficial processes and
outcomes of therapy. For instance, it would seem to be the case that, in its
widest or most accepted sense, the bond or relationship between therapist
and client focuses on the cognitive, affective and behavioural elements in
the client’s experience and that its primary function would be the
investigation of some or all of these elements (depending, at least partly, on
the therapist’s theoretical allegiance) in order to facilitate the possibility of
ameliorative change.
What might there be in, or about, this bond that is so significant? Some
clues from the research discussed so far—clues concerning therapists’
ability and willingness to listen to and be with and for their clients—have
emerged. Similarly, such investigations also point out two distinct emphases
within therapists understanding of the relationship—that is therapists’
tendencies to stress either the ‘doing’ or the ‘being’ elements or qualities
that they bring to the relationship and how the emphasis on one or the other
has a major impact on the therapeutic relationship and, indeed, significantly
alters not only its structure but also its direction and possibilities. However,
the reader’s patience is required. These issues will form the basis of
discussion in Part 5 of this text. Before we can begin to consider them with
some degree of adequacy, a number of related and relevant concerns must
first be addressed.
In my analysis of various critiques of therapy, I set aside the currently
dominant issue of the distribution of power within the therapeutic
relationship. This issue, perhaps above all others, demands our initial
attention since, as I will seek to demonstrate in Part 2, it is only by means of
its clarification, and the subsidiary examination of the various potentialities
of the therapist’s misuse and abuse of power in the therapeutic relationship,
that the beneficial possibilities of therapeutic encounters can begin to be
suitably analysed and assessed.
PART TWO

DEMYSTIFYING THE ISSUE OF POWER IN THE

THERAPEUTIC RELATIONSHIP

Mystery evokes the illusion of power; transparency dissolves it.

David Mearns and Brian Thorne

The great majority of therapeutic institutions see their principal raison

d’etre as that of training suitable candidates to become therapists rather than
as being centres for intellectual discourse focused on the critical analysis
and development of a particular theoretical approach or of therapy in
general. Indeed, my own experience, and that of many colleagues and
students with whom I have discussed such issues, would suggest that in a
number of established institutes critically focused discussion of theoretical
assumptions and their practical applications is not only not viewed with
favour but, rather, is either ‘nipped in the bud’, or may be employed as
evidence for the unsuitability of the critical trainee. In its most pernicious
form, this ‘protection of the faith’ may extend to such lengths that criticisms
will be ‘explained’ or ‘interpreted’ by the institute as unconscious
expressions of the critic’s ‘unresolved psychic conflicts’. As an example of
this, the following encounter, which I had some years ago as a trainee in
one such institute, should substantiate my contention.
As part of the foundational year of training at this institute, I was a
participant in weekly two-hour group therapy led by two trainers—one
male, one female. About four weeks into the group process, the male trainer
strongly urged the group to begin to address him and his colleague as
‘Daddy’ or ‘Mum’ in order to expose long-term conflicts which, he
declared, each of us held in our unconscious. This request struck me, as
well as several other trainees, as being somewhat ludicrous and I voiced my
disdain of what I saw as the heavy-handed attempt to impose a
‘transferential relationship’ on us and questioned its basis. Cutting my
argument short, the male trainer intoned: ‘Mr Spinelli, it is understandable
that you have such a reaction to my suggestion since you are, of course, an
orphan.’
When I responded to this by reminding the trainer that both my parents
happened to be alive and in good health, his reply to me was: ‘This is
beside the point! It doesn’t matter whether your parents are actually alive or
not, the issue is that you are a psychic orphan!’
I remained with that training institute until the completion of the year,
but I chose not to continue this training any further. In any case, I suspect
that I would not have been invited to continue—unless I resolved my
conflicts concerning my ‘psychic orphanhood’ (among others, I suppose)
with the help of a suitable therapist.
My point here is not to deny any validity in the trainer’s comment.
There may well have been some element of truth in his interpretation which
would have clarified some possible issues concerning my then current
relations with my parents. I don’t know. Whatever the case, the issue here
seems to me to be one of how the interpretation was presented to me. The
trainer quite obviously and honestly was convinced of the truth of his
statement and wished me to confirm it. That I rejected it was, to him, by no
means any indication that he may have been in error. Rather, my
‘resistance’ convinced him all the more of the accuracy of his conclusion
since he returned to it several times subsequently and, although on each
occasion I continued to ‘deny’ him, he appeared to remain confident that he
had hit upon an important element in a chain of defences that expressed
both my conflict and the stance I had adopted with regard to authority
figures such as himself. Even the fact that I made it clear to him that what
authority he believed me to have invested him with was minimal, if not
non-existent, did not shake him from his stance. He was my ‘father
substitute’ and that was that.
Now, again, as much as I am willing to concede a potential value in his
point, the arrogance with which it was presented to me clearly added further
conscious resistances to any unconscious ones that may have been there.
These conscious resistances had less to do for me with the wide issue of
‘authority figures’ than they had with the specific issue of what I considered
then, and still consider now, to be a flagrant and specific misuse of
authority. More to the point, I felt unheard and, what is more, concluded,
rightly or wrongly, that this person would never really hear me as long as he
remained stuck in his interpretation.
Today, thinking back to that incident, recognizing the hurt and
confusion it left me with—no less because, up until that point, I had been
committed to the pursuit of therapeutic training specializing in the
particular theoretical model offered at that institute—I am grateful for that
interaction since it clearly—perhaps too clearly—pointed out to me both the
danger and abusive possibilities inherent in therapeutic dialogue.
For it seems to me that this example points to a number of important
issues that therapy must address if it is ever to hope to begin sufficiently to
defend itself from the attacks of its critics and detractors. The concerns
presented seem to me to be so fundamental that I will spend the entirety of
this part of the text considering the effects of this stance and how, to me at
least, it addresses forms of abuse, both subtle and flagrant, which, however
inadvertently, may be carried out on clients in the name of successful
therapy.

1. PHYSICAL AND SEXUAL ABUSE IN THE THERAPEUTIC

RELATIONSHIP

I believe that it would be accurate to state that all therapeutic models

contain within them the possibility of therapeutic interventions being
experienced as abusive by clients. Equally, I believe that there is a case to
be made for the argument that all models of therapy contain the means both
to recognize and, equally importantly, minimize such instances for the sake
of both the client and the therapist. Broadly speaking, all forms of abuse
within therapy—as practised or experienced—originate from the related
issue of power in the therapeutic relationship, particularly when the
relationship is structured in such a way as to imbalance the experience of
power so that it is heavily weighted in favour of the therapist. Instances of
physical and sexual abuse of clients by their therapists provide the most
obvious examples of this power imbalance, but, perhaps far more
significantly, there also exist far more subtle expressions of this imbalance.
Needless to say, each form has its consequences—for both clients and
therapists—as the following discussion will, hopefully, make clear.

A. ABUSE VERSUS MISUSE: A SUGGESTED DISTINCTION

I must first inject a cautionary note. In recent years, concern about abuse in
various settings and relationships appears to have gained a great degree of
attention. It has become an almost everyday phenomenon to hear or read of
instances of abuse in the family, the workplace, social relations, and so
forth. While I do not wish to deny either the value or significance of
questioning and analysing what abusive elements may exist in our various
encounters with others, and how they may be expressed, the widespread and
indiscriminatory employment of the term has tended to promote various
stances of ‘correctness’ in thought and behaviour which have fostered
increasing degrees of fear and isolation in many peoples’ relations with one
another.
Equally, if paradoxically, these concerns may have not only added to
(rather than diminished) the already large number of ‘neuroses’ individuals
may feel they have or express in their relations with both themselves and
with others, but also, more pertinently, may have increased, rather than
reduced, the incidence of aggressive thoughts and behaviours directed
towards oneself or others. In addition, in focusing on the potentially abusive
elements contained in any relation, the very term ‘abuse’ has become so
distilled and weakened in its impact and meaning that its current
indiscriminatory usage may, however inadvertently, be adding further injury
to those who have suffered the consequences of serious, even life-
threatening, physical and sexual violence.
While I am ready and willing to admit that an act such as unilaterally
opting to invade the personal space of another either physically or verbally
may be experienced as improper, uncalled-for, embarrassing, problematic or
even abusive by the ‘invaded’ person, nevertheless it does seem to me to be
important to distinguish this in some way from instances of physical
violence and rape. I am well aware that this is no simple issue to resolve
since we are dealing with questions of lived reality such that, for instance,
having a part of one’s body touched unwillingly or prior to some signal of
permission may be experienced as powerfully as if one had been raped (in
the socio-legal sense of the term).
Nevertheless, it seems sensible to uphold some kind of distinction
between the acts. I have never myself (thankfully!) been raped, but I have,
for example, suffered the pain, anger, guilt and shame of having been
unwillingly ‘touched up’ by a stranger sitting next to me in a cinema. I can
recall the overwhelming sense of personal psychic powerlessness, the
inability to carry out any form of defensive or retaliatory action, and the
deep contempt for both the stranger and myself which I felt then. And while
I may have been able to make use of this experience, among others, in
seeking to imagine and enter into various clients’ accounts of their
experience of having been raped or physically abused, it seems wrong (and
somehow degrading of my clients’ experiences) for me to assert that I, too,
like them, have been raped.
Again, the issue is far too complex and problematic to be pursued any
further in this text. But I raise it here because of its relevance to the
concerns being addressed since I too, like those I am to some degree
criticizing in introducing this topic, have employed the term ‘abuse’(or
‘abusive’) in an indiscriminatory fashion. As such, in order at least to
suggest some sort of distinction at the non-experiential level, I will employ
the term abuse of therapeutic power only when the behaviour of the
therapist is premeditative, principally physical and enters the realms of
legally defined criminality. All those instances involving subtle,
unpremeditated and principally verbal, theoretical or practice-led
exploitative violence towards the client I have opted to label as illustrations
of misuse of therapeutic power.
An example of abuse of therapeutic power would be the appalling list of
physical and psychological violations of clients carried out by Dr John
Rosen and his associates in the name of Direct Analytic Therapy (Masson,
1988). The example of my training experience that was discussed earlier, on
the other hand, would be an instance of misuse of therapeutic power.
Nevertheless, such demarcations cannot be seen as all-encompassing.
Issues surrounding financial improprieties, for instance, may in many
instances ‘straddle’ the dividing line between these two terms. Similarly,
changes in cultural attitudes and mores remind us that such terms are at
least influenced by, if they are not reflections of, alterations in cultural
perceptions. Fritz Perls, the co-founder of Gestalt Psychotherapy, for
example, made it no secret that he had had sexual relations with several of
his clients. At the time when these events took place, Perls’s behaviour was
viewed by many therapists, political activists and feminist theorists as
acceptable, ‘freeing’ for the client, and therapeutically laudable. Today, it
would be judged by virtually all contemporary representatives of these
groups as being blatantly abusive and open to criminal indictment. As such,
the definition of terms like abuse must acknowledge both its context and its
flexibility.
The two main forms of abuse of therapeutic power that have been
addressed with increasing forthrightness by both critics of therapy and by
therapists themselves over the last few years have been those concerned
with instances of physical and psychological violence carried out on clients
by their therapists and the effects of therapists and clients engaging in
sexual relations either during, or shortly following the termination of,
therapy.

B. PHYSICAL AND PSYCHOLOGICAL VIOLENCE

While concerns about physical and psychological abuse of clients in the

name of therapeutic benefit have been raised by a variety of therapists over
the last thirty years or more (Laing, 1967; Cooper, 1967; Szasz, 1974a;
Breggin, 1993), I think it would be fair to say that it was the publication of
Alice Miller’s Thou Shalt Not Be Aware (1985) and Jeffrey Masson’s The
Assault on Truth: Freud’s suppression of the seduction theory (1984) and
Against Therapy (1988) which both re-awakened and intensified public and
professional concern about the use of physical and psychological techniques
the curative aims of which employed blatant forms of coercion,
indoctrination, and the employment of physical violence of such extremes
that it was virtually indistinguishable from torture.
The chronicles of inflicted pain detailed by these authors, Masson in
particular, make valuable, if deeply disturbing, reading.
It should come as no surprise, then, that the vast majority of therapists
clearly do not condone and, indeed, are repelled by these abuses of power
and have taken several important steps to make this stance explicit through
the development of clearly stated ethical codes and standards of behaviour.
Both the BAC and the UKCP, for example, have published explicit codes of
ethics and practice which their members and registered practitioners are
obliged to adhere to. In addition, various means have been created for
individuals who believe that they have been abused in various ways by their
therapists to present their cases to the appropriate complaints and ethical
standards committees of these institutions either directly or through their
member organizations. The BAC has even begun to publish in its main
journal Counselling both the notice of current cases under its Ethical
Standards Committee’s consideration, as well as the name of the counsellor
under investigation, and the conclusions arrived at by this committee once it
has reached its decision. In some instances, where serious abuse has been
ascertained, the practitioner in question has been struck off the BAC
membership list either permanently or until such a time as he or she has
demonstrated sufficient change in his or her professional and personal
stance to ensure as far as is possible that such practices have been
abandoned.
While these measures are by no means perfect, in that they cannot
guarantee the prevention of further instances of physical abuse of clients by
therapists, nevertheless it is evident that they are likely to be sufficient in
most instances. In the UK, the issue is exacerbated somewhat by the current
non-existence of a mandatory register of therapists which would oblige all
those who practise therapy to agree to specified ethical codes and standards.
Even so, the general public, in my experience at least, has become
increasingly aware of the existence of the main professional bodies and,
over the years, prospective clients have tended to enquire as to the
registered or accredited status of the therapist they have contacted.
In any case, thankfully, in the UK recorded instances of physical and
extreme psychological abuse of clients by therapists (as opposed to other
professions) remain a rarity.

C. SEXUAL RELATIONS BETWEEN THERAPISTS AND CLIENTS

The issue of therapists and clients engaging in sexual relations with one
another has also been a matter of increasing concern. Peter Rutter’s Sex in
the Forbidden Zone (1990) and Janice Russell’s Out of Bounds: sexual
exploitation in counselling and therapy (1993) are two recent examples of
texts detailing and analysing the incidence and effects of sexual
involvement between therapist and client. As this form of abuse would
seem to be the more prevalent and morally problematic of the two, it is
worthwhile considering it in greater detail.
As with the issue of physical and extreme psychological abuse, there is,
currently, almost universal agreement among therapists that sexual relations
between therapists and their clients are wrong. Why should such a hard line
be adopted? Could there be any circumstances in which sexual relations
between therapist and client might provoke beneficial effects for the client?
And, equally, might it not be possible that, in the course of the evolving
close, intimate relationship that therapy can engender, a sexual expression
of this bond might be acceptable and realistic, particularly when both
parties are adults who have expressed their consent?
These questions, at first glance, seem proper ones to ask. Nevertheless,
even under these instances the possibility of there being an exploitative
element—however remote—seems to be sufficient reason for nearly all
individual therapists, as well as professional and training institutions, to
proscribe it on the grounds that it is inappropriate, and usually harmful, to
the client.
Even so, it remains to be asked whether therapists tend to do what they
say. Is there evidence that a significant number of therapists continue to
have sexual relations with their clients? And, further, is there any suitable
proof that these relations are harmful to clients? The answers to both these
questions, as we shall see below, while by no means final and complete, are
clearly affirmative.
Although violations involving sexual intimacy between therapists and
clients tend to make up over 50 per cent of the disciplinary actions taken up
by the main American psychotherapy and counselling licensing agencies
(Vinson, 1987), and damages awarded to clients who successfully take
abusive therapists to court can reach multi-million-dollar levels (Pope,
1990), surprisingly, there exists as yet virtually no empirically based
evidence delineating the extent of sexual relations between therapists and
their clients in the UK. (One recent exception to this is Janice Russell’s Out
of Bounds : sexual exploitation in counselling and therapy (1993).) The
current Chair of the Registration Board of the UKCP, Michael Pokorny, has
been quoted as stating that ‘[n]obody really knows how common sexual
activity is between therapist and patient’ (Troupp, 1991). Nevertheless, it
remains the case that well-known therapists such as Carl Gustav Jung, Fritz
Perls and Masud Khan did have sexual relations with a number of their
clients and there exists substantial American research evidence on this issue
which suggests that it is more widespread than might have initially been
supposed (Llewelyn, 1992).

Research data on the incidence and effects of therapist–client sexual

relations
In their recently published survey of existing literature on therapist–client
sexual contact, Kasia Szymanska and Stephen Palmer (1993) note that until
the late 1960s the topic was avoided and was rarely referred to in
practitioner codes of ethics. Similarly, several researchers have pointed out
that data on this issue tended not to be published on the grounds that the
topic was simply too controversial (Pope and Bouhoutsos, 1986; Bates and
Brodsky, 1989). Even as late as 1977, Virginia Davidson’s paper dealing
with this issue, which was sardonically entitled ‘Psychiatry’s problem with
no name: therapist–patient sex’(Davidson, 1977), seemed to point to the
fact that, for many, the subject-matter remained a taboo topic.
One early published research project, however, presented in the form of
a questionnaire distributed to fifty highly experienced therapists, found that
75 per cent of the sample could imagine being in an embrace with clients,
60 per cent acknowledged the possibility of a patient being nude or nearly
so during therapy sessions and 50 per cent allowed the possibility of a
situation wherein the therapist sexually stimulated the patient or vice versa
(Bugenthal, 1963). Masters and Johnson, in their own pioneering research
on this topic, were among the first to warn that a far greater number of
therapists than had previously been supposed had had sexual relations with
their clients and that, in most instances, relations were between male
therapists and female clients (Masters and Johnson, 1966, 1970). Some
years later, the authors further argued that these contacts should be
considered the equivalent of rape and demanded that the establishment of
suitable legislation that would make such contacts open to legal action
should be made a priority (Szymanska and Palmer, 1993).
But not all early literature on the subject condemned therapist–client
sexual relations. Indeed, several physicians and therapists asserted that there
were significant positive effects for clients (Shepard, 1971). The therapist J.
L. McCartney, for instance, claimed to have been in sexual contact with
1,500 of his clients (all of whom were female) who, he argued, had
subsequently reported beneficial effects (McCartney, 1966). (Concerned
readers should note that McCartney was subsequently expelled from the
American Psychiatric Association.)
Most researchers interested in this issue agree that, considered together,
all these studies suggest that somewhere between 5 and 11 per cent of
therapists engage in sexual contact with their clients and that over 80 per
cent of all cases involve male therapists as the perpetrators (Kardener, 1973;
Holroyd and Brodsky, 1977; Bouhoutsos, 1985; Gartrell et al, 1986; Pope et
al, 1986; Pope, 1990).
Studies of sexually abused clients demonstrate that they are
predominantly (92 per cent) female, whose average age is 24.5 years.
Further, 60 per cent of the female clients are either unmarried, separated or
divorced women, the great majority of whom tend to have low self-esteem
and sexual difficulties (Llewelyn, 1992). The average age of male sexually
abusive therapists is 43.5 years. Of these, 55 per cent describe themselves
as being frightened of intimacy, 60 per cent see themselves as father figures,
55 per cent claim to love their clients, and 80 per cent continue to engage in
sexual relations with other clients either simultaneously or subsequently
(Llewelyn, 1992).
Related research revealed that while 79 per cent of these therapists were
in private practice, 14 per cent practised in an organization. Sexual contacts
tended to be initiated in the first few sessions for 30 per cent of the cases,
after six months for 22 per cent, and in 4 per cent of the instances under
study sexual contact began within three months of termination of the
therapy. Finally, 41 per cent of these therapists did go on to consult
colleagues with reference to their involvement; repeat offenders, however,
were found to be less likely to do so (Llewelyn, 1992; Szymanska and
Palmer, 1993).
While it might have been expected that a greater likelihood for sexual
relations between therapist and client would emerge in those instances
where the type of therapy being practised is particularly intensive and
focused on the private psychic life of the client, in fact no evidence linking
a particular theoretical orientation or approach to greater frequency of
sexual relations weighted towards any particular orientation has emerged
(Llewelyn, 1992). Related findings also show that completion of accredited
training does not decrease the likelihood of sexual relations occurring
between therapists and clients. Indeed, if anything, offenders are more
likely to be trained therapists, though this statistic may be partly misleading
in that the great majority of American therapists are likely to have
undergone training of some type or other (Llewelyn, 1992).
The evidence in favour of the conclusion that therapist–client sexual
relations are harmful to clients is overwhelming. In a widely reported study,
for example, Bouhoutsos and his associates reported details of 559 clients
who had had sexual relations with their therapists while in therapy. Of
these, 11 per cent had been subsequently hospitalized, and 34 per cent had
suffered a negative impact on their personal and social adjustment (on the
basis of increases in the incidence of depression, loss of motivation, higher
levels of emotional disturbance, and so forth) (Bouhoutsos, 1985). Apfel
and Simon’s research both confirmed these findings and pointed to some
incidences of clients’ psychotic breakdown or attempted suicide (Apfel and
Simon, 1985).
A number of published first-hand accounts from clients furnish further
testimony of the generally harmful effects of therapist–client sexual
contacts as well as providing researchers with information containing
greater depth and personal insight (Plasil, 1985; Bates and Brodsky, 1989;
Russell, 1993). Needless to say, in all these reports there exists virtually no
evidence of progress with the originating issues that had led these clients to
therapy in the first place (Apfel and Simon, 1985).
Even so, between 50 and 75 per cent of American clients who have
been abused remain unaware that sex between therapists and clients is
unethical or actionable, and, among those who are aware, only between 1
and 4 per cent take out proceedings against the offending therapist (Masson,
1988).
This statement serves as an important reminder that virtually all the
studies carried out have been reliant upon data collected from therapists
themselves (i.e. the potential offender group). As such, just as the number of
incidences of rape is highly likely to be far greater than the number of
incidences of reported rape, so too might it be the case that the agreed-on
percentages of between 5 and 11 per cent may be far less than is actually the
case. In line with this concern, recent reports have suggested that between
50 and 70 per cent of therapists currently in practice will work with one or
more clients who have been abused by a prior therapist (Rutter, 1990; Pope
and Vetter, 1991).
Some researchers have drawn parallels between therapeutic abuse and
other foms of abusive relationship. Like many child abusers, abusive
therapists often deny any harm in their behaviour, tend to rationalize it with
statements such as ‘I loved her’ or ‘I tried to help her to learn how to
experience a truly loving sexual relationship’, and often shift the
responsibility for initiating the act on to the client. Finally, just like the
abused child, the client is often sworn to secrecy and is allowed to relate in
an intimate fashion to the therapist only within the boundaries of a specified
place, usually the consulting room (Stone, 1983).
While such provocative and potentially informative parallels and
resonances should not be dismissed, it is important to bear in mind that
adult clients are not children. They may behave or express and experience
emotions as if they were, but they also retain powers and abilities that
children do not possess. This is not to say that abusive therapists are in any
way less responsible for their behaviour. I am simply pointing out that, just
as there may be many similarities in various forms of abusive relationships,
so too are there significant differences between them—just as there are
likely to be significant differences in the way in which different clients
experience and deal with therapist abuse. It seems to me that there is
enough to deal with in focusing upon the issue of abuse in therapy per se,
without unnecessarily linking it to other instances of abuse.
Interestingly, some of the later research on this topic seems to suggest
the possibility of a decrease in the incidence of therapist–client sexual
relations, together with a decline in the number of repeat offenders (Pope et
al, 1986). While the authors speculate that this may be due to both the
increased publicity given to the issue and to the more stringent sanctions
and penalties that offending therapists open themselves to, it must also be
considered that these decreases may have more to say about therapists’
greater unwillingness to reveal—even anonymously—their sexual liaisons
with clients than about real changes in their behaviour.
Taken as a whole, then, the research findings on therapist–client sexual
relations present a disturbing picture of both the incidence of these relations
and their likely effects on clients.
It is important to remind readers that virtually all the above data is
American in origin and should not be directly extrapolated as being equally
representative of the situation in the UK for a variety of important reasons,
including cultural divergences and the various factors associated with these.
Even so, initial research focused on UK data, while still limited, does seem
to suggest similar patterns of incidence (Russell, 1993). Nevertheless, as I
pointed out before, both the UKCP and BAC have taken steps to control, if
not prevent, therapists from engaging in sexual relations with their clients.
Recently, for example, the BAC has amended its constitution so that it now
states that counsellors who engage in sexual activity with current clients or
within thirteen weeks of the termination of the counselling relationship (a
time-scale derived from American research suggesting that sexual relations
with former clients is most likely to occur within three months of ending
therapy) are acting unethically and are liable to have their names struck off
the BAC membership list either on a temporary or permanent basis. Further,
the BAC’s code of practice also states that if the counselling relationship
has been over an extended period of time, a much longer ‘cooling off ’
period is required and a lifetime prohibition on a future sexual relationship
with the client may be more appropriate. While these steps are by no means
perfect, they can be seen as sincere and significant attempts to deal with the
issue in a pragmatic fashion that both acknowledges the need to protect
clients and the diversity of focus and style of working of therapists.
Certainly, they are an advance on the current situation in the American
Counselling Association which has been unable to adopt a similar stance on
the issue because of the diversity of views of its membership.

D. THE PROBLEM WITH THERAPISTS’ ATTRACTION TOWARDS THEIR CLIENTS AND A

SUGGESTION ON HOW TO DEAL WITH IT

It seems to me that the various attempts to prevent or control the occurrence

of sexual relations between therapists and clients, while clearly laudable,
fail to address a more fundamental question. For even if it were to be found
that a much higher proportion of therapists than has been suggested by
research studies engage in sexual relations with their clients, it would still
remain likely that a far greater number might be tempted to consider this
possibility, even if they elect not to act on it. In other words, we are
presented with the issue of therapists’ attraction towards their clients. This
attraction might be specifically sexual or more general in the sense of the
therapist being attracted to the personality, personal beliefs, social manner
and standing and so forth of the client. It is interesting that whereas there
has been almost from the start of modern-day therapy a recognition of the
possibility, if not likelihood, of clients’ experiencing and expressing
feelings of attraction towards their therapists (Smith, 1991), there has been
far less written concerning the opposite instance or, indeed, of instances of
mutually shared attraction (whether acknowledged or not) between therapist
and client.
What statements have been made concerning this issue are usually
presented under the jargon of transference and counter-transference. I will
explore these terms more fully in Part 3, but for the moment I will simply
say that these terms lead both the therapist and client to the consideration of
other emotionally charged relations (usually from the past—such as with
one’s parents) as either causes of or catalysts for the currently experienced
feelings. But if one does not accept this assumption (even if simply for the
sake of argument), this tells us virtually nothing about how one is to
understand and deal with the current attraction in and of itself. That the very
great proportion of therapists do experience attraction towards their clients
is beyond doubt. A 1986 report revealed that 95 per cent of male therapists
and 76 per cent of female therapists admit to feelings of attraction to clients
at some point in the therapeutic relationship, even if the vast majority opt to
abstain from any action that might provide for their expression (Pope,
Keith-Speigel and Tabachnick, 1986).
How are therapists to deal with these feelings? Are they to treat them as
unacceptable or taboo and seek to find ways to avoid their occurrence and
expression? Do such feelings reveal unresolved concerns and conflicts that
should have been dealt with either during training or in the therapist’s own
therapy? Are feelings of attraction unprofessional and, hence, open to
regulation and directives from the professional bodies? All these questions,
and the many more that readers might consider, reveal complexities, both
hidden and obvious, which do not facilitate easy, or general, answers.
When I have addressed this issue with my students, they have tended to
respond in ways that demand that therapists somehow should be able to
eradicate from their thoughts (by means of some form of determined will-
power) any and all such feelings and, instead, interact with the client from a
neutral, or ‘neutrally caring’, standpoint. Would that it could be so easy! In
the same way as we are far more likely to be overly focused on the colour
‘red’ if we say to ourselves ‘Whatever you do, don’t think of the colour
red’, so too are we likely to be overly focused on our feelings of attraction
towards someone if we tell ourselves ‘I mustn’t think about how attractive I
find this person.’ It would seem to be another instance of ‘sod’s law’ that
the more we tell ourselves not to think of something, or to admit to it, the
more likely we are to think it and to remain focused on it to the extent that it
might begin to hamper severely any other thought or message that we might
offer in its place. If therapists are no different from others, nor better able to
cope with such problems than anyone else (and I firmly believe that they
are not, and cannot), then how are they to deal with the question of
attraction towards their clients?
Firstly, notwithstanding my students’ suggestions, I would argue that
rather than seek to deny or suppress such feelings, or, alternatively, to
‘transform’ them or minimize their impact by invoking such terms as
‘counter-transference’, therapists might do better to acknowledge them as
being present in their experience of, and relationship with, their client. But,
lest I inadvertently mislead the reader from the start of the argument, let me
make it clear that ‘acknowledgement of feelings’ should in no way be
misconstrued to mean, or imply, ‘acting upon them’, either in the form of
their direct communication to the client or in terms of allowing them direct
expression.
Rather, the initial step of acknowledgement, I believe, actually grants a
greater possibility for therapists to deal with the attraction in ways that
prevent, or at least greatly minimize, the potentials for abuse. As the
success of so many self-help groups has demonstrated, no individual can
truly choose to act with regard to any issue, be it problematic or not, until
he or she has acknowledged the issue’s existence.
The typical response given to therapists who find themselves attracted
to their clients is that they should take the issue to their supervisor or to
their own therapy in order to ascertain what separate and personal meanings
and issues this attraction might be expressing in a disguised or symbolic
manner. Without denying the possible values in responding in this manner, I
want to put forward an alternative suggestion.
Let me begin by supposing that a therapist in this situation were to take
the matter up with a supervisor or another therapist and discovered that the
attraction was not related to any separate or personal issue, and that,
instead, what attraction was being felt towards the client was specific and
direct rather than representational. In other words, that the therapist was
attracted to the client simply because the client was attractive to the
therapist. Stranger things have been known to happen! Then what? Well,
then, I would suggest, the therapist has two initial, and obvious, choices.
Either he or she must elect to cease therapy, or, alternatively, to choose to
surrender his or her personal feelings and desires to the possibilities of the
therapeutic relationship. In other words, in both instances, what is being
asked of the therapist is to choose an act of sacrifice.
Sacrifice is not self-denial; rather it is an attempt to place the self in
equal context and value to the other. It is a selfish act, to be sure, but it is
other-directed selfishness. That is to say, it is an attempt to shift from a
hierarchical relationship (where either the self or the other is seen as being
more valuable or significant or deserving of greater attention) towards an
egalitarian relationship (where self and other share equal value, significance
or attention). Put simply, sacrifice is not a question of doing something for
my sake, or for your sake, but for our sake. In this sense, sacrifice is not
principally concerned with giving up but, rather, with embracing, or
encountering, self and other as beings who strive to approach mutual
responsibility and equality.
This is no easy task for anyone to attempt, much less hope to
accomplish. But it seems to me that if there is anything that might
distinguish therapy as a special enterprise, it is precisely this willingness
and attempt on the part of the therapist to sacrifice that which is typical in
relationships and to approach the untypical, or extraordinary. I will return to
this point in order to explore it further and in a more general fashion in Part
5 of this text. For now, I simply want to consider it just a little further with
regard to the specific issue of attraction.
What I am suggesting is that therapists have, among various choices, the
choice of dealing with attraction by first acknowledging it so that they can
remain within the therapeutic relationship from the standpoint of the
sacrifice that comes with the choosing not to focus or act upon something
one perceives to be principally for personal benefit, or alternatively for the
principal benefit of the client, but, rather, for their mutual benefit as
expressed in the therapeutic relationship.
This stance requires of therapists the desire to consider something that is
initially experienced as being in some way problematic as being potentially
useful to the undertaking of remaining with, or ‘being there’ for, the client.
Once again, what is being asked of therapists is nothing more than what is
being asked of their clients—that is, the honest acknowledgement of who
one is, or what one is thinking and feeling, in the current moment. This very
willingness towards honest assessment in itself allows a greater possibility
of avoiding the experience of being ‘swamped’ or overwhelmed by one
element of one’s experience and, instead, of treating that element more
equally as one of several or many elements of current experience. In this
way, the experience of attraction, while by no means denied, is nevertheless
prevented from distracting or overwhelming their attention to the client.
Perhaps a somewhat silly example will here clarify what is being
argued. While researching material for this text, I came across a number of
interesting (or ‘attractive’) issues that I would have liked to have considered
more fully. Had I done so, I would have indulged my own personal desires
to the detriment not only of my potential readers, but also of myself—since
my goal in writing this text is not solely the possible benefits of insight it
might allow my audience, but also my own similar and differing benefits.
As such, I had to sacrifice some personal desires not by denying them, but
by not allowing them to intrude or overwhelm my text-focused attention.
But something else is worth comment. In my choice of retaining my
focus on the writing of the text, I might find to my surprise that, as I go
along in my writing, a relevant point I wish to clarify or explore more fully
might actually become more understandable or enhanced if I employ some
aspect of a topic I had previously set aside as not being of mutual interest.
In this way, that very topic of personal interest now becomes something that
can be utilized for the purpose of mutual benefit and clarification. Once
again, however, this insight is only possible if I have not denied or sought to
expunge this interest but, rather, have simply not allowed it to distract or
overwhelm my chosen focus. Again, placing this point in the context of
therapy, I might find that my experience of attraction towards my client,
which I have acknowledged and chosen not to pursue (rather than deny),
may actually at some point in the encounter prove to be of insightful or
clarificatory value to the chosen focused task of engaging in a therapeutic
relationship. How might this occur?
For example, I might find that as I listen to my client’s account of her
experience of herself, she tells me that she feels that people are readily
attracted to her physical appearance to the extent that she cannot allow
herself, or feels that others will not allow her, to express her other qualities
and that, as a consequence, she feels both her own fragmentation and a
hatred of others since they ‘use’ or treat her solely as an object of physical
appeal and pleasure. In this way, my sacrificed physical attraction towards
her takes on a new and previously unforeseen relevance in that it allows me
a more experientially informed means of further exploring and clarifying
her views, not from some abstracted or distanced stance but, rather, from
one that is able to ‘hold’ both her experience of herself and of others in a
direct or ‘lived’ fashion. Through this stance all manner of issues, such as
her own possible competing attitude towards her appreciation and
resentment of her physical appearance, as well as her competing
appreciation and resentment of others’ physical attraction towards her, may
be exposed and examined in ways that approach the issue more accurately
with respect to her lived experience.
Although I have employed an example that focuses on heterosexual
physical attraction, I want to make it clear that the point being discussed
holds just as significantly for any form of attraction towards a client
experienced by a therapist. Just as I might be attracted to clients (be they
male or female) on a physical level, I might also be attracted to them for
their sense of humour, their communicative abilities, their sense of fashion
and style, the similarity of their life experience to my own, and so forth. In
each case, my inability to prevent what attracts me to them from
overwhelming or intruding on my focused task of engaging in a therapeutic
relationship with them threatens the possibility of fulfilling that task.
Similarly, my willingness to sacrifice personal interests and inclinations
focused on my sense of attraction towards the client not only enhances the
possibility of our maintaining a therapeutic relationship but also may
provide a mutually beneficial means of utilizing those personal interests or
desires. Through this sacrifice, that which was previously experienced as
being problematic might be transformed into something both appropriate
and advantageous to the therapeutic process.

2. THE ISSUE OF POWER IN THE THERAPEUTIC RELATIONSHIP

Both the question of physical and sexual abuse and the more general
problem of attraction contain within them an implicit, fundamental concern.
This is the question of the therapist’s power in the therapeutic relationship
and the means by which the utilization of such power may, in itself, either
inherently contain abusive elements, or, alternatively, lead to various forms
of abuse.

A. AGAINST THERAPY: JEFFREY MASSON ON THE IMBALANCE OF POWER

This issue has been of increasingly greater concern over the last decade.
Much of this has been generated by various critics of therapy in general
and, more specifically, critics of psychoanalysis—particularly with regard
to its early history and development under Sigmund Freud (Thornton, 1983;
Masson, 1984; Crews, 1993). Although by no means the first to raise such
critiques, I think it would be fair to say that it is largely due to the critical
writings of Jeffrey Moussaieff Masson (1984, 1988, 1992) that the concern
with therapeutic power, and its potentials for abuse, has come to be seen to
be of increasing significance to therapists, clients and critics alike.
Masson’s stance seems to me both to present the major concerns raised with
regard to the question of power in therapy, and to take the most extreme
position with regard to the ‘solution’ to the problems it raises, in that
Masson advocates the abolition of therapy on the grounds that the
therapeutic relationship is inherently power-imbalanced in favour of the
therapist and to the detriment of clients. As he himself writes:

The structure of psychotherapy is such that no matter how kindly a

person is, when that person becomes a therapist, he or she is engaged
in acts that are bound to diminish the dignity, autonomy, and
freedom of the person who comes for help (Masson, 1988:24).

Although Masson’s critiques initially focused on Sigmund Freud’s

renunciation of his ‘Seduction Theory’ (Masson, 1984), the first signs of his
increasingly critical view of therapy in general came in 1986 with the
publication of The Dark Science: women, sexuality and psychiatry in the
19th century (Masson, 1986). This ‘reader of the horrors inflicted on
women in the name of “mental health”’ (Masson, 1988:28) chronicled the
various ways in which nineteenth-century women patients had been abused
by the male medical establishment which claimed to help and perhaps
understand them and how the models of science they employed became the
basis for modern theories of psychiatry.
Then, in 1988, came Masson’s well-known attack on the whole of
therapy. In Against Therapy: Emotional Tyranny and the Myth of
Psychological Healing, Masson sought to convince his readers that the very
idea of therapy—in whichever form it is practised—is inherently abusive
and should be banned (Masson, 1988). Instead of therapy, Masson argues,
there should be an egalitarian relationship in some ways akin to friendship,
which does not involve the exchange of money, is not a professional
business enterprise, addresses various feminist critiques of patriarchically
dominated therapy, acknowledges and focuses on the real socio-political
issues that are at the root of personal misery and pain, and which allows
clients to ask personal questions of their co-investigators while expecting to
receive direct and honest answers from them (Masson, 1988, 1992, 1993b).
While admitting that his suggestions remain somewhat vague and
insubstantial, Masson has argued that his call for the abolition of therapy is
akin to that for the abolition of slavery, such that his point is not to develop
a more caring or humane model that seeks to reform therapy, but, rather, to
eradicate it from society (Masson, 1993b).
Masson’s stance on therapy—and on therapists—has, if anything,
grown increasingly negative and strident over the years. In a paper entitled
‘The tyranny of psychotherapy’, he writes:

…it is not very difficult to unmask therapists, especially if they have

achieved any fame. All you have to do is read what they write, and
sooner or later you will come across what you need (Masson,
1992:9).
The ‘impossible’ profession makes demands that simply cannot
be met. No therapist can consistently and permanently avoid the
temptation to abuse the inevitable and inherent power imbalance.
Even the kindest therapist may well experience envy of somebody
else’s capacity for love, or anger that they are leading a more
interesting life, or that they are richer, smarter, better looking,
deeper, happier, more amusing, or whatever quality they have and
the therapist lacks. We may be tested and tempted by our friends in
this same regard in real life, but we have no strangle-hold on them,
nothing that is built into the relationships we do or do not form. But
in therapy that strangle-hold is pre-ordained (Masson, 1992:18).
A response to Masson’s critiques
There is no doubt in my mind that most, if not all, of the concerns expressed
by Masson in his various books and papers are both highly relevant and
deserving of the greatest attention by therapists. I also believe him to be
broadly correct when he states that therapy has not given sufficient
consideration to these criticisms and, indeed, may even have avoided
addressing them to any serious extent prior to his attacks—though it must
be said that others prior to him (such as R. D. Laing, 1967; Thomas Szasz,
1978; and Peter Breggin, 1979) had provided either similar or equally
significant critiques. I also agree with Masson that important issues such as
the extent of the incidence of incest have been ‘whitewashed’ by therapy
and related professions such as psychiatry, and that questions concerning
the purpose and value of training therapists have not been sufficiently
addressed or clarified (Masson, 1992). Further, Masson’s call for a
‘consumer’s guide’ to therapy is both valid and helpful (Masson, 1992)—
and some initial steps in this direction have already been taken by the BAC.
Nevertheless, I am at times disturbed by the often polemical tone of
Masson’s writings which, in many instances, serves only to restrict the
possibility of open and non-defensive dialogue to the extent that, as Jeremy
Holmes has put it, it becomes ‘difficult to show gratitude when someone is
spitting in your face’ (Holmes, 1992:29). I am also troubled by Masson’s
single-minded insistence on proving his case to the extent that even when
he is forced to acknowledge that at least some clients find significant
benefit from the enterprise, he must interpret their experience in ways that
strike me as being no different nor less defensive (or abusive?) than those of
the therapists he criticizes (most recently, by suggesting that such instances
reveal a type of sado-masochistic sexual pleasure generated by the (usually
female) client’s loss of power, and the (usually male) therapist’s exercise of
it, which is fostered by the structure and process of therapy (Masson,
1993b)). But such qualms would be insignificant if Masson’s central
premise were shown to be correct. Are Masson’s conclusions beyond
criticism?
While his examples of some therapists’ physical and sexual abuse of
clients are deserving of all the invective raised against them, they do not, in
themselves, provide sufficient grounds for condemning the practice per se,
not least because Masson cannot provide the evidence to show that most or
even a significant number of therapists behave in these ways towards their
clients.
Practically speaking, it is essential that therapists and therapeutic
organizations seek to ensure that appropriate measures are taken to protect
clients and provide a suitable means for them to address their complaints to
a relevant body which is itself empowered to act on their behalf (e.g.
deregistration of the offending therapist) and that therapists are themselves
more fully aware of their power and how it may become abusive. But all
these measures, and any others that might come to mind, need not lead us to
conclude, as Masson concludes, that the very idea of therapy is wrong. He
may be correct in asserting that the greater the power, the greater is the
likelihood of its abuse. But ‘likelihood’ is not the same as ‘certainty’ and in
this difference lie various means of influencing that possibility such that it
moves further and further away from its realization.
Masson’s principal argument rests on the assumption that an unequal
power relationship is, in and of itself, abusive. This view strikes me as
being singularly naive. What relationship can Masson point to that is not
unequal in power? In pointing us towards friendships and kind, loving
relationships, Masson seems to suggest that these are examples wherein
power has been equalized. But this seems patently false. In all such cases,
power can be seen to be in disequilibrium, constantly shifting between
individuals. Indeed, there exists some research evidence to suggest that his
contention that non-professional relationships are ipso facto less open to
abuse than others is, at best, questionable (Bell, 1989). Any act of
involvement, or relationship, excludes neutrality; relationship is power in
flux.
Masson also raises concerns focused on the dependency of the client
towards the therapist which is fostered in the therapeutic process, and
considers how this can be in keeping with therapy’s broad aims of
increasing the client’s autonomy. In relation to this point, Holmes and
Lindley point out that while there may at first appear to be a fundamental
paradox in this, it is only so due to the mistaken assumption that autonomy
and dependency are in opposition. I agree with their view that

… the capacity to depend and be dependable is an important feature

of most successful intimate relationships. Many people seeking
psychotherapy suffer from problems concerning dependency. They
may feel trapped, and therefore out of control when they form close
relationships; or they may be unable to depend on, and get close to
others, despite the wish to do so. The opposite of autonomy,
therefore, is not dependency, but heteronomy. This means, roughly,
‘not being in control of one’s self ’ Psychotherapy, often in the
setting of secure dependency on a therapist, reduces heteronomy by
helping the patient to be more aware of, and so less controlled by,
experience and feelings which have been suppressed or ignored.
This awareness makes it easier to establish relationships based on
mature dependency. In this way the dependency of the patient on the
therapist does not in itself threaten autonomy (Holmes and Lindley,
1989:5–6).

Power can mean, as Masson insists, the control of the other. But power also
has another meaning: the ability to act, to take charge over oneself. In this
more complete sense, power—and the imbalance of power—is neither
necessarily ‘good’ nor ‘bad’; it is unavoidable.
But, the reader might suppose, perhaps what Masson is suggesting is not
simply that therapy involves an unbalanced power relationship, but that,
more pertinently, that this imbalance is always favourable towards the
therapist. This may seem to be a far more appropriate point to consider.
It is certainly the case, as this text has set itself the task of
demonstrating, that therapists do hold extensive power which they can
misuse or abuse within the therapeutic relationship. Equally, as Petruska
Clarkson recently pointed out, it is important to recognize that clients too
hold power which they can misuse or abuse within the self-same
relationship (Clarkson, 1993). It may be different to the therapist’s power,
but it need not be seen as being necessarily inferior. Just as therapists may
exert their power by setting the time, duration and cost of sessions, or may
attempt to impose unwanted and destructive viewpoints or interpretations
on their clients, so too may clients seek to deviate from the agreed-on
frame, or withhold payments, or simply not show up to sessions, or not
return to therapy without providing notice, or heap undeserved verbal or
even physical abuse on the therapist.
I do not think it is enough to say that abuse of power in therapy (or in
any other instance) is unwanted and if such occurs the relationship must be
dissolved or abolished. Rather, it seems to me far more significant to seek
to understand what has provoked that abuse and, in so doing, prevent its
recurrence. It seems essential to me that therapists be willing to examine
their role and therapeutic interventions precisely for these reasons, and it is
a stated aim of this text to provoke and assist them in this task. Similarly, it
can be argued that one of the principal duties of therapy is to provide the
means whereby clients may examine various facets of their experience of
abuse—either as recipients or perpetrators—not in order ‘to explain away’
or to ‘forgive and forget’, but to better understand and acknowledge it so
that it is either less likely to recur, or so they can better deal with it, or both.
Masson’s arguments seem to hinge on a desire for perfectionism. If
something is not perfect, he seems to tell us, then it should not be allowed
to exist. So, for instance, a good deal of his critique of Carl Rogers rests on
the argument that

[n]o real person really does any of the things Rogers prescribes in
real life. So if the therapist manages to do so in a session, if he
appears to be all-accepting and all-understanding, this is merely
artifice; it is not reality (Masson, 1988:232).

Masson seems to be saying that because no person, much less no therapist,

has fulfilled such goals then to claim to have done so is at best misleading,
if not downright abusive. This may be a valid argument, if this is what
Rogers claimed. However, my own readings would suggest that Rogers sets
forward his necessary and sufficient conditions as aims rather than asserting
that he—or any other person-centred therapist—has achieved such. That
certain aims may be unrealizable in any final, complete or perfect sense
does not mean that there is no value in finding the means at least to
approach them. All of us, I think, have experienced relationships that are at
different points along a continuum that stretches between ‘no acceptance’
and ‘all-accepting’, or ‘no understanding’ and ‘all-understanding’. To
suggest that there is no significant difference in the variants between these
extremes, or to demand an all-or-nothing stance, would suggest to me that
what is being wanted is a somewhat unrealistic perfectionism which no
relationship can hope to offer.
Therapy is clearly imperfect, but it is, nevertheless, one of the few ways
we have found of confronting certain forms of human misery and pain. Yes,
ideally, our families or friends or even ourselves should be more than
sufficient replacements for therapists. But in the world we inhabit, this is
not always the case and, in some instances unfortunately, those self-same
persons may be pivotally implicated in the pain and misery we experience.
As the comedian Lenny Bruce used to say:

People should be taught what is, not what should be. All my humour
is based on destruction and despair. If the whole world were tranquil,
without disease and violence, I’d be standing in the breadline right
back of J. Edgar Hoover (Bruce, 1975).

…And, one might add, all therapists.

Therapy and ethics

But, let us be clear, if we reject Masson’s conclusion and accept that,
however imperfect it may be, therapy still offers at least potential benefits,
then we must be prepared to consider its weaknesses and dangers and seek
to enhance its beneficial possibilities. If for no other reason, then, therapists
should be grateful to Masson, as well as to all other critics, in assisting them
in this task. Masson, in particular, has pointed out a number of fundamental
dilemmas for therapy to address. However implicitly, he has clarified a
number of ethical concerns that deserve attention.
Hare (1991) has argued that we tend to see ethical issues from
subjective or intuitive standpoints. We tend to believe that we know what is
right and wrong. But the many dilemmas we are confronted with
throughout life are not principally concerned with questions of right versus
wrong but about the choices we make between actions that, in themselves,
contain elements of both ‘right’ and ‘wrong’. So, for instance, I may find
myself in a situation where I am forced to decide between extending my
session with a client who is in distress or ending it on the hour so that I can
get to my college on time to teach my students. Whatever choice I make is
neither completely right nor completely wrong. But how I choose is
underpinned by an implicit or explicit ethical stance.
Thomas Szasz has emphasized the role of ethics in therapy (Szasz,
1974c, 1992a) and has argued that a principal task for therapy must be the
greater acknowledgement and consideration of ethical issues raised in such
a relationship. I agree with him entirely on this point. It seems to me to be
paramount for therapists to clarify such matters as how informed a client is
when he or she consents to therapy, whether the therapist’s and the client’s
assumptions as to what their therapeutic relationship is for have been agreed
(or at the very least stated), what specific rules and conditions each brings
to it, and so forth. The resolution of such issues cannot be entirely
generalized nor applied indiscriminately. Nor can the ethical decisions that
are arrived at be seen to be ‘perfect’, but they can be sufficient, or, to
employ D. W. Winnicott’s now-famous phrase, ‘good enough’ (Winnicott,
1971).
All these points should not be seen as suggesting that the dangers of
physical and sexual abuse in therapy, and the issues surrounding the
exercise of power, have been resolved and need no longer concern both
clients and therapists. Obviously, this is not so. But it is fair to say that,
particularly over the last few years, when these questions have been the
focus of so much debate generated by both critical outsiders and concerned
insiders, significant steps have been taken to address the issues and seek to
prevent their recurrence.
The very fact that, in spite of major theoretical and practical divisions
between the various approaches to therapy, organizations such as the BAC
and the UKCP have come into existence, and have begun to address these
concerns, is an achievement that should not be minimized nor scorned for
its imperfections, but, rather, is deserving of continued support. It may be
difficult for the general public to understand just how much effort has had
to be expended in order to get this far. Until relatively recently in the history
of therapy, the consensus has tended to have been one of studied disinterest
in, and avoidance of, dialogue between therapists of divergent approaches
and theoretical stances. That there now exists increasing evidence to
suggest that therapists have developed a greater willingness to address the
concerns raised by issues such as the various abusive potentials within
therapy is a significant development.
Nevertheless, as a practising therapist, I remain aware, together with
many other colleagues, that major, if more subtle, problems remain with
regard to the inadvertent misuses of therapy, and it is to these that we must
now turn for discussion.

3. THE MISUSE OF POWER IN THE THERAPEUTIC RELATIONSHIP

I mentioned earlier, with regard to the views expressed by Jeffrey Masson,

that his concerns first arose when he concluded that Freud had exhibited
‘moral cowardice’ by rejecting his initial theories concerning childhood
sexual abuse and re-interpreting these events as fantasies rather than
memories of actual events. This issue has provided a good deal of on-going
debate among the critics and adherents of psycho-analysis—debates that
have recently resurfaced as a result of a review article of Frederick Crews in
the New York Review of Books (1993) and in the subsequent responses that
have appeared in the Review’s letters pages (1994). I want to consider this
debate not for its own sake but in order to provide an entry point to a
discussion on how theory-led therapeutic interventions may, in themselves,
provoke potential issues focused on the misuse (and possible abuse) of the
therapist’s power in therapy.

A. FREUD’S SEDUCTION THEORY: AN EXAMPLE OF THE MISUSE OF POWER

In 1896, Freud published a series of papers which put forward what has
become known as his Seduction Theory. In fact, there were really two
related, if closely connected, theories being presented. Initially, Freud
claimed that the root cause of the hysterical symptoms exhibited by his
patients had been sexual abuse perpetrated on them either by adults or older
children, including their siblings, nursemaids, members of their family,
governesses, servants, and so forth, prior to his patients’ tenth birthday. By
1897, however, he amended these views to some degree by arguing that
with regard to his female patients (and possibly some male patients) the
main (if not sole) abuser had been their father. Indeed, in his letter to his
confidant and friend Wilhelm Fliess, dated 3 January 1897, Freud wrote
excitedly that he had found clear evidence of paternal abuse and now felt
certain that he was on the right track. So strongly did Freud believe in his
theory that he began to consider that his own father had abused his
(Sigmund’s) brother and several of his younger sisters, since they too
exhibited a number of hysterical symptoms (Hopkins, 1994).
Stated briefly, Freud’s seduction theory argued that his patients had
repressed their memories of these events but, once puberty had set in, this
repressed memory began to express itself in the form of various hysterical
symptoms. As such, Freud saw his task as being that of turning the
repressed memories of his patients into conscious memories because, he
believed, by acknowledging these events his patients would no longer need
to express them in the disguised form of their hysterical symptoms (Gay,
1988).
Although he publicly defended these views in spite of their apparent
unpopularity, towards the end of 1897 Freud too began privately to express
his own doubts as to the validity of his claims and, by 1899, he abandoned
this stance in favour of his new theory of infantile fantasies which he
eventually began to advocate publicly in 1905 (Gay, 1988). This new theory
argued that what Freud had previously thought to be repressed memories
were actually repressed sexual wishes or fantasies from infancy and early
childhood which were principally focused on the patients’ parents.
Why did Freud change his views? He tells us that he did so for several
reasons, primarily because the evidence for his earlier views did not turn
out to be as conclusive as he might have originally imagined and, more
significantly, because his patients’ hysterical symptoms either persisted or
returned in spite of their conscious acknowledgement of their having been
abused. Freud’s critics, on the other hand, have argued otherwise. Masson,
for instance, has argued that Freud abandoned the seduction theory not
because it was wrong, but because it was all too correct and Freud could not
face the defensive social wrath that his continuing adherence to these views
would have provoked. Instead, Masson argues, Freud effectively betrayed
his patients by turning the tables on them with his new theory such that
those who were once the victims of abuse now became the originators of
unconscious sexual fantasies and, equally, those who had previously been
the perpetrators of abuse now became the innocent dupes of their children’s
unconscious fantasies (Masson, 1984).
For many therapists and critics, the evidence seems to be in favour of
the latter conclusion as presented by Masson—so much so, in fact, that it
has recently resurfaced as the main impetus for some current practices
dealing with what has become known as ‘Repressed Memory Syndrome’.
Similarly, some scholars who are critical of Freud’s subsequent theories
have reconsidered these early papers as exemplary of Freud’s lack of
scientific objectivity (Schimek, 1985; Crews, 1993, 1994).
However, an alternative, if no less significant, view can be taken.
Firstly, it is important to correct a mistaken assumption that many of
Freud’s critics have made of this material. Freud did not state that childhood
sexual abuse in itself caused hysterical symptoms. It only did so, he argued,
when the memory of this event had been repressed. As such, Freud’s
abandonment of his ‘seduction theory’ is not, per se, an attempt on his part
to deny the existence of sexual abuse of children by adults (including their
parents). Rather, it is a recantation of the view that hypothesized a causal
relationship between repressed memories of sexual abuse and hysteria.
While it might be justifiable to argue that Freud and his followers
minimized the social reality and significance of sexual abuse in its diverse
forms, it is quite a different matter to suggest that it was not acknowledged
as existing.
Secondly, and of far greater consequence, Freudian scholars such as
David L. Smith (1991) have pointed out that when one reads Freud’s papers
dealing with the clinical evidence obtained for his early theory, quite a
different picture from what has been suggested emerges. For what one
discovers is that Freud’s own evidence is never direct, but is actually
‘indirect, inferential … like an unknown language which must be
“decyphered and translated” in order to yield “undreamed of information”’
(Smith, 1991:8).
What this implies is that Freud’s evidence for his theory was inferential
rather than directly obtained. Freud writes that the ‘scenes’ of abuse had
been reproduced by his patients during their clinical sessions. What Freud
meant by the term ‘reproduced’ is unclear. Jean Schimek, for example, has
written that they involved ‘visual scenes, often of hallucinatory intensity,
accompanied with strong displays of affect, physical sensations and motoric
gestures’ (Schimek, 1985:943), and Smith concludes that

Freud makes a point of emphasizing in each of the 1896 papers that

his patients did not experience these events as memories (they have
no feeling of remembering the scenes—Freud, 1896b:204). It was
Freud, then, and not his patients, who connected the scenes with
hypothetical unconscious memories of sexual abuse. Freud’s later
statements to the effect that his patients told him that they
remembered having been seduced as children are flatly contradicted
by the evidence (Smith, 1991:9).

What both Schimek and Smith go on to argue is that Freud’s seduction

theory was constructed by him in a very selective manner influenced both
by his technique and by his own belief in the truth of his theory. At that
time, Freud employed a ‘pressure technique’ that involved his placing a
hand on his patient’s forehead, applying increasing pressure, and, at the
same time, insisting that the patient produce not just memories in general
but those memories that Freud was certain the patient was repressing. This
scenario can be gleaned from Freud’s own statements:

One only succeeds in awakening the psychical trace of a precocious

sexual event under the most energetic pressure of the analytic
procedure, and against an enormous resistance (Freud, 1896a:153).

If the first discovered scene is unsatisfactory, we tell our patient that

this experience explains nothing, but that behind it, there must be a
more significant, earlier experience (Freud, 1896b:195-6).

In addition, Freud also tells his readers that he would inform his clients
prior to the start of treatment that certain required ‘scenes’ would emerge—
scenes that he would steer them towards (Freud, 1896b).
All this might begin to strike the reader as all too similar to activities
designed to extract confessions from individuals who have been ‘judged
guilty until proven innocent’. What Freud, however inadvertently, tells his
readers is that he began his treatments with a pre-set assumption (i.e. that
they had to have been abused) and that, lo and behold, with the right
amount of physical pressure, insistence, and selective reinforcement he
‘proved’ this to be the case. As Smith concludes after considering Freud’s
account of his treatment of a female patient:

We need to look no further than Freud’s interaction with his patient

to form a plausible hypothesis about why she ‘spontaneously’
became preoccupied with issues of seduction, abuse, and
exploitation (Smith, 1991:23).
It is important to note that Smith’s statement contains added meaning. For it
is Smith’s contention that this patient’s acknowledgement of abuse—in
common with similar statements during treatment—was not simply the
result of Freud’s powerful suggestions, but was a comment on her ‘current
experience of abuse at the hands of Freud’ (Smith, 1991). Smith argues this
in order to clarify certain ideas central to the theory of Communicative
Psycho-analysis, but we need not follow this particular path in order to
understand that Freud’s own unwavering belief in the validity of his theory
clearly influenced and affected his patients’ self-understanding by imposing
a particular viewpoint (i.e. Freud’s) on them.
Smith argues that it is likely that Freud himself came to see this, and it
was probably this insight above all others which led him to abandon his
seduction theory. However plausible Smith’s suggestion may seem (and I
personally think it to be plausible enough for Freud scholars to pursue), it
remains, nevertheless, speculation, since Freud does not ever state this in
any direct manner either in his subsequent papers or in his private letters.
However, even if Smith is essentially correct, we are still faced with
subsequent evidence from Freud’s case studies dealing with aspects of
‘psycho-analysis proper’ (e.g. the cases of ‘Dora’(Freud, 1905) and the
‘Wolf Man’ (Freud, 1918) as discussed by Crews (1993)) that although
Freud changed his theory, his directive behaviour remained pretty much the
same. In other words, Freud continued to impose his beliefs on his patients’
stories, emphasizing and directing them to those elements in their accounts
which ‘fitted’ his theory and provided him with ‘evidential proofs’ of its
correctness. In the case of the ‘Wolf Man’ (Freud, 1918), for instance,
virtually the whole of Freud’s analysis rests on a particular dream which
Freud interprets as a disguised recollection of his patient’s witnessing his
parents engaged in sexual intercourse (Freud, 1918). Not only does the
dream consist of a minute amount of the case material that Freud records in
his account but, additionally, the ‘Wolf Man’ himself, many years later,
voiced serious doubts as to the likelihood of the ‘primal scene’ ever having
occurred, and suggested that he only went along with Freud’s interpretation
because Freud so clearly thought it to be of such significance (Obholzer,
1982).

B. THERAPIST RELIANCE UPON THEORY AS A MISUSE OF POWER

The issue of Freud’s directive, theory-driven behaviour would be of little
relevance to most if it were simply historically placed and specific to Freud
and possibly his early followers. I have raised it, however, because it seems
to me to be of current concern in that a great deal of contemporary
therapeutic practice—regardless of the theory espoused—remains theory-
led and, as such, can be seen to open therapists to accusations of misuse
(however inadvertent) of their therapeutic power.
Virtually all theories of therapy are based to a significant extent on sets
of observations of people’s behaviour. These observations then become the
basis from which views and hypotheses about mental phenomena are
inferred and which seek to describe accurately various psychological
processes (e.g. thought, memory, emotions, etc.) the influences of which
may explain or predict past, present and future behaviour. This, in itself, is
neither a unique nor an unusual form of scientifically influenced enquiry.
The danger only arises when both the observations and the hypotheses that
spring from them come to be seen and employed as truth or dogma. This
danger is not specific to therapy since all scientific enterprise remains open
to such possibilities, but it is especially problematic to therapy because,
unlike established scientific enterprises, therapy is currently made up of
many and diverse theories that share little in common—even at the level of
the most basic assumptions.
As such, in the current state of things, significantly different, even
contradictory, theories share relatively equal value and validity. As we saw
in Part 1 of this text, no evidence has as yet been found to demonstrate the
superior effectiveness of any one theory-derived approach to therapy over
any other. This, in itself, should be warning enough to current therapists not
to depend unnecessarily on the validity of their particular theories as
sufficient rationale for their interpretations and interventions. Unfortunately,
therapists tend not to have heeded this warning. For in presenting the
therapeutic process as being special and unique, and in believing that their
expertise is derived from their employment of skills and methods that are
themselves derived from the theory of mental functioning that they
subscribe to, therapists, somewhat unquestioningly, have tended to adapt
their patients’ ‘stories’ and conflicts to fit the theory that they (the
therapists) believe in, even though they have little basis on which to assert
that their theories are based on reliable and valid evidence.
For example, Katharine Mair points out that the very influential
cognitive-behavioural therapy of Aaron Beck emerged from his
observations of the attitudes of depressed individuals. Mair argues that
Beck

passed off his description of the thinking of depressed people

(beefed up with a lot of jargon) as an explanation of depression,
which had been validated by ‘systematic research’. Even as a
description, its validity has been questioned. There is a wealth of
experimental data which suggests that depressed people do not have
distorted perceptions, and that they may indeed be rather more
accurate than the rest of us in many of their judgments … (Mair,
1992:140).

Similarly, if the therapist’s original idea relates only to a limited aspect of

behaviour, it can be made to sound more general and plausible if it is
infused with ‘a new jargon and hints of organic underpinnings’ (Mair,
1992:141). Terms like ‘syndrome’ and ‘disorder’ may also play a role in
‘authenticating’ a theory. Spanos (1989), for instance, demonstrated that 60
per cent of all the patients in one American clinic were found to be
suffering from ‘Multiple Personality Disorder’, possibly because the
therapists in that clinic were firm believers in the disorder as were,
consequently, the patients themselves. In the same way, ‘Repressed
Memory Syndrome’ has ‘blossomed’ recently in clinics and institutes that
subscribe to its existence.
This is not to say that such symptoms and syndromes do not, or cannot,
exist. Rather, the point being made is simply that therapists should be more
tentative and open to alternative explanatory possibilities before being fully
convinced—or fully convincing their clients—of any particular one.
Unfortunately, this does not seem to be the case and ‘true believers’, in their
readiness to assert the unequivocal truth of their findings, may be inflicting
serious psychological and social damage on their clients (and their
families). Indeed, as in the case of Repressed Memory Syndrome, some
therapists’ diagnostic procedures for determining the symptomatic basis for
their conclusions have been questioned with growing alarm since the
defining symptoms of the syndrome seem so vague and general that they
appear to contain little diagnostic worth. The recent successful case brought
against a therapist who had ‘assisted’ in uncovering his client’s ‘repressed
memories’ of having been sexually abused by her father (the plaintiff) has
raised further concerns about this approach as a contemporary example of
the possible dangers in theory-driven therapeutic intervention.
If therapists remain in general agreement that an important function of
their enterprise revolves around the desire and attempt to challenge their
clients’ world-views so that they become more flexible and realistic, then
they must surely ask the same of themselves. Equally, if they are to answer
charges of abuse and misuse of their authority and power successfully, they
must be prepared to acknowledge that the current status of their theories,
and the applications derived from these, is, at best, tentative and requiring
of attitudes and practices that recognize and express such.

C. AVOIDING THEORY-LED MISUSE OF POWER: SOME INITIAL CONSIDERATIONS

All approaches to therapy acknowledge the importance of its relational

constituents. But, having done so, the impact of the therapeutic relationship,
both at the private or personal level and at the shared or interpersonal level,
has tended to have been insufficiently recognized and explored. It seems to
me likely that many of the concerns expressed about issues surrounding the
abuse and misuse of power in the therapeutic relationship have arisen
precisely because the influence and meaning of these relational features
have not been generally addressed. Among these features is the issue of
therapists’ central reliance on their theories as defining boundaries to their
investigations of, and attempts to understand, the meaning-world, as
perceived and behaviourally enacted, of their clients. But this reliance, if it
is expressed or believed in by therapists in an uncritical manner or in a
fashion that demands unquestioning subservience to theory-driven ‘truths’
by both therapists and their clients, creates a relationship the imbalances of
which provoke and make far more likely the appearance and experience of
varying degrees of abuse.
As an example that should make this point clear, we need only re-
examine my own experience as a trainee as described earlier. My therapist’s
unswerving allegiance to his theoretically derived conclusion that my
rebellion at his insistence that I refer to him as ‘Daddy’ was an expression
of my being a ‘psychic orphan’ produced a relationship that emphasized
and demanded a power-focused conflict between us. Equally, within me, it
provoked all manner of personal views and reactions that, at the time of the
event, could not be explored or examined but only acted on from a fixed
perspective. In my case, those views and responses were primarily assertive
and dismissive of external authority as embodied by the therapist; in
someone else, they might just as easily have been submissive and
unquestioningly accepting of that same authority. In the same fashion,
although I have no knowledge of what they were, various personal views of
my therapist were also sure to have been highlighted and acted on in an
equally closed and unwavering fashion. In the end, probably both of us
experienced the other as being abusive, experienced ourselves as being the
victims of abuse, and, concomitantly, experienced the relationship we had
engendered as being blocked, or resistant to insight, or destructive. If, on
the other hand, my therapist had been more hesitant or willing to have his
theoretical views challenged, then it might have been far more likely that
my response, in turn, would have been more open to a consideration of his
perspective. More than this, however, in our mutual willingness to
contemplate the other’s input, the very nature of the relationship we had
generated would have altered and would have been more likely to have
been experienced by both of us as challenging and respectful, and, while
still imbued with power, nevertheless constructive and trustworthy rather
than debilitating and oppressive. In short, each of us would have been far
more willing and capable of listening to one another.
What is being suggested is not that therapists (or anyone else, for that
matter) should seek to engage with and listen to their clients from a theory-
less or ‘blank slate’ standpoint. It would be the height of naïveté to imagine
that this could possibly be achieved. Rather, the point being argued is
simply that therapists should treat their theories and assumptions critically,
remaining open to their falsifiability, to the uncertainty of the ‘truths’ they
might contain, and to the alternative possibilities with which their
encounters with their clients may provide them.
In relation to this point, I am reminded of a lecture I once attended
concerning some psychological aspects of the Major and Minor Arcanas in
the Tarot deck. In that lecture, it was argued that while each of the four
Kings in the Minor Arcana were, on the one hand, the most powerful cards,
they were, paradoxically, also the weakest because in mastering the
‘element’ they represented they had also become slaves to it in that it was
all they knew or could experience their world through. In their reliance and
unquestioning loyalty to a particular model, therapists run the same risk as
the Kings in the Tarot deck and, thereby, become both extremely powerful
and powerless at one and the same time. Perhaps they might find it
worthwhile to consider another point made in that lecture: that true power
and mastery emerge out of the attempt to balance faith and doubt.
But, in order to do just that, therapists must be willing to reconsider
their most basic and deeply held assumptions. Many of these lie at the heart
of their psychologically derived theories and include such issues as the
influences of the past on current thought and behaviour, unconscious
mechanisms, innate growth of self-actualization tendencies in human
beings, and the existence of a fixed, or real, self. It is to these and other
such fundamental assumptions, therefore, that we must now turn our
attention in order to examine, assess, and, hopefully, demystify.
PART THREE

DEMYSTIFYING THERAPEUTIC THEORY:

1. THE PSYCHO-ANALYTIC MODEL

The greatest psychopathologist has been Freud. Freud was a hero.

He descended to the underworld and there met stark terrors. He
carried with him his theory as a medusa’s head which turned these
terrors to stone. We who follow Freud have the benefit of the
knowledge he brought back with him and conveyed to us. He
survived. We must see if we now can survive without using a theory
which is in some measure an instrument of defence.

(R. D. Laing)

The focus throughout this and the next part of the text will be on a number
of fundamental assumptions that therapists have derived from their theories.
In so doing, it will both examine their meanings and values and consider
how therapists’ tendencies to accept and believe in them from an
unquestioning standpoint may both impede the therapeutic process and
open it to the possibility of misuse.
This is not to say that theories themselves are worthless to both the
therapist and client; all that is being suggested is that the strength of belief
in a particular theory, as well as the manner in which the theories are
applied and presented, may well provoke unnecessary and debilitating
strains in the participants and in the therapeutic relationship to the extent
that the therapy itself may become ‘untherapeutic’.
Equally, it is important to be clear that these suggested alternatives will
not seek to dismiss nor deny the experience-based origins of the avowed
phenomena; rather, the focus for criticism will be on the subsequent theory-
based explanations and interpretations that have been provided.
The great majority of theoretical models of therapy encompass three
main strands of approach: the psycho-analytic, the cognitive-behavioural
and the humanistic. In addition, the humanistic strand also contains
subsidiary transpersonal approaches that focus on the ‘spiritual’ or ‘over-
self ’ elements that influence both intra-and inter-personal relations. Of
course, while nearly all of the large number of current therapies tend to
present themselves as being unique in certain ways, in most instances they
can be seen to be substantially derived from, or seeking to integrate, various
fundamental assumptions that are present in one or more of the three main
models.
As I will seek to argue, each of these three main models, while clearly
offering important psychological insights the relevance of which to the
therapeutic process is obvious, nevertheless contain within them a variety of
theoretical assumptions that, as I will endeavour to demonstrate, contain in-
built problematic elements that significantly affect and determine both the
type and the quality of the therapeutic relationship that is likely to emerge
because of their application. I will consider each of these approaches
separately and concentrate on those elements that I view as being most
significant to the argument being presented.
Before doing so, however, I must confess to my own biased position.
There exists what I believe to be a fourth approach—the existential-
phenomenological model—which, as I have previously mentioned, I
personally subscribe to.
One of the reasons I have been drawn to this approach lies in its stance
of critical—even sceptical—questioning of the assumptions underlying all
models and their applications by seeking to maintain a descriptive focus on
the experience under consideration or investigation. Simply speaking, it
does this by seeking to ‘open up’ or clarify a given experience rather than
‘step behind or beneath’ what is presented (Spinelli, 1989).
But in this very attempt, it confronts investigators with all manner of
biases and assumptions that they bring into the investigative process in
order that they may both acknowledge these factors and attempt to set them
aside (or ‘bracket’ them) as much as possible. This attempt (and I
emphasize that it can only be an attempt rather than a fulfilment) at ‘pure
description’ contains a number of important implications for the therapeutic
process. One of these implications is precisely the topic under
consideration.
Further, the existential-phenomenological model is fundamentally
relational. As such, its focus on therapeutic relationships centres on various
relational variables—including, naturally, the relationship between therapist
and client. This emphasis too is deeply relevant to the current topic.
Finally, while the existential-phenomenological model can be seen to be
a separate approach which can be contrasted to others, it can also be seen as
a model that provides all approaches with the means of clarifying and
critically examining their various biases and assumptions. In this way, it
need not be in competition with other models; rather, it may well be a useful
and constructive tool for all approaches as long as they are willing to be
open to the analyses it engenders.
It is for these three reasons that I have opted to introduce it into this
discussion and into subsequent discussions that will make up the remaining
parts of this text, as I believe that it has much of value to contribute to the
general aim of demystifying therapy.

1. THE PSYCHO-ANALYTIC MODEL: AN OVERVIEW

The history of modern-day therapy begins with the introduction and

application of the psycho-analytic model as formulated by Sigmund Freud.
Taking as its most basic premise the idea of a ‘talking cure’ carried out in a
private, one-to-one encounter bounded by various structural, or frame,
features such as the duration of each session (the ‘fifty-minute hour’), its
setting, location and ‘ambience’(usually a specified room in the therapist’s
private dwelling containing comfortable furniture to sit—or lie—on,
dimmed lighting, and so forth), and emphasizing the need for the client to
speak freely and openly about his or her most private and intimate thoughts
and experiences (‘free association’), it laid the basic foundations for
therapeutic practice as adopted and adapted by the great majority of
therapeutic models, and, as such, currently remains the most widely
influential model—either in whole or in part—in contemporary therapy.
While this model is made up of a substantial variety of sub-models (e.g.
Freudian, Kleinian, Object-Relations, Lacanian, etc.), some of which may
be further sub-divided (e.g. British and American Object-Relations), these
distinctive divergences and reformulations of (primarily) Freudian concepts
lie beyond the boundaries of this discussion. Similarly, the influences of
psychoanalytic theories are extremely wide-ranging, covering virtually all
aspects of psychology such as human development, personality, memory,
sexuality, and so forth, and providing, as well, a philosophy of human
nature, sociological models of group behaviour, culture, religion, and the
arts, and a novel means of conducting critical analyses of historical figures,
events, and literary material.
For all these reasons, my focus on the psycho-analytic model will, of
necessity, restrict itself to specifically therapeutic assumptions which I
believe are fundamental to the applied skills of psycho-analytically trained
therapists and which, as well, are shared by all of the sub-models. Of these
assumptions, I believe that three in particular stand out as being central
concepts of psycho-analytic therapy which have a direct effect on the nature
of the relationship that is engendered between therapist and client. These
are: 1) the notion of hidden or ‘unconscious’ mental processes; 2) the
notion of the past as causal agent of current symptomatic behaviour and
current personality-based attitudes and dispositions; and 3) the allied
notions of transference and counter-transference which play a pivotal role in
the nature of the therapist–client relationship as perceived by the
psychoanalytic therapist.
These three assumptions taken together demand of the therapist the
trained skills to extract from the plethora of the client’s statements and
behaviours those elements that reveal all these factors at work, to interpret
such, and, where necessary, to note the client’s resistances to their
interpretations since such point not only to deeply held defences (or patterns
of psychic pain reduction) but also to those general stances and attitudes
insistently held by the client in spite of their incapacitating consequences.
In many cases, such defences are further understood to originate in psychic
conflicts usually built around sexual or aggressive desires that the client
will not admit to or confront.

2. THE PSYCHO-ANALYTIC UNCONSCIOUS

Quite a few years ago now, during the time in my life when I was most
enamoured of psycho-analytic approaches to therapy, I was working with a
client, June, who had come to me desperate to rid herself of nightly
disturbances that prevented her from maintaining undisturbed sleep for
suitably extended periods of time. June explained to me that she had
suffered in this way since some time not long after the age of thirteen—she
was twenty-two years of age when she began therapy with me—and
believed that the problem had to do with the fact that she could not dream.
When I pressed June further on this last point, she stated that each time
she began to dream (or, more correctly, each time she remembered
beginning to dream) she would ‘see’ an image—the same one each time—
that would startle her out of her sleep. What was the image? Oddly enough,
it was, she said, a chessboard, or at least part of one, since the whole image
consisted of a pattern of dark and light-coloured squares symmetrically laid
out such that they followed one another. That was it. What could be so
disturbing about a chessboard? June couldn’t say. All she knew was that
whenever she saw it, even when talking about it as she was with me, she
would begin to feel anxious, scared, dizzy and on the verge of vomiting.
We talked more about June’s experience of herself and her inability to
sleep for a few sessions and then our weekly meetings settled into
something approximating a psycho-analytic encounter in that she was
encouraged to ‘free associate’ (or express her thoughts freely as they came
to her) while I mainly listened, interjecting the occasional seemingly apt
remark.
Finally, after a relatively brief number of sessions (less than twenty),
June began to focus her associations on the image of the chessboard. We
worked on this over the subsequent three weeks, but as she was clearly
becoming increasingly frustrated in that her associations seemed to be
leading her nowhere, I finally urged her just to stay ‘tuned’ to the image
itself in silence and see what happened. She did so, and suddenly, after
about ten minutes, her face registered a shocked reaction. She began to cry
and continued doing so for about a quarter of an hour, by which time I was
desperate to know what she had seen. Finally, brushing aside her tears, she
smiled and told me. In the course of her concentration on the image, June
had realized that it was not a chessboard at all, but, rather, her family’s
basement floor which was covered by linoleum patterned with red and
white squares. And suddenly she had remembered that a terrifying event
had happened to her in that room when she had been thirteen. A male friend
of her older brother had been there alone with her and had forced her to
fellate him. She had never told anyone of the event and, indeed, had
‘forgotten’ it until now.
The next time I saw her, June informed me that she had had her first
undisturbed sleep in years and had actually managed to dream a proper
dream. Our sessions together ended and that was seemingly that.
Here, then, as far as I was concerned, was clear and straightforward
evidence of unconscious processes being made conscious. June had
repressed the event by allowing it only to express itself in consciousness in
the disguised and innocuous image of a chessboard—an image that,
nevertheless, provoked strong emotional and physical, if seemingly
inexplicable, reactions.
But … the twist in the tale.
A few weeks following our last session together, June telephoned me
and asked if I could see her. I agreed. Was there more repressed material to
work through? Had the disturbances begun again? No, she was fine and
sleeping well and had come to terms with the assault. But there was
something she’d felt the need to tell me. What? ‘Well,’ June confessed, ‘I
hadn’t really forgotten the event. I’d thought of it in a kind of detached way
lots of times. But I just hadn’t connected to it. It was kind of there and not
there in my thoughts. It was like a thought that didn’t belong to me.’
I remember June’s words as clearly today as I did on the afternoon she
first spoke them. They contained a message, an idea, that frightened me at
first since its impact had important consequences for my unquestioning
belief in the unconscious as I’d come to understand it. I continued to
believe in and employ this notion of the unconscious for a number of years,
but I could not shake off the memory of June’s statement, until, eventually, I
allowed myself to accept that what she had told me applied as much to my
own experiences of ‘making the unconscious conscious’ as it had to hers.
For I too had experienced the same phenomenon. Whenever I had
remembered a seemingly forgotten event, I’d felt, often immediately, that
I’d known it all along. The revelatory material had not been hidden from
me; rather, I had somehow disowned it by keeping it separate from my
phenomenological meaning-world.
In some way, the ‘I’ who knew the material and the ‘I’ who defined my
sense of who I was had become, seemingly, disassociated. It had only been
my insistence on believing in the unconscious which had blocked this
insight. But, if this were so, then the key to understanding how I could
detach certain memories such that they seemed not to belong to me lay not
in any notions of an unconscious but, rather, in consciousness itself.
This phenomenon of ‘disowned thoughts and memories’ has been
shared by such a large number of subsequent clients that I have come to
believe that it offers a significant alternative view to phenomena typically
associated with the unconscious. Once again, let me stress that it does not
call into question or doubt the experience of insight or ‘connection’ that is
usually explained as repressed unconscious material being recalled. What it
does question is the adequacy of that explanation. But if that explanation is
judged inadequate, what more suitable alternative can be presented? I
recently wrote a lengthy paper which attempted to provide a suitable
alternative (Spinelli, 1993), but as it was aimed at a specialist audience and
entered into detail that would require incursions into several issues outside
the immediate focus of this part of the text, I will attempt to reframe some
of the more pertinent points raised within it so that the main thrust of my
argument will hopefully be both relatively clear and brief.

A. PRE-PSYCHO-ANALYTIC THEORIES OF THE UNCONSCIOUS

The unconscious was not a new term invented by Freud. It had been around
and employed by a substantial number of philosophers, poets, scientists and
medical doctors since the eighteenth century (Whyte, 1978). For instance,
Henry Maudsley, the great British psychiatrist, wrote in 1867 (a good
quarter-century before Freud’s own research led him to posit the existence
of the unconscious) that the ‘most important part of mental action, the
essential process on which thinking depends, is unconscious mental
activity’ (Maudsley, 1867, quoted in Whyte, 1978:162). But how was the
unconscious defined by these pre-Freudian thinkers?
Broadly speaking, all who employed the term did so in order to assert
the existence—based on their experience—of mental processes that lay
outside, or beneath, immediate, or current, awareness. In other words, this
view of the unconscious expressed the idea that as well as our conscious
awareness there also existed mental activity that took place without our
being aware of it. As such, broadly speaking, the unconscious was a term
employed to represent all mental activity other than ‘those discrete aspects
or brief phases which enter awareness as they occur’ (Whyte, 1978:21).
So, for example, while I might be consciously aware of the movement
of my fingers on my notebook’s keyboard and of the words that appear on
the screen, this conscious awareness is but a minuscule part of all the other
sensory stimuli that my brain interprets and which, in a sense, I am aware of
at a nonconscious, or pre-Freudian ‘unconscious’, level. This view of the
‘unconscious’ is backed up by a good deal of modern experimental
evidence from, among other subject areas, perception studies in psychology.
So, for instance, psychologists have carried out tests employing a machine
known as a tachistoscope which is capable of ‘flashing’ images at micro-
second speeds such that their subjects are unable consciously to process and
be aware of them. However, if they are then presented with an array of
images, including the ‘flashed’, or target, image, they will be able to pick it
out even if they cannot explain the reasoning for their choice. Studies such
as these, as well as related studies on selective perception or attention,
clearly demonstrate that non-conscious mental processing occurs (Spinelli,
1993).
But we can think of this early idea of the unconscious in another way.
When we concentrate on, or attend to, something, we can only do so
because we are ‘selecting’ it from all other possible ‘somethings’. So I am
only able to concentrate on my keyboard by not concentrating on the
images and sounds coming from my street, or my sleeping cat on the
armchair beside me, or the grumbling in my stomach, and so forth. In this
way, we can see that what we are consciously aware of is but a minute
selection of the sum total of possible things we could be consciously aware
of. But these non-selected items don’t just ‘disappear’; we remain aware of
them in a non-conscious manner.
This phenomenon reveals something else of tremendous importance:
consciousness is a relational process. It requires both that which we focus
on and that which we do not. In order for something to ‘stand out’ it needs
all manner of ‘other somethings which are not the focused-upon something’
to stand out from. This idea is usually expressed by the term figure/ground.
While it is a term most commonly employed in object perception studies, its
influence is far greater.
So, for instance, we can only name or describe something not only on
the basis of what it is, or what features it possesses, but also by what it is
not, or which features it does not possess. We can only name, or describe,
ourselves as unique beings, for example, by implicitly or explicitly
contrasting ourselves to all other potential selves (i.e. others). And, indeed,
our statements only make sense, or are meaningful, because of this contrast.
Saying that I am of Italian origin, for instance, is only meaningful if there
exist examples of people who are not of Italian origin.
But ‘others’ can also be internal, or ‘intra-psychic’, contrasts. So if I say
that I am feeling happy, this statement only makes sense because I can
contrast my experience of ‘being happy’ to alternative, or ‘non-happy’
experiences.
So the pre-Freudian view of the unconscious referred to processes or
experiences that, while not currently accessible to consciousness, could
become so in a relatively direct fashion. Equally, this view of the
unconscious revealed an inseparable relationship between conscious
awareness and unconscious awareness.

B. THE PSYCHO-ANALYTIC UNCONSCIOUS

It was Freud, of course, who would extend, if not subvert, this basic idea.
While he accepted the inseparable relationship between the conscious and
the unconscious, he argued for the existence of a barrier between them, such
that that which was unconscious could not be accessed in a direct manner in
most circumstances and only expressed itself in an indirect, disguised
fashion. He accepted previous views to some extent by positing the idea of
the preconscious— that is, thoughts, images, wishes, fantasies and so forth
that were not currently conscious but could become so—but spoke of the
unconscious proper as the ‘residue’ or ‘store-house’ of thoughts, images,
wishes, fantasies, etc. that could not become conscious other than by
concerted and courageous efforts usually brought about by the use of
specific psycho-analytic techniques.
What was so problematic about the Freudian unconscious that it sought
to prevent conscious access? The answer to this question lay in Freud’s
supposition that the unconscious was made up of unacceptable, disturbing,
deeply frightening, irrational, even disgusting wishes and fantasies
originating from our infancy and childhood which we could not (or, more
accurately, would not) allow ourselves consciously to consider because of
their unacceptable sexual (or erotic) and aggressive emotional and imaginal
content. This material, he argued, had been repressed.
Repressed material can be most easily understood as material that we
have somehow ‘blanked out’ from our conscious thoughts by convincing
ourselves that it does not, or cannot, exist. And yet it does. And, more, it
impinges on, or ‘pushes at’, our conscious thoughts, demanding our
attention. As a result, a compromise of sorts occurs. The unconscious
material is allowed expression but in a disguised fashion. We can think of it
as material that has been ‘censored’ in some way so that it becomes
consciously palatable or so obscurely expressed that its true meaning
becomes vague, distorted, indecipherable.
But there is a psychic price to be paid for this compromise. We all know
what it is like to try not to think of something. But imagine what it is like to
try not to think of something that we have convinced ourselves we are not
thinking of in the first place! The result is confusion, befuddlement, anxiety,
a loss of control.
Freud’s theory of the unconscious was revolutionary. It clearly pointed
to, and seemed to explain, all manner of psychic imbalance and conflict. It
appeared to clarify experiences we can all ‘sense’ in ourselves. So the issue
is not that Freud pinpointed false or insignificant experiences—quite the
opposite, in fact; rather, the question is: Is his explanation the most
adequate one? Does it get closer than any other explanation to the lived
experience we have of this process?
My view is that it does not.
Nevertheless, before I attempt to convince readers of the greater
adequacy of my view, it remains important to acknowledge just how
powerful and fascinating an idea the notion of the psycho-analytic
unconscious is.
A major part of that fascination, of course, lies in the connected idea
that, were we to bring to consciousness at least some of the repressed
material that remains at the unconscious level, a great many of the
mysteries, conflicts and oddities that we encounter in our daily thoughts and
actions, oddities that taunt and mystify and disempower us, would be
explained, and, through explanation, diminish or disappear altogether. In
adopting Freud’s early dictum, we come to believe that we suffer mainly
from (unremembered) reminiscences.
It is all too easy to understand, even experience, the strength of this
idea, ‘I want to know my deepest secrets!’ most of our clients exclaim.
‘And you, the therapist, must help me to uncover them!’ Such heartfelt
pleas implicitly require the acceptance of the existence of a Freudian-
derived unconscious. Or so it would seem. For, if not, what would it reveal
to us about our clients? About ourselves? Essentially, that we are liars, that
we deceive ourselves, that that which we say has been repressed is, always
has been, available to us, and that what is mysterious is not some hidden
content, not some missing pieces of the puzzle, but, rather, some mad
mechanism that wishes us to believe in the existence of hidden and
inaccessible material. Such a notion seems absurd, far more absurd than any
notion of an unconscious containing repressed material. But is it?

C. CRITIQUES OF THE PSYCHO-ANALYTIC UNCONSCIOUS

As appealing as the idea of the psycho-analytic unconscious may at first

appear to be to practitioners and public alike, and as useful as it may be in
our attempts to understand ourselves and others, there remain a number of
serious problems with the concept. Several major philosophers such as
Ludwig Wittgenstein (1982) and Jean-Paul Sartre (1956), for instance, have
pointed out a number of logical problems with this idea on the basis that it
is a circular argument, in that the evidence for the existence of the
unconscious, as presented by psycho-analysts, always depends upon the a
priori assumption that it exists. In other words, they argue, if during psycho-
analysis material is presented which it is claimed was once unconscious, the
basis for this claim relies upon the hypothesis of an unconscious, for how
else could the material be recognized as once-unconscious material?
Clearly, even if we accept the notion of the unconscious, it remains the case
that, at best, all we ever directly confront is ‘the unconscious made
conscious’ and never the unconscious itself. But, if this is the case, then we
cannot say that the existence of the psycho-analytic unconscious has been
proven.
Further, if it cannot be directly proven, how can we ever be certain that
the unconscious has been made conscious? Could it not also be the case that
what has been made conscious is yet one more defensive deception we play
upon ourselves? There seems to be no way out of this dilemma. Who could
say for certain that the unconscious has been exposed to consciousness?
As Betty Cannon has recently remarked with regard to this question:

The conscious subject could not, since it has always been out of
reach of consciousness. Nor could the complex recognize itself,
since Freud tells us that it lacks understanding. Only a subject who
both knows and does not know his or her own tendencies and desires
could recognize what had previously been hidden. In fact, only such
a subject would be able to ‘resist’ the analyst in bringing this
material to light, since only such a subject would know that there is
anything to resist or defend against (Cannon, 1991:36—7).

Pursuing this line of argument, Sartre raises concerns about the logical basis
for the notion of repression, arguing that to repress material we must
somehow know and not know it at the same time. While psycho-analysis
would respond to this by arguing that while the unconscious knows the
conscious mind does not, Sartre’s position suggests that the question
revolves around the issue of self-deception, which would suggest that this
‘splitness’ or dissonance is an issue to be examined and understood within
consciousness itself rather than through hypotheses that rely on the notion
of an unconscious.
Just as there are philosophical questions raised with regard to the
psycho-analytic unconscious, so too is there the lack of any conclusive
experimental evidence for either the existence of the psycho-analytic
unconscious or for the notion of repression. With regard to the latter, for
instance, Matthew Hugh Erdelyi, a cognitive psychologist who accepts the
idea of the psychoanalytic unconscious, has critically considered the
empirical evidence for repression and has concluded that while there exist
numerous experimental studies whose data comply with the phenomena
implied by repression (such as the rejection of selective information from
consciousness), the mechanism itself remains open to doubt or to alternative
theoretical explanations (Erdelyi, 1985).
Lastly, just as a number of important therapists who have been
influenced by the writings of Sartre and Heidegger have re-interpreted or
rejected the psycho-analytic unconscious (for instance, the Swiss
psychotherapist Medard Boss (Boss, 1963; Condrau, 1993)), so too is it the
case, as has already been noted in Part 1 of this text, that there exist a
number of therapeutic approaches the beneficial outcomes of which (at least
as far as these can be measured) seem to be no less effective than those
from psycho-analysis, even though they neither rely on nor make use of
hypotheses concerning the unconscious.
Nevertheless, if there were no suitable alternative to the unconscious all
these criticisms would be of little practical importance. After all, even if the
theory is seen to be imperfect and problematic, as long as it remains the
most adequate theory available in so far as it explains otherwise
inexplicable phenomena, then better to work with it than reject it outright.
But I think a more adequate and suitable explanation for the phenomena
associated with the psycho-analytic unconscious does exist, and that while
it allows a radical re-interpretation of the unconscious, not only does it
more adequately attend to, or ‘capture’, the phenomenology of the
experiences associated with the unconscious, it also offers insights that
might be of significant general benefit to the practice of therapy.

D. DISSOCIATED CONSCIOUSNESS

Perhaps ironically, Freud himself toyed with the essential idea of this
alternative viewpoint. At a key moment of theoretical transition, Freud at
first flirted with the notion of advocating the idea of a ‘split’ (or dual)
consciousness (Smith, 1992). He rejected this view in favour of the idea of
the unconscious, but a number of his contemporaries continued to explore
this notion of dissociated, or divided, consciousness.
Among proponents of this alternative view, it was the French
psychiatrist, therapist and the most important of Freud’s early rivals, Pierre
Janet, who first proposed the thesis that certain thoughts, memories, affects,
and so forth (usually associated with a traumatic event) could be
dissociated, or split off, from one’s consciousness and continue to exist as a
separate consciousness. Janet employed the term ‘subconscious fixed ideas’
to represent this secondary, if autonomous, consciousness, and argued that
its manifestations included such phenomena as compulsive activities,
hallucinations and hysteria (Ellenberger, 1971; Braude, 1991). It is
important to note, however, that for Janet the concept of dissociation was
solely a phenomenon of psychopathology.
This latter view has changed over time such that current theories of
dissociation have turned Janet’s original idea on its head in that, whereas
Janet saw dissociation as a failure in one’s capacity to maintain mental
unity, contemporary theorists perceive it as a ‘widespread human capacity,
whose manifestations [range] from the normal to the pathological’(Braude,
1991:103). C. A. Ross, for instance, argues that ‘dissociation is an ongoing
dynamic process in the normal psyche’, in that the ability to attend to
information requires the ability to dissociate irrelevant sensory input from
that which is relevant to one’s focus of attention (Ross, 1989:87).
As such, dissociation is seen by researchers in the field as a capacity of
the human species to ‘split off ’ or compartmentalize ‘volitions, knowledge,
memories, dispositions, and sometimes even behavior’ (Braude, 1991:97)
which, nevertheless, remain ‘potentially knowable, recoverable or capable
of re-association’ (Braude, 1991:98).
In addition, Stephen Braude, in critically discussing the research
surrounding dissociation studies, has contributed significantly to the debate
by reminding us that there is a subtle but important distinction to be made
between ‘believing one’s state to be one’s own and experiencing it as one’s
own’ (Braude, 1991:71). This distinction points out the epistemological (i.e.
knowledge-or belief-based) aspects and the phenomenological (i.e.
experiential) aspects of self-awareness. While it is reasonable to suppose
that in most cases this distinction is blurred, nevertheless, as examples from
certain circumstances such as panic, sexual orgasm or meditation
demonstrate, ‘one’s phenomenological sense of self can be quite vigorous
and acute, even though the ordinarily well-developed epistemological sense
of self is either non-existent or radically attenuated’ (Braude, 1991:74-5).
Generally speaking, what this distinction makes plain is that examples
of dissociation may be understood as instances where the usual links
between knowledge or belief-based awareness and experiential ‘ownership’
of that knowledge have been impaired or ‘split off ’ from one another. This
distinction might clarify many confounding examples from both ‘everyday’
and ‘pathological’ thought and behaviour where knowledge of something is
somehow ‘denied’ one’s experiential awareness.
For instance, in reconsidering the example presented at the start of this
discussion, it might be seen that while June knew that sexual abuse had
occurred, she had denied this knowledge to her experiential self-awareness.
In this way, she succeeded in ‘knowing it as if such knowledge belonged to
someone else’.
What is implicit in this argument is that the question of dissociation
revolves around an individual’s self-concept in that it supposes a
dissonance between beliefs about one’s self and the experience of one’s self.
Bearing this, and the previous points on dissociation, in mind, an alternative
theory to that of the psycho-analytic unconscious can now be presented.

An example of dissociated consciousness

Let me begin with an example taken from my therapeutic practice. One of
my clients, Rebecca, was a woman who was continually being physically
abused by her boyfriend. Although she steadfastedly asserted that she
wanted to leave him, and indeed various realistic possibilities for such an
act were available to her, nevertheless each week she would return to
therapy still living with him.
If we were to take the viewpoint of psycho-analysis, we would be led to
the hypothesis that unconscious wishes or demands lay beneath or behind
Rebecca’s stance and that, if these were to be ‘made conscious’, then she
would be freed from their influence and act accordingly. The alternative
view being suggested is that her contradictory stance (i.e. I must leave him
and I must stay with him) was meaningful in itself, requiring no recourse to
unconscious motives for its understanding.
Rebecca’s problem suggested that something of significance about
herself and her stance in life was being expressed in that ‘split’ position.
Further, its dual meaning could be explored at the conscious level by
clarifying its opposing viewpoints so that they could be reflected upon
rather than remain unreflected. In doing so, what emerged was the
clarification that while Rebecca was deeply miserable in her situation,
nevertheless remaining with her boyfriend provided her with something
(such as security, status, the escape from loneliness) which, if no longer
available to her, would have forced her to face these anxieties. On
reflection, Rebecca saw that this latter circumstance had seemed clearly far
less tolerable to her than that of continuing to live with the man who
brutalized her.
What can be seen immediately is that what it took for Rebecca to make
initial sense of her situation was not the uncovering of hidden or repressed
(i.e. unconscious) material, but rather the willingness and courage to
expose, explore and confront reflectively that which she had allowed to
remain unreflected.
But there is much more to the matter. Again, the view being put forward
would suggest that her stance revealed an additional ‘split’. Through further
clarification, it emerged that Rebecca held very fixed, sedimented beliefs
about herself. In order to see herself as successful, fulfilled, happy,
respectable or, more generally, ‘good’, she had to prove to herself and the
world that she could both enter into and remain in a relationship. To have
failed at either would destroy this self-concept and, generally speaking,
reinforce the belief that she was ‘bad’. Once again, this clarification adds
further meaning to her inability to leave the relationship (for to do so would
condemn her as a failure, a ‘bad’ person).
In this way, it might be seen that Rebecca’s beliefs about herself (or
who she had to be) were held to be of more significance than the awful
circumstances she found herself in. Better to remain in some kind of
relationship—no matter how abusive—than to be in no relationship at all.
Better to be ‘good’ and suffer physical pain than ‘bad’ and racked with
guilt. My client was split between the knowledge of the intolerability of
being in the relationship and the intolerability of not being in the
relationship.
Further still, Rebecca’s stance could also be understood as an expression
of ‘disownership’. What she believed to be necessary (remaining in the
relationship) forced her to disown the competing knowledge she had about
what options lay before her. This was most often expressed in terms such as
‘All my friends get beaten up by their husbands’ or ‘Why should I expect to
be treated differently?’ This is not to say that Rebecca’s statements were
necessarily untrue, only that they allowed her to maintain a position of
stasis. But similarly, it can also be seen that her disownership was also at a
more subtle, if no less significant, level in that it expressed the
disownership of her own experience of herself as a woman who could make
choices in order that she could maintain her sedimented beliefs about what
is required in ‘being a good woman’.
This leads us to one final point for consideration. In the course of our
encounters, Rebecca admitted to experiencing thoughts, or carrying out
actions, that were, somehow, not her own. What did these thoughts and
actions express? Basically, they expressed a stance that rebelled against her
sedimented belief about ‘being a good woman’—a stance that Rebecca
insisted she could not—did not—hold. This, then, is a further expression of
dissociation. Rebecca experienced a ‘split’ in her self as well in that when
she thought or acted in ways which did not fit, or were alien to, aspects of
her self-concept, such thoughts and actions could only be understood as
being not hers nor of her making. It was as if she had access to, or
knowledge of, thoughts and actions that were someone else’s, or which just
seemed to exist on their own as if ‘orphaned’ from whoever had generated
them.
It is important to be clear that the exploration of these various ‘splits’
may well have led (as it did, in fact) to the exposure of sedimented attitudes
or world-views that Rebecca had held since childhood—but this process
would require no need to impose a theoretical structure based on
assumptions concerning her unconscious, or aspects of repressed material;
whatever meanings or explanations she derived from her confrontation with
the ‘disownerships’ in her life had always been available to her—rather
than repress them, she had, more accurately, avoided reflecting upon them
for all manner of meaningful if debilitating—reasons.

Dissociated consciousness: a summary

If we consider the points just raised in a more general manner, it can be
understood that an alternative theory to that of the psycho-analytic
unconscious stresses the idea of consciously unreflected dissociation rather
than repression. In addition, this view argues that whatever the presenting
conflict, its meaning lies in the conflict itself (rather than in what may be
supposed to exist behind or beneath it) such that it is a direct expression of
the conflict rather than a disguised or distorted expression of unconscious
processes. Further, it suggests that the exploration of this meaning can be
achieved through the clarification and challenging of conscious views and
assumptions rather than by interpreting these as obscured ‘eruptions’ from
the unconscious. Finally, it suggests that what has tended to be understood
as the process of ‘making the unconscious conscious’ may be more
adequately described as a movement ‘from disownership towards
ownership’ in that it does not involve the uncovering of lost or forgotten
material but, rather, the acknowledgement of thoughts, affects, memories
and the like as not being somehow alien but, more properly, ‘belonging to
one’s self ’.
Put in another way, this view points to the possibility that many, if not
all, such dissociations reveal that awareness at a phenomenological level
has been somehow dissociated from the epistemological knowledge or
beliefs contained in the awareness such that the experiences are not ‘owned’
or acknowledged as ‘belonging to’ the experiencer.
Having discussed the principal ideas contained in this alternative view,
it becomes important to ask what are the differences between it and that of
the psycho-analytic unconscious?

The psycho-analytic unconscious vs. dissociated consciousness

Ernest Hilgard’s text Divided Consciousness (1986) provides the basis for
some important distinctions. First, there exist significant metaphorical
differences in that where psycho-analytic theory suggests horizontal
barriers between the conscious and the unconscious, wherein unconscious
material is presented as though it were ‘deeper’ or ‘residing beneath’
consciously accessible material, the alternative view being presented
suggests that those barriers are more accurately understood (metaphorically,
at least) as being vertical ‘splits’ in consciousness. Secondly, a principal
assumption of the psycho-analytic unconscious lies in the idea of an active
mental defence principally inhibiting direct access and recall. The
alternative model, on the other hand, avoids this idea and, instead, focuses
on the phenomenological experience of accessible material as being
somehow perceived as ‘alien’ in that it is recognized as something not
belonging to one’s own self-related experience. Thirdly, while
communication with the psycho-analytic unconscious remains indirect in
that the unconscious can only be inferred (through dreams, parapraxes, etc.)
and its ‘language’ is distorted, symbolic, and primitive (primary process
thinking), communication with dissociated conscious states, on the other
hand, is direct (insofar as any first or third-person communication can be
direct) and requires no assumption of a secondary transformational
language such as primary process thinking.
To these three distinctions made by Hilgard, I would add a fourth which
is based on a point discussed earlier. That is, whereas the concept of the
psycho-analytic unconscious requires the assumption that the meaning of a
conflict-provoking event can only be discerned by exposing its hidden (i.e.
unconscious) meaning through the therapist’s theoretically derived
interpretations, the alternate view being put forward requires no such
assumption in that the meaning of the event is obtained through the
descriptive clarification of the conscious event itself as lived and
understood by the client.
Nevertheless, while this alternative approach questions the need to
assume the existence of a psycho-analytic unconscious, it does not
invalidate any of the consciously experienced phenomena that are said to
originate from the unconscious. Even so, it remains to be asked whether the
proposed alternative presents a more adequate position.
Certainly, it avoids the logical inconsistencies of the unconscious as
pointed out by its critics. Also, it is more parsimonious in that it requires far
fewer assumptions than does the previous model, not least because it
jettisons both the very notion of the unconscious as hypothesized by
psycho-analysis and the subsidiary hypothesis of repression. On the other
hand, some might argue that it does rest on the assumption of a divided
mind—a problem that the psycho-analytic model does not necessarily
impose (Gardner, 1993). But, on consideration, this view is not necessary to
the suggested alternative either, since the argument being put forward can
be seen to focus not so much on the idea of a divided mind, but rather on
the division in the interpreter’s reflections. This issue, it seems to me, more
accurately reveals a problem of belief versus experience rather than being
an issue concerned with the unified or partitive nature of the mind. The
mind may well be unified even if the person experiences divided or
conflicting reflections.
Pulling together the various arguments presented, I believe that I have
provided an alternative to the notion of the unconscious that

1. Accommodates all the clinical observations associated with both early

and psycho-analytic theories of the unconscious.
2. Accommodates all the experimental data provided by both critics and
adherents of theories concerning the psychoanalytic unconscious.
3. Removes the logical inconsistencies and circularities associated with
psycho-analytic theories of the unconscious.
4. Removes the necessity of imposing the hypothetical sub(or super-)
structure of an unconscious on consciousness.
5. Removes the tendency to impose a drive or instinct-based metatheory
and, instead
6. Retains its focus on relational issues.
7. Returns the focus of attention to consciousness itself, and
8. Allows for a more parsimonious, adequate, economic and non-
deterministic account of psychic conflict.

Dissociated consciousness: the self

Nevertheless, in order to make a decisive case for the argument it must be
asked whether there exists more powerful, and direct, evidence for its ideas
than might be found for the prior model. I think that a good deal of
independent collaborative evidence does exist, and I have discussed some
of this evidence elsewhere (Spinelli, 1993). It would be too lengthy a
digression for this text to focus on the various forms of evidence available
from a wide range of studies, but, in essence, what all such studies point to
is that the various forms of dissociation that have been studied—ranging
from everyday selective attention to extreme dysfunctions and distortions in
individuals’ perceptual construction of their body-image (including what
parts of one’s body are perceived as belonging to an individual, and what
the body looks like to, and how it is experienced by, an individual)—reveal
a common dissonance factor.
This factor can be most clearly understood as an imposed ‘splitness’, or
‘disownership’ of certain experiences—both current and from one’s past—
on the basis that they do not ‘belong to’ or ‘fit’ the ‘self ’ that we have
defined ourselves as being. While these ‘disowned’ experiences are
available to our conscious awareness, and can be recalled, nevertheless our
awareness of them is from a distanced or alien perspective—we might think
certain thoughts, or remember particular memories, but it is as though these
belong to someone else and have little emotional impact on or meaningful
significance for us. Alternatively, as I will discuss more fully in Part 5,
these disowned thoughts may be so pressing that they temporarily ‘swamp’
the self we regard to be our self, and one or several other alien or
competing ‘selves’ (to whom these alien thoughts belong) control or
‘possess’ us. For most readers, the most obvious examples of such
phenomena that will spring to mind will be those that suggest ‘split’ or
‘multiple’ personality disorders in certain individuals. These are clearly
extreme instances of the mechanism I am suggesting, but my argument is
that something very much akin to this phenomenon is experienced by all of
us—and, pertinently, is the source of the psycho-analytic theory of the
unconscious.
When, for instance, one of my clients, Robert, suddenly ‘connected’ his
current belief that ‘instances of great success are always to be followed by a
major disaster’ with the memory of his father’s constant ‘put downs’ of his
childhood achievements, the connection made it possible for him to see that
the main task he had made for himself of seeking out a life of limited joy, or
neutrality, was an attempt both to express and resolve the conflict contained
in his previously disconnected experience. While this insight might be
understood in terms of unconscious mechanisms, an alternative viewpoint
also emerges. Previous to his connection of phenomena, Robert had always
spoken of his father only in the most positive of terms. Did he not feel any
ill-will toward him? At first, Robert insisted that he did not. So did this
mean that they had never argued? Well … yes and no. Whenever they did
argue, Robert did not feel it to be himself who was doing the arguing; it was
as though ‘someone else’ took over. And how did this ‘someone else’ view
Robert’s father? Oh, as ‘a cantankerous, opinionated old bastard who was
never satisfied with anything’. What can be seen in this admittedly highly
abbreviated case example is precisely the process of dissociation discussed
above. Robert ‘disowned’ those negative feelings that he had about his
father. Yet they remained available to him in that rather than having been
‘repressed’ they had been alienated from Robert’s self-awareness and had
been ‘attached’, or made to belong, to an alien entity who sometimes
‘possessed’ Robert and spoke its—not Robert’s—mind about its feelings for
Robert’s father. But this act of dissociation served a purpose for Robert—it
allowed him to maintain or believe in a ‘self ’ that only thought good things
about his father. When Robert experienced his relationship with his father
as ‘good’ he ‘owned’ that experience because it ‘fitted’ with the self that he
believed himself to be. However, when Robert experienced his relationship
with his father as ‘bad’, Robert could not ‘own’ this experience because it
did not fit the self that he believed himself to be—so the experience had to
be disowned by Robert and be made part of the experience of an alien
possessing entity.
As I will discuss in Part 5, the issue of dissociation has further
significant and revelatory ramifications, all of which hold vital implications
for our understanding of a variety of issues surrounding our concepts and
experiences of our ‘self ’. For the moment, however, I will bring this
discussion to its close, since I believe that it has served its primary purpose
of demonstrating a viable, and more adequate, alternative perspective to the
psycho-analytic concept of the unconscious.
By now, some readers may be left wondering: So what? What if a
potentially better alternative to the idea of the psychoanalytic unconscious
has been presented? Does that have any practical significance? As I will
seek to demonstrate later in this section, I believe that it does have major
implications both for what therapists perceive their function in the
therapeutic encounter to be, and for the wider issue of power in the
therapeutic relationship—particularly in the context of therapists’
interpretations of either ‘unconscious mechanisms’ or ‘disowned
experience’. Before this discussion, however, our attention must first
remain on the critical evaluation of further assumptions to be found within
the psycho-analytic model—of which the next is that of the influence of the
past.

3. THE INFLUENCE OF THE PAST

Perhaps the most widely accepted assumption in the psychoanalytic model

(and in a great many other models, come to that) is that of the past as a
causal determinant of current states of both order and disorder in the
client’s intra-psychic life. As such, for psycho-analytic therapists, the focus
of therapy, at least initially, lies in a backward-moving process that seeks to
uncover the causal origins of current client distress with the aim of making
such origins clearer, or conscious, to the client. In this way, the hope is that
either this awareness will reduce or remove the experientially restraining
influence of the past or that it will allow a conscious acceptance of such
factors and thereby return to the client a greater degree of control over them
and, as a consequence, promote the development of greater flexibility of
thought and behaviour.
While some psycho-analytic therapists talk in terms of ‘ego-
strengthening’ as their main therapeutic focus, others concentrate on the
‘object-relational’ elements that have survived since infancy and which
continue to impose unnecessary limitations on the client’s current relations
both with self and others. In either case, however, such factors are seen to
have developed directly from past causes originating in the client’s infancy
and early childhood (Fine, 1979).
Although I think it would be absurd for me, or anyone else, to seek to
argue that ‘the past’ has no bearing on an individual’s current attitudes to
life, it is, I believe, altogether quite a different matter to question the idea of
the past as assumed and understood by the psycho-analytic model. For,
clearly, the psychoanalytic past is conceived to be both fixed (that is, that
there exists a past) and linearly causal (i.e. that current issues can be, in
theory at least, traced back directly to past unresolved conflicts or traumatic
interludes in the client’s life). So prevalent are such notions of the past that
it must be further acknowledged that many clients themselves hold to such
assumptions and perceive the task of the therapist as being that of
uncovering the issues and influences of ‘their past’ on their current lives so
that the conflicts and concerns that have arisen from, or which have been
aggravated by, the past can be at least partially resolved.
Both these points, I believe, are open to significant criticism which I
will endeavour to address. Further, I will present alternative avenues of
exploration which, I believe, considerably influence the therapeutic task and
the nature of the therapeutic process.

A. A CRITIQUE OF LINEAR CAUSALITY

Linear causality has come to be increasingly seen as the weaker of the two
assumptions. Indeed, even as a general concept, it remains deeply
problematic. For instance, even in controlled behavioural experiments
dealing with various forms of reinforcement where variables are artificially
manipulated so that an event appears to occur as a consequence of another,
there has been a marked avoidance of imposing the notion of causality as an
explanatory device. So, as a concrete example of the unwillingness to
suggest causality, in the now famous studies demonstrating positive
reinforcement within the controlled environment of a ‘Skinner box’, while it
is the case that an animal may come to associate the pressing of a lever with
the appearance of food, it is important to bear in mind that the associated
events are not claimed to be causally related. For, after all, which event is
‘cause’ and which is ‘effect’? Does the pressing of the lever ‘cause’ the
food to appear? Or does the appearance of food ‘cause’ the pressing of the
lever? Much to his credit, B. F. Skinner, the most famous advocate of
modern behaviourism, studiedly avoided any causal implications in his
behaviourally descriptive theory. What Skinner was willing to state was that
a stimulus (a) was associated with a response (b) through some form of
reinforcement. But what elements there may have been that ‘led’ the rat
from a to b (or, possibly, from b to a) remained unknown ‘black boxes’ that
were tied up in all manner of possible variables whose number, variations,
degree of influence, and so forth could not be simply understood in terms of
‘causality’ (Skinner, 1953, 1971). As such, at best we can speak of
correlations, or of predictive possibilities, but not of causal certainty.
Indeed, even Freud, who, to some extent, might be regarded as a
determinist who also incorporated notions of causality into his system,
acknowledged a multicausal position, and indeed his ‘ultimate causes’ (eros
and thanatos drives) are so plastic in their defining boundaries that the
search for intervening causes becomes deeply problematic.
This issue can perhaps be best understood when we take it away from
the realm of psychology and psychotherapy and place it in another context,
such as that of history. If we were to ask, for instance (as so many have
already done), ‘What caused the First World War?’, we would find a
multitude of competing causal possibilities ranging from the murder of the
Archduke Ferdinand in Sarajevo to the disastrous complexity of European
railway timetables.
It is precisely because so many differing ‘causes’ can be provided to
explain a given event that it has become increasingly recognized by most
individuals (with the obvious exception of propagandists and a great many
politicians) that thinking in terms of ‘cause and effect’, particularly in a
linear or uni-directional manner, tells us very little and can be seen to be of
minimal value to our understanding of human thought and behaviour.
As an extreme example that should make this conclusion obvious,
consider the case of an individual who insists that the ‘cause’ of his current
behaviour and manner of thought lies in the activities of the ‘little green
men’ that hover over his head and ‘make’ him do and think what he does.
Such a stance may strike most of us as being somewhat absurd since we
may not believe in, or accept, his contention regarding the existence of
‘little green men’. If we were to argue against this stance by pointing out
that we could not see them, our believer might well clarify his view by
informing us that they were there but had made themselves invisible to
everyone other than himself and that, indeed, their invisibility had caused us
to ask our question in the first place.
And so the argument would continue, becoming increasingly complex
and circular. For, just as the thesis of ‘little green men’ would seem to
explain everything, it would actually have little, if any, direct explanatory
value unless we were to begin to clarify what the man’s belief in the little
green men and their powers over him might mean to him.
If we substitute the theory of ‘the past as linear cause to our current
circumstances’ for that of ‘little green men’ we can see that both lead us
into the same ‘closed circle’ of explanation. Both, after all, are hypothetical
agents the existence of which is reliant on the belief in their influences.
And, just as the believer in the little green men may be able to enter into a
complex discourse regarding their behaviours, powers, appearance, and so
forth, so too may that same analysis be carried out with regard to ‘the past
as cause to the present’. One position only seems more absurd than the
other because we are generally more willing to believe in the idea of the
‘causal past’ rather than in ‘little green men’.
It is seriously misleading to speak as if there were one cause of
something as complex as a person’s current experience or self-awareness.
The assumption that there is tells us more about individuals’ beliefs about
who they are and how they have come to be than it does about any
governing principle of causality. Equally, the belief in this assumption may
have much to tell us not only about what is revealed or ‘explained’ about
individuals through its adoption, but also about what it allows to be
experientially obscured or ‘disowned’.

Chaos theory and causality

It may be the case that part of our difficulty in questioning linear causality
lies in the continuing dependence on nineteenth-century physics of many of
our assumptions concerning human behaviour. The great success of
nineteenth-century physics lies in its ability both to accurately describe and
predict certain kinds of behaviour—such as that of the planets in orbit, the
swings of pendulums, the motion of balls rolling along a surface—broadly
speaking, those movements and behaviours that are orderly and regular. The
geometry employed to represent these movements is in the form of linear
equations that—to mathematicians at least—are far from complex and
easily calculable.
As long as nineteenth-century physics was applied to these orderly and
regular movements, its value was unquestionable. However, there exist all
manner of other movements—such as the turbulence of water, or changes in
the weather—the complexity of which is such that their orderliness and
regularity is neither easily describable nor predictable. When the geometry
of nineteenth-century physics was applied to these movements, its value
was shown to be minimal. The linear equations that physics employed to
study such movements were both limited and limiting in that they could
only deal with small parts of these complex movements and sought to
reduce these complex movements to the level of the fairly straightforward,
regular movements that it had been so successful in describing.
In the 1960s, a new theory was proposed which sought to deal
specifically with complex movements. This theory has become known as
Chaos Theory (Gleick, 1988). Chaos theory concerns itself precisely with
those movements or behaviours the complexity of which is such that they
appear to be unpredictable. Further, even dramatic changes in movement of
these systems (for instance, as I write this, I note that literally over the past
fifteen minutes or so the weather has changed from sunshine to pouring
rain, to sleet, and back to bright sunshine) seem to be dependent in a highly
sensitive manner on alterations in conditions which are both numerous and
subtle. Indeed, so numerous and subtle are they that linear equations have
been shown to be both near-valueless and misleading. Chaos theory avoids
linear equations and, instead, rests on a far more complex geometrical
model known as Fractal geometry.
What is the point of this brief and highly simplified lesson in physics?
We have tended to employ notions derived from nineteenth-century physics
in order to understand and describe the general behaviour of human beings
and to predict it. Our notions of linear causality are expressions of our
attempts to predict through this model. But, as has been shown, the value of
this model of physics is restricted to regular, ordered behaviour. Does this
fit the behaviour of human beings?
Certainly, we would like to think so—and linear causality allows us to
do so. But are we such simplistically ordered creatures? Consider the
following example. Let us say that you decided to audio-tape a dinner-time
conversation between yourself and a friend. If you were to play this back,
you would likely be surprised to note how haphazard were the changes in
topic, mood, and general directional ebb and flow of the conversation.
Indeed, a transcript of the conversation would be much more ‘chaotic’ than
expected in that it would reveal both the art and artifice in staged and
televised encounters between characters.
Now if you and your friend had been asked ‘How did your discussion
move from topic A to topic B?’ the chances are high that some manner of
fairly simplistic linearly causal chain of events would be construed in order
to explain the movement of the discussion. But the audio-taped record
would likely reveal that, far from being so straightforward or linear, the
change came about as a result of several factors, which were both obvious
and subtle. In fact, it would be hard to argue that one specific factor
determined the change; rather, it would make more sense to view the whole
complex system and the innumerable and minute changes taking place
within it as influencing these ‘dramatic’(or noticeable) changes.
The conclusion here is that human beings are much more adequately
understandable when placed within a ‘chaos’ model rather than within a
‘linear’ model. We may have some resistance to this, however, because, in
acknowledging this fact, we would have to admit that changes and
movements in our lives are far more haphazard and difficult to predict than
we would like—or believe—them to be. With regard to the specific topic of
linear causality, we would also have to acknowledge both its limitations and
how it imposes a distorted and limited perspective on our experience of
ourselves as changing beings.
If nineteenth-century models of causality allow us to maintain the belief
that ‘If A, then B’, Chaos Theory models of causality are more akin to what
I believe to be the viewpoint expressed by the Algonquin Nation, which is
‘If A, then … everything.’
As such, it seems very likely that notions of human behaviour which are
dependent on linear causality are highly suspect. Nevertheless, during
therapy, clients are likely explicitly or implicitly to adopt these notions in
order to allow them to make sense of themselves and their relations with
others. While it is vital for therapists to respect these causal constructions,
their therapeutic value lies in what they reveal about clients’ beliefs—not
whether or not they have made accurate or inaccurate causal connections.
The ‘causality’ we impose on our lives expresses what we believe to have
been a necessary factor in our ‘becoming as we are’. If psycho-analytic
therapists persist in maintaining this questionable assumption, they will
only impose limits and distortions both on their model and, more
significantly, on the experience of their clients. Linearly causal perspectives
are important—not because they reveal ‘truths’ about individuals’
development, but rather because they reveal what individuals have come to
believe themselves to be and how they explain their becoming.
On further consideration, it can be seen that assumptions of linear
causality also rely on the view that the past is fixed or constant, in that it
does not change either in character or in content. Is this contention any
more feasible than the previous one?

B. A CRITIQUE OF THE PSYCHO-ANALYTIC VIEW OF THE PAST

When one goes back to the original ideas presented on this topic, what we
discover is that Freud himself reveals in his writings that he held a much
more complex position regarding the nature of the past than he is usually
given credit for. Indeed, a particularly pertinent paper by Freud entitled
‘Constructions in analysis’ (Freud, 1937b) has been discussed by Irvin
Yalom, who provides the following summary:

An analyst who is not successful in helping the patient to recollect

the past should, Freud suggests, nonetheless give the patient a
construction of the past as the analyst sees it. Freud believed that this
construction would offer the same therapeutic benefit as would
actual recollection of past material (Yalom, 1980:347).

As such, what Freud would seem to be suggesting is that whether the

constructed past event is or is not historically ‘real’ or accurate does not
matter; what is important is the process of construction—not the content
itself. For through construction the client is able to forge meaningful links
with a hypothetical past. This is a revolutionary stance for Freud to have
taken. In doing so, he opened the way for us to understand our notions of
the past as being essentially ‘interpretative’ rather than historically fixed or
real. The past, seen in this light, becomes a ‘plastic’ or flexible concept
open to re-evaluation and re-creation dependent on the current attitude and
behaviour of the individual who experiences it.
Let us consider this shift in stance more closely. What is being argued is
that we have far greater flexibility in constructing or interpreting the past
than we might have previously thought possible. At this point, an example
illustrating this contention might prove to be useful.

The fluidity of the past: an example

When I was ten years old, a teacher caught me playing with a pack of
‘bubble gum cards’ instead of doing the arithmetic exercise that she had set
the class. In order to teach me a lesson on obedience, the teacher took the
cards away from me and proceeded to rip them up before my eyes. I
remember walking home that day in tears since the teacher’s deed had
destroyed something I held to be of great significance; my whole world had
been seemingly irrevocably shattered by that incident. That day, and for
several months subsequent to it, I hated that teacher and all she stood for. I
saw in her the source of all that was unfair and wicked in the world, and
though no adult, my parents included, could understand or accept the great
degree of evil that was obviously contained in her act of ripping up my
cards, I most certainly could. At the age of ten, the event had been a
shattering cataclysm in my experience, one that would seemingly for ever
ring in infamy and whose consequences, so I believed at the time, would
remain to influence my life for ever.
Of course, looking at that incident today, some three and a half decades
later, I experience nothing of the powerful emotions I felt then. Indeed, in
the face of all the subsequent ‘cataclysms’ that have entered my life, the
event seems more laughable than life-shattering. In many ways my whole
stance towards the event, and the perpetrator of it, has changed
dramatically. Indeed, for many years I even forgot the event and its seeming
gravity and only ‘chanced’ upon it a few years back when I was searching
for an example dealing with the plasticity of the past.
Now as we can see from this instance, it becomes clear that the
remembered past is composed of two main variables: there is the content or
story element of the past—what occurred—and there is as well the affective
component, that is, the associated feelings and emotions, attitudes, and so
forth which imbue the event with its specific meaning in other words, how
the event is experienced. Now it is clear that while I am able to recall the
event with some degree of accuracy, and as such we can argue that the
‘story’ or content element of the past seems to have remained pretty much
the same, my stance towards it, that is to say my relationship to it with
regard to its emotional meaning and significance, has altered dramatically.
Why is this so? Well, it is not simply because other, more ‘cataclysmic’
circumstances have overwhelmed that one into relative insignificance, but,
more importantly, because I, as the person recalling the event, have changed
over time, such that my attitude towards the significance of ‘bubble gum
cards’ in my life has shifted greatly—so greatly in fact that the incident has
attained a quite different meaning for me than that which it had when I was
the ten-year-old child.
Equally, just as the ‘bubble-gum card event’ may have been presented
by me at the age of ten as being a milestone in my life which stood at the
forefront of my memory and to which I would likely have given centre
stage in the recounting of my history, and, by implication, which I might
well have employed as a means of presenting my identity, my sense of self,
to both myself and others, today, given this same task of historical
construction, I doubt very much that I would even mention it in passing—
assuming that I felt it significant enough even to remember. What this point
bears out is that our reconstructed past is always a selective process—we
could not ever begin to recount all the events in our lives, much less their
relational significance, simply because the task could never be completed.
Indeed, in a way, the task could never truly even begin since just to initiate
the description of the sum total of experience that occurred at the start of
writing this sentence would take me well beyond my life, possibly even
beyond a near-infinity of lives, to complete.
If this last point strikes some readers as a difficult notion to accept or
comprehend, the following exercise should clarify things. Let us say that
you are asked to write down all you experience at the moment you read the
word ‘Now!’ At first, perhaps naively, you might say that little has
occurred. But this seems so because a process of filtering incoming sensory
data and interpreting such has occurred. As discussed in the previous
section, psychologists tend to refer to this as ‘selective attention’ in that
only a minuscule amount of incoming data is being consciously attended to.
A useful, if far more simplistic analogy might be helpful here. Let us say
that for some reason you decide to audio-tape an interview with someone
else. When you play back the tape you might be highly surprised to hear
recorded not only the interview itself but all manner of extraneous noises—
such as the sound of cars going by, birds chirping, planes flying overhead,
and so forth—noises that you had failed to hear during the interview session
itself. The tape recorder picked them up because although it has a basic
filtering system in that it picks up noises within its auditory range, this
system is nowhere near as complex as that which our brain employs in
order to focus on or attend to selected stimuli. Basically, then, at the
conscious level, one picks up input stimuli that the brain is capable of
picking up and which are deemed relevant to the task at hand (which in this
case was conducting the interview). In the same way, the sensory-input
material that you remember as being part of the ‘now’ that you focused on
in the given exercise is only a small part of the full range of material that
your brain attended to in that instant of time. As such, it is entirely feasible
that if we were to have total access to the full range of sensorily available
material at the moment of our exercise, it would be so much that we might
never hope to record it all.
What are the implications of this with regard to the notion of the past?
Clearly, the remembered past also makes up an infinitely small number of
sensorily derived events that our brain has picked up over the course of our
lives. Further, even within the remembered events themselves, what is
consciously recalled is itself a minute selection of all the data contained
within that remembered event. As such, we are left with the conclusion that
the past—even at the level of its ‘content’—is itself a selective
interpretation of the complete past content that makes up that memory.
If we think about this further, we are likely to recognize that in a good
many instances of remembered events our focus point of recall may well
shift significantly such that where once, as in the ‘bubble gum card’
example, my main focus on the event might have been the images on the
cards that my teacher ripped up, in another instance in time the focus might
have shifted to the features of the teacher, or on to the title of the
mathematical exercise book that I should have been concentrating on, or on
the clothes I wore that day, and so forth. In each case, then, it is not the
same past event that I recall. While in a general sense the basic outline of
the story remains the same, in its focused-on details it is a different event
that is being created.
The pivotal element, of course, is the very being who recalls the event
in question, both in the manner in which the event is related and in terms of
the focus points that are emphasized, or which emerge in the reconstruction
of the memory. The past, then, can be seen as plastic and open to
interpretation in our current life make-up. While it may be the case that we
can recall with seeming accuracy any number of past events, even those
from the very earliest parts of our lives, the important element determining
both what is recalled and how it is recalled is the being who recalls.

The past as currently lived and future-directed

This conclusion is crucial to a more adequate understanding of the past for,
as it underlines, both the content and meaning of any remembered past
event hinge on the current view that the remembering being holds about
himself or herself. In this way, it can be seen that rather than influence or
‘cause’ our current thought and behaviour, the remembered past reflects the
current views we hold about ourselves. That is to say, our interpretations of
the past serve to validate our current understanding of ourselves. We
‘manipulate the past, shape and reshape it, so that it ‘fits’ who we believe
ourselves to be (or who we believe we must/must not, can/cannot be). The
past is so tied to the present that it is more accurate to speak of ‘the
currently lived past’ than of the past itself. For, as Freud himself seems to
have understood and implied in some of his writings, the past and present
are meaningfully associated with, and reinforce, one another, not because of
any inherent causally fixed relations but because the being who interprets
both the past and the present, and their relationship to one another, is quite
literally ‘substantiated’ (or made real) through those interpretations.
All of us, then, invoke interpretations of the past in order to define who
it is that we believe ourselves to be today, and in order to validate our
beliefs we further claim that this interpreted past is the causal influence on
who and how and why we are (as we experience ourselves to be).
As if this were not complicated enough, further consideration allows us
to recognize that as well as the relationship between the interpreted past and
the interpreted present, there is also the important matter of the role of the
imagined or desired future to take into account. For, just as one’s current
sense of self is validated through the interpreted past, so too does one’s self-
image contain within it assumptions, goals, purposes and wishes that are
directed toward one’s future. If the interpreted present ‘tells a story’ the
content of which is the interpreted past, then it is also the case that the story
contains elements of intent or purpose which are focused on the future.
Broadly speaking, then, any interpreted past event can be seen to be a
means of defining both who one currently believes oneself to be as well as
who one might wish to become at some future point in time.
If I return to my remembered ‘bubble gum incident’, I can ask myself
‘What does this remembered event have to say to me about who I believe
myself to be now?’ Perhaps it expresses my current concerns about power
and authority and their potentials for abuse. Perhaps, as well, it seeks to
express my concerns about myself as a figure now potentially far more like
the teacher in the remembered event than the child of ten. Whatever the
case, it can also be seen that the remembered event also expresses
something to me about my desired future goals or aspirations or direction in
life. ‘Look,’ it might say, ‘now that you’ve gained some power and
authority, however relative, how are you going to employ them? What do
you want to do with them?’ Or it might reveal some ethically based
aspirations. ‘Do you want to become like that teacher? No? Then what have
you to attend to?’
But let me take the argument further by extending the example. Around
two years ago, I learned that the self-same bubble gum cards that my
teacher destroyed have now become highly sought-after collectors’ items
whose worth runs to thousands of dollars in the American bubble-gum card
collecting world. What has this new information done to my remembered
event? Firstly, it has given it a new form of import. ‘If that blasted teacher
hadn’t destroyed those cards,’ I tell myself, ‘ I might still have saved them
to this day, and I would be able to make a substantial amount of money that
would allow me to entertain thoughts of the kind of holiday that, given my
present financial conditions, I could not otherwise contemplate.’
As such, the remembered incident now has a totally new focus from any
I might have had up until the time when this new information became
known to me. Not only have I reassessed the incident, I have basically
constructed quite a different meaningful past which once again has much
more to say about who I believe myself to be today, and the aspirations,
goals, and ambitions that I hold for the future, than it does about any
linearly causal process initiated by an ‘originating’ event.
Any remembered past event, then, can be understood to be a crucial
indicator not only of one’s currently interpreted self, but also of the future-
directed aims and purposes that that current self embodies. As such, it is far
more adequate to see the past as ‘the past as currently lived and future-
directed’ than to conceive of the past as a fixed and unchanging event-laden
moment in time.

Therapeutic implications
What implications do these various points have for dealing with accounts of
the remembered past in a therapeutic situation?
Clearly, we are faced once more with the realization that the
remembered past is not merely, or even principally, concerned with the past
per se, but rather is an important means of presenting one’s current view of
oneself as well as one’s view of the being that one imagines one will be (or
would like to be, or would like to avoid becoming) at a future point in time.
Equally, this view allows us to understand that the past does not stand in
a linearly causal relation to the being we are today, but, rather, informs both
therapists and clients as to the current beliefs that clients hold about
themselves in the present instance.
In this way, therapists can better understand that if there is a ‘fixedness’
in their clients’ remembrances of the past, it is not a fixedness that is about
prior events but rather is the means by which clients’ current needs to
believe that certain characteristics of their self-image have been ‘fixed’ can
be ‘proven’ correct.
So, for example, if I insist to myself that I can only be a being who
cannot learn to do mathematics, then I require the existence of past events
such as ‘the bubble-gum card incident’ in order both to confirm my sense of
self as one who cannot learn mathematics, and to ‘fix’ that belief so firmly
in that self-construct that it does not readily lend itself to challenge or to re-
appraisal. It is not the past event which has imposed this stance on me;
rather, it is my stance about who I believe myself to be which imposes a
fixed past memory of the event.
But what of instances when the past remains impervious to recall? What
if, as is not unusual, a client perceives the problem to be that a forgotten
past event must somehow hold the key to his or her current conflicts? How
is such an event to be understood in the light of what has been argued?
Once again, it is important to recall Freud’s own view on this. He tells
his followers that finding the actual past event is of far less import than
constructing a probable past that the client can accept and, in this way,
begin to make sense of his or her current situation (Freud, 1937b). In other
words, the therapist’s task is not to reconstruct a real, or objective, past, but
to allow the client to find a past that ‘fits’, or makes meaningful, currently
lived experience. In this sense, it can be seen that the client’s problem is not
truly about an unremembered past, but, rather, that the client cannot make
sense of issues or conflicts within the current beliefs relevant to his or her
present self-construct.
I am in agreement with Freud’s analysis, but I also hold deep
reservations about his suggestion that the therapist should construct a
plausible past event. For this latter decision bestows on the therapist
significant, and potentially destructive, powers. What right does a therapist
have to impose a past, no matter how plausible, on a client? Unfortunately,
many therapists continue to think that they do have this right—and the
consequences of such arrogance have become increasingly obvious of late
as in those instances where the most extreme ‘true believers’ of ‘repressed
memory syndrome’ appear to have manipulated and persuaded clients of
the ‘reality’ of past traumatic experiences that, upon investigation, appear to
have no historical basis.
But, putting aside the ethical issues raised by this, even from a practical,
or therapeutic, standpoint, it can be demonstrated that it is far from
necessary for the therapist to take such actions. The following example
should make this clear.
A client of mine, Alexander, was convinced that his inability to decide
whether or not to risk accepting a more challenging, but also more risky,
new job had to be linked to an unremembered past event, or series of
events, and that if he could but make this conscious, then he would know
what the source of his current conflict was and be able to resolve it. Instead
of trying to uncover the supposedly forgotten material, I asked Alexander to
explore and clarify for himself what it would mean to him either to take the
new job or to remain in his current one. In this way, over time, he was able
to confront and challenge his beliefs about the sort of person that each job
seemed to define for him and consider that in the light of both the person he
currently thought he was (or that he believed others saw him as being) and
the person he would like to be, and how each job allowed or prevented
these aspirations. In doing so, Alexander was able to note and assess not
only the gains and losses in his life which each possibility might provoke,
but also, and more significantly, he was able to give voice to fears he
currently held about how either of these options would force a change in his
current self-construct. Alexander’s inability to decide, as well as his
inability to find the hidden past, were expressions of a meaningful, if
unattended, alternative option: namely, that so long as he could remain
undecided he would also remain ‘himself ’, or as he was. Alexander was
faced with the fear of ‘losing himself ’, and saw that if he were to act upon
either option that feared event would become reality. Considered in this
light, we can see that his inability to remember an assumed key event was a
direct expression of a current conflict concerning his self-construct. To have
‘found’ that unremembered material, or to have constructed it, as Freud
suggested, might have enabled Alexander to decide whether or not to
change his job, but it might also have provoked far more serious psychic
conflicts since the issue of whether or not he was prepared to reconstruct his
self on the basis of his decision would not have been properly addressed.
As we have seen, then, while there is clearly an importance to be
attached to the examination of clients’ past experiences, that importance has
little to do with the discovery and acknowledgement of past causes as direct
sources of their present state. Rather, this examination provides the means
to explore what is being expressed about clients’ current experiences of,
and beliefs about, their present self-construct and its meaning with regard to
their future goals and aspirations.
The past is a creation—an important one, to be sure—as it is a vital
means of establishing those qualities that make us who we believe ourselves
to be, but it is far from the causal source point of such qualities and, in
itself, neither holds ‘the’ truth nor is a fixed point in one’s life.
Such conclusions have important implications for the therapeutic
process, not least because, as I have stated earlier, many clients believe that
the examination of the past is a worthwhile, even necessary, process in the
therapeutic relationship. As therapists, we must respect such beliefs and
accept that it is important for the client to believe in them—just as it would
be necessary, I believe, to accept a client’s beliefs in ‘little green men’. In a
general sense, it is essential for the therapist to believe that the client
believes in such; the only dangers that arise occur when the therapist
believes in such assumptions as ‘real’ truths. In other words, if the client
believes in the past as causal agent, then the therapist must accept that
belief system and work with it in order to ascertain both its meaning to the
client and its importance in providing the client with a sense of his or her
own current self-construct—so long as the therapist understands that what
he or she is exploring with the client is a deeply held belief and not
necessarily anything other than that.
Taking the stance of becoming the ‘discoverers’ or ‘creators’ of clients’
pasts prevents therapists from truly listening as adequately as they can to
them and, in the course of such, both hampering what therapeutic
possibilities may lie in the process and, worse, creating the conditions for
theory-led misuse.

4. TRANSFERENCE AND COUNTER-TRANSFERENCE

The related hypotheses of transference and counter-transference have been

seen by psycho-analytic therapists from Freud himself onwards as
necessary consequences of the therapeutic relationship which must be
‘worked through’ in order for therapy to be both successful and brought to
its termination. So prevalent have these notions become that many
therapists allied to other models of therapy have either explicitly or
implicitly accepted and employed them in their own practice. On the other
hand, some therapists have expressed on-going concerns both about the
validity of these hypotheses and of their effects on the therapeutic
relationship (e.g. Shlien, 1984; Smith, 1991). Ian Owen, for instance, has
recently argued that transference and countertransference provide the means
for therapists to disown the real and conscious aspects of the therapeutic
relationship. In addition, he has suggested that both terms are allusions to a
metaphor that seeks to explain how people misperceive and treat one
another and act in an immature and inflexible manner similar to that of a
child (Owen, 1993a).

A. DEFINING TRANSFERENCE AND COUNTER-TRANSFERENCE

Freud’s original conception of transference and counter-transference posited

that both were based on unconscious wishes emanating either from the
client (transference) or from the therapist (counter-transference) the
meanings of which could only be deduced by psycho-analytic theory.

Transference
When he first introduced the notion of transference in 1895, Freud tried to
express the idea that transference was a disruption in the relationship
between therapist and client brought about by the client’s‘ “false
connection” between the idea appropriate to some past, extra-therapeutic
situation and the analyst’ (Smith, 1991:26). In this sense, transference was a
hypothetical process whereby various emotions and attitudinal reactions
from the client’s past intruded on the present therapeutic relationship.
Initially, Freud felt that transference interfered with the therapeutic
process and had to be removed (Holmes and Lindley, 1989). Over time,
however, he changed this view and argued that ‘transference contains in a
living form the very difficulties in relationships that contributed to the
neurosis. He saw too that, alongside positive transference, there are also
negative feelings towards the therapist that are equally important to
analyse’ (Holmes and Lindley, 1989:127).
In its modern-day usage, transference has been generally defined as
something said to be displaced, projected or transferred on to another from
one’s past ‘prototypes’ and includes treating another, particularly the
therapist, as one’s mother, father, brother or sister. Counter-transference, on
the other hand, has been defined as any disruption of the therapist’s constant
attentive attitude and, rather than being restricted to the therapist’s
unconscious wishes alone (as Freud had originally maintained), has been
extended as a term to mean the whole of the analyst’s unconscious reactions
to the individual analysand—especially to the analysand’s own transference
(LaPlanche and Pontalis, 1985).
Translated into more readily understandable language, transference
refers to an unconscious process in which the client projects on to the
therapist both positive and negative qualities belonging to another
significant person in the client’s life and behaves towards the therapist as if
he or she was that person (Shlien, 1984). Transference is generally viewed
by psychoanalytic therapists as a necessary ‘ingredient’ of the profound
therapeutic relationship that has been formed.
The importance of transference for psycho-analytic therapists (and, very
likely, for a great many other therapists) should not be underestimated. As
David L. Smith has argued, it ‘is at the very heart of psycho-analytic theory
and technique. It is almost universally regarded—within the profession—as
an indispensable concept for understanding the analytic process … and the
analysis of transference is believed to be the most important component of
analytic technique’ (Smith, 1991:25).
Both the therapist’s and the client’s feelings of incongruity in the
relationship are often taken to be the first clue that transference has
occurred. Once the meaning of the transference has been deciphered, the
therapist can employ the therapeutic relationship to challenge the client’s
fixed negative interpretations of early experiences by fostering more
positive and accepting ones through the transference bond that has come
into being. Following this, the therapist can begin to reflect the patterns of
behaviour from which the transference originates back to the client so that
the insight to analyse and change behaviour is made available.
In this way, it can be seen that the popular view of transference as that
of the experience of ‘clients falling in love with their therapists’ is a serious
trivialization of the concept. The theory of transference argues that the
currently experienced feelings, thoughts, and behaviours that the client
directs toward the therapist ‘may be unconsciously influenced, coloured,
and distorted by earlier childhood experiences, especially those with
parents’(Holmes and Lindley, 1989:116).

Counter-transference
As some readers might have already surmised, counter-transference can be
understood as a complementary concept to that of transference in that the
term seeks to express the idea that during the therapeutic relationship the
therapist’s feelings, thoughts and behaviours towards the client may also be
influenced by unconscious wishes and fantasies originating from the
therapist’s childhood which now impinge on and distort the therapeutic
relationship. However, the concept of countertransference has also been
broadened and generalized to include the therapist’s ‘blind spots’—or
conscious emotional responses—towards the client. In becoming aware of
the influence of each of these distortions, psycho-analytic therapists believe
that they can be put to good use in aiding them in their understanding of
their clients since this awareness allows them to remain sensitive yet neutral
towards them (Holmes and Lindley, 1989; Smith, 1991).
General views of counter-transference suggest that it can be
distinguished as either neurotic or non-neurotic (Holmes and Lindley,
1989). Neurotic counter-transference is initially unconscious, and allows the
therapist’s personal psychic disturbances to be expressed in various ways,
including rivalry and competition with the client, idealized identification
with the client, experiencing inexplicable anger or sexual attraction towards
a client, and so forth. Non-neurotic counter-transference refers to the
therapist’s experience of overwhelming empathy (or deep entry into the
psychic world of the client) so that the therapist feels or behaves in ways
that are foreign to him or her but which accurately reflect, or ‘capture’, the
client’s conscious and unconscious experience (Holmes and Lindley, 1989).
Counter-transference makes it evident that the therapeutic relationship
can be highly emotionally laden and that therapists must be sufficiently
self-aware in order both to note their unnecessary contributions to this and
not to be overwhelmed by them so that they may become helpful, rather
than debilitating to the client. Counter-transference is viewed as always
difficult to deal with, and some psycho-analytic therapists have gone so far
as to suggest that a therapist’s confrontation with his or her counter-
transference is an heroic act since it demands a willing exposure to his or
her unruly (even dangerous) unconscious impulses (Strachey, 1934).
Finally, some analysts have argued that both transference and counter-
transference are likely to occur in all relationships that become involved,
intimate or intense—regardless of whether or not they are desired (Balint
and Balint, 1939; Sharpe, 1947).

B. CRITIQUES OF TRANSFERENCE AND COUNTER-TRANSFERENCE

Although both transference and counter-transference have become

generally accepted by a great many therapists, regardless of the model they
have allied themselves to, a number of important problems remain
concerning these concepts which need to be addressed.

General critiques
First, with regard to transference in particular, it is important to be clear that
Freud originally employed the term as a hypothetical unconscious process
designed to explain why it was that clients became emotionally aroused by
their therapists. As such, he was making an explicit distinction between the
observed phenomenon (i.e. the client’s emotional arousal) and the
hypothetical cause (i.e. transference). But many therapists today seem to
have missed this point such that transference appears to have become the
equivalent of the observed phenomenon and a confusion, or blurring, of
phenomenon and hypothesis has occurred (Smith, 1991). As such, it is
necessary to clarify that transference is not ‘proven’ by the appearance of
certain phenomena, only that these phenomena have been connected to, or
correlated with, the transference hypothesis.
Second, it is necessary to bear in mind that the first hypotheses
concerning transference related to its positive expression alone. But when
Freud began to encounter negative reactions to his words, he saw in these
the basis of what he subsequently hypothesized as being negative
transference. However, his sole basis for arguing the existence of the latter
was the evidence of the former and, similarly, it was on the basis of the
existence of these latter that Freud claimed the proven basis of the former!
If readers conclude that this would seem to be a decidedly strange, and
suspiciously circular, argument, they would be right!
Third, transference is commonly understood to be related to, or deal
with, clients’ inappropriate emotional responses. But this viewpoint
assumes that inappropriate emotional responses can be easily distinguished
from appropriate ones—an assumption that even some psycho-analysts
have questioned. Among them, Louis Chertok has concluded that, while
transference is a relevant principle, no current acceptable means exist for
distinguishing the responses associated with it from non-transferential
responses (Chertok, 1968). So, for instance, when as a trainee I expressed
disdain at my therapist’s interpretation that I was resisting him because of
unresolved conflicts with my father, was this (as he believed) transferential
disdain or (as I believed) accurately directed disdain?
In a similar fashion, Otto Fenichel wrote in 1941:

Not everything is transference that is experienced by the patient …

If the analysis appears to make no progress, the patient has, in my
opinion, the right to be angry, and his anger need not be a
transference from childhood—or rather, we will not succeed in
demonstrating the transference component in it (Fenichel, 1941:95).

Fourth, as D. W. Winnicott observed, the therapeutic relationship places a

great deal of strain on therapists, requiring them to avoid attempting to
gratify clients’ expressed desires towards them and to maintain a
professional stance. But one way in which therapists can alleviate this strain
is by interpreting these desires as instances of transference (Winnicott,
1965:72). In this way, the invocation of transference may be self-serving to
therapists rather than therapeutic for clients.

Shlien’s critiques
The above concerns have provoked a number of therapists to raise serious
questions about the whole notion of transference. In his important paper ‘A
countertheory of transference’, the person-centred therapist John M. Shlien
presented the argument that ‘[t]ransference is a fiction, invented and
maintained by the therapist to protect himself from the consequences of his
own behaviour’ (Shlien, 1984:153).
At first, this conclusion may strike many readers, especially those who
are also therapists, as being somewhat over the top. But if there is any basis
to Shlien’s assessment (and the quote from D. W. Winnicott given above
would suggest that there is), just how might the hypothesis of transference
serve to protect the therapist?
As an (admittedly extreme, but illuminating) example of how psycho-
analytic therapists have employed the hypothesis of transference to protect
themselves (or, alternatively, to make fools of themselves), readers might do
well to consider the following account taken from Janet Malcolm’s In the
Freud Archives (1984).
An analyst treated an elderly female client during the years before her
death. When she died, the client’s will revealed that she had altered it so
that, in gratitude for the analyst’s help, he had been bequeathed a substantial
amount of money. Concerned about the ethical issues raised by this, the
analyst informed the client’s lawyer that he could not accept the money and
expressed his desire to have it either returned to the other beneficiaries or
donated to charities. However, the husband of a relative of the deceased,
whose legacy had been negatively affected by the change of will, and who
also, himself, happened to be an analyst, formally objected to the probation
of the will and argued that the elderly lady’s analyst had exercised undue
influence on her through the ‘unconscious utilization of the transference’
(Malcolm, 1984:73). Having become embroiled in these legal manoeuvres,
the lady’s analyst now began to experience acute and disturbing
embarrassment, and, in dealing with it, ‘reinterpreted’ his client’s gesture of
gratefulness and affection as ‘an expression of her hatred of him—an
expression of the negative transference that had never been allowed to
emerge during treatment’ (Malcolm, 1984:73)!
The absurdity of this situation should not obscure its significance. In
order to deal with unpleasant circumstances, both analysts invoked the
hypothesis of transference (both positive and negative). But is this
invocation not significant evidence for Shlien’s contention?
Shlien suggests that what transference may actually be pointing to is the
imbalance of power in the therapeutic relationship. For, through its use, the
therapist alone becomes the person in the relationship who is able to declare
which emotional responses are appropriate and which are inappropriate.
Further, he declares, if the clients found themselves to be in contact for
probably the first time in their adult lives with a figure of authority (i.e. the
therapist) who expressed respect, concern, and care towards them and who
took the time to listen to their life-stories and treat such as being both
meaningful and significant, is it so surprising that they should experience
gratitude, deep trust, affection, love and fear of separation towards that
person? And, in the same way, if the clients had come to believe that that
figure of authority had offered respect and interest but, in fact, had betrayed
them by not believing their accounts, or siding with other versions of the
accounts, or misinterpreting them, would it equally be surprising if they
responded angrily or violently towards the therapist?
But by invoking terms such as positive or negative transference,
therapists are able to distance or exculpate themselves from such criticisms.
When one adds to this the fact that, just as nearly all the early therapists
were men, so too were the great majority of their clients women, it becomes
possible to consider that the reliance on transference may also have served
the dual purpose of diluting the ‘sexually charged’ atmosphere of the
sessions and protecting the therapists from accusations of sexual
improprieties by their critics as well as serving as a useful means of reining
in any ‘unprofessional’ thoughts or responses they themselves may have
had.
Placed in this perspective, it becomes sensible to consider whether there
exists a ‘climate’ within the psycho-analytic process itself which might
impose on the client various conditions and responses that can then be
‘explained’ in terms of the transference phenomenon. Perhaps, as one critic
has put it, ‘[t]ransference develops in consequence of the conditions of the
analytic situation and the analytic technique’ (Waelder, 1956: quoted in
Shlien, 1984:165).
When we consider the later addition of the notion of
countertransference, we are presented with a problem concerning
transference which psycho-analytic therapists seem to have left
unconsidered. For the very ability to recognize transference rests on the
assumption that the therapist is a kind of ‘blank screen’ to the clients’
expressions of emotional experience. But the hypothesis of counter-
transference no longer allows therapists to view themselves in this way. So,
once again, how can therapists be certain that their awareness of
transference is not, conversely, a misconstrued instance of counter-
transference?
Considered in this light, the following statement by Shlien deserves
serious attention:

Over many years, I have been perceived in many different ways.

Humble and proud, kind and cruel, loyal and unreliable, ugly and
handsome, cowardly and brave, to name a few wide-ranging
contradictions. Someone must be mistaken? No, they are all true.
This sense of my self … makes me hesitate before characterising
someone’s perception as distortion (Shlien, 1984:169).

Again, as Shlien argues, ‘transference is a shorthand term for qualities and

characteristics of human interaction. Any shorthand will fail to represent the
particulars of a unique relationship. Rather, the shorthand will obscure (in a
somewhat comforting way, to be sure) the realities of the relationship’
(Shlien, 1984:170).
Shlien suggests that the psycho-analytic therapeutic process (in the
same way as other therapeutic processes) not only permits but encourages
‘intimacy, privacy, trust, frequent contact, revelation of precious secrets’
(Shlien, 1984:171). In this way both the content of the revelations and the
process of revealing is a form of erotic, or erotically charged, activity.
Similarly, Shlien argues, the therapist’s attempts to understand, or ‘enter
into’, the client’s world-view is a form of ‘love-making’, whether or not the
therapist intends it to be such. Just as misunderstanding can be seen as a
form of ‘hate-making’.

Understanding, or being understood, or feeling that one is

understood affects us all in psychological and physiological ways.
The sensations originate in the situation and through the encounter
when it is experienced as being benevolent. It is not transferred or
inappropriate. In the same way, experiencing the fact that someone
else experiences you as having understood them also generates
affects and physiological events that are a direct consequence of this
real, immediate encounter (Shlien, 1984:172).

Considered in its totality, Shlien’s argument reveals a fundamental illogical

assumption in the hypotheses of transference and counter-transference.
Both, ultimately, rest on the view that

any response that duplicates a prior similar response is necessarily

replicating it. But similar responses are not always repetitions. They
appear to us to be repetitions because, in our effort to comprehend,
we look for patterns, try to generalize. There is breathing as a
general respiratory pattern, but my most recent breath is not taken
because of the previous one: rather for the same reason the previous
breath was taken (Shlien, 1984:174).

This last point, it seems to me, is of vital importance. For what Shlien is
pointing out (to rephrase his analogy) is that each breath we take, while
duplicating in significant ways previous breaths, has its rationale (its
meaning, if you will) in its current situation. In a similar fashion, the
emotional reactions of the client, or of the therapist, while in the therapeutic
encounter, may have resonances with past relations, but are meaningful (or
‘of ’) this current encounter. As such, to see them solely as transferential or
counter-transferential is, at best, limiting their significance (if not deeply
distorting it) because the meaning of the emotional reaction within the
current encounter is being either minimized or obscured simply by imposing
the terms transference or counter-transference on it.

C. RE-INTERPRETING TRANSFERENCE AND COUNTER-TRANSFERENCE

It seems to me to be evident from the various points just discussed that a

Freudian-derived view of transference and counter-transference cannot
distinguish examples of these hypotheses from their non-examples. Even
among those who accept these hypotheses, and who argue that they become
apparent to therapists through their personal experiences of training
analysis, there exist numerous disagreements both at the level of
identification of instances of either and at the level of what these instances
might mean. These disagreements suggest that the notions of transference
and counter-transference reveal entrenched positions (or sedimented
perspectives) taken by many therapists which may actually hinder their
understanding of their clients, of themselves, and of significant facets of the
therapeutic relationship. While therapists may be prepared to qualify and
correct the meanings of these hypotheses, they seem to be unwilling or
unable to question the basic concept itself. And yet, serious questions are
there to be raised. How, then, might one continue to accept and respect the
phenomena that are associated with these hypotheses without relying on the
hypotheses themselves?
I would suggest that rather than pursue the unsuccessful routes
discussed above, therapists might consider that all encounters always
contain elements of transference and counter-transference in that every
encounter expresses similarities or resonances with previous experiences in
our lives.
Within the psycho-analytic model itself, there is some partial agreement
with this view. Melanie Klein, for example, theorized that transference
should be viewed as a component of every act and encounter in a client’s
life and should not be viewed as a singular outcome of the therapeutic
process (Klein, 1952). However, Klein’s stance creates more problems than
it resolves since she advocates this interpretation of transference in order to
validate her own ‘brand’ of psycho-analysis which hypothesizes a number
of innate, fundamental ‘unconscious phantasies’ which originate during the
earliest part of human life and which deal primarily with issues of sexuality,
destruction and reparation which the therapist must interpret from the
client’s conscious statements.
The following example, summarized by David L. Smith from the work
of the Kleinian therapist Hanna Segal, should clarify this idea:

Segal recounts how a candidate opened the first session of his

training analysis with the announcement that he wished to obtain a
psychoanalytic qualification as rapidly as possible. He then went on
to mention some digestive troubles that he had been experiencing
and then, in a different connection, mentioned cows. Segal promptly
interpreted this, informing her analyzand that the cow represented
her analyst, and that he wanted to empty her greedily of her
‘analysis-milk’ in the minimum time possible (Smith, 1991:44).

This is fascinating as an interpretation, but it is also seriously flawed in that

it requires an act of faith for anyone to accept its validity. For, as Smith
points out, the basis from which the transferential interpretations are made
rests on the prior assumption of unconscious fantasies. But these, in turn,
are assumptions ‘proof ’ of which is determined through the therapist’s
interpretations. As such, the theory is circular, self-validating and
unfalsifiable (Smith, 1991).
If we pursue the idea that any interaction contains within it the ‘echoes’
of all other interactions that one has engaged in elsewhere and with others,
it becomes evident that therapists would not be able to distinguish certain
specific ‘echoes’ as ‘transferential’ or ‘counter-transferential’. Indeed, any
claims to this ability would be open to counter-claims of unnecessary
mystification of the therapist’s skills and knowledge, and would reveal that
such distinctions simply serve the therapist’s interests rather than have
value or validity for the client. On the whole, therapists seem reluctant even
to consider this possibility. Indeed, when I made a similar point at a
workshop examining the notion of transference, I was met with immediate
protests about the impossibility of my claims and the evidence of an over-
sceptical closed-mindedness on my part. And yet I would suggest that,
given the unresolved problems with the hypotheses of transference and
counter-transference, such a point of view is at least as tenable as those that
accept the hypotheses and is deserving of serious consideration simply on
grounds of logic.
But what is so special about these hypotheses such that so many
therapists of diverse orientations seem unwilling to let go of them? I would
argue that it is precisely the demystificatory nature of the suggestion which
makes it so difficult for some therapists to consider it seriously. For if they
were to allow themselves to ponder this option it would force them to
acknowledge the centrality of the current therapeutic encounter and that
what is expressed and experienced within it has as much to say about the
existing relationship between therapist and client as it does about any other
in their, and their clients’, past encounters.
Invoking the notion of transference and counter-transference allows a
significant shift in the nature of the therapeutic relationship such that the
focus of interest and emphasis is moved on to other relationships. In
emphasizing these, therapists allow themselves to step aside from the issues
within the existent relationship and to minimize their involvement in the on-
going process.
What is being suggested is that there is sound logical and therapeutic
reason not to allow the correlated past experiences to swamp the meanings
contained in the current encounter. Rather, what the therapist should seek to
maintain is an attitude that gives equal value and significance to resonating
elements (rather than viewing one as being the substitute of the other) so
that a more adequate meaning for the current experience can be gained and
understood as an expression of both the client’s and the therapist’s current
relationally construed experience of themselves and each other.

An alternative perspective on transference and counter-transference

In this way, the argument being presented inverts the significant aspects of
the hypotheses of transference and countertransference in that the
resonating elements originating in past experiences are seen to be
significant in that they clarify the meaning of current experience and the
current self-construct—not the other way around.
Some time ago, a client, Nick, who was himself a trainee in therapy,
came to a session and after some twenty minutes started to show increasing
signs of tension and discomfort. Eventually, he began to express what was
bothering him, and, in doing so, directed some very angry words towards
me. I was seeing Nick in my office at home and, as he came for his twice-
weekly sessions in the afternoon, when I was usually free, I would be
waiting for him at the entrance of the house and, on hearing the sound of
the gate being unlatched, I would open the front door in greeting. On this
particular day, however, for various reasons, I had had to attend to a number
of last-minute matters so that when Nick arrived he was not instantly met
by me but, instead, had to ring the door-bell. Now here he was, furious with
me for not having enacted our ‘ritual’ and searching out a significant
meaning for this event. Placed within the context of the hypothesis of
transference, I, as a therapist, could have taken this to have been an instance
of negative transference and sought to assist Nick in refocusing his anger on
the ‘correct guilty party’. The alternative to this, which was the approach
that I pursued with Nick, was to remain focused on his anger as it was being
directed towards me and explore it as it was being manifested rather than
seek to understand its latent significance. In so doing, through clarification,
Nick began to express not only his current feelings as directed towards me,
but also those feelings that ‘resonated’ with his current ones and which had
been focused on others in his past (in particular, his mother). As such, a
connection could be made between his current experience and past
experiences, or between his relation to me and his relation to his mother.
But, in doing so, one relation (that of Nick to his mother) was not
interpreted as being the ‘cause’ of his current supposedly transferred
feelings towards me, nor was it allowed to ‘swamp’ the other on the
theoretical basis that it was the more significant relationship. Rather, we
were able to move back and forth between these relationships, exploring
their similarities and differences and their meaning to Nick. By taking this
clarificatory stance, I was able to listen to Nick’s statements about either
relationship (i.e. the one with me and the one with his mother) and
challenge him to explore those statements from the standpoint of both
relationships. So, for example, when Nick mentioned that his mother had
always given the impression that she would do what he asked, but had
actually rarely fulfilled his wishes, thereby leaving him with a sense that he
could not trust her, I was able to challenge this statement in the light of our
relationship by saying: ‘And so when I give you the impression that I will
be trustworthy by being at the door, and then fail to be there, it leaves you
with the feeling that I may not fulfil your wishes either—though I might
seem to pretend to.’ Equally, when Nick expressed that he’d felt that
through my act of omission I was letting him know that I was becoming
bored with him and wanted to end our sessions, I was able to challenge this
by getting him to clarify whether or not he’d felt that his mother had held
similar feelings towards him.
But it is important to be clear that this kind of exploration can only take
place if therapists are willing to engage with their clients and recognize that
their presence is not only as a representative or transferential other, but that
they are the other in the current encounter. And, in being so, their words,
their behaviour, and their presence are at least as ‘real’ and significant as
that of any ‘other’ whom the client brings from his past encounters. Indeed,
following the view of the past discussed earlier, it can be argued that the
‘others’ from the client’s past are being employed to express issues
concerning clients’ experiences of their current relationships—including, of
course, those with their therapists.
The same process can be seen to account for those instances of counter-
transference which therapists may experience during therapy. For example,
during my therapeutic encounters with Nick, it became apparent that our
lives ‘parallelled’ one another’s in differing ways and that a number of
issues and conflicts raised by Nick, and the manner in which he understood
them, bore similarities with concerns—both past and current—in my life.
While these were, to some degree, useful to me in my attempts to enter
Nick’s world-view as expressed through these issues, it was equally
apparent to me that I must also be cautious in not assuming that our
experiences and views were one and the same and, thereby, ‘swamping’
Nick’s world-views with my own.
Instead, what I could—and did—do was to ask myself: ‘What is it about
this current encounter with Nick that is provoking me to consider and focus
upon these parallels in the particular way I am considering and focusing
upon them now?’
In other words, while acknowledging the ‘resonances’ being evoked,
rather than perceiving them as instances of ‘countertransference’—which
would have led me away from the current encounter and which would have
placed Nick in the role of my ‘transferential other’—I was able to stay with
the current encounter and treat the resonances as they were being
experienced as being possible insights or cues that emerged from my
attempt to ‘enter’ Nick’s world-view and which were, therefore, of potential
worth in my gaining a more adequate sense of what might be implicit within
Nick’s explicit statements.
For instance, at one point during a session, Nick began to speak of how
grateful he was feeling towards me for having taught him to see certain
aspects of himself in a manner that had greatly simplified his understanding
of himself and how he related with others. As I attempted to gain a better
sense of Nick’s experience of himself as he told me this, I was struck by a
sudden memory from my childhood. On my first day of school, I was being
taught to write the number 8 by drawing two circles that ‘met’ one another.
As it happened, I had already been taught by my parents how to write an 8
properly and I began to do so. When the teacher saw me doing this, her
response was not one of praise (as I’d expected) but rather of anger. She
wanted me to ‘unlearn’ what I already knew in order that she could ‘teach’
me to do something that was more ‘primitive’ than what I was already
capable of doing. The emotions this memory provoked were of deep
confusion and resentment. Why did I have to pretend I didn’t know
something I already knew in order that some idiotic teacher could convince
herself that I had learned something from her? Why did I have to please her
at the cost of a lessening of my own self-worth? Now, sitting across from
Nick, I found myself experiencing a great deal of anger.
Seen from the standpoint of counter-transference, Nick had become my
‘counter-transferential other’ in that he’d somehow ‘represented’, through
his words, my long-ago nemesis. In doing so, according to this hypothesis,
he’d provoked some ‘unruly’, insufficiently analysed childhood conflicts
within me which I should ‘take away’ and scrutinize. In following this line
of thought, my evoked memories had little to do with my current
relationship with Nick except insofar as it was through ‘Nick as
representative of my teacher’ that I had been made aware of issues that,
while affecting this current relationship, were not really part of it.
The alternative view being proposed would take quite a different
perspective which would—did—have significantly different consequences
for the current encounter. This view takes into consideration the possibility
that my memory was directly relevant to the current encounter in that it
might have been my way of conceptualizing that which, in my attempt to
‘enter’ Nick’s world-view, I had grasped as being ‘implicit’ within Nick’s
explicit statement to me. In other words, when Nick told me about how
grateful he was, was there an aspect to his gratefulness which also revealed
a sense of anger similar to what I remembered experiencing from my
encounter with my teacher? This is not to say that Nick did not feel grateful,
but, rather, that he might have felt both grateful and angry.
I was able to test this possibility by putting it to Nick that I appreciated
his positive statements and also wondered what he was telling himself when
he told me how grateful he was. In this instance, Nick’s reply was that he
was telling himself that he had to be really stupid not to have figured things
out for himself rather than have to rely on me. The following brief dialogue
took place:

‘So, Nick, does that mean that I’ve had a role in your making yourself feel
stupid?
‘Well … if you put it that way.’
‘Do you put it that way?’
‘Yeah … I guess I do.’
‘So, is this something general? “When I feel grateful to people, I make
myself feel stupid”?’
‘Yeah … I guess … Well, not all people. Just some people.’
‘Which people?’
‘People who think they know me better than I do.’
‘Ah … does that mean that you see me as someone who thinks he knows
you better than you know yourself ?’
‘Yeah … Sure you do. You’re supposed to, anyway!’
‘And if I do … What’s that say about what’s going on here?’
‘I don’t know … It’s confusing. Like, sometimes it feels like we’re two
adults talking about me. And then, sometimes, it feels like you’re the adult
and I’m a child.’
‘And it’s when you’re feeling like a child that you feel grateful and stupid?’
‘Yeah. Sometimes you’re just clever and you say something that I hadn’t
thought of before. Then I just feel grateful. But other times, you get ‘clever-
clever’, you know? And you say things that I know already but I wasn’t
ready to talk about yet. Then I feel grateful and stupid.’
‘And like a child.’
‘Yeah.’
‘So, when I’m ‘clever-clever’ you feel like a child … who am I like?’

In this way, that which could have been seen as merely ‘counter-
transferential’ takes on quite a different perspective and allows the focus to
remain on the current encounter rather than lead it away from it.
Nevertheless, it is evident that there exists a risk in this perspective in that
all such ‘resonances’ must be treated with caution by the therapist and, if
presented to the client, must be hesitant or ‘invitational’. A further risk must
also be mentioned: in order for therapists to adopt this perspective, they
must also be willing to accept their clients’ statements about them—
whether positive or negative—non-defensively in order that they can
explore with as much honesty as they will allow themselves those
potentially significant ‘resonances’ which the encounter evokes.
This re-interpretation of the hypotheses of transference and counter-
transference promotes a fundamental shift in viewpoint as to the
significance of the therapeutic relationship. For if therapists were to let go
of the more commonly held assumptions regarding these hypotheses, they
would find themselves very much more experientially ‘in’ the therapeutic
relationship. At the same time, the adoption of this stance opens therapists
to direct confrontations not only with the strengths and skilful expertise
they might bring to the relationship, but also to their weaknesses and
failings. Further, it confronts them once again with the power contained in
the theories they adopt and employ—and whose main interests that power
may serve.

5. INTERPRETATION

A. THE ISSUE OF INTERPRETATION IN THERAPY

The previous discussions on the unconscious, the past, and

transference/counter-transference serve to demonstrate the implications and
consequences that can occur when therapists fail to see beyond their
theories, or employ them in ways that emphasize the mystificatory aspects
of their role and authority in the therapeutic process.
Equally, all the points discussed implicitly address the important issue
of interpretation in that all the hypotheses discussed are definitionally
reliant on this therapeutic ‘skill’. If they have each been found to be
problematic or open to differing analyses, then these alternatives arise out
of the uncertainties encountered through interpretation. And yet,
interpretation is a central therapeutic skill, and not only for the psycho-
analytic model. What then can be done with the problem of interpretation?
In the first instance, it must be acknowledged that to assert that a
therapist (or anyone else for that matter) can claim to engage in any form of
dialogue with a client which is free of interpretative variables would not
only be a false claim, but also an absurd one. In an important sense, from a
mental standpoint we can do nothing but interpret. I have argued this
position extensively elsewhere (Spinelli, 1989) and will discuss it more
fully in Part 5. This view can be seen to hold great significance in the
therapeutic enterprise. For within this specific instance, the therapist’s aim
of ‘entering the world-view of the client’ (in order to understand it, ‘reflect
it’, ‘interpret it’, or whatever) can also be seen to be a project that cannot be
fulfilled in any final or complete sense. Therapists, like anyone else, place
any number of assumptions and biases (be they personal, sociocultural,
theoretical or whatever else) on their experience or understanding of their
clients which cannot be removed or avoided and, as such, they can only
hope to arrive at more or less adequate approximations of their clients’
experience. Clearly, then, therapists can do nothing but interpret their
clients’ inner worlds as expressed through their statements and behaviours.
This somewhat over-simplified contention should, nevertheless, make
clear that the questions and issues surrounding interpretation in therapy do
not focus on the argument of whether a therapist should or should not
interpret, but, rather, are concerned with how (or what kind of)
interpretations can be made, and which manner of interpreting will be most
beneficial and clarificatory both to the client and to the therapist’s aim of
gaining an increasingly adequate understanding and experience of that
client’s self-awareness in relation to the issues and conflicts being
confronted.
I would suggest that one way of clarifying categories of interpretations
lies in determining whether they are analytically or descriptively focused.

B. ANALYTIC AND DESCRIPTIVE INTERPRETATIONS

Analytic interpretation
An analytical interpretation seeks to go behind or beneath the presented (or
‘manifest’) material contained in a statement so that its hidden (or ‘latent’)
meaning may be ascertained. For instance, a client’s statement that ‘I am
terrified of rats’ may be analytically interpreted as meaning that the client is
expressing in a disguised fashion some form of antagonism or revulsion
towards a sibling, or even towards the therapist. The ‘manifest’ statement
therefore is understood to be a disguised expression of a ‘latent message’
which, for any number of reasons, the client is unwilling or unable to
express in a direct fashion. Analytical interpretations, therefore, place on
therapists the superior knowledge (gained through their training) that allows
them to understand the ‘true’ or ‘correct’ meaning behind their clients’
statements with which, at some point in the course of therapy, they will
confront them. In relation to this last point, however, it must be said that
some intriguing research evidence drawing on transcripts of analytic
sessions from the Tavistock Clinic revealed that it was impossible to arrive
at criteria for determining the ‘truth value’ of particular interpretations
offered by analysts (Farrell, 1967).
In any case, this avowed ability to ‘see through’ clients’ manifest
statements and motives is characteristic of the psychoanalytic model (and
several other models of therapy). And the assumptions contained within the
hypotheses of the unconscious, past influences, and transference can be
understood to be essential ‘tools’ for the accomplishment of this task.
At the same time, analytical interpretations place therapists in a position
of great power since they rely on their abilities to understand and reveal the
hidden meanings in their clients’ statements and behaviours before they are
consciously acknowledged by the clients themselves. Indeed, the psycho-
analytic hypothesis of clients’ resistance (or unwillingness to accept the
truth of the therapist’s interpretations) only makes sense when placed within
these presuppositions. But all of this also endows therapists with the ability
to know ‘the truth’ and, in this way, they become ‘truth bringers’ to their
clients who, in turn, must rely on and accept their offerings in order to
ameliorate their condition.
In this fashion, the therapeutic relationship that is based on analytic
interpretations fosters the client’s dependence on the therapist and comes to
resemble a relationship such as might be seen between parent and child.
While psycho-analytic therapists might claim the inevitability of this and
thereby argue that their theories have been validated, it remains to be asked
whether, instead, what has been done is to set up the conditions for self-
fulfilling prophecies to be enacted.

Descriptive interpretation
A descriptive interpretation, on the other hand, retains its focus on the
manifest material and seeks to extract the meaning of that material to the
client by engaging the client in a descriptively focused process of
clarification wherein the manifest material may be ‘opened up’ to mutual
investigation. This might be done, for example, by focusing on various
elements contained in the manifest material and considering what they
express to the client about his or her currently lived experience, what they
reveal or imply about his or her self-construct, relations with others, and so
forth. In this way, a descriptive interpretation of the statement ‘I am terrified
of rats’ might focus on the clarification of such elements as: what the
experience of ‘being terrified’ is like for the client; what its meaning is in
relation to his or her self-construct; what the client thinks and believes
about others’ views and attitudes towards his or her expression of ‘being
terrified’; what views and assumptions the client holds towards ‘rats’; and
so forth. While this descriptive process might well lead to conclusions
similar to those derived from analytic interpretations, it might equally guide
investigation to quite different ones. For example, it might be discovered
through descriptive analysis that the client finds rats to be attractive and
lovable creatures and that the issue has more to do with the experience of
‘being terrified’ of them than it does about the animals themselves.
Alternatively, in describing the experience of ‘being terrified’, the client
might clarify that this is a generalized experience in his or her relations with
others.
In other words, descriptive interpretations ‘stay with’ the manifest
material. In doing so, they restrain therapists from searching out its hidden
meaning from a theory-led standpoint. Nevertheless, it remains the case that
interpretations are being made by the therapist. Firstly, because the therapist
makes decisions about which elements in the client’s material seem
worthwhile clarifying. And secondly because the therapist must at some
point make assumptions about the client’s descriptions as being ‘good
enough’ approximations of the client’s unique and not fully shareable
world-views.
Nevertheless, while it must be acknowledged that descriptive
interpretations still place therapists in positions of power, it is a
qualitatively different type of power to that assumed by analytical
interpreters, not least because they avoid assumptions of therapists’ theory-
based independent accessibility to the underlying meaning and truth of
clients’ statements and behaviours.
Rather, such meanings are seen to emerge from the descriptive process
and, even then, remain only partially available to therapist and client alike.
Indeed, in the descriptive process meanings always remain incomplete and
open to further elucidation and are continually placed in the context of
current experience rather than being seen as fully revealed and determined
regardless of time and circumstance.
While descriptively focused therapists are by no means passive
‘reflectors’ in their clients’ process of elucidation (since it is evident that
therapists direct clients to examine and clarify certain selected elements in
the manifest material), the rationale for such directions and the manner in
which such directions are given reveal a distinctively different focal
emphasis to that of analytical interpreters. For while the latter rely on their
theoretical assumptions to lead them to the assumed latent material which
they will subsequently analyse on the basis of their theoretical formulations,
the former’s directions are principally governed by their aim of ‘entering
into’ the meaning-world of their clients so that their assumptions and
theories concerning their current self/other relational constructs can be more
adequately exposed to clarificatory examination.
Nevertheless, it remains the case that while the descriptive model may
minimize many potentials for misuse of therapeutic power which are
inherent in analytic interpretations, all instances of descriptively focused
interpretations place a certain degree of directive power on therapists which
cannot be dismissed or disregarded.
This inescapable conclusion clearly demands descriptively oriented
therapists to address the basis on which their decisions are being made.
Clearly, they respond to certain cues, either from their clients’ statements or
from the manner in which these statements are made, which they believe
might indicate something of import. But this, in itself, would imply that
they are active interpreters, and, as such, are pursuing some manner of
hypothesis or theory-derived stance in their dialogues with clients, even if
these are far more flexible and open to clients’ rebuttals or rejections than
the theory-led stances of analytically oriented therapists.
It must be concluded, therefore, that all therapeutic encounters, no
matter how client-concerned they may be, are open to potential misuse or
abusive influences by therapists. I am well aware that this judgement may
be employed as ‘ammunition’ by critics of therapy; nevertheless, it would
seem to me to be of greater benefit for therapists and clients alike to
acknowledge the ‘givens’ or limitations of therapeutic encounters and to
strive to develop approaches that are more adequate in their recognition of
therapists’ influences and powers so that they may better avoid inordinate
abuses, rather than argue that, until such time that the impossible occurs and
a ‘perfectly safe’ form of therapy comes into being, one should forestall the
continuance of ‘imperfect’ therapeutic encounters regardless of the
therapeutic benefits that might be derived from them.
Therapy, like all other investigative approaches, may be incomplete and
approximate. But it can, nevertheless, inform and enlighten. The
philosopher Martin Heidegger suggested that it is fundamental to the make-
up of all human beings that we ‘never arrive, but are always only “on the
way”’ (Heidegger, 1962). This view, taken in a wider context, strikes me as
a particularly apt summation of all attempts at human enquiry and
clarification—therapy included—in that they, too, ‘never arrive, but are
always only “on the way”.’
This stance, for me, defines the notion of ‘more adequate’
interpretations in that it stresses the attempt to remain open to increasing
possibilities of meaning and significance rather than seeking out a final and
fixed ‘truth’. It seems to me that all those encounters (therapeutic or
otherwise) which strike us as being special and significant to our
understanding of ourselves are imbued with an ‘openness of interpretative
possibilities’, just as it is through these encounters that we are reminded that
‘whatever we might think, it is more than that’.
That interpretations are expressions of power cannot be disputed, but
power is not in itself a problem, just as interpretations are not in themselves
problematic. Rather, what problems may arise can be seen to be related to
the manner in which they are employed. Descriptively oriented
interpretations, as employed in therapy, allow a greater possibility for the
recognition that both therapists and clients wield power, and while the
power each wields may not be the same, or even equal, nevertheless
possibilities exist which allow power to be employed to enhance the
potentials of therapeutic dialogue. It is this very shift away from
competitive and towards more co-operative expressions of power which
ultimately distinguishes descriptive interpretations from analytic ones. It is
this self-same shift, I would argue, which should be the aim of all
therapeutic discourse.

6. CONTRASTING CASE STUDY EXAMPLES

Since the psycho-analytic model of therapy, perhaps more than any other,
contains significant issues that permeate much of therapy and, as
pertinently, public views of therapy, the discussion of two actual case
examples—one psycho-analytic, the other from my own practice—should
enable readers to understand in a more concrete fashion how the
assumptions discussed and criticisms made of this model provoke quite
differing approaches to, and interactions within, the therapeutic encounter.

A. AN ANALYTICALLY FOCUSED CASE STUDY: ‘A CHILD LEADS THE WAY’

I will begin by summarizing a case study by Patrick Casement, a well-

known and highly respected psycho-analytic therapist and training analyst,
which can be read in its entirety in Casement’s text Further Learning from
the Patient (Casement, 1990). I must also state my indebtedness to one of
my students, Ms Imogen Smallwood, for first pointing out this case, and its
intriguing implications, to me. I must also state at the outset that my
decision to focus on this study is partly based on the high regard I hold for
its author, not least because he seems to be far more willing than other
psycho-analytic colleagues to expose his approach to therapy to critical
analysis both by himself and by others. Although, as will become apparent,
I have significant reservations about many of the assumptions and
interpretations he brings to the case discussion, I hope that these will be
read as constructive attempts to make plain the differences in approach
discussed above, rather than as destructive attacks on either the psycho-
analytic model or the author of the case study. I am very much in favour of
increased dialogue between representatives of differing models and would
hope that my comments will be read in this spirit of respectful airing of
differences and agreements.

The case
Patrick Casement’s case presentation ‘A child leads the way’ (Casement,
1990) begins with a number of important remarks by the author. He informs
his readers that his encounter with the six-and-a-half-year-old girl he names
Joy was the first analytic work he undertook and that he wishes to discuss
the case because it was through Joy that he learned of the importance of the
therapeutic setting as a means of providing clients with the space to
verbalize their anxieties, and, as significantly, that he was able to overcome
his reluctance to carry out his own analytic interpretations (rather than rely
on his assumptions of what other analytic therapists might say) so that Joy
could begin to communicate to him her own understanding of what she
required. The case presentation itself focuses on the first five weeks of his
regular sessions with Joy which, initially, were on a five-times-a-week
basis.
Joy was referred to him by her mother’s own analyst, who
recommended Casement as a ‘reading teacher’ who could also attend to
Joy’s ‘psychotherapeutic needs’. Although Casement accepted the
invitation, he acknowledges his own strong reluctance to take on a
therapeutic relationship with Joy on the sensible grounds that he had not
been trained to work with child clients. (Nor, it must be said, had he trained
as a reading teacher.)
Even so, Casement admits, he had been recently stimulated by his
reading of Melanie Klein’s analysis of a child client (Klein, 1961). Klein,
Casement concluded, had managed to provide the boy ‘with a symbolic
language through which he could, eventually, communicate deep anxiety or
unconscious phantasy with a possibility that this could be understood by the
person who had been teaching him this language’ (Casement, 1990: 32—3).
This passage holds the key to Casement’s approach throughout the case
study. Readers should note, however, the circularity of thought in Klein’s
argument. For if she is teaching the language to the child, how could she
not understand it? Surely the question is more whether the boy had
understood it—or, perhaps, that he had understood what his teacher wanted
him to understand.
In any case, Casement decides that he will not make any interpretations
with Joy and, instead, will allow her to think in a relatively unrestrained
manner.
Joy was the middle child of three, and the only daughter. According to
what her mother’s analyst told Casement, Joy’s mother was experiencing
problems in accepting and demonstrating affection towards Joy because she
was a girl. Soon after her birth, Joy had been passed on to a nanny.
Although her mother engaged in minimal physical contact with Joy, she
was seen as being over-indulged and was allowed a great deal of freedom to
do as she pleased. In contrast to this state of affairs, both Joy’s brothers
experienced a warm and affectionate relationship with their mother; indeed,
the younger child, who was two years old, was under the direct care of his
mother.
Casement initially met Joy’s parents at their home around a fortnight
before Christmas and received further details of Joy’s schooling and her
reading difficulties. At this same interview, he was informed by Joy’s father
that she was ‘a very sexual child’ (ibid: 34) who behaved quite seductively
towards him. In order to make Joy feel special, and in order to make up for
his being away from the family a good deal of the time owing to his work
commitments, Joy’s father had begun to take Joy away to the family’s
seaside home over the weekends—an experience which, he claimed, Joy
appreciated a great deal. In addition, Joy’s father expressed the hope that
Joy would ‘fall in love’ with Casement and, in so doing, learn to read for
him. Finally, the parents informed Casement that the family poodle, Polo,
was likely to have puppies in the spring as she had recently been mated
with a ‘boyfriend poodle’. It was agreed that Casement would meet Joy
every weekday morning during the week before Christmas and less
frequently following the holidays.
On the morning of their first meeting, Casement is met by Joy’s mother
who leads him to the drawing room which he describes as ‘huge (for
purposes of play-therapy) … oppressively clean and tidy and respectable’
(ibid: 34), but because of the ambiguity of his role he feels unable to ask
that their meetings be held in a more suitable room.
At last, left alone with Joy, Casement unpacks his bag and reveals,
along with various items of remedial reading material, some coloured felt-
tip pens, plasticine of various colours, a scribbling pad, scissors and sticky
paper, and informs Joy that although they will eventually get around to
playing some reading games, for the present he wants her to play with
whatever materials she wishes. Choosing some brown-coloured plasticine,
Joy declares that she wants to make a figure of Polo the poodle. At this, she
proceeds to shape ‘a fat sausage from which she pinches legs, head and tail’
(ibid: 35).
Noting that it is a good likeness of a dog, Casement then comments in a
somewhat leading manner: ‘Polo is rather fat, isn’t she?’ (ibid: 35). To
which Joy responds that of course she is because she went away to stay
with Gonzo the boy poodle and Joy’s parents have informed her that she
will have puppies.
Bored with the poodle, Joy begins to make a model of her older brother
who, she declares, is almost as big as Casement. Again, somewhat
leadingly, but explaining to his readers that he wished to give Joy
‘permission to be more explicit about sexual differences because of the
apparent discrimination against her by her mother’ (ibid: 35), Casement
asks how they (i.e. Joy and Casement) could tell that the figure was a boy,
and urges her to show him. In response, Joy makes a long thin sausage,
looks at her teacher, then flattens it in a manner that Casement describes as
‘mischievous’, and, announcing that this is her brother’s school cap, she
lengthens its peak. At this, Casement replies that her brother has a large
peak. Telling him that this is so he can keep the sun out of his eyes, Joy
proceeds to make another ‘thin sausage’ which, after some initial hesitation,
she squashes into the shape of a satchel. Then, repeating her movements,
she makes still another ‘sausage’, looks up and down the figure’s body, and
then places it inside the satchel announcing that this is her brother’s ‘big
pencil’. Finally, shaping a lump of plasticine, and ‘after more hesitation and
“knowing looks”’ (ibid: 35), says that this is her brother’s ink-pot.
Having now grown bored with playing with plasticine, Joy begins to
draw her mother with Polo beside her. Adding ‘rain’ dots to her picture, she
then draws her father first with an umbrella and then with a satchel,
followed by a black sun, and, finally, her brothers. While drawing, she tells
Casement that she will reveal a secret to him which he mustn’t reveal to
anyone else, the secret being that she has hidden a telephone under a chair
so that she can ring up a friend of hers without anyone knowing.
Reflecting on the material presented to him in the first session,
Casement concludes that Joy is knowledgable about pregnancy and the
primary sexual differences between males and females but is frightened to
be explicit, that her plasticine creations reveal various penis symbols, that
her comment to him about her brother being nearly as big as him might be a
possible early indication of transference, that Joy’s drawings reveal an
ambivalence towards her parents, that Joy wishes to be allowed to be
special in her mother’s eyes and that, on the basis of subsequently learned
additional information, that Joy has been a persistent bed-wetter since her
mother’s last pregnancy, that the rain in her drawing is an expression of her
eneuresis. Finally, with regard to her sharing her secret with him, Casement
writes: ‘I felt she sounded conspiratorial in telling me her secret—
something that must be kept just between her and me. But we may also be
seeing an unconscious prompt for me to establish boundaries around her
contact with me’ (ibid: 36).
I have gone into some detail with regard to this first meeting, not only
because it provides readers with a good sense of Casement’s approach to his
work with Joy but also, and more importantly, because it encapsulates the
whole of the case presentation.
For in spite of his claim that he would abstain from interpretation and
allow Joy to express herself, Casement, from the start, focuses and directs
his (and Joy’s) attention to what he assumes to be the focus of Joy’s
disturbances—her sexuality.
All of Casement’s subsequent accounts of particular sessions, and his
reflections upon them, reveal his single-minded conviction that Joy must
address explicitly—to herself and to him—her knowledge and anxieties
related to her sexuality.
I will provide some examples of this below, but readers should also note
that from this initial encounter the notions of transference and the
unconscious have already been introduced, as has the idea that behind Joy’s
creative manifest material there must lurk significant latent material that is
clearly sexual (the penis symbols) and aggressive (Joy’s ‘squashing’ of the
symbolic penises). Though Casement does not express his interpretations in
a direct manner to Joy, nevertheless he does so indirectly through the
leading questions he poses. It should also be noted that while Casement
does not wish to interpret and thereby restrict the inner world of his client,
he does seem to suggest that he has already understood it. But what is his
basis for this? Partly, it is likely to have been shaped by his reading of
Klein, but also he seems to have accepted Joy’s father’s statements about
her sexuality and seductiveness with little question, thereby possibly
imposing on Joy’s expression of her inner world a far more restrictive, if
also more subtle, interpretative barrier.
Casement’s reliance on his analytic interpretations and the leading
manner with which he imposes them on Joy is made even more obvious
during the second session when Joy begins to draw a gorilla with large
thumbs, followed by three squiggles with a banana on top and then,
drawing a banana in the gorilla’s hand, states that she likes to take bananas
when her mother isn’t looking. In response to all this, Casement asks Joy to
show him that the gorilla is a man on the grounds that she has indicated her
jealousy towards her brothers, and perhaps towards her father, because they
are allowed to have what she would like to have. She had to steal bananas
whereas the man gorilla had a banana all to himself. But readers should
note how subtly Casement has turned his supposition that the gorilla was a
man into a proven statement on the basis that ‘the phallic symbolism of the
big thumbs, and the banana, seemed obvious’ (ibid: 37).
Equally, he seems to pay no consideration to the events as they occurred
in that Joy was not ‘responding’ to the fact that the gorilla had a banana, she
willingly gave him one by drawing it.
The influence of Casement’s analytical stance on both the content and
manner of his interpretations becomes even more apparent during the third
session. While drawing, Casement inadvertently rubs one of his eyes, to
which Joy says: ‘I should have told you—you mustn’t rub an itch, because
although at first it feels nice it soon begins to hurt’ (ibid: 38). Not
surprisingly, Casement takes her words to be an allusion to masturbation,
but, for the moment at least, elects to remain silent. Later in the session,
when Joy draws a complex picture involving, among other images, a man
dangling from a crane (whom she says is Casement himself) trying to go
down into a treasure cave which is guarded by Polo and Gonzo, Casement
produces an interpretation that suggests that the picture is rather like the
dogs mating and that the man has to enter the cave so that later a baby will
emerge from it. Joy rejects this interpretation outright, reminding Casement
that the dogs are not where he says they are. It is only when Casement alters
his suggestion to something more acceptable (‘Well, perhaps it is like you
having secrets which have to be guarded carefully, and you won’t let
anyone except me in to know about them’ (ibid: 39)) that Joy expresses
happiness at his attempts to interpret. Nevertheless, Casement feels
sufficiently justified to stick with his first interpretation because, as he tells
his readers: ‘I had made these comments so that she knew she was allowed
to speak about sexual matters, which I could tell—from what I knew about
her and from her play—were evidently preoccupying her’ (ibid: 39).
When the sessions begin again, following the Christmas break, Joy is
initially restless and difficult to control. In his reflections, Casement
wonders whether Joy may have been angry with him for not having come to
see her. This seems a reasonable explanation, but even here Casement
interprets it in a somewhat grandiose manner by suggesting that Joy ‘might
have … felt obliterated’ (ibid: 40) by his absence.
The extent of Casement’s uncritical belief in the accuracy of his
interpretations and his pushing of them on Joy are further clarified during
session eight. Noticing that Joy has been drawing a large number of images
of sharp teeth and dismembered limbs, Casement comments:

‘You’ve been drawing a lot of teeth today. Does that mean that you
want to bite people because you are angry?’ She replied: ‘No.’ I
continued: ‘Well, I have noticed that you do draw teeth when you’ve
been angry with me over the reading.’ She seemed to accept this but
she made no actual reply (ibid: 43).

And so the sessions continue until session twelve when, for Casement, a
significant shift occurs. Casement presents Joy with a reading game
wherein he selects a series of letters—PA PE PI PO PU—and adds a T to
each of them to make a word. Joy seems interested in this reading game and
makes her own word, NIT, which is her ‘favourite’ word of the day, and
then follows this with other words made up with Casement’s assistance. In
his reflections on this session, Casement writes that an important moment
has occurred in that Joy made the game her own and that a real sense of
sharing had been felt by both of them. I agree with Casement on this point.
But could it be that this sharing experience came about because Casement
has, for the moment at least, ceased interpreting and placed himself ‘in’ the
relationship with Joy, allowing her to express herself without the imposition
of his theoretical perspective? Interestingly, it might be worth considering
that Casement is not as entirely free of his biases as he thinks. For, on
reflection, some of the letters he selects, when read aloud, sound like
infantile excretory language (PI, PO, PU). In any case, a significant shift in
the process has occurred and its influence on Joy is as immediate as it is
obvious—perhaps not least because they are finally engaged in the activity
that Joy has been led to believe is the rationale for Casement’s presence (i.e.
he is helping her to read).
However, Casement the analytical interpreter soon returns with a
vengeance. Bringing a torch into the room at the start of session sixteen, Joy
states that this is her gun and then begins to burrow around the cushions on
the settee. Having created a ‘secret passage’, she begins to climb into and
out of it. Casement writes:

I responded to this reference to ‘secret passage’ and said to her that

it was rather like being born. She wasn’t too sure about this, but she
had so far always rejected such comments from me. (Joy had a rich
capacity for phantasy and imagery in her own terms. Interpretations
still seemed to be experienced by her as an intrusion into her private
world.) (ibid: 52).

Not that these acknowledged rejections seem to bother Casement a great

deal. Noting that Joy has placed the lit torch under her jumper while saying
that no one will know where it is, he supposes (to himself)

that she was wanting to boast of an obvious penis-like protrusion

that I couldn’t fail to notice. But, as I didn’t know what she called a
penis (or if she had any word for it at all), I tried to interpret this
more vaguely by saying ‘It makes you look like a boy.’ She wouldn’t
accept this. ‘What do you mean?’ she asked. I replied lamely: ‘You
know what I mean.’ … (ibid: 52).

Having decided that he has been too inhibited in interpreting the sexual
allusions in Joy’s statements to her, Casement now embarks on a series of
encounters which seeks to remedy this situation. In the very same session,
for example, he interprets Joy’s emphatic unwillingness to accept his
statement that she wonders what her parents do together in their bed by
suggesting to her ‘that she had denied this so strongly because she really
wanted to know very much’ (ibid: 53). Similarly, during session seventeen,
Joy draws what she first calls a cow, then a bull. When Casement asks her
to show him that it is a bull, she draws horns on the image. But Casement is
not satisfied by this and asks ‘what it had underneath that made it a bull’
(ibid: 54). Once again, however, Joy will not play along, and she replies that
she’s never looked underneath a bull.
Finally taking the bull by the horns, so to speak, during session twenty-
one, Casement makes a figurine of a man ‘with a very obvious penis’ (ibid:
55). Joy’s reaction to this image is to remind her teacher that a man doesn’t
have three legs. Now unwilling to avoid direct verbal references to sexual
differences, Casement tells her ‘that she knew very well that it wasn’t a
third leg, but that it was what her brother … has and calls “a penis”’ (ibid:
59). However, as Joy does not seem to understand this word, Casement
translates it into the infantile word ‘winkle’. Joy finds this hilarious and
begins to recite: ‘Winkle, twinkle, little star; how I wonder what you are!’
(ibid: 59) and removes the figure’s penis, leaving Casement to ponder,
somewhat ruefully (and honestly), that he, his words, and the plasticine
penis have all become very much the butt of her humour. Even so, he
remains convinced of the value of his interpretations and thinks it to be
‘extraordinary how explicitly Joy had been illustrating her need for me to
interpret her sexual curiosity and anxieties about it’ (ibid: 59).
From session nineteen on, the frequency of sessions is reduced to four
times per week. Parallelling this change, Joy’s behaviour becomes
increasingly messy and uncontrollable to the point where Casement finally
finds it necessary to confront Joy’s mother and request a room change. This
is duly granted and the setting for the sessions is moved to the children’s
play-room. However, on the very next day following this decision, Joy is
taken ill and Casement doesn’t see her again for five days. It doesn’t seem
to occur to him that Joy’s behaviour may have had something to do with the
changes in their relationship. Rather, he interprets her unruly behaviour as a
demand on her part to be provided with the right environment for her to
express her ‘messy thoughts’ and, subsequently—contradicting this
interpretation—wonders whether her illness is connected to Joy’s feelings
about his seeing her mother.
Whatever the case, sessions twenty-one to twenty-three, which are the
last on which Casement provides detailed commentary, seem to have been
quite significant for the therapeutic relationship. For instance, during
session twenty-two, Casement explicitly informs Joy that the hole that she
has just poked through a sheet of paper with a pen ‘was pushing a penis into
a baby-hole’ (ibid: 60) and was an expression of her desire to have a penis
like her brother’s. No longer resistant, Joy accepts this. Indeed, later, when
Joy pushes a pencil in and out of Casement’s hair, she tells him that it is a
penis. Similarly, when she makes a plasticine man, she provides him with a
‘huge and unmistakable penis’ (ibid: 60). And again, during session twenty-
three, when pondering the difference between ‘h’ and ‘n’, Casement tells
Joy that the ‘n’ has had its tail cut off. Understanding, Joy answers that the
‘n’ has had its penis removed.
Casement’s sessions with Joy continue for another fifteen months,
during which time Joy’s bed-wetting diminishes and subsequently
disappears. Finally, and not least significantly, her reading improves and
Joy begins to find pleasure in its worth.
For Casement, the eventual success of this case lay in Joy’s recognition
of her own worth as a female which became expressed in her improved
reading abilities and the cessation of her eneuresis. But all this rested on her
being allowed to address her unmet needs to discuss sexual issues in a
direct fashion which ‘helped her to understand the hidden things about
herself as a girl’ (ibid: 62). He concludes:

we have an opportunity to witness a child repeatedly giving active

cues for me to respond to her most pressing needs. And, by
following these leads (as I gradually developed the courage to
respond to them), I eventually began to grapple with those key
issues.
The naivety of this untrained approach highlights what Joy
needed from a therapeutic relationship. Persistently, and with
increasing clarity, the process of her unconscious search showed me
where she needed to go. I had to learn to follow (ibid: 64).

The case discussion

In considering this case, it is important to recall that it is, as Casement tells
us, the first in his career as a psycho-analyst and that, as such, it would be
unfair to emphasize particular points of clumsiness or inconsistency. On the
other hand, the fact that Casement had elected to present this case not as a
trainee but as a well-established and respected analyst would suggest that he
is not entirely ill at ease with it. Equally, in a spirit of fairmindedness, it is
necessary to acknowledge that he is quite critical of himself throughout the
presentation and, indeed, makes much of his clumsiness in order to make
the case for the valuable lessons that clients can teach to their therapists. I
am in wholehearted agreement with this viewpoint. The question that must
be asked, however, is whether Casement is correct in his conclusion. Did a
child lead the way? Or is it the case that she was led in a particular direction
by her therapist? I would suggest that, on the basis of what is stated in the
presentation, the latter view is the more likely.
Throughout the discussion, Casement’s interactions with Joy are riddled
with theory-led assumptions which are clearly expressed in his
interpretations—both ‘timorous’ and direct—which attempt to impose a
specific ‘sub-text’ on Joy’s statements and behaviours. With these
assumptions in mind, Casement analyses the ‘movement’ in the therapy as
being one that shifts from ‘veiled allusions’ to Joy’s sexual concerns
(though I am not as convinced as he is that these allusions are, indeed, quite
so ‘veiled’) to the direct acknowledgement of them on the part of the
therapist.
Now it may well be that Joy does hold these concerns; but the question
that is of importance to us is whether they are the ones she is attempting to
express to Casement and whether it is the clarification of these, through
Casement’s interpretations, which is the key to her eventual improvement.
We must recall that the issue of Joy’s sexual curiosity is something that
is raised by Joy’s father, not Joy herself. This is, itself, a curious
circumstance. For while Casement seems to accept the father’s statement as
true, I suspect that I am not the only person reading the case to have
wondered about the remark itself and what it might mean for Joy’s father to
have volunteered it quite so readily to someone who, after all, was
supposedly there to teach her to improve her reading abilities. Perhaps Joy’s
father knew of Casement’s double role, but, if so, this is not made clear.
In any case, what does seem clear is that Joy is very much the ‘outsider’
in the family. Her mother’s relationship with her is obviously different to
that with Joy’s brothers. Could it not be as likely that just the fact that Joy is
allowed to engage in a special relationship with Casement, wherein she is
permitted (even encouraged) to play and express herself in the presence of
someone else, might, in itself, promote the improvements that Casement
subsequently notes?
In the same way, while Casement seems convinced that these are due to
his new-found willingness to address Joy’s sexuality directly, is it not also
of possible significance that these changes occur exactly at the point when
Casement finally finds himself able to stand up to Joy’s mother and
convince her to change the setting for his sessions with Joy? Could it not be
from this event in itself (which Casement tells us Joy was a partial witness
to) that Joy might have been convinced that Casement’s allegiance was to
her and not to her mother and that it was this realization that provoked her
change of stance towards him (and towards herself)? Prior to this, Joy
seems to have alluded to her uncertainty about Casement (e.g. he was ‘a
clown’ who was also ‘a spy’), but once she became convinced that he was
there for her, she began to ‘reward’ him—and herself.
As to the sexually leading interpretations that Casement makes
throughout, is it also not possible that rather than being ‘on the mark’ (as he
believes them to be), these might have been seen by Joy initially to be odd
and confusing, possibly even amusing and curiosity-arousing? And, in the
end, perhaps she came to see that in order to ‘please’ him, or just keep him
coming back and maintaining his relationship with her, she would have to
accept and learn to play within the ‘rules of the game’ as set by him? In
other words, Joy, like possibly all other children, learned to adapt to the
(often) odd demands of this particular adult so that she could gain the
benefits of his attention, affection, concern, and so forth, and, in turn, be
allowed to express the same towards him and towards herself.
Of course, we cannot ever know whether these alternative viewpoints
might have promoted the kind of beneficial changes in Joy which Casement
notes at the conclusion of his paper. But they seem to me to be worth
serious consideration. In Part 1 of this text, I pointed out that research with
clients indicates that the aspects of therapy which they most value have
little to do with the theories held and expressed to them by their therapists,
but rather emphasize more ‘mundane’ elements such as the ability to
express themselves, to be listened to, to be in a relationship with someone,
and so forth. It is as though clients seem to be saying: ‘So long as I am
allowed all these, I’ll put up with the “mumbo-jumbo” that you (the
therapist) seem to find so important.’ Might not Joy have concluded the
same?
So, did she lead or was she led? As in most other circumstances,
probably both. I would suggest that Joy was clearly led by Casement with
regard to her having to accept the ‘rules of the game’ as expressed in his
analytic interpretations and their reliance on the theoretical assumptions
espoused by him. In this way, I believe that he is deluding himself in
thinking that it was Joy who led him to make such interpretations in an
increasingly direct manner. On the other hand, I would suggest that, having
learned the rules, Joy was able to lead Casement into a relationship that, if
still imbalanced and power-based, nevertheless provided her with the means
to express and experience various significantly human aspects of encounter
which seemed to be sorely lacking in her other experiences with adults.
What is illuminating is that even a therapist as concerned with clients’
experiences and as willing to learn from them as Casement undoubtedly is
completely fails to consider these possibilities. Led as he is by his theories
and by his analytic attitude towards interpretation, he imposes assumptions
on the encounter which may have little therapeutic value and which greatly
mystify the relationship.
But are there any suitable alternatives? How might an attempt to remain
at a descriptive level of interpretation promote a therapeutic relationship
that retains the process and outcome benefits just discussed but which also
avoids the interpretative impositions required of analytic approaches?
Hopefully, the following example, drawn from my own work, will provide
some initial clarification.

B. A DESCRIPTIVELY FOCUSED CASE STUDY: ‘SEX, DEATH AND THE WHOLE DAMNED
THING: THE CASE OF STEPHEN R’

The case
When he first introduced himself to me, Stephen R believed himself to be
on the brink of committing suicide. I was, he stated emphatically, his last
real hope. Just turned thirty years of age, some eight years earlier Stephen R
had set himself a ‘life-plan’, or schedule, which demanded that he be
already married and a father by the age of twenty-nine, and was upset by
what he saw as his failure to fulfil this goal. Stephen R was a bright, fit and
handsome young man who was already highly successful in his job where
he held a position of significant authority in a middle-sized management
firm. His income approached £40,000 per annum and included various
additional perks such as an expensive company car. He enjoyed and felt
stimulated by the demands of his work, and was, as far as he perceived it,
well liked, admired and respected by his colleagues and administrative staff.
Similarly, by his own admission, Stephen R had no difficulties in forming
strong, open relationships with women, and had had, over the years,
numerous short-term, intensely emotional and sexual relationships with
various partners and was currently in a relationship that had begun some six
months earlier. Although he professed himself to be bisexual and had
‘experimented’ sexually with several men, he now yearned to remain in the
current monogamous relationship he was in with the woman who, he
believed, would ‘become the mother of his children’.
His most pressing problem, he admitted, was an unusual one, at least as
far as he was concerned. Bluntly, with little sign of embarrassment, he
explained that although he wished to marry his partner, and that this desire
was shared by her, one major obstacle stood in the way of their mutual
yearning to have a child: he could not bring himself to ejaculate while
engaged in penile—vaginal intercourse. He explained that while he had no
difficulty in achieving and maintaining penile erection, and enjoyed penile
—vaginal intercourse, once he felt himself to be on the verge of ejaculation
he found it necessary to withdraw and to ejaculate on his partner’s body.
My request for clarification on this point provided the added information
that, once he’d ejaculated, Stephen R then felt compelled to lick up and
swallow his semen and that, indeed, it was only once he’d fulfilled this task
that he could fully experience the psychological pleasure of orgasm. In the
early months of their sexual relationship, his partner had not been disturbed
by this behaviour (or so Stephen R believed), especially as its compulsive
nature had been obscured by the non-appearance of this reaction during
other forms of sexual intercourse (mainly mutual masturbation and anal
intercourse), although, on reflection, Stephen R realized that while he had
not prevented his partner from swallowing his sperm during oral
intercourse, he did not enjoy this act a great deal and had usually found
ways of ensuring that he’d disengaged his penis from his partner’s mouth
before ejaculation. When I queried his rationale for this, he explained that
he believed that women didn’t really enjoy swallowing sperm. Following
several moments of mutual silence, he added that another reason might be
because as a teenager he’d been told by a friend that some women had been
known to become pregnant as a result of swallowing sperm. When I asked
Stephen R whether he still believed this information to be correct, he
blushed for the first time in our dialogue and admitted that, although in one
sense he knew of the impossibility of such an eventuality, nevertheless he
could not truly dismiss this information.
‘Stranger things are possible,’ he joked. ‘Wasn’t Christ supposed to
have been conceived via some jiggery-pokery through Mary’s ear?’
‘Perhaps so,’ I concurred, ‘but that conception is supposed to have been
somewhat unique. Are you suggesting that any conception that you and
your partner may bring about would have to occur under similar
circumstances?’
‘If I don’t resolve the problem, it looks like it might have to!’ he joked
once more.
The remainder of our session yielded the following information:
Stephen R’s problem was not a new one in his life, nor was it specifically
related to his current relationship. It had been present since his first sexual
encounter with a woman and, perhaps unsurprisingly, had been the stated
cause of the break-up of at least three previous significant relationships. It
had also been the spur to his ‘experimentation’ with sexual relations with
men, since for a period of time his own ruminations and attempts to
understand this behaviour had led him to consider the possibility that he
‘might be gay’. However, although he had enjoyed his period of
‘homosexuality’, he had discovered that he preferred intimate contact with
women. While he had been somewhat relieved by this knowledge, the
significance and mystery of his problem had intensified over the years and
had now reached crisis point. Although he had not discussed this issue with
any of his friends, nor any of his sexual partners (including his current
partner), he had taken steps to read up on sexuality and had concluded that
he required the services of a sex therapist.
When I informed him that, while I was more than willing to explore
sexual problems with clients, I was not a specialist in sex therapy, he
became somewhat dejected and asked whether I could supply him with
names of sex therapists. I responded that I was willing to provide him with
suitable organizational addresses which he could then follow up. Several
minutes of silence ensued, at the end of which Stephen R said: ‘Well, seeing
as I’ve started this with you, perhaps I should stay on for a while and see
what you have to offer.’
I repeated that I was willing to work with him but added that I could
only ‘offer’ to explore with him what he was willing to bring into the
dialogue. I don’t know what he understood from this statement, but,
nevertheless, he replied that he wished to work with me. The remainder of
the session was devoted to the clarification of practical and ‘frame’-related
issues leading to a verbal contract between us.
We met once a week and during the following five weeks the focus of
our dialogue, set by Stephen R, was the exploration of his sexuality. One
issue that I sought to clarify quite early on in these sessions was related to
his use or non-use of a condom during intercourse and what effect this had,
if any, on his inability to achieve intra-vaginal ejaculation. Surprised with
himself, Stephen R admitted that he had not considered this before, but,
considering it now, he realized that, while he still avoided attempting intra-
vaginal ejaculation even while wearing a condom, he could think of at least
a couple of instances in the past when he had, indeed, ejaculated during
vaginal penetration. ‘But I hated myself for it afterwards,’ he added. In any
case, even if he’d been able somehow to ‘do it’ while wearing a condom in
the past, this option was no longer available since he and his partner, having
agreed to maintain a monogamous relationship some two months earlier,
had ceased taking any precautions. It was also during this time that Stephen
R informed me that he experienced his greatest sexual pleasure while
masturbating in private and that even when he was in an on-going sexual
relationship his masturbation ritual was still regularly enacted. This ritual
required him to angle his body in such a way, and to practise a version of
the stop-start technique devised by Masters and Johnson, so that, on
ejaculation, he could catch the jet of sperm with his mouth and swallow it.
The swallowing of his own sperm was the essential element to the ritual and
his failure to do so, as happened on occasion, led to strong feelings of
dejection and the compulsive need to repeat the act, once sufficient time
had elapsed, until he succeeded.
I asked him to explore and describe his experience of dejection further
but, although he showed every sign of attempting to vocalize his
experience, he soon gave up, stating that nothing he could verbalize
occurred to him. I suggested that he stay with this experience of
nothingness and explore that. What did it feel like to him to come up with
nothing? What did he associate with this experience? Much to Stephen R’s
surprise, he found that the first related thought brought him, once more, to
the remembered experience of those few occasions in his life when he had
been too aroused to prevent himself from ejaculating while his penis was
still inside his partner’s vagina. On such occasions, he had experienced an
instantaneous ‘low’ that he’d tried, but usually failed, to conceal from his
partners. And how had he eventually rid himself of this unpleasant feeling?
There was only one way: an extended session of ‘successful’ solitary
masturbation.
We also explored the meaning and significance of his homosexual
relationships. What emerged from these discussions was Stephen R’s
contention that, although he had ‘ceased being a homosexual’, nevertheless
he looked back on his sexual experiences during this time in his life as
being second in intensity only to his masturbation rituals. Clarification of
this point led to the awareness that, for reasons he could not pin down, he
had felt particularly free and relaxed in his sexual encounters with other
men. How so? Was it because of their activities? Did these avoid any form
of penile penetration, for instance? No. Anal intercourse was commonly
practised, and enjoyed, by Stephen R. Was it the experience of being
protected with a condom that allowed the pleasure? No, he confessed;
although he and his partners had tended to use condoms, there had been a
number of occasions when they had risked anal sex without them. Now,
looking back on this, it surprised him to discover that the use or not of a
condom had had no significant effect whatsoever on his ability to ejaculate
during penetrative intercourse with men. This realization provoked a great
deal of contemplation and, initially at least, confusion.
It was during the eighth session that Stephen R announced that he was
beginning to get bored with his exclusive focus on sexuality and wished to
talk about other matters.

‘What would you like to talk about?’ I enquired.

‘I suppose you want me to talk about my past.’
‘Do you want to talk about your past?’
‘Christ, no!’
‘All right, then, what do you want to talk about?’
‘This is just a way to get me to talk about my past, isn’t it?’
‘Do you want to talk about your past?’
‘I knew it! Well, I’m going to call your bluff and talk about something
else!’
‘Fine. What do you want to talk about?’
Stephen R laughed loudly. ‘Okay, smart arse. I’m not going to give in to
this!
I’ll talk to you about my favourite author! How’s that grab you?’
‘Tell me what you want to say about your favourite author.’
So, grudgingly, not quite sure whether he’d ‘won’ the argument or not,
Stephen R told me that his favourite author was the American writer
Norman Mailer. He’d just recently finished reading his novel Ancient
Evenings, Mailer’s re-interpretation of The Egyptian Book of the Dead, and
prior to that he’d read The Executioner’s Song, a ‘novelization’ of the life
and execution of Gary Gilmore. He asked me if I’d read these books as
well. I answered that I had. He then stated that the first of Mailer’s books
that he’d ever read had been An American Dream, that it was still his
favourite, and that he now intended to reread it. ‘What was it that impressed
you about that particular book?’ I asked. ‘Its style. The way it’s written. The
main character …’ He paused. ‘Mostly, it was that scene where Roark kills
his wife.’
I remembered the scene as well; it’s difficult to forget. In it, Mailer
describes in detail a woman’s desperate attempts to escape death by
strangulation, her failure to do so, and the involuntary release of her urine
and faeces at the moment of her death.
‘Put yourself in the woman’s place for a moment,’ I suggested. ‘What do
you see happening to you?’
Stephen R shuddered at the thought. ‘I wonder what it must feel like,’ he
half whispered.
‘What’s the “it”?’
‘All that crap and piss coming out of you.’ (Long, silent pause.) ‘I suppose
I’d be squirting “cum” all over the place as well.’
‘And what does that thought leave you with?’
Stephen R laughed. ‘I guess I’m wondering what that would feel like!’
‘What would it feel like?’
‘I don’t know. Horrible, I suppose. But then again, who knows?’
He paused, smiled once more. ‘I read somewhere that some people do that
to themselves, nearly hang themselves just to “come” like that. It’s
supposed to be the ultimate “come”.’
‘Do you think it might be?’ I asked.
Still considering his last statement, Stephen R paid no attention to mine. He
produced a sudden smile. ‘We’ve got back to sex again,’ he laughed.
‘Via death,’ I challenged.
‘Yeah, well, they’re connected, aren’t they?’
‘How do you connect them?’ I asked.
Much to my surprise, tears started to flow out of his eyes. He cried for
the rest of the session.
During the ninth and tenth sessions, Stephen R chose to return to the
exploration of immediate concerns in his life, primarily the increasing
degree of tension that had been developing between his fiancée and himself.
As I’d never heard him use the word ‘fiancée’ before, I enquired as to
whether there had been a recent decision made concerning their
relationship. Indeed there had. A day or so following the events of the
eighth session, Stephen R and his fiancée had decided to marry as soon as
reasonably possible and ‘get on with the business of producing offspring.’
‘And how is “the business” progressing?’ I enquired. Perhaps not
surprisingly, Stephen R’s reply was to confess that he’d been working so
hard lately that the frequency of their love-making had declined somewhat
dramatically over the last two weeks. And what of the frequency of his
masturbatory ritual? That had remained the same; indeed, it might even
have increased a little. I then asked whether he saw any relationship
between the decline in frequency of sexual intercourse and the increased
tension between the couple. He did. And had they talked about it? They
had. And? The discussion had been going well until his fiancée had
wondered aloud whether Stephen R really did want to have children. After
that it had turned into a slanging match that had still to be fully resolved. I
asked him whether he’d thought that his fiancée’s question had been
justified or not. His anger obvious by the grimace on his face, Stephen R
shouted back at me: ‘Of course not! I do want to have kids! It’s just this
bloody problem that gets in the way!’ He paused, then added: ‘I don’t
know. You don’t seem to be able to help. We just keep going around and
around in circles. Maybe I should have gone to see a sex therapist in the
first place!’
‘I can understand your concern,’ I replied. ‘You took a chance in staying on
with me and, right now, you’re not sure whether this was the right decision
for you to have made.’
‘I don’t know, do I?’ he said. ‘It’s just that … Oh, I don’t know!’
In spite of this statement, at the completion of our session Stephen R
said ‘I’ll see you next week’ as he left the room.
From the very start of the eleventh session, he seemed particularly
agitated. With a strong emotional tone to his voice, and his body shaking in
uncontrolled spasms, he sat down. For some minutes he remained silent,
avoiding looking me in the eyes. Finally, sighing deeply, he stated that he
wanted to tell me something.
‘I’ve been thinking things over,’ he began. There’s something I need to let
you in on.’
I made a gesture with my head, attempting to convey the message that I was
‘with him’.
‘Something you said a few weeks ago has stayed with me. In fact, I can’t
stop thinking about it.’
‘Something I said,’ I repeated.
‘Yes. About death.’
‘What about death?’
‘It was in connection with Mailer’s books.’
‘Yes, I remember that. What did that say to you?’
‘Well, I remembered later that I read somewhere that orgasm used to be
referred to as “the little death” or something like that.’
‘You see a connection between orgasm and death,’ I ventured.
‘I’m not sure. I want to explore this with you.’
‘Okay. Let me just throw something out, then. I remember a phrase out of
some book I read once that goes: “Death is the price we pay for sex.” Does
that link in to your own thoughts at all?’
Initially, the phrase struck Stephen R as being odd, but he seemed
intrigued enough by it to want to clarify its meaning. Though he asked what
I thought it meant, I responded that, while I was willing to share my
interpretation with him, I would first appreciate knowing what the phrase
meant to him.
‘I don’t know,’ he replied. ‘It seems a bit screwy. That’s why I wanted to
know what you made of it.’
‘Okay. Then let me ask you this: what do you think the phrase means to
me?’ For the first time that day, Stephen R smiled. ‘You want to know what
I think that you think?’ he chuckled. That’s crazy!’
‘Humour me,’ I said.
He paused, considered the request once more, then began. ‘I guess that to
you it might mean that since we all die, then sex is the only thing we have
to make us want to stay alive for as long as possible.’
‘Do you mean it’s the thing that makes life worth living?’
‘Yeah.’
‘Anything else?’
‘Like what?’
‘I don’t know. Put it within the context of your problem. Does anything
come up?’
‘Having kids?’
‘Yeah. Reproduction.’
‘The only thing that comes to mind is another question.’
‘Which is?’
‘Well, if we didn’t have to die maybe we wouldn’t be so worried about
having kids.’
‘If I didn’t have to die, I wouldn’t have to worry about reproduction,’ I
rephrased.
‘Yeah.’
‘Let’s play with that a little bit. What if we change a couple of words
around?
“If I didn’t have to reproduce—”’
‘I wouldn’t have to worry about death,’ Stephen R completed.
Mere seconds later, Stephen R’s facial appearance altered dramatically. His
face turned pale, his jaw, quite literally, dropped.
‘That’s what I was trying to put into words earlier, but I couldn’t then! That
sums it up exactly!’ he exclaimed.
‘Good. So let’s explore this one.’
We did precisely that for the remainder of that session and the following
two. These explorations proved useful to Stephen R since they led him to an
initial clarification of his personal views and anxieties concerning his
eventual death. Further, they opened up discussion concerning the death of
his father some six years earlier. In turn, these led to his concerns about the
noticeable ageing process he’d observed in his mother. Finally, they led him
to the remembrance of an incident from his childhood when, aged seven,
he’d seen his father cry at his father’s (Stephen R’s grandfather’s) funeral.
This had been the first ‘real’ experience of death that he’d encountered and
it had frightened him to the extent that he remembered having nightmares
about it for several weeks afterwards. Most significant, for Stephen R, was
the connected memory of his father saying to someone (Stephen R? Stephen
R’s mother? He could not recall) during this time: ‘At least he had children
to cry for him! I can’t imagine dying all alone, without any of your own
kids there.’
Repeating this phrase out loud to himself, as much as to me, Stephen R
now saw a double meaning to it. Could he, making sense of it as a child,
have construed it to mean that death itself was impossible so long as one’s
offspring had not yet come into being?
Perhaps. Whatever the case, of far greater significance to Stephen R was
the fact that, parallel to these explorations, his relationship with his fiancée
had begun to improve and the frequency of their love-making had once
again returned to its previous level. More significant than its quantity,
however, had been its improved quality. For the first time in his sexual life,
Stephen R found himself ‘really giving himself to someone’.
With all this in mind, Stephen R and I were now able to reconsider his
‘problem’, and aspects of his sexuality in general, in a new light. This
activity led him to the insight that all his actions had been expressions of his
divided, yet connected, views on reproduction and death. If he did not make
the possibility of his fatherhood more likely through intra-vaginal orgasm,
he was, in some way, prolonging his own life, almost making himself
‘immortal’. Considering his sexual relations with men and women, he
began to wonder whether his greater enjoyment of homosexual encounters
was related to the fact that he knew in all certainty that no childbirth was
possible in such relations, whereas with women there was always the
uncertain possibility, the superstitious thought, that pregnancy might just
somehow occur even in the strangest of circumstances. Perhaps the very
fact that he could engage in, and enjoy, anal intercourse with men leading to
penetrative orgasm, whether he used a condom or not, further revealed that
the crux of the issue lay in his concern that virtually any variant of sexual
intercourse with a woman (regardless of whether he used a condom or not)
might, somehow, lead to her pregnancy and, by implication, set up the
mechanism initiating his eventual death.
Similarly, when we explored both his masturbation ritual and his
compulsive need to lick up his sperm from his partners’ bodies, Stephen R
now interpreted this as an act whose meaning lay in the self-same quest to
cheat death. For in taking back into himself the very substance that was
necessary for another’s life to begin, it was as though he were ‘erasing’ the
life-endangering aspects of the sexual act. After all, if the potential for life
was being returned to him, then no quantity of substance (or of ‘life-time’)
was lost.
In his own way, Stephen R had found the means to refute the quotation I
had offered him. Indeed, he must have arrived at the essence of that quote
long before he’d ever heard it from me and had been living a good part of
his life as a challenge to its meaning. That had been acceptable, or at least
often adequate, as long as the idea of becoming a father remained simply
that. Once presented with a real possibility of reproduction, this world-view
had been threatened to its foundations. To take part in a successful attempt
at reproduction would pave the way to his own eventual death.
This explanation seemed to be particularly worthwhile to Stephen R in
that it opened up to him various ways both to reassess the fundamental
premises on which he’d built up the ‘meaning’ of his sexuality and how
this, in turn, had dictated the limits to its expression. More specifically, it
allowed him to begin to deal directly with his ‘problem’. This task took
further time and exploration, but during our seventeenth session he proudly
announced that he had managed to achieve orgasm during penile—vaginal
intercourse. Not that he’d greatly enjoyed the act, but at least he’d done it!
And more, he realized that what had allowed him to do so was the thought
he’d maintained during the act that now, at last, he knew without doubt that
he really did want to have children, even if death was the price required of
him.
Our sessions together came to an end in the twenty-sixth week. By then,
Stephen R’s ability to achieve orgasm during penile—vaginal intercourse
seemed no longer to be an issue for him; indeed, he claimed to have begun
enjoying the act for its own sake. Interestingly, the frequency of his
masturbation ritual had not declined. For Stephen R it remained something
deeply private, personal and important.

Case discussion
Although this case is by no means a typical example of my practice owing
to the brevity of its duration and, to a lesser degree, to the specificity of its
concern, I believe that it provides a fairly accurate representation of my
style of working and, more significantly, of an approach that seeks to avoid
the imposition of unnecessary theory-led assumptions and which attempts
to remain at a descriptive level of interpretation as was discussed in the
previous section.
Firstly, it seems to me that the fundamental premise of the stance I
adopted was that of accepting and working with the material provided by
Stephen R without, from the start of the enterprise, seeking to impose on it
my preconceived theories and assumptions concerning the meaning and
aetiology of the presented problem. Instead, the interventions made
attempted to be invitations to explore and clarify the meanings of Stephen
R’s statements as perceived and understood by him. This attempt required a
great deal of willingness on my part both to confront and seek to set aside,
or ‘bracket’, the plethora of personally held views, opinions, and meaning-
biases concerning the issues being disclosed and explored by Stephen R.
This was by no means an easy, or always possible, requirement to fulfil, and
part of my rationale for providing brief snippets of dialogue in the case
discussion was to allow readers to see how my responses and interventions
sought to adhere to this form of descriptive challenging.
So long as I attempted to stay with, and respect, the content of Stephen
R’s disclosure, my challenges took the form of silence, or clarificatory
questioning, or even the introduction of new, if still directly related,
material (such as, for example, my disclosure of the quotation concerning
sex and death). All these challenges may have been ‘risky’, in that they may
have misunderstood what he was attempting to express, but I believe that
they provided the means to a more open, effective and less artificial
dialogue between us. At the same time, they allowed Stephen R to indicate
on several occasions that he was entitled to reject particular challenges
without having such responses interpreted by me as forms of ‘resistance’.
Nevertheless, it is important to make clear that the approach I employed
did depend on the assumption that all the issues raised by Stephen R were
meaning-derived in that their presence, or their problematic nature,
reflected assumptions or world-views held by him. As such, while it
remained my task to challenge such world-views through descriptive
interpretation, the relative effectiveness of these challenges could be
evaluated on the basis of whether Stephen R’s responses indicated that I had
adequately described and clarified his world-view. Put simply, what I
attempted was to ‘enter’ his meaning-world, and to experience and interpret
it in a manner akin to his experience. It is in doing so that I, in my
‘otherness’, was able to assist him in confronting, exposing and challenging
the (often unstated) assumptions, limitations, and ‘sedimented perspectives’
held by him. To attempt do so required me to try to accept Stephen R’s
meaning-system, however irrational it might have appeared to me to be,
and, rather than dispute it by means of any other alternative meaning-
systems, to seek to expose and challenge whatever inconsistencies, gaps,
unstated assumptions and so forth I had perceived to exist in his meaning-
system. Obviously, I could only begin to achieve this if Stephen R’s
meaning-system had been sufficiently understood, and, as importantly, if
Stephen R felt me to be trustworthy enough to allow me access to it.
This approach also turned my task away from symptom removal (i.e.
‘curing’ Stephen R) and towards a refocusing on symptom exploration and
clarification. Again, I must acknowledge an assumption here that the
symptoms expressed were themselves ‘clues’ or representations of Stephen
R’s world-view. While, obviously, symptoms may diminish or cease to exist
(as in Stephen R’s case) because of the therapeutic encounter, a severe
limitation would have been imposed on what ability I had to attend to and
challenge the client if I’d made the removal of symptoms the principal goal
of our therapeutic dialogue.
Readers may have also noted that throughout the case discussion no
reference was made to ‘unconscious’ factors or mechanisms. I believe that
the case demonstrates how it may be that significant insight into the
conscious meaning-world of the client, allowing extensive shifts in psychic
orientation, is both possible and, dare I say, sufficient, without the
imposition of any theoretical assumption concerning an unconscious
mechanism.
Similarly, while Stephen R’s perception of his past was employed in
order to clarify aspects of his current experience, the past as discussed can
be seen to be, more accurately, an exploration of the ‘past as currently lived
and future-focused’ rather than ‘the past as it really was’ or ‘the past as
fixed in time and meaning’. Nor was there any assumption of the past as a
‘linearly causal’ element in Stephen R’s current experience. While it
remained his ultimate right to choose to impose causality on his world-
views if he so wished (and, in this case, it is implicit that this is what
Stephen R elected to do), I would argue that I, as the therapist, did not need
to assume such, and, indeed, that whatever ability I demonstrated in
remaining open to the myriad of alternative possibilities as to the ‘why’ of
his current world-views or experience allowed a greater adequacy in my
ability to ‘hear’ him. Finally, the approach avoided any reliance on the
hypotheses of ‘transference’ and ‘counter-transference’ and, instead,
presented an alternative stance that was in keeping with the one discussed
previously.
If, by this point in the discussion, some readers have begun to think that
this approach to psychotherapy is somewhat easier to apply than other
approaches, it remains my duty to dissuade them of this conclusion. The
abdication of a position of authority or superior knowledge is no simple
task at the best of times; it becomes even more problematic when, not
unusually, one’s clients seem to demand such of the therapist. I have
included an obvious example of this in the case summary (Stephen R’s
query as to whether he had done the right thing in continuing to work with
me). My response, whatever its value, attempted to ‘stay with’ his concern
as expressed rather than to adopt a defensive stance which, for instance,
might have sought to interpret the statement as an expression of ‘negative
transference’, or might have tried to convince him that his initial decision
had been the right one, or might have attempted to mollify his implicit
demands by providing information or theoretical explanations designed to
demonstrate my superior knowledge and authority. I can assure the reader
that the temptation to adopt any of these latter positions retains its strength
over time (or, at least, it does for me!) regardless of what value there might
be in keeping it in check. My own view on this is that the strength of the
temptation is related to the personal difficulty I experience in attending to
the material being expressed.
Perhaps more than any other, this approach exposes therapists to their
own biases, prejudices, and sedimented outlooks and challenges them to
find the strength (at times, even the courage) not to allow them to interfere
with the process of listening. For example, the case discussed brought up
for me difficult, often painful, personal material surrounding the issue of
reproduction. In this instance, I felt able to ‘bracket’ it sufficiently; though I
can assure readers that this is not always the case.
In a similar vein, when I step back from the case itself, and my
relationship to Stephen R, I can see that, in a more abstract sense, his
concerns might well be understood in terms of theoretical outlooks that
posit the existence of a fundamentally human ‘death anxiety’. However,
while it may be useful to view and discuss it from this perspective, it seems
to me that all the points I have made in this discussion would be seriously
weakened had I, in some way, imposed this theoretical perspective on my
dialogue with Stephen R. As far as I can judge it, the critical reader might
take issue with me in one instance alone namely, on the occasion when,
following Stephen R’s resumes of Norman Mailer’s books, and his
declaration that we had returned to the subject of sex, I made the statement:
‘Via death.’ I was well aware of the risk in this challenge, and, perhaps
more pertinently, that I might be stretching the boundaries of descriptive
interpretation too far. And yet it seemed a proper statement to make at that
moment on the grounds that the focus of Stephen R’s descriptions of
Mailer’s books had been the themes of the death journey, reincarnation,
death by execution, and murder. Further, had Stephen R dismissed my
challenge, I would not have pressed him on it. While it is true that he
arrived at conclusions in line with those suggested by the hypothesis of
‘death anxiety’, and while I cannot ever be entirely certain that my own
theoretical leanings did not, in some subtle way, impose themselves on our
dialogue through my challenges, thereby influencing his clarifications of his
worldviews, nevertheless, as I hope the case summary clearly shows, no
overt references to ‘death anxiety’ were made at any point in the therapy.
Once again, it seems to me that if ‘death anxiety’ is, indeed, a
fundamental aspect of the human condition, then clients can and should be
expected to discover it for themselves without the theory-based assistance
of the therapist. I believe that Stephen R did confront aspects of his ‘death
anxiety’, and that he was better able to do so through the quality of our
dialogue, but I am also reasonably convinced that he did so without my
having to ‘guide’ him towards it.
In a similar fashion, Stephen R was able to express his sense of the
relationship and how it did or did not fulfil his needs in various way, not
least through his decision to end therapy at a time he thought opportune.
My own preference would have been for him to have continued in therapy
somewhat longer, since I felt that there was more—indeed, most likely
much more—for us to explore. But whatever my feelings on this matter, I
believe it more important that Stephen R’s (or any other client’s) decision
should take precedence and, in doing so, establish that whatever power
exists in the relationship does not belong solely to the therapist.
Most significantly, I hope that the case presented has allowed readers to
gain a sense of the fundamental importance of the therapeutic relationship
itself. For, far more significant than any theoretical views or their various
applications, it seems to me that whatever was made possible in a beneficial
sense for Stephen R emerged through the quality and respectful openness of
the dialogue we engaged in. In this sense, the case as presented could only
convey a small part of that encounter and, even then, what was conveyed
was itself a very limited expression of the manner in which the sessions
were conducted. I will have more to say about this question in Part 5 of this
text, but for now I hope that my attempt to demonstrate to readers that the
possibilities of descriptively oriented interpretations are by no means
limited and can provide clients with as valid and sufficient an insight as
might be obtained from the psycho-analytic model while, at the same time,
remaining less open to the dangers and difficulties contained within the
latter.
But the alternatives presented are by no means the only ones that have
been forthcoming or which have taken a critical perspective on the
numerous assumptions contained within the psycho-analytic model. Both
the cognitive-behavioural and the humanistic models arose partly in
response to many of these same assumptions, and each has become a major
therapeutic model in its own right. Equally, as Part 4 will seek to
demonstrate, each has also raised novel concerns for therapists which
require critical attention.
PART FOUR

DEMYSTIFYING THERAPEUTIC THEORY:

2. COGNITIVE-BEHAVIOURAL AND
HUMANISTIC MODELS

It is easy to love a perfect being. The real test is to love a being who is also
imperfect.
Anonymous

Part 3 of this text discussed a number of fundamental assumptions

contained within the psycho-analytic model and considered their
implications with regard to the practice of therapy in general and the issue
of therapist power in particular. While the psycho-analytic model has had—
and continues to have—a vast influence on both therapeutic theory and
practice, it would be misleading to suggest that it is the dominant model in
contemporary therapeutic thought. From around the middle of this century,
two other models rose to prominence, both of which have had a major
impact on our understanding of therapy and each of which, in its particular
fashion, has advanced both its theory and practice. As in Part 3, Part 4 will
discuss these two models—the cognitive-behavioural model and the
humanistic model—and appraise a number of fundamental assumptions on
which each theory rests. Equally, as in Part 3, it will focus particular
attention on the implications of these assumptions with regard to the overall
issue of power in the therapeutic relationship.

1. THE COGNITIVE-BEHAVIOURAL MODEL

A. AN OVERVIEW

The cognitive-behavioural model of therapy focuses on action-oriented

approaches aimed at altering particular patterns of individual thought and
behaviour which have been classified as debilitating or irrational. The
various techniques that make up this model share a common emphasis in
that they are founded on an experimentally derived scientific view of human
behaviour and, as such, their specific procedures rely heavily on
experimental data analyses as the primary means of confirming their
reliability and validity.
In turn, the results obtained from experimental work also provide the
means for practitioners to amend or significantly alter their current
procedures. In this way, therapeutic techniques that have adopted the
cognitive-behavioural model can claim verification for its assumptions
through extensive quantitative research, where primary attention rests on
the testing and measurement of therapeutic outcomes and the statistical
analysis of the efficacy of the procedures employed. The emphasis on on-
going experimental research is both a central defining characteristic of this
model and remains the most important means of designing and refining
systematic applications of cognitive-behavioural therapy to presented
problems.
The cognitive-behavioural model assumes a fundamental relationship
between individuals and their environment which is both interactive and co-
productive (Bandura, 1986). To this extent, it argues that just as individuals
act on, or shape, their environment, so too are they shaped by it. However,
whereas in the past, solely behavioural models were applied to therapy, the
current model emphasizes the cognitive elements in human behaviour so
that the examination of clients’ beliefs and biases is a central concern of the
cognitive-behavioural therapist (Ellis and Whiteley, 1979).
Equally, the cognitive-behavioural model focuses on clients’ current
issues or problems and the immediate factors influencing these rather than
concern with the analysis of their possible originating determinants.
Therapists’ interventions are designed to be instructive, or broadly
educational, so that specific skills can be learned, practised, and generalized
to meet the particular needs and conditions of individual clients (Corey,
1991). In doing so, specific and concrete outcome goals are designed. These
are negotiated with clients on the basis of such factors as how realistic the
goals may be and what advantages and disadvantages in terms of the
client’s lifestyle and world-view their fulfilment may elicit.
Similarly, cognitive-behavioural therapists’ interventions focus on the
clarification of how a client experiences a particular problem or
maladaptive condition and what the client does in response to this
cognitively construed experience.
For example, if a client’s presenting problem is stated as being
‘depression’, the cognitive-behavioural therapist will initially seek to
understand what the specific elements of the experience that are contained
in the client’s definition of ‘depression’ may be, and will then go on to
clarify with the client what consequent behaviours are enacted both to
express and attempt to deal with the condition. In doing so, the cognitive-
behavioural therapist might uncover various irrational beliefs or
assumptions held by the client (such as the view that ‘I am not allowed to
make mistakes’) which in themselves may be provoking the experience of
‘depression’. Alternatively, the therapist may discover that the client’s
response to the experience of depression is to take himself to bed and sleep
for hours, which, while temporarily alleviating the condition, subsequently
aggravates it owing to the various inter-personal consequences of this act
and their reinforcement of the conditions that led to the initial assessment of
‘depression’. So, for instance, having taken himself to bed, the client fails to
appear at work, which leads to his superiors being angry with him, which
further provokes and reinforces the belief that ‘I am not allowed to make
mistakes’, which in turn sets off the depression once again.
In negotiating a concrete goal with the client, the cognitive-behavioural
therapist may find that the initially desired goal is unrealistic (e.g. ‘I never
want to make mistakes again’) and that a more realistic goal must be set
(e.g. ‘I must find more suitable ways of dealing with my making mistakes’).
In doing so, the therapist may have to challenge underlying fundamental
assumptions and beliefs held by the client (e.g. ‘I am not allowed to make
mistakes’) by pointing out their inappropriateness or irrationality (e.g. ‘My
mistakes may be irritating, but are an allowable fact of life’). Equally, the
therapist may seek to teach the client more rational ways of dealing with the
presenting problem (e.g. ‘When beginning to feel depressed, find something
to do which re-affirms various positively held values and beliefs about
yourself ’).
In some cognitive-behavioural approaches, various relaxation or
desensitizing techniques will be taught (Jacobson, 1938; Wolpe, 1969); in
others, the cognitive-behavioural therapist will engage in dialogue with the
client which aims to diminish or remove the irrational belief and replace it
with a more rational one (Ellis and Whiteley, 1979). Alternatively, some
cognitive-behavioural therapists will utilize the relationship itself as a
means of promoting the therapist as a model for the client to observe,
imitate and learn from (Bandura, 1986). Various popular assertiveness
training procedures, for instance, employ any one or combinations of these
techniques.

B. RATIONAL-EMOTIVE BEHAVIOUR THERAPY (REBT)

One of the most influential of the approaches using a cognitive-behavioural

model is Rational-Emotive Behaviour Therapy (REBT), which was
developed by Albert Ellis (Ellis and Whiteley, 1979). A key assumption of
REBT is that human beings have a biological tendency to think irrationally
(or ‘crookedly’). Equally, however, human beings also have ‘the capacity to
change their cognitive, emotive, and behavioral processes … and train
themselves so that they can eventually remain minimally disturbed for the
rest of their life’(Corey, 1991:329). REBT argues that these irrational
assumptions tend to be expressed in terms of deeply ingrained demands that
people either make of themselves or of the world (e.g. ‘I/the world must/
should/ ought to be’ … ) which act to impede severely individuals’
constructive experiences of life.
Ellis’s REBT model basically focuses on the irrational beliefs that
follow an activating event and which give rise to particular behavioural and
emotional consequences. The task of the REBT therapist is to dispute these
beliefs so that more rational ones may be accepted and, therefore, provide a
new attitude towards subsequent activating events and (implicitly) provoke
novel, and rational, behavioural and emotional responses.
So, for instance, a client enters REBT because she feels that ‘life is no
longer worth living’. A recent event that has provoked this conclusion may
be that she attended the wedding ceremony of her last single friend and now
she finds herself to be the one remaining single person in her circle. Further,
in response to this activating event, she feels shunned, lonely and
unattractive and, looking back on her life, has concluded that there is
something wrong with her, that her previous relationships were both
intermittent and unsatisfactory, that her job is unrewarding, and that the
future is likely to hold no significant positive changes. When asked to
describe the beliefs and assumptions she holds about this general stance,
she answers that ‘life is unfair, I am a hopeless failure, and I am an awful
and boring person who deserves what she’s getting’.
The REBT therapist, following Ellis’s approach, would seek to
challenge her beliefs by demonstrating to her that she has turned a number
of desirable outcomes into ‘musturbatory needs’, and that she is irrationally
‘awfulizing’ both the conditions to her life and herself. Further, the therapist
might attempt to convince her that she is capable of adopting other, more
rational, viewpoints, and that she could do things to change at least some of
the conditions of her life. For instance, she could join clubs or societies
where she might meet suitable partners, or she might consider what she can
do to improve her job or find a more interesting one.
In addition, and as a way of putting these suggestions into practice, the
REBT therapist would be likely to set her weekly ‘homework’ exercises
designed to help her achieve some of these goals in a more systematic
fashion. At the same time, REBT theory assumes that the act of carrying out
these exercises itself challenges and weakens the client’s irrationally held
beliefs.
In general, the REBT therapist attempts to re-educate her, not only in a
behavioural sense, but in an attitudinal sense, by trying to shake her out of
the pattern of beliefs she has adopted. Nevertheless, some of these beliefs
may be so deeply held and ingrained that they go back to childhood and her
early relations with ‘significant others’ such as her parents, siblings and
teachers. The therapist focuses on these and, again, seeks to demonstrate to
her that her beliefs concerning these can be reconsidered and reassessed.
In the course of this interaction, the REBT therapist, together with the
client, might uncover further related assumptions and beliefs that strengthen
her irrational stance towards the world. For instance, the therapist and client
might find that, as a child, she had developed the belief that her role in the
family was to be the ‘carer’ of others and that, whenever she attempted to
fulfil her own needs, this upset other members of her family because they
did not receive her whole-hearted attention. The therapist might then
dispute the client’s underlying assumption that she was responsible for her
family’s upset by wanting or doing something other than what they
expected by attempting to demonstrate to her, through disputational
dialogue, that the others’ responses were of their own making and, hence,
their responsibility rather than hers.
Throughout, the REBT therapist works from the assumption that, ‘in
order to bring about a philosophical change’ (Corey, 1991:335), the client
must accept:

1. The reality that she has largely created her own disturbances and has
the ability significantly to change them.
2. That her problems stem mainly from irrational beliefs and demands.
3. That she must learn to identify and dispute these beliefs and replace
them with rational alternatives.
4. That she must be willing to commit herself to practising the adoption of
a new and rational philosophy through the use of the cognitive, emotive
and behavioural skills she has learned in therapy (Dryden and Ellis,
1988).

In order to achieve this, the REBT therapist must be sufficiently skilful both
in discerning the irrational beliefs held by the client and in arguing the case
for rational alternatives. Further, the therapist must be sufficiently empathic
towards the client for her to be willing to address and reconsider her beliefs
while in dialogue with the therapist. To this end, the therapist must be
recognized as being both trustworthy and intelligent enough to earn her
attention and respect in a manner similar to that of a good teacher. Finally,
the therapist must be sufficiently practised in a variety of skills that include:
the disputation of irrational beliefs, the setting of suitably realistic and
relevant homework, and the training of the client to change or make more
precise her own ‘inner’ language, or to develop a technique of mental
imagery designed to remove irrational emotional patterns and replace them
with rational ones. More recently, REBT therapists have begun to employ
role-playing techniques and ‘shame-attacking exercises’, as well as to
develop the use of both humour and forceful debate in order to facilitate the
movement from intellectual to emotional insight (Corey, 1991).
While all these assumptions and techniques are specific to REBT,
nevertheless variations of most, or all, of them can be found in the various
approaches that fall within the cognitive-behavioural model.

C. CRITIQUES OF THE COGNITIVE-BEHAVIOURAL MODEL

As can be deduced from this brief summary, the hypotheses and

assumptions contained in the cognitive-behavioural model stand in
significant contrast to those that are to be found in the psychoanalytic
model. On the whole, they avoid reliance on hypothetical systems such as
the unconscious, are more present-oriented, and while the relationship
between therapist and client is considered to be an important element, it is
primarily the ‘instructional quality’ of the relationship, rather than its
‘transferential basis’, which is considered to be essential. As an additional
contrast to the psycho-analytic model, cognitive-behavioural therapy is
principally derived from, or supported by, experimental data, and the
cognitive-behavioural model prides itself (with some justification) on its
scientific foundations which allow it to remain flexible and accepting of
reformulations of its techniques on the basis of the on-going research
carried out by its practitioners and theorists.

The question of the therapist’s superior knowledge

At the same time, while clearly different in significant ways to the psycho-
analytic model, the cognitive-behavioural model nevertheless shares a
fundamental assumption with the former. For both models emphasize the
therapist’s superior knowledge and ability—even if the manner in which
this superiority is understood and applied is different. This common strand
within both models can be traced back to the therapist’s virtually
unquestioning belief in, and adherence to, the theoretical assumptions
underlying the chosen approach. In this way, any failures of therapeutic
intervention can be blamed either on the client’s ‘resistance’(in the psycho-
analytic model) or the client’s misapplication of (or unwillingness to apply)
the specified instructions presented by the therapist. While the cognitive-
behavioural model claims to be the most flexible in its on-going
reassessment of its theory and its applications based on the ‘results’
engendered, nevertheless it must be asked if these results reflect the
qualitative experience of the client and are valid within that experiential
framework. That clients who have worked within the cognitive-behavioural
model are as likely to experience dissatisfaction with its effects as they are
with any other model, and go on to other forms of therapy just as frequently
as do other clients, would suggest that there exists a significant weakness
within the model. My own view is that this weakness lies in the assumption
of ‘objectivity’—an assumption, among several, which I will discuss more
fully below.

The values and limitations of a scientific model

The cognitive-behavioural model has come to be widely employed in a
number of therapeutic settings, particularly within clinical and educational
establishments, where its action-oriented focus on process and outcome is
particularly valued. While clearly concerned with presenting itself as a
model that is based on clear, scientifically derived principles that are open
to experimental verification, at the same time the cognitive-behavioural
model contains a number of biases and assumptions that require some
clarificatory examination.
While its emphasis on scientific principles and experimental design is
obviously a great strength of the cognitive-behavioural model, it may also,
somewhat perversely, be seen as a weakness of some potential significance.
The roots of cognitive-behavioural therapy lie in developments that have
occurred in academic, experimentally oriented psychology over the last
thirty years. Once deeply steeped in the behaviourist theories of John
Watson and B. F. Skinner, which avoided all inferences of unobservable,
hypothesized mental processes and which basically expunged terms like
‘consciousness’, ‘mind’, ‘will’, and so forth from the psychological
dictionary, contemporary academic psychology has undergone what has
become known as the cognitive revolution. Owing to inherent weaknesses
in the strict behavioural models that, in a variety of instances, were shown
to be insufficient in themselves to explain human faculties such as memory,
linguistic ability, abstract thought, and the like, and whose own
experimental findings in these areas revealed flaws and contradictions in
the theories themselves, growing numbers of psychologists became
increasingly dissatisfied with behaviourism and began to develop cognitive
approaches that focused on intermediary, or mediating, processes that,
while not directly observable, could be inferred from experimental findings.
In this way, previously ‘taboo’ terminology (e.g. ‘mental acts’,
‘feeling’, even ‘consciousness’ itself) began to be re-introduced as proper
subject-matter for psychologists to study and examine. Soon enough, the
findings obtained from these new approaches began to be applied in various
ways—not least in therapy, thereby giving rise to the cognitive-behavioural
model in its diverse approaches.
However, while these changes provided the basis for significant
theoretical and applied developments, theorists and practitioners have
retained their allegiance to their behaviourist ‘roots’ by remaining firmly
bound to experimental procedures geared towards the study and analysis of
quantitative (or statistically measurable) variables. This is, in itself, nothing
to be derided. However, it has become increasingly a matter of concern and
debate that this quantitatively oriented methodology may be, at best, limited
in its scope of enquiry. With particular reference to its applications in areas
such as therapy, it has been argued that this ‘quantitative exclusivity’ may
be methodologically unable to address and examine a number of relational
and process variables that are increasingly acknowledged as being central to
analyses of therapy.
As was discussed in Part 1 of this text, most experimental studies of
therapy are focused on ‘outcome’, but far fewer have examined ‘process’
variables (Reason and Rowan, 1981; Kline, 1992). Put another way, while
quantitatively based experimental studies may be very useful, and
necessary, for the analysis of certain measurable changes that may result
from therapy, they are severely restricted in studying those variables that
appear within the relationship (i.e. relational variables) which are primarily
qualitative rather than quantitative. As such, while the cognitive-
behavioural model emphasizes what has occurred as a result of therapy, it
says very little about how the therapeutic relationship is experienced, or,
indeed, how the relationship itself influences outcomes.

The status of the emotions

In the specific context of the approaches discussed above, it can be seen
that ‘the “feelings” or emotions of clients are paid scant attention other than
in terms of their cognitive or behavioural content’ (Corey, 1991:327). These
experiential factors seem to me to be of substantial importance, not least
because they serve as significant guides for the therapist in seeking
accurately to ‘enter into’ the client’s world-view. If they are minimized, the
therapist is less likely to gain a suitable understanding of the client’s
experience. In the cognitive-behavioural model, the emphasis placed on
problem-solving, goal-setting and condition treatment, while in itself valid
and laudable, may well prove to be counter-productive if the features being
stressed as important by the therapist are not ‘in tune’ with the client’s
experience.
So, for instance, to return to the second example discussed above, what
is being argued is that it is of importance for the therapist to gain an
understanding of what it is like, or what it means to the client to feel
‘shunned’ or ‘unattractive’ or ‘different to her friends’. For, surely, it is
through the exploration of this ‘felt experience’ that the therapist may better
understand what is problematic or unacceptable to the client about herself
or her relations with others. But the cognitive-behavioural therapist, in
avoiding this exploration, imposes assumptions on this felt experience on
the basis that the therapist somehow already knows what it is, and what it is
like for the client. And, further, as a result of this assumption, the
‘problem’, the goal-plan, and the treatment may not truly express or
represent the client’s issues. In this way, while the client’s beliefs and
behaviours may change with regard to the problem as defined by the
therapist, the underlying, or ‘felt’, issues may well remain and provoke
‘new’ problems.

The question of symptom substitution

While some critics of the cognitive-behavioural model have incorrectly
suggested that clients will eventually ‘transfer’ or substitute one set of
symptoms for another (so, for instance, a client who is successfully treated
for a phobic reaction towards dogs will come to substitute something else
such as dust or cars for the anxieties once associated with dogs), what I am
arguing is that the issue is not one of ‘symptom substitution’ but that, rather,
the underlying conflict being expressed symptomatically has not been
sufficiently understood and addressed by the therapist so that it remains
even though its associated symptoms may have been treated successfully.
My own experience with clients who have previously been in therapy with
cognitive-behavioural therapists is that rather than ‘substitute’ symptoms,
they increasingly ‘internalize’ them such that they become more diffuse and
general rather than focused on a specific thing or event. In this way, an
important question arises as to whether they have really been helped by
therapy or whether the therapy has exacerbated the problem by dissociating
it from its symptomatic focus.
The question of objectivity
This issue leads directly on to the question of the role of the cognitive-
behavioural therapist as a directive instructor or teacher. The assumption of
this stance places a good deal of power and authority on therapists in that it
is assumed that not only do therapists ‘know’ their clients’ issues and
concerns as specifically experienced by them (the clients), but, just as
significantly, that therapists know better than their clients how to deal with
them on the basis that they (the therapists) are more able to be ‘objective’
about them. It is this assumption of the objectivity of the therapist that now
needs to be addressed.
Once again, it is understandable on the basis of the history and
development of the cognitive-behavioural model that the notion of
objectivity should be greatly stressed. After all, a primary characteristic of
the model is its emphasis on ‘objective measurement’ by means of
quantitative experimental studies. The problem with this view, however, is
that the notion of a truly objective investigator, observer, or experimenter
has been sufficiently cast into doubt by developments within science itself.
As I discussed earlier, it is more accurate to speak in terms of
interpretational investigations rather than objective analyses. This is
particularly relevant to the specific ‘investigations’ that can be carried out
in the therapeutic process since the therapist is interpretationally involved in
the process. While it is fair enough to say that the therapist may provide
viewpoints that clarify or add new meaning to the client’s world-view, and
in this way may be seen as being broadly educational or instructive, the
cognitive-behavioural model takes this view several steps further when it
suggests that the therapist is being objective. For this latter stance implies
that the therapist can distinguish the ‘real’ from the ‘unreal’—a position
that would be difficult to maintain. If the cognitive-behavioural model were
to argue that therapists challenged contradictions and illogical assumptions
within the client’s world-view, there would be little argument, but by
invoking the assumption of the therapist’s objectivity, the model bestows
unnecessary and potentially abusive power on the therapist.

Normative influences
Nevertheless, the evidence that exists as to the efficacy of outcomes
resulting from cognitive-behavioural interventions must be acknowledged.
In a broad sense, the cognitive-behavioural model ‘works’. But the question
must be raised: Who does it work for? The cognitive-behavioural model
places the therapist in a position of a normative judge whose principal
raison d’etre is to define and attempt to remove those client beliefs and
behaviours that have been deemed to be irrational or debilitating. But in
doing so, it is implicit that it is the therapist who makes the initial
assumption—on grounds that are culturally influenced and culturally
desirable—as to which attitudes and behaviours are ‘irrational’ or
detrimental to the client’s psychological well-being. In this way, the
therapist becomes a broadly libertarian representative of the norms and
codes of conduct of the society of which both the therapist and client are
members. But such socio-cultural norms and codes are not in themselves
‘objective’. In this way, the cognitive-behavioural model opens itself to
criticisms of therapy as a means of controlling alternative or dissenting
views that may be seen as being disturbing, unacceptable or dangerous by a
particular society.
Clearly, all of us must in some way deal with the dilemmas of
conflicting personal and socio-cultural attitudes and desires, and therapy is
an important means of confronting such dilemmas, but if therapists base
their interventions on the stance that, in being objective, they have
somehow resolved these dilemmas and are in some way better able or better
informed than the client as to what is true, good, and right for the client,
then they run the risk of imposing a socially conformist ideology on the
client.
For instance, if we consider the example of the client who no longer
feels that life is worth living which was discussed earlier, the ‘objective’
stance taken by the therapist assumes that her conclusion is wrong and steps
must be taken to deal with it. But this view adopted by the client may be
seen as not merely something that originates from ‘within’ the client, and is
personal to her alone, but also as a ‘response’ to attitudes and assumptions
that are dominant within her society concerning the undesirability of ‘being
single’. From the therapist’s response to the issue we can see that such
attitudes and assumptions are held by the therapist as well, and that the
goals set and the interventions made result from these assumptions and
attitudes. Does this suggest that the client should be ‘doomed’ to remain
feeling the worthlessness of her own life? Not at all. But until the
assumptions are exposed and challenged so that their possible meaning and
influence on the client’s own world-view are clarified, the therapist cannot
assume a knowledge or understanding of the client’s experience of
worthlessness.

Rational and irrational beliefs

This issue also raises questions with regard to the cognitive-behavioural
model’s distinction between rational and irrational beliefs. Once again, it is
only by assuming the ability to maintain an objective stance that therapists
can impose such distinctions from an external perspective. Just how
‘irrational’ is the client’s belief that her life is worthless and meaningless?
Given the very real demands that society makes on her, which she has not
been able to fulfil, her conclusion may be saddening or upsetting, but not
necessarily ‘irrational’. Once again, it is not just a view that has somehow
come to her because of some internal psychic malfunction, but, rather,
through her relations with others. If there is ‘irrationality’ it is an
irrationality that has as much to do with her society’s assumptions and
views as with hers. Would it not make more sense for the therapist to work
from a stance that accepts her conclusion, rather than disputes it, and seeks
to clarify just what it is about this conclusion which the client finds difficult
to cope with, rather than assume its ‘inherent irrationality’? Perhaps, in
doing so, the therapist might discover that the problem is not that she is
single in a world of couples but that she believes that her willingness to
remain single is a sign of abnormality and, hence, her conclusion as to her
‘worthlessness’ is a consequence of this. Whatever the case, the therapist
cannot begin to uncover the source of her conflict if its consequence is
immediately understood as being ‘irrational’.

The therapeutic relationship

Further, while there is some acknowledgement of the significance of the
relationship between client and therapist, nevertheless its importance tends
to be stressed as a means to an end (which is the client’s willingness to learn
from the therapist and apply the learning-based goals that have been set)
rather than being of value in and of itself. This emphasis on a tutor–pupil
orientation creates a very different and goal-oriented dialogue which limits
the nature of the encounter in a manner that minimizes, if not excludes, the
possibility of any significant learning (other than on the level of skills
amelioration) on the part of the therapist. The very scientific attitude taken
towards the task of therapy seeks to emphasize the ‘curative’ aspects of
therapy and, as such, it is of little surprise that cognitive-behavioural
approaches are those that are most strongly concerned with the analysis of
the success of therapy—such success being mainly statistically focused and
to a large extent defined and determined by the therapist’s parameters of
concern.
This conclusion, in turn, reveals a fundamental assumption within the
cognitive-behavioural model that the process of therapy is one where
primarily one individual (the therapist) ‘does something to’ another
individual (the client) on the basis of the assumptions the former has as to
the nature of psychic disturbance and the superiority of one form of
behaviour and mental attitude over another. As such, the investigation of the
client’s meaning-world, while clearly relevant to cognitive-behavioural
therapists, has a much more specific and defined purpose than that of
clarification and challenge, since it is focused on finding the means
whereby the therapist can determine the best means of inducing beneficial
change in the client. There is a strong, if implicit, medical stance in this
approach—a stance that suggests that, as with a visit to one’s GP, it is the
task of the therapist to employ specialist knowledge in order to ascertain the
nature of the disturbance, to impart only as much knowledge of this to the
client as is deemed necessary and relevant, and to set out particular tasks (in
the form of ‘homework’) which, if they are followed according to the
specific instructions laid down by the therapist, should ameliorate or
remove the disturbing symptoms.
While cognitive-behavioural therapists clearly challenge their clients’
views, they do so in a limited sense in that the challenged views are only
those that are deemed by the therapist to be relevant to the specific goals set
in the initial consultation with the client. In addition, the form of challenge
is disputational in that the therapist does not seek to ‘enter into’ the client’s
world-view but rather to attack it from the onset in order to rid it of its
inconsistencies and irrationalities, and to present an alternative position that
is the therapist’s and is deemed to be both rational and more beneficial for
the client to adopt. But, in all such cases, the distinction between that which
is ‘irrational’ or ‘unbeneficial’ and that which is ‘rational’ or ‘beneficial’ is
made by the therapists themselves on the basis of their authority. Gerald
Corey, among many others, has expressed his concern about the
implications of this, particularly with regard to REBT.
[C]lients can easily acquiesce in a therapist’s power and authority by
readily accepting the therapist’s views without really challenging
them or without internalizing ideas. As a precaution it seems
essential for therapists to know themselves well and to take care not
to merely impose their own philosophy of life on their clients
(Corey, 1991: 360).

The issue of what constitutes rational behavior is central here. In line with
this concern, I would point to a further crucial issue that has not been
suitably considered by cognitive behavioural therapists. So long as this
model emphasizes the exploration of client’s goals in order that they may
be analysed as ‘realistic’ or ‘unrealistic’, it places significant
interpretational power in the hands of therapists. But, on consideration, the
issue is less about client’s goals than it is about the means by which clients
seek to achieve them. If cognitive behavioural therapists retained their
principal focus upon the clarificatory challenge of such means (i.e. the
process) rather than whether their desired outcome is realistic or not, they
would continue to attend to their clients without opening themselves to the
concerns expressed by their critics.

The issue of successful outcomes

The cognitive-behavioural model claims to have provided the necessary
data to demonstrate the superior efficacy of its approach to therapy over all
other models. This ‘proven’ efficacy has helped substantially in determining
the extensive adherence to this approach in the majority of clinical,
educational and institutional settings on the basis of its success rate and
relative brevity. However, what the cognitive-behavioural model appears to
have failed to consider is that just as there may be other, less directly
quantitative measurements for determining success, so too may it be the
case that its definition of success, which of necessity must be a
quantitatively measurable definition, may in itself be significantly limited
and limiting. That is to say, in failing to give due consideration to clients’
less easily quantifiable (or even unquantifiable) responses, such statistical
analyses are able to provide only a partial representation of success, which,
in turn, is heavily skewed in favour of the model. It may be all too easy to
‘prove’ success on the basis of statistics—not necessarily because one is
‘cooking the books’ but, more importantly, because statistical ‘language’
restricts the ‘meaningfulness’ of analyses to measurable elements and fails
(or is unable) to say anything about other elements which, if considered,
might produce a radically different conclusion. Statistics need not
necessarily be ‘damned lies’ to be seen as incomplete—or even inadequate
—measurements of success. We need look no further than to Parliament
where, for years, the ruling Conservative Party has been producing statistics
‘proving’ that we are all so much better off. Even if we were to agree that
these data have not been ‘fudged’, the limitations of these claims, at the
lived level of most citizens’ experience, remain all too obvious. This is not
to deny what success has been achieved by the cognitive-behavioural
model, only to clarify that ‘success’, in its terms, is a restricted concept.

Change
The emphasis on quantitative measurement raises one final, important issue.
This emphasis assumes the all-pervasive importance of change as a result of
therapeutic intervention. For, otherwise, the quantitative measurements
would be of little value. But this assumption is itself open to question. Is
therapy necessarily about observable and quantifiable change? Should
therapists equate the evidence (or lack of such) of change in their clients as
the determinant for effective therapy? It would appear to be the case that
many therapists (and non-therapists) do. But does this have to be the case? I
will explore this issue more fully below when considering the humanistic
model, since perhaps more than any other model it appears to insist on this
assumption. But it should be noted that the critical observations made
therein apply equally to the cognitive-behavioural model.

D. CONCLUSIONS

From this brief synopsis, it should be clear that the cognitive-behavioural

model avoids many of the assumptions of the psycho-analytic model of
therapy, in that it minimizes, if not dismisses, notions of the unconscious,
the determinist influences of the past, and the importance (if not existence)
of transference and counter-transference, and seeks to avoid interpretations
intended to expose hidden or symbolic meanings. Indeed, the emphasis
placed on the clarification and descriptive analysis of currently experienced
issues, and the focus on the unique experience of the client, would initially
suggest that a good deal of convergence (both actual and potential) exists
between the cognitive-behavioural model and the descriptively focused
model I have presented in various parts of the text (and which will be
discussed more fully in Part 5) as a source for alternative perspectives with
regard to various therapy-related issues under discussion.
At the same time, however, as I have attempted to demonstrate, a
number of significant divergences remain. Principally, these revolve around
the cognitive-behavioural model’s assumptions of objectivity, its inability to
consider the client’s ‘feelings’ other than as cognitive indicators of
rationality or irrationality, its superficial examination of the therapeutic
encounter per se, and its emphasis on the directive instructional role of the
therapist. While I am of the belief that constructive dialogue between these
two models would be both relevant and useful, and would personally
welcome this, nevertheless it is of some importance to remain clear as to
what these current divergences are and to consider their significance and
impact on the therapeutic process.

2. THE HUMANISTIC MODEL

A. AN OVERVIEW

The humanistic model, like the psycho-analytic and cognitive-behavioural

models, has had a major influence on therapy and is today the most widely
employed model within the British counselling movement. Characterized
by its emphasis on the exploration of current subjective experience, its
promotion of qualitative factors such as compassion, acceptance and
tolerance as essential characteristics of the humanistic therapist, and its
accentuation of those positive, constructive capacities and potentials for
growth and development which it assumes to be present in all human
beings, it remains steeped in a humane and libertarian philosophy that is
often at odds with the currently dominant competitively oriented and
punitive ethos of contemporary British society.
The humanistic model of therapy has its immediate origins in the
humanistic and ‘human potential’ movements in psychology which
flowered principally in North America and in Britain between the mid-
1960s and early 1970s. This psychological ‘revolt’, which became
characterized as the ‘Third Force’ in psychology, rejected the reductionistic
orientations of both psychoanalysis and behaviourism as being ‘de-
humanizing’ and argued that psychology’s tendency to ‘study human beings
by dividing them up into various parts’ not only produced limited
knowledge but, more significantly, succeeded in removing from individuals
their experience of themselves as whole, autonomous beings. In place of
these approaches to psychology, humanistic psychologists emphasized the
study of conscious experience (rather than the study of the unconscious or
of behaviour per se), and presented a view of human beings which
emphasized their wholeness, integrity, freedom of choice, autonomy,
uniqueness and ultimate undefinability (Shaffer, 1978). Equally, it took as
fundamental the view that all human beings have an innate tendency to self-
actualize (Maslow, 1968). These assumptions, in turn, led to the
development of a number of applied techniques designed to promote
subjective exploration which would allow a realization of these human
potentials. Humanistic therapy emerged from these developments as a
unique model focused on self-actualization through the exploration of
current subjective experience in a constructive and accepting environment.
Given the diversity of its influences and the unique emphases of
influential practitioners and theorists such as Abraham Maslow, Carl
Rogers, and Frederick (Fritz) and Laura Perls, the humanistic model in
therapy represents a wide range of approaches and techniques among which
the most well known include Person-Centred Therapy, Gestalt Therapy and
Transactional Analysis (TA). While each of these differs significantly in a
variety of ways from the others, nevertheless all share a number of
fundamental attitudes concerning therapy. Broadly stated, these attitudes
emphasize the following features:
First, the humanistic model argues that the focus of therapy should be
on the client’s currently lived experience, rather than on the past influences
that may have led up to, or which might explain, this present position. In
this way, the humanistic model is experientially focused on the ‘now’ of
experience. In order to remain at the level of exploration that emphasizes
current experience, humanistic therapists focus on descriptive questioning
and clarification (which, broadly speaking, focuses on issues concerned
with the ‘what’ and ‘how’ of experience) and avoid analytic questioning
(which, in its implicit and explicit causal assumptions, emphasizes the
uncovering of past events through its focus on the ‘why’ of experience).
Second, the humanistic model concentrates on the ‘totality’ of the client
rather than emphasizing the client’s presenting problem. In this way, it is
not oriented towards problem-solving, but, rather, concerns itself with the
examination of issues and concerns within the client’s experience which
give rise to, or are expressed as, problems. The therapeutic relationship,
therefore, provides ‘the necessary freedom to explore areas of … life that
are now denied to awareness or distorted’ (Corey, 1991:210).
Third, the humanistic model places the task of understanding or
interpreting the client’s experience on the client rather than on the therapist.
In this way, the therapist must be willing to set aside theoretically based
assumptions, biases and generalizations about human experience so that the
client can be viewed as a unique being who generates distinctive, singularly
applicable meanings and world-views.
Following this last point, the fourth feature of the humanistic approach
lies in its emphasis on the client’s freedom and ability to choose how to ‘be’
and what meanings to live by. In this way, the humanistic model restrains
therapists from assuming or presenting themselves as being more capable
than clients of discerning or interpreting their experiences.
The fifth general characteristic of the humanistic model is that it
promotes an egalitarian relationship between therapist and client. In
furtherance of this stance, the therapist is equally free to choose to disclose
personal attitudes, feelings or conflicts that arise from the encounter.
The sixth feature is that the humanistic model views the curative or
positive benefits of therapy as arising from within the therapeutic process
itself. More specifically, it argues that these potentials can be realized once
the therapist adopts an accepting and caring stance towards the client,
expresses congruent or genuine attitudes, and is able accurately to reflect
the subjective experience of the client so that it is opened up to non-
defensive exploration. While this view is most apparent in Person-Centred
Therapy which emphasizes the above ‘being’, or attitudinal, attributes as
both necessary and sufficient for a beneficial therapeutic encounter,
nevertheless, even when various other humanistic approaches, such as
Gestalt Therapy, do employ a number of skills-based techniques designed to
promote self-challenge or emotional discharge, they continue to emphasize
the therapist’s ‘being qualities’ as essential constituents of the process
which provide the necessary qualitative variables for the techniques to be
both appropriate and successful.
The seventh characteristic of the humanistic model argues that the
problems or presenting symptoms that clients bring to therapy reveal an
underlying experience of incongruence at the level of the self-concept. As
such, clients’ own awareness of themselves is understood as being
fundamentally divided in a variety of ways, all of which are focused on the
self. So, for instance, clients may experience incongruence between the
current view they hold of themselves and their ideal self, or between the
self they believe ‘must’ be as opposed to the self that ‘is’ (Person-Centred
Therapy); or between assumed ‘ego states’ representing child, adult and
parental stances and values within the self (Transactional Analysis); or they
may have ‘disowned’, dissociated or depersonalized unacceptable, painful
or contradictory aspects of their self (Gestalt Therapy). Seen in this way, the
task of humanistic therapy becomes that of integration, either by providing
the means for increased self-congruence, or self-acceptance and validation,
or a greater willingness and ability to ‘own’ one’s experience.
Underlying these characteristics, the humanistic model contains a
number of fundamental assumptions or viewpoints about human nature.
Deeply influenced, not surprisingly, by philosophical attitudes rooted in
humanism, it emphasizes human beings’ capacity for transcendence or self-
actualization. It argues that all individuals can develop a clearer and more
integrated awareness of their personal and species-shared values, of the
choice and responsibility they are capable of acknowledging, and of their
experiential uniqueness, through the exploration of their human potentials.
As such, the humanistic model assumes that human beings have an
innate tendency to grow, or develop, in a positive, life-affirming manner
regardless of the disabling conditions present in their environment. It is this
fundamental assumption which is the source of humanistic therapists’
rejection of the role of ‘the authority who knows best what is right for the
client’, and which infuses their belief that clients have the inherent capacity
to move away from maladjustment toward psychological health’ (Corey,
1991:208). For instance, Carl Rogers, the founder of Person-Centred
Therapy, has argued that all human beings share a number of fundamental
values (including sincerity, self-knowledge, sensitivity to one’s own and
others’ feelings, and so forth) and that these will express themselves in a
relationship that is experienced as being accepting, open and non-
threatening, thereby allowing the individual to develop in a manner that is
both positive and naturally directed towards the realization of their full
potential (Kirschenbaum and Henderson, 1990a).
These views, in turn, reveal the humanistic model’s assumption that
human beings have an innately positive nature which may be impeded or
twisted by negative environmental influences that place conditions or
demands on the individual’s capacity for actualization. ‘[I]t is cultural
influences which are the major factors in our evil behaviour … I see
members of the human species … as essentially constructive in their
fundamental nature but damaged by their experience’ (Rogers, in
Kirschenbaum and Henderson, 1990b:238). Nevertheless, no matter how
damaged their condition, individuals remain capable of expressing their
positive nature.

When an individual’s negative feelings have been quite fully

expressed, they are followed by faint and tentative expressions of the
positive impulses which make for growth … the more violent and
deep the negative expressions (provided they are accepted and
recognized), the more certain are the positive expressions of love,
social impulses of fundamental respect and of a desire to be mature
(Rogers, in Kirschenbaum and Henderson, 1990a:71-2).

Finally, the humanistic model assumes the existence of a core, unitary self
which is the source point for individual development and actualization
directed towards becoming ‘the self which most truly is’ (Rogers, 1961).
Once again, this assumption clarifies the humanistic therapist’s dual
emphasis on both the exploration of incongruence within the client as a way
of eliciting the existing discrepancies between lived experience and the self-
concept and on the therapist’s own ability to remain ‘real’ or congruent in
the therapeutic encounter. In maintaining both emphases, it is argued, the
client becomes more able and willing to accept and integrate aspects of
lived experience that did not previously ‘fit’ the self-concept and, through
this acceptance, is put in touch with the core self.

C. CRITIQUES OF THE HUMANISTIC MODEL

Each of these assumptions requires some critical examination. However,
before going on to consider what I believe to be crucial areas of concern
within the humanistic model, it is important to address one of its most
distinctive features, namely the value it places on the therapist’s willingness
to self-disclose during therapy.

Self-disclosure
Clients often question therapists’ unwillingness to reveal aspects of their
lives to them, or to state their personal views on particular issues. This one-
sided stance seems at the very least artificial and unnerving to clients, and is
likely to be the source of a good deal of irritation directed towards the
therapist. The psychoanalytic model set the standard view on therapist self-
disclosure by arguing that therapists’ self-disclosures impinged on the
transference relationship and were, therefore, to be strictly avoided. By and
large, subsequent therapeutic models have adopted this position to varying
extents, although a number of therapists, R. D. Laing for instance, have
argued that in some cases at least it is therapeutically counter-productive for
the therapist to avoid self-disclosure (Laing, 1960). In a similar fashion,
critics of therapy such as Jeffrey Masson have pointed to therapists’
unwillingness to disclose their views as a further means of maintaining an
imbalance of power that is heavily weighted in favour of the therapist
(Masson, 1988).
Various approaches within the humanistic model have argued for the
importance of therapist self-disclosure since it makes clear the therapist’s
willingness to be ‘real’ or congruent in the encounter and, by extension,
promotes the establishment of a real encounter within the artificial confines
of the therapeutic process.
While this view should not be dismissed as insignificant, it remains
possible to consider instances where therapist self-disclosure, regardless of
circumstance, may be as counter-productive as the unwillingness to self-
disclose. For instance, a number of humanistic practitioners have tended to
interpret the notion of therapist ‘transparency’ or ‘congruence’ as being the
equivalent of their right to express feelings or attitudes currently
experienced towards the client. These might include interest, boredom,
irritation, relief, anger, love, and so forth. While such terms may certainly
reveal the therapist’s current attitude towards the client, and so present an
image of ‘congruence’, it is easy to see that in a great many circumstances
they might well be experienced as abusive by the client in that they might
be interpreted as statements of demand or lack of acceptance of the client’s
current way of being. So, for example, if a client is informed that the
therapist ‘is bored’, is it not likely that what will be understood by this
statement is: ‘You are not allowed to be boring; you must change’?
At the same time, humanistic therapists might well point out that not to
have disclosed their experience would have promoted the continuation of a
‘false’ encounter and that their feedback to their clients, while possibly
experienced as painful or confrontative, would nevertheless reveal their
willingness to engage with clients on an egalitarian level that does not seek
to protect or infantilize them.
Both views seem to me to have some merit. Nevertheless, even if one
were to accept the humanistic stance and engage in self-disclosure, it would
appear sensible to consider both what to self-disclose and how to express
that self-disclosure. In the first instance, therapists should ask themselves
whether their intended disclosure is principally for the purposes of serving
the therapist’s personal interests or those of the client. So, to return to the
previous example, if the disclosure of boredom is primarily to give vent to
rising frustration with the client, then it is unlikely that the disclosure will
be of much therapeutic benefit; better for the therapist to attend to the
experience and consider what it might be saying about the current state of
the therapeutic relationship rather than seek to change it. On the other hand,
there might be some relational benefit in addressing the experience of
boredom; but here too it becomes important to consider how it might be
addressed. The statement made by the therapist might be presented as
demanding (‘I am bored’) or as invitational (‘Look, I don’t know if it’s just
me, but I’m experiencing a growing sense of boredom. Is this anything like
what you’re experiencing?’) While the former implicitly places the
emphasis or source of the experience on the client (therapists do not
‘naturally’ get bored, so if boredom is being experienced it must have
something to do with the client), the latter acknowledges the therapist’s
interpretational role in the experience and allows the client to challenge it.
In one sense, therapists, however unwilling they may be to do so, cannot
do other than self-disclose. How they dress, their appearance, their posture,
their gestures and mannerisms, the language they employ, their accent, the
environmental features of their consultation room, all these factors and
many more ‘reveal’ them—as, indeed, does the very fact that they invest so
much significance in their anonymity. Equally, when a client asks the kind
of question that requires some degree of self-disclosure, it might be wise to
enquire of the client what meaning this question has to the client—but it
might be just as important to offer to answer it directly.
My own experience has been that clients want very few self-disclosures
from me and that when they ask for them they are not just giving way to
their curiosity, nor are they seeking to assert their power, nor are they
revealing some transferential issues, but, rather, they are likely to be
expressing something about our on-going encounter with one another. And
if I address their question or statement in this light, it does not compromise
my anonymity but is a revelation both to myself and to them that I am
willing to engage myself in their world-view.
As such, the humanistic model’s attitude towards therapist self-
disclosure is integral to its general stance and assumptions concerning the
nature of therapeutic discourse and, in this sense, is valid. At the same time,
the way self-disclosure is interpreted and how it is expressed suggest an
underlying assumption concerning its view about the ‘self ’ and ‘self/other’
relations which requires further attention. First, however, several other, if
related, fundamental assumptions within the humanistic model need to be
considered.

Self-actualization
When addressing the issue of the innate capacity to grow or actualize,
humanistic therapists often invoke analogies in the plant and animal
kingdoms. They might refer, for instance, to the analogy of an acorn which
is innately predisposed to grow into an oak tree (Corey, 1991) or, more
commonly, they point out that potatoes placed in the unnatural environment
of a basement will still, quite naturally, sprout roots that direct themselves
towards distant window-light (Thorne, 1992). These analogies serve to
convey the experiences of human beings who, in spite of the adverse
conditions of their environment, will nevertheless struggle to express their
potential. While such analogies are, at best, metaphorical, they are also,
more significantly, limited. For, on consideration, these examples, while
making the point that all living things struggle to remain alive and may
survive to some degree under the most difficult of circumstances, have
nothing really to say about self-actualization.
Equally, what is omitted from such analogies is the fact that in a great
number of environmental conditions acorns will simply not grow and
potatoes will just rot away. As to the ‘natural’ direction of growth and
development, it is difficult to see how a distinction can be made between
‘natural’ and ‘unnatural’ conditions for growth. If we remain at the level of
analogy, the development of cross-breeding techniques in plants and
animals has demonstrated that the capability of living things to survive rests
on their capacity to mutate in response to various changes in the
environment (be they artificially induced or in response to uncontrolled
variations in such factors as weather and temperature), such that these
mutated species may differ significantly from the original. But can we say
that one is ‘natural’ and the other is not? In this way, the direction of growth
is not governed by ‘the thing itself but by its relations with the environment.
In the same way, human beings develop in such myriad directions that it is
more sensible to speak of this process as one of interactive disclosure rather
than ‘upwardly directed growth’.
In other words, while it might make sense to speak of human beings as
expressing themselves within set conditions and, in turn, through their
presence, influencing those conditions so that ‘all and everything’ is in a
state of continuing flux, it is somewhat naive and narrow-minded to assume
that, ideally, ‘naturally directed’ growth would occur in a condition of
stasis.

Change
Underlying this stance is the notion of change itself. Some humanistic
therapists—like so many other individuals—may speak somewhat glibly in
terms such as ‘life is change’ and will therefore focus on ‘change’ as being
central to the therapeutic enterprise. Now while there is a fundamental
sense in this assertion, since one of the ‘givens’ or invariants of human
experience is its plasticity or on-going changing process, it is important to
be clear that the ‘changes’ that humanistic therapists emphasize are those
that are in some way or other ‘directed towards growth’. This is a much
more limited and limiting notion of change than that invoked by phrases
such as ‘life is change’ since it focuses on a particular aspect of change
which has been interpreted as being ‘natural’ or ‘good’ or ‘valid’ because it
is seen as being ‘self-actualizing’.
In humanistic therapy, it can be seen that therapists ‘value’ their clients
because of their assumed ability to change in a self-actualizing direction.
But what if this assumption were to be questioned and all that could be said
of change were that ‘it is’ and that, as such, human beings change in so
many ways and so continuously that no particular direction can be inferred
as ‘natural’?

Conditional unconditionality
Such a conclusion raises an unforeseen yet significant problem for the
humanistic model. For while all humanistic therapists seek to maintain and
provide their clients with qualities or conditions such as acceptance and
accurate empathic understanding from an ‘unconditional’ standpoint, it
must be asked: How conditional on the assumption of innate positively
directed growth is this ‘unconditionality’? In other words, if this
assumption were to be removed or presented as doubtful, would humanistic
therapists still offer those qualities? My own questioning of a number of
humanistic therapists on this very point suggests that at the very least they
would find it extremely difficult to maintain an accepting attitude towards
their clients and, in some cases, would seriously question their basic
rationale for providing therapy.
If the basis for the provision of acceptance, empathy and so forth rests
on the assumption of an underlying inherent ‘goodness’ or ‘positively
directed development’, then it would be the case that such assumptions,
however worthy or humanly desirable they might be, would have been
shown to be implicit demands or conditions set by the therapist for the
client to accept and demonstrate. Such demands may be far more subtle
than any other that clients may have experienced in their lives, but they
remain demands nonetheless, and clients, once they have ascertained them
to be such, are likely to respond to them as conditions for their way of being
which must be fulfilled in order that they may be accepted or deserving of
the attention being given.
Such subtle guidelines require acknowledgement from humanistic
therapists for they reveal that rather than being unconditionally accepting
‘reflectors’ of clients’ subjective experiences of themselves, they are
actually directive and impose a stance for clients to adhere to. Rollo May
has argued this same point by noting that in his observations of person-
centred therapists working with clients at the Veteran’s Hospital in
Madison, Wisconsin he found that the therapists did not acknowledge
clients’ expressions of hostile feelings that were both generally directed and
focused on the therapists themselves. May suggested that this unwillingness
on the part of the therapists acted as an impediment to the clients’
expression of self-autonomy (May, in Kirschenbaum and Henderson,
1990b). Interestingly, in his response to May, Carl Rogers, while regretting
this evidence and emphasizing the need for therapists to accept all
expressions of feelings, nevertheless characterized the clients’ feelings as
‘negative’—but why should this additional label be attached to these
feelings unless, however implicitly, they are to be discouraged?
In a similar fashion, such directives may prove to be far more
problematic and difficult for clients to contend with than any of the
explicitly stated conditions presented by cognitive-behavioural therapists.
For clients are likely to wish to accept the assumptions of humanistic theory
and desire to see themselves as growth-oriented, innately good beings. But
what happens when clients cannot see the evidence of this assumption, or
worse, see its ‘evil’ contradiction in the thought or behaviours they
engender? In such circumstances, are clients not likely to conclude that
something far more seriously problematic exists which in some way defines
them as being fundamentally flawed and somehow less than human? Rather
than provide them with a sense of experiential choice and responsibility,
does it not invoke the experience of passive victimization to external
influences?
Given this, it would seem to me far wiser to adopt the position argued
by the existential philosopher and psychotherapist Emmy van Deurzen-
Smith, that ‘people may evolve in any direction, good or bad, and that only
reflection on what constitutes good and bad makes it possible to exercise
one’s choice in the matter’ (van Deurzen-Smith, 1988:56-7).
Further, the emphasis placed by humanistic therapists on the therapeutic
relationship itself reveals a hidden agenda above and beyond the
establishment and maintenance of the relationship itself in that it contains
the implicit goal of nurturing the positive growth and goodness of the client.
But why should humanistic therapists insist on this unless it is something
that is more for their benefit than it might seemingly be for their clients? If
humanistic therapists require such an assumption, does it not seem
worthwhile for them to examine this demand in order to clarify in what
ways it might be influencing or directing their ability and willingness to
listen to their clients in as flexible and attending a manner as possible?
Perhaps even more importantly, the humanistic model’s contention that
those attitudes and behaviours that are termed ‘negative’ or destructive
result from the ‘twisted influences’ of environment need further
examination. As well as suggesting a form of determinism that runs counter
to the humanistic model’s fundamental stance, this view places the person
outside the environment. Once again, as Rollo May has pointed out, this
assumption ignores the influence that all of us have in interpreting,
perpetuating or altering the cultural environment we exist in and define
ourselves through. ‘Culture is not something that is made up by fate and
foisted upon us’ (May, in Kirschenbaum and Henderson, 1990b:241).
Rather, human beings and their cultures co-constitute each other; that is to
say, each defines, and is itself defined through, the other. This relational
definition places each of us, or implicates each of us, within our culture—
not outside it—just as our culture is implicated within each of us.
While the humanistic model initially seems to suggest, or articulate, this
viewpoint, on analysis what is revealed is that its assumption of the
separateness of ‘self and society’ is a required stance for it to hold. This
conclusion is made explicit in Rogers’ response to May when, presented
with experimental evidence disputing this humanistic assumption, all he is
able to state is that ‘there is much I don’t understand about some evil
behaviors. The experiments … are a shocking puzzle to me …’ (Rogers, in
Kirschenbaum and Henderson, 1990b:254), for which he can supply no
adequate explanations.

The self
The humanistic model’s emphasis on the self as a distinct and separate
entity opens it to further significant criticism in that this stance contains an
inherently solipsistic (or self-aggrandizing) attitude the implications of
which for the self– other relationship are as pertinent as they are profound.
The humanistic model has for many years been criticized, and satirized,
for its implicit disregard for others’ subjective realm on the basis that each
of us is solely, and separately, responsible for the interpretation we give to
our experience. An extreme example of this view would be the so-called
Gestalt Prayer:

I do my thing, and you do your thing.

I am not in this world to live up to your expectations.
And you are not in this world to live up to mine.
You are you, and I am I,
And if by chance we find each other, it’s beautiful.
If not, it can’t be helped (Perls, 1976:4).

While it would be unfair to suggest that this extremity of solipsistic

absurdity has continued to dominate humanistic thinking, nevertheless what
does remain is the false logic on which such self-centred stances are based.
For while there is a validity in suggesting that our experience of the world
is an interpretational process, what is missing from this stance is the
recognition that the ‘self ’that interprets is itself an outcome of reflective
interpretation derived from a fundamental relational ‘given’ of being. In this
way, self and other (however each is defined) co-constitute, or derive their
definitional meanings from, one another. As such, rather than suggest, or
allow (or even, as Perls’s ‘prayer’ makes explicit, celebrate and exult in) a
real and verifiable distinction between self and other, this view presents us
with the very opposite conclusion in pointing out the inextricable nature of
self–other as relational foci within the co-constituted reality within which
each is perceived to exist.
That, over time, the humanistic model may have significantly re-
appraised its stance on the self is beyond doubt, but that many of its
practitioners still insist on notions of the self which do not make its
relational context explicit is also a current reality. The very title of one of
the main humanistic journals, Self and Society, exemplifies the issue
through its ambiguity of meaning. For while on the one hand the title may
be read to mean that humanistic thought recognizes the lack of any real
division between self and society, it can also be read as a statement that
acknowledges the exact opposite viewpoint.

The ‘real’ self

The humanistic model’s approach to the self raises a further area of concern
in that it expresses the virtually universal assumption among humanistic
theorists and practitioners of the existence of a fundamental or real self that
is the source point and means of expression of the positive growth
properties and innate natural goodness of any individual. Indeed, it can be
seen that it is precisely this stance on the ‘real self ’ that allows humanistic
therapists to retain their assumptions concerning positively directed growth
and change. Each view requires the other in order to be meaningful.
Further, it is the maintenance of this view of the fixed and fundamental
existence of a ‘real self ’ which allows a distinction to be made between the
‘real self ’ and all expressions of ‘false selves’ that clients may manifest. In
upholding this view, humanistic therapists are able to focus on the assumed
manifestations of positively directed growth in their clients as expressions
of the ‘real self ’ that continues to exist and exert its influence in spite of all
the ‘false selves’ (that is, the destructive, growth-preventative, ‘bad’
attitudes and behaviours) that clients exhibit.
But, once again, it must be asked how humanistic therapists are able to
distinguish the ‘real self ’ from the ‘false selves’ other than by relying on
the assumptions they hold concerning the nature of human beings. In this
way, the humanistic model’s notion of the ‘real self ’ reveals an inherent
circularity of argument that itself relies on the unfalsifiability of its
assumptions (that is to say, if one initiates all investigations on the basis that
a ‘real self ’ exists, then all the accumulated evidence can do nothing but
‘reveal’ the ‘correctness’ of this assumption).
This stance also reveals the significant interpretative power that
humanistic therapists bestow on themselves in that, however explicitly or
subtly, it is they who, in the encounter, direct their clients towards the
recognition of their ‘real self ’, influence their movement towards closer
identification with such, and point out or reinforce the gains and rewards
available once this assumption has been accepted. Far from assisting
humanistic therapists in remaining ‘unconditional’ or accepting of the
client’s experience, the notion of a ‘real self ’ promotes conditionality and
lack of acceptance since any manifestation of a ‘false self ’ (however
defined) is at best tolerated, rather than accepted, by the therapist, and even
then only because this toleration will better enable the client to change in
ways that will promote (‘real’) self-actualization.
It is surprising to me that therapists as astute as Carl Rogers appear to
have failed to see, much less seriously considered, the directive and
potentially abusive features contained in their stance concerning the ‘real
self ’. In not doing so, they have, however inadvertently, promoted the
development of one more model that limits the client’s possibilities of being
and which lumbers important aspects of humanist philosophy with an
assumption that is difficult to defend. This is particularly galling given the
oft-stated claims of humanistic theorists such as Rogers and Perls that their
models are founded on existential phenomenology (Shaffer, 1978; Corey,
1991). Perhaps they are partly so, but if such authors had given serious
consideration to the relevant aspects of existential-phenomenological
thinking, they would have realized that the notion of self that emerges is
one that emphasizes as fundamental the view of ‘self-in-relation’ and self as
‘plastic’ constituent of reflection (van Deurzen-Smith, 1988; Spinelli, 1989,
1993).
Gerald Corey has succinctly expressed this important divergence
between humanist and existential-phenomenological thought:

[E]xistentialists take the position that we are faced with the anxiety
of choosing to create a never secure identity in a world that lacks
intrinsic meaning. The humanists, in contrast, take the somewhat
less anxiety-evoking position that each of us has within us a nature
and potential that we can actualize and through which we can find
meaning … for the existentialist there is nothing that we ‘are’, no
internal ‘nature’ we can count on … (Corey, 1991:206).

Placed in this perspective, we can begin to see that statements concerning

‘real’ and ‘false’ selves become limiting, if not absurd, notions to maintain.

A case example
As in the previous critiques of other therapeutic models under discussion, it
seems worthwhile to consider the points just raised from the concrete
standpoint of a case presentation. The following summarized example,
taken from the person-centred approach to therapy advocated by Carl
Rogers (Rogers, in Kirschenbaum and Henderson, 1990a: 135-52), should
clarify a number of the issues under discussion.
At the age of eighty, Rogers gave a thirty-minute demonstration of his
person-centred approach in front of six hundred workshop participants in
South Africa. In spite of its brevity and therapeutic limitations, Rogers felt
that it illustrated ‘several aspects of the therapeutic process as it occurs in
the changing relationship between therapist and client’ (Rogers, in
Kirschenbaum and Henderson, 1990a: 138).
Rogers’ volunteer client was a thirty-five-year-old woman named Jan
who presented him with two problematic fears which she wanted to
explore. These were: her fear of marriage and children, and her fear of
ageing. As Jan expressed it: ‘It’s very difficult to look into the future, and I
find it very frightening’ (ibid: 139).
When Rogers asked which of these fears she would prefer to look at
first, Jan selected the problem of ageing. Asked to clarify this fear, she
noted that she had only five years left before turning forty, that this concern
had been affecting her self-confidence and that the feelings had only begun
some eighteen months to two years earlier. When asked whether anything
significant had happened during this time which she might have associated
with the onset of the fear, Jan at first replied that she couldn’t think of
anything and then added that her mother, whom Jan saw as being youthful
and intelligent, had died at the age of fifty-three. On further reflection, Jan
disclosed that her mother had been a talented woman but that
‘unfortunately, towards the end, [she] became a bitter woman. The world
owed her a living … I Jo feel that what happened to my mother is
happening to me’ (ibid: 141).
As the encounter progressed, Jan refocused her attention on the second
issue—her fear of marriage. Initially, her words suggested that the concern
involved an underlying fear of commitment. With further clarification, the
issue was seen not to be about commitment in general, since Jan claimed to
be able and willing to commit herself to her work and her friends. It was her
specific inability to commit herself to marriage and children which was the
problem. Then, following a long silence, Jan stated:

… My love is for the arts, right? I’m very much involved with music
and dancing. I’d like to be able to just throw everything up and
devote my life to music and dancing. But unfortunately the society
that we live in today forces one to work and live up to a social
standard. It’s not something I regret. It’s something I miss,
something I really want to do … I’m getting older and I keep turning
around and running back (ibid: 142).

On further reflection, Jan expressed her fear of being trapped. This

experience seemed to be something that went unnoticed by everyone but
herself, since others glibly pointed out to her that she was ‘in her prime’ and
that she ‘had everything going for her’. With this, Rogers suggested to her
that while others’ views were accurate reflections of Jan as she was ‘on the
outside’, she was quite a different person ‘inside’. In response, Jan revealed
that she enjoyed playing ‘the naughty little girl’ since it allowed her to get
away with things.
Following this, Jan spoke of her frustration at not having someone else
to believe in her and provide her with the necessary confidence she felt she
lacked. Rogers’ subsequent response to this is illuminating:

Somebody you can relate to. And I guess that this may seem like a
silly idea, but I wish that one of those friends could be that naughty
little girl. I don’t know whether that makes any sense to you or not,
but if that kind of sprightly, naughty little girl that lives inside could
accompany you from the light into the dark—as I say, that may not
make any sense to you at all. [Puzzled by his words, Jan asked
Rogers to elaborate.] Simply that maybe one of your best friends is
the you that you hide inside, the fearful little girl, the naughty little
girl, the real you that doesn’t come out very much in the open (ibid:
148).

Finally, as the session drew to its close, both Jan and Rogers joked about
their mutual ability still to be ‘naughty little children’ in spite of their
chronological ages.
This encounter is fascinating on a number of counts. Firstly, it manages
to convey the essentials of Rogers’ person-centred approach (and, more
broadly, of several key assumptions within the humanistic model),
including his willingness to accept the client, his ability to reflect her
statements accurately and sensitively, and his openness in disclosing aspects
of his experience of himself to Jan. At the same time, however, it also
reveals Rogers’ (and the humanistic model’s) underlying assumptions and
how these sometimes lead him to step out of a ‘reflecting mode’ and into a
directive one. Most obviously, this occurs when Rogers chooses to return to
the theme of ‘the naughty little girl’—a theme that Rogers re-introduces
spontaneously quite some time after Jan has mentioned it and then moved
on from it. Rogers’ rationale for this is that it ‘was the kind of intuitive
response that I have learned to trust. The expression just formed itself
within me and wanted to be said’ (ibid: 148). However, in doing so, Rogers
seems to remain unwilling to acknowledge it as a directive interpretation on
his part and, rather, mystifies it as an ‘intuitive response’. More pertinently,
however, Rogers’ own words with regard to this reveal his theoretical belief
in the ‘real self ’—a belief that Jan eventually seems to come to accept,
work with, and gain insight from.
While I have no criticism of Rogers’ decision to express his hunches (in
this, it is he who is being implicitly critical of his own approach), I do take
issue with his assumption that ‘the naughty little girl’ is the real Jan and
that the ‘adult’, fearful Jan is somehow an aspect of an ‘unreal self ’. Could
they not both be experientially ‘real’ in the same way as Rogers can be
‘real’ being the eighty-year-old man and ‘the naughty little boy’? In
ascribing ‘reality’ to one and not to the other, Rogers is being led by his
theory and, in being led, is possibly missing a vital feature of Jan’s problem.
For Jan herself expresses herself as being torn between opposing
demands. She tells us that she wants to be free to be committed to her
artistic development but feels that she should be doing what is socially
acceptable for a woman of her age—like being married and having children
perhaps? She presents this initially by speaking of her mother who was
talented but became a bitter woman—perhaps because she did the ‘socially
acceptable’ thing and married, raised children and did not put her talents to
any great use? Could it not be that Jan’s dilemma lies in the issue of having
to choose the direction of her life and not whether she is being ‘real’ or not?
Both options are ‘real’, just as the Jan who will emerge from either choice
will be ‘real’.
The issue does not seem to me to be one of ‘reality’ versus ‘unreality’
but, rather, that of Jan’s experience of anxiety in choosing a direction in her
life and her expression of that anxiety through her fears and her
unwillingness to acknowledge the choice she has (however limited) by
invoking ‘societal demands’. Given this position, it would have been useful,
perhaps even essential, to have explored Jan’s experience of, and the
meanings she gives to, her relations with others and with herself and how
these relations are expressed in the self that she has constructed. But none
of these views and strategies is open to Rogers. Firstly, because he believes
in the ‘wisdom of the organism’ (ibid: 151) to direct itself towards self-
actualization and this belief prevents him from acknowledging that several,
and incompatible, directions are possible. Secondly, because he views the
organism, and the ‘correct’ or ‘real’ direction it will take, as being ‘set’
rather than disclosed through and within its relations with the world that
contains it.
Would these opposing views have any significance for Jan? Rogers tells
us that, following her encounter with him, Jan stated: ‘I realize that to face
life as a whole person, I need to find those missing parts of me’ (ibid: 152).
But what parts were missing? This conclusion suggests that, in her quest for
integration, Jan might still be putting off making choices and, in her internal
quest, will remain cut off from her relations with others, or possibly even
experience herself as a victim of them. Jan, in accepting Rogers’ views,
now seeks to fill that ‘gap’ through a form of self-development or growth
that is internalized so that a greater self-awareness and integrity will be
achieved.
The alternative view being put forward might instead ask Jan to
consider what it would be like for her if she were to have to go on living
with that gap for the rest of her life. In so doing, it would allow Jan to
remain focused on her current experience as it is being lived rather than
both introducing and emphasizing a hypothetical option that may never be
realized. At the same time, in attending to Jan’s lived experience of herself,
this alternative perspective would allow Jan to explore her divided stances
on the possible directions that her life might take, and the gains and losses
contained within each perspective, from a relationally based standpoint.

The limitations of the humanistic model

The critical points just discussed both abstractly and through the case
presentation presented above should clarify what I believe to be significant
problems within the humanistic model. Nevertheless, it must be said that
there is much contained within the humanist orientation that avoids many of
the issues raised by the psycho-analytic and cognitive-behavioural models
of therapy, and which promotes a number of attitudes on the part of the
therapist which reduce the likelihood of misuse or abuse of the therapeutic
encounter.
Significant among these are the therapist’s respect for the experiential
meaning-world of the client; the therapist’s willingness to consider that the
exploration of this meaning-world in itself will cultivate the client’s
capacity to examine and clarify his or her issues and stances so that they
may be placed within the context of choice and responsibility; the
therapist’s avoidance of being led by theory or skills and, in contrast, the
significance placed on the therapist’s expression of attitudinal qualities such
as concern, care, openness and acceptance as the essential means of
encouraging the client to recognize and acknowledge these same qualities
in himself or herself; and the emphasis placed on the therapeutic
relationship itself as a safe yet challenging arena for self-expression and
self-exploration.
All these points, I would suggest, while to some extent implicit or
potential within the previous models, are made explicit within the
humanistic model and, in being so, provide its most prominent, and by no
means insubstantial, distinguishing characteristics. At the same time,
however, while emphasizing the important implications of relationship
within therapy, the humanistic model’s adherence to views of ‘the self ’, as
discussed above, opens it to serious charges of philosophical naïveté which
place the therapist in the position of willing collaborator in potential extra-
therapeutic misuse and abuse of self-elevating attitudes and behaviours that
the client might adopt in various social relations.
I believe that this last point, sadly, has not been sufficiently considered
by the majority of humanistic therapists. Nevertheless, it strikes me as being
of central ethical importance.
When I first began to explore the possibilities of therapy, I initially
embraced humanistic approaches since they seemed to provide the most
open and accepting attitude towards the exploration of the possibilities of
experience within a therapeutic relationship. However, not long after I had
begun to immerse myself in such approaches, I was perplexed to discover
that they seemed to engender the most prominent abuses of therapeutic
power I had yet encountered. Some of this abusive power lay in the ‘guru-
like’ qualities that many trainees tended to attribute to their trainers and, in
a more general sense, on the originators of the particular approach within
the humanistic model they were training in. While this was not, in itself, an
unusual development within any training process, it seemed odd to me that
it should be so obvious within humanistic circles. Far worse, however, it
soon became blatantly evident that the originators and trainers themselves
seemed both eager and willing to allow and encourage such stances in their
trainees, and seemingly revelled in the power bestowed on them.
Such stances, which have now been exposed by critics and historians of
these approaches (Masson, 1988), involved all manner of abuses—
including sexual and financial abuses—which were allowed to continue
unchallenged. The elevation and quasi-adoration of the founder bordered
on, and sometimes even surpassed, that of devotees of one of the many
‘gods’ and ‘enlightened beings’ who arose in the 1970s—and who often
adopted the techniques and language of a variety of humanistic approaches
(as, for instance, was the case with Werner Erhard, the founder of est
(Rosen, 1979)). Indeed, as I began to practise, I noted my own promotion
and encouragement of similar attitudes in my clients towards me. For
reasons that I could not then make sense of, the very approach that seemed
to offer a more egalitarian and caring relationship between therapist and
client actually provided the means of the development of something that in
many ways was the exact opposite of that being promulgated.
On consideration, I believe that such a situation evolved precisely
because of the elevation of the self that permeated, however subtly or
blatantly, the humanistic stance. While preaching co-operation, such
approaches actually glorified competition between beings—a competition
that stressed the self as separate and non-relational—which was exemplified
in the dictum: If it feels good, do it. Under such conditions, an individual
could elevate his or her desires as being the only ones of import, and if the
enactment of such desires provoked misery or harm in others, well, so be it;
these other ‘selves’ had simply not learned how to assert their wishes and
demands adequately or in a manner that allowed their dominance and
superiority.
It was on the basis of such stances that the so-called ‘Me Decade’ that
characterized the latter half of the 1970s in the West took hold. This in turn,
I believe, allowed the development of the brutalizing and inhumane socio-
economic ethos of ‘Reaganism’ and ‘Thatcherism’ which dominated the
1980s. For while it might seem initially that the humanistic approaches of
the 1970s and the ‘monetarist philosophies’ of the 1980s stood at opposite
ends of the spectrum (and, indeed, each side viewed the other as its
‘Satan’), it can be seen that in their shared adoption of a competitive
ideology they were both expressions of the same principle: namely, the
elevation of the individual as being responsible only for his or her own self-
interests—be they psychological or economic—regardless of the impact
these may have had on others.

Transpersonal approaches
While it is the case that this emphasis and view of the self which has
dominated the humanistic model has been criticized by theorists and
practitioners representing other models of therapy, it would be misleading
to suggest that there has been no internal criticism. For instance, while
Rogers tended to write about the self from the generally accepted
standpoint, it is also clear that he emphasized the relational elements of the
self in a number of his writings and seemed to be aware of the inherent
dangers in the elevation of the self (Kirschenbaum and Henderson, 1990a,
1990b).
At the same time, the growth of interest in transpersonal models within
humanistic approaches can be seen to be a significant attempt to deal with
solipsistic tendencies apparent within humanistic approaches in that,
through their additional concentration on the ‘beyond, across, or through
self elements’ of the psyche (Valle, 1989), these models allow the analysis
of the psyche from a less egotistical stance that delves into the underlying
spiritual or idealistic concerns and experiences of individuals.
Transpersonal approaches are framed within a stance that emphasizes
the individual’s aspirations and potentials within the wider context of the
world in general, as well as the spiritual or ideal dimensions of experience.
In this way, they focus on those elements of experience that are ‘beyond the
level of personal self-awareness … in which identity is not confined to the
individual mind or more limited sense of self ’ (Valle, 1989:262). While
such experiences are often associated with the spiritual dimensions of
being, this need not be the case in that they point to those aspects of human
interaction which call into question the usual boundaries that one imposes
between self and other. Perhaps an example from my own life will clarify
what is being argued.
Some years ago, I found myself sitting on the lawns of the University of
Surrey. It was a bright, sunny early summer day, I had just eaten my first
bowl of fresh strawberries of the year, and I was feeling relaxed and
contented. As I sat and watched people go by, I drifted into a non-focused
state of awareness that seemed to treat all sensory stimuli as being equal in
significance. While in that state, my very sense of ‘I’ or self seemed to
‘blend’ into the stimuli such that my consciousness of them did not impose
a subject–object split. Rather, consciousness seemed unitary and inter-
connected; I was not aware of the perceived stimuli, I was the perceived
stimuli to the extent that I could not be distinguished from them. In fact, it
was only when a distinction was forced back into my awareness by the
thought ‘I must be experiencing satori’ that the unified experience ended
and ‘I’ was once again a separate, bounded being able to distinguish my self
from other beings.
This experience captures, I believe, the essential concerns of
transpersonal enquiry. It was, for me, neither a spiritual nor a religious
experience, but it did extend the possibilities of meaning that I had placed
on my understanding of my ‘self ’. It was not experienced as a loss of self,
but rather as an extension of self that called into question both the
boundaries I had imposed on my ‘self ’ and the ‘reality’ of distinction
between self and other.
Such experiences are not uncommon. Many of us may have gained a
sense of them through sexual relations, prayer, meditation, drugs, extreme
tiredness, illness, or even through gardening. It may even be the case that as
infants and young children, prior to having built up a fairly clear and fixed
self-construct, such experiences are commonplace. Whatever the case, as
they appear to be part of our experiential ‘make-up’ as human beings, and
as mention of them can be found in all cultures dating back to our earliest
civilizations, they are as deserving of enquiry as any other experience.
While studies of such experiences have been a subject of interest to
psychologists since the beginnings of modern psychology (James, 1890), it
has only been in recent years that transpersonal studies have developed as a
specific field of psychological enquiry (Tart, 1975).
While transpersonal approaches present views of the self that are
implicitly critical of those underlying the humanistic model, nevertheless
the tendency to replace such with the assertion ‘of a greater trans-personal
… self or one (i.e. pure consciousness without subject or object)’ (Valle,
1989:261) opens them to significant criticism.
Rollo May, for instance, has criticized this assertion on the grounds that
‘it is a contradiction in terms to think one can make a psychology by
throwing out or “leaping across” … the person’ (May, 1986:87). According
to May, such assumptions can lead to the avoidance or minimization of
consideration of aspects of human experience such as cruelty, anxiety and
suffering, and promulgate a confusion between psychology and religion by
‘taking a point of view which goes beyond humanness’ (May, 1986:89).
Equally, it can be argued that many transpersonal studies seem to suggest
conclusions that treat these transpersonal experiences as pointing to
evidence for the extra-experiential, or objective, reality of a spiritual or
super-natural dimension. In other words, there is a danger of imposing a
meaning or ‘reality’ on such experiences which elevates them in a manner
all too similar to the humanistic model’s elevation of the self as a ‘reality’
that is separate and non-relational.
At the same time, responses to these criticisms argue that transpersonal
studies focus on radical shifts in one’s reflection of the relational
possibilities of experience and of the plasticity of boundaries within the
self-construct and that these bring into question such matters as the general
lack of psychological distinction between ‘mind’ and ‘consciousness’(Valle,
1989). On the other hand, it seems to me that critics are not as concerned
about the idea of exploring these possible distinctions as they are about the
tendency on the part of transpersonal theorists and practitioners to assume
and assert them.
Nevertheless, it should be evident that there is much to be gained in
allowing the therapeutic process to acknowledge and address the
‘experience of duality dissolving’, not least because it may form part of the
concerns that individuals bring to therapy and, therefore, should be treated
with the acceptance and respect that therapists would be expected to
provide towards any meaning or belief that the client presents. Equally,
however, it would also be expected in these circumstances, as in any other,
that therapists would seek to clarify the specific meaning of this experience
to the client and to challenge the contradictions or unreflected assumptions
contained within the presented meaning.
Even so, while it remains ethically questionable for therapists to reject
or seek to overturn the spiritual beliefs of clients simply because they are
beliefs that do not form their own world-views, in the same way it would be
an abuse of the therapeutic relationship if therapists sought to impose their
spiritual or transpersonal beliefs on their clients. This conclusion would, I
think, be shared by most therapists, regardless of the model they
represented. But another, more problematic possibility exists. What if it
were to be the case that both the therapist and the client shared the view that
the transpersonal elements of experience pointed to a transpersonal reality?
This possibility would not be difficult to imagine. In such instances, the
therapist’s willingness and ability to clarify the meaning of the client’s
beliefs may be seriously compromised in its effectiveness since it would be
as much of a challenge to the position adopted by the therapist as it would
be to that held by the client.
This is certainly not an impossible situation for the therapist to face or
deal with, nor would it by any stretch of the imagination be specific to
transpersonal therapists or to transpersonal issues raised during therapy.
Nevertheless, it must be asked, if some therapists opt to label themselves as
‘transpersonal’, or present themselves as allied to transpersonal approaches,
what influences do these terms have on the therapeutic relationship in
general and on the exploration of transpersonal beliefs and experiences in
particular?
As such, transpersonal approaches, while important in that they provide
the humanistic model with a potentially significant palliative to excessively
solipsistic assumptions concerning the self, and focus on aspects of human
experience that have tended to be neglected or dismissed by other
therapeutic models, also contain some cause for concern since, by their very
emphasis on the transpersonal realms of experience, they too remain open
to tendencies bordering more on religious conviction than on therapeutic
encounter.

3. GENERAL CONCLUSIONS
Throughout the whole of the discussion in Parts 3 and 4 of this text, I have
attempted to argue that the various existent approaches that have
significantly influenced therapeutic encounters all contain a number of
theoretically derived assumptions that may well work against the very
enterprise that therapists set for themselves. Further, I have tried to
demonstrate how these self-same assumptions impose themselves in diverse
ways on the therapeutic encounter such that they both limit therapists’
ability to listen and attend to their clients and make more likely the
possibility of misuse and abuse of therapists’ power.
At the same time, while it must be acknowledged that these forms of
power reveal dilemmas that cannot be fully resolved since all are based on
various questions of interpretation (which is itself a ‘given’ of human
encounter), I have also sought to demonstrate alternative possibilities that,
while remaining respectful of the lived experience of clients and the
meanings they have derived from them, nevertheless allow therapists to
adopt a descriptively focused approach to the therapeutic relationship which
provides sufficient means to clarify and challenge clients’ experiences.
However, in adopting this alternative model, it becomes evident that
therapists open themselves to a number of significant challenges. Among
them are those challenges that confront therapists with a number of power-
based issues that are derived from the particular relationship with their
clients that their therapeutic model will allow or promote. Similarly, a
number of challenges arise from the fundamental act of labelling oneself as
a therapist.
In exploring such issues, a number of basic premises held by particular
models of therapy, or either implicitly or explicitly shared by all of them,
have been considered and criticized. These criticisms have focused on
problems of logic or evidence as well as on their impact on the therapeutic
relationship. 1 have sought to keep these criticisms constructive in that
alternative possibilities have been presented which acknowledge the
phenomena associated with the assumptions under consideration while at
the same time providing what I believe to be more adequate interpretative
analyses.
With regard to the specific issues discussed concerning aspects of the
therapeutic process, all the points raised broadly emphasize the possibilities
that emerge when therapists avoid seeking to impose their own theory-led
views in order that they remain better able to suspend their theoretical
judgement as to the nature and basis of their clients’ issues in the same way
as most therapists are willing to attempt to suspend as far as possible their
personal judgements of their clients. I have attempted to demonstrate that
what obstacles stand in the way of this suspension are mainly derived from
therapists’ reliance on their theories and their skills-based applications.
In the light of this, I have suggested that these various obstacles can be
partially dealt with through various forms of clarificatory challenge that
seek to remain at a descriptive level of interpretation and which, in doing
so, may expose unreflected assumptions, biases, stances and approaches to
living that the client himself or herself can begin to question and/or
reconsider in a manner that leads to a more reflected-on form of acceptance
or allows the possibilities of change. But it should also be clear that such
challenges rely far less on therapists’ skills or theoretical knowledge
(though clearly these are irrefutable elements in any form of interpretative
task) than they do on the nature of the relationship that has been
engendered.
But the development and maintenance of such a relationship does not
rest solely on clients’ willingness and courage to clarify and assess their
experience of life. Nor does it depend on the specialist skills the therapist
brings to the encounter. Nor on a combination of the above. Rather, as I will
argue in Part 5, the central features revolve around a number of ‘being-
based’ attitudes or qualities which seem to me to lie at the heart of the
therapeutic process and its possibilities.
PART FIVE

DEMYSTIFYING THE THERAPEUTIC

RELATIONSHIP

The technique of treatment must be yourself.

Alfred Adler

Virtually all therapeutic models are in agreement that the relationship

within the therapeutic process is of central significance. Similarly, as was
discussed in Part 1, research focused on various aspects of the therapeutic
process has demonstrated that the therapeutic relationship is one of the very
few recurring variables extracted from the principal studies—whether they
are processor outcome-oriented—to be singled out by both therapists and
clients as being essential to the success of therapy (however ‘success’ might
be measured). And yet, what there might be about this particular
relationship which is so significant—or, indeed, ‘particular’—remains
largely unclear.
Some clues from research studies suggest that its importance and
uniqueness lie in the therapist’s ability and willingness to listen to and ‘be
with’ the client. But these terms also remain somewhat vague, and if they
are to be helpful they must be clarified further. Analyses of therapeutic
models have also noted two distinct emphases, or tendencies, within
therapists’ understanding of the relationship—tendencies that stress either
the ‘doing’ or the ‘being’ elements or qualities that therapists bring to the
relationship and how the emphasis on one or the other significantly affects
not only the structure of the therapeutic process but also the direction it is
likely to take and the specific exploratory possibilities it will allow to both
the client and the therapist.
The final part of this text proposes the view that whatever it may be that
can be said to remain unique or special or of potential benefit about the very
enterprise of therapy is principally dependent on the establishment and
maintenance of a relationship that both expresses and promotes the
exploration of the possibilities of being.
Unsurprisingly perhaps, it is the existential-phenomenological model
which has pursued this same focus of exploration and, indeed, has taken the
questions surrounding the meaning-possibilities of ‘being’ to be its primary
defining characteristic. As such, some initial discussion concerning relevant
aspects of this model would seem warranted.

1. AN OVERVIEW OF THE EXISTENTIAL-PHENOMENOLOGICAL

MODEL

A. BASIC THEORETICAL ASSUMPTIONS

As has already been noted in previous parts of this text, the existential-
phenomenological model assumes an inter-subjective basis to all mental
activity. In other words, it argues that everything that we are, or can be,
aware of, all that we reflect on, define or distinguish, is relationally derived.
The very experience of ‘being’, for instance, is only opened to
conscious reflection when it is placed in the contextual relationship of
being-in-the-world. In this way, the reflecting being and the focus, or
object, of reflection are each fundamentally defined, or co-constituted,
through one another.

Intentionality
The structural tendency, or ‘given’, through which relations emerge has
been termed intentionality. Intentionality refers to the fundamental
relational act whereby ‘consciousness’ reaches out, or extends to the
‘stimuli’ of the world in order to ‘bring them back to itself ’—or interpret
them—as ‘meaningful things’. This idea may initially be difficult for many
readers to take in, so I propose to approach it from another angle which
should be easier to understand.
Jean Piaget, the most influential developmental psychologist of this
century, argued that all human beings (indeed, all species) inherit two
‘invariant functions’, or ‘givens’, of existence: the tendencies towards
organization and adaptation.
Organization refers to our tendency to systematize, integrate or make
coherent the structures of our experience. This tendency towards
‘meaningfulness’ (as existential-phenomenological theory interprets this
‘given’) will be discussed below.
Adaptation, as the term suggests, refers to our species’ ability to adapt
to the environment (or ‘the world’). According to Piaget, we do so by
means of two complementary processes: accommodation and assimilation.
For example, my three-month-old niece, Christina, became attracted to the
‘trackball mouse’ device I’d placed next to my notebook computer. As I
held it up for her, she tried to grasp it. But, whereas she had learned to grasp
various other objects, she had never grasped this ‘mouse’ before. As such,
she had to accommodate her previously learned grasping ‘structures’ to suit
the particular shape, features and contours of the ‘mouse’.
At the same time, however, Christina’s attempts to grasp the ‘mouse’
revealed her efforts to assimilate this novel object into her already learned
grasping structure. In other words, she approached it as if it were the same
as those things that she already had the ‘structures’ to grasp.
This combined process of accommodation and assimilation allowed
Christina’s grasping structure to adapt to a novel environmental (or ‘world’)
stimulus through the complementary acts of approaching the ‘mouse’ from
the standpoint of its similarity to previous objects (assimilation) and by ‘re-
structuring’ itself to suit the difference, or novelty, of the ‘mouse’
(accommodation).
Piaget argued that both processes are simultaneously present in every
act (be it physical or mental) and are the essential ‘building blocks’ of
intellectual development (Ginsburg and Opper, 1969).
Now if we return to the question of intentionality, it is possible to argue
that intentionality refers to this same tendency to adaptation (as it does to
that of organization) through complementary processes akin to
accommodation and assimilation. So, when existential-phenomenologists
argue that ‘consciousness extends itself, or reaches out, to the world’, they
are referring to the fact that ‘consciousness’ and ‘the world’ are in
simultaneous and inseparable relationship one to the other. We only ‘know’
the world through our conscious relation to it. But our developing relations
with the world rest on the self-same processes of accommodation and
assimilation. So, if ‘the world’ presents me with a novel ‘thing’ I try both to
identify it on the basis of how it is similar (in shape, feature, possible
function, etc.) to those ‘things’ I already ‘know’, and also how it is different
to them. In this way, my intentional relation with this newly interpreted
object enfolds it into my previous relations but, equally, extends those
previous relations into this ‘novel-thing world’ and thereby reconstructs
them in the light of this ‘novel thing’.
Once again, this may sound complex as an explanation, but an example
should clarify what is being argued. During my first few years of life, we
had a family dog, Dianella, and my ‘knowledge’ of dogs was initially
shaped through my relationship with her. As time went on, I was introduced
to other dogs. This forced my previous knowledge of Dianella to attempt to
‘enfold’ my current, novel relations with dogs (i.e. acknowledge their
similarities) and ‘extend’ my previous relations to include the new dogs (i.e.
acknowledge their differences) and thereby ‘reconstruct’ the whole of my
relations with dogs (i.e. ‘broaden’ the meaning possibilities of my
experience of dogs). So, for instance, while Dianella was a particularly
friendly and affable dog who allowed me to pull her tail and pick her up
with barely a grumble, I was soon introduced to dogs who were less tolerant
and, indeed, to a dog who responded to my attempt to pick him up by biting
my right leg. These various relations, focusing on the similarities and
differences of the dogs encountered in my world, altered the whole of my
relations with dogs. With each new dog I encountered, my relational stance
with regard to the meaning-possibilities of dogs was reconstructed (so that,
for example, once I’d been bitten, dogs were not just usually friendly,
subservient creatures, they were also capable of hurting me).
So intentionality refers to this fundamental structure whereby our
‘reality’ is shaped, or interpreted, through our relations, and whereby each
new relation, while reliant on previous ones, nevertheless extends or
reconstructs the structure or ‘meaning’ of the previous relations in order
that the newly emerging structure can ‘enfold’ the new relation. This
viewpoint is the basis for the existential-phenomenological critique of ‘the
past’, as was discussed in Part 3, in that our current remembrance of the
past is not of ‘the past as it was then’ but of ‘the past reconstructed in order
that it may enfold current experience’.
The same fundamental tendency of intentionality reveals that through
the process of reconstructing the meaning-possibilities of those ‘things’ that
we are in relation with, we also reconstruct the meaning-possibilities of the
‘thing-constructing’ being. So if I return to my example of the dogs in my
early life, while my relations with the different dogs reconstructed the
meaning-possibilities of the ‘being’ of dogs, it also extended the meaning-
possibilities of my own ‘being’. Just as my earliest relations allowed me to
formulate my sense of my ‘self ’ as a being who loved dogs and enjoyed
playing with them, my later relations reconstructed the meaning of my
‘being’ to that of a being who loved dogs and enjoyed playing with them,
and who also feared and hated them.
As such, intentionality, considered from the standpoint of ‘being’,
reveals that both ‘self ’ and ‘other’ (or ‘the world’) are made meaningful, or
‘come into being’, through their interdependent relations, so that it can be
said that they ‘co-constitute’ one another. Equally, through intentionality,
the meanings of ‘self and other’ are revealed as plastic, or unfixed in
meaning, in that each new relation presents both ‘self and other’ with novel
meaning-possibilities that allow the on-going, perpetual extension of their
meaning.
However, for reasons I will discuss below, the intentional relationship is
most often experienced in such a way that the outcome of relations, rather
than seeming to extend the meaning-possibilities of the ‘being’, actually
appear to sediment the meaning of the ‘being’, such that the novel,
potentially meaning-extending experience is ‘split off ’ or ‘disowned’.
For example, as a child, I learned to tell the time by playing with my
father’s wristwatch. He would teach me the notion of hours and minutes
and seconds and then test my knowledge by getting me to set particular
times on his watch. As I learned to do this quite easily and well, it became
an important means for me to experience myself as being ‘good and
intelligent’ through my father’s statements to that effect. One morning,
however, I began to play with his watch by myself and, unhappily, the
winding mechanism fell apart. When my father saw what I had done, his
words of anger provoked the experience of myself as being ‘bad and
stupid’. So, through my intentional relation with my father’s watch, I had
reconstructed my meaning of myself to be that of ‘good and intelligent’ and
‘bad and stupid’. However, this extension was rejected for various reasons,
so that my ‘being’ could maintain a sense of ‘self ’ that was sedimented in
the perspective that I was only ‘good and intelligent’. The novel meaning-
possibility (‘bad and stupid’) could not be enfolded within this sedimented
self-structure and therefore had to be ‘disowned’ in some manner or other
so that the sedimented perspective could be upheld.
Therefore, while intentionality at the ‘being’ level reveals the co-
constitutional basis of ‘self and other’, it must be borne in mind that our
experience of this may, in some ways, be rejected or denied.

Intersubjectivity
One of the important consequences of this argument is that each of us is
actively involved, or implicated, in construing, or attempting to make
meaningful, our experience of the world—which includes our experience of
ourselves, of others, and all those features, objects and mental processes
that make up our lived reality. In this way, the existential-phenomenological
model argues that we can never properly speak in terms that suggest a real
distinction between subjective and objective, or ‘internal’ and ‘external’
(e.g. ‘in my thoughts’ or ‘out there’), since all these terms remove us from
the interpretative relationship that is at the basis of our experience.
This can be a deeply unsettling perspective to adopt since, in one stroke,
it places us in an uncertain, relativistic realm of being. Whatever meaning
we may ‘find’ for ourselves, for instance, is seen to have no independent, or
external, basis; rather, it is ‘meaningful’ only in an interdependent sense.
Experientially speaking, nothing ‘is’ other than in terms of relation.
As a species, human beings are bounded by the ‘givens’ of our psycho-
biological make-up. We experience ‘reality’ not as it is, but as it appears to
us to be. In this way, each of us, while sharing the ‘givens’ of our species,
also brings into our experience of reality all manner of biases and
assumptions which are derived from our unique standpoint. As such, while,
for instance, it appears to be a ‘given’ of our species to perceive reality in a
‘thing’-like fashion, the specifically labelled, or named, ‘thing’ that each of
us experiences, and the manner or mode in which we experience it, is
dependent on various linguistic, socio-culturally derived influences as well
as influences from our own personal experience that dispose, or bias, us to
perceive it in the way we do.
As a ‘thing-interpreting’ species, we perceive our world (and ourselves)
to be ‘thing-like’ or ‘object-based’. Further, from a particular linguistic and
socio-cultural background we label, or define ‘things’ (which is to say, we
provide them—or ourselves—with meaning). Equally, from each of our
own personal experiences of ‘things’, we further define ‘things’ in terms of
their relational meanings built up from our unique experiences of—and in
—the world. Given these various combinations of interpretative acts, all of
which are present in any experience, it can be seen that, fundamentally, our
experience is always unique.
If we consider this conclusion further, however, we can understand that,
as well as being unique, our experience is also never fully shareable. So you
could never fully experience any ‘thing’ as I do, nor could I ever fully
experience any ‘thing’ as you do, or as anyone else does. In order to do so,
we would have to have complete access to each other’s sum total of past
and current personal experience. At best, I might make attempts to provide
you with some sense of my experience of ‘things’, just as you might, but
our attempts, though they might be increasingly adequate, would never be
total or complete.
From the standpoint of our ‘being’ or existence, it can be concluded that
each of us is alone in our experience. And yet, paradoxically, this
‘aloneness’ emerges precisely because we are in relation to one another.
That is to say, ‘aloneness’ is itself dependent on a prior relational distinction
that has been made—namely, that of ‘self ’ and ‘other’.
‘I’ am only unique because ‘I’ exist, or have come into being. But ‘I’
only exist, in a manner that I can describe, distinguish, or experience,
because of the prior act of separating my ‘self ’ from your ‘self ’ or, as the
existential-phenomenological model would have it, the act of distinguishing
‘I’ from ‘not I’. At some point in our early development, each of us
becomes ‘self-aware’. But to do so requires us to define, or make ourselves
‘meaningful’, by distinguishing that which is ‘I’ from that which is ‘not-
I’(or distinguishing ‘self ’ from ‘other’).
However, as has already been discussed, our experience of ‘I’ is by no
means ‘fixed’. Rather, it is a ‘plastic’ relationally based experience. Even
our past, which is the major means by which we maintain our sense of ‘I’, is
experienced selectively on the basis of such factors as our current
circumstance and our future-directed goals and aspirations.
Interpreted reality
Not surprisingly, if we attempt to take in the full impact of all these ideas,
we are confronted with the meaninglessness of it all. This meaninglessness
refers to the idea that nothing—not you, nor I, nor any ‘thing’—has
intrinsic or independent or static meaning. If things are ‘meaningful’, then
they are so only because they have been interpreted as being so. In this way,
‘meaning’ too is a relative and plastic concept. Each of us, if we follow this
line of argument, does not inhabit an independently ‘meaningful’ world—
rather, we, as a species, as cultures, and as individuals in relation to one
another, shape or create the various expressions of meaningfulness that we
experience and believe in.
Our need to make things meaningful (by defining, or distinguishing, or
‘bounding’ them) appears to be another ‘given’ of our species. Our
intolerance of meaninglessness seems to be deep-rooted, even fundamental,
in our make-up. Meaninglessness instils in us anxiety—something
seemingly meaningless disturbs us, such that we refuse to accept it and
attempt to find ways to make it meaningful. We might do so by likening it
to another object whose meaning is known to us and with which the foreign
object seems to share some characteristics, or we might impose some sort of
functional purpose on the foreign object which, again, places it in a
‘meaningful’ context derived from our experience. Looked at in this way, it
may be argued that much of our success as a species in dominating our
planet has been due to our ‘quest’ for meaning.
But meaning also has its price. If I conclude that my meaning—my
identity, let us say—is defined by certain fixed characteristics, attitudes,
patterns of thought, and so forth, then when I am experientially confronted
with evidence to the contrary, or which expands the ‘meaning’ I have given
myself, I must either accept the evidence and reshape or extend my
meaning of myself, or I must reject, or disown, the evidence in order to
maintain my fixed meaning.
The former option provokes anxiety because my meaning is now more
flexible—and, hence, tends towards greater plasticity which, in turn, is
directed towards meaninglessness. The latter option, on the other hand,
forces me to deceive myself because I pretend to not experience that which
I do experience. As Taoist philosophy reminds us: In either case, it will
hurt.
Choice
One important means that we have at our disposal to combat this experience
of ‘hurt’ is to deny the possibilities of choice that we may have available to
us. In this way, even if the anxieties and deceptions in our lives remain, at
least the added hurt of our own active role in their ‘being’ can be allayed.
The existential-phenomenological idea of choice has often been
misunderstood to suggest that we possess unlimited freedom to choose how
and what ‘to be’. This view, quite simply, is wrong. The choices that we are
free to make arise within a ‘bounded world’. Ours is a situated freedom,
which is to say that it is a freedom whose boundaries lie within the
intentional relationship through which each of us, as a ‘being-in-the-world’,
is co-constituted. In this way, we are not ‘free to choose what we want’ but,
rather, free to choose how to respond to the ‘stimuli’ of the world. In fact,
more accurately speaking, we are condemned to choose. A stanza from a
song by Bob Dylan captures this idea most vividly:

Ah, my friends from the prison, they ask unto me,

‘How good, how good does it feel to be free?’
And I answer them most mysteriously,
‘Are birds free from the chains of the skyway?’ (Dylan, 1964).

As such, our choice is not interpretational at the event—or stimulus—level.

The stimuli in our lives may be determined by or based on pure chance; we
cannot choose them, only, at best, seek to predict them. What choice we
possess is at the level of what meaning we bestow on them and how we
respond to that meaning.
Equally, choice is not to be understood as being solely at the level of
‘choosing between optional stimuli’ or even between ‘optional meanings of
stimuli’. For reasons that will be discussed more fully below, we may have
sedimented particular meanings so that no optional alternative seems
available. Even then, however, we can choose to acknowledge or accept
that one sedimented meaning or choose to deny that we have chosen it.
This last point may initially strike some readers as being a trick of logic
in order to maintain the view that we always choose. Far from it. Many of
the problems and issues that clients bring to therapy originate through this
self-same ‘unwillingness to choose the one choice available’. In this stance
of unwillingness, clients are forced to place themselves in the position of
‘passive victims of circumstance’. The one choice may remain the same
regardless of the position I adopt towards it, but the experience of ‘being’
varies significantly depending on whether I choose to accept its presence in
my relational world or whether I deceive myself by denying its presence
(and, at times, further deceive myself by believing that another choice
option is available).

B. AN OVERVIEW OF THE THERAPEUTIC IMPLICATIONS OF EXISTENTIAL-

PHENOMENOLOGICAL THEORY

Therapy, from an existential-phenomenological standpoint, involves a

relationship between therapist and client which explores and clarifies the
experience of being of the client with the purpose of examining those
anxieties and those deceptions (as uniquely expressed or derived) which
‘hurt’ or stultify the client’s experience of being-in-the-world.

Bracketing
Existential-phenomenological therapists attempt to explore their clients’
experience of being-in-the-world by seeking to ‘enter into’ their world-
view. The main means by which they undertake this is the process of
bracketing those views, biases, assumptions, theoretically derived or lived
perspectives from their own personal experience so that they may open
themselves to the experience of the client as it is being lived. I will discuss
this attempt more fully below, as it has significant implications for
therapists’ expressed ‘being qualities’ and ‘ability to listen’. But for the
moment, I want to stress that the process of bracketing remains an attempt
rather than suggest the idea that a therapist can fully bracket personal
experience. In the same way, the therapist’s ‘entry’ into the world-view of
the client is also an attempt that may be more or less adequate but never
complete for reasons relating to the notion of ‘aloneness’, discussed above.
In adopting this stance, existential-phenomenological theory
categorically rejects the postulate that anyone, even the most empathic of
therapists, possesses the ability to observe the subjective experience of
another person precisely as it actually is. Instead, what is being suggested is
that while this experience remains inaccessible in any complete sense, the
approximation of another’s experience is certainly possible to increasing
levels of adequacy which approach, if never reach, precision. Equally, while
the aim requires therapists to attempt to bracket their own personal biases,
assumptions, and so forth, nevertheless, if paradoxically, all that they (or
anyone else) can know, even approximately, about their clients’ conscious
experience of ‘being’ is dependent on their own awareness of their personal
experience. In the attempt to ‘enter’ their clients’ world-views, existential-
phenomenological therapists employ descriptively focused interpretations
that are designed to attend to clients’ statements concerning their
experience, to open them to clarificatory examination, and to challenge
those assumptions that remain at the implicit level of the statement. Readers
will recall that I examined these ideas more fully in Part 3.

Encounter
Most significantly, the existential-phenomenological model bestows on the
relationship between therapist and client an undisputed centrality because it
is through this relationship itself that the client’s issues are manifested or
‘brought forth’ for examination. In other words, the therapeutic relationship
is seen to be the ‘microcosm’ through which the ‘macrocosm’ of the client’s
lived reality is expressed and opened to enquiry.
But, equally, in order for this enquiry to reflect ‘microcosmically’ the
‘macrocosmic’ experience of the client in a suitably adequate, or ‘good
enough’, fashion, the therapist must be both willing and able to ‘place’
himself or herself into the relationship. This notion of encounter requires
both therapist and client to ‘be there’. From the standpoint of the therapist,
this ‘being there encounter’, as we shall see, contains significant and
specific ramifications.

2. AN EXISTENTIAL-PHENOMENOLOGICAL MODEL OF THERAPY

From the ideas just discussed, the focus of therapy can be seen to be the
exploration of the meanings and significances that clients place on the
various relationships they engage in. But this act of exploration itself
emerges out of the current relationship between therapist and client which,
itself, must be acknowledged as being ‘meaningful’ not simply as a result of
what is ‘done’ within it, but, more to the point, because of the ‘experience
of being’ that it engenders.
In its recognition that therapist and client are engaged in an
interdependently disclosing process, the existential-phenomenological
model emphasizes the notion of encounter. In this way, therapists cannot
‘step aside’ or ‘be objective’ when listening and responding to the client’s
statements; rather, they acknowledge their involvement and engagement
within the existing therapeutic relationship.
While the meaning and function of ‘relationship’ within the therapeutic
process remains somewhat vague, what research evidence exists (as
discussed in Part 1) has tended to dispel ‘common sense’ views (at least as
far as therapists can be said to hold such!) that factors like the theoretical
model being employed, specialist skills applied, or the extent of their
training are the significant relationship-based variables that will increase the
likelihood of beneficially experienced therapy of quantifiable ‘successful’
outcomes. But if these are not the ‘essential ingredients’ or necessary
abilities that might help to define ‘good’ therapists or distinguish them from
‘bad’ ones, what might they be?

A. BEING VS. DOING

During my first few meetings with trainee therapists, I often pose two
questions for them to consider: ‘Who do you think you are being when you
say that you are being a therapist?’ and ‘What do you think you are doing
when you say that you are doing therapy?’
These questions usually provoke initial consternation in my trainees
since many of them find that either they have never asked themselves such
questions before and, now confronted with them, seek to provide
sufficiently suitable answers to reassure themselves (and their tutor) that
they have the necessary qualifications to have earned them their place on
the training programme, or else they assume that the answers would appear
to them to be so obvious that there must be some hidden ‘trick’ or angle to
my queries. But my rationale in asking such questions does not lie in either
of these concerns. Rather, my queries are designed to expose and confront
the many and varied underlying, or unstated, assumptions that trainees hold
concerning therapy’s aims, goals and defining characteristics and of their
own similar assumptions with regard to their perceived stances and attitudes
towards themselves as trainee therapists.
Most often, the answers provided revolve around two broad axes. In
response to the first question, trainees often reply with statements that seek
to delve into, or define, a variety of skills or specific knowledge bases that
they assume to be part and parcel of the training requirements of a therapist
(these might include or emphasize the therapist’s role as ‘interpreter’,
‘solver of life’s puzzles’, ‘provider of unconditional positive regard’, and so
forth, which trainees believe they already possess or expect to develop at
some point during their training). With regard to the second question,
trainees tend to come up with a wide variety of skills such as those they are
likely to have been taught at a foundation-level course, or which they may
have observed being applied by their own therapists whose functions appear
to serve the purpose of alleviation of ‘distress’, and of promoting ‘cures’,
‘growth’, ‘strengthening of the ego’, ‘beneficial change’ or any
combination of the above (and similarly related) aims.
As might have been already noted, in most instances the answers given
to the first question would seem to be either interchangeable with those of
the second query (and vice versa), or are so closely related to them that a
distinction would appear to be impossible and one single statement would
suffice in blending together both the questions and their ‘proper’ answers.
So, for instance, just as trainees might believe that their primary defining
characteristics of ‘being a therapist’ involve the necessary knowledge to
interpret the client’s statements in such a way as to expose the unconscious
wishes or motivations behind them, or in order that their statements might
be considered in the light of the client’s early life experiences and relations
with ‘significant others’ such as their parents, in a similar fashion they will
assume that the ability to provide accurate interpretations of a client’s
statements or behaviours is a primary skill or a central feature of what they
do (or will learn to do) as therapists.
What this process reveals in part is that trainees tend to make little
distinction (or perhaps, more accurately, tend to find it difficult to provide a
distinction) between who they are and what they do. Now while this, at first,
might seem an issue particular to the concerns of therapy, on further
consideration it would appear that this difficulty, if not inability, to
distinguish ‘being’ from ‘doing’ is far more widespread and extends to all
aspects of one’s attempts to define oneself. For any number of reasons,
many of them undoubtedly culturally based, it seems sensible for us to think
of ourselves in terms of what we do. Readers can test this contention for
themselves. Just ask yourself ‘Who am I?’ and see what you are able to give
as a response to this question. The chances are that your answers will
principally focus on a variety of ‘doing’ qualities or aspects concerning
various features and characteristics of your life. Now on further
consideration, while one’s own answers might appear to be suitable,
consider how you might feel if someone other than yourself, asked for some
reason or other to ‘sum you up’, were to give the self-same responses.
While not incorrect, the statements might well seem unsatisfactory. ‘But
I’m not just those things!’ each of us might well retort. ‘Who I am is much
more than that!’
But if asked to expand on this sense of dissatisfaction, in order to
provide the additional missing defining qualities that would give a more
competent version of who one is, the task might lead to a disquieting
conclusion. Much of what we can define about ourselves clearly revolves
around the things we do, or which interest us, or which represent ideals or
convictions we hold and might attempt to put into practice as defining
‘values’ around which to guide and focus our lives.
However, no matter how exhaustive a survey of such characteristics
might be, still a sense of incompleteness is likely to remain. Such things
would certainly ‘fit’ with the definitions we provide for ourselves, but they
fail to ‘capture’ us.
Perhaps this concern is a fanciful and self-elevating illusion that many,
if not all, of us harbour about ourselves. The well-known behavioural
psychologist B. F. Skinner, for instance, in his text Beyond Freedom and
Dignity (1971), argued forcefully for reconsidering deeply held, even
fundamental, assumptions we are likely to hold about our ‘specialness’ as
human beings. This is a valid point, I think, and one that many therapists,
particularly those whose allegiance lies within the humanistic model,
should be more aware of. It seems to me to be often the case that
approaches inviting a ‘celebration’ of being human unnecessarily also
involve, or at least suggest, a questionable, even dangerous, elevation of the
individual or the species such that ‘special’ often becomes synonymous
with ‘superior’—a highly suspect connection. So we must be careful: the
inability fully to define our ‘being’ is not in itself a statement of elevation.
Rather, one might put it more correctly as a statement of acceptance, a
recognition of uniqueness that extends equally, if diversely, throughout all
humanity.
Some time ago, I overheard a new company president remind his staff
that they needed to remember that they were all replaceable, that no one
was to think that the company could not get by, survive, and prosper
without them. While there is some validity in his argument in that it warns
against the false assumptions that engender attitudes of misguided self-
aggrandizement, and, similarly, points out that nothing done by any one of
us cannot, with very few exceptions, be achieved as successfully by
someone else, nevertheless there remains a fundamental error in the
contention.
This error, not surprisingly, stands revealed precisely because of the
being factors that underlie our behaviour. These factors may not be in any
way easily open to statistical or quantitative measurement in any complete
sense, but their effects can be dramatic. For while the actions or activities of
any one individual can, in themselves, be duplicated from mechanical
standpoints that might well be observable and measurable, there still remain
all manner of qualitative factors that invest, perhaps even in some odd way
‘fuel’, the behaviour and which remain unique to each individual. In this
way, no one person is truly replaceable in any complete or final sense.
Again, one need look no further than to the world of business and industry
for examples of this; there are a good many accounts of successful
companies which, having been bought out or taken over by new
management which has replaced the original staff with its own, equally—or
even more highly—skilled work-force, find that their success and profits
quickly diminish. These companies, once profitable, subsequently find
themselves in serious financial difficulties which, as often as not, lead to
bankruptcy (Peters, 1992).
Let me stress that such situations rarely involve factors such as lesser
expertise or other quantifiable variables. Rather, they reveal the influence or
far less definable ‘being qualities’ or ‘attitudinal factors’ that might, for
instance, generate a particular ethos or level of commitment that imbues the
company with its particular and unique ‘being-in-the-world’. For reasons
that remain incomprehensible to me, a great many ‘captains of industry’
(and a great many more ‘would-be captains’) continue to remain oblivious
to such factors and, instead, go on to insist that all members of the work-
force (save themselves, perhaps) are replaceable. Only in recent years, for
instance, has it been the case that a focus on issues and features dealing
with factors designated as ‘the human environment’ and the influences of
such on the day-to-day running, and success, of a company has been treated
with any degree of seriousness by the business community. Indeed, a great
many ‘troubleshooting’ companies have come into existence whose
expertise revolves around ‘human environment influences’ and who
provide specialist consultants whose task is to analyse and mobilize a
company’s ‘human environment’ principally through the application of
techniques derived from various off-shoots of the ‘Human Potential
Movement’ (such as ‘encounter groups’ or ‘est’) which arose in the heyday
of the humanistic psychologies of the late 1960s and early 1970s.
Now while it may not be entirely surprising that business and industry
have been slow to recognize and acknowledge the influences of such ‘being
factors’ in the work environment, it does come as something of a shock to
realize that the world of therapy also contains major gaps both in its
language and theories with regard to these self-same issues.
A number of years ago, as a workshop participant at the annual
conference of the British Psychological Society Special Group in
Counselling Psychology, I was involved in an exercise that very neatly
illuminates this point. The session group was given two tasks. In the first,
we were asked to note down the main qualities and factors that would guide
and influence our decision in appointing a new member to our hypothetical
team of therapists. In the second task, we were asked to note down the main
qualities and factors that would determine our decision in selecting a
therapist for our own personal therapy. The results of the exercises were
then discussed and, needless to say, they revealed significant variations. For
while the vast majority of participants tended to focus on such factors as the
type, duration and standing of training, and the skills-based knowledge and
expertise that a candidate obtained from it (in general, the ‘doing qualities’
of job candidates) with regard to the first task, when it came to considering
the qualities we would be looking for and attached great significance to in
our own personal therapist, the emphases lay in personality factors, the
therapist’s willingness and ability to listen accurately and non-
judgementally, his or her ‘caring’ concerns, and so forth—in other words,
those general ‘being qualities’ that seem so difficult to pinpoint but which,
nevertheless, were deemed by us to be essential.
But what was it that provoked such differing emphases in our two tasks?
It would seem to me that the main elements responsible for producing
such disparate results are precisely the factors considered in Part 1 of this
text. That is to say, when confronted with a task that puts into focus
qualities or skills which it is assumed are pertinent in seeking to clarify the
nature and identity of therapeutic enterprises, therapists will turn to the
skills-based or ‘doing qualities’ that would appear to provide or add
substance to their claims of professional uniqueness, theoretical allegiance
and training-derived expertise. At the same time, when confronted with
their interests and desires as individuals seeking therapy for personal
reasons (as opposed to training requirements or purposes), they (like many
others) are likely to minimize such factors and, instead, focus (quite
correctly, I believe) on the personal characteristics and ‘being qualities’
they would hope to encounter in an individual whose principal concerns
would lie in his or her ability and willingness to attend to or accept them.
But such a result quite naturally begs an obvious question: Would not
the various clients coming to therapists, or to their practice, be more likely
to seek out and emphasize those very same ‘being qualities’ rather than
determine their choice principally on the basis of those qualities centred on
the therapist’s theoretical orientation, training and skills? And, if so, would
it not be more sensible to seek to hire individuals who fulfilled the ‘being
qualities’ satisfactorily rather than base one’s decisions primarily on ‘doing
qualities’?
If readers recall the summary of findings dealing with clients’ values
and expectations of their therapists provided in Part 1, the answer to these
questions would appear to be resoundingly affirmative.
Clearly, the situation is not necessarily an ‘either/or’ one. Ideally, one
would hope to find in one’s therapist both sufficient professional expertise
and personal qualities that would allow suitable attendance. Indeed, it
would be absurd to claim that the ‘being qualities’ most desired do not
involve some element of skill that might have been either learned or
enhanced through suitable training. But, if so, should one not expect the
emphases in training programmes to be clearly (though not necessarily
exclusively) focused on those ‘being qualities’? As one theorist has put it:

It seems to me that what is important … is not so much what the

analyst says as what he is. It is precisely what he is in the depths of
himself—his real availability, his receptivity and his authentic
acceptance of what the other is—which gives value, pungency and
effectiveness to what he says … (Nacht, 1969:40).
In keeping with this view, most training programmes do appear to
acknowledge the importance of these qualities by insisting that their
trainees undergo personal therapy of suitable duration.
But are these sufficient and clear indicators of trainees’ development of
their ‘being qualities’? Unfortunately, this is not necessarily the case. For in
a great many training programmes the importance of personal therapy is not
specifically for such purposes but, rather, is a primary means of
demonstrating to trainees, or convincing them of, the ‘truth’ and
effectiveness of the training institute’s theoretical assumptions and derived
practices. While the personal benefit of ‘training therapy’ may be valued by
the institute, nevertheless trainees are in many cases vetted by their
institutes as to their suitability as representative practitioners of a particular
approach by means of their training therapy. Indeed, it is not uncommon for
the trainees’ personal therapists to be closely involved in the decisions
governing candidate suitability to practise as a representative of the
approach in question and, in order even to be considered a suitable ‘training
therapist’ for an institute, training therapists must themselves subscribe to
the theoretical assumptions (some might say ideology) of the training
organization.
Now this would make perfect sense if it were the case that the
knowledge of particular theoretical stances and their applications had been
shown to be necessary or more efficacious to successful therapy. But the
evidence for such, as has been demonstrated in Part 1, is sorely lacking.
Indeed, what has emerged from a great variety of research analyses on this
issue is that the factors likely to allow for the experience of successful
therapy are minimally dependent on the theoretical approach advocated by
the therapist, or by the type or extent of training that he or she has
undergone. Rather, the data have suggested something quite different: in
studies focused on those cases where therapy is experienced as being the
least successful, the tendency has been for the therapist to be overly strict or
‘fixed’ in adhering to the tenets and practices of theory that he or she has
trained in.
This is not to say that therapists should adopt a laissez-faire attitude
towards their theoretical models—rather, it suggests that it is not merely the
model alone, or in itself, which increases the likelihood of beneficial
therapeutic outcomes, but, rather, that the particular relationship between
the model and its representative (i.e. the therapist) is the key factor. What
might research tell us about this relationship?
While there exists some evidence to suggest that therapists’ consistency
in adopting and staying with a certain model correlates positively with
beneficial outcomes (Malan, 1959, 1963; Luborsky et al, 1975), the case
remains that research studies are consistent in their failure to verify the
beneficial superiority of any one of the major models of therapy over any
other (Luborsky et al, 1975; Mair, 1992). On the other hand, research has
been able to indicate significant differences between different therapists
with regard to their effectiveness—regardless of the model they have
adopted (Luborsky et al, 1975). And, further, there exists some suggestive
research evidence that indicates that there is a positive correlation between
beneficial therapeutic outcomes and therapists’ democratic, non-
authoritarian attitudes (Lerner, 1972). Readers will also recall the question
of ‘non-specific factors’ in therapy which emphasize the personal qualities
of therapists, regardless of the model being adopted, as predominant factors
in beneficial outcome (Aebi, 1993). Lastly, I remind readers of the ‘Dumbo
Effect’ which would suggest that it is therapists’ beliefs in their models as
being valid or superior, rather than the ‘natural’ superiority of the models
themselves, which provide them with the ‘magical’ means to fulfil the
conditions required for beneficial therapy.
Considering these various factors together, it seems clear that models, in
themselves, cannot be said to be the key factor. Yet they are important with
regard to what they may provide the therapist at a ‘belief ’ level. I would
suggest that the issue here lies precisely in the kind of relationship that any
particular therapist will have with his or her model. If the model
overwhelms the therapist, in that he or she seeks merely to ‘accommodate’
to it, and practises therapy ‘by the book’, then this will be expressed in
various ways that impose a ‘rigidity’ and fixedness of outlook on the
therapist which, in turn, will restrict the therapist’s ability to ‘be’ in the
relationship with the client as anything other than as servant to the
theoretical model. If, on the other hand, the therapist not only
accommodates to the theory but also ‘assimilates’ it to his or her ‘being’
structures, then the theory will have become a direct expression of the
therapist’s ‘being’, thereby allowing the relationship with the client to be
one where the therapist ‘is there’ as one who ‘owns’ the theory in that it
‘captures’ or ‘embodies’ who the therapist ‘is’. An example of the
significance of this change in emphasis can be found in Patrick Casement’s
case study ‘A child leads the way’, which was summarized in Part 3.
Readers will recall that, for Casement, the significant beneficial shift in the
therapeutic relationship came when he ceased doing therapy as he imagined
expert therapists would and allowed himself to become the therapist.
Although I have expressed a number of reservations about Casement’s
particular theoretical assumptions, nevertheless it is plain that once
Casement ceased being a ‘slave’ to his theory and instead allowed himself
to express it in his way, the therapeutic relationship altered in a qualitatively
significant manner.
Again, the issue here is not principally the validity or reliability of one
theory over another, but, rather, the greater likelihood that an extreme
adherent of any one approach is more likely to take a more mechanistic,
‘doing-based’ stance towards therapeutic encounters—a stance that,
conversely, is likely to minimize the ‘being qualities’ of both the therapist
and client.
This conclusion raises another important concern with regard to the
training of therapists. For the great majority of trainees, who have usually
invested a great deal of time, energy and income in order to train, an issue
of primary importance would be that all these efforts are not in vain and that
their training leads to a successful conclusion. But if success is measured to
a significant extent by the trainee’s ability to understand, accept and apply
the specific theoretical assumptions of the training institute, then it becomes
more likely that they will be placed in the position of compromising their
concerns, critiques, innovative hypotheses, and, perhaps most importantly,
the unique qualities they possess as individuals, in order to comply more
closely with the beliefs and assumptions of their trainers, supervisors and
therapists. At worst, they run the risk of allowing themselves to be
‘indoctrinated’ by the training institute. The most vociferous and severe
opponents and critics of therapy have emphasized this very possibility and,
while it might be argued that their stances are unnecessarily extreme,
nevertheless they cannot be entirely dismissed.
Our concerns with ‘doing’ reveal an emphasis that is probably culture-
bound. But might it not be the case that a great many of the psychological
problems that our clients present us with are in themselves in some way
linked with this self-same assumption? Clients, not surprisingly, are likely
to think that the sources of their problems lie in their lack of knowledge or
lack of success in ‘doing the right thing’. Such viewpoints reveal a
mechanization of thought and being that a great many philosophers and
psychologists have pointed out as being part and parcel of the fundamental
crises in our societies (Fromm, 1976; May, 1983). For when we are only
able to distinguish or define ourselves through what we do, we place
ourselves in an orientation of thought that equates us with machines—
which, of course, are replaceable objects, quantifiable in value and,
however complex, likely to malfunction or run down over time.
In 1979, as a member of the Edale Research Group, an independent
collective interested in the analysis and exploration of the explosion of new
‘cults’ that had arisen throughout the 1970s, I became a participant in one
of the est training sessions in London. One of the exercises that the three
hundred-odd people carried out over the two weekend sessions struck me
then, as it still does today, as a very powerful expression of just what can
occur when our ‘being qualities’ are disregarded or else are equated entirely
with our ‘doing skills’.
The exercise was of seeming simplicity. The group was divided so that
it formed lines of about twenty individuals. One by one the lines were
required to walk up to the raised stage at the front of the hall where the
training took place and simply stand there and look out over the remaining
members of the group. We were instructed to do nothing, just stand still and
look out over the group impassively, not seeking to gain anyone’s attention
or interest through any gestures, smiles, prolonged eye contact, and so forth.
When the mechanics of the exercise were first presented, I recall thinking to
myself, naively, ‘What is the point of this?’ I couldn’t imagine a less self-
confrontative or dangerous game to play. It did not take me long to discover
just how wrong I was. Within a minute or so of the first line ascending the
stage, I witnessed various individuals in that line-up begin to cry, faint,
become dizzy, feel sick, and wail in psychic pain. These same effects were
repeated line after line, time and time again. Now while I am not condoning
the many potentially manipulative or otherwise problematic practices that
took place during the est training, I simply wish to point out that this
experience was a particularly powerful example of what can occur to people
when they are stripped of the many ‘doing defences’ they have learned to
apply when presenting themselves to others (and to themselves).
I spoke to a number of people in the break following this exercise and
asked them about its meaning for them. Many reported the deep sense of
unease they had experienced during the brief time they had stood on stage.
Some stated that they had felt completely empty, transparent, open for all to
see. Others pointed to their sense of discomfort, even disgust, with
themselves as ‘beings with nothing to do’. Some claimed that the
experience had led them to confront ‘the games’ that made up their lives,
their insecurities, their fears, their deepest anxieties. One person, a teacher
by training, revealed that while he had thought that the exercise would be ‘a
cinch’ since he was used to being the focus of attention in a group and had
never felt any nervousness or unease in this position, it had been the most
difficult and painful of all the exercises we had done and, indeed, he had
fainted within seconds of his being up on stage. When I asked him to clarify
his statements a little further, he said:

It was like people could really look into me, see who was there
behind all the bullshit facade. It was as if my deepest being was
being revealed and I couldn’t stand it. Worse, though, I was seeing
myself in this way for the first time. I was just this living thing that
had nothing to offer except my aliveness—and it didn’t seem
enough. What did I have to offer? What could I say in my own
defence for existing? Sure, there are things I can DO. But those had
been taken away from me. I had no excuses. I wanted to cry: ‘Why
me? What’s so goddamn special about me that I’m alive and
breathing?’ (Spinelli, 1979).

This person’s statements ring true, I suspect, for a great many of us. We
have swallowed the idea that our meaning and reason for living lie in the
acts that we carry out. But more than this, I would suggest, such views point
to the difficulty we have in clarifying the distinctions between ‘being’ and
‘doing’; indeed, we rarely consider the very possibility of such distinctions
so that our ‘being’ is our ‘doing’.
One theorist and therapist who emphasized these very same points
much more clearly and powerfully than I will ever be able to was R. D.
Laing. Throughout his writings, Laing argued that varieties of severe mental
distress and disturbance such as ‘schizophrenia’, rather than being primarily
a form of ‘illness’ best dealt with by means of medical models of treatment,
could be more adequately understood as expressions of deep ontological
insecurity—that is to say, serious ‘dis-ease’, conflict and fragmentation of
various facets of one’s experience of one’s own being as expressed through
one’s relations with oneself and with others (Laing, 1960). Further, Laing,
together with his colleague Aaron Esterson, argued the case that ontological
insecurity arises precisely when the distinction between who one is and
what one does (or must/mustn’t be or do) remains unclear or
indistinguishable through one’s relations with self and others (Laing and
Esterson, 1965).
Many of my trainees are initially mystified, if not angered, when, early
on in their training, I urge them to consider their assumptions concerning
the function of therapy and assert that any assumptions that place at the
forefront of thought ideas such as ‘helping’, ‘curing’ or even ‘changing’ the
client are worth investigating, not only with regard to their impact on the
therapeutic encounter, but also for the possible dangers that such views may
provoke for both their clients and themselves. Further, I ask them to
consider what it might be like for them and their relationship with their
clients if they could set aside, or ‘bracket’, such aims and assumptions.
Invariably, one or more of my trainees will respond: ‘But if we are not there
to do any of those things, then just what are we there for? What can we
offer our clients?’
When I respond that perhaps all we can offer, at least initially, is our
‘being there’ or ‘presence’, I am usually met with looks of concern,
confusion and sometimes even scorn. Can our presence be enough? Surely
not!
And yet, it is not unusual for anyone who has practised therapy to think
of instances when whole sessions have passed by with no interjection or
interpretation or request for clarification—indeed, where no comment
whatsoever from the therapist has been forthcoming or has been asked for
by the client—and yet the client will assert at the end of the session that he
or she has experienced tremendous insight, benefit, relief, catharsis—in
short, a whole gamut of positively experienced changes in outlook and
awareness which he or she will then proceed to thank the therapist for
having prompted (or even ‘made’ happen).
During my first few years working as a therapist, I found such
statements to be far more unnerving and troublesome than any deviant or
disturbing behaviours or experiences that clients acted out or related to me
about various problematic aspects of their lives. Truth to tell, when they
made these comments, I felt that I had conned them in some way or other,
that I had not ‘earned’ the fee paid me since, when it came down to it, I had
done nothing throughout that whole session which I could label a
‘therapeutic act’. I confess that, on occasions, in spite of the evident
satisfaction, relief, joy or sadness in my client’s demeanour, I convinced
myself that they were fooling me in some way or other. I hated it when
these circumstances arose because clients had done something seemingly on
their own—they had not allowed me to ‘help’ them by way of my expert
interventions but had, rather, gone ahead and done something for
themselves! They had not allowed me to put to use the years’ worth of
knowledge and skills I had accumulated and invested so much time and
energy in acquiring. Indeed, when I went on to confront such feelings and
thoughts (for I was at least aware of their absurdity), I also noted (as I
previously mentioned in Part 1) that similar emotions arose in me when
clients told me of insights or profound developments in their thinking and
behaviour that had occurred outside our sessions together when they had
been talking in an open and honest way with others—family, friends, even
relative strangers or acquaintances. What was my anger and discomfort
about?
I suspect that it had largely to do with my desire and commitment ‘to be
a good therapist’ which, more accurately stated, meant ‘my belief in my
own specialist abilities and powers, and my expertise’. But if clients could
achieve significant beneficial insight without my employment of any of
these skills, or (perhaps worse) when other ‘amateurs’ usurped my role,
then what did this say about such vaunted abilities?
I can assure the reader that it is painfully embarrassing to reveal this,
but it is also my belief that these feelings and thoughts were not specific to
my own particular ‘neuroses’; rather, through discussions with colleagues
and trainees, I have come to accept that they are far from uncommon.
Instead, they seem to me to be direct outcomes of those attitudes and
positions that place ‘doing’ at the forefront of the therapeutic process. For,
if this is the case, then it becomes a vexing, and disheartening, question to
ask how it can be that clients can claim substantial benefit from therapy
when the therapist has done absolutely nothing. But, if nothing has been
done, then it becomes sensible to question whether a focus that prioritizes
these ‘doing’ elements is always proper. And if this line of questioning is
pursued, then it becomes both valid and necessary to consider what may be
some of the differences and possibilities in the therapeutic encounter when
the ‘being qualities’ expressed by therapists are emphasized over the
‘doing’ skills that they may have learned to employ.
One of the first variations that this re-orientation forces therapists to
reconsider is the notion of expertise. If therapists are specialists, what are
they specialists in?
In very broad terms, most, probably all, therapists and clients would
agree that individuals who have engaged in a beneficial therapeutic process
will have discovered novel possibilities of understanding and, often,
changing various disturbing and debilitating patterns of thought and
behaviour. I would suggest that in addition to the above—and perhaps more
significantly—such individuals will have found, or expanded, various
means whereby they can acknowledge and express their current stance or
experience through the relationships they engage in with the world both
with regard to their internal, or world-as-self, relations and their relations
with others (including other people, living organisms, and the physical and
socio-cultural environment). That is to say that therapy can allow a more
experientially adequate means of acknowledging and examining who one is
and how one is, relationally speaking, in a given moment of experienced
time.
This view may be seen as being reminiscent of Freud’s profound
statement regarding the possibilities of analysis providing the means to
enhance the potential to love and work (Freud, 1940). While some have
tended to read this conclusion as an expression of Freud’s limited—even
pessimistic—hopes for therapeutic interventions, it seems to me to be,
instead, an admirably realistic, responsible and humanly respectful stance
for therapists to adopt.
The experience of living presents one with constant and uncontrollable
vagaries of change. It has become a truism or homily to state that ‘life is
change’, yet the accuracy of this statement cannot be lightly dismissed.
Nevertheless, it is also the case that as often as we may mouth this view, our
tendency is to act in ways that suppose that we can in some manner offset
this ‘rule’. We present ourselves to ourselves and to others as though we
have conquered change. Indeed, we make all manner of attempts to build up
a model of ourselves and our world that promotes the opposite notion—
which is that ‘life remains the same’ and, by implication, that we remain the
same.

B. BEING WITH AND BEING FOR THE CLIENT

An important implication of a ‘being’ focus in therapy is that it allows

therapists to acknowledge themselves as changing beings whose current
manner of existence is expressed through their interactive relationship with
their clients. As such, it concedes to therapists a far greater range of
possibilities of relating to clients in differing, if apposite, ways. This in
itself is a freeing process that would be far less possible if therapists were to
emphasize ‘doing skills’ that, in contrast, would more likely demand the
maintenance of a similar stance or ‘way of being’ regardless of the situation
or relationship encountered. Does this mean that a ‘being’ focus allows a
laissez-faire attitude to the therapeutic process? Certainly not. For being, in
the therapeutic process, requires therapists to uphold a stance that is both
that of being with and also of being for the client. While closely related, and
mutually inclusive, these two stances point out emphases the implications
of which are worth more detailed consideration.

Being with
Firstly, in being with the client, therapists acknowledge the interdependence
in the therapeutic relationship, and place an emphasis on those qualities of
being that seek to promote an attitude that does not, initially at least, seek to
confirm the ‘objective truth’ of the client’s statements, or whose aim is to
present disconfirmations, rebuttals, contradictions, alternative possibilities,
and so forth, but, rather, which stays with the experienced truths of the
client as they are being related in order that they, and whatever implications
such truths may hold, may be exposed to further investigation and
clarification by both the therapist and the client. In this way, the process of
‘being with’ the client allows the focus of the relationship to remain firmly
on the client’s experientially based statements (be they verbal or non-
verbal) so that they can be ‘opened up’ with regard to the meaning or
meanings that the client (not the therapist) perceives them to hold. The
following example should clarify this argument.
A prospective client, Rose, once telephoned me to make arrangements
for our first meeting. Towards the end of our discussion, having set the time
and date of our appointment, Rose expressed the need to inform me that I
should know in advance that she had a particularly unsightly facial
disfigurement about which she was deeply embarrassed. Prepared (as far as
I could be) to be confronted by what I imagined to be my client’s gruesome
appearance, I was surprised to meet a particularly attractive (to me, at least)
middle-aged woman whose facial features showed no sign of any obvious
blemish. Sitting down, she immediately launched into an account of how
her life had been marred by her disfigurement to the extent that she avoided
unnecessary contact with others lest she experience their repulsion towards
her. As Rose described her experiences, it slowly dawned on me that the
source of her anguish was a tiny, nearly imperceptible mole on her left
cheek. This, then, was ‘the terrible scar’ that had so burdened her life!
I am convinced that had I pointed out to her then and there what seemed
so obviously to me (and probably to anyone else except her) to be an absurd
concern on her part, I would never have seen Rose again. Instead, I found
the means to acknowledge her reality and began to explore with her, her
experience of herself as a ‘scarred’ being. It was only much later in the
therapy, when Rose felt herself to have been sufficiently understood by me,
that the question of how others (myself included) saw and reacted to her
disfigurement was confronted. Without going into unnecessary details about
this encounter, it is sufficient to state that Rose had always been aware that
others did not see the mole as she did, and while she could understand their
viewpoint, she could not accept their insistence that she, like they, should
acknowledge it as being insignificant. Indeed, the mole had come to stand
for, or represent to Rose, her sense of her uniqueness and independence
from what she perceived to be the powerful demands of others for her to
‘fall into line’ with their accepted ways of thinking and behaving.
In this way, the mole was not only Rose’s ‘problem in life’, it was also
her primary means of ‘salvation’, since it allowed her the means of
asserting and identifying herself as a separate and unique being. All of this,
and the subsequent insights that emerged for her throughout our time
together, would have been highly unlikely had I not attempted to ‘be with’
Rose’s experience of herself. While it is possible that immediate
confrontation might have led us to similar clarifications, it might just as
well have prevented any possibility of this and, worse, Rose’s experience of
therapy may have been labelled, with some justification, as abusive.

Being for
Being for the client enjoins to remind therapists that for the duration of each
session they have agreed to attempt a process of encounter whereby they
will seek to inhabit the experiential world of the client for the sole sake of
allowing the client a form of ‘reflecting self ’ encounter with another who
seeks to be the self. Such a process, once again, subverts the possibility of
the therapist’s task being that of ‘truth-bringer’, ‘healer’ or ‘helper’ in any
purposive or direct manner. All such may be experienced by the client, of
course, as would be the case if any one of us were to be in a situation where
we were willing to confront our concerns, stances, fundamental
assumptions, fears and anxieties in a manner that was as open and honest as
we might allow ourselves.
The notion of ‘being for’ the client urges therapists to ‘attend to the
client’, as R. D. Laing put it (Evans, 1976). In other words, it urges
therapists neither to lead the client in various directions that they think to be
of import, nor to be led by the client into avenues of thought or affect that
remain unclear or disconnected to both or either participants, but to seek to
keep up with them side by side (to pursue the analogy) so that the client’s
path becomes the therapist’s path and an approximate symmetry of thought
and assumption becomes possible.
The distinction between ‘being with’ and ‘being for’ is subtle yet
significant. For while the former focuses on therapists’ willingness to
acknowledge the lived reality of the client, the latter further asks therapists
to attempt to enter the client’s lived reality in order that they may
experience that reality in a manner that approaches the client’s way of
being.
So, for instance, just as my example concerning my client, Rose, sought
to clarify the notion of ‘being with’ in that it expressed my willingness to
consider Rose’s view of her lived reality as experientially valid, so too, can
it provide a concrete example of ‘being for’ the client in that, through such
willingness, I, as the therapist, was able to contemplate what it might be
like to live reality as Rose did and, hence, to partially enter into her way of
being so that my comments, clarifications and challenges sought to be
parallel reflections of Rose’s stance in life rather than impose alternative
or competing stances.
In this attitude of ‘being for’ my client, then, I was able to approximate
Rose’s reality to the extent that I could ‘live’ it and, in so doing, perceive
and provide a voice for the meanings, assumptions, implications, paradoxes,
possibilities and limitations with which that reality was imbued not from a
distanced, abstract, or ‘other-focused’ standpoint, but from a standpoint that
approached hers. In this way, for example, I was able to guess that if, as
Rose, I was able to see the mole not only as others saw it, but also in a
manner that others could not, then the mole might contain a meaning that
was not only specific to itself but also general to Rose’s meaning of self in
relation to others. In my attempt to ‘be for’ Rose, I could grasp that, like the
mole, Rose was seemingly like she believed others insisted she be (i.e.
insignificant), but experientially she was of major significance (even if she
was the only one to be aware of this).
The injunction to ‘be for’ the client is by no means an easy one for
therapists to adhere to, nor is it ever fully possible for them to achieve
because, as I suggested earlier, no one is ever fully able to experience or
interpret the world in exactly the same manner as another. Nevertheless,
perhaps during brief moments in an encounter, therapists may experience a
sense of the uncanny in that they may feel themselves to be temporarily
‘lost’ or ‘swallowed up’ in the client’s world. Not surprisingly, this
experience may often be characterized as unpleasant or disturbing and,
sometimes, even frightening. Conversely, this may also happen to clients if
they are led too forcefully or quickly into an experience of exploring the
meaning of their issues from the theoretical standpoint adhered to by their
therapist. Once again, Laing’s work with deeply disturbed and fragmented
beings provides vivid examples of what may occur both when a therapist
seeks to ‘be with’ and ‘be for’ a client as well as, alternatively, what further
fragmentation may occur when therapists, adopting a more objective model,
impose their—or ‘consensus’—reality on their clients (Laing, 1960, 1967,
1982).

The experience of the client’s lived reality

The experience of the other—even at an approximate and incomplete level
—is often disorientating and may be deeply unnerving. The very
‘strangeness’ of the lived experience of the other and, perhaps as
commonly, the recognition that it may bring forth similarly shared, if
unreflected, assumptions in one’s own life, may be good reasons in
themselves for therapists to seek to establish rationales that avoid making
this their aim. Nevertheless, to address and understand these issues from
standpoints such as ‘transference’ or ‘counter-transference’ (as was
criticized in Part 3) seems to me to miss the point of what is being argued.
Indeed, the reason why some therapists have criticized these terms becomes
more understandable in that, rather than highlighting important areas of
unconscious conflict, in either the client or the therapist, the difficulties
encountered may, more accurately, reflect an unwillingness to engage in this
kind of ‘being’ encounter. The difficulties may, in themselves, be defensive
and protective barriers, or obstacles, that serve to distance both the therapist
and the client from the acknowledgement and exploration of the direct
experience each has of the other and of themselves in relation to the other.
It would not be surprising, since more than any therapist (other than
Laing perhaps) it was Carl Rogers who sought to emphasize and distil the
‘being qualities’ essential to therapy, if readers have begun to suspect that
what I have been attempting to communicate is a rehash of Rogers’ notion
of ‘mirroring’ or ‘reflecting back’ (Kirschenbaum and Henderson, 1990a).
But this too would be an erroneous assumption. While there are certainly
some points of similarity, I would contend that my argument contains
several significant points of deviation from, or perhaps more accurately can
be understood as being an extension of, Rogers’ ideas.
Firstly, the points I have been making do not seek to suggest or pretend
that therapists (even if this were possible) should seek to ‘erase’ themselves
such that the client is presented with a blank reflective screen for inspection
and analysis. While Rogers clearly seems to have made such suggestions,
other comments of his make clear that he did not by any means fully adopt
or seek to adhere to this naive position. Unfortunately, quite a substantial
number of person-centred therapists I have encountered do, on the other
hand, seem to believe themselves capable of such magical feats and are
convinced that their ‘reflecting back’ of the client’s statements is bereft of
interpretation or of their own being. This stance is patently absurd since the
very fact that they choose to reflect back certain statements and leave others
unreflected (a necessity in any form of encounter) itself reveals their input
and presence. As such, I am not arguing here a case for ‘mirroring’ in any
ordinary sense of the word. If there is any ‘mirroring’ suggested in my
comments, it is more along the lines of a somewhat distorted mirror or,
better yet, the kind of ‘black mirror’ that was alleged to have been
employed by alchemists and practitioners of the arcane arts, the properties
of which were claimed to lie in its ability to reflect back that which is only
implied by the surface features of the reflecting object.
Secondly, unlike person-centred therapists who avoid the direct
questioning and challenging of clients’ statements, but whose art lies in
making the reflection itself the challenge, so that the impression is given
that they have added nothing to their clients’ utterances, I would suggest
that the emphasis on ‘being qualities’, while similarly urging therapists to
avoid adding anything to their statements which seeks to impose analytical
or ‘rational’ interpretations originating from their theoretical or personal
biases and assumptions, nevertheless acknowledges therapists’ own input
into the relationship and therefore allows (indeed, insists) that therapists
urge clarification of clients’ experience by means of the descriptively
focused interpretations that were discussed in Part 3.
Thirdly, the attitude being advocated makes clear that therapists are not
being asked to ‘be themselves’ as Rogers and a number of his followers
seem to advocate. The ‘self ’ that the therapist is being asked to attempt to
be is a self-in-relation whose focus resides in ‘the other’ (i.e. the client).
This injunction is not entirely unlike the task required of actors who have
trained in the ‘Method’ school founded by Lee Strasberg and whose
essential aim revolves around ‘immersing’ themselves or ‘entering into’ a
specific character or object. As such, in order to seek to achieve this task,
the ‘self ’ that they are being, while always invested with ‘the self ’ of the
actor, nevertheless expresses itself and ‘is’ in the world in a much more
complex and divergent manner than that suggested by the term ‘being
oneself ’.
Once again, this attempt makes clear that while one cannot ever fully
expect to be ‘the other’ in any complete sense (in the same way that each
method actor will ‘be’ a unique Hamlet or Blanche DuBois through his or
her ‘living interpretation’ of such characters, which will evoke differing
qualities and emphases in the interpretation), nevertheless one can focus
one’s sense of being such that it seeks to ‘reside in’ the interpreted
experiential realm of the client.
The enterprise of ‘being with and for’ the client serves, among other
things, to diminish the likelihood of the therapeutic encounter becoming
unnecessarily mechanistic or solely focused on what the therapist is able to
do. At the same time, while it by no means dismisses the value of learned
skills or knowledge on the part of the therapist, it does place these within a
perspective that emphasizes ‘doing’ as an extension of, and not a substitute
for, the therapist’s being in the relation. As such, what therapists ‘do’
should always be understandable within, and an expression of, their
attempts to acknowledge and enter into the client’s world-view rather than
being the means of emphasizing their ‘taking charge’ of the therapeutic
encounter in order to promote cure, symptom alleviation, growth, or
change.
I am personally convinced that, however paradoxically, such worthy
aims become more likely, or at least may be achieved with the client’s
greater willingness and co-operation, precisely when therapists give up all
assumptions of having the power, the professional credentials and skills,
and (perhaps most importantly) the personal need to achieve such. In this
sense, the willingness and attempt ‘to be with and for the client’ may be
seen as an act of courage on the part of therapists (just as it is an act of
courage for clients to be willing to confront their attitudes to various aspects
of their lives) and may well be an essential element of the ‘specialness’ that
is claimed for therapy.

C. LISTENING

The concentration on this focus in a training situation also provides a

worthwhile means of discerning which ‘doing skills’ are perceived as being
fundamental to therapy regardless of the theoretical orientation one trains in
or wishes to espouse. A skill that arises continually and which all trainees
whom I have taught acknowledge as being both fundamental and of
unexpected difficulty and complexity is that of listening. It would seem
both useful and informative, therefore, to consider this skill both in itself
and in the light of the points I have made with regard to the question of
‘being qualities’.
Listening skills seem at first so basic and fundamental to trainees and
lay persons alike that it appears initially absurd even to consider them as
specialist skills. ‘Everyone knows how to listen!’ might be a common
claim, but, as I hope to demonstrate, this view may be somewhat naive.
If pressed to think of an example from their lives, most people are likely
to be able to name someone who is ‘a good listener’. What do people mean
by this phrase? On consideration, the definition of a ‘good listener’
centrally involves someone who will allow them to voice concerns,
experiences, affective circumstances and so forth without the kind of
intrusion that would imply any form of judgement or bias; who will avoid
advice-giving or suggestions either completely or at least until such a time
as these might seem appropriate or welcome; who will comment in such a
way as to reveal that they have heard ‘the core message’ contained within
an account; and whose challenges, calls for clarification, or even
interpretations flow directly from the statements or experiences recounted.
Similarly, ‘a good listener’ is someone who can ‘hold’ the speaker in that he
or she appears to provide a sense of openness, a willingness or even
encouragement to hear the full story and its emotional content without a
sense of disinterest or a desire to hurry one along in the recounting of
events and their emotional impact on the speaker; who will acknowledge
and allow one to express a variety of emotional behaviours such as grief,
anger, joy, confusion, rage or hilarity without a sense of the listener’s own
discomfort or embarrassment; and who, in this way, fulfils such notions as
‘empathy’, ‘congruence’ and ‘concerned respect’.
All of us, I am sure, have at some time or other in our lives yearned to
be in the presence of ‘a good listener’ in order that we might pour out our
tales of woe, misery, frustration, confusion and even joy. We may have
found such a person among our family, friends, teachers, representatives of
our religion, or even complete strangers encountered serendipitously. Some
of us may have engaged the services of a professional such as a specialist
adviser or, of course, a therapist. And many more, I suspect, may have
looked in vain among any or all of these possibilities and failed to find the
person who would qualify in terms of the criteria required of ‘a good
listener’. Clearly, then, although it would seem initially the case that ‘good
listening’ is a straightforward process requiring little, if any, expertise, there
appears to be a particular ingredient, or set of ingredients, which, while not
initially obvious, nevertheless reveal themselves as being essential once
their absence is recognized.
As it is claimed to be by nearly all authors and practitioners of therapy
as an essential, or foundational, skill for the development, maintenance of,
and (at least partial) fulfilment of the inherent possibilities in the therapeutic
relationship, ‘good listening’ would seem to be a skill that is worthwhile
examining. And, indeed, as might be expected, a wide array of training
texts focus on the development of ‘good listening’ skills by means of useful
exercises and lessons focusing on concrete examples designed to assist the
trainee in the development of his or her own skills. Gerard Egan’s widely
employed text The Skilled Helper (1982), for example, provides a
practically focused analysis of listening skills emphasizing the value of
listening to client statements from the standpoint of their content and
specificity and in terms of the client’s focus on specific experiences,
behaviours and feelings and emotions in particular situations. In addition,
Egan endeavours to clarify how the trainee may learn to listen out for both
the overt and covert messages contained in a client’s remarks (Egan, 1982).
While there is much of value in such analyses and their related
exercises, particularly for training purposes, at the same time I would argue
that such ‘doing’ skills are in and of themselves at best of limited value if
they are not in some way reflections or behavioural expressions of the
person who enacts them. We are all likely to have had first-hand experience
of someone (even ourselves) who might say and do all the right things and
yet with whom we still feel a good deal of distrust or sense of unease.
Sartre’s now-famous example of the overly solicitous waiter comes to
mind as someone who fulfils this scenario—since in this illustration we are
presented with someone who is, in many ways, the perfect waiter, and yet
there exists in him something totally lifeless, empty, somehow more
android-like than human (Sartre, 1956). Relevant to this, the novelist Philip
K. Dick, author of many masterpieces of speculative fiction, has suggested
that one of the principal qualities that distinguishes a human being from an
android is the human’s ability to balk at carrying out certain acts (Rickman,
1988). An extension of this point would suggest, I believe, that our very
humanity rests upon such characteristics as our unpredictability and
imperfection. Which is to say that human beings possess the acknowledged
capacity to alter their thinking and behaviour (e.g. they can elect to do
something in a manner that is different from usual) in ways that can both
surprise and shock in part due to their unexpectedness.
Predictability and perfectionism
Although both the more behaviourally focused and analytic approaches to
therapy tend to concentrate (in admittedly different ways and for differing
reasons) on the predictability of human behaviour, as, indeed, do all
theories to varying degrees, it seems to me to be equally pertinent for those
who make it their task to investigate human experience also to consider our
unpredictability.
Why should this point be of significance in the current discussion? The
neglect, or avoidance, of the possibility of the unpredictable implicitly leads
us to the desire or aim for perfectionism. The machine-based android and
Sartre’s overly obsequious waiter both seek out forms of perfectionism to
the extent that change or divergence from their typically complex but highly
regulated and patterned forms of behaviour become intolerable and near-
impossible.
One of my clients, Tania, a teenage student terrified of sitting her A-
level exams, expressed the notion of perfectionism when she stated:
‘What’s the point of sitting an exam if I don’t know if I will pass it?’ As
well as revealing her intolerability of failure, this viewpoint expresses an
implicit demand for the predictable, to know pretty much before anything
happens what its outcome will be. As understandable as this desire may be,
what is rarely acknowledged is the restriction on our experience of life
which predictability imposes. While the unpredictable may be anxiety-
provoking, it is also the source of a great many experiences that are both
invaluable and deeply meaningful to us all. As much as we might yearn for
the predictable, when our lives become overly imbued with it they appear to
be far less ‘life-filled’ and increasingly insignificant.
Over time, I have observed this attempt to avoid uncertainty and to
build up a predictable and protective experiential environment to be a
widespread feature in the lives of many of my clients. For somehow, in
having constructed their lives in such a regulated manner, they seem to have
entrapped themselves into ways of relating to the world that severely
restrict the possibility of deviation from thought and deed both at the
everyday level and at levels that are perceived by them as being of utmost
importance. In such circumstances, the very individuals and events (such as
their spouses, children, lifestyles) that were once valued because they were
construed as providing the means for security and the avoidance of
uncertainty have themselves become the ‘problematic focus’ of lives
experienced as restricted and unfulfilling. In their own words, such clients
see themselves, in these instances, as beings ‘going through the motions’ or
‘pretending to be human’ or ‘no longer experiencing and expressing
feelings of love, worth and concern’.
But therapists too, in their attempts to be ‘experts who always do and
say the right thing’, need to consider how much of their relationship with
their clients (not to mention themselves) is restricted when it rests on
assumptions that are similar, and similarly limiting, to those likely to be
experienced by their clients. For instance, an activity such as listening,
when confined by therapists’ devout allegiance either to a theoretical
framework or to various learned skills, can also become equally restricted
and restricting since not only will therapists, in all likelihood, listen out
principally for those parts of what is being said that are either explained,
implied or predicted by the theory they advocate and represent, and thereby
will minimize the value of other statements made by the client, but they will
also listen even to these ‘highlighted’ sections of discourse in a manner that
will allow them to ‘feed it back’ to their clients through the utilization of
specifically learned communication skills that, typically, are designed to
focus concentration on those areas deemed significant by therapists. In a
similar manner, therapists may come to believe that by following such
directives they will approach therapeutic ‘perfection’ in that the anxiety of
the unforeseen or the incorrect will be allayed. In these ways, although
therapists might seek to give the impression that they are listening as
adequately as possible to their clients’ statements, and might believe that
they have found ways of promoting themselves as caring, empathic
listeners, they might in fact subtly (and sometimes not so subtly) and
inadvertently be revealing the ‘mechanism’ of their listening such that
although clients may not be able to point to anything that is incorrect in
their therapist’s listening, they may nevertheless feel themselves to be
unheard or unacknowledged at a ‘human’ level.
As such, therapists’ reliance on a fundamental skill such as listening as
something which expresses first and foremost their desire and attempt to be
seen as experts, who through the accurate employment of learned training
skills express (or, more humbly, approach) the ‘perfect embodiment of
listening’, paradoxically increases their clients’ doubts that they will ever be
truly heard. Or, in other words, therapists might hear all the right things,
yet still have failed to listen.
How can therapists avoid this situation? It would seem that a necessary
step is for them to accept the ‘unknown possibilities’ within every act of
listening, or, more generally, within every encounter, by acknowledging that
their own involvement within it is not at the ‘perfectionist android’ level but
at a human level which, while aiming for the best that one can offer, can
also embrace uncertainty, insecurity and error. Considered within a more
concrete perspective, this view urges therapists to avoid restricting their
listening such that it focuses solely on and adheres to their specific
theoretical and personal perspectives. To do so does not mean that they
must forsake, or pretend not to hold, such outlooks, but, rather, that they
should concede that their perspectives can form only part of the listening
process. What other parts are there to this process? Broadly speaking, they
involve therapists’ capacity and willingness to listen from the perspective of
the client. In their attempt to achieve this, therapists are more likely to shift
from self-focused listening towards (at least partial) other-focused listening.
That is to say, ‘good listening’ occurs when the listener attempts to listen as
if the listener were also the speaker.

Other-focused listening
Acknowledging this frees therapists to listen not just to the statements
originating from ‘someone else’ (i.e. clients) but also to the statements that
originate from within ‘the being who is seeking to be the other’ (i.e. the
therapist). These latter statements may be perceived as hunches or ‘niggling
concerns’ that appear to insist on being attended to. While acknowledging
that there may be some danger in expressing these, or that they may be
completely off-track, I would personally advocate their acceptance and, in
some instances, even their introduction into the dialogue, as long as they are
presented in a manner that makes clear therapists’ ‘ownership’ of them, as
well as their acknowledgement that they may have no bearing whatsoever
on the client’s issues and may be rejected by the client with no fear that this
will be interpreted as a form of ‘resistance’, or that they reveal a ‘hidden
truth’ that only therapists’ superior knowledge or expertise with regard to
the client’s mental realm has revealed. Presented in this manner, clients will
not only be much more willing to hear such statements and allow them into
the dialogue, far more importantly (and paradoxically) they will increase
the likelihood of clients experiencing their therapists as good—and human
—listeners.
A brief if perhaps somewhat ‘eerie’ example might clarify what is being
suggested here. About four years ago, I had become interested in exploring
the possibilities of being involved in a television documentary on the life
and work of the aforementioned American writer, Philip K. Dick. Just prior
to my seeing the client discussed in this example, my agent phoned me to
say that there had been some unexpected interest shown in the project and
that he would set up some initial meetings with a potential producer. When
my session with my client, Lawrence, began, he immediately started to talk
about a dream he’d had two nights before that was disturbing him. When I
asked him what he wanted to tell me about the dream, Lawrence explained
that it involved a friend from his adolescence, named Dick, whom he’d not
thought of for many years (certainly, he’d never before mentioned this
person in any of our previous sessions). I enquired as to what Lawrence
thought the significance of Dick’s appearance in his dream might be, and he
immediately responded that, it was funny, but all he could tell me was that
he’d found it odd that Dick should be in the dream by himself. Who else
should have been with Dick? As it transpired, for a period of some years
during his teens, my client had had two very close friends who had always
seemed to be linked to one another until they’d had a major row over a
girlfriend and, as a consequence, had ended their friendship, each vowing
never again to be seen in the other’s presence. In spite of this, Lawrence,
who subsequently moved to London and lost contact with both of these
friends, realized that he had maintained a mental link between Philip (the
other friend) and Dick.
The correspondence between the two friends’ names and the author’s
name struck me as being both amusing and uncanny—so much so, in fact,
that I could not immediately set it aside. Nevertheless, I asked Lawrence to
tell me about his relationship with his two friends and he began to explain
that, in many ways, they had been exact opposites. And had he ‘held them
together’, so to speak? Yes, in fact they’d often used him as a kind of go-
between. Such statements only added to my inability to let go of ‘my’
Philip Dick. For, both in his life and in his writings, he had expressed and
explored an on-going sense of ‘splitness’ to such an extent that in a number
of his later novels he made this splitness explicit by placing himself directly
in his stories not as a single character but as two characters who could only
be ‘made whole’ if they could find or recognize each other (Dick, 1981,
1987).
As I continued listening to my client, the interweaving themes of
‘splitness’, separation and acting as ‘go-between’ led me to consider that
just as Philip Dick, the author, had invented two characters in order to
express his splitness, so might it be the case that my client’s two friends
‘splitting apart from each other’ might be reflections of his own sense of
personal (and seemingly irreconcilable) splitness. As such, I said to him:
‘Look, this might be totally off the wall and irrelevant, but I keep getting a
picture of these two friends of yours, who are such opposite characters, as
saying something about you—the way you feel about yourself being
sometimes more like one, sometimes more like the other. And just as you
were the “glue” that held your two friends together, maybe in doing so you
were kind of holding yourself together as well. But when that “glue” failed
externally in the case of your friends, maybe it also failed at an internal
level as well … Is there anything at all in this for you?’
As it happened there was and, in this instance at least, my hunch—
which was derived from my having combined Lawrence’s material with
‘my’ material on the basis of their possible resonance—proved useful to
him and to my ability to gain a more adequate understanding of his
experiential world. But I could also have been totally wrong in my
supposition. And yet, in listening to Lawrence as though I were the speaker,
I could not deny the coincidence or the possibility that the coincidence
informed my listening. As such, I took a risk based on what I was hearing
from both of us. But, in doing so, I had to acknowledge this in my statement
and allow the option of error.
Listening, then, requires acceptance. But this acceptance is not just at
the level of accepting what the speaker is saying but also of what the
listener is hearing, not just from the client but also from ‘within’. It is not an
issue of ‘technique’, but of ‘being’.
If therapists are willing to ‘be in relationship with’ or encounter their
clients, then they must accept that it is not merely their theories or skills
which they bring to the relationship, it is themselves. But to accept this
requires their acknowledgement of uncertainty as to what this encounter
might reveal, what they might bring to it that is of value to the client, and
which direction it may take at any given point in time.
With this view in mind, it should now become clear why I encourage
my trainees to set aside all ideas of cure, help, promotion of growth,
positive change, and so forth when engaged in a therapeutic encounter,
since all these direct and restrict the encounter and impose on both the
client and the therapist a focus on ‘doing’ rather than one on ‘being’.
In promoting this view, I am in full agreement with Rogers’ emphasis
on therapists aiming towards ‘transparency’ and ‘congruence’. And, like
Rogers, I would argue that this is possible only once therapists recognize
the primacy of their ‘being qualities’ as opposed to the ‘doing skills’
available to them, so that what they ‘do’ extends and reflects—rather than
mechanizes and obscures—who they are. This form of ‘disclosure’ on the
part of therapists has little to do with what they may or may not reveal
about the personal events and relationships in their lives; rather, it points
out that they cannot remain ‘anonymous’ within the encounter in that they
bring their experience of themselves as participants into it. In line with this
thinking, the following statement by Martin Buber, while focused on his
view of the process of teaching, has much to say about therapy:

The teacher who wants to help the pupil to realise his best
potentialities must … know him not as a mere sum of qualities,
aspirations, and inhibitions; he must apprehend him, and affirm him,
as a whole … this he can only do if he encounters him as a partner in
a bipolar situation … (Buber, 1970:78).

D. ENCOUNTER

In shifting the emphasis of therapy on to the realm of ‘being’, therapists are

led to acknowledge the centrality of the encounter which contains within it
the willingness on the part of both participants to seek to engage with one
another in a manner that recognizes and utilizes the specialness and
uniqueness of the on-going relationship. Such a stance brings into focus the
realm of possibilities contained within the notion of an interactive
encounter.
Existential-phenomenological theory argues that such encounters are
occurring in an inter-subjective realm through which one’s experience of
‘being’ does not occur within each participant but, rather, is co-constituted
between them. It is this ‘middle ground’, or ‘space’ between the engaging
beings, which allows an accepting dialogue to occur. At the same time,
what can be taken as being ‘special’ within the therapeutic relationship is
that the individuals have agreed to engage with one another in such a way
that their disclosures share the common purpose of remaining focused on
the examination and clarification of the experience of being of one of the
participants—the client. Nevertheless, because this common focus is
relational, both therapist and client experience themselves-in-relation, the
other-in-relation, and each-other-in-relation.

Realms of encounter
These ‘three focal points’ in the therapeutic encounter are rarely made
explicit in theories of therapy. Yet it seems to me that recognition of each is
essential if one is to approach therapy from a ‘being’ standpoint. As such, if
we consider this view from the perspective of the therapist, what is being
argued is the following: In the first realm of relation, I, as therapist,
experience my ‘self ’ in that relation and am able to note and consider what
I bring to the relationship (this would include my knowledge, my skills, my
expertise, the personal and theory-based views, opinions and biases that I
attempt to bracket, and my sense of my own being, as well as the particular
focus I place on listening to the client). Equally, at the second realm of
relation, I, as therapist, experience the client as ‘the other’ and note and
consider that I interpret what he or she brings to the relationship (this would
include my understanding of the issues and concerns expressed, their
affective components (i.e. those emotions, attitudes and values associated
with the issues being expressed), and what is implied about the other’s
sense of his or her own being through these). At the third realm of relation,
I, as therapist, experience my ‘self-being-in-relation-with-the-other’ and
note what ‘emerges’ or is disclosed through the interaction between the first
two realms—which is the ‘material’ expressed in this third realm of
relation.
In the same way, the client experiences the therapeutic encounter from
these three ‘focal points’—which is to say:

1. The client’s experience of ‘self ’ in the relation.

2. The client’s experience of other (the therapist) in the relation.
3. The client’s experience of ‘self-being-in-relation-with-the-other’.
My view of therapy is that its particular ‘specialness’ lies in the exploration
of the various conjunctions or points of contact between both participants’
relational realms. While most therapeutic models emphasize and work with
either the first or second (or both the first and second) relational realms,
they rarely attend to the third, or indeed to the conjunction between the
therapist’s and client’s experience of ‘self-being-in-relation-with-the-other’.
Yet it is precisely this third realm which existential-phenomenological
theory, as applied to therapy, illuminates and provides with its unique ‘take’
on therapy. In this way, it argues that it is through the exploration and
clarification of this ‘being realm of between-ness’ that the remaining two
realms are more adequately disclosed to clarificatory challenge.
A concrete example should make my point clearer. A client, Annie,
came to me for therapy because she could not understand how it could be
that she had felt, and continued to feel, no grief whatsoever over the recent
death of her mother. She had always felt that she had loved her at least as
much as any other daughter would love her mother. As far as Annie was
concerned, they’d had a good, caring relationship. They saw each other
regularly and had not had any significant rows. As she lived nearby, her
mother often ‘baby-sat’ Annie’s children and this had allowed Annie and
her husband to go out and have some time to themselves for an evening
most weeks. In many ways, Annie felt, her relationship with her mother had
been good—indeed, in her own words, ‘as good as anyone had a right to
expect’. And yet, now that her mother had died, Annie felt nothing; indeed,
she’d felt more sadness when reading about the death of a movie star than
she had about her mother’s. Why could she feel no grief ?
In considering this from the standpoint of the relational views I have
been discussing, I, as therapist, would seek to enter Annie’s experiential
world by ‘immersing’ myself in the account she has given me so that I
might attempt to experience these events as she does. I might ask myself:
‘What and how would I be like if I were Annie?; what might “I-as-Annie”
experience of myself as I relate this experience?; what and how might “I-as-
Annie” imagine that others would experience “me” as being?; what and
how might “I-as-Annie” imagine the experience of others (including the
“other” who is her therapist) being in response to what “I-as-Annie” have
stated?’
In other words, I would be attempting to ‘be’ like Annie in her relations
both to herself and to others. In doing do, my attempts would rely on both
my own personal experiential responses to Annie’s statements and to the
experiential responses I might imagine were I to be Annie. In each instance,
my attempts would include, however cautiously or sceptically, whatever
theories, assumptions, biases, and ‘resonances’ her statements provoked ‘in’
me, since these would be the interpretative basis from which I could extract
a sense of the ‘relational meanings’ contained in Annie’s statements about
her experience. In asking Annie to describe and clarify her experience
further, I would be putting my interpretational understanding to the test, so
that, hopefully, I would gain an increasingly adequate awareness of Annie’s
experience. As I did so, I might challenge Annie with descriptively focused
statements or questions that sought to express my attempt at ‘entering’ her
world-view.
These would serve a dual function: firstly, they might confirm for Annie
that I had understood what she had stated at an explicit level; and secondly,
they might confirm for Annie that I had understood the experiential
implications of these explicit statements.
So, for example, in clarifying Annie’s statement that she had loved her
mother yet could feel no grief over her dying, the following dialogue
emerged:

‘Annie, what’s it like to know that you love your mother and yet not be able
to express that in the form of grieving?’
‘It makes me wonder if I really love her.’
‘So … because I can’t grieve, perhaps I didn’t love.’
‘Yes … that’s how it feels to me.’
‘So, when you were at the funeral and saw your sister and brothers crying,
they were expressing their love for your mother.’
‘Yes. Well, I guess so. At least they were crying.’
‘And there you were, not crying.’
‘I just couldn’t feel anything!’
‘Well … Would I be right in saying that it wasn’t that you weren’t feeling
anything, but that you were feeling that you should be feeling grief but
weren’t able to feel or express it?’
‘I wanted to!’
‘Yes. And as much as you wanted to, still you couldn’t.’
‘I wanted to desperately! She was my mother, after all! But I just couldn’t!’
‘What was it like for you to be in this “I want to, but I can’t” stage?’
‘It’s awful! I don’t feel in control.’
‘Tell me what that’s like for you: to “not feel in control”.’
‘It’s awful. It’s like I don’t know who I am any more. I know what the right
thing to do is, but when I try to do it, it just doesn’t happen. And so I’m
there trying to convince myself to do what I want, but it’s almost like I’m
trying to convince someone else who doesn’t want to hear what I’m saying
or who does hear it, but refuses to go along with me. It’s like I’ve been
pushed aside inside my own body.’
‘And this other “being” who’s pushed you aside, what are you trying to tell
it?’
‘To listen to me! To just get out so that I can do what I want.’
‘You want to cry, but “it” doesn’t.’
‘Yes.’
‘Okay … now, what I’m wondering is: this “I-it” thing. Is it unusual for you
to experience this or is it that you usually feel “I-it” and “it” usually does
what you want “it” to do and then, sometimes, like in this instance, “it”
rebels?’
‘No. “It’s” not me. When I want something, and I do it, it’s me who’s doing
it. But when I want something and I don’t do it, it’s “it” that stops it from
happening.’
‘I see. So you’re only aware of “it” when you can’t do what you want to
do.’
‘Yes.’
‘So, who, or what, do you think this “it” is?’
“I wish to God I knew!’
‘So do I. But, look: we began this exploration with my asking you what it
was like to love your mother and yet not be able to express grief at her
dying. And you answered that it makes you wonder whether you really did
love your mother. But now, you tell me that it’s not you who can’t cry, it’s
“it” that won’t let you. Now, maybe “it” doesn’t love your mother, but that’s
no reason to suppose that you don’t—you’re just not in charge. And yet,
that’s what you are wondering: maybe I don’t love my mother because I’m
not grieving. Does that mean that “it” isn’t as separate from you as you
seem to be suggesting?’
‘I don’t know. I’m confused now. Are you saying that I’m “it”?’
‘If I were saying that, what then?’
‘I suppose that I wouldn’t be in touch with myself. My real feelings. I’d be
trying to make myself cry when I didn’t want to cry.’ [Annie begins to cry.]
‘You’re crying now.’
‘I feel awful! You must think I’m awful!’
‘For crying?’
‘No! For not crying at my mother’s funeral!’
‘Is that what makes you feel awful—that I, or anyone else, might think you
were awful?’
‘They’d certainly wonder if I did love Mum!’
‘Ah … So, if I don’t cry at Mum’s funeral, the others will wonder whether
or not I really did love her. But if I do cry, then they will know that I do
love her.’
‘Yes … But, just as you said that, what I wanted to say was that it’s none of
their bloody business! What do they know about me and Mum?’
‘What do they know?’
‘My sister said that I was Mum’s “favourite”. That she cared a lot more for
me than she ever did for her or any of my brothers. But it wasn’t like that!
It’s just that we lived nearer each other and saw more of each other than my
mum saw of my sister and brothers. They could have made more contact.
Just because I did and they didn’t, is that something to blame me for?
They’re crying now and saying how much they’ll miss her, but when she
was alive they didn’t seem to miss her all that much. They didn’t have her
round for Sunday dinner or ring her up every other day …’
‘But you did. And they’re crying, and you’re not.’
‘They’re crying for themselves, not for Mum!’
‘And you’re not crying.’
‘They’d love it to see me cry. They’d love it. Then they’d be able to say to
themselves that it was all right for them to care so little for Mum, because
she got all the care and attention she needed from Annie. They wouldn’t
feel guilty … I know how Mum felt about it. She’d ask why the others
didn’t come to visit her as often as they could. They really hurt her.’
‘Annie, let me see if I’ve understood what you’re saying because this seems
important. That question you began with: “Do I really love Mum?” I have
the feeling that it’s a question that you want the others to be asking because
if they were to, then they might start to feel more guilty for having paid
your mum so little attention before she died. Am I right so far?’
‘Yes. And it makes me think how they could be so two-faced, sitting there
crying their eyes out when they didn’t really care all that much.’
‘So … Are you saying that their crying expressed their lack of care?’
‘Yes.’
‘And if they’d seen you cry, that would have helped them to maintain this
pose?’
‘Oh! I see what you’re saying: I wouldn’t let myself cry in front of them
because if I did, then they would be let off the hook.’
‘Is this what you’re saying?’
‘Yes. I can see that.’
‘Okay, well … this makes me wonder about that “it” that wouldn’t do what
you wanted it to do. Maybe “it” was doing what you wanted it to do all
along.’
‘Yes. But I also wanted to cry.’
‘For Mum. Not for them.’
‘I wish they’d never come to the funeral! Is that awful of me to wish that?
But I do wish it!’
‘If they’d not come, you would have grieved?’ [Annie begins to cry again.]
‘Are you crying for her now?’ [Annie nods in agreement and continues to
cry for several minutes. Finally she wipes her eyes and sighs deeply.]
‘Thank you. I needed to do that.’
‘You can cry for Mum when you want to, even though I’m here as well.’
‘You’re not being two-faced and pretending to be upset about Mum.’
‘Unlike your brothers and sisters.’
‘Why should I give a damn about them? I do, though! I make their feelings
more important than my feelings for Mum! I couldn’t let myself cry for her.
Not even when I was alone and they couldn’t see me. Maybe I didn’t love
Mum after all.’

After all her questioning, Annie seemed to have come full circle and
returned to the starting point of our encounter. Even so, this extract should
serve to clarify some of the points being made above.
Readers may have noticed that my initial comments and queries were
designed to clarify Annie’s experience as it was being related. In some
instances, these attempts remained at the level of ‘rephrasing’ or ‘reflecting’
what had been said. On some occasions, however, in order to clarify her
experience, it was necessary to expose a possible contradiction in Annie’s
statement such as when she stated that she’d felt nothing and I queried
whether what she meant was that she felt she should feel something. This
clarification was as much for me, in that whatever her response it would
have given me a clearer sense of her experience, as much as it might have
been for Annie. In seeking to clarify this, and several other points made by
Annie, I attempted to stay with her experience as she saw it, both from the
standpoint of her relation to herself (which was suggested during the ‘I-It’
discussion) and her relation to others (which, in this extract, focused on her
relation to her brothers and sister and, to a much lesser degree, on her
relation to her mother). But, in order to gain an understanding that suitably
approximated Annie’s experience, I also had to gain a sense of how Annie
experienced others and how she supposed others experienced her. Only by
considering all these relations from a perspective that approached Annie’s
could I gain a more adequate overall ‘feel’ for her.

Empathy
I believe that this point is of some importance since it presents the notion of
‘empathy’ from a significantly different perspective. For many therapists,
the expression of empathy focuses on the client’s experience in a manner
that isolates and refocuses it within the therapist’s experiential realm. In
terms of the case extract just discussed, for instance, a therapist might
empathize with Annie’s experience of not being able to express her grief by
focusing on the experience itself, linking it to a similar personal experience
and, thereby, gaining an experiential sense of what it is like ‘to want to but
be unable to express a feeling’. While valid and valuable, this attempt at
empathy is also limited in that, while it may succeed in ‘capturing’ the
experience in isolation, it fails to grasp it within its relational context to the
being (i.e. Annie) who experiences.
The level of empathy I am suggesting is one wherein the therapist
attempts to ‘capture’ the experience within the experiential realm of the
client. In other words, it requires the therapist to empathize first with the
client’s experience of himself or herself and then consider how this being
would experience the particular feeling. As such, I, as therapist, first had to
gain an adequate sense of Annie’s experience of herself in relation to
herself and others and then ask how ‘I-as-Annie’ would experience
‘wanting but being unable to express my grief ’. Empathy at this level may
be deeply unsettling but also of substantial importance since in this specific
attempt at empathy I might also gain a broader, or more overall empathic
sense of a client’s experience. While, of necessity, requiring the therapist to
treat this broader sense of empathy with caution and flexibility, nevertheless
it may allow the therapist to clarify the potential meaningful connections
between what is stated explicitly and what is implied more generally within
the explicit statement.
So, for instance, towards the end of the dialogue with Annie, I
responded to her statement ‘I wish they’d never come to the funeral! Is that
awful of me to wish that? But I do wish it!’ with: ‘If they’d not come, you
would have grieved?’ This clarificatory challenge relied on a broader sense
of empathy that I felt I had with Annie. The statement does not reflect
Annie’s explicit comment but, rather, focuses on what seemed to me to have
been implicit both within it and, in a wider sense, within Annie’s general
experience of herself as viewed by her brothers and sister. It is clearly an
interpretation on my part, and it could well have been an erroneous
interpretation, but it was one that emerged out of my attempt to empathize
with Annie and, in so doing, to hear her statement as if ‘I-as-Annie’ were
speaking it. In attempting this, I was also able to hear/speak what I took to
be the implicit meaning that expressed itself through her words.
It is following this challenge that the then-current encounter between
Annie and myself was brought into focus. Prior to this, the encounter had
maintained its explicit focus on the first two ‘realms’ (i.e. the experience of
self-in-relation and the experience of other-in-relation). Now we were able
to encounter ‘each-other-in-relation’ by bringing Annie’s act of crying into
the current encounter and exploring its possible implications. For me, as
therapist, it allowed me to further my understanding of Annie’s relational
issues with ‘others’ by both explicitly being the current significant ‘other’
in Annie’s experience and by attempting to ‘enter into’ Annie’s experience
of myself as current other. Equally, from Annie’s standpoint, the encounter
at this third ‘realm’ allowed her to bring me into her experience of
‘significant’ others, both as a representative and as an exception to her
‘rule’ concerning her view of ‘significant others’. In this way, her
experience was both illuminated (or clarified) and challenged and proved to
be a key moment in her further exploration of her experience.
Broadly speaking, through the exploration of these ‘realms of
encounter’, both therapist and client bring into focus their experience of
themselves, their experiences of the other, and their experience of
themselves-in-relation-with-each-other. My personal conviction is that in
making these relations explicit and open to clarification, the therapist
challenges the client to explore the self– self, self–other and self-with-other
relations whose meanings ‘contextualize’ the client’s experience of ‘being-
in-the-world’. At the same time, it is precisely because the client’s ‘being-
in-the-world’ is disclosed within the accepting framework of the therapeutic
encounter that the possibility of recontextualization (experienced as
‘change’) can occur.

Therapist encounter
But this process is not solely directed towards the client. If the therapist is
truly engaged in this encounter, then a similar challenge and possibility
emerges for the therapist. It is for this reason that therapy, within the
existential-phenomenological model, contains therapeutic potentials for
both participants, not solely for one. In acknowledging this, the therapist is
led into a stance of being that itself aims at openness and clarification. In a
broad sense, it can be seen as a ‘process of disclosure’ for both.
It would not be surprising, then, to consider that therapists’ willingness
to disclose themselves as beings-in-encounter may itself provide the client
not only with the example of the possibilities of disclosure but also with the
courage to attempt such an enterprise. One of the strengths of the
humanistic model in therapy lies precisely in this acknowledgement on the
part of the therapist. Nevertheless, such a stance also contains within it
possible obstacles or dangers, since it is essential for therapists to be clear
as to both what is disclosed and how this disclosure is presented to the
client.
The humanistic model emphasizes the therapist’s ‘transparency’, but on
closer investigation what this ‘transparency’ typically turns out to be is a
form of disclosure that is focused on the first two realms of relation—which
is to say the therapist’s experience of ‘self-in-relation’ and of the ‘other-in-
relation’. Disclosure at this level allows the therapist to express his or her
current experience (e.g. ‘I am feeling irritated’) or his or her experience of
the other (e.g. ‘I feel you are being evasive’). The existential-
phenomenological model, on the other hand, would seek to avoid therapist
disclosure at these first two realms and, instead, emphasize those therapist
disclosures that remain at the third relational realm (i.e. that of ‘self-being-
in-relation-with-the-other’). In simple terms, it would focus disclosure on
the therapist’s experience of that ‘in-between realm’ in the relationship
rather than on the disclosure of self or other. In other words, disclosure at
this level would examine how the current ‘microcosmic’ relationship both
reveals and challenges the client’s ‘macrocosmic’ relations with self and
other. It is this insight, through encounter, which I believe provides therapy
with its ‘specialness’ and potential for beneficial outcome.
In order to clarify this last point further, we must turn our attention to
the issue of ‘self and other’ as experiential ramifications of ‘being’.

E. THE SELF-CONSTRUCT

The issues discussed so far bring to light a highly significant area of

concern: namely, the notion of ‘self ’ as understood by the existential-
phenomenological model. While I have already provided some general
comments on this in the critique of the humanist model’s view of the self in
Part 4, it is now necessary to examine the existential-phenomenological
position regarding the ‘self’ with particular emphasis on the therapeutic
process.
On initial consideration, the existential-phenomenological model’s view
of ‘the self ’ may strike many readers as being either odd or absurd. For this
model argues that the question of whether or not a ‘self ’ exists, in the sense
that each of us ‘has’ a self that is real (as opposed to ‘unreal selves’), fixed
or (relatively) stable, and which seeks to express, or actualize itself is, at
best, open to doubt. Instead, this model prefers to view the self as a focal
point in relation and, as such, speaks only of ‘the-self-in-relation’ rather
than ‘the self as a separate, fixed and complete ‘entity’. This is not merely
an abstract distinction; as I hope to demonstrate, this view has significant
implications both at a general ‘lived’ level and for the ‘self ’ in the
therapeutic relationship.
While Western thought tends to conceive of the self as the source, or
originator, of an individual’s experience, existential-phenomenological
theory proposes that the self is the product of, or that which emerges from,
relational experience. In other words, it views the self as being indefinable
other than in a relational sense.
As I have stated before, in order for me to say anything about ‘who I
am’, I am also implicitly expressing ‘who I am not’. If I say that I am
‘male’, for instance, this statement about myself only has meaning because
I equally hold to be meaningful the existence of ‘females’ (or, to be more
precise, if somewhat sexist, of ‘non-males’). As was suggested earlier in
this text, our notion of ‘the self ’ is a partial, or selective, reflectively
derived interpretation that is dependent on a series of relational ‘deductions’
based on aspects of current experience, selected elements drawn from past
experience which both ‘resonate with’ and give some validity to our current
sense of ‘self ’, and certain future-oriented goals or aspirations which direct
the ‘self ’ forward in time. In this way, the ‘self ’ is more properly speaking
a relational construct and, as such, if, for the sake of simplicity and Western
bias, we insist on speaking of a ‘self ’, we should at least acknowledge our
bias by referring to the self-construct.
Put another way, our constructions of the self rely on the previously
discussed perceptual notion of figure/ground, wherein the ‘figure’ focus on
this relation is the self-construct and the ‘ground’ focus is ‘that which is not
currently perceived to be the self ’ (that is, ‘the construed other’). The
advantage of understanding the self-construct in this way is that in its
flexibility of boundaries it provides a more adequate ‘fit’ with a number of
experientially derived illustrations that point to the plasticity of our
experience of our ‘selves-in-the-world’. I have discussed this plasticity of
the self-construct elsewhere, pointing to a number of instances that reveal
how our experience of our ‘selves’ undergoes constant (often subtle,
sometimes radical) re-interpretation (Spinelli, 1989, 1993). Among such
instances, I want to focus on one that, while admittedly radical and unusual,
should nevertheless make clear the central concerns being discussed.
Proprioceptive dysfunctions is a term employed to point out a number
of disorders in the recognition of one’s body definitions and boundaries
which may arise from severe illness or from psychological disorders such as
depression. Jonathan Miller provides a telling example of variations in
proprioception in a number of stroke victims who disowned parts of their
bodies—usually their limbs (Miller, 1978). In other words, while they
continued to recognize the existence of, let us say, their left arm, they did
not experience or accept this limb as being theirs. It had somehow become
alien, or belonging to another. In order to explain this seemingly attached
appendage to their bodies, they produced the most outlandish explanations
to account for the ‘alien’ limb, going so far, in some cases, as to argue that
it belonged to someone else who was standing behind them and pretending
that his arm was attached to them and, as consequence, they kept ‘sneaking
looks’ behind them in order to catch the prankster at his game. They could
not easily be dissuaded from their vociferous denial of the ownership of this
limb, and it often took long periods of time before they began to
‘reconstruct’ their body image in order to incorporate the alien limb. The
clinical neurologist Oliver Sacks has also presented a number of even more
extreme instances of these dysfunctions in his illuminating text The Man
Who Mistook His Wife for a Hat (Sacks, 1985).
Similarly, readers may be more familiar with the equally disturbing, if
experientially opposite, instance of phantom limbs, wherein patients who
have had a limb amputated will initially insist, because their experience
tells them so, that the missing limb is not, in fact, missing at all. In a similar
fashion, it is only after a fairly lengthy period of time that the perception of
this ‘phantom limb’ dissipates and the patients can gain a new body image
sans limb.
Now what have these dysfunctions to do with the self-construct?
Clearly, one means that we have of defining our ‘self ’ is in terms of the
body that the ‘self ’ inhabits or expresses itself through. Indeed, for some of
us, our bodies are our selves. In either case, studies of proprioceptive
dysfunctions reveal that the ‘self ’ constructed from our body image does
not necessarily have to fit the actual boundaries of the physical body. We
may exclude parts of our body from our body image, or we may include
non-existent parts of our body in our body image.
With this idea in mind, let us turn to the self-construct. Existential-
phenomenological theory proposes that a similarly ‘plastic’ process occurs
with regard to our construction of our selves. In some instances the self-
construct appears to alter so that it includes much more than it might
ordinarily do in its self-definition. For instance, while in the throes of
sexual ecstasy, the self might be experienced as ‘blending into’ the ‘self ’ of
one’s sexual partner such that the normally ‘separate’ selves seem to
become ‘one self ’. Equally, during instances of meditation, or deep
relaxation, ‘the self ’ might appear virtually to disappear or become
‘indistinguishably connected’ to ‘all and everything’. This same
‘disappearance’ of the self may occur when we are deeply immersed in an
activity such as long-distance running, driving a car, or gardening.
What is paradoxically intriguing about these instances is that rather than
being undesirable or unrewarding from a ‘self-focused’ standpoint, in fact
they usually provoke deep ‘self-satisfaction’ or are seen as significant,
rewarding, or highly meaningful experiences in our lives.
Perhaps more commonly, however, we experience the plasticity of the
self-construct when aspects of it are denied or disowned. In these instances,
we are confronted with thoughts, emotions, or behaviours that (seemingly)
cannot possibly be ‘self-generated’ or arising from our ‘self ’. For example,
having injured someone or smashed an object against a wall in anger, we
might ask ourselves: ‘Whatever possessed me to do that?’ Such a question
contains the implicit assumption or statement that it was not one’s ‘self ’
who originated the act, but that, rather, it was initiated by someone, or
something, other than our ‘self ’. These circumstances point to aspects of
dissociation or experienced division in the ‘self ’, which, as I argued in Part
3, might provide us with a more adequate alternative to the concept of ‘the
unconscious’.
Indeed, as I discussed in my alternative to ‘the unconscious’, these
dissociations point to a ‘splitness’ between experience and belief. These
same distinctions between phenomenology and epistemology seem to me to
be key features for our understanding of the self-construct. So, for instance,
one of my clients, Clive, who was a fundamentalist lay preacher,
experienced sexual arousal when in the presence of certain female members
in his religious commune. But Clive’s belief that he had ‘overcome the
temptations of the flesh’ required him to explain his experience as that of
‘temporary possession by Satan’.

Dissociation and sedimentation

Placed in the context of this discussion, this example allows us to
distinguish dissociation, or ‘splitness’ between experience and belief, from
a self-construct standpoint. Clive’s self-construct included the belief that he
(or his ‘self ’) no longer felt sexual arousal and so had to disown or
dissociate those experiences that did not fit this self-construct. But, in order
to explain the experience of sexual arousal, he had to invoke the existence
of an alien ‘other’ (in this case, a supernatural ‘other’ in the form of Satan).
The importance of this explanation was that it allowed Clive to retain his
belief in his constructed self. Its price, however, was the invocation of an
alien entity that, at times, overwhelmed or possessed Clive’s acceptable,
constructed self. As I argued in Part 3, it seems to me that such instances
might be better understood, and therapeutically challenged, by viewing
them as aspects of conscious self-deception derived from a fixed belief in
one’s self-construct rather than as examples of uncontrolled unconscious
impulses.
But we need not go to the extremes presented in the above example to
recognize that all of us, to varying degrees, carry out similar forms of
dissociation or disownership in order to maintain a self-construct that will
appear to convince us of the ‘fixedness’, stability and reality of the ‘self ’
rather than view it as a relationally disclosing construct.
It was Carl Rogers who first focused on the self from a standpoint that
he demarcated as the self concept so as to provide the central explanatory
feature for the psychotherapeutic understanding and alleviation of psychic
dissonance and disturbance (Kirschenbaum and Henderson, 1990a, 1990b).
Rogers further proposed the concept of the ideal self as a therapeutically
useful means of exploring clients’ aspirations for growth or actualization.
At the same time, however, the ideal self might equally be the basis for
psychic disturbance and dissonance since it might be so restrictive and
intolerant in its ideals that the ‘current self ’ could be experienced as ‘never
quite good enough’.
Rogers’ stance can be understood as a re-interpretation of the psycho-
analytic model’s hypothesis of the relationship and conflict between the ego
and the super-ego. The super-ego, as the internalized unconscious ‘moral
principle’, expresses itself consciously as our conscience which both
‘rewards’ those thoughts and deeds that fulfil its demands and ‘punishes’
those thoughts and deeds that violate its injunctions (as such we speak in
terms of having a good, or clear, conscience or having a guilty conscience).
While these hypotheses are important in that each resonates with
peoples’ experiences to a substantial extent, there remain significant
conceptual and logical problems within them which qualify their
usefulness. With regard to the psycho-analytic model’s notion of the super-
ego, it can be seen that this concept depends on the assumption of the
Freudian-derived unconscious—which, as I sought to demonstrate in Part 3,
itself contains significant problems. In the case of Rogers’ hypothesis, on
the other hand, the problems encountered are derived from his assumption
of a ‘real and permanent self ’ which, in turn, forced him to invoke the
existence of ‘false selves’. The difficulties raised by this stance were
discussed in Part 4.
As an alternative to these problematic viewpoints, existential-
phenomenological theory argues that while such hypotheses validly express
the experience of dissonance and are therapeutically helpful in that they
provide various means of exploring clients’ experiences of ‘splitness’, their
key flaws can be removed only once we consider the ‘self ’ to be an
impermanent, plastic construct that exists only as an outcome of relational
factors. As such, the self-construct is ‘grounded’ in relation and can only be
said to be ‘real’ insofar as it is that which reflects and is reflected on in any
given experience.
In other words, the self-construct reveals the self that is being
experienced when it is being experienced.
If this view of the self-construct provides a more adequate perspective
for the understanding of our experience of our selves, it must be asked how
it explains the phenomenon of ‘splitness’ or disownership of experiences
that would appear to ‘belong’ to the ‘self ’. How, for instance, would this
approach understand Clive’s divided experience?
In order to address this question, readers should recall the examples
presented when the phenomenon of proprioceptive dysfunctions was
discussed above. In such instances, the problem lay in the patients’ deeply
held beliefs concerning their body image. These beliefs were so strong or
fundamental to their body image that they disregarded the evidence of their
own perceptions. Such strong, fundamental beliefs have been labelled in
existential-phenomenological theory as sedimented. Sedimented beliefs,
then, are those that insist on the primacy, or correctness, of one particular
perspective over all others. However limiting or distorted or irrational they
may be, it will take a great deal to override their interpretative power.
Racist or sexist attitudes readily come to mind as examples of
sedimented beliefs that are far from easily broken or dispelled. Why might
this be so? One suggestion, again derived from existential-
phenomenological analysis, is that these beliefs ‘hold together’ the self-
construct of the believer. In other words, sedimented beliefs are the
foundational ‘building blocks’ of our constructed self. As such, to give
them up forces individuals to fundamentally reconstruct, or redefine,
themselves in their self/other relations. As much as they might limit or
distort experience, they also serve to maintain or allow self-defining
viewpoints. For example, the belief that women are ‘inferior’ to men
maintains or allows the belief that I, as a man, am superior. If I change my
views concerning the inferiority of women, I not only change my
relationship to women, as ‘others’, I also change my relationship to myself
in that I can no longer consider myself as superior in the way I did before.
This novel perspective may be deeply disturbing or anxiety-provoking in
that it calls into question my very sense of ‘self ’, or ‘who I am’.
In such ways, sedimented beliefs allow me to maintain a fixed, possibly
even secure, stance or ‘sense of my own being’ regardless of how distorted
or limiting that sense may be.
Further, as well as being personally derived, sedimented beliefs may
also be, more broadly speaking, socio-culturally derived or influenced in
that they reveal a particular culture’s or society’s sense of itself. In many
ways, these culturally sedimented perspectives define the culture or society
in that they allow it (and its members) to appear or present itself (or
themselves) as distinct from other cultures or societies.
Following this line of argument, existential-phenomenological theory
suggests that the belief in a permanent, fixed, relatively stable and on-going
‘self ’ is itself both a personally and culturally sedimented belief. This is not
to say that such beliefs are necessarily ‘wrong’. For instance, if this line of
argument is correct, we can see that without certain fundamental
sedimented beliefs we would hardly be able to distinguish our most basic
defining characteristics such as our name, where we lived, what work we
did, who our friends and family were, and so forth. It would seem that a
‘given’ of human experience is that we hold sedimented beliefs. As such,
the question that needs to be asked is not whether or not we should hold
sedimented beliefs but, rather, whether certain of our sedimented beliefs
define us too restrictively or impose unnecessary limitations on our self-
construct.
At the same time, however, it must be recognized that, however
restrictive, all sedimented beliefs serve to define the self-construct and, as
such, in most instances, the challenging of these beliefs is highly likely to
be met with serious resistance because a challenge to any part of the self-
construct also challenges the whole of it.
With these points in mind, we can now return to the example of my
client, Clive. We can understand that Clive’s quandary was one that
expressed a conflict between his beliefs about himself (I have overcome the
temptations of the flesh) and his experience (I am sexually aroused). To
have acknowledged his experience in a direct, or straightforward, manner
would have forced Clive to reassess his beliefs and call them into question.
But to have done so would have, in turn, forced him to reassess and call into
question certain aspects of his sedimented self-construct. Had Clive done
so, he might have been able to accept, or ‘own’, his experience of being
aroused. But the ‘price’ of this acceptance would have been the experience
of anxiety-laden uncertainty (perhaps overwhelming uncertainty) about his
very sense of ‘self ’, or who he was.
Rather than risk this, Clive’s alternative was to retain that security by
‘disowning’ his experience of arousal. In doing so, he was able to maintain
his sedimented belief about his self-construct. The price of this strategy,
however, was the experience of temporary ‘alien possession’ (in this case,
supernatural possession by Satan).
Either choice presents a quandary. While each offers something (i.e. the
movement towards ‘authenticity’ through the ‘ownership’ of experience or
the secure maintenance of a sedimented self-structure), each also has its
price (i.e. the increase of uncertainty and anxiety provoked by a partially
de-sedimented sense of self or the ‘disownership’ of certain experiences).
To invert Jean-Paul Sartre’s famous epigram that, as human beings, ‘we are
condemned to choose’ (Sartre, 1956), we can conclude that ‘either choice
condemns who we are.’
This quandary reflects the general conflict of ontology (or ‘being’). This
can be most easily understood when considering this conflict as expressed
in questions concerning identity (who one is). For to know who I am (or
must be, or can be, or ought to be, and so forth), I must also know who I am
not. But, if so, then what am I to do with (or how am I to explain) those
circumstances when I experience myself as being not who I am (or, more
accurately, who I believe myself to be) but, rather, who I am not (or who I
believe I must not be, or cannot be, or ought not to be)? Clearly, I have only
two principal options: either to alter or extend my notion of who I am so
that I can ‘own’ or ‘integrate’ those previously ‘alien’ experiences; or to
find some means of ‘disowning’ the experience (such as by seemingly
‘forgetting’, or not attending to—that is, avoiding reflection—or by
invoking internal or external physical, biological, socio-cultural, psychical
and/or supernatural agencies that temporarily ‘possess’ me into becoming
who I am not) in order that I may maintain my previously held beliefs
concerning my identity.
For any number of reasons, principally having to do with the
maintenance of a sedimented self-construct, it is the second option which
appears to be the one we most commonly choose since, through it, a certain
set of defining characteristics, behaviours, attitudinal factors, and traits
emerge which define our self-construct and demarcate and limit its meaning
possibilities. In addition, the second option, while demanding a form of
self-deception, nevertheless allows an abdication of our experiential
responsibility not only with regard to the responsibility contained within
our relations with the world as expressed through our actions and their
consequences, but also with regard to the responsibility inherent in our
human ability to reflect on such.
But it remains important to be clear that the self-deception being
referred to here is not one that leads, as Rogers suggests, to a contrast
between a ‘real self ’ and one or more ‘false selves’. Rather, it expresses a
conflict, or dissonance, between the current self-construct as it is believed
to be in terms of sedimented assumptions and the currently experienced
self-construct which, in part, does not conform to the restrictions imposed
by these sedimented beliefs.

The self-construct: therapeutic implications

When these views are applied to the realm of therapy, what emerges as
typical in clients’ concerns and conflicts is that they have tended to adopt a
number of deeply sedimented beliefs and perspectives concerning their self-
construct whose limiting features, usually expressed in terms of who one
‘can only be’ (or must/must not be, or should/should not be), are
experienced as problematic and the source of deep misery and psychic pain.
This division between clients’ beliefs in their self-construct and their
experiences, which bring into question the validity of this self-construct,
lead them to ‘disown’ experiences that the believed-in self-construct cannot
accommodate without risking the breakdown of its defining characteristics
—and, therefore, of itself.
In this way, clients are divided beings not only in terms of the
dissonance between their beliefs and experiences concerning their self-
construct, but, just as importantly, in terms of their desire to break down the
sedimented beliefs that have given rise to this dissonance and the opposing
desire to retain these sedimented beliefs. Stated simply, they want to change
yet remain essentially the same.
It seems to me that many therapists are not sufficiently aware of these
‘divided loyalties’ and of their significance to the client. For if they were to
take the courageous ‘leap of faith’ that would allow them to challenge their
sedimented beliefs, clients would put at risk their very sense of their
constructed self. Since the sedimented beliefs provide the foundations on
which their self-construct (no matter how limiting or distorted it may be)
has been built up, any ‘weakening’ of these beliefs through therapeutic
challenge threatens the maintenance of the entire self-construct.
One cannot change ‘bits’ or parts of the sedimented self-construct
without its effects being felt by the whole of it; to remove one sedimented
aspect alters the entire structure. So, for instance, to employ an initially
trivial, but relevant, example; if I were to change my hairstyle, it is not just
my hairstyle that is altered; rather my whole sense of ‘self ’ is changed
sometimes to the extent that I not only ‘feel’ myself to be ‘a new me’, but
the very way I think about myself, or how I move, or the attitudes and
aspirations I hold about my ‘self ’, undergoes (sometimes dramatic)
alteration.
But, as was discussed earlier, personal sedimented beliefs do not arise in
isolation. Rather, they are constructed through relations with others (either
at the level of personal interaction with family, friends, acquaintances, and
so forth, or at the broader socio-cultural level). In this way, it must also be
borne in mind that any challenges to the sedimented beliefs of a particular
individual also challenge the sedimented beliefs pertaining to that
individuals relations with others both at the level of personal and socio-
cultural interaction (e.g. how the individual views, understands, accepts, or
rejects these others).
These challenges, in turn, dispute the sedimented beliefs not only of the
personal and socio-cultural others’ relations with the individual (e.g. how
the personal and socio-cultural others view, understand, accept or reject the
individual), but also of the others’ relations with themselves since their own
sedimented beliefs are in part reliant on their relation with that individual.
So, for instance, let us say that Clive’s sedimented beliefs are so
challenged that he begins to ‘own’ his sexual arousal rather than ‘disown’ it
by explaining it in terms of Satanic possession. Let us first consider the
significance of this with regard to his relations with personal or immediate
others. Clive’s newly emergent self-construct now needs to decide how to
deal with sexual arousal and may, for instance, begin to express it more
openly towards his friends in the community on the basis that it is important
for him now to be honest with them about his sexual feelings. Already,
then, a significant relational change between Clive and his friends occurs in
that he now views, or constructs, them in a different manner. At the same
time, Clive’s friends’ previous sedimented beliefs about him as a ‘morally
upright’ individual may be challenged such that they now begin to relate to
him as a ‘changed’ or ‘sinful’ or ‘possessed’ man. Equally, however,
Clive’s friends’ sedimented beliefs about themselves are also challenged in
that they might begin to question their own sexuality or whether the
spiritual beliefs they have adopted through the influence of Clive’s sermons
are as worthy or morally sound as they had once thought them to be.
Significant relational changes can also be seen to occur at the socio-
cultural level. Again, Clive, having now accepted his experiences of sexual
arousal, may begin to question his previously sedimented beliefs about the
‘truth’ of the God and Satan on which his community is founded. Equally,
his community may begin to question whether it can tolerate such an
individual, or may begin to re-interpret Clive as a new prophet worthy of
reverence. Furthermore, the community may begin to question its own
sedimented beliefs in terms of its moral codes and either strive to re-assert
them by ‘purifying’ itself of heretics like Clive or ‘liberalize’ its canons by
allowing a greater degree of moral flexibility.
What is important here is the recognition that a challenge to the
sedimented perspectives held by any one individual not only opens that
individual’s entire self-structure to question, but also has implications for
both that individual’s sense of meaning of others (both at the immediate
personal level and at the sociocultural level) as well as those others’ sense
of meaning of that individual and of themselves and of their relations
between one another. These interconnected relations are all to some degree
defined and upheld through sedimented perspectives that allow the ‘self ’
(whether personal or socio-cultural) to maintain its identity.
As was discussed earlier, these same concerns present themselves in the
therapeutic process through the relational realms of encounter. As such,
therapists must be much more aware of the risks that clients take when they
decide to enter therapy and, equally, must be far more wary of their own
explicit and implicit demands for clients to change. As such, therapists’
challenges to the sedimented beliefs of clients must be clear and direct, but
also cautious and invitational to clients’ consideration. It must also be borne
in mind that clients’ resistance to the challenging of sedimented beliefs,
while usually originating in the constructed self, may also come from others
(either significant individuals in clients’ lives or, more broadly, from
clients’ sociocultural backgrounds) who have in various ways imposed their
own sedimented beliefs on those of the client.
If clients’ self-constructs change through therapy, then such changes
have their repercussions throughout the whole of clients’ relational realms.
It would seem necessary, then, for therapists to be clear about these
ramifications so that they may be considered within the course of therapy.
All too often, however, therapists, somewhat naively, focus solely on
change, and its effects, at the level of clients’ self-relations as though these
have no impact on their wider relations with others. While, obviously,
therapists’ concerns must remain focused on their clients, nevertheless the
recognition that clients are not beings in isolation allows therapists to
explore with them the various realms of relation through which the self is
constructed and the implications that change in the client’s self-construct
may have on those self–other relations.
The problems that arise when this view is not considered are plentiful.
All too often, clients, having altered their self-construct, are prone to
‘disowning’ their previous construct and the relations with others that that
construct identified with. It is hardly surprising, then, to find as a
consequence of this that clients’ ‘disownership’ of their past lives includes
the disownership of those ‘others’ (such as their spouses, families, friends,
colleagues, jobs and lifestyles) who are most closely identified with the
‘disowned’ self. In many of these cases, such instances of ‘change’ seem to
me to be questionable since what has occurred is that one ‘disowning’ self-
construct has been replaced by another such that while what is being
disowned is different, the very issue of disownership has not been properly
challenged.
A concrete example of this can be seen in many cases of ‘mid-life
crisis’ where an individual undergoes an alteration of self-construct which
merely replaces one set of disowned relations with another, rather then
promote a greater willingness to ‘own’.

F. THE THERAPIST AS OTHER

One important means by which therapists can assist clients in such

explorations emerges precisely through their willingness and ability to place
themselves in the encounter. In doing so, they become the microcosmic
representative of the ‘others’ in the client’s macrocosmic self-other
relations. In this way, while they may be able to assist the client in
challenging his or her current self-construct, they also allow the client to
‘test out’ the implications for any newly emerging self-construct’s relations
with both self and others.
It can be seen that in adopting this stance, therapists are better able to
address the various ethical and value-laden implications within the
therapeutic enterprise—implications that critics (both pro- and anti-
therapy) have rightly addressed (Szasz, 1974a; Masson, 1988; Holmes and
Lindley, 1989) and which have recently resurfaced in the UK and elsewhere
through the critical examination of therapy by abused clients, families and
friends of clients, and by the media.
In addition, this issue appears to me to be particularly pertinent to
concerns expressed about the practice of therapy within a broader multi-
cultural perspective. In following the conclusions derived from the above
argument, it becomes imperative for therapists (whether they share the same
socio-cultural views and biases as their clients or whether they and their
clients are representative of differing socio-cultural backgrounds) to
consider seriously the value-laden assumptions they bring into the
encounter as ‘representative others’. In either case, various concerns will
arise which therapists would be wise to consider. In particular, the arising
issues will reveal attitudes or biases held by the therapist with regard to the
relationship between self and other as perceived by the therapist as
‘representative other’ of either the same, or similar, socio-cultural
background as that of the client, or of a different socio-cultural background
to that of the client. In each instance, the degree to which these biases may
be influencing the therapist’s own stance with regard to both the desires of
the individual client and the normative power of the client’s socio-cultural
background requires the therapist’s attention.
For instance, consider the scenario where a client from a culture that
holds strict observances regarding some moral code of conduct not held by
the therapist’s culture expresses in therapy the desire to break away from
this moral code. While the therapist’s alliance is with the client, the
significance of the client’s desire to break the taboo needs to be explored
not only with regard to what this means to the client as an individual, but
also to what it means to the client as a representative of his or her cultural
background. The private exploration of the therapist’s own attitudes and
biases towards the issue itself, the therapist’s understanding of the client’s
experience of the issue, and the relationship of the client’s self-construct
towards the issue would seem to be obvious areas for clarification. But, in
addition, the exploration of the client’s perception of his or her culture’s
stance towards the issue and the implications for the client’s self-other
relations (both at the ‘immediate other’ and ‘broader cultural other’ levels)
with respect to the client’s potential choices would also seem essential
regardless of whether the therapist comes from the same or a different
socio-cultural background. This would be all the more pertinent if the
therapist held particularly strong views regarding the issue under question.
While it might initially be thought that the sharing of a socio-cultural
background would be more desirable since the therapist would be better
able to understand or ‘relate to’ the various self-other implications, on
reflection it can also be seen that this need not necessarily be the case and
that, depending on the strength of the views concerning the issue held by
the therapist, his or her identification with that culture—or personal
rejection of certain viewpoints held by that culture—may influence the
client in a manner that would reveal the misuse or abuse of the therapist’s
power in the therapeutic relationship.
But this issue need not be seen to be restricted to concerns at a socio-
cultural level. All manner of issues related to gender, sexual orientation,
religion, moral dilemmas, and so forth reveal the difficulty of the therapist
seeking to adopt a neutral position.
And yet, while it must be acknowledged that the attainment of neutrality
regardless of the presenting issue cannot be fulfilled, how does it remain
possible for the therapist at least to attempt to approach it more adequately?
Though it may come as a surprise to some readers, my suggested
response brings us back to the issue of the sedimented self-construct.
In my prior discussion of the sedimented self-construct, I purposely
restricted my focus to issues concerning the client’s self-construct and its
implications for the therapeutic encounter. But, as I have argued throughout,
the existential-phenomenological model’s view of encounter implicates the
therapist. As such, it would seem both obvious and necessary to consider
the question of the sedimented self-construct from the standpoint of the
therapist and consider its implications for the therapeutic encounter.
As I argued earlier, therapists’ willingness and ability to ‘be with and
for’ the client requires not only the attempt to accept the client’s relational
world-view as it is expressed, but also necessitates the attempt on their part
to ‘enter into’ that world-view and seek to experience it as if it were theirs.
But, in order to do so, therapists must be both willing and able to ‘be’ from
a framework of a flexible self-construct. For if therapists’ own self-
constructs are overly sedimented there is no possible way they can begin to
attempt ‘entry’ into their clients’ experiential world.
The question of therapists ‘being’ in the encounter in a manner that
discloses their flexibility of self-construct can be considered from the
standpoint of sacrifice, as was discussed in Part 2.
In the same way that therapists are capable of sacrificing their emotional
or sexual attraction towards their clients by acknowledging the attraction
(rather than seeking to suppress it, or ‘transform’ it through the use of such
terms as ‘countertransference’), in order that it will not intrude
unnecessarily or overwhelm the encounter, so too can they, more generally,
acknowledge those aspects of their sedimented self-structure that
incapacitate their attempt to ‘enter’ their clients’ experiential world.
The sacrifice involved here is that which asks of therapists to attempt
nothing more than they ask of their clients, which is to clarify and challenge
aspects of their sedimented self-structure and to consider the ‘being’
possibilities that emerge. But in their attempts to ‘be’ flexible, therapists
must be prepared to challenge not only their personal biases, assumptions
and viewpoints which place their sedimented self-construct in competition
with that of their clients in a general sense, but also those aspects of their
sedimented self-construct in the particular sense of self-as-therapist which
provide them with the power and mystique that will allow their personal
assumptions and biases to compete with, and, more often than not, succeed
in reshaping their clients’ self-constructs so that they reflect their (i.e.
therapists’) own.
The very act of calling oneself a therapist invokes power. Even if
therapists seek to divest themselves of such, it remains likely that their
clients will wish to bestow power on them. Part of this desire, I suspect, is
that in investing their therapists with power and authority clients will
maintain those very facets of their sedimented self-constructs that are most
problematic to them. If so, the greatest misuse or abuse of therapists’ power
can be seen to be that which seeks to resolve clients’ conflicts in a manner
that fails to consider their standpoint, or world-view, as reflected in the
problematic issue and which, instead, reflects the therapists’ world-views.
On the other hand, in adopting the stance of sacrifice, therapists enable
themselves to move out of a competitive ‘being’ relation with their clients,
which is based on the wishes and assumptions that fuel their self-construct,
and instead seek to co-operate with, or encounter, their clients in a way that
expresses therapists’ willingness to acknowledge and ‘enter into’ their self-
constructed perspectives.
It would not be surprising to find that this willingness on the part of
therapists to present their ‘selves’ to their clients from a stance that allows
the clients’ self-constructs to ‘be’—regardless of how bound they may be to
their sedimentations—and, more, which values them enough to seek to ‘be
like’ them in order to better reflect and clarify and understand, in itself
provides clients not only with the example of the ‘being’ possibilities
available through the expression of a more flexible self-construct but also
enables them to attempt such an enterprise.
Equally, in sacrificing their own sedimented perspectives, therapists are
likely to challenge their clients’ sedimented perspectives with regard to
their ‘being’ relations with others. For the chances are high that clients’
previous encounters with others were competitive, in that they experienced
others as being disdainful of, or threatening towards, or as the demanding
architects of, their self-structure. In this way, therapists, as the ‘other’ in
their clients’ current relational experience, present a novel ‘other’ who
accepts rather than competes with the client’s self-construct, who clarifies it
rather than attempts to threaten or reshape it from the ‘other’s’ construed
perspective, and who presents challenges from within the client’s self-
constructed experience rather than from outside it. Once again, this novel
other, simply in its very ‘being’, allows an encounter to occur which opens
the client to the examination of possibilities of ‘being-in-relation’ which
itself allows the questioning of the necessity of the client’s maintenance of
the current problematically experienced sedimented self-structure.
In the light of the comments and concerns I have expressed, it would
seem to me that if there is any significant value in therapeutic training it
rests precisely in the challenging of as many of the trainee’s sedimented
perspectives in as many ways as might be found both viable and ethically
possible, in order that trainees may learn to challenge their sedimented self-
structure so that their ‘being’ in the encounter is as flexible as they can
allow it to be. This, to me at least, is the value of the different models and
approaches to therapy. It is not because they ‘work’, or that one ‘works’
better than any other, or that they contain ‘truths’, but because each
challenges our sedimented self-constructs.
As such, while it remains sensible to some degree for trainees to wish to
specialize in a particular model, such specialization should occur only
following initial training from a multi-modular standpoint. But, in order to
accomplish this, training institutions’ own ‘sedimented self-constructs’
require challenging—and this may not be an easy goal to achieve as long as
such institutions persist in maintaining unquestioning, sedimented beliefs
about the model they advocate.

G. CONCLUSION

In summary, the existential-phenomenological model provides therapists

with a significantly different attitudinal and methodological approach,
which is focused on their ‘being qualities’, to their encounter with clients.
In its advocacy of this stance it allows for the focus of therapy to remain on
the descriptively focused exploration of the current, conscious experience
of clients (whose meaning is partly bounded by ‘the-past-as-currently-
experienced-and-future-directed’) and it emphasizes the therapist’s attempt
to ‘enter’ the meaning-world of the client in order to interpret it in a
descriptively focused manner so that such interpretations approximate the
client’s experience rather than impose the therapist’s theoretically derived
interpretations.
From the above perspective, the therapeutic process focuses on this
conflict between ‘self-as-experienced-in-relation’ and sedimentations in the
self-construct in order to clarify the meaning of such dissociations from the
standpoint of the client’s anxieties of ‘being’ within the realms of self–self,
self–other and self–and–other relations so that it brings into focus the
client’s current experiences of conflict, anxiety and denial in terms of how
they both express and protect aspects of the client’s sedimented self-
construct.
Further, the above explorations allow the clarification of the client’s
experience in terms of his or her possibilities, limits and denials of situated
freedom and choice. Equally, they also clarify the client’s current meaning-
world such that the unstated, unreflected, distorted, or previously
unidentified aspects of current experience may be considered and
challenged in terms of their influence on the client’s experience of ‘being-
in-the-world’.
Most importantly, this model emphasizes the notion of the encounter
between therapist and client as expressing in microcosm the client’s
macrocosmic ‘being’ relations with self and other. In a similar fashion, it
stresses the ‘being qualities’ of the therapist with regard to the therapist’s
willingness and ability to ‘be with’ and ‘be for’ the client, to listen and
respond to the client in a manner that approximates the client’s relational
experiences, and to be implicated as a ‘being-in-relation’.
Through this realignment, the tendency on the part of the therapist to
seek to cure, change, help, or promote the growth of the client is
‘bracketed’; so that the encounter may foster the client’s experience of
acceptance of and by self and other through which genuine clarification and
challenge of debilitating beliefs and behaviours may occur.
Finally, in its broadest sense, the sceptical stance it advocates brings to
light implicit assumptions and sedimented beliefs contained in all models of
therapy so that they may be clarified and challenged. In this way, while it
can stand as a coherent, systematic and rigorous model in its own right, the
existential-phenomenological model provides all therapists with a
methodological stance that not only removes from them much of their
professional mystique, and a good deal of the power that comes with this,
but also continually confronts and challenges their theoretical and personal
beliefs, their sedimented stances towards themselves and others in their
lives, and their ability to attend to clients whose ‘material’ may provoke all
too painful reminders of their own deceits and anxieties. At the same time,
the willingness to encounter another in this fashion may also remind
therapists of the immeasurable wonder and joy that are possible when
beings encounter themselves through one another.
For therapy, along the lines suggested, is not directed solely towards
clients; rather, encounter directs itself and involves both therapist and client.
If therapy, as some have suggested, is akin to a play, then it is surely a play
of mystery and suspense where important clues may be revealed but no
final solution is forthcoming.
In such a play, the therapist is neither its director, nor its critic, nor its
audience, but its co-writer.
CONCLUSIONS

Pain sure brings out the best in people, doesn’t it?

Bob Dylan

1996 marked the official centenary of therapy in its modern-day form.

During its first one hundred years, therapy has progressed from being a
controversial, either critically reviled or lauded ‘talking cure’ to an
increasingly accepted, even indispensable, form of care. The availability of
therapy in the UK has increased dramatically over the last decade and is set
to grow at an even more unprecedented rate during the remaining years of
the twentieth century and into the twenty-first.
During this time, an enormous diversity of therapeutic approaches has
arisen, attracting proponents and detractors, critics and ‘true believers’. In
many instances, the experience of therapy’s clientele has been positive—or
at least not negative. Owing largely to its popularization in cinema, novels,
theatrical productions, radio, magazine ‘agony columns’, and popular
psychology self-improvement manuals and techniques, therapy is no longer
widely viewed as something to be associated with either the very ‘sick’ or
the very rich. Increasingly, people have tended to view it as something
probably anyone could benefit from at some point in their lives.
Along with its growth and availability have emerged successive
concerns about its risks, its efficacy, its potentials for misuse and abuse, its
investment of power in the therapist, its mystique. Similarly, questions have
arisen concerning the training background, qualifications and expertise of
therapists and how these may influence or affect both the process and
outcomes of therapy.
Partly in response to such concerns, and partly as a means of being
recognized as the competent UK authorities to speak on matters pertaining
to therapy in the European Community, both the UKCP and the BAC
maintain publicly available voluntary registers of psychotherapists and
counsellors. In addition, both organizations have established regular, on-
going dialogue with one another as well as with the British Psychological
Society and the Royal College of Psychiatrists.
With the growth in authority of the UKCP and the BAC as the
increasingly recognized ‘host’ bodies of psychotherapy and counselling in
the UK, therapy has begun its inevitable movement towards regulated
registration which, if nothing else, will help to safeguard the general public
from physical, psychological, sexual and financial abuse by professionally
recognized therapists.
All these achievements indicate that therapy as a whole is currently
undergoing an internal evolution whose significance is already apparent. At
the same time, however, as with all evolutions-in-progress, formidable
issues and problems remain for therapists to face. Among them, as I have
discussed throughout this text, are such questions as the purpose of training,
the significant theoretical divergences of the major therapeutic models, the
efficacy of therapeutic intervention, and what constitutes ‘good’ therapy
and ‘good’ therapists.
It should by now be clear to the reader that my views on therapy
demand the consideration of each therapist as a living embodiment of the
therapy being provided and that the emphasis of therapeutic encounter
should not be solely, or even principally, focused on the ‘doing’ skills of the
therapist but rather on the ‘being qualities’ he or she is able to express in the
course of therapeutic interaction. Further, I have attempted to argue that the
‘specialness’ of therapy, for me at least, lies in each specific and unique
encounter that occurs between the therapist and the client. As such, while I
am broadly in sympathy with the current movement towards regulation, I
remain uneasy that, in this movement, the focus of regulatory attention will
be principally, if not solely, on the ‘doing’ elements of therapy, since these
are open to standardization, measurement and training criteria, and that
therapists’ ‘being qualities’ will continue to be seen as ‘addenda’ or
outcomes of the proper utilization of ‘doing’ skills.
My concern is exacerbated by the dearth of research evidence that can
point to valid and reliable evidence to demonstrate that either the ‘doing’
skills or the theoretical models of therapy in themselves provide successful
or beneficial therapeutic outcomes. If this text has hoped to convince the
reader of anything it is that such conclusions are inappropriate and that, if
anything, it is the attention given to the ‘being qualities’ of therapists that
requires serious and methodical investigation.
To claim that ‘doing skills’ and the learning of theoretical models (and,
more usually, a theoretical model) can alone be the hallmarks of training
seems to me to be highly questionable. ‘But,’ you might respond, ‘at least
this stance does no harm.’ On the contrary, as I have sought to argue, over-
dependence on ‘doing’ skills and debatable theoretical assumptions opens
therapy to a number of mystifications that elevate the power and authority
of therapists and, in so doing, increase the potentials for their misuse and
abuse.
My aim, throughout the text, has been to confront a number of these
mystifications by questioning various fundamental assumptions that either
all of therapy, or particular models of therapy, have adopted. I have done so
not because I have ‘an axe to grind’ against therapy, but because, as it is my
own profession, I believe that such confrontations provide a valuable means
for clarifying one’s stance as a therapist and for challenging the
mystificatory assumptions that one may bring to therapy or place on
oneself. It is my hope that such analyses have been of value both to
therapists and potential clients alike. For the former, it was not my aim to
disable or undermine their attempts to care and assist, but, rather, to
strengthen those possibilities and to fortify their sense of their own capacity
as human beings for enriching the lives of clients and of themselves. For the
latter, I hope that my stated concerns have been of assistance in enabling
them to be aware of the possibilities and limitations of therapy so that, if
and when they choose to enter therapy, they will be clearer about what it
may offer and that, should they so choose, their choice will focus more on
the therapist than on the model that he or she represents.
I am well aware of what I have not found the space to discuss in this
text. Perhaps most of all, I recognize that a significant feature of my
experience of therapy has remained unmentioned: this is the occurrence and
value of humour and laughter during the therapeutic encounter. It seems
strange to me that something that seems so significant to both client and
therapist, and to their relationship with one another, has been so rarely
mentioned, much less studied by therapists. Perhaps the acknowledgement
of the power of laughter would prove too threatening to therapy’s mystique.
Still, I think that there is much to be gained by considering its place and
potential.
While I share the view held by most of my colleagues that therapy has
much to provide that is both unique and valuable, I am also greatly sceptical
of many of the inordinate claims that have been made regarding its inherent
superiority and solitary effectiveness over all other attempts to confront our
‘inner demons’. Over the years, I find myself increasingly ‘underwhelmed’
by tales of therapists’ courageous journeys into their personal underworld
through which they have emerged ‘cleansed’ and singularly capable of
providing for the ‘treatment’ of others.
There is, I’m afraid, a great deal about the doing of therapy that is
somewhat of a conceit. But. . . through one’s encounters with one’s clients,
it is also a great privilege. And if I have expressed my concerns about the
former, I hope that I have also demonstrated my appreciation of the latter.
In line with this last point, I remind readers that all the issues that were
stressed throughout Part 5 suggest that the very ‘specialness’ of, and
beneficial possibilities in, therapy are expressed through the various
features of the encounter itself and of those ‘being qualities’ that emerge
through the meeting between therapist and client. Considered in this light,
the value of therapy does not lie in the things that are ‘done’ within it by
both the therapist and the client, but by the ‘charged’ relationship they have
with one another which expresses itself through what they ‘do’ and who
they allow themselves to ‘be’ within it.
In this way, the relational ‘realms’ focusing on the experience of self-in-
relation, the experience of the other-in-relation, and the experience of self-
in-relation-with-the-other, are opened to descriptively focused clarification
and challenge. While the object of focus must obviously be the client’s
experienced relations, nevertheless the therapist cannot be excluded since
the therapist ‘is’ in relation. In this way, the therapist is both the client’s (or
self ’s) relational ‘other’ and is ‘the-other-attempting-to-be-the-self ’ in the
relation. In that meeting point of all the various relational realms, the client
is able to confront the sedimented perspectives, anxieties, contradictions
and denials of ‘being-in-the-world’ which such perspectives both express
and defend against. In ‘owning’ these, the client may begin to examine
them from the stance of choice which allows both acceptance and the
exploration of the possibility and implications of change.
Therein, for me, lies the power and value of therapy. Acknowledging all
of its imperfections, its limitations, its potentials for misuse and abuse, and
its unnecessary mystifications, it remains, nevertheless, one of the very few
means available to us for encountering ourselves openly and honestly in the
presence of another and thereby regaining not only a sense of our own
worth, but of the worth of others.
Yes, of course, therapy can help us to solve our problems, to find more
happiness and peace, to rid us of our ‘neuroses’, to ‘put us in charge’, to
integrate, to change and cure us. But, then again, it might not. Indeed, put in
this context, it might well be fair to argue that therapy has itself invented a
great many of the discontents and ‘dis-eases’ that it proposes to alleviate or
remove.
But therapy, as I have suggested, when it is ‘being’-focused, can be far
more than a mere palliative that seeks to excuse or exonerate us from our
anxiety or deceit or guilt. Rather, it can confront us with our possibilities or,
to paraphrase Abraham Maslow: with all that one knows one could do with
one’s life. In this, therapy allows us a means of acknowledging that we are
co-constituted beings ‘in-the-world’ whose relations with ‘others’ both
reflect, and are reflected in, our relations with ourselves.
The Upanishads of Sanskrit philosophy teach us, in their wisdom, that
‘when there is another, fear (or anxiety) arises.’ In a different, if related
fashion, one of the aphorisms of the Code d’Amour Provencale states: ‘He
who loves is always full of fear.’ And Freud, to his great credit, pointed out
that the development and maintenance of social systems always contain a
conflict of interest between the individual and the community (or the other)
which requires some form of personal sacrifice of one’s individualistic
desires.
Many have tended to read each or all of these statements as being
deeply pessimistic, requiring the individual to abdicate or deny some part of
his or her ‘being’ for the ‘good’ of others. I believe such conclusions to be,
at best, misleading. Certainly, there is a sacrifice, and, as both the above
statements and existential-phenomenological theory suggest, its price may
well be irresolvable anxiety. But it is only through the step of
acknowledging anxiety that novel possibilities of ‘being-in-relation’ emerge
—possibilities that allow us to accept—even cherish the price of sacrifice.
If ‘others’ provoke our fears, then they also provoke our ability to accept
and love not only others, but ourselves as well.
The great error of our age has been the attempt to construct social
systems that emphasize our fears of relationship. We have elevated either
the individual or the community and set them off one against the other, as if
they were natural antagonists. And we all know far too well the destructive
consequences of both philosophies.
Here in Britain, for instance, the 1980s marked a period that emphasized
individual advancement and success and denied the very existence of
society—a view that the Institute of Economic Affairs, the very same free-
market ‘think tank’ that provided the ideological basis of Mrs Thatcher’s
monetarist policies, has now reappraised and revoked in favour of the
philosophy that individuals need to take personal responsibility for the
maintenance of social institutions (Guardian, 1993).
In a similar, if oppositely focused manner, ideologies at the other
extreme, which emphasized the community over the individual rights of its
members, have engendered equally antagonistic tendencies. The breakdown
of Soviet communism, for example, has provoked a response wherein the
Russian community now finds itself at the mercy of black-market profiteers
who manifest the worst tendencies of uncontained capitalism.
It may well be that the unprecedented growth in the demand for therapy
in the UK over the last decade reflects the influence of an ideology of
rampant individualism. Just as the growing signs of ‘backlash’ against
therapy may reflect the realization of the damage done to social relations of
every kind by the adoption of and belief in that self-same ideology.
Whatever the case, it is, I think, fair to say that the issues presented by
clients in the therapeutic encounter embody the competing tendencies
contained within these divisive philosophies and reveal these same
consequences at a microcosmic level.
If therapists merely seek to ‘repair’ the individual, they perpetuate these
ideologies and maintain that divided and antagonistic experience that
requires ‘self ’ or ‘other’ to appear to ‘win’ and yet always ‘lose’.
But therapy can provide an alternative. In the microcosmic encounter
that places the therapist in the position of the ‘other’, newly experienced
possibilities of relation can emerge. The ‘self ’ that is the client can
recontextualize his or her relational experience of self-to-self, self-to-other,
and self-with-other. And while it is the case that the ‘other’ in this particular
instance may be ‘special’ or unusual and far from representative of all the
‘others’ in the client’s experience, let us not be too hasty in minimizing the
influence of this unique encounter.
The fractal geometry of Chaos Theory has revealed a most remarkable
parallel in the movements of complex systems, such that if one were to
compare the movement of the system as a whole with that of a minute part
of the system, the features and observable changes in either would be
virtually the same (Gleick, 1988). Recall, as well, that the view of causality
within Chaos Theory argues that changes in movement at a minute,
seemingly insignificant level affect and alter the whole of the complex
mechanism.
Therapy too, taken from the existential-phenomenological perspective
discussed in Part 5, argues that, if focused on the experience and expression
of ‘being’, the encounter between therapist and client can be seen as a
microcosmic parallel to the client’s macroscopic ‘being’ relations. And if
the client’s experience and expression of ‘being’ is clarified and challenged
from a therapeutic stance that accepts that being, as it experiences and
expresses itself through the therapist’s attempts to ‘enter’ the client’s
experiential world-view, then could it not be that the consequences of those
clarifications and challenges at the microcosmic level of encounter will
resonate at the macrocosmic level?
The term symmetry expresses the idea of beauty resulting from balance,
congruity, or harmony between two or more parts of an underlying whole. It
is my belief that therapy, once shorn of its trappings of unnecessary power
and mystique, can reveal itself as a valid and unique form of encounter
whose potential can provide individuals with the means of regaining some
experience of symmetry between ‘self and other’.
A ‘fearful symmetry’ to be sure, as William Blake wrote; but a
symmetry none the less.
BIBLIOGRAPHY

ADORNO, T., The Jargon of Authenticity. (Routledge and Kegan Paul, London 1964)
AEBI, J., ‘Nonspecific and specific factors in therapeutic change among different approaches to
counselling’, Counselling Psychology Review, 8, 3:19–32, 1993
ANON., Counselling: definition of terms in use with expansion and rationale (amended version)
(British Association for Counselling, Rugby 1991)
ANON., ‘Think-tank rounds on Thatcherism’, Guardian, 27 September 1993:3
ANON., BAC Code of Ethics and Practice for Counsellors (amended version) (British Association
for Counselling, Rugby 1993)
APFEL, R. and SIMON, B., ‘Patient–therapist sexual contact’, Psychotherapy and Psychodynamics,
43:57–68, 1985
AXLINE, V., Dibs: in search of self. (Penguin, Harmondsworth 1964)
BALINT, M. and BALINT, A., ‘On transference and countertransference’, Primary and Psycho-
Analytic Technique (M. Balint, ed.). (Livenght (1965), NY 1939)
BANDURA, A., Social Foundations of Thought and Action: a social cognitive theory. (Prentice-
Hall, Englewood Cliffs, NJ 1986)
BARTLETT, J., ‘First Off ’, Ms London, 21 March 1994:3
BATES, C. and BRODSKY, A.M., Sex in the Therapy Hour: a case of professional incest. (Guilford
Press, London 1989)
BECK, A.T., Cognitive Therapy and the Emotional Disorders. (International Universities Press, NY
1976)
BELL, L., ‘Psychotherapy and user empowerment’, Clinical Psychology Forum 23:12–14, 1989
BERMAN, J. S. and NORTON, N. C., ‘Does professional training make a therapist more effective?’,
Psychological Bulletin 98:401–7, 1985
BETTELHEIM, B., Freud and Man’s Soul. (Chatto and Windus, London 1983)
BETTELHEIM, B. and ROSENFELD, A.A., The Art of the Obvious: developing insight for
psychotherapy and everyday life. (Thames and Hudson, London 1993)
BEUTLER, L. E., ‘Toward specific psychological therapies’, Journal of Consulting and Clinical
Psychology 47:882–97, 1979
BILLEN , A., ‘Freudians’ slips are showing’, Observer, 30 January 1994:21
BLOCH, S., and CHODOFF, P. (eds.), Psychiatric Ethics (2nd ed.). (Oxford University Press,
Oxford 1991)
BOHM, D. and HILEY, B. J., The Undivided Universe: an ontological interpretation of quantum
theory. (Routledge, London 1993)
BOORSTIN, D. J., The Discoverers: a history of man’s search to know his world and himself.
(Random House, NY 1985)
BORDIN, E. S., ‘The generalizability of the psychoanalytic concept of the working alliance’,
Psychotherapy: Theory, Research and Practice 16:252–60, 1979
BORYS, D. S. and POPE, K. S., ‘Dual relationships between therapist and client: a national study of
psychologists, psychiatrists and social workers’, Professional Psychology: Research and
Practice 20:283–93, 1989
BOSS, M ., Psychoanalysis and Daseinsanalysis (trans. L. Lefebre). (Basic Books, NY 1963)
—Existential Foundations of Medicine and Psychology. (Aronson, NY 1979)
—‘The unconscious—what is it?’, Readings in Existential Psychology and Psychiatry (K. Hoeller,
ed.). (REPP, Seattle 1990)
BOUHOUTSOS, J., ‘Therapist–client sexual involvement: a challenge for mental health
professionals and educators’, American journal of Orthopsycbiatry 55:177–82, 1985
BRAUDE, S. E., First Person Plural: multiple personality and the philosophy of mind. (Routledge,
London 1991)
BREGGIN, P., Electroshock: its brain-disabling effects. (Springer, NY 1979)
—Toxic Psychiatry. (Fontana, London 1993)
BROADBENT, J., DAY, A., KHALEELEE, O., MILLER, E. and PYM, D., Psychotherapists and the
Process of Profession-Building. (OPUS, London 1983)
BRUCE, L., The Essential Lenny Bruce. (Panther, London 1975)
BUBER, M., I And Thou (trans. W. Kaufmann). (T. & T. Clarke Ltd (1987), Edinburgh 1970)
BUGENTHAL, J. F. T., American Psychologist 18:563–7, 1963
—Psychotherapy and Process: the fundamentals of an existential–humanistic approach. (McGraw-
Hill, NY 1978)
CALESTRO, K., ‘Psychotherapy, faith healing and suggestion’, International Journal of Psychiatry
10:83–113, 1972
CANNON, B., Sartre & Psychoanalysis: an existentialist challenge to clinical metatheory.
(University Press of Kansas, Lawrence, Kansas 1991)
CASEMENT, P., Further Learning from the Patient. (Routledge, London 1990)
CHASSEGUET-SMIRGEL, J. AND GRUNBERGER, B., Freud Or Reich? Psychoanalysis and
illusion. (Free Association Books, London 1986)
CHAYTOR, D. (ed)., Training in Counselling and Psychotherapy (9th ed.). (British Association for
Counselling, Rugby 1992)
CHERTOK, L., ‘The discovery of the transference: toward an epistemological interpretation’,
International Journal of Psycho-Analysis 49:560–76, 1968
CLARKSON, P., Comments made at the 6th Annual Conference of the Society for Existential
Analysis, 20 November 1993
CONDRAU, G., ‘Dream analysis: do we need the unconscious?’, Journal of the Society for
Existential Analysis 4:1–12, 1993
CONKLING, M., ‘Sartre’s refutation of the Freudian Unconscious’, Readings in Existential
Psychology and Psychiatry (K. Hoeller, ed.). (REPP, Seattle 1990)
COOPER, D., Psychiatry And Anti-Psychiatry. (Barnes & Noble, NY 1967)
COREY, G., Theory and Practice of Counselling and Psychotherapy (4th ed.). (Brooks/Cole, Pacific
Grove, California 1991)
CREWS, F., ‘The unknown Freud’, The New York Review of Books, 40, 19:55–66, 1993
CREWS, F. et al, ‘The unknown Freud: an exchange’, The New York Review of Books, 41, 3:34–43,
1994
DAVENHILL, R. and OSBORNE, J., ‘What relevance psychotherapy?’, The Psychologist 2:56–60,
1991
DAVIDSON, V., ‘Psychiatry’s problem with no name: therapist–patient sex’, The American Journal
of Psychoanalysis 37:43–50, 1977
DEURZEN-SMITH, E. van, Existential Counselling in Practice. (Sage, London 1988)
—‘Ontological insecurity revisited’, Journal of the Society for Existential Analysis 2:38–48, 1991
DICK, P. K., Valis. (Corgi, London 1981)
—Radio Free Albemuth. (Grafton, London 1987)
DINNAGE, R., One to One: experiences of psychotherapy. (Viking, London 1989)
DIXON, N. F., Subliminal Perception: the nature of a controversy. (McGraw-Hill, London 1971)
—Preconscious Processing. (Wiley, NY 1981)
DRYDEN, W. (ed.), Individual Therapy: a handbook. (Open University Press, Milton Keynes 1990)
DRYDEN W. and ELLIS, A., ‘Rational–Emotive Therapy’, Handbook of Cognitive Behavioural
Therapies (K. S. Dobson, ed.). (Guilford Press, NY, 1988)
DYLAN, B., ‘Ballad in Plain D–’, Another Side of Bob Dylan. (M. Witmark & Sons, NY 1964)
EDELSON, M., Hypothesis and Evidence in Psychoanalysis. (University of Chicago Press, London
1984)
EGAN, G., The Skilled Helper. (Brooks/Cole, Monterey, California 1982)
EINZIG, H., Counselling and Psychotherapy: Is It for Me? (British Association for Counselling
pamphlet 1991)
ELLENBERGER, H. F., The Discovery of the Unconscious. (Basic Books, NY 1971)
ELLIS, A. and WHITELEY, J. M.(eds.), Theoretical and Empirical Foundations of Rational–
Emotive Therapy. (Brooks/Cole, Pacific Grove, California 1979)
ERDELYI, M. H., Psychoanalysis: Freud’s cognitive psychology. (W. H. Freeman and Company, NY
1985)
EVANS, R. I., Dialogue with R. D. Laing. (Praeger (1981), NY 1976)
EYSENCK, H. J., ‘The effects of psychotherapy: an evaluation’, Journal of Consulting Psychology
16:319–24, 1952
—‘An analysis of psychotherapy versus placebo studies’, Behaviour and Brain Studies 6:275–310,
1983
EYSENCK, H. J. and WILSON, G. D. (eds.), The Experimental Study of Freudian Theories.
(Paladin, London 1973)
FARRELL, B. A., ‘The criteria for a psycho-analytic interpretation’, Essays in Philosophical
Psychology (D. F. Gustafson, ed.). (Macmillan, London 1967)
—The Standing of Psychoanalysis. (Oxford University Press, Oxford 1981)
FEIFEL, H. and EELLS, J., ‘Patients and therapists assess the same psychotherapy’, Journal of
Consulting Psychology 27:310–18, 1963
FENICHEL, O., Problems of Psychoanalytic Technique. (The Psychoanalytic Quarterly, Inc.,
Albany, NY 1941)
FINE, R., A History of Psychoanalysis. (Columbia University Press, NY 1979)
FONAGY, P., ‘What is scientific about psychotherapy’, The British Psychological Society
Psychotherapy Section Newsletter 11:18–29, 1991
—‘How can we ensure that there will be psychoanalytic psychotherapy in the year 2003?’, paper
delivered to the Annual Conference of the British Psychological Society Psychotherapy Section.
(London, January 1993)
FOUCALT, M ., Madness and Civilization. (Penguin, Harmondsworth 1961)
FRANCE, A., Consuming Psychotherapy. (Free Association Books, London 1988)
FRANK, J. D., Persuasion and Healing (2nd ed.). (Johns Hopkins University Press, Baltimore 1973)
—‘Non-specific aspects of treatment: the view of a psychotherapist’, Non-Specific Aspects of
Treatment (M. Shepherd and N. Sartorius, eds.). (Hans Huber, Toronto 1989)
FREELY, M., ‘A suitable case for treatment’, Guardian, 9 February 1994:44.
FREUD, E. L. and MENG, H., Psycho-Analysis and Faith: the letters of Sigmund Freud and Oskar
Pfister (trans. E. Mosmacher). (Basic Books, NY 1963)
FREUD, S., Project for a Scientific Psychology, in The Standard Edition of the Collected Works of
Sigmund Freud 1:281–397. (Hogarth Press, London 1895)
—‘Heredity and the aetiology of the neuroses’, in The Standard Edition of the Collected Works of
Sigmund Freud 3:142–56. (Hogarth Press, London 1896a)
—‘The aetiology of hysteria’, in The Standard Edition of the Collected Works of Sigmund Freud
3:189–221. (Hogarth Press, London 1896b)
—The Interpretation of Dreams, in The Standard Edition of the Collected Works of Sigmund Freud 4,
5. (Hogarth Press, London 1900)
—‘Fragment of an analysis of a case of hysteria’, in The Standard Edition of the Collected Works of
Sigmund Freud 7:3 –122. (Hogarth Press, London 1905)
—Introductory Lectures on Psychoanalysis, in The Standard Edition of the Collected Works of
Sigmund Freud, 15, 16. (Hogarth Press, London 1917)
—‘From the history of an infantile neurosis’, in The Standard Edition of the Collected Works of
Sigmund Freud 17:3–122. (Hogarth Press, London 1918)
—The Ego and the Id, in The Standard Edition of the Collected Works of Sigmund Freud 19:3–59.
(Hogarth Press, London 1923)
—‘The resistances of psycho-analysis’, in The Standard Edition of the Collected Works of Sigmund
Freud 19:212–22. (Hogarth Press, London 1925)
— The Question of Lay Analysis: conversations with an impartial person, in The Standard Edition of
the Collected Works of Sigmund Freud 20:179–250. (Hogarth Press, London 1926)
—‘Analysis terminable and interminable’, in The Standard Edition of the Collected Works of
Sigmund Freud 23:211–53. (Hogarth Press, London 1937a)
—‘Constructions in analysis’, in The Standard Edition of the Collected Works of Sigmund Freud
23:257–71. (Hogarth Press, London 1937b)
—An Outline of Psychoanalysis, in The Standard Edition of the Collected Works of Sigmund Freud
23:141–207. (Hogarth Press, London 1940)
FREUD, S. and BREUER, J., Studies on Hysteria, in The Standard Edition of the Collected Works of
Sigmund Freud 2. (Hogarth Press, London 1895)
FROMM , E ., To Have or To Be? (Harper and Row, London 1976)
GARDNER, S., Irrationality and the Philosophy of Psychoanalysis. (Cambridge University Press,
Cambridge 1993)
GARFIELD, S. L., The Practice of Brief Therapy. (Pergamon, NY 1989)
GARFIELD, S.L. and BERGIN, L. E. (eds.), Handbook of Psychotherapy and Behaviour Change
(3rd ed.). (Wiley, NY 1986)
GARTRELL, N., HERMAN, J., OLARTE, S., FELDSTEIN, M. and LOCALIO, R., ‘Psychiatrist–
patient sexual contact: results of a national survey’, American Journal of Psychiatry 143:1126–
31, 1986
GAY, P., Freud: a life for our time. (J. M. Dent and Sons, London 1988)
GELLNER, E., The Psychoanalytic Movement. (Paladin, London 1985)
GINSBURG, H. and OPPER, S., Piaget’s Theory of Intellectual Development: an introduction.
(Prentice-Hall, Englewood Cliffs, NJ 1969)
GLEICK, J., Chaos: making a new science. (Heinemann, London 1988)
GOODMAN, N., ‘When Is Art?’, The Arts and Cognition (D. Perkins & B. Leondar, eds.). (Johns
Hopkins University Press, Baltimore 1977)
GRAHAM, H., The Human Face of Psychology. (Open University Press, Milton Keynes, 1986)
GREENBERG, L. S., ‘Advances in clinical intervention research: a decade review’, Canadian
Psychology, 22, 1:25–34, 1981
GREENBERG, L. S. and PINSOF, W. M., The Therapeutic Process: a research handbook.
(Guilford, NY 1986)
GROTSTEIN, J. S., ‘Reflections on a century of Freud: some paths not chosen’, British Journal of
Psychotherapy, 9, 2:181–7, 1992
GRÜNBAUM, A., The Foundations of Psychoanalysis: a philosophical critique. (University of
California Press, Berkeley 1984)
GUGGENBUHL-CRAIG, A., Power in the Helping Professions (9th ed.). (Spring Publications,
Dallas, Texas 1989)
HALMOS, P., The Faith of the Counsellors. (Constable, London 1965)
HARE, R., ‘Ethical therapy’, Psychiatric Ethics (2nd ed., S. Bloch and P. Chodoff, eds.). (Oxford
University Press, Oxford 1991)
HARRE, R., ‘What is scientific about psychotherapy’, The British Psychological Society
Psychotherapy Section Newsletter 11:14– 17, 1991
HATTIE, J. A., SHARPLEY, C. F. and ROGERS, H. J., ‘Comparative effectiveness of professional
and paraprofessional helpers’, Psychological Bulletin 95:534–41, 1984
HEIDEGGER, M., Being and Time (trans. J. Macquarrie and E. Robinson). (Basil Blackwell, Oxford
1962)
HEIDER, J., The Tao of Leadership. (Wildwood House, Aldershot, Hampshire 1986)
HEIMANN, P., ‘On countertransference’, International Journal of Psycho-Analysis 31:81–4, 1950
HILGARD, E. R., Divided Consciousness: multiple controls in human thought and action. (Wiley,
NY 1986)
HILGARD, E. R., ATKINSON, R.L. and ATKINSON, R.C., Introduction to Psychology (9th ed.).
(Harcourt Brace Jovanovich, NY 1987)
HOLMES, J. and LINDLEY, R., The Values of Psychotherapy. (Oxford University Press, Oxford
1989)
HOLMES, J., ‘Response to J. Masson’s “The tyranny of psychotherapy” ’, Psychotherapy and Its
Discontents (W. Dryden and C. Feltham, eds.):29–36. (Open University Press, Milton Keynes
1992)
HOLROYD, J. and BRODSKY, A., ‘Psychologists’ attitudes and practices regarding erotic and non-
erotic physical contact with patients’, American Psychologist 32:843–9, 1977
HOPKINS, J., ‘The unknown Freud: an exchange’, The New York Review of Books, 41, 3:34–5, 1994
HOWARD, A., ‘What, and why, are we accrediting?’, Counselling, 3, 2:90–2, 1992
HOWARTH, I., ‘Psychotherapy: who benefits?’, The Psychologist, 2,4:149–52, 1989
HOWE, D., On Being a Client: understanding the process of counselling and psychotherapy. (Sage,
London 1993)
HUSSERL, E., Phenomenological Psychology. (Nyhoff, The Hague 1977)
IHDE, D., Experimental Phenomenology: an introduction. (State University of New York, Albany
1986)
JACOBSON, E., Progressive Relaxation. (University of Chicago Press, Chicago 1938)
JACOBY , R ., Social Amnesia: a critique of conformist psychology from Adler to Laing. (Harvester
Press, Hassocks 1975)
JAMES, W., The Varieties of Religious Experience. (Macmillan (1985), NY 1890)
JAMIESON, A. and JONES, C, ‘The BAC basic principles of counselling’, Counselling 4:155–6,
1993
KARDENER, S., FULLER, M. and MENSCH, L., ‘A survey of physicians’ attitudes and practices
regarding erotic and non-erotic physical contact with patients’, American journal of Psychiatry
130:1077–81, 1973
KARDENER, S. H., ‘Sex and the physician–patient relationship’, American Journal of Psychiatry
131:1134–6, 1973
KAZDIN, A. E., ‘Comparative outcome studies of psychotherapy: methodological issues and
strategies’, Journal of Consulting and Clinical Psychology 54:729–57, 1986
KIRSCHENBAUM, H. and HENDERSON, V. L., The Carl Rogers Reader. (Constable, London
1990a)
—Carl Rogers: Dialogues. (Constable, London 1990b)
KITZINGER, C, ‘Feminism, psychology and the paradox of power’, Feminism and Psychology
1:111–29, 1991
—‘Thomas Szasz: the myth and the man’, The Psychologist, 4, 2:120–2, 1992
KLEIN, M., ‘The origins of transference’, International journal of Psycho-Analysis 33:433–8, 1952
—Narrative of a Child Analysis. (Hogarth Press, London 1961)
KLINE, F., ADRIAN, A. and SPEVAK, M., ‘Patients evaluate therapists’, Archives of General
Psychiatry 31:113–16, 1974
KLINE, P., Psychology and Freudian Theory: an introduction. (Methuen, London 1984)
—‘Problems of methodology in studies of psychotherapy’, Psychotherapy and Its Discontents (W.
Dryden and C. Feltham, eds.). (Open University Press, Milton Keynes 1992)
KOESTLER, A., The Sleepwalkers: a history of man’s changing vision of the universe. (Hutchinson,
London 1959)
LAING, R.D., The Divided Self. (Tavistock Publications, London 1960)
—Self and Others. (Penguin, Harmondsworth 1961)
—The Politics of Experience and the Bird of Paradise. (Penguin, Harmondsworth 1967)
—The Voice of Experience: experience, science and psychiatry. (Allen Lane, London 1982)
LAING, R. D. and ESTERSON, A., Sanity, Madness and the Family. (Penguin, Harmondsworth
1965)
LaPLANCHE, J. and PONTALIS, J. B., The Language of Psycho-Analysis (trans. D. Nicholson-
Smith). (Hogarth Press, London 1985)
LEO, J., ‘Talk is as good as the pill’, Time Magazine, 26 May 1986:88
LERNER, B., Therapy in the Ghetto. (Johns Hopkins University Press, Baltimore, 1972)
LLEWELYN, S., ‘The sexual abuse of clients by therapists’, paper delivered to the BPS Annual
Conference, 1992
LOMAS, P., The Case for a Personal Psychotherapy. (Oxford University Press, Oxford 1981)
LUBORSKY, L. and SINGER, B., ‘Comparative studies of psychotherapies: is it true that everyone
has won and all must have prizes?’, Archives of General Psychiatry 32:995–1008, 1975
—‘Therapist success and its determinants’, Archives of General Psychiatry 42:602–11, 1985
MAIR, K., ‘The myth of therapist expertise’, Psychotherapy and Its Discontents (W. Dryden and C.
Feltham, eds.) (Open University Press, Milton Keynes 1992)
MALAN, D., ‘On assessing the results in psychotherapy’, British Journal of Medical Psychology
32:86–105, 1959
—A Study of Brief Psychotherapy. (Tavistock, London 1963)
MALCOLM, J., Psychoanalysis: The Impossible Profession. (Pan, London 1982)
—In the Freud Archives. (Knopf, NY 1984)
MALUCCIO, A. N., Learning from Clients. (Free Press, NY 1979)
MASLOW, A., Towards a Psychology of Being. (Van Nostrand Reinhold, NY 1968)
MASSON, J., The Oceanic Feeling: the origins of religious sentiment in India. (University of
Toronto Press, Toronto 1980)
—The Assault on Truth: Freud’s suppression of the seduction theory. (Penguin, Harmondsworth
1984)
—The Dark Science: women, sexuality and psychiatry in the 19th century. (Virago, London 1986)
—Against Therapy: emotional tyranny and the myth of psycho-logical healing. (Fontana, London
1988)
—Final Analysis: the making and unmaking of a psychoanalyst. (HarperCollins, London 1991)
—‘The tyranny of psychotherapy’, Psychotherapy and Its Discontents (W. Dryden and C. Feltham,
eds.). (Open University Press, Milton Keynes 1992)
—My Father’s Guru. (Harper Collins, London 1993a)
—‘Issues of power in the psychotherapeutic relationship’, paper delivered to the 6th Annual
Conference of the Society for Existential Analysis, November 1993b
MASTERS, W. H. and JOHNSON, V. E., Human Sexual Response. (Churchill, London 1966)
—Human Sexual Inadequacy. (Churchill, London 1970)
MAY, R., Psychology and the Human Dilemma. (W. W. Norton & Co., NY 1967)
—Love and Will. (W. W. Norton & Co., NY 1969)
—Freedom and Destiny. (Delta, NY 1981)
—The Discovery of Being: writings in existential psychology. (W. W. Norton 6c Co., NY 1983)
—‘Transpersonal or transcendental?’, The Humanistic Psychologist, 14, 2:87–90, 1986
MAY, R., ANGEL, E. and ELLENBERGER, H., Existence. (Clarion, NY 1958)
MAYS, D. T. and FRANKS, C. M. (eds.), Negative Outcome in Psychotherapy and What to Do
about It. (Springer, NY 1985)
MCCARTNEY, J. L., ‘Overt transference’, Journal of Sex Research 2:227–37, 1966
MCCONNAUGHY, E.A., ‘The personality of the therapist in psychotherapeutic practice’,
Psychotherapy, 24, 3:303–14, 1987
MCCORD, J., ‘A thirty year follow-up of treatment effects’, American Psychologist 3:284–9, 1978
MCLEOD, J., ‘The client’s experience of counselling and psychotherapy: a review of the research
literature’, Experiences of Counselling in Action (D. Mearns and W. Dryden, eds.). (Sage,
London 1990)
MEARNS, D. and THORNE, B., Person-Centred Counselling in Action. (Sage, London 1988)
MILLER, A., Thou Shalt Not Be Aware: society’s betrayal of the child. (Pluto Press, London 1985)
MILLER, J., The Body in Question. (Cape, London 1978)
MISIAK, H. and SEXTON, V. S., Phenomenological, Existential and Humanistic Psychologies: a
historical survey. (Grune & Stratton, NY 1973)
MURGATROYD, S., ‘A framework for intervention’, Counselling Psychology Review, 8, 3:4–7,
1993
NACHT, S., ‘Reflections on the evolution of psychoanalytic knowledge’, International Journal of
Psycho-Analysis 40:32–42, 1969
OBHOLZER, K., The Wolf-Man Sixty Years Later: conversations with Freud’s controversial patient
(trans. M. Shaw). (Routledge and Kegan Paul, London 1982)
OLDFIELD, S., The Counselling Relationship: a study of the client’s experience. (Routledge and
Kegan Paul, London 1983)
OMER, H. and LONDON, P., ‘Metamorphosis in psychotherapy: end of systems era’,
Psychotherapy: theory, research and practice 25:171–84, 1988
ORLINSKY, D. E. and HOWARD, K. I., ‘Process and outcome in psychotherapy’, Handbook of
Psychotherapy and Behaviour Change (3rd ed., S. L. Garfield and A. E. Bergin, eds.) (Wiley,
NY 1986)
OWEN, I., ‘The tower of Babel: searching for core clinical, theoretical and ethical issues in
psychotherapy’, Counselling Psychology Quarterly, 5, 1:67–78, 1992
—‘Core skills for psychotherapy’, Counselling Psychology Review, 8,2:15–23, 1993a
—‘The personalities of psychotherapists’, Counselling Psychology Review, 8, 3:10–14, 1993b
PERLS, F. S., Gestalt Therapy Verbatim. (Real People Press, Moab, Utah 1969)
—The Gestalt Approach and Eye Witness to Therapy. (Bantam Books, NY 1976)
PERSAUD, R., ‘Talking your way out of trouble’, Sunday Times, 26 September 1993, Style and
Travel section:8–9
PETERS, T., Liberation Management. (Macmillan, London 1992)
PILGRIM, D., ‘Psychotherapy and social blinkers’, The Psychologist 2:52–5, 1991
PLASIL, E., Therapist. (St Martins Press, London 1985)
POPE, K. S. and BOUHOUTSOS, J. C, Sexual Intimacies between Therapists and Patients.
(Praeger, NY 1986)
POPE, K.S., KEITH-SPEIGEL, P. and TABACHNICK, B., ‘The human therapist and the
(sometimes) inhumane training system’, American Psychologist 41:147–58, 1986
POPE, K.S., TABACHNICK, B. and KEITH-SPEIGEL, P., ‘Ethics of practice: the beliefs and
behaviors of psychologists as therapists’, American Psychologist 42:993–1006, 1987
POPE, K.S. and VETTER, U., ‘Prior therapist–patient involvement among patients as seen by
psychologists’, Psychotherapy 28:429–38, 1991
POPE, K.S., ‘Therapist–client sexual involvement: a review of the research’, Clinical Psychology
Review 10:477–90, 1990
POPPER, K.S ., Logic of Scientific Discovery (revised ed.). (Hutchinson, London 1960)
REASON, P. and ROWAN, J., Human Enquiry; a sourcebook of new paradigm research. (Wiley,
Chichester 1981)
RICKMAN, G., Philip K. Dick: in his own words (revised ed.). (Fragments West/The Valentine
Press, Long Beach, California 1988)
RIEFF, P., Freud: the mind of the moralist (3rd ed.). (University of Chicago Press, London 1979)
ROGERS,C. R., On Becoming a Person. (Houghton Mifflin, Boston 1961)
—A Way of Being. (Houghton Mifflin, Boston 1980)
ROSEN, R. D., Psychobabble. (Avon Books, NY 1979)
ROSS, C. A., Multiple Personality Disorder: diagnosis, clinical features, and treatment. (Wiley, NY
1989)
ROWAN, J., ‘Response to K. Mair’s “The myth of therapist expertise”’, Psychotherapy and Its
Discontents (W. Dryden and C. Feltham, eds.). (Open University Press, Milton Keynes 1992)
RUSSELL, J., Out of Bounds: sexual exploitation in counselling and therapy. (Sage, London 1993)
RUSSELL, J., DEXTER, G. and BOND, T., ‘A Report on Differentiation between Advice,
Guidance, Befriending, Counselling Skills and Counselling’. (British Association for
Counselling and the Department of Employment 1993)
RUSTIN, M. and RUSTIN, M., ‘Relational preconditions for socialism’, Further Contributions to
the Theory and Technique of Psychoanalysis (J. Richards, ed.). (Hogarth Press, London 1960)
RUTTER, P., Sex in the Forbidden Zone. (Unwin Hyman, London 1990)
SACKS, O, The Man Who Mistook His Wife for a Hat. (Pan, London 1986)
SAINSBURY, E., NIXON, S. and PHILLIPS, D., Social Work in Focus: clients’ and social workers’
perceptions in long-term social work. (Routledge and Kegan Paul, London 1982)
SALMON, P., ‘Psychotherapy and the wider world’, The Psychologist 2:50–1, 1991
SARTRE, J.-P., Being and Nothingness: an essay on phenomenological ontology (trans. H. Barnes).
(Routledge (1991), London 1956)
SCHAFER, R., A New Language for Psychoanalysis. (Yale University Press, London 1976)
SCHIMEK, J. C, ‘Fact and fantasy in the seduction theory: a historical review’, Journal of the
American Psychoanalytic Association 35:937–65, 1985
SEDGEWICK, P., PsychoPolitics. (Pluto Press, London 1982)
SHAFFER, J.B.P., Humanistic Psychology. (Prentice-Hall, Englewood Cliffs, NJ 1978)
SHARPE, E., The psycho-analyst’, International journal of Psycho-Analysis 28:1–6, 1947
SHEPHARD, M., The Love Treatment: sexual intimacy between patients and psychotherapists.
(Peter Wyden, NY 1971)
SHLIEN, J. M., ‘A countertheory of transference’, Client Centered Therapy and the Person Centered
Approach (R. Levant and J. Shlien, eds.). (Praeger, NY 1984)
SIEGHART, P., Statutory Registration of Psychotherapists: report of a profession’s joint working
party. (Plumbridge, Cambridge 1978)
SKINNER, B. F., Science and Human Behavior. (Macmillan, NY 1953)
—Beyond Freedom and Dignity. (Knopf, NY 1971)
SMAIL, D., ‘Towards a radical environmentalist psychology of help’, The Psychologist 2:61–5, 1991
SMITH, D. L., Hidden Conversations: an introduction to communicative psychoanalysis.
(Routledge, London 1991)
—‘On the eve of a revolution: Freud’s concepts of consciousness and unconsciousness in “Studies on
Hysteria” and the “Project for a Scientific Psychology”’, British Journal of Psychotherapy,
9,2:150–6, 1992
SMITH, M. L. and GLASS, G. V., ‘Meta-analyses of psychotherapy outcome studies’, American
Psychologist 32:752–60, 1977
SMITH, M. L., GLASS, G. V. and MILLER, T. I., The Benefits of Psychotherapy. (Johns Hopkins
University Press, Baltimore 1980)
SPANOS, N ., ‘Hypnosis, demonic possession and multiple personality’, Altered States of
Consciousness and Mental Health: a cross-cultural perspective (C. A. Ward, ed.). (Sage,
Newbury Park, California 1989)
SPERRY, R. W., ‘Perception in the absence of neocortical commisures’, Perception and Its Disorders
(Res. Publ. ARNMD, vol. 48). (The Association for Research in Nervous and Mental Diseases,
NY 1970)
SPINELLI, E., ‘An analysis of est’, Archives of the Edale Research Group, 1979
—The Interpreted World: an introduction to phenomenological psychology. (Sage, London 1989)
—‘Sex, death and the whole damn thing: the case of Stephen R’, Journal of the Society for
Existential Analysis 3:39–53, 1992
—‘The unconscious: an idea whose time has gone?’, Journal of the Society for Existential Analysis
4:19–47, 1993
STILES, W.B., SHAPIRO, D. A. and ELLIOTT, R., ‘Are all psychotherapies equivalent?’, American
Psychologist 41:165–80, 1986
STILES, W. B. and SHAPIRO, D. A., ‘Abuse of the drug metaphor in psychotherapy process-
outcome research’, Clinical Psychology Review 58:352–9, 1988
STONE, A., ‘Sexual misconduct by psychiatrists: the ethical and clinical dilemma of confidentiality’,
American Journal of Psychiatry 140:195–7, 1983
STORR, A., ‘The concept of cure’, Psychoanalysis Observed (C. Rycroft, ed.). (Routledge and
Kegan Paul, London 1966)
—The Art of Psychotherapy. (Butterworth/Heinemann, London 1979)
STRACHEY, J., ‘The nature of the therapeutic action of psychoanalysis’, International Journal of
Psychoanalysis 15:117–26, 1934
STRUPP, H., FOX, R. and LESSLER, K., Patients View Their Psychotherapy. (Johns Hopkins
University Press, Baltimore 1969)
SULLIVAN, H. S., Conceptions of Modern Psychiatry. (W. W. Norton & Co. (1953), NY 1940)
SZASZ, T., The Manufacture of Madness. (Granada, St Albans 1973)
— The Myth of Mental Illness: foundations for a theory of personal conduct (revised ed.). (Harper
&c Row, NY 1974a)
—Law, Liberty and Psychiatry. (Routledge and Kegan Paul, London 1974b)
—The Ethics of Psychoanalysis: the theory and method of autonomous psychotherapy (revised ed.).
(Basic Books, NY 1974c)
—The Myth of Psychotherapy: mental healing as religion, rhetoric, and repression. (Doubleday,
Garden City, NY 1978)
— The Theology of Medicine. (Oxford University Press, Oxford 1979)
—‘Taking Dialogue as Therapy Seriously: words are the essential tool of treatment’, Journal of the
Society for Existential Analysis 3:2–9, 1992a
—Our Right to Drugs: the case for a free market. (National Book Network, Inc., NY 1992b)
SZYMANSKA, K. and PALMER, S., Therapist–client sexual contact’, Counselling Psychology
Review 8, 4:22–33, 1993
TART, C. T. (ed.), Transpersonal Psychologies. (Routledge and Kegan Paul, London 1975)
TAYLOR, J. and WAGNER, N. N., ‘Sex between therapists and clients: a review and analysis’,
Professional Psychology 7:593–601, 1976
THORNE, B., ‘Person-centred therapy’, Individual Therapy: a handbook (W. Dryden, ed.). (Open
University Press, Milton Keynes 1992)
THORNTON, E. M., Freud and Cocaine. (Blond & Briggs, London 1983)
TORREY, E. F., Witchdoctors and Psychiatrists: the common roots of psychotherapy and its future.
(Aronson, NY 1986)
—Freudian Fraud: the Malignant Effect of Freud’s Theory on American Thought and Culture.
(HarperCollins, NY 1992)
TOWNSEND, C, ‘What’s in a name?’, Counselling 4:252, 1993
TROUPP, C, ‘If you can’t trust your therapist. . . .’, Guardian, 28 February 1991: 23
VALLE, R.S. and KING, M. (eds.), Existential–Phenomenological Alternatives for Psychology.
(Oxford University Press, NY 1978)
VALLE, R.S. and HALLING, S. (eds.), Existential–Phenomenological Perspectives in Psychology.
(Plenum Press, London 1989)
VALLE, R. S., ‘The emergence of transpersonal psychology’, Existential–Phenomenological
Perspectives in Psychology (R. S. Valle and S. Hailing, eds.). (Plenum Press, London 1989)
VINSON, J. S., ‘Use of complaint procedures in cases of therapist–patient sexual contact’,
Professional Psychology: Research and Practice 18:159–64, 1987
WANN, T. W. (ed.), Behaviorism and Phenomenology: contrasting bases for modern psychology.
(University of Chicago Press, Chicago 1964)
WELDON, F., Affliction. (HarperCollins, London 1994)
WHYTE, L. L., The Unconscious before Freud. (Julian Friedmann Publishers Ltd, London 1978)
WINNER, E., Invented Worlds: the psychology of the arts. (Harvard University Press, London 1982)
WINNICOTT, D. W., The Maturational Process and the Facilitating Environment. (Hogarth Press,
London 1965)
—Playing and Reality. (Tavistock, London 1971)
WITTGENSTEIN, L., Philosophical Investigations. (Macmillan, NY 1953)
—‘Conversations on Freud; excerpt from 1932–3 lectures’, in Philosophical Essays on Freud (R.
Wollheim and J. Hopkins, eds.). (Cambridge University Press, Cambridge 1982)
WOLPE, J., The Practice of Behavior Therapy. (Pergamon Press, NY 1969)
YALOM, I., Existential Psychotherapy. (Basic Books, NY 1980)
INDEX

abuse, 3, 5, 34, 47–8, 57, 60–81, 107, 172–3, 176, 229, 230, 231
see also power
acceptance, 207
accommodation, 180–1
adaptation, 180–1
advice, 10–12
Aebi, J., 51–3
analytic interpretation, 123–4
anxiety, 4, 51–2, 172, 184, 219–20, 232
arousal, 53, 112
art, definition of, 22–3
assertiveness training, 149
assimilation, 180–1
attraction, 65–9, 226
Axline, V. M., 16–7

Beck A. T., 38, 79

befriending, 11–13
behaviourism, 100, 152, 159
‘being’, 23, 54, 179–208, 226–8, 232–3
‘being for’, 199
‘being-in-the-world’, 180, 185, 186, 214, 228
‘being with’, 198–9
beliefs, 150–5, 176, 192–3, 219–228
see also irrational beliefs
Berman and Norton, 44, 47–8
body, 217
bracketing, 186
Braude, Stephen, 92–3
British Association for Counselling (BAC), 8, 15
British Medical Association, 34

Calestro, Dr Kenneth, 26, 27

Casement, Patrick, 126
categories, definition of, 21–4
causality, linear, 99–103
change, 31–6, 40–6, 51–4, 102–5, 149–53, 158, 197, 204, 219, 222–4
chaos theory, 101–2, 233
Chertok, Louis, 113
children, 75–6, 99, 175,
choice, 184
clients,
beliefs of, 176, 223
challenge to beliefs of, 222
cognitive-behavioural approach to, 54, 55, 149, 156
and conditional unconditionality, 165
dependency of, 72
experience of, 177, 227
humanistic approaches to, 160, 173, 174
past experiences of, 103–9
and self-construct, 215–24
and sexual relations with therapists, 61–9
and transference, 110–11
views on effectiveness of therapy, 44–6
world-view of, 122, 124, 148, 153–64, 176, 186, 202, 210, 225, 233
cognitive-behavioural model, 147–51
critiques of, 151–9
efficacy of, 157–8
experimental basis of, 148, 151–3
normative influences in, 155
objectivity of therapist in, 154–8
rational and irrational beliefs in, 155
status of emotions in, 153
therapeutic relationship in, 153, 156, 179
Communicative Psycho-analysis, 78
consciousness, 175, 176, 180, 181
see also Dissociated Consciousness
see also Unconscious
Corey, Gerald, 10, 148, 149, 150, 151, 153, 157, 160, 161, 164, 169
counselling, 1–21, 41–4, 60–6, 190
compared with psychotherapy, 16–21
definition of, 15
effectiveness of, 43–5
see also therapy
counter-transference, 65, 66, 110, 111, 112–18, 158
critiques of, 112–16
definition of, 110–12
re-interpretation of, 116–23
Crews, Frederick, 69, 75, 76, 78
culture, 1, 27–37, 167, 175, 184, 193, 220, 224, 225
cure, 16–17, 32, 41, 49

‘death anxiety’, 145–6

dependency, 72
depression, 41, 79, 80, 148, 216
descriptive interpretation, 123, 124–6, 144, 145
Duerzen-Smith, Emmy van, 10, 166, 169
Dick, Philip K., 206–7
dilemmas, 17, 74, 155
disclosure, 162–4, 215
disownership, 94–7, 218–24
see also dissociation
Dissociated Consciousness, 92–7
dissociation, 92–8, 217, 218–27
‘doing’, 187–231

Egan, Gerard, 203

Einzig, Hetty, 15–16
Ellis, Albert, 149–50
emotions, 153, 203–17
empathy, 112, 203, 213–14
encounter, 22–4, 30–55, 116–22, 125–6, 172–8, 186–233
realms of, 208–214, 223
see also therapeutic relationship
encounter groups, 30
Erdelyi, Matthew Hugh, 91
Erhard, Werner, 173
ethics, 15, 60, 62, 74
existential-phenomenological
model, 3, 10, 84, 169, 179–215
choice in, 184–5
empathy in, 213–14
encounter in, 186
and intersubjectivity, 182
past in, 182
self in, 215–24, 227
therapeutic implications of, 186
experience, 159–60, 182–4
experimental data, 80, 97, 147, 151
Eysenck, Hans, 24, 38

falsifiability, 38, 39
fantasies, 75–89, 111, 117
Feifel and Eells, 44, 46
feminism, 35, 36
Fenichel, Otto, 113
frame, see structure
France, Anne, 45
Frank, J. D., 43, 48
freedom, 159–60, 185,189
Freud, Sigmund, 2, 7, 13, 16, 26, 38–40, 60, 69, 75–116, 197, 232
criticism of, 39, 69, 75
on the past, 103, 106, 108
and Seduction Theory, 75–9
on transference and countertransference, 110–13
on the Unconscious, 85–9
future, 106–9, 144, 184, 227

gender, 35–6
Gestalt Therapy, 10, 159–61, 167
Goodman, Nelson, 22
Greenberg, L. S., 50
growth, 164–72
guidance, 11–12
H

Halmos P., 26
Heidegger, Martin, 91, 125
Hilgard, Ernest, 95, 96
Holmes and Lindley, 10, 14, 16, 25, 26, 27, 31, 35, 72, 110, 111, 112, 224, 238
Howard, Alex, 20–1
Howarth, Ian, 44
Howe, David, 44, 45
human nature, 85, 161
humanism, 26, 161
humanistic models, 146–215
change in, 165
conditional unconditionality in, 165–6
critiques of, 162–72
limitations of, 172–4
real self in, 167–9
self-actualization in, 164–5

‘I’, 184, 208–10

identity, 104, 169, 175, 184, 221, 223
incest, 71
incongruence, 161–2
individual, and society, 232–3
industry, 190
intentionality, 180–2
interpretation, 53, 54, 122–6, 135–58, 167–78, 185–95, 201–2, 214–27
interpreted reality, 184
intersubjectivity, 182–4
irrational beliefs, 148–55

Jacoby, Russell, 29–31

Janet, Pierre, 92
Jung, C. G., 37, 61

Klein, Melanie, 10, 37, 85, 117, 127, 129

Kline, Paul, 40–5, 153
L

Laing, R. D., 33, 71, 83, 162, 195, 199

laughter, 231
listening, 81, 145, 202–9

McCartney, J. L. 62
McLeod, J., 45, 46
Mair, Katherine, 27–8, 47–50, 79–80
Malcolm, Janet, 114
Maslow, Abraham, 17, 159, 232
Masson, Jeffrey, 3, 5, 24, 25, 33, 37, 39, 59, 60, 63, 69–76, 162, 173
Maudsley, Henry, 87, 88
May, Rollo, 166, 167, 175
meaning, 104–9, 118, 123–6, 144, 156–8, 172–3, 227
meaninglessness, 184
measurement, 147–58, 189
medicine, 17, 28, 49, 53
memory, 76–80, 104–8, 120
Miller, Alice, 60
Miller, Jonathan, 216
‘mirroring’, see ‘reflecting back’
multi-culturalism, 35–7

National Health Service, 33–5

National Institute for Mental Health, 41, 44

objectivity, 76, 152, 154–8

Oldfield S., 45 ,46
organization, 180
‘other’, 144, 182–4, 199–202, 206
outcome studies, 32, 37, 39, 41–4, 48, 51, 54
Owen, Ian, 13, 40, 110

past, the, 99–101

construction of, 103–9
as currently lived and future-directed, 106–7
in existential-phenomenological model, 182
and linear causality, 99–101
therapeutic implications of, 107–10
perfectionism, 73, 204
Perls, Fritz, 59–61, 167–9
Persaud, Dr Raj, 8
Person-Centred Therapy, 159–61
physics, 101–2, 233
Piaget, Jean, 180–1
Pilgrim, David, 28–9
placebos, 41–51
power, 3–5, 14, 37, 44–55, 56–98, 107, 114, 122–6, 146, 154–62, 173–7, 225, 233
abuse and misuse of, 58–64, 75–82
imbalance of, 69–74
predictability, 204
problems, 17
proprioceptive dysfunctions, 216–19
psychiatry, 33, 34, 62, 70–1
psycho-analysis, 7, 10, 16, 26, 37–9, 75, 90–6, 117
analytic interpretation in, 126–34
criticism of, 24, 37–41, 69, 75, 90–2
and influence of the past, 99–110
and the Unconscious, 85–98
see also psychotherapy
psychology, 38, 85, 88, 152, 159, 175, 176, 190
psychotherapy, 3–45, 59–61, 69–72, 145, 229
attack on, 69–74
compared with counselling, 16–20
definition of, 4, 9, 13–23
effectiveness of, 43–9
and medicine, 16–17
and religion, 26
state provision of, 33–5
see also therapy

rape, 58–60
Rational-Emotive Behaviour Therapy (REBT), 149–65
recovery, 42
reductionism, 28, 29
‘reflecting back’, 200–1
reinforcement, 53, 78, 99–100
relation, 181, 202, 208, 215–18, 222–3, 227–8
relationship, see therapeutic relationship
relaxation techniques, 149
religion, 24, 26–7, 39, 176
Repressed Memory Syndrome, 76, 80, 108
repression, 91, 95, 96
research methods, 50
Rieff, P., 26
Rogers, Carl, 12, 17, 29, 30, 73, 161–74, 200–8, 218–21
Rosen, Dr John, 59
Ross, C. A., 92
Rowan, John, 50–1, 153
Rustin and Rustin, 26

Sacks, Oliver, 216–17

sacrifice, 67–9, 226, 232
Salmon, Phillida, 28
Sartre, Jean-Paul, 90–1, 203–4, 220
Schafer, Roy, 40
science, 37–9, 49, 101–3
sedimentation, 218–31
Segal, Hanna, 117
self, 93–5, 97–8, 161–2, 199, 201–2
in existential-phenomenological model, 215–21
in humanistic therapies, 167–78
and influence of the past, 106–9
and other, 181–2, 184, 208–9, 214–15, 224, 227–8, 233
real, 168–171, 221
transcending of, 174–7
see also self-construct
self-actualization, 82, 159–72
self-awareness, 31, 93, 175
self-concept, 93–4, 161–2
incongruence in, 160–1
self-construct, 108–9, 118, 124, 175–6, 215–28
see also self-concept
self-deception, 91, 218, 221
self-disclosure, 162–4
sexual abuse, 58, 69, 71–7, 93
Shlien, John M., 110–16
skills, 3, 12–16, 23, 85, 117, 148, 151, 178, 187–230
see also ‘doing’
Skinner B. F., 100, 152, 189
Smail, David, 29
Smith, David L., 77, 111, 117
Smith and Glass, 43
society, 48, 49, 155, 156, 167–70, 220, 232
split personality, 92
‘splitness’, 91, 97, 207, 217–19
state, 33–7
statistics, 157
see also experimental data
Storr, Anthony, 40–1
structure, 52–55, 69, 71, 95, 180–2, 193, 220–7
Strupp, H., 45
super-ego, 218
‘symptom substitution’, 154
symptoms, 144
systematic desensitization, 192
Szasz, Thomas, 16, 33–5, 60, 71, 74, 224

Thatcher, Margaret, 29, 174, 232

theoretical models, 43, 83, 192, 230
and misuse of power, 79–82
and therapeutic effectiveness, 43–7
therapeutic process, 45, 46, 160, 179
variables in, 153
see also therapeutic relationship
see also therapy
therapeutic relationship, 53–5, 56–8, 66–98, 110–46, 153–63, 166, 173–7, 179–227
abuse in, 57–74
in cognitive-behavioural model, 153, 155–7
in existential-phenomenological
model, 83–4, 186–7
in humanistic models, 159, 160
interpretations in, 122–6
misuse of power in, 75–82
power in, 69–75
transference and counter-transference in, 118–22, 145
see also encounter
see also therapists
therapists
assumptions about power of, 3–4
and attraction to clients, 65–8
and ‘being’ versus ‘doing’, 187–228
beliefs of, 26, 49, 53, 176, 192
and counter-transference, 111–12, 117–22
definitions of, 20
entry into client’s world-view, 185–6
and experience of client’s lived
reality, 200–2
expertise of, 196–7
importance of personality of, 45–7
and need for sacrifice, 66–9, 225–6
neutrality of, 225
objectivity of, 154
as other, 224–33
power of, 69–82, 157
and predictable behaviour, 204–5
reliance on theory as misuse of
power, 79–82
self-disclosure of, 162–4
and sexual relations with clients, 59, 61–5
superior knowledge of, 123, 145, 151, 206
and therapist encounter, 214–15
training of, 47–8, 191–3
and transference, 110–29, 144–5, 158–62, 200–26
understanding of therapeutic
relationship, 179
see also therapeutic relationship
see also therapy
therapy
attack on, 69–74
and change, 32, 50–2, 157–8
clients’ views of effectiveness of, 44–6
critiques of, 24–55
definitions of, 4, 9, 13–15, 20–7, 45, 54
distinguished from related terms, 11–13
diversity of types of, 9–10, 37
‘Dumbo Effect’ of, 50–3
efficacy of different methods
compared, 43–4
ethics in, 60–2, 74–5
gender in, 35–7
importance of relationship in, 23–4
interpretation in, 122–6
listening in, 202–9
measurement of efficacy of, 39–41
multi-cultural critiques of, 35–7, 224
mystification of, 3–6, 117, 230
open definition of, 22–4
and past experiences, 107–9
popularity of, 7–8, 229
and religion, 24, 26–7, 39, 176, 225
scepticism about, 3–4, 8–9, 231
scientific critiques of, 37–55
and the self-construct, 176, 215–21
social context of, 48–9
socio-political critiques of, 25, 28–32, 70
state provision of, 33–35
structure of, 14–15, 52–54
training in, 8–9, 47–8, 227
see also counselling
see also psychotherapy
see also therapeutic relationship
see also therapists
‘things’, 183
Torrey, E. F., 27
Townsend, Clare, 17–18
training, 8–9, 12, 15–18, 26–9, 44, 47–54, 56–71, 123, 187–230
Transactional Analysis (TA), 159–161
transcendence, see self-actualization
transference, 65, 144–5, 200
critiques of, 112–16
definition of, 110–12
re-interpretation of, 116–22
see also counter-transference
‘transparency’, 163, 208, 215
transpersonal therapies, 176–7

Unconscious, 85–98
United Kingdom Council for Psychotherapy (UKCP), 2, 8, 13, 47, 60, 61, 75, 229

violence, 58–60

Weldon, Fay, 8
Winnicott, D. W., 74, 113–14
Wittgenstein, Ludwig, 21–22, 90
‘world’, 181–2
world-view, 143–4, 186

Yalom, Irvin, 103