Finding a therapeutic practice, we are sometimes told, is often the expression of a desire for change. But ‘therapy’ is hardly separate from the culture it resists, and can transform that culture. If the poet WH Auden could describe Freud as ‘no longer a man / now but a whole climate of opinion’, then surely that is because Freud’s language eventually became ours; Phrases like ‘acting defensive’ or ‘feeling conflicted’, as John Forrester says, have been absorbed into everyday speech. A particular therapeutic practice helps to create the self that wants to be described (such as the epochal emergence of what Philip Rieff once called ‘psychological man’), as models of successful treatment and its language for thoughts, emotions, and behavior become part of the common sense of the culture. Even the use of ‘therapy’ tells us something about the contemporary state of culture, indexing more than any individual therapeutic act. ‘You NEED Talking to a therapist’ is a refrain often printed on t-shirts, worn by internet celebrities of all stripes, and the comment sells the sense that recommending therapy can be seen as an act of care as much as it can be a moral correction. for bad behavior (‘go to therapy, you naughty boy!’).
Our climate of opinion, however, is hardly Freudian, even if Freud’s own social and therapeutic insights remain as topical as ever. As Bruce Fink wrote at the beginning of his acclaimed introduction to Freudian practice, ‘(m)y impression, based on some three decades of psychoanalytic teaching, practice, and supervision, is that the most basic methods developed by Freud for accessing the unconscious. is no longer taught to most students of psychology and psychoanalysis’. And sometimes it is strange to think that ‘analysis’ was considered a hegemonic therapeutic force: according to Robert P. Knight, there were only 485 members of the American Psychoanalytic Association in 1952, most of them practicing in New York – thus almost a force mass. Today, however, therapy is more cognitive- and behavioral than psychoanalytic, and the therapeutic encounter is usually limited to ten to fifteen sessions, sometimes with weeks or even months between them (a (a friend of mine jokes that he likes to tell people he’s been in therapy for ‘years’, even though he’s only met his therapist a few times).
These new therapies have their origins in East Coast American psychology in the middle of the century, popularized mainly by the ‘neo-Freudian’ Aaron Beck and the rational-emotive behavioral therapist Alfred Ellis. In cognitive modalities, the clinical emphasis is often more on developing goals and skills than coming to terms with the unconscious (despite the theory). Indeed, Ellis’ work straddles the line between science and self-help psychology: his best-selling co-authored book A Guide to Reasonable Living (1961) has chapters titled ‘The Art of Never Being Desperately Unhappy’, ‘How to Stop Blaming and Start Living’, and ‘Controlling Your Own Destiny’, where the emphasis falls on individual responsibility and accountability, to ‘control. ‘ despite one’s psycho-social environment. Ellis also often used experiences from his own personal history that led him to reject psychoanalysis and embrace the behavioral model. In a famous anecdote, he challenged himself to approach 130 women in one month at the Bronx Botanical Gardens to overcome his social and romantic anxiety. ‘Thirty left immediately’, Ellis recalled, ‘I spoke to another 100, for the first time in my life, no matter how worried I was. No one threw up and ran. No one called the police.
A psychoanalytic approach can be a little more cognizant, as such signs of behavior – not throwing up and running away or calling the police – hardly conflict with deeper feelings of discomfort. The success of cognitive therapies is sometimes attributed to the political climate in which they were born: in a culture of excessive economic rationalization, it can be seen why the economics of behavioral therapies are attractive to governments looking to fund the cheapest therapies. . Ellis himself once symptomatically drew a line between his own practice and the psychoanalytic model along these lines: ‘Freud has a gene for ineffectiveness, and I think I have a gene. for efficiency’, he said, ‘If I were not a therapist, I would be an expert in efficiency’. In fact, cognitive therapies are often accompanied by a particular kind of politically charged language, where the old notions of ‘patient’ (or ‘analysand’, for that matter) are replaced by ‘client ‘ and analytic language shaped by emotional skills-management, as Lily Scherlis recently explored in an excellent article in the cultural politics of Dialectical Behavioral Therapy by Marsha Lineham.
Cognitive therapies are also maintained thanks to their status as ‘evidence-based’, although it is difficult to assess their effectiveness. As Nancy McWilliams illustrated in her famous psychoanalytic riposte to the DSM, Psychoanalytic Diagnosis (2011), the desire for a fully efficient, fully scientific therapy can be an important marker in determining a person’s individual psychopathology. In the case of obsessional neurosis (or what he calls ‘Obsessional and Compulsive Personalities’), the emotion needed for therapy is often kept at a safe distance by ‘oppressive thinking’ rationalizations: ‘a man’, wrote McWilliams, ‘who was my companion. an intake interview answered my question about the quality of his sexual relationship with his wife with the sad statement, “I finished the job”‘. But a recent study based on a large-scale meta-analysis remarkably suggests that the documented efficacy of cognitive-behavioural therapy for the treatment of depression fades over time. The authors speculate that, among other things, new treatment methods may act like placebos, offering an initial boost upon first entering the cultural sphere before fading. -an of their potency, can only be an opinion in our extreme psychological climate.
As analysts and commentators have pointed out for many years now, analysis opens up a space for ineffectiveness in a world defined largely by demands for the opposite: ‘can be precisely given emphasis on the specificity of psychotherapy that remains its trump card’, as Darian Leader put it well in another forum dedicated to the efficacy of psychotherapy, ‘the fact that it rejects the lies that god of pseudo-scientific techniques and offers a space where every person can be heard outside the framework of the service industry. One of the most important and controversial psychoanalysts of the twentieth century, Jacques Lacan, once outlined the singularity of the psychoanalytic method, showing how it departs from the kind of ready-made model of therapy: ‘analysis as a science’, he said, ‘Always a science of the particular’. There is no formula for the direction of an analysis, no handbook on how to treat a patient, no ‘standard model’: the ethics of an analysis usually emphasizes the uniqueness of each case, how one should listen to a patient as what they have to say can turn the whole body of analytic theory.
One reason that occurred to me as to why psychoanalysis seems out of time, out of place in our therapy-positive culture, is that it sometimes becomes an account of why the therapeutic encounter can fail rather than a lig -on theory of why it works. At first glance, its main concepts – the unconscious, displacement, resistance, repetition compulsion, defense mechanisms, screen memories – are all explanatory mechanisms aimed at explain why people undergoing therapy find it so difficult to change, why the therapeutic encounter is in danger of faltering or stumbling at a particular moment, why the relationship between the therapist and patient can strengthen some characteristics instead of losing them. Psychoanalysis is a fundamentally incredulous activity and seeks to disrupt even the strongest narratives we tell ourselves about ourselves. As Lacan puts it, ‘
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2025-01-02 23:42:00
