Is it science, religion, art or a waste of time?
By Adam Phillips The New York Times
THURSDAY, MARCH 2, 2006
LONDON Psychotherapy is having yet another identity crisis. It has
manifested itself in two recent trends in the profession in America: the first
involves trying to make therapy into more of a "hard science" by putting a new
emphasis on measurable factors; the other is a growing belief among therapists
that the standard practice of using talk therapy to discover traumas in a
patient's past is not only unnecessary but can be injurious.
That psychotherapists of various orientations find themselves under
pressure to prove, to themselves and to society, that they are doing hard-core
science (which was a leading theme of the landmark Evolution of Psychotherapy
Conference in California in December) is not really surprising.
Given the prestige and trust the modern world gives to scientific
standards, psychotherapists - who always have to measure themselves against the
medical profession - want to demonstrate that they, too, deal in the
predictable; that they, too, can provide evidence for the value of what they
do.
Since at least the middle of the 19th century, Western societies have
been divided between religious truth and scientific truth, but none of the new
psychotherapies are trying to prove they are genuine religions. Nor is there
much talk of psychotherapy trying to inhabit the middle ground of arts, in
which truth and usefulness have traditionally been allowed a certain latitude
(nobody tries to prove the value of Shakespeare).
One of the good things psychotherapy can do, like the arts, is show us
the limits of what science can do for our welfare. The scientific method alone
is never going to be enough, especially when we are working out how to live and
who we can be.
In the so-called arts, it has always been acknowledged that many of the
things we value most - the gods and God, love and sexuality, mourning and
amusement, character and inspiration, the past and the future - are neither
measurable or predictable. Indeed, this may be one of the reasons they are so
abidingly important to us. The things we value most, just like the things we
most fear, tend to be those we have least control over.
This is not a reason to stop trying to control things, but it is a reason
to work out in which areas of our lives control is both possible and
beneficial.
It is not news that most symptoms of so-called mental illness are efforts
to control the environment, just like the science that claims to study them.
It would clearly be naïve for psychotherapists to turn a blind eye to
science, or to be "against" scientific methodology.
But the attempt to present psychotherapy as a hard science is merely an
attempt to make it a convincing competitor in the marketplace. It is a sign, in
other words, of a misguided wish to make psychotherapy both respectable and
servile to the very consumerism it is supposed to help people deal with.
If psychotherapy has anything to offer - and this should always be in
question - it should be something aside from the dominant trends in the
culture.
This means that its practitioners should not be committed either to
making money or to trivializing the past or to finding a science of the soul.
If you have an eye test, if you buy a car, there are certain things you
are entitled to expect. Your money buys you some minimal guarantees, some
reliable results. The honest psychotherapist can provide no comparable
assurances. He or she can promise only an informed willingness to listen, and
the possibility of helpful comment.
By inviting the patient to talk, at length - and especially to talk about
what really troubles him or her - something is opened up, but neither patient
nor therapist can know beforehand what will be said by either of them, nor can
they know the consequences of what they will say.
Just creating a situation that has the potential to evoke previously
repressed memories and thoughts and feelings and desires is an opportunity of
immeasurable consequence, both good and bad. No amount of training and
research, of statistics-gathering and empathy, can offset that unique
uncertainty of the encounter.
As a treatment, psychotherapy is a risk. Psychotherapists are people
whose experience tells them that certain risks are worth taking, but more than
this they cannot rightly say. There are always going to be casualties of
therapy.
Psychotherapy makes use of a traditional wisdom holding that the past
matters and that, surprisingly, talking can make people feel better - even if
at first they resist it. There is an appetite to talk and to be listened to.
Religion has historically been the language for people to talk about the
things that mattered most to them, aided and abetted by the arts. Science has
become the language that helps people know what they want to know, and get what
they want to get.
Psychotherapy has to occupy the difficult middle ground between them, but
without taking sides. Since it is narrow-mindedness that we most often suffer
from, we need our therapists to resist the allure of the fashionable
certainties.
Adam Phillips is a psychoanalyst and the author, most recently, of "Going
Sane: Maps of Happiness."
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