As manager of a large clinic I oversee many different kinds of psychotherapeutic work. All of it comes with different demands: those of accrediting bodies, of intellectual or methodological affiliations, and of less easy to locate authorities such as thinkers or charismatic figures a therapist might hold in high esteem, and for whatever reasons identify with or want to follow. This paper explores the relationship between these demands and things that may be being ‘done’ to clients. However much some of us deny it, particularly the more psychoanalytic of us, we are always ‘doing’ things to our clients. We provide them with rooms; we listen and we talk, and so on. These kinds of things, however, might be rather easier for our clients to complain about: ‘I don’t like this room, you haven’t heard a word I’ve said and the sound of your voice makes me ill.’
Increasingly however, there are therapeutic activities, workshops, or perhaps EMDR sessions where the things that are ‘done’ are more concrete or active. Clients are ‘debriefed’ or follow a light source. In these things the idea that they may not like what they are subjected to in the name of a good process (the ‘right’ process in line with a set of demands), that they may be disappointed but find it hard to protest, is perhaps overlooked. Therapy is in danger of becoming a grievance machine.
I was reviewing the procedures concerning clients starting work at the clinic I run, in particular the details of contracts. Some of my thoughts related to others I had previously had about therapy as a contract in the sense of an instrument, and a discomfort I have been feeling about the way I believe my profession has become increasingly over-regulated. This over-regulation is usually excused as necessary to protect clients’ interests against unscrupulous or unprofessional therapists.
Certainly there are bad therapists. Rogue individuals who have slept with, embezzled, misled, borrowed from or otherwise abused their clients. But when regulation becomes an industry, and I am not simply talking about accreditation by bodies but forms of treatment drawing allegiance to a particular thinker or charismatic figure, whether that is Freud or Pia Mellody, something else enters the equation: the survival of that industry. People initiate businesses for different reasons, not always to thrive commercially, but once an organisation starts to flourish and make money its employees become bound to acting in its best interests. They must make money. They must create new products in order to make money; and those imperatives generate forces. This piece is about the effect of those forces.
As I said, these were thoughts that had concerned me before I started rifling through contracts, and some of them I will deal with in other places. What I noticed, however, as I read through the detail of the contracts and started to think about how what I read related to the demands of the bodies laying claim to the processes those contracts sanctioned, was that I was very irritated.
I feel irritated when I see someone unwittingly bound into something that they might reasonably object to, and then denied the right to withdraw or to object, or both. I mean situations where complaint has been ‘managed’, but often not through any chain of decisions to which anybody could be laid accountable. Unconscious processes accounting for a lot, perhaps.
So there were reasons why what I was doing might irritate me, but I couldn’t see why my feelings were quite so heightened; and I think this is where my thoughts intersected with the ones I have repeated here. I could call them the unconscious effects of bodies, organisations, institutions, call them what you will, seeking to assert themselves so that they might thrive. The anxious drive of entities striving to be in the world, where to be involves, amongst other things, ensuring a certain way of doing things persists.
What happens to the people called on to administer on behalf of these bodies? Official, therapists, and in the end, clients? To what extent are they bound to please that body? And what place is there for anger, if anger is the emotion we need to call on for justice, if we wish to complain?
Perhaps we could look at this in the light of one particular therapeutic intervention: an experiential workshop based on Pia Mellody’s Post-Induction Therapy. Part of this workshop often involves a process described as ‘giving back’ feelings. The process of ‘handing back’ shame to a parent, for example, which has become a feature of many experiential, workshop-based forms of psychotherapy. In many ways I don’t need to be convinced of how effective these workshops often are. Like other forms of trauma treatment, EMDR for example, they address the past in ways that might mean long-term psychotherapy can become an option for people who might otherwise have found the process impossible to engage with. They help make it, as Bessel Van der Kolk put it: ‘safe for people to stare reality in the face’.
Having worked with people for some time after they’ve gone through processes which emphasise ‘handing back’ feelings I have however noticed a couple of tendencies. Some clients remain in a cycle of blaming and denigrating people, usually parents, who they addressed in the workshop. Often this is overt, other times it is more subtle, by displacement: for example attacking figures or groups that stand for authority or coherence without having particularly evolved thoughts about why they are doing so. Other clients, usually those who more subtly denigrate, seem intent on telling me, at the expense of a more complex mixt of feelings, how good they feel and how great things are. They seem constrained by a desire to please or assure me that they had a wonderful experience. Am I imagining it, or are they really in some way angry? I ask, and I am reassured: absolutely not. I feel good, I feel strong, I feel solid.
A client might seem less ashamed of themself, having emotionally and intellectually invested in a new sense of their ‘separateness’, but they still seem removed from the liberty and autonomy which objectively seems available to them in life. Why do they seem angry, in spite of what they say?
When I think about what’s happening if, in the presence of a therapist, working with what becomes called my inner child, I symbolically hand back my shame, this doesn’t surprise me; especially if I recognise that working with the ‘inner child’ can be such a good way of exploring what certain forms of therapy might call my unconscious.
As I become aware of my ‘inner child’, what happened to me when I was young, I get to know me more as I was then. I feel something of myself and what affected me when I was a child more as it was at the time. I can become conscious of qualities such as shame that were projected onto me, which have determined my life in ways I didn’t imagine. In all of these things I see the positive potential of workshops.
Some therapists would go further, though. They would say I can reject the feelings I introjected as a child and symbolically, in the form of enactment, hand them back to the person who I believe gave them to me. They would try to give me a story with a happy ending, calling it, perhaps, ‘closure’.
There’s something that the French psychoanalyst Jean Laplanche wrote which might tip us off about how careful we need to be with happy endings. Or at least that we need to think about what we might be doing if we wish to give our clients an immediate sense of ‘job done’:
Psychoanalysis shows us that history is neither a continuous nor a cumulative process, that it does not have a happy ending, that it does not evolve smoothly and that its course is marked by repression, repetition and the return of the repressed. (Laplanche, 1989)
Maybe I could take a lead from Laplanche and explore how psychoanalysis suggests gestures such as ‘handing back’ might not be a good idea?
My idea of what comprises ‘me’ is perhaps a peculiar thing. When I watch a film at the cinema, for example, where’s that film happening? If I proceed through my various assumptions, things I haven’t considered, and whatever feels intuitively right or wrong I might arrive at a strange thought: it’s happening in me. That’s why you and I can see different things in the same film. Whatever I go to watch I see in the company of me and my whole life: all of my thoughts, feelings and anything else in me, the rubble of my unconscious and the summits of my epiphanies.
Anything that occurs, even sometimes if I am unaware of it, can become something in me. So we take on other people’s feelings, actions and words and make them our own. Can we ever let go of them again? I really don’t know, but I imagine something is only likely to change like that slowly, without any ‘handing back’. I need instead a strong sense of what I have received (which these workshops are very good at providing) and how I may have responded to it. How has it entered my relationships to people, places and things? And above all, to myself: the ways in which I think of me.
Life gives us many opportunities for this, but it needs to happen at the right moment. Daniel Stern’s ‘moments of meeting’ are moments that cannot be artificially constructed or enacted, or more importantly managed. They can only be recognised.
I’m thinking, for example, of the kind of thing that happens to Joanna Kavenna’s unnamed narrator in the novel Come to the Edge (2012). Having been left by her husband because he desires a child she believes she cannot give him, she escapes to live in dire circumstances with the extraordinary Cassandra White, a woman who has no desire to please anybody. Cassandras, of course, tend not to.
‘You should get more angry,’ she tells me over dinner.
‘I thought I was quite angry.’
‘You’re not at all angry. You think you deserved it. You think your barren womb drove your husband away. Have you ever considered the notion that it might have been him?’
‘Him who drove himself away?’
‘Him who was barren.’
‘No, I never really thought of that.’
‘Ridiculous, you let him blame you for everything.’
“Why are you here, living a life you hate, if you don’t think you were to blame for everything?’
‘I don’t know.’
‘Of course you don’t know. It’s far too complicated for your limited reserve of clichés. You can’t understand yourself at all.’
‘That’s not true.’
‘You should have shot him.’
‘Your husband, of course. You should have got a shotgun and shot him in the arse.’
Relational psychotherapy at its best, although possibly not as my accrediting body might sanction it. And although you may detect a joke in this, I would also like you to keep in mind something very serious: the point of this piece really. Contemporary psychotherapy of all kinds is becoming an enterprise intended to please.
Change, when it comes, needs to come unexpectedly, sometimes shockingly, unwantedly, and in relation to someone or something outside of me. Sometimes the only appropriate response might be anger. Kavenna’s narrator might be muted, but neither is she at this point grateful.
When I hand back feelings as part of a therapeutic exercise, however, I am returning them to an internalised character, the sense of that character – my mother, for instance, and the ways in which these come together, that I have been developing and carrying since my birth. In doing so, even if I don’t realise it, I still take care of her feelings. I’m left to curate them, and who wants to be their family’s emotional guardian? In a curious but confusingly real way they remain in me.
It’s from this, I believe, that a sense of blame emanates. Forgiveness can’t occur in an internal economy. There needs to be something outside it, something unknowable, to interject unexpectedly and help me realise what I don’t know. A therapist or a Cassandra.
I believe there can be a release from blame, a kind of letting go, but that’s what we talk about when we talk about mourning – and that process will take a very long time. Freud wrote about melancholia (Freud, 1917), a strange process of not letting go. Are we talking about something like that, here, when we talk about ‘handing back’? Handing back not as a letting go, but actually as a form of incorporation, of taking something else in? Compromising myself and feeling bitter rather than being honestly able to address someone else?
All of this, I would argue, from trying to give our clients too much. Why do psychotherapists sometimes try to give their clients too much? Perhaps because they, themselves, have not been able to let something go: the desire to fix and the sense of completeness that comes from ‘getting it right’. But a therapist who, whether or not they know it, worries about ‘getting it wrong’ is little more than a bureaucrat, an official of whatever organisation or powerful figure they feel that they belong to; that they feel indebted to because they have not heard Cassandra speak: You should get more angry. These are where the forces that drive compliance originate; where the need to please arises like a nasty little stream bubbling from a sick old hillside.
What’s a grievance machine if it isn’t a desire to please?
A grievance machine: a way of accumulating resentment. A grievance machine: an inability to stare reality in the face; an avoidance of loss and a failure to let go, to mourn. A grievance machine: a ghost of a machine that haunts psychotherapy, which can bring it to its knees.
Freud, S. (1917). Mourning and Melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XIV (1914-1916): On the History of the Psycho-Analytic Movement, Papers on Metapsychology and Other Works, 237-258.
Kavenna, J (2012). Come to the Edge. Quercus
Laplanche, J. (1989). New Foundations for Psychoanalysis. Wiley-Blackwell.