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Dangers Inherent in the Trivialization of Psychotherapy

DEFINITION  OF  PSYCHOTHERAPYturn for the moral awareness that could
prevent them from being corrupted? If I
For the purposes of this essay, I will usetake a maintenance antibiotic to combat any
the term "psychotherapy" to refer to ainfection that I might get, having the
particular type of interpersonal processantibiotic doing the work my immune system
intended to facilitate conscious awareness ofshould and could, how can I expect my immune
that which had previously beensystem to remain robust or even reasonable
unconscious. It is not meant to includecompetent?Â
the direct attempt to modify behavior,
whether overt as action or covert as thoughtsON  THE  TRIVIALIZATION  OF  PSYCHOTHERAPY
and feelings, through medication or
manipulation of the external consequences ofGiven the significance noted above of
behavior. Similarly, it does notreclaiming deep introspection through
include counseling, coaching, advising, orpsychotherapy, it is noteworthy that
teaching  as  its  primary  goal.psychotherapy itself is in some ways under
attack at the present time. At the most
THE  RECENT  HISTORY  OF  PSYCHOTHERAPYsuperficial level this attack has to do with
funding--i.e. payment for psychotherapy by
In its current form psychotherapy has beenprivate health insurance and public
popular for only about a century, althoughagencies. Although a statistical case
its roots are ancient. Freud calledcan be made for the proposition that good
attention to the importance of the personalpsychotherapy pays for itself in increased
unconscious, repository of those thoughts andproductivity and reduced utilization of other
feelings which are unique to a particulargeneral medical resources, there seems to be
individual and presumed to be a result of hisa trend toward the restriction of third party
or her personal life experiences andfunding for psychotherapy. One theory
genetically transmitted instincts. Jungfrequently put forward to explain this
invited us to notice the collectivestrange trend is that it is simply a result
unconscious, where we find ourselvesof the greed and shortsightedness of the CEOs
connected to all of humanity through sharedof managed care organizations. No doubt
patterns of thoughts and feelings. Eachthese  factors  play  a  role.
of them found the contents of a person's
dreams to be of particular value in accessingAt a deeper level a more pernicious trend is
the unconscious, whether personal oremerging--the trivialization of
collective.  Many followers ofpsychotherapy. Those who find deep
these two pioneers have refined theintrospection to be personally threatening
methodology for accessing these two types ofhave always expressed their anxiety through
unconscious material and integrating it intodeprecating references to psychotherapy as
one's conscious awareness, particularly withinvolving self-absorption, navel gazing, and
regard to the manifestation of unconsciousmental masturbation. More recently the
material in the transference andways in which psychotherapy is trivialized
countertransference. However, Freud andhave become more subtle and perhaps even
Jung deserve most of the credit for makingauto-immune in nature.  That is,
popular in modern culture the idea that theeven among those who describe themselves as
exploration and integration of unconsciouspsychotherapists there seem to be increasing
material is a very important task, perhapsnumbers who see their work as little more
even the most important task any person canthan providing a mental tune-up so that the
undertake.Âclient can function more efficiently in his
or her already prescribed role in
THE  GOAL  OF  PSYCHOTHERAPYsociety.  At the core those who
dismiss all introspection as nonsense, and
Interestingly, both Freud and Jung becamethose who see psychotherapy as merely
interested in the unconscious through theirintended to relieve symptoms, both seem
role as physicians, whose goals are healingto share a disregard for the importance of
and the alleviation of suffering. Eachdeep introspection and the human relationship
of them realized that these goals could bein  the  conduct  of  psychotherapy.
served through greater conscious awareness of
the unconscious, although Freud's modelIf one assumes that the human relationship is
implied somewhat more modest goals thanimportant in psychotherapy, then the
Jung's. Freud held that greaterselection of a good psychotherapist for a
awareness of the contents of the personalparticular person involves much more than
unconscious might help one to adjust morefinding one with certain academic or
comfortably to the demands of civilization,professional credentials. It involves
but that a certain degree of discontent wassome exploration of the inherent
unavoidable. Jung believed that thecompatibility, or fit, between the two
exploration of the collective unconsciouspersons involved before a prediction can be
could reveal the purpose of one's life andmade of the probable outcome of the
bring one closer to a state of union withpsychotherapy. Such exploration is all
God. It is important to note that, inbut prohibited by most managed care
spite of a difference in the ultimate goal ofarrangements. First the psychotherapist
psychotherapy, the exploration of unconsciousis usually referred to as a "provider of
process, particularly as manifested in theservices," a term which seems to connote that
contents of dreams and fantasies, werethe function is more important than the
considered  to be central in its achievement.person. That might be true for a person
who delivers a pizza to one's home, but it is
THE  LARGER  IMPORTANCE  OF  PSYCHOTHERAPYmost certainly not true for a person with
whom one contemplates entering into a most
As noted above, psychotherapy is a new nameintimate relationship. After getting
for an ancient practice. Introspectionpast the insult of thinking of one's
in the broadest sense has ancient roots inpsychotherapist is a provider of services,
practices such as contemplation, meditation,one is told that it is necessary to select a
dream incubation and interpretation, fastingpsychotherapist from a preselected panel of
and other ascetic practices, prayer,candidates, a very small fraction of those
religious ritual, music, ingestion ofwho might otherwise be available. The
psychedelic plants, vision questing, sleepmembers of this panel have usually been
deprivation and the like, to facilitatechosen on the basis of some minimal academic
it. The intentional use of anyrequirements and the willingness to work
technique which facilitates introspectionunder adverse conditions. These adverse
implies that introspection is in some way ofconditions include low pay and frequent
value. Whether one limits that value toviolation of the privacy necessary for
the alleviation of some psychologicaleffective  psychotherapy.
suffering, as Freud would, or sees the value
as ultimate spiritual realization, as JungThe trivialization of psychotherapy as a
would, there is no disagreement that there isresult of the conditions imposed by managed
value in the facilitation or enhancement ofcare is increasingly being matched by
introspection.conditions imposed by the professional
disciplines which provide formal training and
One way to examine the value of introspectioncredentials for most psychotherapists.Â
is to think about one's source ofPsychology is probably the discipline with
authority. In particular, the externalthe most noteworthy case of identification
versus internal locus of the source ofwith the aggressor. It has actively
authority is important to consider. Ifpromoted the "manualization" of
an external authority, such as parents,psychotherapy. This term does not refer
culture, or church, leads me to believe thatto conducting psychotherapy without the use
I should feel guilty or fearful, then theof machinery; it refers to the notion that
alleviation of such guilt or fear may comefor any given condition, like depression,
about as a result of discovering a morethere is a single correct therapeutic
powerful internal source of authorityapproach to be taken. This approach can
which contradicts this belief. Ofbe described in a manual, and then any person
course there can be no guarantee that one canwho can read the manual and follow its
contact a more powerful internal source ofinstructions can perform the
authority. Similarly, there is notpsychotherapy. While it may be true
guarantee that, once contacted, it willthat anyone who can read a map and drive a
indeed counteract a belief previouslycar can deliver a pizza, it is certainly not
instilled from an external source ofthat simple with psychotherapy. For
authority. However, many examples ofpsychology as a profession to pretend
such a counteraction are part of theotherwise trivializes and demeans
experience  most  psychotherapists.psychotherapy.  Ã‚
Here is a personal example of the shift fromI was recently involved in an informal
an external to an internal source ofsupervision session, in which a very mature
authority. I was born in Utah andand sophisticated psychotherapist presented a
raised a Mormon.  I left Utah incomplicated clinical dilemma which had arisen
the first year of my life, and left thein one of her psychotherapy groups.Â
Mormon church in the second decade. TheSeveral respected colleagues, all working
final chapter took place in my fourth decade,within essentially the same theoretical
after having cultivated my sense of innerframework, offered feedback. Although
authority in therapy for 8 or 10 years, whenthe underlying premises about the importance
I managed to get myself officiallyof such things as authenticity, integrity,
excommunicated. During the course ofand respect were the shared by all, the
the trial which resulted in myactual recommended actions to be taken
excommunication, I was sternly admonished bydiverged greatly. The woman presenting the
some of the members of the jury that thecase thoughtfully took in all these
price I was going to pay in the hereafter forrecommendations, asked for clarification or
having been cast out of the Mormonelaboration regarding some of them, and then
brotherhood would be high indeed. Thisformulated her next intervention for her
invocation of the external authority of thegroup. She also commented that the
belief system of the church produced a briefdiversity of opinion from highly respected
surge of terror in me--what if they werecolleagues was both disturbing and relieving,
right? Realizing after a few momentssince it made clear that there is no single
that my great fear was the result of mycorrect approach to any given clinical
having been abusively conditioned as a childsituation. Clearly this woman is not a
by such frightening stories, my terrorcandidate for getting involved in anything
quickly converted to rage.  Nowthe looks like "manualization." On the
paying more attention to my inner authority,other hand, she is someone to whom I would
I managed to suppress expression of both ofrefer, without hesitation, a person I
these strong emotions and to continue with alove.Â
fairly interesting dialogue with my jurors,
and even got invited to offer a closingThe most recent example of the trivialization
prayer when the trial came to an end.Âof psychotherapy in our culture has come in
The most powerful experience of my innerthe form of legislatively mandated keeping of
authority came after I walked out of the"Medical Records."Â In some instances
church. When I got to the parking lot,legislation has been written in such a way as
and was quite separate from those whoto include psychotherapists in general, and
represented external authority of the church,psychologists in particular, within its
I spontaneous and exuberantly began to leaprequirements. For psychotherapists to
into  the  air  and  shout  for  joy.keep such records has at least two
trivializing implications for
A more interesting question about internalpsychotherapy. First is the implication
versus external authority comes up when therethat there would be some genuine utility in
are major philosophical or moral questions inthe keeping of such records. This
need of answers. Questions about theassumes that a person could move from one
purpose of one's life, the ultimate nature ofpsychotherapist to another, have his or her
reality, or what is intrinsically moral in"Medical Records" transferred to the new
response to a given situation, are examplespsychotherapist, and pick up where he or she
of such questions. These are the typesleft off with the previous
of questions that come up repeatedly duringpsychotherapist. This is a preposterous
the course of one's life, and one isassumption when applied to as personal a
therefore well advised to have some ongoingrelationship as is involved in
way of introspecting deeply enough to be ablepsychotherapy. The second, and perhaps
to  find  answers  as  they  are  needed.more chilling, implication of such record
keeping is contained in the actual act of
As example of the need for such answers waswriting down for possible future disclosure
presented a few years ago by the publicationto others, as yet unnamed, any meaningful
of the book, Hitler's Willing Executionerspart of what transpires in
(Goldhagen, 1996). It told of thepsychotherapy.  It would be hard
thousands of German citizens, seeminglyto imagine a mechanism more antithetical to
normal and decent human beings, who willinglythe creation of the kind of trust and safety
went along with one of the most ghastlyrequired for meaningful psychotherapy to take
examples of genocide the world has seen.Âplace.
It is interesting to speculate about the
response of a German bureaucrat to the newsWHAT  IS  TO  BE  DONE?
that he will no longer be managing the
logistics of railroad cars filled withThe problems arising from the trivialization
merchandise bound for market. Startingof psychotherapy are the tip of the
tomorrow his job will be the same with theiceberg. The trivialization of
minor exception of the cargo, which will nowintrospection lies below it, with grave
be human beings bound for torture andconsequences for the Titanic of humanity if
death. He goes home, has dinner withignored. No amount of enforcement of
his family, helps his children with theircurrent or future environmental laws have a
homework, makes love with his wife, and goeschance of saving the earth in the long run
back to work the next day to carry out hisunless a significant percentage of humans
slightly revised duties. What ishave a more immediate and personal experience
missing from this picture? I wouldof a deep connection to other humans in
suggest that introspection is missing.Âparticular and to All Things in general.Â
If this man had a habit of introspection,A similar statement could be made about the
whether through prayer, meditation,possibility that international treaties,
contemplation, or psychotherapy, it is hardtribunals, and organizations will save us
to imagine that he would go to work the nextfrom future wars or nuclear holocaust through
morning believing that his participation intheir ability to impose external constraints
genocide would not be in violation of someon our behavior. As mentioned above,
intrinsic moral principle. (Forthey may heighten our awareness of the
research supporting this rather broadproblems we face, and they may helpful by
generalization, see May, [1987].)Âstarting meaningful dialogue between people
Without such introspection, he is at thewho would otherwise be killing each
mercy of external authority, in this case theother. However, if such dialogue does
German state, which clearly reports to him nonot ultimately lead to a greater appreciation
moral conflict in his compliance. Inof The Other, genocide will merely be
fact,  quite  the  opposite  is  the  case.postponed. Dialogue combined with
introspection can provide the opportunity to
I am not suggested that a brief course ofgenuinely experience "walking a mile in your
psychotherapy or meditation instruction wouldenemy's moccasins," and this experience can
have stopped a German bureaucrat in his orin turn open us up to non-violent options for
her tracks in the weeks before genocidedealing with old hatreds and fears.Â
became the assignment of the day. TheAnything that facilitates the kind of
development of moral awareness that I amintrospection which can lead to such deeply
suggesting such introspective practices mightmeaningful experiences increases our chances
have fostered would have to begin muchof survival, not to mention peace of
earlier. The popular TV show, "Themind. Anything one can do to support
Sopranos," makes an attempt to examine whatthe profound significance, as opposed to
might happen when a person whose moraltrivialization, of such a process should
development has arrested at an early age ishelp. The first step probably has to be
exposed to psychotherapy as a adult.Âa reaffirmation of the importance of deep
The result is certainly not a rapidintrospection in one's own life.Â
compensation for earlier deficiencies in suchClearly psychotherapy is not the only way to
development. What I am suggesting isdo this, but it is a very good place to
that a habit of introspection over the coursestart.  Ã‚
of one entire life, or at least one's entire
adult  life,  can  make  a  difference.References
At the most generic level it would seem thatGoldhagen, Daniel Jonah, Hitler's Willing
the capacity for introspection may beExecutioners: Ordinary Germans and The
something like a muscle. With regularHolocaust, 1996, Alfred A. Knopf, New York,
use it becomes flexible and strong and can be640  pages.
very helpful to its owner. Without
regular use it atrophies and becomesMay, Gerald G. Will and Spirit, 1987, Harper,
useless. In the most extreme case ofSan  Francisco,  368  pages.
neglect of the inner life, one not only loses
the capacity to introspect deeply; one alsoADDENDUM
can lose the awareness that there even exists
any significant internal territory to exploreSince this paper was originally drafted, two
through introspection. Such a lossthings have occurred which call for
makes one extremely vulnerable to the Hitlersadditional comments. The first of these
of the world, which in turn makes all of usis the series of tragic events which took
vulnerable. Just as there is increasingplace on 9-11-01. The second is the
evidence that regular mental activity canresponse of the editor to the first
counteract the loss of cognitive capacitydraft. Among other things she notes
that often accompanies aging, so regularthat deep introspection might lead to the
introspective activity could be expected todesire for violence, rather than the
sustain  the  capacity  to  introspect.opposite, and that many good and moral people
do not introspect and have never experienced
Although the Hitlers of the world give apsychotherapy.
dramatic lesson about our vulnerability as a
species if we lose sight of our internalIn the weeks after September 11, like many
resources, more mundane examples abound.Âothers, I found myself very curious about the
The young retail clerk who cannot make themotivational dynamics of those who had been
simplest of change without using thewilling to kill so many others. Â
calculator built into the cash register hasWhat began to emerge for me was a picture of
lost sight of an internal ability toyoung men who had been completely cut off
calculate. The weatherman who tells usfrom meaningful interpersonal support for
that tomorrow will be a miserable day becauseintrospection since they were very
rain is predicted invites us to forget thatyoung.  This means not only the
we can decide for ourselves whether we enjoydeprivation of anything as structured and
rainy weather. The increasingly bizarreformal as psychotherapy, but also the absence
warning labels that come with electronicof any opportunity for more informal
appliances, telling us to refrain from allinterpersonal exchanges having to do with
sorts of things that would only be done by aintrospection or subjective experiences other
person too handicapped to live outside anthan those prescribed by family, friends,
institution or a person committed to areligion, and one's entire social
painful suicide, invite us to ignore ourmilieu. In the extreme I imagined what
common  sense.it would have been like for one of those
young men, in the months before September 11,
However, it is the ignoring of our internalto have raised doubts or misgivings about the
resources regarding how to live a meaningfulplans they were making. A dream, a
and a moral life that presents the greatestfantasy, or an emotion that had such
possibilities for individual and massimplications would have to have been
misery. A life without a conscioussuppressed or repressed almost
sense of meaning or purpose will generate aimmediately. Certainly to allow oneself
certain desperation of its own, which is insuch experiences, and to open discussion
some way the manifestation of the unconsciousabout them with one's fellows, would have
as it tries to get one's attention regardingbeen to risk complete rejection as a minimum,
the failure to heed one's calling.Âand  immediate  death  as a high probability.
However, if one's habits and culture do not
generally support introspection under suchAt the opposite extreme would be the ancient
circumstances, one is likely to express one'smystical and meditative traditions of the
desperation in harmful ways. Theworld. What little I know of Buddhist
situation is made worse by the absence ofand other such practices is that an enormous
internal awareness of morality, leaving evenvariety of powerful subjective experiences
greater room for destructive acting out ofare expected when the seeker enters into the
such  desperation.particular form of deep introspection
associated with a given tradition.Â
The use of introspection to discern an innerVivid fantasies of unbridled sexuality and
moral awareness is particularly under assaultviolence are common, but in the end give way
in much of the world today. Laws,to--or perhaps are part of-- experiences
regulations, ethics codes, religious creeds,which ultimately develop deep compassion and
mandatory sentencing, and other externalequanimity in the seeker.Â
constraints on behavior, are displacing ourPsychologically this process may be seen at
internal awareness of what is moral and whatleast in part as a withdrawal of the
is not. As such external rulesprojection of evil which, when projected,
proliferate, they invite us to forget that weleads to the perception of "evil-doers" in
ever had any internal way of knowing suchexternal reality and the conviction that
things in the first place--like theÂone's holy task is to slay them. The
young clerk who scarcely is aware of havingVietnamese Buddhist monk Thich Nhat Hanh
the capacity to make change without a cashreports having been able to view the corpses
register. Psychotherapy is one way toof six young men he regarded as his sons,
facilitate a reconnection with our innerbrutally murdered because of their opposition
moral  compass.to the war in Vietnam, and still feel
compassion  for  their  killers.
This is not to say that external constraints
on behavior are always negative. I amPerhaps most people navigate a middle course,
quite pleased to have external constraintsbeing somewhat introspective in a random or
when needed in the short to prevent injuryunconscious sort of way. Thanks to
and death to humans as well as othersleep researchers we know that everyone
species. They may also raise awarenessdreams, whether or not the dreams are
by calling to the public's attention certainavailable for conscious recall upon
problems that need to be addressed.Âawakening. Similarly, everyone
However, in the long run such externaldaydreams, although there appear to be
constraints run the risk of displacing andenormous differences in the degree to which
weakening our internal constraints.Âthis experience is invited or
These internal constraints seem to me to besuppressed. In any case, a certain
our only long term hope. If we rely ondegree of introspection seems to be inherent
some of us to wield the power to constrainin the human condition.  It is up
others of us, who will constrain the some ofto us to decide how much to nurture this
us who are constraining the others? Iftendency, as individuals and as a culture or
power corrupts, where will those in powersociety.



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