Dangers Inherent in the Trivialization of Psychotherapy

DEFINITION OF PSYCHOTHERAPYcould prevent them from being
For the purposes of this essay, I will use thecorrupted? If I take a maintenance
term "psychotherapy" to refer to a particularantibiotic to combat any infection that I might get,
type of interpersonal process intended to facilitatehaving the antibiotic doing the work my immune
conscious awareness of that which had previouslysystem should and could, how can I expect my
been unconscious. It is not meant toimmune system to remain robust or even
include the direct attempt to modify behavior,reasonable competent?Â
whether overt as action or covert as thoughtsON THE TRIVIALIZATION OF PSYCHOTHERAPY
and feelings, through medication or manipulation ofGiven the significance noted above of reclaiming
the external consequences of behavior.Âdeep introspection through
Similarly, it does not include counseling, coaching,psychotherapy, it is noteworthy that
advising, or teaching as its primary goal.psychotherapy itself is in some ways under
THE RECENT HISTORY OF PSYCHOTHERAPYattack at the present time. At the most
In its current form psychotherapy has beensuperficial level this attack has to do with
popular for only about a century, although itsfunding--i.e. payment for psychotherapy by
roots are ancient. Freud called attentionprivate health insurance and public
to the importance of the personal unconscious,agencies. Although a statistical case can
repository of those thoughts and feelings whichbe made for the proposition that good
are unique to a particular individual and presumedpsychotherapy pays for itself in increased
to be a result of his or her personal lifeproductivity and reduced utilization of other
experiences and genetically transmittedgeneral medical resources, there seems to be a
instincts. Jung invited us to notice thetrend toward the restriction of third party funding
collective unconscious, where we find ourselvesfor psychotherapy. One theory frequently
connected to all of humanity through sharedput forward to explain this strange trend is that it
patterns of thoughts and feelings. Each ofis simply a result of the greed and
them found the contents of a person's dreams toshortsightedness of the CEOs of managed care
be of particular value in accessing the unconscious,organizations. No doubt these factors play
whether personal or collective. Âa role.
Many followers of these two pioneers haveAt a deeper level a more pernicious trend is
refined the methodology for accessing these twoemerging--the trivialization of
types of unconscious material and integrating itpsychotherapy. Those who find deep
into one's conscious awareness, particularly withintrospection to be personally threatening have
regard to the manifestation of unconsciousalways expressed their anxiety through
material in the transference anddeprecating references to psychotherapy as
countertransference. However, Freud andinvolving self-absorption, navel gazing, and mental
Jung deserve most of the credit for makingmasturbation. More recently the ways in
popular in modern culture the idea that thewhich psychotherapy is trivialized have become
exploration and integration of unconscious materialmore subtle and perhaps even auto-immune in
is a very important task, perhaps even the mostnature.  That is, even among
important task any person can undertake.Âthose who describe themselves as
psychotherapists there seem to be increasing
THE GOAL OF PSYCHOTHERAPYnumbers who see their work as little more than
Interestingly, both Freud and Jung becameproviding a mental tune-up so that the client can
interested in the unconscious through their role asfunction more efficiently in his or her already
physicians, whose goals are healing and theprescribed role in society.  At the
alleviation of suffering. Each of themcore those who dismiss all introspection as
realized that these goals could be served throughnonsense, and those who see psychotherapy as
greater conscious awareness of the unconscious,merely intended to relieve symptoms,Â
although Freud's model implied somewhat moreboth seem to share a disregard for the
modest goals than Jung's. Freud held thatimportance of deep introspection and the human
greater awareness of the contents of therelationship in the conduct of psychotherapy.
personal unconscious might help one to adjustIf one assumes that the human relationship is
more comfortably to the demands of civilization,important in psychotherapy, then the selection of
but that a certain degree of discontent wasa good psychotherapist for a particular person
unavoidable. Jung believed that theinvolves much more than finding one with certain
exploration of the collective unconscious couldacademic or professional credentials. It
reveal the purpose of one's life and bring oneinvolves some exploration of the inherent
closer to a state of union with God. It iscompatibility, or fit, between the two persons
important to note that, in spite of a difference ininvolved before a prediction can be made of the
the ultimate goal of psychotherapy, theprobable outcome of the psychotherapy.Â
exploration of unconscious process, particularly asSuch exploration is all but prohibited by most
manifested in the contents of dreams andmanaged care arrangements. First the
fantasies, were considered to be central in itspsychotherapist is usually referred to as a
achievement."provider of services," a term which seems to
THE LARGER IMPORTANCE OFconnote that the function is more important than
PSYCHOTHERAPYthe person. That might be true for a
As noted above, psychotherapy is a new nameperson who delivers a pizza to one's home, but it
for an ancient practice. Introspection inis most certainly not true for a person with
the broadest sense has ancient roots in practiceswhom one contemplates entering into a most
such as contemplation, meditation, dreamintimate relationship. After getting past
incubation and interpretation, fasting and otherthe insult of thinking of one's psychotherapist is a
ascetic practices, prayer, religious ritual, music,provider of services, one is told that it is
ingestion of psychedelic plants, vision questing,necessary to select a psychotherapist from a
sleep deprivation and the like, to facilitatepreselected panel of candidates, a very small
it. The intentional use of any techniquefraction of those who might otherwise be
which facilitates introspection implies thatavailable. The members of this panel have
introspection is in some way of value.Âusually been chosen on the basis of some minimal
Whether one limits that value to the alleviation ofacademic requirements and the willingness to
some psychological suffering, as Freud would, orwork under adverse conditions. These
sees the value as ultimate spiritual realization, asadverse conditions include low pay and frequent
Jung would, there is no disagreement that there isviolation of the privacy necessary for effective
value in the facilitation or enhancement ofpsychotherapy.
introspection.The trivialization of psychotherapy as a result of
One way to examine the value of introspection isthe conditions imposed by managed care is
to think about one's source of authority.Âincreasingly being matched by conditions imposed
In particular, the external versus internal locus ofby the professional disciplines which provide formal
the source of authority is important totraining and credentials for most
consider. If an external authority, such aspsychotherapists. Psychology is probably
parents, culture, or church, leads me to believethe discipline with the most noteworthy case of
that I should feel guilty or fearful, then theidentification with the aggressor. It has
alleviation of such guilt or fear may come aboutactively promoted the "manualization" of
as a result of discovering a morepsychotherapy. This term does not refer
powerful internal source of authorityto conducting psychotherapy without the use of
which contradicts this belief. Of coursemachinery; it refers to the notion that for any
there can be no guarantee that one can contactgiven condition, like depression, there is a single
a more powerful internal source ofcorrect therapeutic approach to be taken.Â
authority. Similarly, there is not guaranteeThis approach can be described in a manual, and
that, once contacted, it will indeed counteract athen any person who can read the manual and
belief previously instilled from an external sourcefollow its instructions can perform the
of authority. However, many examplespsychotherapy. While it may be true that
of such a counteraction are part of theanyone who can read a map and drive a car can
experience most psychotherapists.deliver a pizza, it is certainly not that simple with
Here is a personal example of the shift from anpsychotherapy. For psychology as a
external to an internal source of authority.Âprofession to pretend otherwise trivializes and
I was born in Utah and raised a Mormon.Âdemeans psychotherapy. Â
 I left Utah in the first year of my life,I was recently involved in an informal supervision
and left the Mormon church in the secondsession, in which a very mature and sophisticated
decade. The final chapter took place inpsychotherapist presented a complicated clinical
my fourth decade, after having cultivated mydilemma which had arisen in one of her
sense of inner authority in therapy for 8 or 10psychotherapy groups. Several respected
years, when I managed to get myself officiallycolleagues, all working within essentially the same
excommunicated. During the course oftheoretical framework, offered feedback.Â
the trial which resulted in my excommunication, IAlthough the underlying premises about the
was sternly admonished by some of theimportance of such things as authenticity,
members of the jury that the price I was goingintegrity, and respect were the shared by all, the
to pay in the hereafter for having been cast outactual recommended actions to be taken diverged
of the Mormon brotherhood would be highgreatly. The woman presenting the case
indeed. This invocation of the externalthoughtfully took in all these recommendations,
authority of the belief system of the churchasked for clarification or elaboration regarding
produced a brief surge of terror in me--what ifsome of them, and then formulated her next
they were right? Realizing after a fewintervention for her group. She also
moments that my great fear was the result ofcommented that the diversity of opinion from
my having been abusively conditioned as a childhighly respected colleagues was both disturbing
by such frightening stories, my terror quicklyand relieving, since it made clear that there is no
converted to rage.  Now payingsingle correct approach to any given clinical
more attention to my inner authority, I managedsituation. Clearly this woman is not a
to suppress expression of both of these strongcandidate for getting involved in anything the
emotions and to continue with a fairly interestinglooks like "manualization."Â On the other
dialogue with my jurors, and even got invited tohand, she is someone to whom I would refer,
offer a closing prayer when the trial came to anwithout hesitation, a person I love.Â
end. The most powerful experience ofThe most recent example of the trivialization of
my inner authority came after I walked out ofpsychotherapy in our culture has come in the
the church. When I got to the parking lot,form of legislatively mandated keeping of "Medical
and was quite separate from those whoRecords."Â In some instances legislation has
represented external authority of the church, Ibeen written in such a way as to include
spontaneous and exuberantly began to leap intopsychotherapists in general, and psychologists in
the air and shout for joy.particular, within its requirements. For
A more interesting question about internal versuspsychotherapists to keep such records has at
external authority comes up when there areleast two trivializing implications for
major philosophical or moral questions in need ofpsychotherapy. First is the implication that
answers. Questions about the purpose ofthere would be some genuine utility in the keeping
one's life, the ultimate nature of reality, or what isof such records. This assumes that a
intrinsically moral in response to a given situation,person could move from one psychotherapist to
are examples of such questions. Theseanother, have his or her "Medical Records"
are the types of questions that come uptransferred to the new psychotherapist, and pick
repeatedly during the course of one's life, and oneup where he or she left off with the previous
is therefore well advised to have some ongoingpsychotherapist. This is a preposterous
way of introspecting deeply enough to be able toassumption when applied to as personal a
find answers as they are needed.relationship as is involved in
As example of the need for such answers waspsychotherapy. The second, and perhaps
presented a few years ago by the publication ofmore chilling, implication of such record keeping is
the book, Hitler's Willing Executioners (Goldhagen,contained in the actual act of writing down for
1996). It told of the thousands ofpossible future disclosure to others, as yet
German citizens, seemingly normal and decentunnamed, any meaningful part of what transpires
human beings, who willingly went along with onein psychotherapy.  It would be
of the most ghastly examples of genocide thehard to imagine a mechanism more antithetical to
world has seen. It is interesting tothe creation of the kind of trust and safety
speculate about the response of a Germanrequired for meaningful psychotherapy to take
bureaucrat to the news that he will no longer beplace.
managing the logistics of railroad cars filled withWHAT IS TO BE DONE?
merchandise bound for market. StartingThe problems arising from the trivialization of
tomorrow his job will be the same with the minorpsychotherapy are the tip of the iceberg.Â
exception of the cargo, which will now be humanThe trivialization of introspection lies below it, with
beings bound for torture and death. Hegrave consequences for the Titanic of humanity if
goes home, has dinner with his family, helps hisignored. No amount of enforcement of
children with their homework, makes love with hiscurrent or future environmental laws have a
wife, and goes back to work the next day tochance of saving the earth in the long run unless
carry out his slightly revised duties. Whata significant percentage of humans have a more
is missing from this picture? I wouldimmediate and personal experience of a deep
suggest that introspection is missing. Ifconnection to other humans in particular and to All
this man had a habit of introspection, whetherThings in general. A similar statement
through prayer, meditation, contemplation, orcould be made about the possibility that
psychotherapy, it is hard to imagine that he wouldinternational treaties, tribunals, and organizations
go to work the next morning believing that hiswill save us from future wars or nuclear holocaust
participation in genocide would not be in violationthrough their ability to impose external constraints
of some intrinsic moral principle. (Foron our behavior. As mentioned above,
research supporting this rather broadthey may heighten our awareness of the
generalization, see May, [1987].)Â Withoutproblems we face, and they may helpful by
such introspection, he is at the mercy of externalstarting meaningful dialogue between people who
authority, in this case the German state, whichwould otherwise be killing each other.Â
clearly reports to him no moral conflict in hisHowever, if such dialogue does not ultimately lead
compliance. In fact, quite the opposite isto a greater appreciation of The Other, genocide
the case.will merely be postponed. Dialogue
I am not suggested that a brief course ofcombined with introspection can provide the
psychotherapy or meditation instruction wouldopportunity to genuinely experience "walking a
have stopped a German bureaucrat in his or hermile in your enemy's moccasins," and this
tracks in the weeks before genocide became theexperience can in turn open us up to non-violent
assignment of the day. The developmentoptions for dealing with old hatreds and
of moral awareness that I am suggesting suchfears. Anything that facilitates the kind of
introspective practices might have fostered wouldintrospection which can lead to such deeply
have to begin much earlier. The popularmeaningful experiences increases our chances of
TV show, "The Sopranos," makes an attempt tosurvival, not to mention peace of mind.Â
examine what might happen when a personAnything one can do to support the profound
whose moral development has arrested at ansignificance, as opposed to trivialization, of such a
early age is exposed to psychotherapy as aprocess should help. The first step
adult. The result is certainly not a rapidprobably has to be a reaffirmation of the
compensation for earlier deficiencies in suchimportance of deep introspection in one's own
development. What I am suggesting islife. Clearly psychotherapy is not the only
that a habit of introspection over the course ofway to do this, but it is a very good place to
one entire life, or at least one's entire adult life,start. Â
can make a difference.References
At the most generic level it would seem that theGoldhagen, Daniel Jonah, Hitler's Willing
capacity for introspection may be something like aExecutioners: Ordinary Germans and The
muscle. With regular use it becomesHolocaust, 1996, Alfred A. Knopf, New York, 640
flexible and strong and can be very helpful to itspages.
owner. Without regular use it atrophiesMay, Gerald G. Will and Spirit, 1987, Harper, San
and becomes useless. In the mostFrancisco, 368 pages.
extreme case of neglect of the inner life, one notADDENDUM
only loses the capacity to introspect deeply; oneSince this paper was originally drafted, two things
also can lose the awareness that there evenhave occurred which call for additional
exists any significant internal territory to explorecomments. The first of these is the
through introspection. Such a loss makesseries of tragic events which took place on
one extremely vulnerable to the Hitlers of the9-11-01. The second is the response of
world, which in turn makes all of usthe editor to the first draft. Among other
vulnerable. Just as there is increasingthings she notes that deep introspection might
evidence that regular mental activity canlead to the desire for violence, rather than the
counteract the loss of cognitive capacity thatopposite, and that many good and moral people
often accompanies aging, so regular introspectivedo not introspect and have never experienced
activity could be expected to sustain the capacitypsychotherapy.
to introspect.In the weeks after September 11, like many
Although the Hitlers of the world give a dramaticothers, I found myself very curious about the
lesson about our vulnerability as a species if wemotivational dynamics of those who had been
lose sight of our internal resources, morewilling to kill so many others. Â
mundane examples abound. The youngWhat began to emerge for me was a picture of
retail clerk who cannot make the simplest ofyoung men who had been completely cut off
change without using the calculator built into thefrom meaningful interpersonal support for
cash register has lost sight of an internal ability tointrospection since they were very young.Â
calculate. The weatherman who tells us This means not only the deprivation of
that tomorrow will be a miserable day becauseanything as structured and formal as
rain is predicted invites us to forget that we canpsychotherapy, but also the absence of any
decide for ourselves whether we enjoy rainyopportunity for more informal interpersonal
weather. The increasingly bizarre warningexchanges having to do with introspection or
labels that come with electronic appliances, tellingsubjective experiences other than those
us to refrain from all sorts of things that wouldprescribed by family, friends, religion, and one's
only be done by a person too handicapped to liveentire social milieu. In the extreme I
outside an institution or a person committed to aimagined what it would have been like for one of
painful suicide, invite us to ignore our commonthose young men, in the months before
sense.September 11, to have raised doubts or
However, it is the ignoring of our internalmisgivings about the plans they were
resources regarding how to live a meaningful andmaking. A dream, a fantasy, or an
a moral life that presents the greatest possibilitiesemotion that had such implications would have to
for individual and mass misery. A lifehave been suppressed or repressed almost
without a conscious sense of meaning or purposeimmediately. Certainly to allow oneself
will generate a certain desperation of its own,such experiences, and to open discussion about
which is in some way the manifestation of thethem with one's fellows, would have been to risk
unconscious as it tries to get one's attentioncomplete rejection as a minimum, and immediate
regarding the failure to heed one's calling.Âdeath as a high probability.
However, if one's habits and culture do notAt the opposite extreme would be the ancient
generally support introspection under suchmystical and meditative traditions of the
circumstances, one is likely to express one'sworld. What little I know of Buddhist and
desperation in harmful ways. The situationother such practices is that an enormous variety
is made worse by the absence of internalof powerful subjective experiences are expected
awareness of morality, leaving even greater roomwhen the seeker enters into the particular form
for destructive acting out of such desperation.of deep introspection associated with a given
The use of introspection to discern an inner moraltradition. Vivid fantasies of unbridled
awareness is particularly under assault in much ofsexuality and violence are common, but in the end
the world today. Laws, regulations, ethicsgive way to--or perhaps are part of-- experiences
codes, religious creeds, mandatory sentencing, andwhich ultimately develop deep compassion and
other external constraints on behavior, areequanimity in the seeker. Psychologically
displacing our internal awareness of what is moralthis process may be seen at least in part as a
and what is not. As such external ruleswithdrawal of the projection of evil which, when
proliferate, they invite us to forget that we everprojected, leads to the perception of "evil-doers"
had any internal way of knowing such things inin external reality and the conviction that one's
the first place--like the young clerk whoholy task is to slay them. The
scarcely is aware of having the capacity to makeVietnamese Buddhist monk Thich Nhat Hanh
change without a cash register.Âreports having been able to view the corpses of
Psychotherapy is one way to facilitate asix young men he regarded as his sons, brutally
reconnection with our inner moral compass.murdered because of their opposition to the war
This is not to say that external constraints onin Vietnam, and still feel compassion for their
behavior are always negative. I am quitekillers.
pleased to have external constraints when neededPerhaps most people navigate a middle course,
in the short to prevent injury and death tobeing somewhat introspective in a random or
humans as well as other species. Theyunconscious sort of way. Thanks to sleep
may also raise awareness by calling to the public'sresearchers we know that everyone dreams,
attention certain problems that need to bewhether or not the dreams are available for
addressed. However, in the long run suchconscious recall upon awakening. Similarly,
external constraints run the risk of displacing andeveryone daydreams, although there appear to
weakening our internal constraints. Thesebe enormous differences in the degree to which
internal constraints seem to me to be our onlythis experience is invited or suppressed.Â
long term hope. If we rely on some of usIn any case, a certain degree of introspection
to wield the power to constrain others of us, whoseems to be inherent in the human
will constrain the some of us who are constrainingcondition.  It is up to us to decide
the others? If power corrupts, where willhow much to nurture this tendency, as individuals
those in power turn for the moral awareness thatand as a culture or society.