Bring back knowledge!

I went to the dentist recently and was profoundly grateful to find a skilful, experienced and probably highly trained dentist. I really wouldn't have been happy with someone who said that they knew all about dentistry because they had been on a whole weekend course in how to do it, had had couple of fillings themselves and had even read a books on it!

When it comes to psychotherapy, it seems to be very different. Many people seem to believe that they know what psychotherapy is and how it should be done and are perfectly happy to set up as therapist; others are happy to go. It is based more on belief, fashion and conviction than on knowledge or experience. I suppose that this is part of a post-modern, pluralist world suspicious of expertise and hegemony. Reluctantly, after nearly thirty years as a therapist, I have come to the conclusion that most people really don't know what psychotherapy is; they confuse it with personal growth or development or some particular ideology that they subscribe to which often boils down to willpower or belief. They are offered self-help books, quick-fix courses and the encouragement to become powerful, discover themselves and follow their own truth. If fits with a culture of instant change, instant expertise lack of respect for experience (as if human distress has really changed that radically).  There is scant understanding of the difference between the pre-personal; the personal and the transpersonal that Ken Wilber writes of. 

What many will say is that the State should licence therapists but this requires us to trust the government. No thanks!  In Soviet Russia, Freud's works were secretly printed and circulated underground. The present government's love affair with Cognitive Behavioural Therapy (CBT) is only slowly coming to an end. The alternative is for people to become more discriminating.

To evaluate a therapist, as well as trusting your intuition ask them how long they have seen some clients for; (warning;  less isn't better some people take quite a time). Ask they about how they deal with suicidal clients,  how they understand dissociation and embodied trauma; what their experience of long term therapy as a client was like, if they have good regular supervision; their understanding of ego-strength and how it can be built. Ask about what they can do between sessions and what support is offered.

Negative K

I was a teenager in the late 60’s and am from the humanistic tradition of psychotherapy.  It is a tradition based in optimism about what we may be and the sense of basic goodness at the heart of every person which, although it may be corrupted by pain and distress; can be recovered. At its best, I still believe, it represents the deepest spiritual truth; at its worst it is a naïve optimism about people and life and possibilities.  Anyone who has worked as a psychotherapist for a long while is likely to come up against the notion of damage and what can and can’t be repaired in people.  Miracles are always possible and radical change certainly happens.  In the past I have tried with clients to support a realistic idea of what can be changed with the metaphor of the difference between an open weeping wound and a scar. Nothing can create perfect skin but therapy can help change an open wound into a scar; healing doesn’t eradicate all traces of the past, it makes life possible;  the trauma is still discernible but no longer dangerous.

However, clinical experience sometimes takes us to look at the sense that some clients have of damage. Perhaps this is the “Basic Fault” (see M. Balint) that can’t be repaired.  Wilfred Bion, a brilliant  and original developer of psychoanalysis, came up with a theoretical formulation of the functions of Love, Hate and Knowledge in both positive and negative forms.  Negative Knowledge (K minus) is the core part that actively doesn’t want to know and destroys knowledge and awareness.  Its forms can be very destructive of any goodness in the internal world and of any attempts to help. There are many other ways of conceptualising this.  Unless you have led a charmed life as a person and as a therapist , you will have met people who seem impossible to help and who perform the alchemical task of turning gold into shit.  They twist everything good into a force against themselves or others who try and help. 

Melanie Klein gave another way of understanding this through her use of the concept of envy.  Where someone perceives good qualities in another they try and destroy them rather than emulate them or use the gifts being offered. If they receive any goodness into themselves then they turn and try and destroy that through self-attack. The very qualities and experiences which could help them,they seek to destroy. It is very primitive and very real in some people.  I am sure there are Christians that would say that it is the Devil at work. Jungians may say these people are in the grip of an archetype such as The Witch or The Judge. Other forms of understanding this in different cultures can be of possession of the person by a spirit that requires exorcism; a variety of shamanic process. In its positive form this is sometimes called soul retrieval.  Shamanism and psychotherapy are close together as an increasing number of books now recognise such as Christa Mckinnon’s  Shamanism and Spirituality in Therapeutic Practice , recently published. 

The irony is that this work all requires some sort of positive therapeutic relationship; and that is precisely what negative K seeks to destroy. Sometimes therapy and life requires a process of hanging on to this relationship even when results and common sense suggest otherwise. In this respect working as a therapist is an act of faith against a sea of unknowing, unreason and darkness.  The struggle to maintain the therapeutic relationship and get agreement to name and work on the trauma ( which can be very effective using energy psychology methods), is sometimes the bulk of the work. As a committed therapeutic relationship is now against the cultural norm of instant gratification and moving on; this is particularly hard.  The boundary in therapy and life between commitment and masochism is sometimes very hard to discern!

Pleasure

I met a pleasure based psychotherapist recently. When Janov's Primal Therapy came along I seem to recall that he said that a therapist was a dealer in pain. So is therapy about pleasure or pain and trauma?

Nobody would go to a therapist to talk about how happy they were or what a great childhood they had; but it is one of the more interesting questions in therapy the extent to which we have to go in to past pain and trauma to clear it out. In our culture we have the "no pain, no gain" school of development. A deeply Puritan culture like the British is very suspicious of happiness. I can lead straight in to the arms of The Devil. In most therapies, both humanistic and analytic happiness could well be covering something up; even a manic defence against deep sadness. Of course this can be true but it is also true that many defences, particularly somatic ones, tend to block access to all deep emotions; pain as well as joy.  This is simply because all strong emotions and body sensations are close together in their emotional anatomy and neurology. On a fairground rollercoaster the riders play with the edge between fear and excitement; screaming with fear as the car descends and then cueing up for another go! A father playing with a young child may throw them up in the air and catch them giving squeals of joy, excitement, fear overcome by return to safety. Deep sobbing and deep belly laughter are quite similar to observe from the outside. In the intense autonomic activation of orgasm, pleasure and crying can come together. Those in to BDSM are experts on the edge between pleasure and pain and how both can lead to altered states of consciousness.

Many therapies are very interested in trauma; particularly if that term is extended from single incident events such as an accident, or act of abuse or death of someone to include developmental trauma such as having a depressed mother when there would be many occasions when the required empathic attunement and caregiving weren't there. In the past going into the pain was seen as the only way. Now with modern energy psychology methods such as AIT(www.aitherapy.org) that I practice this is known not to be necessary. Just naming the trauma and finding the location in the body is often enough to clear it.

So as we block pleasure and pain, when a client comes in for a session reporting that they feel good. Unless I am very suspicious of this, I will only want to move feeling good to feeling fantastic. There has been more attention recently to positive psychology and to the concept of Flow,  (from Mihaly Csikszentmihalyi);  a state of being where we are not divided and distracted but fully engaged in life at that moment.

So while I will try as a therapist to stay fairly divided in my attention between pain and pleasure. I have a growing sense that working with pleasure and how to expand it and deepen it within our bodies and our neurology is a powerful way forward. This forms a large part of my book Tantric Psychotherapy that I am working on at the moment (see www.tantricpsychotherapy.com )