David Smail Psychotherapy Society and the IndividualDavid Smail

8/12/2019 David Smail Psychotherapy Society and the IndividualDavid Smail

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Psychotherapy,

Society and theIndividual

David Smail

Talk given at the 'Ways with Words' festival of literature,

Dartington, 12th July,1999


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There is no doubt that psychotherapy can be perhaps usually

is a very powerful experience. Like many other kinds of

experience, however, its power the weight of conviction it

imposes is no guarantee of its validity.

There are of course many kinds of psychotherapy, frequently

radically incompatible with each other, theoretically

irreconcilable and technically mutually inconsistent. And yet

nearly all share one crucial characteristic: they involve an on-

going often indeed protracted closely intimate relationship

between two people. (Group therapy is quite a different kettle of

fish, and Ill not be talking about it for present purposes.) It is

this relationship, technicized by the psychoanalysts astransference and counter-transference, which gives

psychotherapy its experiential power. Its really quite difficult to

spend many hours of your life cooped up in the consulting room

of someone who is intently trying to understand you without

emerging with the feeling that something momentous has

happened.

Its very nearly impossible to discount the conviction ofsignificance which our personal feelings so often carry with

them. An example which may be familiar to people here who

havent experienced psychotherapy may be that of writing.

Many professional writers speak with awe of the magical

experience of writing, of the way it seems to take place through

them, almost as if their words were being written by the hand of

God. Portentous accounts of creativity have been grounded on

this experience. Indeed, I have experienced it often myself andcan vouch for its capacity to leave one feeling deeply moved.

It wasnt until a man I knew told me how his short stories came

to him that I began to get an idea of what this experience is

about. His eyes misting with emotion, he told me how his

stories seemed eerily to write themselves, how they poured

themselves from the end of his pen faster than he could control

the muscles of his hand. He positively glowed - humility and


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pride in equal proportions - that the mystery of the creative act

should have been vouchsafed to him.

The trouble was, his were without question the worst short

stories I have ever seen committed to paper. Chaotically

constructed, banal, misspelt and ungrammatical, they were in

fact barely literate.

What this reveals, I suspect, is merely that for anyone, creatively

gifted or not, writing tends often to carry with it a different kind

of experience from talking, without the same kind of illusion of

control: one is more aware, with writing (rather perhaps as with

dreams), that the ego is not as central as we often take it to be.Thats all.

The experience of psychotherapy is rather like this. No matter

what the content of what passes between client and therapist, the

relationship generates in both a conviction of profundity and

significance which leads not only to a (most often) erroneous

belief that fundamental changes have taken place in the client

but also a widespread certainty in the truth of the theoryemployed and the efficacy of whatever technique the therapist

claims to have used. Once youve experienced this you are more

than likely to be hooked. Perhaps this is why (though probably

not consciously) so many schools of psychotherapy insist on

acolytes going through the therapeutic experience themselves.

Most religions and cults make the same kind of requirement.

The power of personal experience is not to be underestimated,

and (as well, of course, as more noble human sentiments andachievements) prejudice and bigotry depend upon it.

If we take a step back from personal feelings, difficult though

that may be, we are likely to get a more sober view of the

significance and efficacy of psychotherapy. Taking this kind of

step back is of course precisely what science is supposed to be

about, and although the social sciences can scarcely be

considered as a unified and uncontentious field (if it wasnt such


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a clich Id say they were riven with dissent) it is still true that

over half a century of intense scientific examination of

psychotherapy, producing countless volumes indeed libraries

of evidence, provides little support for the confidence most

therapists, as well as many of their clients, have in their

procedures.

So far as a scientific consensus is possible, we might be able to

agree that the helpfulness of therapy, such as it is, has more to

do with the personal qualities of the therapist than with any

particular theory or technique; that such personal qualities are

not a matter of training, so that many people who are not

qualified therapists are likely to be as good or better at it thanpeople who are; that fairly obvious forms of commonsense

enquiry and advice (ponderously baptised cognitive-

behavioural) are likely to be more effective in alleviating

psychological distress than are the more recondite procedures

of, for example, dynamic psychotherapy.

The best thing for psychotherapists faced with this kind of

evidence to do is to look around for grounds for dismissing it.Human ingenuity being what it is, that is not too difficult,

especially in postmodern times when the whole boring nature

of so-called positivistic science is discredited at some of the

highest intellectual levels. But thats not what I want to do, not

least no doubt because my own experience of getting on for

forty years as a clinical psychologist accords rather well with the

scientific evidence (and of course I am as vulnerable as anyone

to personal conviction!).

What seems to me important is to understand why

psychotherapy is not as effective as people feel it to be and,

more important, to develop a more satisfactory idea of how

psychological distress comes about and how it might best be

dealt with.

I am making some assumptions here which need to be spelt out


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freedom and responsibility.

Even this, though, has its own attendant set of dangers: a

defence of subjectivity and celebration of individuality can

quickly develop into a pervasive orgy of interiority in which

people become so exquisitely sensitive to their own feeling-

states and intuitions, etc., that they are virtually removed from

the public world of spontaneous social action. Absolutely

nothing is more boring and futile than focussing to the exclusion

of almost everything else on the quality and finer meaning of

ones own sensations and experiences not to mention dreams.

Therapy junkies can easily find themselves in that kind of

condition, and spend far more time than is good for any of uswriting about it.

But I think what most people understand by psychotherapy is

precisely a form of treatment for psychological disturbance, and

certainly by far the majority of the practitioners of the myriad

forms of therapy available today at least imply that that is

indeed the nature of their game even if they dont openly claim

it. In other words, what most psychotherapists are offering atleast tacitly is a professional service involving established and

validated procedures for the relief of distress. In this situation, it

seems to me perfectly legitimate to ask for evidence that such

procedures do indeed exist and that they work. And it is

precisely here, of course, that psychotherapies become unstuck

in a big way. Now I dont at this point want to get embroiled in

a dispute about evidence and what may legitimately be said to

constitute it: social scientists can (and will, nothing is morecertain) go on squabbling about that kind of thing for ever.

Pretty well everyone not having directly vested an interest in a

particular therapeutic brand name is agreed that the evidence for

the effectiveness of therapy is overall weak. What I do want to

do is suggest some reasons why this isnt such an outrageous or

dismaying circumstance as some may feel it to be. In fact its

pretty well to be expected.


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Psychotherapy is, when one comes to think about it, a curious

phenomenon: one very much of the twentieth century and

indeed particularly suited to these supposedly postmodern

times which is perhaps why it is currently booming as never

before. We have become so familiar with the ideas explicit and

implicit in psychotherapy, it chimes in so harmoniously with the

Zeitgeist indeed in part it is definitive of the Zeitgeist that it

becomes quite a struggle to see how curious a phenomenon it is.

But what it does, I would suggest, is something quite radical

even violent to the nature of our personhood and our relations

with the world. To be more specific: it disembodies us and it

dissociates us.

Through its focus on the individual and its limitation for the

most part of its analysis to the individuals relations with a) his

or her family and b) the therapist, psychotherapy lifts the person

out of the physical and social contexts which actually shape and

maintain him or her as a person. It simply ignores the main

factors and influences which make us the people we are. The

aim, of course, is to free us, to give us power over our lives and

the ability to change their course when things go badly. But it isan illusory freedom and one which in the long run does us much

more harm than good. In fact, if only it could speak for itself,

the consensual core of psychotherapeutic thinking would find

much to agree with in Margaret Thatchers dictum that there is

no such thing as society, only individuals and families. It might

even go further in maintaining that, its all being in the mind,

there are no such things as bodies either. Let me just take the

factors of disembodiment and dissociation one at a time.

Disembodiment

In nearly all its varieties, psychotherapy tends to think of bodies

as unproblematic, as secondary to mental influence; in many

respects the mind is seen as constitutive of physical structures.

This is seen at its most extreme in the view that, through the

operation of imaging a person can organize a kind of


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biological attack on pathogenic physical processes such as the

production of cancer cells. (Apart from its absurdity, this kind of

thinking can lead to very unfortunate consequences, for what

starts out as a half-baked notion of the magical power of thought

ends up in people feeling responsible for their inability to cure

their cancer.)

The privileging of the mental is rarely as extreme as this, but is

still widespread in psychotherapeutic thinking. Psychoanalysis,

of course, gives colossal power to the Unconscious and its

ability to shape our bodily experience and reactions, and ideas

like that of psychosomatic illness can quickly slide into a view

that psychological events cause physical ones. Such ideas maybe harmless enough even quite fruitful as a kind of rhetorical

counter to an unthinking biological mechanism, but they too

easily come to underpin a received and utterly erroneous

notion of the power of mind over matter.

In run-of-the-mill therapeutic work the factor of disembodiment

is encountered most frequently, albeit somewhat indirectly, in

the pervasive notion of insight. At first glance the idea that wecan act freely on the basis of what we see to be the case and that

the identification of misconceptions is enough to enable us to

change our ways seems innocent enough, and indeed forms one

of the principal pillars of everyday ways of thinking.

Psychotherapy is built around this idea. In order to change their

neurotic ways, people have to see into their reasons, conscious

and unconscious, for clinging on to them, and having done so

will be able to take a different course.

Whats the matter with that? you may say. Well, the matter is

that our learned patterns of thought and action are not merely

mental acquisitions, but are embodied. It is no easier for people,

for example, to throw off anxiety and lack of self-confidence

merely through having seen into its history than it is for them to

speak anything other than their mother tongue simply by being

given an account of how they came to speak it. Psychotherapy


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tends in this way to represent our personal characteristics and

conduct as matters of choice, as though we were, from infancy

on, disembodied wills, selecting (even if unwisely or

unconsciously) what suited us from a kind of hypermarket of

possibilities.

But experience is embodied. Wired in. We may if we are lucky

be able to an extent to choose our influences (good parents will

do this for us as we grow up, and the more resources they have

at their disposal the more successfully they will be able to do it)

but we cannot choose whether or not to be influenced, or to

become uninfluenced once we have been influenced. As Ive

found myself saying over and over again to people, you cantchoose to forget how to ride a bike. The same is true with so-

called psychological influences: you cant just divest yourself

of their consequences merely because it now suits you (having

gained insight) to do so.

Dissociation

Because psychotherapy focuses almost exclusively for thederivation of its theory and practice on the two occupants of the

consulting room, looking beyond for the most part only to the

members of the patients immediate family, the result is a

dissociation (social dislocation) of the individual which has

profound implications for the understanding of how, among

other things, psychological distress comes about. A world is

created in which it seems as though persons are made solely

through the interplay of wilful action among those with whomthey are most intimately involved that is to say in the

proximal relations with their family and some others with

whom they have close, intense, relations, including of course

their psychotherapist. It is their relations with the latter which

are seen as crucial to their psychological transformation. Left

unanalysed in this situation, and very possibly not considered at

all, are the influences of the wider culture and social

environment.


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In mainstream psychotherapeutic thinking there is nowhere to

look for the meaning of action beyond the actors themselves,

and so the potent factors in the process of becoming a person

and the struggle to change are likely to be seen as intention, will,

desire those factors which in fact all of us in our day-to-day

lives take for granted as the sources of our conduct. However,

because it is every therapists experience that people cannot

change merely because they intend to or want to, another

dimension has to be added to the equation to explain their

apparent recalcitrance, and that of course is the dimension of the

Unconscious which becomes a repository for intentions and

desires of which the person is unaware. What you then end upwith is a kind of voluntarism at one remove, where therapists

can hint at what people really (unconsciously) desire and

intend, and chide them (though obliquely) with a kind of

concealed moralism: now youve seen what youre really up to,

dont you think youd better change your ways? As an account

of human conduct this really is extraordinarily inadequate.

In many areas of our lives we are in fact shaped by forces wellbeyond the reach of our will and even in some respects of our

understanding. Very significant parts of what we take to be our

personal individuality are quite literally culturally determined.

Socio-economic influences affect us as intimately and as

uncontrollably as the weather. As people we are locked into a

network of social power-relations which sets the strictest limits

on what we are able to achieve purely through the action of our

own will (it was of course Michel Foucaults particularachievement to elucidate the nature of this apparatus of social

power). What aspects of our personal and interpersonal conduct

may be controlled by powers which we cannot even see, let

alone influence, is far from clear, largely because our

individual-centred psychology has for the most part failed to pay

them any attention. However, what is clear, I think, is that the

influence upon us of such distal powers is far, far greater than

we have so far been able to understand and severely limits what


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can be achieved through such proximal undertakings as

psychotherapy.

We are through and through social creatures, and our happiness

and unhappiness are conditioned by our relations with each

other not just as face-to-face individuals but through highly

complex networks of social organization. And that organization

is above all structured by power. How much we are able to alter

our circumstances, and so perhaps affect the balance of our

happiness and unhappiness, will depend not on our being able to

tap sources of will power, hitherto perhaps buried in our

unconscious, but on what forms of social power are available to

us from without.

Please let me remind you at this point that I am not trying to say

that psychotherapy as an undertaking or as a vocation (the

preferred term of Paul Gordon, who will be speaking this

afternoon and whose version of psychotherapy I have little

quarrel with) is intrinsically invalid. What I am saying is that in

its guise as technical procedure of change, the disembodiment

and dissociation of human beings which psychotherapy so easilybrings about ends up inevitably in a very probably

unrecognised belief in magic, for the material means of

causality have been removed from the picture. We are not the

kind of self-creating, self-changing entities that psychotherapy

so often assumes us to be. Our conduct is shaped and given

meaning by a social world and mediated by biological structures

which we cannot change simply by seeing the necessity for

doing so or desiring to be otherwise. There is in fact no suchthing as will power if we are able to will an action it is

because the power is available to us to perform it, and that

availability of power originates from without, not from within.

We can transcend the reality of social power (of its facilitating

as well as of its constraining effects) and of the capacities and

limits of our own biological structure only in our imagination,

and when it comes to affecting the circumstances of our lives

which cause us pain, imagination is not the most potent


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instrument.

I am not saying anything new with this. Im sure that to many it

seems, as it does to me, so obvious as to verge on banality. What

I am doing is taking a side in a debate which runs right

throughout the history of culture. In view of this, it always

surprises me how upset with what Im saying some people seem

to get. Apart from sheer abuse from some fellow professionals

(e.g. that Im suffering from clinical depression), the most

frequent accusation aimed at me is that I am depriving people of

hope. But this is the case only if the version of psychological

suffering and its treatment offered by the therapeutic paradigm

is the only valid possibility. I am indeed saying thatpsychotherapy as a technique or set of techniques for the

treatment of psychological distress can only be of limited value

(not that it is valueless). This is because by far the greater part of

psychotherapeutic theory has failed to progress beyond the most

nave psychology of personal development and essentially

magical ideas of change. I dont see anything particularly

hopeful about reliance on magic as a cure for distress. Hope lies

in other directions. Perhaps I should take just a little time to givean indication of what kind of other direction might be worth

following.

From a psychological point of view the Twentieth Century has

been a colossal diversion (certainly in the West) from an

examination of the way individuals are created and maintained

by their environment. The quality of thought Plato gave in his

Republic to the kind of cultural diet most suitable for its futureleaders is barely conceivable now, where about the most we get

is cursory studies or literature reviews to show, for example, that

television has no influence on violence. Our emphasis, as I have

already indicated, is very heavily on the inside, on mental

factors such as choice and will, and moral factors mostly seen as

personal, such as responsibility. Because of this, our gaze is

diverted from the social world around us and our preoccupations

are with self-transformation of the personality rather thanpolitical transformation of the society beyond the boundaries of


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our skin.

The logical culmination of this one whose lineaments are

already clearly discernible is that our world becomes virtual

rather than actual, and in place of a materially created reality we

are immersed in an ideality which is spun by its various doctors

into all manner of marketed wishfulness. At the political level

exhortation and the avowal of values come to be seen as an

acceptable substitute for material action.

The costs of pretending that we are immaterial beings capable of

self-transformation into shapes and conditions of our own

choosing, as essentially free of the limitations of the body as ofthe constraints of society, are I believe already to be seen in the

forms taken by the psychological afflictions of the young, some

of whom have become prey to a kind of anxiety in which they

are panicked by, for example, the experience of their own

bodies; they have simply not been taught what it is to be a

human being and do not recognize feelings which are the

common lot of ordinary mortals.

We have become absolutely to depend on the notion that it is

possible to change aspects of ourselves we find inconvenient, to

erase the inscription upon us of the environmental influences

which surround us. Rather than accepting that experience marks

us for good and all, we wish to insist indeed have come to

expect and demand - that its effects can be counselled away.

But would it really be so terrible if psychotherapy didnt work inthe way we seem to expect it to? Perhaps if we were shaken out

of our bewitched fascination with imagination and virtuality,

the wishful invention of interior worlds which have no

embodied substance, we might come to see that paying sober

attention to the realities of social structure and of our relations

with each other as public, not simply private, beings is an

option. A difficult one certainly not so easy as dreaming and

wishing but at least a real one. What this would entail is a


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recognition that maybe prevention is more possible than cure; a

down-grading of psychology in favour of an up-grading of

politics.

Where, though, would this leave individuals? Would we not, for

example, be in danger of depersonalizing ourselves and risking

becoming part of a grey, undifferentiated mass, prey to

totalitarian solutions of the kind too often experienced already in

this now dying century? I really dont see why this should be.

Politics doesnt have to be dishonourable. There is no reason in

principle why we shouldnt be able to resurrect a politics whose

central concerns are with such things as liberty, justice and

equality. Very difficult, certainly; nave, Utopian, idealistic, Icant deny. But at least not, like the psychology of self-creation

and self-transformation, impossible.

Our disillusion with and widespread rejection of what passes for

politics these days that is, for the most part, the acquisition and

manipulation of power by large interest-groups leave us

exposed to ideologies at least as dangerous as those recognized

as political. For the marketed ideology of interiority, the worldof third ways where public opposition is supposed to be at an

end and the interests of all can be reconciled, where exhortations

to personal responsibility, naming and shaming and other

forms of sanctimonious moralizing take the place of

government, all these take us in to a realm of make-believe

where there is only an illusion of control, and where the real,

material principles of social reality threaten to run riot.

I hope it is clear from what Ive said that I am absolutely not

meaning to suggest that the lives, interests or feelings of

individuals be sacrificed to some idealized political notion of the

common good. Perhaps psychotherapys greatest contribution

(though by no means always and everywhere) has been, as

already suggested, to support and sustain individual subjectivity,

to respect individual feelings and to respond compassionately to

individual pain. But these humane aims and impulses did not


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originate with psychotherapy and are in fact not realizable by it

in any other context than that of a personal relationship. That is

to say, psychotherapy is incapable of bringing about change on a

wider social scale if only because it hasnt the powers available

to it to do so. The kind of moral aim which underlies the best

psychotherapy cannot be achieved by a procedure of personal

transformation or cure (on an analogy with medicine), but by

constructing a context of taking care which, as I argued in an

earlier book, can be furthered only politically, i.e. as a collective

social undertaking.

Even the respect for individuals which lies at the heart of the

best psychotherapy can too easily become submerged in apernicious moral and aesthetic prescriptiveness by no means

dissimilar from political totalitarianism. For it is easy for

therapists to slide from a compassionate interest in how people

are into a superior judgement of how they ought to be. In part it

is this phenomenon which feeds the whole culture of personal

change to which psychotherapy is so prone. It is impossible to

be exposed for long to the privileged insights which the role of

psychotherapist offers without becoming aware of the darkerand more depressing sides of human experience and conduct,

and so hard to resist an impulse to moral exhortation (in

however veiled a form) and to holding up to people a model of

normality or being to which they should strive to conform.

But this is just another form of tyranny, disguised victim-

blaming in which people are asked to do the impossible.

Impossible because the vast majority havent in fact got the

powers available to them to effect the changes considerednecessary.

We would do better, I think, to see that the kind of changes

which might improve our lives are matters of social, not

personal concern and action. If we need to change anything it is

the social environment in which we are all located and

embodied. This leads to a very different psychology from the

one we are used to, a very different way of conceiving


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experience and action (ways that, unfortunately, I havent the

time to develop now, but which I touch on in my books The

Origins of Unhappiness and How to Survive Without

Psychotherapy).

It leads also to a very different way of conceiving of ourselves

and each other, but not one which is totally unfamiliar to us.

Rather than seeing ourselves as free agents, able in principle to

pick and choose the ways we want to be, we could, I suggest,

see ourselves as characters, not unlike characters in novels (I

should probably say some novels): fixed, predictable, often

caught tragically on paths not of our own making and from

which diversion is not an option. Characters we can identifywith whether through love, pity or fear, but also characters

created by sets of circumstances and worlds which maybe it

would have been possible to influence, characters whose

experience means something by virtue of pointing to ways in

which sets of circumstances and worlds could be. Characters,

that is to say, who exist not just for themselves, but for a future.

Documents

David Smail Psychotherapy Society and the IndividualDavid Smail