Tuesday, March 23, 2010

Therapy? Are You Mad?

By Kevin Murphy
Psychoanalytic Psychotherapist,
Dublin, Ireland.*

If you need therapy you must be mad. So runs the old fashioned attitude. But it is not so old that, despite our modern attitudes and enlightened approach, it still doesn't linger in many people’s minds. The word ‘mad’ is long since gone from medical and therapeutic usage. But it lives on in the popular imagination.
I mention this because the predominant unspoken, and sometimes spoken, fear that people have about coming to therapy is that they are mad. Either they are mad to need therapy or else they will be diagnosed as mad once they are in therapy or if anybody they know finds out about them they will be labelled as mad. There is a recognisable degree of paranoia here but the greater part of this fear is reasonable and is due to the product of social stigma which is a very powerful tool.
The word itself is short-hand for not being normal. Normal people don’t need therapy. Normal people have happy lives. Normal people fall in love with the perfect person and have perfect relationships. Normal people don’t need to go to someone to ‘talk’ about their problems. It’s all pretty attractive stuff, this normal world occupied by normal people.
I was reminded of this listening to a seminar last weekend by London based psychoanalyst Gerry Sullivan. He was in Dublin speaking on the topic ‘The Role of the Father; Decline or Displacement?’ for the Association for Psychoanalysis and Psychotherapy in Ireland. He pointed out that for Freud the three broad structures that operated within society were psychosis (clinical madness), perversion (of the sexual kind) and neurosis.
The last of these is the largest category by far and the one into which all our obsessions, hysterias, phobias, compulsions, addictions, depressions and anxiety-related conditions are grouped. This, for Freud, was the category that underpinned society, this was normal. To be normal, for Freud, is to be neurotic.
One can only wonder, therefore, where this message has disappeared to in the past one hundred years or so? How have people suffering from sadness, fear, inadequacy, inability, hidden prohibitions, and all the other afflictions that make dealing with reality difficult, come to consider themselves as abnormal? It is a hard question to answer without taking into account the societal changes in the past century. But we can safely assume that somewhere along the way we have forgotten how flawed human beings actually are. Or maybe not forgotten but chosen not to recognise it. And so we now find ourselves in the 21st century believing that any flaw is not just unacceptable but is a sign of some inherent abnormality.
Advances in science, while undoubtedly welcome, have also had the unpleasant side-effect of creating a body of thought in which there is no place for ordinary flawed humanity. The popular social discourse, too, requires our young people to be word-perfect and looks-perfect pretty much from the start of their lives. There is very little room now for difference or anything that falls short of the imaginary norm of perfection. Anyone unlucky to find themselves in this position, and there are very, very many, is then left dealing with a potentially uncomfortable relationship with themselves, to whatever degree it manifests.
Why? Because we have come to believe too much in ideals. An ideal way to live, an ideal way to look, an ideal way to interact with others, an ideal way to think. And while that might serve us reasonable well in our relations to the outside world, what one often finds is that the very place it breaks down is when the person is left to their own devices, isolated to whatever extent, in their own company and with their own thoughts. The reason is because this pursuit of ideals is often one that is devoid of meaning, in the sense that it does not satisfy us or answer our questions at a core level. This is not to say that having achievable goals and setting out in a defined way to reach them is not a good thing. No I am talking about demanding of ourselves that we become flawless and display no weaknesses or deficiencies in the living out of our lives. One is a reasonable ask. The other is not.
* The next blog will appear on Tuesday April 13th, 2010.

Tuesday, March 16, 2010

Staying Away From the Talking Cure

By Kevin Murphy
Psychoanalytic Psychotherapist,
Dublin, Ireland.

As I was saying last week, there are reasons why people should not do psychotherapy. And while it may seem counterproductive for a psychotherapist to say so, I am outlining some of those reasons in order to help people who do choose to enter into therapy to do so with a greater sense of purpose. Last week I mentioned the concepts of relationship, commitment and change that are inherent in the process. I said that if people had difficulty with any of these areas then it might be a good idea for them not to do therapy.
This week I wanted to look at an often overlooked area: speech. It might seem like an obvious thing to say but psychotherapy is a talking therapy. The phrase comes from Freud who essentially invented it and it has been taken on since then in many other forms of therapy. But as the name suggests, the talking cure, as it was known in Freud’s time, is about, well, talking.
It is always interesting to notice how many people do not do much talking in their lives. Naturally we can’t go around talking about how we feel to total strangers. Even friends and family can get tired listening to us if we talk too much about ourselves. But, as an exercise, try and notice next time you opt to say nothing when there is something important you want to say to people you know well and you would otherwise be comfortable speaking to.
The art of speaking, at least from a therapeutic point of view, is not about knowing exactly what you want to say or having the words to describe deep or complicated ideas about ourselves. The first thing people are asked to do in psychoanalytic psychotherapy is to simply talk about the first thing that comes to mind. We are not referring to buried things, or deep things, or complicated things, or meaningful things. We are simply referring to whatever is foremost on one’s mind.
After that, it is about allowing oneself to follow on to the next thing that comes to mind, and then the next and so on. The experience, generally speaking, is that by the end of the session we are usually on to a subject we had no idea we were going to speak about and one that engages our interest fully. And it is all done by not directing the person to talk about anything in particular.
Now this might sound like a simple process but there are people who have difficulty with this very simplicity. And, in fairness, it is easier to understand how it works once one has done it a few times rather than explain it in cold print. Be that as it may, it can pose a problem for some people. The freedom of speaking about whatever one wishes can be too much. The requirement to speak about whatever comes to mind can often be problematic for some, despite its simplicity. And so if the business of speaking – and remember, the act of speaking requires us to put ourselves into the forefront of what we are doing – is too difficult or too onerous then psychotherapy might not be the ideal choice for you.
And finally on this subject, we come to the notion of freedom. Without going in to it too obscurely or too deeply there are broadly two types of freedom at work when it comes to psychoanalytic psychotherapy. The first kind is the kind I referred to a little earlier and it is the freedom to speak about whatever comes to mind, in whatever way you wish. By this latter point - in whatever way you wish - I mean that it doesn’t have to be in a formal beginning-middle-end style of narrative. So, you see, this first type of freedom is quite extensive. Psychoanalysis allows us to speak about things that come to mind in whatever loose order they happen to come. There doesn’t have to be a big point at the end of it. Stylistically speaking, we don’t have to begin in a flourish and marshal all our points to an overwhelming conclusion.
Once we are speaking out the things that come to mind, as they come to mind, then we are doing it properly. Again, this is easier to do in practice than to explain in print. But if allowing yourself the freedom to speak without having to come to neat conclusions about everything, or have a definite reason for choosing to speak about something in particular, might not be for you, then you might want to reconsider doing psychotherapy.
The second form that this freedom takes is the freedom that comes when the mistaken illusions under which we operate begin to lift. This takes place some time after we have begun the work properly and it is first noticeable in small ways. We stop seeing things in exactly the way we always have and it is first brought home to us when we experience the sensation of having a completely new and refreshing take on something ordinary. This is a sign that a new freedom is emerging in how we view the world and our place in it.
Naturally, such a shift can mean giving up on old illusions we have had – I can never succeed, I will never be loved, I will never change – and with it comes a degree of resistance. Why? Because, paradoxically, we might want to change but we might also want to remain as we are. I touched on this when I spoke about the concept of change and here I am simply broadening it out to include the notion that freedom from old ideas is the ultimate form of change. If, however, you think you might have difficulty with that kind of thing, then maybe psychotherapy is not for you.
So the conundrum exists that although people might opt for therapy in order to change themselves or aspects of their lives, they can resist it at the same time. Some even believe they can change parts of themselves as if they were somehow unconnected to the totality of who they are. Psychotherapy works best when it approached with a degree of open-ness and honesty. It does not work when change is sought while holding on to and refusing to give up on old ways of thinking about ourselves. Why? Because the old ways of thinking about ourselves are usually the reason we seek out therapy in the first place.

Tuesday, March 9, 2010

Some Reasons Not to Do Therapy

By Kevin Murphy M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

It’s probably not often that you’d go to buy something and the salesperson would give you reasons why you shouldn’t buy it. It would be like a car salesperson pointing out that walking is better for you than driving. Or a TV salesperson telling you that watching TV is not a good thing. Or a travel agent pointing out the dangers of sun on the skin. It would be hard to imagine it happening.
But the decision to undertake psychotherapy can often benefit from people questioning themselves a little before they go ahead. Unlike, however, the salesperson who tries to put people off, the exercise is designed to strengthen people’s resolve to go ahead.
The first reason not to do psychotherapy is that it involves a commitment. This does not mean a life long commitment. But it does mean that for however long or short you decide to do it, that you do it. And it’s not simply about showing up at the appointed time every week because the analyst or therapist wants to see you. It’s about committing oneself to approach it with a degree of resolve, consistency and, yes, maybe courage. This is usually a good indication of a sense of inner strength and purpose. Recognising that the decision to approach therapy from a committed perspective is evidence of this internal strength often comes as a surprise to people. Yet, those who want to but never do therapy haven’t found a way to tap into this simple but often overlooked resource. The decision to approach it this way also tends to mark out those who begin therapy as having a greater chance of getting something out of it. If it doesn’t sound like you, then it’s a good reason not to do therapy.
The second reason not to do psychotherapy is that it involves engaging in a relationship. Naturally it is a professional relationship in which all the professional and ethical rules apply but it is a relationship nevertheless. As such it involves taking oneself along to spend time in the company of another person, hopefully a suitably trained person and someone whose contributions might play a significant role in the experience. If, however, the experience of engaging with an other person is one that is overshadowed by distrust, or doubt, or cynicism or resentment, then this element of therapy is going to be problematic. For some people it is the stumbling block on which therapy falls. They simply cannot get past the negative connotations which the professional relationship, in the way it mirrors their broader relationship experiences, represents. If, however, a person is able to bring all that ‘baggage’ with them and still allow themselves engage in the process, then a productive outcome is far more possible. The element of being able to sustain a relationship with an other person is as much a part of the therapeutic process as anything that gets said or discovered during the sessions. If you are not able to reach out and conduct a relationship, in spite of the personal, internal forces that can try to undermine it, in spite of the damage to trust that prior relationship experiences have created and to however limited an extent the professional relationship might manifest itself, then it’s a good reason not to do psychotherapy.
The third reason not to do psychotherapy is that it involves the potential for change. One hundred per cent of people who walk into a psychotherapist’s office will say their objective is to change something in their lives or in themselves. Yet not all of them achieve this. Why? Because change is impossible? No, because change can be uncomfortable. I’m thinking of two instances of people who stopped very early on in their therapy because they each discovered, in their own way, that key relationships in their lives had not in fact been loving relationships but had instead been abusive and manipulative ones. In one of those of examples, the potential existed for the relationship to have breached legal definitions of consensual sex. This is just an example of what change can involve for some people. We are talking about someone seeing themselves in a new and not so positive light. The downside of change can also exist for those who are fixed on their ‘issue’ and hold on voraciously to all aspects of its place in their lives. They refuse the possibility that their experiences, the stories of their life, the place of key relationships in their personal formation, in their details and in their potential meaning, have anything to do with where they are now. Are their issues impossible to resolve? No, but they are unwittingly refusing to allow change take place. So if the possibility of change is too difficult a concept to accommodate then perhaps it is a good reason not to do psychotherapy.
I’m going to leave it there for this week and next week come back and look at further reasons why someone should not do psychotherapy.

Monday, March 1, 2010

The Dark Art of Infidelity

By Kevin Murphy,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

There’s been a lot of it in the news recently, the subject of cheating men. Men that, for all intents and purposes, appear to have good relationships with their current partners but who seek out excitement with other women. They are not the first and they will not be the last. And it is not confined to the rich and famous.
The expectation might be that one would question the actions of these men, probe their motivations, assess their ability to engage in trusting relationships. But the analysis of what causes men to act on the belief that the thing they do not have is the thing they really want can often seem more philosophical than psychological.
There is another, perhaps more interesting, side to this that usually gets less attention. Consider the women – wives and long term partners, mostly - that are cheated on. And consider, in particular, the pattern of forgiveness that is usually a feature of their approach to the relationship problems they face. Not that forgiveness is a bad thing; once we are clear on what and who exactly is requiring forgiveness. And once the extent of the hurt and pain caused by being thrust into the role of victim has been fully understood.
If we accept for a moment the old maxim that we are a product of our time, the era in which we live, then we could profitably look for a moment at the expectations that contemporary western culture places on women. They must be attractive at all times, they must be independent, liberal, intellectual, and resilient. Then when it comes time to settle down and have a family, if that is what they choose, they are then required to be good mothers, faithful to their partners and makers of happy homes. That’s something of a shortcut, I know, but you get the idea.
The ideals that contemporary women are required to live by also dictate that when it comes to matters of love, that they be, well, flexible. If a man, or should we be more specific and say ‘the’ man, in their lives turns out to be less than ideal, a great deal will be sacrificed before that becomes an impediment to the relationship. That’s probably due to another cultural requirement under which women live – being without a man is particularly unacceptable. No one wants to be alone, that is not in question. But the stigma that attaches to a woman without a man is nothing short of unbearable for very many women.
Which, I suppose, brings us into the territory of psychoanalysis itself. Why is it that being without a man might be an unacceptable prospect, a fear so strong that it would lead women to live out lives in relationships that are demeaning to them or perhaps diminishing them? It might not be stretching it to say that each of the women in the most recent public cases have been demeaned in some way. Yet each in their own way have shown varying degrees of willingness to soldier on. In one case, the relationship was ended by the affronted woman, having had enough of repeated infidelity. But the other two women have chosen to remain in the relationship.
Now popular thought would have you accept that women in love do these kinds of things. It is, after all, their choice. It also suggests an important positive quality: despite public humiliation they have chosen to forgive. But remember the men they have chosen are young, attractive, financially successful and therefore powerful in their own right. These men fit the perfect equation that results in an ideal relationship and an ideal life. And let’s be honest, nobody wants to give up on an ideal, no matter how tough it gets.
Psychoanalytic theory, on the other hand, has long proposed that once we have made our choice of lover based on the ideal we are working towards, then something else happens. From that point on we almost unconsciously seek to become the thing that will guarantee us the maximum emotional return from the person we have chosen as our love object. This is why we often see women putting up with unacceptable behaviour from their partners, or agreeing to what would normally be considered unacceptable demands within the relationship or accepting assurances for poor conduct that are often facile and insubstantial, or engaging in behaviours that they are simply not comfortable with. And remember this is happening at a time in history when Western women are essentially at their strongest.
There is a profoundly strong drive within us, not simply to please the other person, but to subtly transform ourselves into what it is we believe will ensure they continue longing for us. The theories of teacher and analyst Dr Jacques Lacan call this process the dialectics of desire. Having a name for it doesn’t mean to say that people don’t get hurt or that the powerful attraction of an ideal is an easy one to deal with. No, the challenges that are intrinsic to human relationships always remain. But when viewed from this perspective, it allows us question why a woman who might be a loving partner and whose sole intent is to engender love, trust, security, fidelity and companionship in her relationship can still be deemed inadequate or insufficient in such a fundamental way.