Tuesday, January 11, 2011

The Only Way Out Is In

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

It’s that time of year when new resolutions are decided on. For many people the idea to enter therapy, an idea that might have been on their minds for a long time, will finally become a reality. It is a big step, and it is one that should not be taken lightly. Be prepared to commit to however long it takes to reach your objectives. Don’t let anyone tell you that therapy is short or that its objectives can be achieved easily. It is work, and sometimes difficult work, depending on the nature of the issues.
What is that old saying about a free lunch? There’s no such thing. You’ll hear the same sentiment bandied about in other terms – no pain, no gain, or that other old saying ‘nothing worthwhile comes easily’. Yes there is always the allure of things magically falling into place with the minimum of effort. And there are plently of people out there willing to promote that message. But things that are truly beneficial are usually the product of focus and determination and time. So when it comes to choosing which you want, another old hackneyed saying comes to mind: ‘you pays your money and takes your choice’.
Of more concern, however, is the question people have about what they should do once they begin therapy. It seems a curious question when you consider how familiar people are with the process of therapy now. So many movies and so many books include examples of what therapy is and what it does. Yet many people ask the same question. What should I do? What should I talk about?
The question, when you think about it, is a demand for an answer to something very obvious. In therapy you talk. And it is a demand for someone else, in this case the therapist, to put words on something they already know themselves. The answer is as simple as it is profound: speak. Speak about all the things you want to speak about. And speak about all the things you don’t want to speak about. The only way out is to put our experiences into words. The act of doing so brings out new meanings about them, dispels old fears, reduces their emotional effect on us and brings greater understanding and acceptance.
Yet speaking out who we are and what we have experienced, simple as it sounds, is not easy. The act of speaking brings with it built-in resistances and people will go to great lengths to avoid it. You can see this going on all around us all the time, not just in terms of therapy. Look at the most popular advances in human communication over the past decade and notice how they have offered us new ways to avoid speaking. Texting has allowed us avoid speaking. Internet social sites have allowed us avoid speaking. You can also see signs of this trend in the large number of changes within society and communities generally and you can trace the same trend; the reduction in actual speaking. And yet, this is the very reason why people end up needing therapy. Therapy is not a ‘cure’ for the absence of parents or friends or priests or neighbours or success or good looks or good fortune. It is a cure for not speaking. When we don’t put ourselves into language and define ourselves by speaking, the quintessential act that designates us as human beings, we run the risk of ceasing to fully exist. Equally, when we put ourselves into therapy by asking the therapist to do all the talking for us (What do I do? What do I talk about?) then we are also avoiding speaking and so it becomes a form of therapy owned by the therapist, not the client.
There is no way of avoiding the obvious. Therapy is about speaking. And often it requires us to speak about the very things we would rather not speak about, things that portray us in a way that we would rather not know about. As such, as French psychoanalyst and teacher Jacques Lacan once said of his own challenging theories, the only way out is in.
Perhaps it might be useful to hear what the man who discovered this simple technique has to say on the subject. Sigmund Freud discovered the talking cure back in the mid-1890s. Well, actually his colleague Josef Breuer did when he was working with a patient he disguised with the name Anna O. Anna was being treated with hypnosis for an array of physical and hallucinatory symptoms when she suggested (not the therapist) that it would be better if she was allowed simply talk about the things she was experiencing. And so began psychoanalysis. What Freud did was take this powerful innovation and then offer a technique called free association which allowed the person follow the chain of their speaking wherever it might lead.
This form of treatment is remarkably free of rules. In fact there is only one and it is called 'the fundamental rule'. It states that we, as clients, must speak about whatever comes to mind without criticizing it. That last part is worth repeating: without criticizing it. This is intended to allow us overcome the natural resistances to choosing what it is we will and will not say. As the same time it requires us take an objective stance to our own ideas and thoughts by not criticizing them. As a matter of course, we tend to pick what we think are the most important things and exclude what we think are trivial ideas or notions that portray us in a bad light. Paying money to go for therapy is wasted if we do not follow this fundamental rule. It sounds simple but it can also be challenging. You must never give in to self criticism, as Freud says, and must say the things you object to saying precisely 'because' you don’t want to. (Freud, p.135.)* Nothing must be left out just because it is unpleasant. That is probably what makes psychoanalysis one of the most challenging, innovative and powerful therapeutic treatments available.
In terms of where to begin, Freud said that the client begins the session by starting wherever they want to. The therapist does not begin the session, the client does. This is to ensure that it begins on something the client wants to talk about, not the therapist. If I as therapist say, ‘Tell me about…’ I have immediately prejudiced the course of the session by making it go in the direction that I desire. That is not the way of analytic therapy.
Freud also said that the place where the client begins speaking in each session is irrelevant. Curious as it might seem the thing that you, the client, choose to start speaking about does not matter. It can be anywhere, about anything. The important thing is to simply start speaking, again with the fundamental rule in mind, speaking about the first thing that comes to mind without criticizing it. The place you start might not be earth shattering in itself, it usually never is, but it is where it leads to that is important. Inevitably it leads to ideas that are central to the speaker’s life.
Now the other interesting thing about analytic therapy is this. It is different to an ordinary conversation. In fact, it is not an ordinary conversation. Some people like to say they have come for a chat but it is never a chat in the ordinary sense of the word. Usually, with a chat, we keep a connecting thread running through our remarks and we keep side issues that are not relevant out of the way. (Freud, p.134.)* But these side issues are just as important so speak them out in the same spirit as saying whatever comes to mind. As Freud put it, act as if you are in a train that is travelling through the countryside and you are describing everything you see to someone in the carriage with you.
Another feature of this therapy is that a systematic narrative with a sensible beginning, middle and end is neither encouraged nor expected. Often you will hear people say, 'I've been wandering all over the place' as if it was some sort of flaw. In this therapy it is not a flaw, it is actually the process being properly carried out. Equally, similar details are often repeated at later times but with a fresh twist. In this form of treatment, there is no question of talking about the same things over and over. Even if issues get repeated, they are being changed slightly in the repetition so that new meanings are attaching to them all the time.
And finally, what else is the fundamental rule asking of all of us when it requires us to say whatever comes to mind? It is asking us to be honest. And it is asking us to be honest not with the therapist but with ourselves. You will often find some people asking how can talking about oneself change anything? There are two answers to that question: the first is, it can change pretty much anything you want it to change, if you are honest in your approach to the treatment. Secondly, the act of asking that question is usually a diversionary tactic to avoid speaking. The requirement to say everything that comes to mind, and to do so as honestly as possible, is not an easy one. Some people, but not all, will do everything they can to avoid it. Even though it is an incredibly simple requirement, in practice it very clearly marks the difference between those who benefit from this form of therapy and those who don’t.
• Freud, S., (1913) Standard Edition, Vol 12.