The “Great Divide” and a Need for Caution in Psychotherapy

In this paper, there is an argument made that in a world that is increasingly naïve in its divisiveness, we in the field of psychotherapy are not immune from such naivete. Therapeutic binaries such as that between thinking and feeling and brief and long-term therapy are identified and analysed. An effort is made to identify what it is that each of us as therapists have in common and to highlight ways in which we can maximise their usefulness.

The “Great Divide” and a Need for Caution in Psychotherapy

Britain seems to be trying to hold on to actual or partial social and political dominance. Bevan Shields writes in the Melbourne Age of 26/8/20, of the anguish around The Last Night of the Proms in London in which there has been a decision by organisers, later changed, for the 2020 version to play, but not sing, “Rule Britannia” and “Land of Hope and Glory” because of the nepotistic associations to them that alienate Irish, black Jamaican and black-of-any-sort residents as well as underprivileged British. This is a divide around past glory versus much lessened present glory. There continue to be articles presented in the Australian Broadcasting Commission and the Melbourne Age and Sydney Morning Herald of unequal school performances that are dependent on class and gender.

We live in a world in which there is fear and uncertainty. This is not to presume that fear and uncertainty have not existed at earlier times, but present-day instant media cause us to feel the universal nature of the fear more strongly. I presume, as do many others, that the impact of Covid 19 virus has made this situation more stark. We are living at a time when the relative security of wealthy nations can no longer be taken for granted and the fear that is engendered has highlighted binaries as we struggle to respond. One such is so-called black versus white. According to Joseph Stiglitz (2012), in his provocative book, says that his native US is no longer home to the American Dream, but instead to a “Great Divide”. There is disturbance expressed at the fact, for example, that one-fifth of America’s children live in poverty; the average wage of male high-school leavers has declined by 12 per cent in the past 25 years; and the pay of CEOs has swelled from 30 times the average worker’s wage to 300 times.

The “Me Too” movement is another in which there seems to be increasing leverage within Western societies no longer to ignore the dominance of women by men whose last vestiges reside in their mindlessness as they assert power in relation to women. This occurs in homes, businesses, and politics but its core is hard wired; that power over is a primary motivation in human relationships and compassion and empathic understanding are not. Fortunately, although 100 years in the making, there seems to be greater hope than ever that this situation is seeing a reverse. One can only hope that gender divide, as well as the natural varieties of sexual expression need to be acknowledged instead of being subjected to forms of polarising prejudice.

The analysis provided by Frenchman; Thomas Picketty, has begun to provide a substantial amount of evidence in support of his thesis that rising inequality is hard-wired into capitalism. Those favoured with social connections and economic skill in a capitalist environment, can accumulate power and wealth while condemning those without such skills or interest to relative powerlessness. This used to be true of the stark class differences in Europe that preceded the first world war but is now, ironically, greatest in the United States. One of the key drivers of such difference is the relational advantage provided by friendship and family networks in Western societies. Trump’s America is an extreme example. Monarchist societies have and continue to be longstanding maintainers of advantageous difference. Let us also not forget that modern China has a capitalist culture, notwithstanding its totalitarian governance.

What these observations have in common is that human advancement is needed. Advancement, at present, however, is contingent mainly on economic freedom so that human creativity is primarily associated with material development and comfort. Advancement in areas such as community, family and friendship circles are being neglected. I know from over fifty years’ experience as a therapist, that such development as that attached to economic advancement is rarely what is of concern to my clients. Instead, they struggle with ways they might better experience peace of mind and find a sense of personal purpose.

People who turn up in the rooms of a therapist are often accused of there being something wrong with them or that they are inferior in some way. My own conviction is that they are people who have a capacity to experience the subtleties of a lived life and are finding that there is little in it that is nourishing. I find repeatedly that clients thank me for attending to their expression and find it helpful because they are so unused to receiving it or doing the same for themselves. Instead, they are inclined to repeat personal attacks that they’ve learned since birth and which are reinforced by society through personal contacts or through media in which there are normative expressions about right living and other forms of right behaviour or right thought. Oh, if it were that simple.

When people feel overwhelmed, the toughest thing is for them is to see ways forward and it is the sense of overwhelm that mostly accounts for limited foresight.

To explore these claims that I am making I want to focus on my work with couples. I see the difficulties presented by each person in the relationship as sharply underlining the difficulties that each has in being faithful to their own ways of being because of fears about failing to live up to the expectations of the other. The problems faced by the couple are a microcosm of those that each of us face in the broader canvas of our lives.

When a couple comes to see me, it does not take long for me to feel a degree of anxiety arising within from pressure being applied to me. I am recalling initial sessions with a couple with whom I have been working for four years. In confessing this, I also want to point out that change takes time; and present-day pressure to name objectives, list methods and conclude time needed to create change is symptomatic of Piketty’s (2012) view that inequality is hard-wired into capitalism. Since capitalism is based on the steps I have just identified, there is an assumption that change is able to be engineered. I am here to say that efforts by therapists to “engineer” anything with clients is counter-productive unless the client understands and accepts the role of being engineered. My own experience is that when I meet clients and they realise that I am not on about assessing them and bringing out a set of tools to change them, they express sighs of relief and understand that I am there to help them experientially to understand themselves and to make choices within their own lives.

Anyway, I return to my account of the clients to whom I was referring at the start of my last paragraph. I recall an early session in which the woman (they are a heterosexual couple) looked at me with a conspiratorial eye and began to describe the limitations of her partner and of the changes needed for him to contribute to the recovery of their relationship. There were expressions she made that implied that we two were professionals when it comes to understanding the human condition and that, together, we will be able to work it out (I need to add, that I feel certain as I write the above, that she would disagree with me and remind me of my age, I’m 78, and my untrustworthy memory). I am also presuming that her sense of professional equality arose from particularly important work she had done with a woman therapist over 15 years.

I also remember the first time I met her partner. Somewhere during the course of that session, my sense was that he felt okay enough about being with me to talk about the difficulties they were having but wanted to impress on me that he was not there to be changed into any preconceived version of what he was expected to be.

As time has passed, there have been revealed that each of them has plenty of reason to be self-protecting in the ways I have just described and it is equally true that there have been eminent reasons for each to be reserved, and to desire personal independence and self-contained control. Today, I learned that the man grew in circumstances where his mother was brought up not to burden anyone and this meant that she had to manage anything problematic by herself. Consequently, she is quiet and self-maintaining most of the time except when she reckons that someone else is invading her space and being careless with her. She will then lay down the law. With his father, the father is a benevolent sort of man with a high level of sociability and is charming enough to avoid conflict. When my client was a boy, he spent a lot of time alone and he developed a lot of anxiety and fear about direct physical conflict and has retained specific bodily sensations that come on when there is conflict (trembling, weaknesses). He then physically removes himself. The belief he has, based on these family dynamics, is that if someone erupts there is trust that the other will take it on board and be responsive. This means that the next time they are present to each other, there is nothing left over about the eruption, so they can "get on". He is conscious that his avoidant behaviour fires his lady up because it leaves her feeling invalidated and unloved. He says, though, that his experience of her is that when she expresses disappointment and he tells her that he understands, she says him in return, that he doesn't. These early learnings exist at the present moment as he struggles to acknowledge that his partner is someone on whom he can rely when such is necessary, but there are also tendencies in herself that make it hard for him, or anyone, to know that she experiences love and a longing to be taken seriously by the other.

The woman (please pardon my abstract reference – I want to avoid any possibility of her being identified), like the man is about 50 years old. She is unhealthily overweight and suffers from a profound experience of being unworthy such that she has frequent experiences that she does not exist. Anything that her partner does or says to reinforce this experience causes her initially to plead for understanding but when he self-justifies, she becomes enraged and yells at him. The back and forth of these behaviours reinforce alienation but since each has struggled with this experience all their lives, each has no desire to end the relationship but also feels hopeless about desirable change coming about. I need also to point out that the woman has had awful experiences of sexual abuse, beginning at the hands of her parents when she was a baby. She has every reason to trust no one, including me. As I write, I am aware that I will need to ask their permission for these disclosures in my paper but, at present, I need to write and to let my reader know about the core issues that require attention if professional work needs adequately to be attended to. I only want to say at this stage, that if you are reading this part of my paper, you will know that I have my clients’ permission.

I hope I will have little more to say about my clients since I want to protect their privacy and focus on the processes of therapy and their necessity, in a social matrix in which binary thinking is rife and destructive. Therapists are equally prone to think in unhelpful binaries.

The first therapist binary to which I wish to attend is that of thinking and feeling. Since the early behavioural work of Skinner, there has been an emphasis in thinking and behaviour. Skinner was even vainglorious enough to insist that feeling was irrelevant to his work. Since, behaviourists have acknowledged that human feeling might be relevant but much of their treatments proceed as if feeling is problematic, something more to be controlled than anything more. My experience with clients is that feeling is the direct route to organic understanding that imbues conceptual understanding with validity. It is this validity that changes behaviour. I have recently published a paper about these issues. (Wills, 2018).

My view is that the approach to understanding that first emphasised feeling and intuition was in the work of Carl Jung. He noted that affects were the life blood of the psyche. I am afraid that I don’t know enough of Jung’s work to have a process understanding of how he worked but I do know that the encouragement of the subtleties of client affective and somatic experiences were central to assisting them to develop the fullness of their personality, a process he named individuation. This notion of individuation is central to my intentions in work with clients. Regarding the couple to whom I have referred, I think that their potential was interfered with early on. For the man, it was from being left alone by overwhelmed parents and for the woman, both of her parents’ narcissistic preoccupations meant that their lives and work were primary and any efforts by my client to express her individuality to them was immediately appropriated and the validity of my client’s experience questioned. Consequently, when she experiences her partner as placing more importance on self-justification than on her immediate expression, she becomes split and angry.

In recent times, I think that each of them has become clearer that my intention when offering therapy is to understand as deeply as I can, moment by moment and reflect this back. Where there is acknowledgement by the client, I simply continue to find out more and when there is no acknowledgment, I affirm that and continue to find out more. When working, I also look carefully for signs of emotion arising. Given that we are all brought up to see feeling as a sign of weakness, clients often quickly go on to say the next thing. I usually intervene and say “hey, wait a second, you seemed to be feeling something. Let me know what’s going on”. Sometimes I will not be so direct, but I do not forget; especially if the expression arises again. I need to point out in the interests of completeness, that my woman client says that the deepest cause of her alienation arises from not being understood and while she was able to acknowledge that I am presenting a context for therapy that is extending of her knowledge, there are important ways I’ve referred to her that indicate my failure to understand her but she reckons we need to deal with this in our therapy, not in this paper.

What I have discovered in the processes just described, is the challenge of being as empty as I can whilst on the other side of the relationship. I’ve been a Zen practitioner since 1973 and have learned from Zen that suffering arises from egoic attachment, that such attachment is virtually never-ending and that the only way to deal with it is to remain in the here-and-now as best one can. For this reason, I hope that when eventually I am dying, I will notice fear, return to the present moment, and remain curious until the next evasion takes place. ¹ All of this, to me, is also a reflection of the work of Carl Rogers (1942). From him, I have learned the power of disinterest ² in what the client says. The client expresses, I listen as deeply as I can and reflect it back. Moreno et al. (1932), also, referred to this as “mirroring”.

The second binary I have in mind is the tension around the use of assessment. Assessment is a big thing in psychological therapies. Official assessments are in a constant process of change and reasonably can be argued to have begun in 1921 when the American Psychiatric Association was first set up and the first of the Diagnostic and Statistical Manuals (DSM) was published. What is laudable about the intention and effort has been to establish a systematic way of describing the existence and frequency of psychological disorders, to differentially classify and to provide definitional frameworks for treatments. I have always been suspicious of this last criterion, however. My suspicions have been aroused because of what I see as an overgeneralisation from the precise definition of physical disorders within medicine and their treatments. In this latter, effective treatments rely on precise understandings of disorders. With psychiatric “disorders” however, treatments that do not require specific biomedical interventions have varieties of psychological “treatments” prescribed as if the treatments match the descriptions and are specifically effective. Since this has not been proved to be the case and here, I draw the reader’s attention to the work of Messer and Wampold (2006) and, more recently that of Beutler et al. (2012), there is a need for we who work in the therapeutic fields to be modest about the claims we make. In my view, psychological treatments that are most specific, such as: cognitive and behavioural ones, and those based on specific methodologies such as: Eye Movement Desensitisation and Re-processing, are described as specific and brief to be in accordance with expectations that are embedded in descriptions in DSM manuals. The expectations, in turn come from the growing requests of governments for mechanistic understandings of human psychological disorders to reduce the costs of medical treatments. To succumb to these pressures is to ignore the likelihood that psychological conditions that arise over many years cannot majorly be modified using short-term therapies because they are not basically mechanistic in nature.

The third problematic binary relevant to our work is efforts we make with our clients to present a professional façade to them over against being immediate or present to the other. There are many subtle ways in which we can avoid being ordinarily human when we relate to others, including our clients. Fundamentally, such avoidance occurs when we are reserved. Being reserved is to keep something to ourselves that could be deepening of our relationship with the other if expressed. As therapists, we usually have learned a substantial amount of theoretical material in the field of psychology and this theoretical understanding can cause us to distance ourselves from the objects of this understanding.

In therapeutic work, when, for example, the therapist is oriented more to assessment than to encouraging development and change in clients, clients can emerge from consultations feeling personally minimised and unable to make use of what the therapist has to say. What are likely causes of these processes? When Stanford psychiatrist, Richard Almond (2011) was conducting a review of the work of Freud, he highlighted the scientistic language used by translators of Freud’s writing, particularly that of Strachey (1934). He concluded that Freud’s descriptions of “Little Hans”, misinterpreted by Strachey, were better understood as: “the child’s experience, attachments, and internal models are complex, fluid and multi-faceted” (Freud, 1909). Such language presents an open and flexible way Freud was thinking about the boy’s consciousness and is contrary to subsequent inferences that have been made about the relatively rigid structures that have been attributed to him. Principle among them is Freud’s theory of attachment. Freud pointed out that it is a two-way process, but to my view, much of the professional reserve of therapists is attributable to efforts to understand client transference but to avoid the same processes going on in the therapist. The fact is that transference will go on and the therapist’s responsibility is to be open to understanding both sorts but always at the service of the work of clients. I could go on but hope to have drawn attention to the binary forces that exist within psychology in which we are encouraged to be objective to the point of alienating ourselves from our clients.

What, then, do we do to manage some of these binaries? Primarily, my answer is to avoid splitting processes within ourselves. We are socialised creatures as are all of life’s animals. Socialisation permits us to avoid being left out and vulnerable to destruction. Consequently, it is moot as to the virtue of discovering the ways that each of us is unique. Nonetheless, the whole of humanist-existential literature contains argument about the virtues of becoming true to your being and this, notwithstanding the fear that is engendered in those who would prefer to maintain present order into eternity. The word “liberal(ism)” is being bandied about nowadays as if it is a form of defection; the word “traitor” is even being used. In the United States, strong efforts are being made at the present time by those incumbent, to abuse those who don’t want to be herded in accordance with strict views about gun ownership, the rightful place of colours other than white and the rightful place of “trickle-down” economics (Bennet, 2007).

When Martin Buber (1937) wrote of relationships, he posited a primary distinction between circumstances in which the other is primarily an “it” to the subject, and others in which the other is primarily a “thou”. His point was that while instrumentalism can be necessary for reflecting, designing and executing plans, it is a mistake if it is brought to bear on relationships in which there is a hope for each opening up to the other – opening up without design and with a desire for greater intimacy. As a theist, Buber had humankind’s relationship to God in mind when writing in this way. In effect, the “I-thou” relationship was contiguous with one’s efforts to encounter God. In fact, the word “encounter” was used by Buber to underline the quality of relating that is contained in the “I-thou” relationship. Subsequently, in the two or three decades following the late 1950s, there emerged in the Western world a hunger for this type of relating that was the basis of so-called “encounter groups”. To continue to reflect on the necessity for a theistic core to Buber’s contentions would take me outside the main arguments being raised here, however.

I mentioned earlier about a recent paper of mine (Wills, 2018) in which I engaged in a qualitative analysis of the work of an Australian colleague who was demonstrating the use of CBT with a client who had become so scared of life that he was being accused of being a bully in his place of work. I was extremely impressed with the quality of the work of the therapist who provided the so-called “CBT” treatment. My approval arose from the subtlety, respect, and congruence that he displayed virtually throughout the session, that is, until he explicitly began to advise thinking and behavioural revisions to his client. When this happened there was sufficient evidence, according to my qualitative analysis, of a retreat in both to cognitive explanations for the client’s sense of worthlessness My conclusion was that the deterioration in the value of the work was entirely attributable to the imperatives embedded in the therapist’s task of demonstrating CBT method. What is more, what I observed was entirely consistent with the work of Wampold & Imel (2015) when they presented evidence of the lack of any superiority among different ways of conducting therapy. My view is that their conclusions arose from the extremely high probability that it was the quality of the working relationship among therapists and clients among those different methods that explains outcome, not the theoretically preferred explanations. I realise that, at this point, I might be accused of making the same mistake; that is to reify a theory. My defence against such an accusation, is that since difference according to theoretical model is not able to explain outcome quality, the only viable alternative is about working relationship quality and such quality is about subtle processes. It would be as useless to think of such qualities as a theory as it would be to develop theories about Bach’s creativeness. Possible, but unrelated to the creativity.

The quality of working relationship was formally identified many years ago by Carl Rogers (1942) and has been extended and differentiated by people like Greenberg and Safran (1987), Greenberg (2002), Elliott et al. (2004), Egan & Reese (2018). I do remain suspicious of the operational differentiation offered by them, however. My fear, as I hope is now obvious, is that scientistic minds might well become more interested into the differential effects of the variables they identify than into the overall quality of the working relationship. I want to argue that they have provided us with a gift when they find names to enlighten us about the nature of an optimal working relationship but I want to caution any person learning about approaches such as theirs against forgetting their abilities to be present, real, respectful and understanding when they are working.

Many people are arguing that the world will be a safer place when more women are senior politicians, not to mention in senior positions in public and private institutions. The reason, at present, is that they are more in touch with relational subtlety but be careful not to presume that these qualities are native to women. Over time, when struggling to handle the power-oriented forces that exist within humankind, even women might end up becoming more concerned with difference than with similarity.

Footnotes

1. After sitting, I have been taught to say: “Caught in a self-centred dream, only suffering. Holding to self-centred thoughts, exactly the dream. Each moment, life as it is the only teacher. Being just this moment, compassion’s way.

2. Forgive my excess caution. It is important to me that “disinterest” is not taken to be the absence of interest when it means that one’s personal investment in the content of what is being reflected, is absent.

References

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Bennett, W. J. (2007). America: The Last Best Hope. New York. Harper Collins.

Beutler. L. E., Forrester, B., Gallagher-Thompson, D., Thomson, L., & Tomlins, J. B. (2012). Common, specific, and treatment fit variables in psychotherapy outcome. Journal of Psychotherapy Integration, 22(3), 255-281.

Buber, M. (1937). I and thou. Translated by Ronald Gregor Smith. Edinburgh & New York, NY: Charles Scribner’s sons.

Egan, G. & Reese, R.J. (2018). The Skilled Helper: A Problem-Management and Opportunity Development Approach to Helping. Melbourne. Brooks/Cole.

Elliott, R., Watson, J., Goldman, R., & Greenberg, L. (2004). Learning Emotion-Focussed Therapy: The Process-Experiential Approach to Change. Washington DC. American Psychological Association.

Freud, S. (1909). Analysis of a Phobia in a Five-year-old boy. SE 10: 3-152.

Greenberg, L. (2002). Emotion-Focused Therapy: Coaching Clients Through Their Feelings. Washington. American Psychological Association.

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Freud’s The Dynamics of Transference One Hundred Years Later

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Messer, S. B. & Wampold, B. E. (2006). Let’s Face Facts: Common Factors Are More Potent Than Specific Therapy Ingredients. Clinical Psychology, Science and Practice. May 1.

Moreno, J. L., Jennings, H. H., Whitin, E. S. (1932). Group method and group psychotherapy. Boston, Beacon.

Piketty, T. (2014). Capital in the Twenty-First Century. Cambridge, MA. Harvard University Press.

Rogers, Carl R. (1942). Counseling and Psychotherapy. Cambridge, MA. Riverside Press.

Stiglitz, J. (2015). The Great Divide. Penguin, New York.

Strachey, J. (1934). The Nature of the Therapeutic Action of Psycho-Analysis. Int. J. Psycho-Anal., 15:127-159.

Wampold, B.E. & Imel, Z.E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. New York: Routledge.

Wills, G.H. (2018) Counselling Psychology: Aesthetics as a Core Frame of Reference. Psychotherapy and Counselling Journal of Australia. Vol. 6 #1, September.

George H. Wills (PhD, M.A. (Psychology), Dip. Psych. F.A.P.S)

Counselling Psychologist

Mountain Psychological Associates