Photo credit: Laurent/Meeus/BSIP/Science Source. Photo Researchers, Inc
As helpful and life-saving as contemporary psychology and psychodynamic therapy have been to me, I have a few complaints against them. At times certain common attitudes and practices have actively disrupted and delayed my healing. And I don’t mean the occasional bumbling or even toxic therapist. I mean what seem to be wide-spread assumptions and tendencies within the field.
To contrast, let me start by explaining what my relationship with other medical professionals looks like. When I go to the doctor or even take my cat to the vet, I am told clearly and plainly what the possible diagnoses might be, what other tests are available that could clarify the situation, what the risks and benefits of various treatment options are, and I’m left in the end to choose for myself what medical treatment plan to pursue.
If my doctor feels herself to be out of her depth, she provides a referral to a specialist. I am also free to check with other doctors for their opinions on the matter.
In other words, the process is transparent and places me in the role as a patient as responsible for my own health-care decisions. The basic assumption about the two of us–the doctor and the patient–is that the doctor is an expert in diagnosis and treatment options, while I am an expert in knowing what risks I am willing to tolerate and how much time and money I want to sink into fixing the problem. Our expertise is complementary.
It didn’t used to be like that. It used to be that you went to the doctor, and they told you what to do, and you did it more or less without question. We have changed as a society, and placing all responsibility on the doctor to know and decide what is best for the patient is no longer acceptable or practicable.
Psychotherapy, on the other, is in many ways the opposite. A clear diagnosis is rarely provided unless your condition involves a clear biological component–like bipolar disorder or depression. A treatment plan is not laid out, nor are the possible benefits or risks discussed. The patient is not free to seek out a second opinion.
In some respects, psychology remains mired in what I can only describe as colonial attitudes, in which the patient is expected to trust the good doctor implicitly to heal her.
To some extent, psychotherapy is just less clear-cut than medical science and sometimes a proper diagnosis is not known at the outset, nor exactly what treatment plan needs to be followed, but I don’t think that’s the only explanation for it. I blame the lingering influence of Freud–who had very patronizing, authority-centered attitudes toward his work.
“I am actually not at all a man of science, not an observer, not an experimenter, not a thinker. I am by temperament nothing but a conquistador–an adventurer, if you want it translated–with all the curiosity, daring, and tenacity characteristic of a man of this sort.” (Sigmund Freud, letter to Wilhelm Fliess, Feb. 1, 1900).
Although clients enter the psychotherapist’s office because they want to get better, they are expected to resist treatment. If we seek a second opinion, it is seen not as being a responsible patient, but as lack of trust for authority. Therapists still assume they need to break through our defenses. Psychotherapy, to some extent, pathologizes the normal adult desire to be independent, autonomous, and responsible for one’s own life and actions.
My medical doctor knows that if I come in because my symptoms are bothering me, I will most likely choose an effective treatment plan and stick to it, because I want change. Most therapists assume that, despite the trouble my symptoms are giving, I will reject a diagnosis and not stick to a treatment regimen. So the question of diagnosis is sidestepped, and the treatment plan is never overtly articulated.
This is nonsense. There are some patients who really do want a quick fix, and will quit therapy if they know how difficult it’s likely to be. But why not just tell them? A client who does not want to suffer through treatment should be free do that, in the same way that I chose not to pursue treatment of my geriatric cat’s fast-growing cancer a few months back. Why try to sneak in guerrilla therapy a client does not want and is only submitting to due to a lack of awareness?
Worse, if I really do want change, and am willing to tolerate the risks associated with it, why allow me to struggle with disappointment and frustration because I did not know how great they would be? Especially if I would embrace them if I knew they were coming?
I can tell you if I had known the degree of dissociation and trauma I needed to deal with from the outset of my 15 year search for healing, I would have articulated disbelief and resistance to it. But a core part of me would have been vastly relieved to know what the real problem was and would have been able to embark in a productive line of psychological work much earlier in the process, instead of spinning my wheels for 10 years wondering what the real problem was. If I had known what I was doing and why, I would have been able to do it better much earlier.
In fact, it was really only when I changed my own attitude towards healing that I began to see real change: it was only after I saw myself as solely responsible for developing my own course of treatment that I began to see significant gains. When I relied on a process that was not only inadequate and ineffective, but also kept me dependent and out of control of my own psychological work, my progress was very slight. Not only was I less able to do the work, but I was less invested in it. I did not know what it was, so I could not do it as well. I did not know the purpose of it, so I was less willing to spend time or energy on it. And it was in many respects the wrong course of treatment, but I did not know to keep looking until I found the right one.
In schools, we have also shifted our attitudes about our students. Although state and national standards dictate curriculum, we talk more and more about ownership, about letting students know clearly where they are, and giving them choices about what steps to take next to improve their learning. And they are children.
So why does psychology remain so untrusting, so patronizing, and so colonial in its attitude toward patients? Why does it remain mired in the era of Dr. Livingstone, when conquered peoples were seen as savages in need of re-educating and civilizing at the hands of all-knowing authority figures? Why has it been unable to move forward in terms of how responsibility for decision-making should be distributed?