Figuring out psychotherapy (and my issues with it) – part II

I was going to finish my personal review of Jaeggi´s book. So what is up next is Chapter Five, which deals with the therapeutic relationship.

Chapter 5

In this chapter Jaeggi describes a fundamental conflict therapists experience: Knowing that the therapeutic relationship is the most important aspect of therapy, they feel like they have to be particularly good with relationships, especially empathic and warm at all times, but in reality they find that they might feel nothing towards the patient or even experience negative emotions; not to mention that their private lives might not look all too good. Also, they never quite know how close or distant the therapeutic relationship is supposed to be.

It´s not like I can´t relate to that. I have quite some difficulties dealing with negative emotions towards loved ones; I feel like I ought to have good feelings about them always and anytime. Especially during my friendship with Athena this was a major problem.

Jaeggi describes four different ways in which therapists tend to deal with these problems which are on a continuum that ranges from idealistic to hard-nosed. Some therapists make themselves try to empathize with everything the patient says until their are burnt out, others keep the patients at arm´s length and scornfully refuse to meet their emotional needs, even morally condemn them for those needs. I read a statement by one of those therapists and I wish it had come with a trigger warning. It didn´t take much to recognize the similarities to Dr. Stoneface. That guy claimed that almost all patients are “spoiled, demanding, absolutely unwilling to take responsibility”. It reminds me of certain arguments. What that other therapist describes is exactly how I felt Dr. Stoneface saw me. Straight from the moment I was late for our first session. Seems it never had too much to do with me.

Next, Jaeggi makes a suggestion that is extremely infuriating. Jaeggi suggests that the therapist should not try to be an ideal dialogue partner or a perfect person, but – an actor. He should not show his own feelings or demand any genuine feelings from himself, but display to the patient any emotion which might be of therapeutic use to the patient. The patient, of course, mustn´t know about that. If he becomes aware either of the therapist´s real feelings or of the fact that the therapist is acting in the first place, therapy is not going to work out.

Please note that Jaeggi doesn´t say all therapists do it that way. Maybe, probably, there are people out there who are genuine and honest. Jaeggi says, though, that therapists should be like actors.  Once again, to me this looks as if therapy would (at least if done according to her rules) rely on a deception of the patient. The patient mustn´t know that the insights gained in therapy are mere constructs (and I´m still not sure if I can agree with that), the patient must mystify the therapist, the patient mustn´t know the therapist is just acting. Which forever leaves the patient in an inferior position. And not just the patient. The general public. Everybody might at some point develop mental issues, after all, as she points out in an almost snide remark towards the end of the book: “The public sees the masks and the self-deceit of the therapist and looks at him with disdain; but as soon as someone is feeling miserable himself he is easily capable of idealizing his therapist as a saviour!” Well, thank goodness reading her book didn´t render me incurable, huh!

Her book confirmed all the fears I had about therapy. I already had those fears when I first entered therapy. When I started seeing Dr. Stoneface I was worried that maybe I knew too much, maybe I would be able to resist too well. I felt guilty whenever I read anything about psychotherapy; I felt like I was sabotaging the process. At the same time this seemed absurd and unfair to me; could it really be that the process relied on me not knowing anything about it? Would I be “allowed” to learn about it afterwards, or would I always have to stay away from it? How stable was a change, how reliable a cure if it strongly depended on me not knowing how it had worked? How was this compatible with the freedom of thought, the stability, the openness and sincerity I ascribed to a state of being cured? Did I not believe that, once you were cured, you didn´t have to keep any secrets from yourself anymore or repress any unwelcome truths?

That aside, I believe that Jaeggi underestimates the patients. I believe they might realize and perceive more than she gives them credit for. I, for example, described a while ago how I often felt like Dr. Stoneface´s emotions were staged:

I simply couldn´t take him seriously. How could anyone be that upset over me eating in session, or for looking at a questionnaire? I had a feeling that he was merely displaying anger in order to affect me in some way, and sometimes I felt like I was part of some stupid play or some secret melodrama.

Now, I wonder if maybe he displayed that anger in order to demonstrate to me that I behaved like a spoiled, demanding and irresponsible child. It seemed so artificial, like a disciplinary measure, not like I´d really hurt him. He was annoyed as a matter of principle.

I believe the other occasion on which I felt like the entire situation was theatrical and artificial might actually have been genuine to some extent; I do believe he lost his temper for real. Yet the situation itself was so clichéd, so loaded with expectations and pathos that I just couldn´t take it seriously. It affected me, yes, but I was also incredibly tired of these games:

I had somehow accused him of being arrogant. He really lost his cool and yelled at me: “Why, it´s YOU who is arrogant…” Once again, I had this weird, mixed reaction. On the one hand, I felt adrenaline shoot all through my body, a mixture of shock and rage. On the other hand, though, I felt like I was part of a staged therapeutic outbreak again. I felt reminded of the movie “Girl. Interrupted.”, where people are healed because they provoke someone into screaming the ugly truth into their faces. “Wow”, I thought. “This is probably the moment where I should crumble because suddenly I am shown my true face.”

If the therapist is an actor and the patient is unaware of it, we´re basically dealing with a form of deceit. If the therapist is an actor and the patient is more or less aware of it, the patient might start to feel like an actor, too, and respond with cynicism. I´m wondering, though: What if I had not felt like an actor?

Staging warm, positive feelings is one thing. Feigning understanding even if you wonder what on earth the patient was thinking might pass as a “white lie” in some situations. But staging sternness, anger, indignation? Finely calculated for the effect it will have on the patient? Isn´t that incredibly sick and sadistic? And then, of course, there is the question what to do if patients start to realize the therapist is just acting. Gaslight them?

There is more to say about the book, especially about a chapter in which Jaeggi writes about abuse and destructive power dynamics in therapy, but I´ll write about that some other time.

 

 

 

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