True and False Experience

Human Element in Psychotherapy

Peter Lomas

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351301060
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Is psychotherapy first and foremost a technique that can be described, learned, and practices, or is it a relationship in which techniques play a part but ordinary human qualities are the crucial factors? True and False Experience discusses those factors that have made it difficult for therapists and patients to meet as equals in a natural and ordinary way, keeping them from establishing a genuine relationship with each other.

Lomas acknowledges Freud as the most valuable and influential theorist of psychoanalysis, but he also questions the consequences of his detached and scientific methods. Lomas also critiques psychotherapeutic theory since Freud, examining the work of the main contributors to the field, including R. D. Laing, Erik Erikson, Melanie Klein, Rollo May, and Carl Rogers. As an alternative, Lomas recreates relations between himself and some of his patients in order to demonstrate how therapy can develop into a straightforward and personal contact between therapist and patient.

In a new introduction, Lomas analyzes the changes that have occurred in society over the past twenty years and rethinks his work in a historical perspective. True and False Experience is an essential and stimulating resource for psychotherapists, psychoanalysts, counselors, and social workers.

Introduction

The mind has a thousand eyes,

And the heart but one;

Yet the light of a whole life dies

When love is done.

F. W. BOURDILLON

This book is about psychotherapy, although I shall not restrict myself to the encounters that take place within the walls of a consulting-room.

During the course of writing the book I have become increasingly less inclined to view the psychotherapeutic process as a medical or scientific endeavour. It is, I believe, less a matter of applying a technique than forming a relationship, less an attempt to treat a sick person than to find one’s way through the false ways in which a person may live, and help him to experience his life more truly. This is not to imply that the psychotherapist should preoccupy himself primarily with people who are clearly seeking for the true meaning of life and ignore the vast majority of the mentally ill, but it encompasses the view that the therapist and his patient are obliged to undertake this kind of search, in greater or lesser degree, if a fruitful outcome is to be expected.

These two facts about the nature of psychotherapy complement each other. If its aim is to reveal the patient’s capacity to experience life in a real way, then one can only expect this to happen if the therapist himself acts in the encounter as a real person: true experience has little chance of emerging in a false setting.

Yet I believe the traditional psychiatric – and even psychoanalytical – approach to disturbed people contains elements which severely limit and often completely prevent the tender growth of a true experience which has already received disappointments and reversals before professional help is sought out.

Before discussing this matter any further I would like to report two extracts from psychotherapeutic sessions. They are taken from the first two of my sessions with patients today and therefore, not being carefully selected, are likely to be reasonably typical.

The first was with a middle-aged woman who had three children. She reported an event that had occurred over the weekend. A friend had invited her to her home for the day but had included only one of the children in the invitation. ‘Does she think children are just like numbers?’ she said angrily. ‘Children are individuals.’

I made the comment that she herself had, in childhood, felt she was not treated as an individual whose wishes and interests counted, and went on to note that she consistently anticipated that I would treat her in a similarly mechanical way, not seeing her as a unique person but as merely one patient among others.

She agreed that she did expect this of me; then she returned to the subject of her childhood, remembering how her parents had reacted to her games and productions with a well thought-out response, given in their own good time. It was unlike the present situation with her own children, in which there was an immediate and spontaneous interchange of comment and feeling.

The second patient was a man in his twenties who, as was characteristic of him, lay on the couch motionless and talked in a withdrawn and rather hopeless way about his loneliness. At one point in the session I said: ‘Don’t you think that I, too, might be lonely? Here I am sitting with you in this room and you are withdrawn from me. Don’t you recognize that I don’t want this, that I want to get to know you better?’

Patient: ‘No, how could you? I can’t believe it. You are self-sufficient. You don’t want me.’

Me: ‘What makes you think I’m self-sufficient? Why should I be different from you? I need people like you do. And I need you to stop keeping away from me.’

Patient: ‘What could I give you? I can’t imagine it. It’s ridiculous. I feel so much a nothing. I never do anything in my life.’

Me: ‘But in any case one doesn’t like people just because of their achievements, but because of what they are. Don’t you?’

Patient: ‘Yes. That’s true for me.’

Me: ‘So why don’t you believe that other people might like you for what you are?’…

At the end of the session he smiled in a warmer way than usual. ‘It’s a hard world,’ he said.

The following observations occur to me about these extracts.

They are concerned with love. One could think of the phenomena in theoretical terms of various kinds (a Freudian psychoanalyst might, for instance, consider the patient’s urges to derive from an instinctual desire for physical gratification) to explain love, but such deductions, even if correct, would be irrelevant. I could deduce the existence of a wish to seduce me in some way or to rival my other patients, and so on, but to do so would introduce factors of secondary importance. What these patients were speaking of was – irreducibly – love.

It was made explicit by the first patient that worthwhile love was spontaneous and saw the other in his uniqueness.

It was believed – by the second patient – that the only kind of love available to him was a conditional one; that he had to earn it by achievement, that he would not be loved for himself alone. Both patients, it seemed to me, felt sad, or cynical, about the fact that, in their experience, love was conditional: that it was given only if one behaved well or only in stereotyped, formal ways.

The patients are bringing to me, of their own volition, basic problems of living; first and foremost, of love; and I am trying to understand and help them. In doing so I bring to bear (implicitly or explicitly) my own philosophy of living. For instance, I assume that it is better to be in communication with people than withdrawn from them.

I do not speak, or think, in terms of an illness which has to be cured. I am not attempting to classify, make a prognosis or form a plan of treatment. What I am doing has little in common with traditional medical treatment.

I am – as far as I consciously know – truthful in these situations: that is to say, I don’t lie, humour, or attempt to confuse.

In neither example do I reveal special skill, knowledge, or insight. Yet I am not ashamed of my responses. They seem to me to show a certain amount of understanding of human nature and to be reasonably appropriate.

If I made a mistake it was, I think, more likely to be due to a human error than a failure of something that could be called a technique. For instance, on reflection, it seems to me that in the first case laziness or conservatism may have led me into the easy path of uninvolved interpretation whereas in the second case my impatience might have forced the patient into a conformist response which did not come from the heart.

My own responses in the two examples are, in one respect, rather different. In the first, I reveal my feelings only implicitly, if at all, whereas in the second I declare them much more openly. (I refer here to the words spoken, which are the only data I am giving. My non-verbal behaviour – my tone of voice, etc. – would be difficult to convey accurately in print. It was, so far as I can tell, much as one might expect from the verbal report: that is to say, for instance, my voice showed more feeling and urgency in the second interchange.)

I feel less easy at reporting the latter example. Whereas in the former I could, if I chose, think of myself as a professional person, standing back in a detached and objective manner that would remain true to my training as a scientist, a doctor, a Freudian psychoanalyst (and, behind that, probably, a male who grew up in England as a member of the lower middle class), in the latter I am no longer an observer. I make an appeal – an appeal to the patient to change and an appeal that he consider me as a person. I reveal something of my nature and I show emotion.

My behaviour is perhaps best described as an ordinary human response to a person in trouble. This is not a response, however, that the two patients expect. They assume that I am a professional person whose feelings are not aroused by them, who is – at least in this context, but not only in this context–above the kind of feelings through which they are so tormented. I am, in their eyes, different from them; there is a gulf between us: the therapist and his patient, the well and the sick, the serene and the disturbed, the helper and the helped, the loved and the unloved. In the second case I am impelled to challenge this preconception. The patient’s response, at the end of the session – ‘It’s a hard world’ – suggests to me that my challenge had made some impression on his previous assumption. He did not say it in a tone which meant ‘It’s a hard world for poor, unhappy me’, but ‘It’s a hard world, isn’t it, for me and you and others who live in it?’ It was a recognition of our mutual frailty and ordinariness. This, to my mind, is the crux of the matter. Unless there is an acceptance by the therapist of equality with his patient, the undertaking is jeopardized from the start. Nothing is easier than to say that one treats other people whose status is in some way inferior to one’s own (as, for instance, Pupil/Teacher or Boss/Worker) as an equal, and nothing is easier than to write a book saying that one treats one’s patients as equals. But the ways in which one person confers inferiority on another are legion and infinitely subtle and are not incompatible with what is usually called a ‘kind’ or ‘humane’ approach to the other person. My primary aim in this book is to explore and discuss some of the ways in which a harmful inequality between parent and child leads to false ways of experiencing life which later may be adjusted in a psychotherapeutic setting. This will involve, at times, explorations into the theoretical frameworks upon which psychiatry and psychoanalysis have been built. A further point. If what I am doing is ordinary, is it of use, and if it is, then how? Why report it? Who wants to know about ordinary behaviour? Were it not for the fact that I am a professional – an expert or specialist who is supposed to be qualified in some way to cure people – I would not have been invited to write this book. (I would not feel justified, for instance, in giving an account of how I bring up my children or make love to my wife – unless I had literary powers and were to disguise it all in a novel – as though I was specially clever in these matters, an example of excellence to put before others less clever and good.) It is necessary here to attempt to clarify what I mean by ordinary.

Each person develops special interests and skills and may take up a special type of work. In health, however, his sense of identity and perceptual stance remains primarily based on the fact that he is an ordinary human being, made of the same stuff as his fellow men, capable of understanding and being understood. If – perhaps as a form of defence against accepting what he is – he comes to identify himself primarily with a certain characteristic or function (as, for instance, an official may equate his rank with his worth) he has, to that extent, become alienated from his ordinary self.

Those who seek out help from a psychotherapist have, in some way and in some degree, lost their capacity for ordinary living. They have come to regard themselves as special, an experience that is painful either because they feel too odd or wicked or stupid to be understood by an ordinary person, or because they feel that those around them are quite unable to appreciate their real nature: they are in a special position in that they cannot share their experience in the way that seems possible for most people. (In both cases a compensation may set in, resulting in the idealization of this specialness, as in the fantasy of being God, Christ, or Napoleon.) The help that is needed is the restoration of the patient’s sense of being an ordinary person, potentially acceptable and understandable.

It would seem reasonable to suppose that this restoration would most readily take place in an atmosphere of ordinariness; in a relationship in which the patient feels valued for his ordinary human qualities, those which he shares with the rest of mankind: fundamentally, his capacity to experience. And in order to value him for these qualities the other person must have them and show that he has them: he must be an ordinary human being; he must not conceal his frailty.

In so far as the psychotherapist sets himself apart from his patient, giving the impression – even if only implicitly, by reticence – that he is a different order of being, his capacity to heal is reduced. Several arguments can be put against this.

Firstly, the therapist needs to remain detached in order to protect himself and his patient from too disturbing an emotional involvement.

Secondly, the therapist needs to remain detached in order to perceive the patient more clearly (more scientifically).

Thirdly, the therapist needs to remain detached in order to be a blank screen on which the patient can project his fantasies.

Fourthly, the therapist acts, in the psychotherapeutic setting, as a specialist. This does not imply that he is not also an ordinary human being nor that his attitude to the patient lacks humanness.

None of these objections are, to my mind, valid. The first three I shall discuss in Chapters 5 and 8; the last I shall concern myself with now.

The therapist does, indeed, have special experience. He is accustomed – unless an absolute beginner – to being in the presence of troubled people and trying to help them. One would expect him to have learned something from this and therefore to be able to give more help than the average man-in-the-street. However, although this is true – and is, indeed, the chief justification for anyone’s calling himself a psychotherapist – it is a less telling point than appears at first sight. Helping troubled people is not so specialized an occupation as many others (such as surgery). It is the main burden of the work of many people – such as mothers, social workers, clergymen – who do not regard themselves as psychotherapists, and it forms an important part of ordinary living: from infancy onward people are troubled and those around them learn ways of helping. The skill required to help a troubled person is one that is primarily learned in the school of ordinary living. The most a psychotherapeutic training centre can hope to achieve is to attract those suited to the work and increase their capacity to do it. It can do this by making the trainee aware of the false ways in which he characteristically behaves towards people. It can help him avoid taking up the false roles, including that of a specialist, into which he might be attracted or seduced. It can, in other words, help him to be ordinary and to remain so in difficult circumstances. In doing this it would forewarn him that the therapeutic endeavour cannot be expected to be less difficult and demanding than are all other intimate relationships that occur in one’s life. By far the most important element in such a training is to give the pupil an opportunity to experience for himself the help that is possible in a psychotherapeutic encounter – a fact which has been recognized by most training centres since the work of Freud. The two most serious hazards of this procedure are, firstly, that the pupil may be unable to reveal himself openly to the training therapist for fear of being considered unworthy to qualify, and secondly, that he may emerge as a graduate from the institute with the belief that the prime purpose of his experience has been the acquisition of a special technique.

The burden of what I am saying is this – once the psychotherapeutic situation is conceived in more differentiated and formal terms than ‘Here is A trying to help B’, there is a danger of a gulf developing between the two people which all the training and technique in the world will not bridge. The significant characteristic of the psychotherapeutic situation is that it is, or should be, a place where it is possible to be ordinary in a society that for the most part requires people to relate to each other by means of special roles, as for instance – doctor and patient, social worker and client. To put it another way, all situations, at least all that I can think of, involve some specialization of function. This diminishes experience only if undertaken defensively (as a flight from the ordinary) or if it involves such preoccupation that a truly balanced vision of life becomes impossible. The forces that have moulded contemporary psychiatry and psychotherapy have, I believe, made it very difficult for two people to meet each other to discuss, in a natural and ordinary way, the problems of one of them.

If the main argument of this book appears rather obvious to some readers, I would ask them to look at it as a record of my attempt to escape from the obscurities of a speciality into the common light of day. And if the language that I use is simple, this is not out of a desire to avoid complexity, but because I believe that ordinary language is the most adequate means available to convey the facts of human experience. I would, for the most part, use the same language if I were writing a paper for a professional journal.

Although the traditional approach to mental disturbance is still dominant in our society, it has met with severe criticism in recent years. The most forceful and cogent of this criticism takes a form, in Britain at least, which is characteristic of that radical opposition to established values known as the ‘counterculture’ or ‘alternative society’, and constitutes not only a critique of the impersonality of contemporary psychiatry but a rejection of the c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction to the Transaction Edition
• 1 Introduction
• 2 The Nature of Illness
• 3 Perceptual Distortion in Contemporary Society and Psychiatry
• 4 The Merits and Limitations of Freudian Psychoanalysis
• 5 The Existential-Phenomenological Approach to Psychotherapy
• 6 The Hopeful Return to the Past
• 7 The Attempt to Resolve Confusion
• 8 The Practice of Psychotherapy
• Notes
• Index