The Psychotherapy of Everyday Life

Peter Lomas

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351302982
• Topic: Psicologia
• Subtopic: Storia e teoria della psicologia

The place of the psychotherapist within the hierarchy of the medical profession and his status in the public opinion are ambiguous: many myths and ill-informed fears cloud the practice of psychotherapy not the least of which is the thorny issue of doctor-patient relationships. In this finely etched book, Peter Lomas puts the case for a personal psychotherapeutic approach based on his work with patients over many years.

The Psychotherapy of Everyday Life argues that the response to a person who comes for help should be an intuitive one, not hidebound by confusing technical theory. Psychotherapy is best understood as the application of ordinary interpersonal competence within an unusual setting, and formulations about its nature should take this point into account as their starting point.

In his brilliant new introduction, the author juxtaposes the clinical neutrality of Sigmund Freud to the Saridor Ferenczi position, which entails a sense of the rights of and respect for the patient. Lomas holds that Freud initiated the setting but brought to bear upon it an unnecessary and inappropriate theoretical superstructure that now stands between therapist and patient. It is not ideology but everyday judgment that should be the touchstone of treatment. Rigid professional distance can blind the analyst to the actual needs of real people.

1. The Question of Wisdom

I am strong. I cultivate in myself the best human
sentiments: love, devotion, honesty, abnegation, heroism,
disinterestedness . . . - Avdennko, addressing the Seventh
Congress of Soviets in January 1935 (quoted by David
Caute in ‘The Illusion’)

In what is called ‘individual psychotherapy’, two people meet and talk to each other with the intention and hope that one will learn to live more fruitfully. In spite of significant variations, this, in general, is the form it takes. How can such a thing happen? How can one person help the being of another?

Firstly, and most obviously, someone may be expected to help by means of his wisdom, love, sympathy, strength of character, and whatever simple virtues that will avail in his efforts to bring succour to the one in distress.

Secondly, a person may help by measures which are out of the ordinary: by invoking powers derived from supernatural sources, or by the use of techniques which, under the influence of the scientific tradition, have been gathered together by specialists into various theoretical frameworks and methods of working. Because I am not concerned in this book with the supernatural (for I have nothing useful to say about it) my discussion of this second kind of help will be limited to the scientific approach.

I want to make it clear that I am using the word ‘technique’ in this context to denote that form of behaviour towards another person which derives from a special body of theory. I therefore differentiate it from ‘tactics’ or ‘strategems’ which, although often referred to by psychotherapists as ‘techniques’, are, in fact, simply the kind of ploys which we use in ordinary life, and are a manifestation of an attitude which (if we approve of it) we call ‘tact’, or (if we disapprove) we call ‘manipulation’. The confusion between the words ‘technique’ and ‘tactics’ has, I believe, arisen because those who rely on a body of theory inevitably take a detached view of the therapeutic encounter - a view which has something in common with that of the person who, in ordinary circumstances, has a tendency to adopt a tactical approach to people rather than act spontaneously.

It would seem possible, and perhaps likely, that this similarity is not accidental - that it results from the fact that people who are reflective and cautious in their relationships are drawn towards theory more than their fellows. Therefore, while making the distinction between wisdom and scientific technique we may note that the extent of the gap between the two depends in part upon our ideas about wisdom: if we consider that a wise man is shrewd and circumspect we will expect him to take a detached if not ‘scientific’ view.

It is as well, I think, that I lay my cards on the table right away and state the over-all conclusions to which I have come about psychotherapy.

Firstly, if we are to search for a paradigm for our work, we should look to that of friendship rather than the application of scientific theory.

Secondly, the commonplace attitudes which are relevant to healing lie in the direction of warmth rather than coldness, trust rather than cynicism, closeness rather than distance, encouragement rather than discouragement, spontaneity rather than calculation. This is not to say that the therapist should not, in his efforts to heal, manifest at times attitudes designed to distance and discourage, and might even resort to harsh and devastating criticism, but that such approaches to the other will not be in the ascendant. Let me here risk a word that may seem naive in this context: the wise man who seeks to heal will, in his dealings with the troubled person, reveal qualities that we normally associate with the word ‘good’. And this thought brings problems.

It is not considered unusual for a parent to have a loving attitude towards his child. Similarly, a friend may care for another, or someone may go to help an injured or sick person, without attracting comment. But if a man were to set himself up and say, ‘This is the kind of thing I do. I love my children, I show concern for my friends, I am ready to go to the aid of the sick and injured’, we may accuse him of arrogance. It is as if he were saying, ‘I thank thee, Lord, that I am not as other men: I am loving, kind and considerate.’

What then of the psychotherapist? A psychotherapist is someone who sets himself up as one who helps others, who publicly announces that he has the necessary qualities. It is true that the saintliness of his position is modified by the fact that he does this for money, but even so he implicitly asserts that he has within him the capacity to help. How are we to think of this assertion? If we are to say, ‘He helps by means of a learned technique’, then there is no problem. But if we believe that the ability to bring relief to those in anguish depends in no small part on the possession of attributes such as wisdom, lovingness, patience, honesty, etc., then the therapist appears to be in an embarrassing situation. He seems to be saying, ‘I have set myself up as a therapist because I have the virtues required of such work.’

I am not alone in openly stating that the therapist’s love for his patient often plays a significant part in healing and may even be the crucial factor.¹ How do those - and they are many - who implicitly believe in the importance of their caring deal with the charge of arrogance to which they are vulnerable? Primarily, I believe, by evasiveness. They say, ‘We all of us, naturally, care for our patients.^* This can be taken for granted. It is the baseline of our work, from which the important part emerges, the part we talk about, namely, our technique.’ But this statement submerges the truth that non-technical qualities are central to healing. And a danger has appeared: that therapist and student may become so preoccupied with technique that their capacity to recognize, and even manifest, human qualities is diminished.

* Although the term ‘patient’ has connotations which make it unsatisfactory in the context of psychotherapy, I use it in this book as I can think of no better substitute.

In writing this book, having the set of suppositions about psychotherapy that I have just outlined, I am in a difficult position. How can I describe my work without blushing? How can I avoid giving the impression that I believe my love for my patients to be of sufficient degree to justify writing about it?

But this seemingly presumptuous claim is not as immoderate as might appear. If I say to a colleague (to put it somewhat naively), ‘I help people by wisdom and love, whereas you rely on technique’, it might be taken to imply that I believe I have a greater capacity for loving than he, but I do not think that I am necessarily making such a claim. What I say could have two different meanings. Firstly, ‘We both help by wisdom and love but you fail to recognize or acknowledge this fact.’ Alternatively, I am saying, ‘I know I am not a wiser or more loving person than you but at least I don’t wreck such capacity as I have for revealing such virtues by adhering to a theory which neglects their value and even discourages their manifestation.’

Although I believe this claim is not, in fact, arrogant, I have some sympathy with those who view it with suspicion. The temptation to bask in the idea that one is more virtuous than one’s fellows is almost irresistible; and patients can all too readily idealize the therapist and tempt him into the belief that he is an uncommonly wise and loving human being. (The virtues which a therapist may care to overvalue in himself are varied; although lovingness is perhaps the commonest, there are of course, others: sensitivity, intelligence, toughness, shrewdness, etc.)

The point I wish to make is not that the therapist who attributes virtues to himself is necessarily under an illusion, but that human pride is such that it is difficult for a practitioner to proclaim that these qualities are important in his field of work. Everything that we have learned about modesty, all our opposition to pride and pomposity, causes us to shrink from such statements. Yet if we are to pursue the truth (as Freud himself advised us to do) we cannot evade the problems which arise from a consideration of the significance of human qualities in healing.

The two questions which first come to my mind are: firstly, how do we distinguish between a personal and a technical response? Can personal responses be studied in the way that technical ones can without destroying what we seek to understand?

Secondly, might it be better to leave the personal features to look after themselves and focus on that which we can talk about, namely technique? Is it not possible that the moments in therapy of supreme significance are elusive and contain a quality which cannot be pinned down any more than a poem or a sonnet be satisfactorily dissected?

The factors which make it difficult to approach these questions intelligently are not restricted to those concerning pride and modesty; there is also the matter of rigour. To the extent that we regard psychotherapy as a serious pursuit we will wish to select, train, practise, and research with rigour. But on what kind of basis do we pursue rigour? In this respect psychotherapy is in a peculiar position. If I am a clergyman I would not - as yet - be required to produce statistics or perform experimental work, but I would be expected to know my Bible. If I am a doctor I will have been to medical school and learnt the traditional scientific approach to the functioning of the body. But if I wish to practise psychotherapy it is not at all clear what I should do to best equip myself for this purpose. Even those who pursue the most taxing course available - a Freudian or Jungian training - are taunted by Behaviourists for their lack of ‘scientific rigour’, by psychiatrists for their ignorance of applied neurophysiology, by philosophers for their adherence to a nineteenth-century model of the mind, by sociologists for their preoccupation with the individual psyche . . .

As an example of this kind of dilemma I would like to refer to an interesting book written a few years ago by Richard Chessick entitled Why Psychotherapists Fail.² I will start by - gladly - repeating two quotations from eminent psychoanalysts which strongly reflect my own beliefs and of which Chessick clearly approves:

It seems to me that what is more important . . . is not so much what the analyst says as what he is. It is precisely what he is in the depths of himself - his real availability, his receptivity and his authentic acceptance of what the other is - which gives value, pungency and effectiveness to what he says. . . The communication from one unconscious to another which becomes established in the transference relationship between therapist and patient permits the latter to perceive the profound benevolent attitude of the physician. (S. Nacht, ‘Reflections on the Evolution of Psychoanalytic Knowledge’, I.J.P.A. (1969), 50, 597)

How to teach patience and devotion, tact and timing, decency and tolerance, empathy and intuition, modesty and respect in the face of supporting loyalty and keeping distance, carefulness and courage, honesty and frankness? (Martin Grotjahn, ‘Problems and Techniques of Supervision’ , Psychiatry (1955), 18, 9)

Chessick’s response to this challenge is interesting. He does not, as would Nacht and Grotjahn, advocate a traditional Freudian training but aims at something wider. Certainly it does not lack rigour. He proposes a curriculum ‘based on an eight-hour day, six-day week and four-year duration’. He includes ‘a minimum reading list in philosophy that ought to be required in the training of every psychotherapist’ (Chessick’s italics). The formidable list of forty-nine books contains such difficult works as Kant’s Critique of Pure Reason and is eclectic in nature.

I have much sympathy with Chessick’s aims. The endeavour to broaden one’s mind with the writings of the great philosophers is surely to be praised and can have a modifying effect on the narrow vision of those who unthinkingly accept the prevailing world view of our time or confine themselves to the theories of one psychotherapeutic school. Indeed, if he had worded his formula somewhat differently - if he had been content to suggest that such books can be useful to the potential psychotherapist - he would have my support. But his insistence on the necessity of this programme for all students suggests an exaggerated view of the relevance of intellectual distinction to the capacity to help others, a fantasy of producing an élite (a race of Plato’s philosopher-kings), and a determination to be rigorous at all costs. It is not as easy as that. Intellectual sophistication is, alas, no guarantee of the kind of qualities for which Nacht and Grotjahn are looking. Indeed, bookishness can often stand in the way.

Our path lies, I believe, between two extremes. On the one hand is the belief that no teaching is necessary to the practice of psychotherapy; anyone can do it, and therefore no one need bother to learn. On the other hand - and this is the dominant view and one that is characteristic of our insecure culture - no one should be permitted to engage in psychotherapy unless he can show evidence of rigorous training in some sort of technique. I am personally convinced that, in view of the prevailing philosophy of our time, the chief danger lies in the second view: we have lost touch with the elemental factors involved in help and we put our faith in the compartmentalized knowledge of the ‘specialist’.

The simple notion of ‘help’ readily evokes in us the suspicion of a well-meaning but naive, undisciplined, and sentimental approach to the other. Although we may be justified in viewing apparent simplicity with circumspection, we should, I believe, be equally careful in our assessment of operations which show the outward manifestations of rigour. How, for instance, does one listen with rigour? It might seem, at first sight, that a tape-recorder could do the job better than us or, failing electronic aids, we should, in motionless silence, hang upon every word. Yet, on the contrary, I believe that a person may often hear another best - may draw him out and understand him best - when to an outside observer he appears to be engaged in ordinary conversation. The criteria by which we can measure rigour in psychotherapy are therefore not obvious. In seeking for them I would like to quote from another area of study, F. R. Leavis’s last book, The Living Principle: ‘English’ as a Discipline of Thought:

The discipline is not a matter of learning a deduced standard logic or an eclectic true philosophy, but rather of acquiring a delicate readiness of apprehension and a quasi-instinctive flexibility of response, these informed by the intuited ‘living principle’ - the principle implicit in the interplay between the living language and the creativity of individual genius. My ‘interplay’, which is manifested in the language as the writer uses it, is an intimation that I have in mind my point that a language is more than a ‘means of expression’ : it embodies values, constatations, distinctions, promptings, recognitions of potentiality.³

It seems to me that a good psychotherapist brings to his work not only a rigour which is the equivalent of the close attention to the text required of the literary critic but a comprehensive view of life of a kind which permits an enhancement of living in another human being - an attitude which transcends the particular discipline he has chosen tofollow. He will stand or fall by his ability tofoster a creative advance in another and, although the circumstances of his task are unique, his general aim is similar to that of all those who are concerned with personal growth. These two requirements - a focus on another person in a certain situation and a capacity tofoster growth - do not always go together. The first may occur without the second - and we have an observer. The second may occur without the first - and we have a helpful person in a non-psychotherapeutic situation. But they will both be present when someone with a healing attitude makes a serious attempt to help another.

If one were to imagine a continuum of the appropriate predominance of ‘scientific’ or ‘ordinary’ perception in various areas of living then psychotherapy would come somewhere in the middle, and it is to this fact that we must attribute the main cause of its present state of confusion. It is less a science than a craft, but it is a craft the aptitude for which derives more from a general experience of living than is usually supposed. In this respect it has much in common with teaching and I would like to make a comparison between the kind of help offered to a child by the two disciplines.

In our society the child is taught at first by ordinary people: his parents. After a certain age, however, experts begin to play an important part in his education. Although parents may have vested interests in their children which interfere with their capacity tofoster growth, it is, on the whole, commonly accepted that they are the best people to bring up their offspring. There is sound sense in this notion. The love, devotion, dedication, and sacrifice required over the years to enable a child toflourish is not often to be found outside a family (a fact which is neglected by those writers who have in recent years made a savage attack on the family, basing their criticism on studies of failure).

In certain ways and under certain conditions the task of bringing up a child is too heavy upon the parents, particularly in these days when the extended family has largely disappeared and the technicalities of living and working have become so complicated; and therefore additional help is required. If our society were one in which a sense of c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• Introduction to the Transaction Edition
• Introduction to the Original Edition
• 1 The Question of Wisdom
• 2 The Ordinary and the Special
• 3 The Situation of Psychotherapy
• 4 The Paradox of Transference
• 5 Receptivity
• 6 Criticism
• 7 The Language of Psychotherapy
• 8 Uncertainty
• 9 The Teaching of Psychotherapy
• 10 Postscript
• Index