Shouldn't I Be Feeling Better By Now?

Client Views Of Therapy

Yvonne Bates

• Publisher: Bloomsbury Academic
• Year: 2005
• Print ISBN:
  9781403947406
• Edition: 1
• eBook ISBN:
  9781350305649
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Around one in four clients of counselling and therapy either deteriorate in treatment or show no signs of recovery. Why does therapy fail this significant proportion of vulnerable people and what can be done about it? This ground-breaking volume assembles the first ever collection of client critiques of therapy as a way of kick-starting an urgently needed debate. Including contributions from a range of internationally respected therapists, the book identifies areas of concern and seeks to provide constructive solutions for the future.

Nominated for the Mind Book of the Year Award 2006

Part I

Client Stories

Chapter 1

Love in an Estate of Bondage

Sylvia Wilde

A significant feature of Sylvia Wilde’s story is the seemingly automatic nature of the development of extremely strong and overpowering feelings towards each of her therapists. Such heightened emotions, often termed ‘transference’, are a central issue in many chapters of this anthology. It is generally agreed that the precise nature and cause of this phenomenon are unknown. Some therapists, particularly psychoanalysts, deliberately encourage it because they believe that working through it is one of the keys to a successful outcome. Clients are not usually forewarned that they might experience transference before starting therapy. The subject is discussed in depth by Rosie Alexander and Michael Jacobs in Chapter 15.

It would seem that for Sylvia and many others, including clients of therapists who do not have a psychoanalytic or psychodynamic orientation, ‘transference’ has proven to be an extremely dangerous phenomenon that has led to a significant deterioration in mental well-being. Most of the time, say therapists, it works itself through to a positive outcome. But how many times does it not?

A colleague suggested recently that in many ways ‘transference’ resembles electro-convulsive therapy. They are both treatments that may ‘work’ in some cases, without anyone really understanding why, and there are usually a number of unpleasant side effects. In other instances, they seem simply to cause a great deal of harm. No matter what the outcome, they are thoroughly humiliating and tortuous procedures. It is therefore a matter for debate as to whether, even in ‘successful’ cases, the ends justify the means.

‘Love in an Estate of Bondage’ also raises the issue of anger. It is quite common for a therapist (irrespective of her orientation) to encourage a client to ‘get in touch with her anger’, and express it in the consulting room. There are several different theoretical reasons for this (see e.g. Goldberg (1993); Engel (2003)), but at the root of these is the idea that we fear the consequences of expressing anger, and that with the therapist we can learn that it is safe to do so. In Sylvia’s experience, however, and perhaps this is not unusual, her therapists reacted badly and punishingly when the anger was directed at them personally, rather than in the abstract (see also Chapter 2). This compounded the original fear of expressing the anger, rather than diminishing it.

It is not often that the issue of the therapist’s dependency upon the client is discussed in the literature – for an exception see Harland (1999) – but as Sylvia found, the client’s perception that the therapist needs her can be a powerful motive to keep her attached. This raises the question as to whether some therapists do enough to dispel such concern on the part of the client.

Other subjects touched upon within this chapter include the potentially destructive or abusive nature of some psychoanalytic interpretations, the negative consequences of therapist self-disclosure, affordability and the economic burden that can be placed upon a client, and the question of whether the analytic relationship can obscure reality, in direct contrast to its intended effect (see also Rose, 2003).

Love in an Estate of Bondage

I may have been in my teens when it actually occurred but the memory feels as if it comes from much earlier for it is accompanied by feelings of childlike bewilderment. My mother, struggling with shame and embarrassment, told me that my father had walked out of an important business meeting; that he had gone to the mental hospital where he had formerly been a patient, and sat in the grounds weeping for the psychotherapist he used to see there. I was as baffled as my mother. We simply could not understand such a thing. I didn’t know it then, but I was learning something about my own fate. My father’s burden was passed on to me.

Move forward ten or more years. I am a student who has been struggling with psychological problems. Every Tuesday and Thursday, promptly at 4.30 in the afternoon, I stand at the long windows in the college library, which look out over the house where the student health service has a therapy section. I am waiting to catch a glimpse, as she sets off for home, of the therapist I used to see there.

I saw her for two years – once a week in the first year, and twice a week in the second year. Then she had to get rid of me. I wouldn’t go voluntarily; I wouldn’t say that I was cured; I wouldn’t say that I was grown up now and could go out and get on with my life. I ‘loved’ her; I pined for her.

She said I was immature, regressed, greedy – those were only some of the things she said I was. She had gone about things in the correct manner: she had set a deadline. She had tried to persuade me to go into group therapy, which she said would help me to be less introverted; and I had obediently gone into group therapy. But I still pined for her.

Now I am going to tell you something that I know you will find very hard to understand. I pined for her despite the fact that on some level I knew that I disliked her. ‘Love is the response of the victim to the rapist’ I read in some feminist writer’s work many years later. I could understand. Love for Mrs N. felt, in a curious way, like being raped. It felt induced. I felt it although I didn’t want to feel it – or rather, didn’t want to feel it for her. Rosie Alexander in Folie à Deux (1995), describes how entering into transference can seem automatic, in its way an almost chillingly impersonal process. If a robot or a monkey were sitting in the chair, she claimed, it would be just the same. I certainly recognised this in my feelings for Mrs N. I sometimes wonder if the intense ‘love’ I was to feel for a succession of therapists was in part an attempt to escape from that automatic, impersonal aspect of transference.

Almost all of Mrs N.’s interpretations were destructive: ‘anti-therapeutic’ in more technical language. Looking back I see how curiously she reincarnated the powerful verbal undermining my father managed to deal out to those around him (and probably himself too). This element of negative transference could have been used to help me if either she or I had been aware of it, but neither of us was. Mrs N. had been trained in a rigid Freudian and Kleinian tradition, and taught me to see myself as Melanie Klein’s sadistic baby, or Freud’s polymorphous pervert – as no doubt had happened to my father before me. I cannot understand how anyone can fail to see the enormous potential for destructiveness in psychoanalytic theories.

Next came Susan. (All names are fictional.) Susan was the only one that I sought out for myself rather than being sent to. She was everything I longed for that Mrs N. wasn’t: natural, affectionate, imaginative, humorous, and above all ‘spiritual’. She was Jungian, and I loved Jung. She welcomed ‘dependence’. ‘You need to be dependent so that you can yourself become dependable’, she said, and others have said it to me since. Transference was necessary for psychotherapy to work, and a strong transference was a positive thing. ‘I need her for a year’, I said to a friend after my first few visits, not realising they were the first steps on a long, long road that had no turning. It was to be nearly twenty years without missing even a single session – though not all with her.

Love for Susan did not feel like rape because it felt natural, even if exaggerated. I genuinely liked her. The first year I was elated. She encouraged me to paint and I discovered this wonderful creativity in myself. She found amazing meanings in my dreams, which I learned were full of Jungian symbols, as were my paintings. For the first time I received what felt like genuinely helpful interpretations of my childhood experiences and their effect on my present problems. At last I felt I could understand myself a little. I found all this very healing.

Then the problems started in the second year. I was getting angrier and angrier in my sessions, and Susan simply could not take it. Instead of coming out of her house feeling happier and full of energy, I felt frustrated and miserable. I had encountered the seesaw of ‘good sessions’ and ‘bad sessions’, which was to be my torment for years to come. The most defeating thing about it was its unpredictability. Years later I was talking to someone else who had been through the same mill. We agreed, ‘It’s like setting out in the morning thinking “will it rain today?” You just don’t know, but you know that if it does rain, it will rain sulphuric acid.’

Psychotherapists believe that this is all grist for the mill and part of the process; painful but necessary. Some will say that I needed to get angry. The irony was that even Susan said I needed to get angry. ‘I feel very sorry for you’, she said once. ‘There is so much anger in you and it just has to come out.’ But not at her, please. All of my therapists said that I needed to express my anger. Yet in all of my years in the consulting room, I can remember hardly any occasion when I was able to be angry with a therapist and not have them respond in a way that made me feel crushed and defeated – and anxious to say sorry in the next session. The therapist was always right. In reality, they had power because I ‘loved’ and needed them so much, I couldn’t afford to be angry, for they did not love or need me. When the chips were down, they could always threaten not to see me.

Apart from Mrs N., I believe that all three of my subsequent therapists were gifted and genuinely compassionate people, yet even a ‘good’ therapist has a shadow side, and the patient will encounter this deeply – the more deeply the stronger his/her transference. Not all of a patient’s anger is to do with the patient’s own unresolved problems – that fact should be obvious, but all too often goes unheeded.

I now categorise my four therapists into four ‘types’ that perhaps others may recognise: the persecutory (Mrs N.), the vain and inflated, the very lovable, and the psychotic. The examples unfold in that order.

The problem with Susan was that she was infuriatingly self-admiring. I believe all of the transferences people had felt for her had gone to her head. Something similar happened with my ‘number four’, whose story I tell later. Susan was always talking about herself and her family, and the wonderful things she did for people in general, and for her other patients. Not only did I get jealous, but I became frantic at having my sessions taken up with things that were irrelevant to me. In my frustration I started to throw cushions at her. She became nervous. She thought I should see someone else.

She was very gentle about it. There was no deadline; she herself found me ‘number three’ and even agreed to my seeing both of them for a while to help me over the transition. Nevertheless, it was still rejection, however gently done. It meant a deeper feeling of failure, even though I was soon happy with the change.

‘Number three’ was a man I shall call Gustav. I saw him the longest: nine years and four months. Despite later disillusion, I still feel grateful to Gustav and cherish his memory. He was sixty-one when I had my first session with him, and with his slight German accent he embodied the archetypal wise, kind, elderly father-figure analyst. He was tall and well built with a ruddy complexion and white hair, and exuded an ebullient, warm, outgoing charm and enthusiasm. He clearly loved his job and – more important – loved people. His humanity was profound and it seemed to me all-embracing. Nothing except cruelty and intolerance earned his rejection. His culture was equally wide, for it included a wealth of European folk, literary and spiritual tradition, both Protestant and Catholic, that is forgotten now except perhaps in academic courses. He was like Beethoven’s music, I always thought. The spiritual ingredient was very important to me, but it was just one aspect of the width of the human spirit, of human ways-of-being, that he seemed at home with. In comparison to him, most people – whatever their beliefs or lack of them – seemed to have a narrower view of humanity.

Gustav was officially Jungian but was not rigid about theory and weaned me away from my intensely theoretical Jungianism at that time. In religious terms he was a kind of humanist but it was a humanism that was consciously rooted in Christian tradition, not set in opposition to it. Without believing literally in Christian theology he believed strongly in its psychological value. So he left more than one of his former patients with a religious faith he did not himself share – a strange paradox.

I adored Gustav. My love for him was far more than transference and he is the only one for whom I do not put the word in inverted commas. This was certainly good for me, and although there was a heavy price to pay, I still regard it as a blessing to have spent a decade in an intimate relationship with someone I loved so deeply. One might have thought that these nearly ten years would have more than compensated for the bad experiences with the previous therapists. Nevertheless, when Gustav died suddenly of a stroke I was left not only devastated by the shock and bereavement, but also, it would seem, not really much further on. Within six weeks I was with another therapist, and building up a new dependent transference.

For several years after the initial bereavement I felt extremely angry with Gustav. One of the worst aspects of the loss was that for a long time I couldn’t recall my old love for him without it suddenly reversing itself into a distressing inner rage. It was like opening the oven door and receiving a hot blast of air in your face. I was told it was part of the bereavement process, but it was more than that. The consequence was that I lost the good side of the relationship with him, and so with therapist number four I felt I had to start all over again. I remember a dream before Gustav’s death: I was a wealthy widow living in a large house but I was unaware of the money my husband had left me and went to work for a pittance somewhere. It seemed prophetic.

That dream of course could be interpreted in another way too: that I was unaware of my own inner wealth (in Jungian terms that of my animus = the husband) and devalued myself (= work for a pittance) in order to keep my relationship with Gustav. Money symbolism in my case was especially apt. Although I loved him the most of the four, it is in relation to him that I have coined the title of this chapter: ‘love in an estate of bondage’. I mean bondage in its economic sense, like the bondage of a feudal peasant to a landlord.

Gustav was a Harley Street analyst and his fees were high. He told me he charged me very little compared to what most of his patients paid, and I believe him. Nevertheless, to me on my secretary’s salary it was a very great sum. I saw him three times a week. Gustav himself considered twice a week too little, four times a week as preferable and three times as a workable compromise. So I struggled to pay for my three-a-week and felt all the time that I was short-changed because I couldn’t afford the fourth! I had to work overtime most weeks to meet the bills, sometimes up to sixty hours a week, but was left with a constant struggle to make ends meet. The idea of bondage, though exaggerated, is not altogether wide of the mark. Although on the surface I was under no compulsion, what felt like my overwhelming need for Gustav was translated into an economic burden that forced me to ignore the demands of every other aspect of my life. And of course, inevitably, the financial poverty increased the emotional dependence. That neither he nor I could see that simple fact highlights the unreality of the consulting room: the process that shuts out the ordinary world from the hermetically sealed alchemical chamber, in which I believed I would find the treasure that I was seeking. Jungians cultivate alchemical symbolism for the process of analysis, but this can help one gloss over the very real question of just what is the goal that one is seeking, in my case at such great cost.

I do not believe Gustav was exploiting me. The unreality lay in the huge gap in the value of money between someone who had so much of it and someone who had very little. Gustav knew my circumstances but had no conception of the world of ordinary work. He kept saying that the financial struggle would inspire me to get a better job, whereas in fact the insecurity stifled initiative. Moreover he believed as intensely as I did in the enormous value of analysis – especially analysis with him!

To return to the hot blast from the oven door: like the others, Gustav talked about anger a great deal, and saw it positively. Like the Beethoven he resembled, he was a lover of sturm und drang; he proclaimed his belief in passion and conflict. He scoffed at easy, idealistic self-satisfaction, whether in religious, political or other aspects of life. ‘Guaranteed shit-free analysis’ was his contemptuous comment on a colleague of his. I feared that with no other analyst, indeed with no other person, would I dare to express my fe...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements and Dedication
• Preface
• Introduction
• part: 1 Client Stories
• part: 2 Practice Issues
• part: 3 Working Towards Solutions
• Afterword
• Appendix: Research into the Efficacy of Counselling and Psychotherapy and its Relevance to Subjective Reports
• Suggested Further Reading
• Index