The Impossible Profession

A friend of mine recently passed along an article from The Spectator which reports the dramatic decline of psychoanalysis in New York . New York has long  been the thriving hub of psychoanalytic culture so to discover that psychoanalysis is now something that very few New Yorkers do comes as something of a shock.  The article, which unfortunately fails to distinguish psychoanalysis from other forms of psychotherapy, reports that a recent survey reveals that the average number of clients that a therapist sees is a mere 2.75 (per day? per week? per year?--the article didn't say) .  So what has happened? According to this article,  prospective patients now turn to other forms of treatment to deal with their psychological complaints.. CBT, anti-depressants, meditation and yoga were all mentioned as preferred alternatives., even though the last one can hardly begin to address the problems that psychotherapy typically deals with. But the tone of the article was one of faint mockery and referred to Woody Allen and his famous neurosis as if that sort of case were typical for therapy. The survey on which the article was based seems somewhat questionable, as well. Just who were queried? The New York Times runs an excellent series of articles about psychotherapy called "Couch", the regular appearance of which suggests that psychotherapy still has an important place  for its readers. So is it possible that the survey was restricted to classical or orthodox Freudian analysts and neglected to canvass the far more numerous psychodynamic practitioners who draw heavily on psychoanalytic theory without adhering to Freudian practices? Even so, it would still seem that Freudian psychoanalysis, which once predominated in psychotherapy and is the progenitor of virtually every form psychotherapy, may now be in terminal decline. And though the reasons for that are not hard to guess, there is a larger question beyond the fate of psychoanalysis. Is the future for every form of psychotherapy as dim as it appears to be for psychoanalysis?

Regular readers of this blog might recall my post about Raymond Tallis's highly favourable review of Why Freud Was Wrong  by Richard Webster, which was published twenty years ago. The title pretty much says it all, but that was not the only influential book that was highly critical of  Freud and psychoanalysis, though perhaps no other book laid out the case against the Freudian project in such comprehensive detail. About the same time that Webster published his book, Frederick Crews wrote a series of articles in the New York Review of Books (the most prestigious literary periodical in America) which savaged Freud and his methods. Later published as a book entitled The Memory Wars,  it mainly took aim at the bogus scientific authority with which quack psychotherapists made spurious and dangerous diagnoses. Crews argued that therapists who encouraged false memories in vulnerable clients had found their precedent in the Freudian example of claiming that the theory of repression gave psychoanalysts privileged access to the repressed memories of their patients. Although many of those quack therapists were practising something much more akin to exorcism than psychoanalysis, Crews didn't rate Freud's theory of repressed memory as any more scientific than the beliefs of the quacks. In fact, Freud's passionate insistence that he was a medical specialist whose theories were based in empirical science has been proven to be false. But Freud's error turned out to be a most profitable mistake as psychoanalysis found great prestige by its claim to be a reputable medical science. Indeed, the Freudian legacy of selling dubious therapeutic practices as medical science is not confined to some quacks arguing for things like demonic possession. It also influences mainstream psychiatry which, having long ago turned its back to the possibilities of a talking cure, now pushes ineffective and harmful drugs because prescribing pills is what doctors are supposed to do. 

The truth is--and always was--that psychotherapy is more of an art than a science. And by the standards of that art, Freud, in spite of his flaws and claims to be a scientist, was a very great and original artist. What psychoanalysis first did is what all effective forms of psychotherapy still do, which is to encourage the patient to make meaningful introspection of his motivations and feelings and by doing so, reach a deeper, more truthful self understanding. To be sure, the self reckoning that occurs in psychoanalysis must occur in psychoanalytic terms, which is perhaps one reason why psychoanalysis may now be in decline. Thanks in part to the efforts of critics like Webster and Crews who have exposed psychoanalysis's pretensions to be a science, the sort of well educated people who once turned to analysis for treatment of their psychological complaints no longer do so. But if psychotherapy is not--indeed, cannot be--a science as Freud assured us that it was, what does it have to offer to people who want solutions or answers to real life problems that are anything but imaginary? Freud himself once called psychoanalysis "the impossible profession", referring to the difficulty of meeting the conflicting demands of psychotherapy. But nowadays, it seems, any form of psychotherapy may no longer be viable as a profession because it lacks the credentials of a science that Freud seemed to have secured. 

The idea that two fallible people, the therapist and the client, could ever reach a satisfactory resolution to the client's problems without the benefit of science, holds a certain anxiety for many people.  Indeed, it is the lack of certitude that makes psychotherapy seem like such a doubtful enterprise. But the truth of feeling that psychotherapy seeks is less about factual or scientific certainty than it is about making sense of the client's experience in the face of the myriad unknowns that arise unpredictably in the course of living.  As a therapist, I am often struck by how little I know about the clients I work with. Although I may know all their essential biographical facts, as well as their secrets that could find expression only in the security of a strong therapeutic relationship, something always remains unsettled and unknown, no matter how much has been revealed. That unknown element almost always refers to some future development in the client's life.  "What's going to happen to me?" clients often ask, as if their futures lay hidden in a prophesy they haven't yet discerned in the memories they hold. For my part, I am even less in a position to know how their lives will unfold than they are. Yet I know that by finding and sharing in their sense of unknowing, a new perspective on their experience can arise which can lead to meaningful change. 


Therapy, then, is best conducted in a climate of wonder, but not vacant or wistful wonder. It is wonder that taps into the pressure of the client's life situation without becoming captive to that pressure. This is very difficult and as Freud observed, can make psychotherapy appear to be an impossible profession.  Yet, even in our information obsessed scientific era, psychotherapy remains a necessary vocation.