Some Thoughts

Editor’s note: This article in its original format was first published in Inside Out in Winter 1999 as ‘Some Thoughts as Inside Out Closes’

I was involved in the beginning of Inside Out fifteen years ago.  It feels timely to reflect on how psychotherapy has changed during the life of the journal and how it is now viewed from 2006.

Inside Out was formed from a multiplicity of intentions and much like any action, it seems futile to look for a single cause.  However, some important motivators were:

1. To offer a vehicle for the emergent specialism of Humanistic and Integrative Psychotherapy within the broader field of psychotherapy;

2. To create publicity relating to the organisation of the profession of psychotherapy in the light of emerging  realities from a wider European context;

3. To go some way to meet the demand in the general public for psychotherapy writing which was accessible and not driven solely by standards of academic rigour, while maintaining a good standard of thought and experience sharing.  This spoke to the growth of interest in psychotherapy.

The first question related to a particular kind of psychotherapy, the second to issues about psychotherapy in general, and the third concerns attitudes to psychotherapy in the wider public arena.

I will address these questions, beginning with a few thoughts about the emergent specialism of Humanistic and Integrative Psychotherapy. Fifteen years ago, the label of Humanistic and Integrative was just beginning to be spoken of in Ireland. It was a designation of a particular branch of psychotherapy that had been coined in the UK, forming a section of the UK Council for Psychotherapy, then the Rugby Standing Conference. It was a useful designation as it described a transition from a split position which had arisen between humanistic psychotherapy and psychoanalytic psychotherapy.  Humanistic psychotherapy had its roots in the 1940s, ‘50s and ‘60s, arising in large part as a reaction to psychoanalytic thinking which was seen as more steeped in biological and medical models of thinking eg ‘patient’ vs ‘client’.  Humanistic psychotherapy brought a stronger focus on the co-creation of relationship and on the expression of feeling, as against understanding alone. While these are but very broad brush-strokes and a more adequate perspective can be found in John Rowan’s the Reality Game (1983) and Carl Roger’s On becoming a Person (1961), I hope that I can convey something of the split which appeared between the two areas of psychotherapy. I saw the addition of the term “Integrative” to “Humanistic” in the mid 1980s as conveying a movement towards holding this split in a new way, rather than using the primitive defence mechanism of splitting as had emerged prior to that time (Segal 1979). In Klein’s view, the earliest, most primitive way the baby deals with pain is to split into the good/bad. She calls this ‘the schizoid position’. A later development she describes as ‘the depressive position’, where both good and bad can begin to be tolerated both in self and other. One could see the emergence of the title of ‘Integrative’ as a move towards a more maturing position within psychotherapy.  Elements of this integration were also emerging in Group Analytic thinking which, while strongly influenced by psychoanalytic thinking, was beginning to be influenced by Systems thinking and Complexity Theory (Waldrop 1992).  Such an integration title was being made more possible by the growth of Object Relations Theory, a branch of psychoanalysis which abandoned the drive-structure model of pure psychoanalysis.  Humanistic psychotherapy, I believe, drew much of its early strength from contesting the biological model of psychoanalysis which saw the individual seeking to discharge psychic energy to maintain an equilibrium.  This view was seen to focus entirely on the internal of the individual, his/her instinctual urges and their control. The Object Relations view saw the individual motivated by the urge for relationship and saw that it is the network of human relations an individual is embedded in that structures their psyche.  This view as expressed by Fairbairn (1952) and others, has gradually gained increasing adherents and their influence moved outside psychoanalysis itself by the 1980s (Gomez 1997). Such a shift had allowed some humanistic psychotherapists to re-consider psychoanalytic concepts and begin to explore an integration of the more active processes from Body Oriented Psychotherapy and Gestalt Psychotherapy with Object Relations perspective.

I think that this development had moved further by the end of the 1990s where Integrative Psychotherapy is an entity by itself, separate from Humanistic and Psychoanalytic Psychotherapy.  This move to an Integrative approach to psychotherapy is gaining strong ground in many countries.  Norcross says, “A metamorphosis is occurring in mental health: the integration of the psychotherapies.  This movement has experienced dramatic and unprecedented growth in the past decade” (1990). This metamorphosis has now, I believe, produced a new ‘creature’, the Integrative Psychotherapist.  This move is seen by the development of the European Association for Integrative Psychotherapy, which is consolidating with others the identity of the new grouping.  I think that the clarifying of the essence of the Integrative style is still being developed and needs to be articulated.  Perhaps a new journal of Integrative Psychotherapy in Ireland is needed.  In essence this integration for me is the marriage of a holding presence and an active presence in the psychotherapist.

I now hear some of us who espouse an Integrative perspective struggling to articulate our differences from both a Humanistic and a Psychoanalytical perspective. An example might help. The Humanistic mode of involvement in a session with a client might involve the congruent naming of one’s own experience.  The Psychoanalytic mode might involve reflecting silently on one’s own experience and offering an interpretation of what may be happening in the client informed by the counter-transference.  The Integrative mode we might call an embodied interpretation which would name the interpretation but would congruently locate the issue in the therapist’s own experience.  In this way, the therapist’s feelings are not only experienced but named, not only named but related to client material, and in the process of holding struggling energies in one’s own body, containment is offered which is both empowering and holding for the client, one’s self and the process. I believe in the view that you cannot offer what you haven’t experienced.  I see more psychoanalytically oriented psychotherapists embracing body-oriented psychotherapy for themselves, thereby experiencing their somatic processes at depth.  This process precedes judgment and interpretation and enables a deep witnessing of the other through one’s own experience.  An example here might be the well-known Jungian analyst and author, Marion Woodman, who now incorporates movement, dance and deep bodywork in her work. On the other hand, humanistic psychotherapists are now experiencing therapeutic experiences which make strong use of the transference relationship. The difference here is often one where there is not a premature move towards the equality of relationship which can disallow the depth experience of primitive relationships as they are re-experienced in the psychotherapy. These moves on the part of diverse sections of the psychotherapy profession allow a growing momentum for integration in the profession.

I wonder if the time for a Humanistic and Integrative Psychotherapy type of therapy is reaching its end; is this valuable but transitory form now giving way through a dialectical process to a newly emergent form, Integrative Psychotherapy?

The second question I raised relates to the development of psychotherapy over the past decade or more in Ireland. When Inside Out started psychotherapy was still not seen fully as a profession in its own right – a position attested to in the Strasbourg Declaration 1990 (Appendix). Now I see psychotherapy firmly established as a profession, separate and distinct from psychology, psychiatry etc. This is evidenced by the Dept. of Health now recruiting for psychotherapy posts in the health service. It is also apparent that a general standard of training for psychotherapy is being agreed; training to be of seven years duration, with an undergraduate degree in human/social sciences followed by four years specific psychotherapy training. This is embodied in the European Training Standard agreed by the European Association for Psychotherapy in 1997. Thus it is fair to say that the profession of psychotherapy has moved on considerably in a decade. One image can suffice to portray the movement. Fifteen years ago, a group of psychotherapists from Holland came to Dublin to present their views for a psychotherapy which needed psychology or psychiatry as a basis for entry to the profession, the so-called core profession model. We then had a European Annual Conference of Psychotherapy held in Dublin 2000, celebrating a grouping coming of age as a separate independent profession without reference to the other professions.

Of course issues still abound around professionalisation. For example, recently we have begun to hear calls for statutory regulation of psychotherapy, following some outcry about counselling in relation to adoption. We have also heard psychiatrists such as Professor Patricia Casey of UCD expressing concern for psychotherapy and counselling standards. While such concerns are well founded, it is worth clarifying that a subtext may be the battle still being waged as to which professional grouping will receive expenses cover from health service insurance groups, VHI, BUPA, etc. The winners of such contests will mould much of the future of psychotherapy in Ireland.

The professionalisation of the profession has continued over the past six to seven years.  Issues continue to arise: I wonder how a designation of psychotherapist in the Health Services might be somewhat challenged by the growth of counselling psychology as a qualification of choice in some statutory services.  This exists where the named grading is counsellor/therapist. I wonder how the designation of counsellor/therapist relates to one of psychotherapist. The training and personal development of a psychotherapist may be different from a counselling psychologist or counsellor but a clear articulation of the standards of each may be useful. I believe that to work in an in depth way with clients a strong element of personal development or reflective practice is required, I would want to see such a demand being made for all who do the work either in state or private services.  By this I mean that trained practitioners would need three to four years of individual and/or group psychotherapy for their own development. They would also need to develop a coherent self care package that includes self reflection and physical discipline so as to avoid burn out. So standards of training and continuing professional development need to continue being debated.

The third question is in relation to the unprecedented growth of interest in issues related to psychotherapy in the general public, which was also a motivator in the pitching of the level of conversation in Inside Out ten years ago. The decade has seen an unparalleled growth in interest in personal development and therapy. This growth is probably not unrelated to the dramatic decline in the place of religion in Irish culture over the similar period. As the population gets more sophisticated we are no longer confusing psychotherapy with a spiritual search. We are coming to see it more appropriately as a set of valuable techniques to help the ego function more effectively with less internal conflict (Murphy 1999).  While such a shift has been of value in rebalancing a society where guilt was far too strong a motivator for behaviour, the move to a more individualistic endeavour has also had its difficulties.  One dilemma has been that in the movement to replace religion with therapy as the primary meaning making structure, guilt may be abandoned, but so may remorse. Remorse is a sensitivity which holds us in relationship and sensitises us to our effect on the other, without which we grow narcissistic and eventually lose our capacity to live in community – a hellishly lonely experience – maybe we can see such a mentality in the Celtic Tiger. It is important to distinguish between such narcissistic individualism and a mature self-contained self. It is becoming increasingly clear that individual psychotherapy needs to end in the latter maturity and not in the egoist over-indulgence that can eschew the holding of appropriate boundaries and limits. My article, ‘Psychotherapy and Loneliness’ (1997) attempts to address questions relating to the end of psychotherapy.

One potent force that I believe is helping to withdraw energy from individual psychotherapy is the pursuit of emotional growth and agility that is gaining momentum outside of the confines of psychotherapy. While psychotherapy is an invaluable tool in the treatment of emotional pathology, it is no longer the prime medium for intentionally emotional engagement. For example, over recent years we have seen the phenomenal success of Daniel Goleman’s Emotional Intelligence (1996) and Robert Cooper and Ayman Sawaf’s Executive Emotional Intelligence (1997). These works have emphasised the potential for individuals to develop their emotional literacy, fitness and depth.  Such development is now not being seen simply as a means of overcoming pathology or as necessary for one’s intimate relationships, but as requirements for optimum functioning and productivity in work and social relationships. This shift to centre staging emotion in our lives is, I think, partly the result of the impact of a century of psychotherapy, but it opens the focus more on optimal functioning than pathology, a focus which Abraham Maslow pioneered forty years ago. However, I wonder if a change is arising in this aspect also. There may be a shift from the modernist and individualistic perspective to the post-modernist one where the ego is decentred and the individual is seen as no longer bounded clearly by a skin, but created in relation to the other in a continual process of co-creation. This view acknowledges the fractured nature of identity which Lacan (1975) speaks of. It is also a perspective that begins to recognise the inherent fragility and possibly mirage-like quality of the individual ego. In this the concerns with group, community, organisation, may well overtake the obsession with the individual and may herald a decrease in our societal compulsion to self-develop in favour of exploration of sustainable group, community and organisation activities. These concerns relating to how psychotherapy relates to other spheres of cultural life are key to helping the profession not sink into a narcissistic inwardness. Our own recent conference in June 2005 which addressed the place of politics in psychotherapy and psychotherapy in politics was one attempt to address some of these issues. I think there is place for more such conversations along these lines.

There was a timely death and now there is useful rebirth of this journal where we can articulate the concerns of the 21^st Century profession.  If I were to venture to name a core concern it would be related to how we foster a depth in ourselves and our profession that ensures that we do not get caught in regulation and legality so that we maintain our personal and professional innocence even as we grow out of our naivety.

Ger Murphy works as a trainer and psychotherapist with the Institute for Creative Counselling and Psychotherapy in Dun Laoghaire and works with groups, teams and organisations applying insights from psychotherapy to the area of work. he has a particular interest in Somatic and Body -oriented approaches to psychotherapy and growth.

Appendix:

1. The Strasbourg Declaration on Psychotherapy 1990

The Strasbourg Declaration on psychotherapy is the bedrock of the European Association of Psychotherapy’s commitment to establishing a compatible and  independent profession of psychotherapy across Europe.

1.1  Psychotherapy is an independent scientific discipline, the practice of which amounts to an independent and free profession.

1.2  Training in psychotherapy takes place at an advanced, qualified and scientific level.

1.3  The multiplicity of methods of psychotherapy is assured and guaranteed.

1.4  In a process of psychotherapy training is carried out in full and includes theory, self-experience and practice under supervision.  Adequate knowledge is gained of further processes of psychotherapy.

1.5  Access to training is through various preliminary qualifications in particular human and social sciences.

Bibliography

Cooper & Sawaf, (1997) Executive Emotional Intelligence, New York: Perigee Books.

Fairbairn, W.R.D. (1952) Psychoanalytic Studies of the Personality, New York: Routledge.

Goleman, D. (1996) Emotional Intelligence,  New York: Bantam books.

Gomez, L. (1997) An Introduction to Object Relations, U.S.A.: Free Association Books.

Lacan, J. (1975) Ecrits,  New York: Humanities Press.

Murphy, G. (1997) ‘Psychotherapy and Loneliness’, Inside  out, Winter.

Murphy, G. (1999) Psychotherapy and Spirituality, Eisteach, IACP Journal, Spring.

Norcross, J. (1990) Eclectisism and Integration in Counselling & Psychotherapy, New York: Brunner/Mazel.

Rowan, J. (1983) The Reality Game,  New York: Routledge.

Rogers, C. (1961)  On Becoming a Person, New York: Marnier Books.

Segal, H. (1979)  An Introduction to the Work of Melanie Klein,  London: Karnac Books.

Waldrop, M.M. (1992) Complexity – The Emerging Science at the Edge of Chaos, U.S.A.: Pocket Books.