The Future of Psychotherapy: Two Therapies

John Rowan

Rather than try to predict the future, I would just like to say what I would like most in the future. And what I would like is for everyone involved to be clear that there
 are two quite different things both called therapy – the term I use to encompass
 psychotherapy, therapeutic counselling, counselling psychology, etc.

Adjustment therapy is dedicated to cure. The client comes in for the removal of
 symptoms which may be intensely painful or even disabling. Much crisis work is
 like this. In any case there is usually a pretty clear focus for the work, and one
 might call it focused therapy. It is relatively easy for therapist and client to agree
 on what is wrong and how to go about getting it right again. We are talking about
 restoration to normality. Most therapists have to do some of this work, and
 counsellors in particular are often faced with the need to do it, because they are
 often in front-line positions. In all situations where there is an external constraint 
on the number of sessions allowed, we have to speak of this form of therapy.

Liberation Therapy is dedicated to emancipation. The client comes in either with 
similar symptoms (but soon reveals that more is involved), or more commonly with
 much vaguer complaints. Phrases like – “My life is not working”, or “I just can’t 
make sense of it all”, or “I should be happy but I’m not” – indicate that there is no specific symptom to aim at. Such people are more in need of personal growth than 
of any kind of cure. The task here is to open up the way for the client to move on 
to the next stage in their psychospiritual development. We could call this
 unfocused therapy.

If this simple division were only better understood, many of the current arguments
 would be cut short. The demands of insurance companies, EAP employers, NHS 
trusts and accountants in general for specific results would be seen to apply only to
 Adjustment Therapy. In Liberation Therapy there are no specific results, because
 there is no clear aim. In fact, the very same move from “Esteem from others” to
 “Esteem from self (for example) could mean (for one client) becoming more 
involved with others, more compassionate, more loving or (for another) becoming
 less worried about the opinions of others, and more authentic and autonomous.

Adjustment Therapy involves horizontal translation – we move from one position 
to a better one at the same level. Liberation Therapy may involve vertical 
transformation, where our whole idea of who we are and what we are about may 
change quite radically.

Looked at in this light, the old argument about short-term versus long-term therapy 
looks quite different. Short-term work is often very much indicated for Adjustment
 Therapy: it is seldom much use for Liberation Therapy. Conversely, Liberation
 Therapy normally entails long-term therapy, though sometimes it the person is ripe
 and ready enough, short-term work is sufficient.

It can happen, of course, that someone comes for Adjustment Therapy, but it then 
turns out that the problems are much older, much more deep-seated than was
 apparent at first. It will then become long-term work, but will not necessarily turn
 into Liberation Therapy. A person who is damaged deeply and early may require 
long-term work, not because they have moved over into personal growth, but
 because there is so much work to be done at a deep level if anything at all is going 
to change. And a person who thinks they are coming for a long-term stint may find
 everything resolved in short order, simply because they are so ready to move on – 
ripeness is all.

The Psychoanalytic Approach


The humanistic view has traditionally been that psychoanalysis aims at adjustment 
to the status quo, while the various humanistic approaches aim at liberation,
 including spontaneity, creativity, authenticity and the real self. But a book came 
out not long ago written by two psychoanalysts saying that this was not the case.
 They pointed to a split within psychoanalysis itself. They pointed to the fact that
 we find some people, such as Karen Horney, Bernard Robbins, Maxwell Gitelson,
 Ernst Ticho, B. Glueck and Donald Winnicott, were found to be saying that the
 ultimate aim is autonomy, liberation and the discovery of the true self.

The authors also had to say, of course that we find others, such as Waelder, Gaskill, 
Rangell, Brenner and Kernberg, saying that the ultimate aim is to understand the
 pathological structures, and to work through their connections within the patient, 
thus ending the psychopathology. This is about coming to terms with the real
 limitations of life: it would include the ability to increase the patient’s capacity to 
tolerate temporary regression and to recover from it. “More adaptive kinds of
 compromise formations are instituted.” In other words, adjustment. (Sandler & 
Dreher 1996).

What I noticed about this book, however, was that no matter how I chased through 
the extensive quotations given in it. I could not find the words “authenticity” or
”spontaneity” anywhere in this book. It still seems to me, then, that there is a 
difference between the psychoanalytic approach and the humanistic one, even
 when we look at those psychoanalysts who are closest to the humanistic position
.

The Cognitive-Behavioural Approach

It hardly needs to be argued that the cognitive-behavioural approach is all about
 adjustment. We find statements such as – “These studies showed cognitive therapy 
to be as effective as anti-depressants with depressed patients”, “Beck suggests that
 we are all capable of functioning as rational problem-solvers”, or more elaborately:
 “Cognitive therapy has three main goals: to relieve symptoms and to resolve p
roblems: to help the client to acquire coping strategies: to help the client to modify underlying cognitive structures in order to prevent relapse.”

All these quotes come from the chapter by Moorey (1990).

In behaviour therapy, again, we have clear statements such as: “The behavioura
l model views psychological well-being in terms of control over one’s environment and good adjustment in social, interpersonal, work, sexual and leisure activities
. (O’Sullivan 1990)

It would not be profitable to go further into this, since it is well known that the
 cognitive-behavioural approach always prefers to have definite goals agreed with 
the client.

The Jungians

It is hard to be sure about the Jungians, since they are wildly different in their ideas 
and practices. Jung himself was clear enough. He says:

“As far as possible I let pure experience decide the therapeutic aims. This
 perhaps seem strange, because it is commonly supposed that the therapist has an
 aim. But in psychotherapy it seems to me positively advisable for the doctor not 
to have too fixed an aim.” (Jung 1966) This makes it clear that Jung was basically 
more interested in Liberation Therapy. James Hillman, it seems to me, goes 
further. He says:

“Suffering is necessary for increased awareness and the development of 
personality… If malfunctioning and suffering are viewed only pathologically,
 the physician prevents himself from sensing his own wound… The purpose of train
ing analysis is not merely to heal the personality of the analyst, but to open his wounds 
from which his compassion will flow.” (Hillman 1990)

This striking statement goes deeper, and says that far from therapy being about cu
re or adjustment, it is about respecting pain and death. Hillman goes on to talk about
 how the therapist should treat complexes or subpersonalities:

“As energetic centres, complexes rather than cured or killed may be transformed, 
and as purposeful entelechies the dialectic with them develops their dynamism and furthers consciousness.” (Hillman 1990) This again is an original statement,
 which it seems to me goes further than most in showing respect for what the client 
brings. Of course, one of the definitions of what Jungians are ultimately after is
 individuation. Andrew Samuels has an excellent chapter entitled ‘The Self and Individuation’ which deals with this. He says:

“When discussing individuation, it is important to remember that Jung was careful
 to distinguish this from an ‘unconscious wholeness’, a false individuation. 
’Conscious wholeness’ in contrast is a successful union of ego and self so that both
 preserve their intrinsic qualities.” (Samuels 1985)

In the discussion of individuation, it seems clear that this is one of the most
 important general aims in Jungian analysis. And Colin Feltham and Windy Dryden 
go so far as to say that: “Individuation can be roughly equated with self-
actualization.” (Feltham & Dryden 1993) It seems, then, that the Jungian 
approach is about liberation.

The Humanistic Approach

And this brings us to the humanistic approach. Considering the wide variety of 
schools which come under the humanistic umbrella, there is an impressive degree 
of unanimity about the goals of this general approach.

In Gestalt therapy, it is well known that Fritz Perls used to say that most people 
went in for the actualisation of their self-image, whereas he was more interested in 
the actualization of the self. In recent Gestalt therapy there have been many 
changes since the sixties, but we still find a basic text saying: “Self-actualization, 
then, is an organismic process involving the gradual development of one’s unique
 potential through the acknowledgement of what one is.” (Korb, Dorrell & Van de 
Riet 1989) And the authors go on to say that one of the most important aspects of 
the self-actualised person is authenticity. As we shall see, authenticity is one of the 
key aspects of humanistic goals. The same authors continue: “The person who is 
free of unfinished business from the past, free of unrealistic expectations of the 
future, in touch with present organismic processes, and in good contact with the 
environment will express the self authentically.” In their biography of Fritz Perls,
 Petruska Clarkson and Jennifer Mackewn have this to say: “The fullness of living 
is born not of inauthentic manipulation and control of other people and the 
environment, but of authentic self-realization. People actualize their full potential 
by knowing and facing themselves in their wholeness.” (Clarkson & Mackewn 
1993)

Similarly, James Bugental (one of the premier writers on authenticity in our time) 
says that authenticity is a combination of self-respect (we are not just part of an 
undifferentiated world) and self-enactment – we express our care or involvement in
 the world in a visible way. Here is a key quotation: “By authenticity I mean a
 central genuineness and awareness of being. Authenticity is that presence of an 
individual in his living in which he is fully aware in the present moment, in the 
present situation. Authenticity is difficult to convey in words, but experientially it 
is readily perceived in ourselves or in others.” (Bugental 1981) In other words,
 what we in humanistic psychology are saying is that authenticity is an experience. 
And it is an experience which we seek in therapy – both for the therapist and for 
the client. And this is not an easy option. As Jean-Paul Sartre memorably put it: 
”Authenticity consists in having a true and lucid consciousness of the situation, in 
assuming the responsibilities and risks that it involves, in accepting it in pride or
 humiliation, sometimes in horror and hate. There is no doubt that authenticity 
demands much courage and more than courage. Thus it is not surprising that one
 finds it so rarely.” (Sartre 1948) This is still as true today as it was when it was 
first written. Authenticity and self-actualization is no easy option. It may be 
noticed here that any version of psychotherapy which says that everything that 
happens in the session must be either transference or countertransference can have
 no place for authenticity.

One of the most fully worked-out theoretical statements on the values of
 actualization and integration for the humanistic approach is to be found in the work
 of Alvin Mahrer. His theory of the optimal state is to be found in two chapters, one 
on integration (78 pages) and one on actualization (42 pages). It would be out of 
place to try to do justice to all this here, but let us just quote a couple of passages
 to get the flavour: “It involves the commitment to be whatever there is within to 
be. This is the leap of faith, the tearing of one’s self from what one is and the 
falling into whatever is there within. In this commitment, I am the one to decide 
the one who makes or fails to make the commitment. It is my commitment not my 
parents’ or my group’s or my spouse’s. I am the responsible director of my
 process of internal change.” (Mahrer 1989)

That was from the chapter on integration. And here is one from the chapter on 
actualization: “The highest levels of interpersonal relationships are thos
e characterized by integration and actualization. This kind of relationship exceeds 
one of integrative love, mutual integrative oneness, and mutual integrative being-
one-with. Because of the nature of actualization, these highest levels of 
interpersonal relationships are also characterised by mutual contexts enabling each 
participant toward increasing depth and breadth of experiencing. When
 relationships are of this order they define the highest and most valued interpersonal 
relations available to human beings.” (Mahrer 1989)

It can be seen that integration and actualization do not result in a separate 
autonomous self which has no need for others. This is sometimes not quite 
understood by those who think that humanistic psychology is defined by Maslow and Rogers.

Conclusion

This has been a brief trot round some important landmarks. I suppose what I really
 wanted to say was that if we make a clear distinction between adjustment therapy 
and liberation therapy we are in a better position to resist any doctrine or argument
 which depends upon the assumption that there is just one thing called therapy.

Some people may feel that I should have said something about transpersonal 
therapy. My view on this is that transpersonal work in psychotherapy should not 
be regarded as a separate form or school of therapy, but as a dimension which we 
ignore at our peril. It is clear to me that transpersonal work is within the
 framework of liberation, and simply takes it further into higher or deeper realms.

References


Bugental, James F T (1981) The Search for Authenticity (Enlarged Edition) New
 York: Irvington.

Clarkson, Petruska & Mackewn, Jennifer (1993) Fritz Perls London. Sage

Feltham, Colin & Dryden, Windy (1993) Dictionary of Counselling London: 
Whurr

Hillman, James (1990: 1964) Suicide and the Soul Dallas: Spring

Jung, Carl Gustav (1966) The Practice of Psychotherapy (Collected works vol.16) 
London: Routledge

Korb, Margaret P, Gorrell, Jeffrey & Van de Riet, Vernon (1989) Gestalt Therapy:
 Practice and Theory (2nd ed) New York: Pergamon Press

Mahrer, Alvin R (1989) Experiencing Ottawa: University of Ottawa Press

Moorey, Stirling (1990) ‘Cognitive Therapy’ in W Dryden (ed) Individual Therapy: 
A Handbook Buckingham: Open University Press

O’Sullivan, Geraldine (1990) ‘Behaviour Therapy’ in W Dryden (ed)
 Individual Therapy: A Handbook Buckingham: Open University Press

Samuels, Andrew (1985) Jung and the Post-Jungians London: Routledge

Sandler, Joseph & Dreher, Anna Ursula (1996) What do Psychoanalysts Want? The Problem of Aims in Psychoanalytic Therapy London: Routledge

Sartre, Jean-Paul (1948) Existentialism and Humanism London: Methuen