Psychotherapy
and prostitution: A dialogue
Abstract
This article [1] consists of a dialogue constructed around the
following questions: Is psychotherapy truly the prostitution of friendship and
love? That is, is there not a more than superficial similarity between the
psychotherapist’s selling of love, and the prostitute’s selling of ‘love’/sex?
If there is something problematic about the latter, then oughtn’t we to be
equally disturbed about participating in the former?
One
of us (R) is a philosopher (and an
amateur co-counsellor[2]). The other of us (E) is a practitioner of and advanced trainee in Gestalt
psychotherapy. Both of us have been /are the ‘recipients’ of Gestalt therapy.
This
dialogue speaks from and to the way we have faced these questions, these
dilemmas, not only intellectually but also in the concretion of our actual
lives, our experience.
Introduction:
Money for love?
R: The question I would like us to debate is:
Under
what circumstances can it be right to take money for the provision of love, in
the form of psychotherapy?
Or
to put this ‘awkward’ question even more bluntly:
Are
those who take money for love
prostituting themselves, and thereby
doing something which is contrary to their/our deepest potential for humanity
and authenticity?
These questions could in turn be seen
as part of a more wide-ranging investigation of what therapists’ role in
society should be. Are therapists -- should therapists be -- ‘neutral’
quasi-physicians with a professional expertise? Or tacit political activists?
Or paid friends?
I
submit that the forms of therapy which any right-thinking person would take to
be ‘valid’ do not really have at their core a theoretical body of knowledge.
They are deliberately informal and non-systematic. Like a friend (we might
think of friendship as a kind of expertise, a kind of skill, only a very
informal, non-systematic kind) or a lover, a real psychotherapist will work on
the basis of their own and the other’s experience. It is true that, like
loving, therapy is something which can be done well or badly -- but it would be
absurd to say that ‘lovers’ can be ranked according to their possession or
otherwise of a body of expert knowledge. Consulting a good therapist or
counsellor is not like consulting
(say) a computer technician -- when one pays for the expertise and theoretical
know-how which the technician has and which one does not oneself have. It only
looks that way in highly-theorized and arguably over-complex and authoritarian
forms -- such as most (all?) versions of Psychoanalysis. If one looks rather,
at Gestalt, with its emphasis, in part inherited from Phenomenology and
Existential Philosophy, on the here and now, and on the therapist being truly
present as a person in the ‘dialogue’ of a therapy session, rather than at
(say) Kleinian Psychoanalysis (which to me is a paradigm of over-interpretation
and over-therorization), then one doesn’t find an activity remotely resembling
that of being a computer technician, or even a doctor. Rather, one finds an
activity which is centred in attention toward another; in really being present
with them as one talks with them; in loving.
I
think that the psychotherapist is placed in an unavoidable dilemma or paradox:
the more human-centred and non-intellectualistic their therapy is, the better
-- but, at the same time, the less tenable and comfortable it is for them to
ask to be paid.
I
think we need to ask directly what one is being paid for, if one offers one’s
services as a psychotherapist. If it turns out that one is being paid in order
to be a friend, or a ‘lover’, then we need to ask: Is it right to be paid for that?
E: I think you are right to talk about the
importance of the compassion, intuition and heartfelt presence of the Gestalt
therapist. But these qualities are informed and guided by a theoretical body of
knowledge. And it is for the artistic and scientific weaving of this knowledge
with humanity that a client pays. Psychotherapists are not, therefore, being
paid solely for love.
Before
we go on to look in detail at why therapists are paid, however, I want to note
that your approach is partly about what’s
right, about how things (society, people) should be. That’s interesting, because we therapists do not often
deal with such issues directly. People don’t contact a therapist because they
want society to be different. (But a truly field-theoretical approach may
demand some aware views about society.)
So your approach does I believe remind us of something potentially
radical and useful, something we should not lose sight of.
There
are two sides to the coin: How society should be, and how we have adjusted
(often at our cost) to how it is. Which of these should the therapist concern
themselves with?
R: I am going to try to emphasize that it’s one coin: that its ‘two sides’ have to be integrated. I am going to
argue that how society should be is: less dependent upon money changing hands.
Why should it be that the socio-ethical role of ‘psychological healer’ is one
that is hierarchically segmented and that some people pay others for?
Why are therapists paid?
E: There are some simple short answers to this
question.
Firstly, the ‘psychotherapeutic healer’ is paid for their
availability to the client. That is,
for being open, tolerant, patient, caring, forgiving etc. . Also, for being
authentic in all this, and for bringing that authentic response into the dialogue.
R: But can you be authentic toward someone, while
stopping yourself from responding as you really would want to, if you let
yourself? I mean: say you felt like just telling the client to go away?
E: You are being authentic within a role. Actually,
all authenticity and spontaneity is surely best seen as framed within some
constraints. When we choose to say something, we are constantly also choosing
to ‘stop ourselves’ saying something else. This doesn’t make us inauthentic.
So:
all this is part of the artistry, the deliberateness, of working as a
therapist. The deliberate engagement with a client is not or at least not
primarily one of ‘love and friendship’, but it can still be regarded as a
relationship, and (at best) an authentic one.
R: As yet, I am unconvinced that authenticity is
possible in the specific circumstance of a professional therapist or counsellor
facing a client. My doubts can
perhaps be illuminated by my introducing the following quotation, from Jeffrey
Masson:
“We do not care what kind of a person a plumber
is. Nor does a plumber have to claim that he is there because he loves plumbing
and is dying to help. It is just a way to make a living.
Therapy is different than any other profession in
this regard. Therapy is not just a way to make a living. Anyone who said,
honestly, that this was the reason he wanted to be a therapist would never be
accepted for training at any institute, even though this is the motivation for
many therapists, or it soon becomes the motivation. Clients have to be kept in
the dark about this ...[This] is an impasse, and I see no way out...” [3]
E: Masson applies his objections wholesale across
all therapy and counselling, whereas surely we need to be specific about what
is of value or otherwise in different approaches. I think that Masson raises
serious issues, which therapists must address; but I can think that
Gestaltists, at least, can successfully address most of them. Partly because we
link psychological growth directly with ‘spiritual’ growth, and with what you
are calling ‘love’. I think it is
important for a therapist to be loving: it is the unteachable and fundamental
quality to which people are attracted if they want to heal themselves in the
presence of another. But it is not (only)
the loving which they are paying for -- it is rather, as I alluded to at the
beginning, one or another specific form of theoretically-informed intervention.
This theoretically-informed expertise is a second -- and crucial --
reason for payment being appropriate.
You
said earlier, R, that there is not
even a remote resemblance between a computer technician (or a plumber!) and a
therapist. I disagree; I say that we synthesize an I-Thou approach with an I-It
application of the theoretical
principles of a given therapy. ‘I-Thou’ does not have to contradict ‘I-It’.
R: I suppose I can see how it might be useful
sometimes to treat a client as an ‘It’: to observe them, and say, “I notice that
you always put your hand over your mouth, when you try to speak about x”, or whatever it may be. I suppose
some of this, and some knowledge about the importance of breathing, posture,
etc., is in a way teachable. I am not sure that it would be well-described as
the application of a theory, though, if the word ‘theory’ is to mean anything
like what it means to scientists or engineers. It sounds to me more like the
deepening of a capacity for caring and sophisiticated interaction with others.
When one ‘observes’ another in a loving and deeply-interested way, one does not
I think treat them as an ‘It’, and does not look upon what they are doing as a symptom of a problem.
If
you call what you do the application of a theory, then you run the risk of
falling into a formulaic ‘interpretivism’ (like in some Psychoanalysis) or,
worse, a formulaic ‘explanationism’ (like in much Bio-Psychiatry).
E: I think that a Gestalt psychotherapist need not
explain positivistically, nor over-interpret, but can still be well-described
as applying her knowledge to a given situation. In addition, one gains
expertise, as one becomes a more experienced therapist, in keeping an overall
view of the shape of therapy, and
thus of when, for instance, to make such-and-such a kind of strategic
intervention, and when not.
R: I think that being intelligent about the shape
of a process of mutual supportive interaction is something which good
therapists can just do -- just in very much the same way that good friends (and
lovers) can do it. I think that the way that (good) therapists talk and relate
is through and through ordinary and commonplace [4] (I intend this as no insult!). If you say any
different you may, incidentally, have to face an uncomfortable question: Should
Psychoanalysts (e.g.) be paid more than Gestaltists, for example, because they
have a more complex theoretical framework? The psychoanalysts seem to think so!
But I very much doubt it -- I think that most Theory-centred therapy is worth
much LESS than therapy which is
really based in love, attention and equality.
E: I quite agree that many people, lay and
professional, have good ‘meta-awareness’ of process (though many don’t). And the assumption that
complexity (verbal, intellectual, interpretational) is more valuable than simplicity
is based on a whole world-view which I am out of sympathy with. People resolve
their personal problems, in the main, not because complex theories or texts are
applied to them, but because of a loving atmosphere, because of a respectful
I-Thou stance from another, because of simple things like feeling heard and
seen in one’s dark moments.
R: That is just what I have been saying.
E: Well, I admit that you are (at least partly)
right. In Gestalt, we talk about love and dialogue, we practice presence and
inclusion: the relationship per se is
the primary arena for healing. You could therefore say that we are primarily
(like prostitutes) selling a relationship. And you could say that if it is love
that we are selling, then that involves us in an even more tangled and perilous
enterprise than that of prostitutes, who only claim to be selling something
‘clinical’!
R: The therapist doesn’t -- mustn’t -- literally
kiss their client, but I for one find the ‘metaphorical kiss’ which the
therapist gives their client in return for ‘love-money’ perhaps more repulsive
than the paid attentions -- the literal sex -- that a prostitute gives their client (such attentions, notoriously, do not
normally involve literal kisses, either).
E: I don’t agree with your way of putting it; but I
do agree that the situation of Gestalt is especially uncomfortable. In
conventional psychology and/or in dynamic psychotherapy, which foreground
scientific explanation, or at best interpretation, and even when working
with feelings in the encounter call them ‘transference’ and
‘counter-transference’, practitioners are not claiming to be ‘loving’ or
‘authentic’ and then selling that love. But that is what Gestaltists do. So you
could say that we are doing something
potentially worse than what prostitutes (or conventional psychology and
psychiatry) do.
In
stepping out of the old expert-patient dyad, we do seem to be in hot water if
we sell what we want to call an existential encounter. Still, the fact somehow
remains: most people I know who have experienced this healing say it is worth
paying for.
R: Just as the fact remains that people often
collude with their own oppression. (Perhaps that’s too harsh a word; perhaps
not.)
I am worried about the commodification
of something which it would be better
not to commodify. What is most
important is love, empathy etc. ... and these are not -- should not be --
commodities. To commodify these things is,
ceteris paribus, to facilitate continued tutelage and oppressive social
relations.
E: It would be difficult to dispute that love and
empathy are best not commodified. But I do not agree with your implication that
therapists keep clients in tutelage. This takes me naturally to a third
aspect of what one is being paid for, as a therapist or counsellor: the focus being primarily on the client. The roles in a therapeutic
relationship are somewhat
‘assymetrical’ -- it’s not like two well-adjusted lovers in private life. We do
not maintain a rigid expert-patient hierarchy in Gestalt -- but there is nevertheless
a deliberate assymetry to the encounter between therapist and client, an
asymetry intended to be for the client’s benefit.
R: Yes, but to use that as your premise just begs
the question against what I have been saying. Co-counselling, for instance, questions this assymetry that we find
across the shop from Psychoanalysis to Gestalt or Philosophical Counselling. It
asks whether you can really have a dialogue -- two people really listening to each other, and present to each other -- if that degree
of asymmetry is built into the situation. Whereas, if there is symmetry after all -- and this point
applies especially to Gestalt, which of course does not hold that the focus should be exclusively on the client, for it holds that the therapist must
endeavour to be truly present in the
encounter -- then why is money changing hands?
E: Co-counselling doesn’t wipe out the asymmetry --
it just allows the asymmetric roles to alternate.
Anyhow, It’s not quite as you say in
Gestalt: Neither ‘the client’ nor ‘the therapist’ are separate entites, but
rather they are inter-linked phenomena co-created by the two people in the
room. Obviously, this view implies a reassessment of the nature of the
‘asymmetry’ you are speaking of.
Whereas
you seem to be rigidly equating payment, correlated to titles or ‘roles’, with
asymmetry. (And a similarly simplistic version of ‘(a)symmetry’ seems to be in
play in co-counselling, at least as you describe it.)
This
leads me to think that there is something dividing us which is more fundamental
than the particular issue which we are debating. Before we go any further into
the specifics, I want to try highlight this deeper general division -- by means
of saying something about the form and content of what you are doing here, in
our dialogue.
Different models of thinking: Philosophical versus psychotherapeutic?
It
seems to me that you bring a particular type of thinking to this discussion
which is fundamentally different from the ‘field’ thinking which informs
Gestalt. It seems to me as if the implications of your model of thinking are
that of the “prevailing public ideology” of positivistic science which insists
that “only proceedures scoured of possible bias, properly regulated and
scrutinised are ethically and intellectually sound.” [5] This pervasive, highly rationalistic approach is
one which even the natural sciences are now questioning as a wholly valid
paradigm. Field-theoretical ideas propose a fundamentally different approach to
how we apprehend or understand the connections between phenomena, between
things (in this case, money and ‘love’). To classic Western thinking, Gestalt’s
is an approach that could seem irrational and unconvincing. E.g. The very
notion of ‘understanding’ is understood by mainstream Western thinking in a
thoroughgoingly logical and ‘objectivistic’ manner -- unlike in Gestalt.
R: I would want to question your picture of ‘field’
thinking, or at least question whether in reality it has any foundation in or
any very close relation to the bits of modern physics which metaphorically it draws upon. Let me
quote from Lolita Sapriel, writing in this Journal,
to instantiate an example of what I am worried about: “Field theory is a part
of the paradigm shift that has occured in physics, medicine, psychotherapy,
infant research, quantum mechanics, and psychoanalysis... . This paradigm shift
represents a move away from a belief in a mechanistic, observable objective
reality, to one where the meaning of reality is understood as co-created and
co-constructed. In this paradigm, the concept of the observer affecting the
observed is understood and accepted.” [6]
I think that physics, including
quantum mechanics, is being completely misrepresented in this quote. Sure, we
can all probably agree that the meaning
of reality is rightly understood as ‘co-constructed’ by us and reality.
After all, ‘meaning’ is through and through human -- reality would have no
meaning in a universe devoid of intelligent life. But from that, it does not
follow that reality itself is not
objective, not observable. Ask a physicist: I’m sure they will have no trouble
agreeing with Sapriel at least in general terms on ‘the meaning of reality’,
but it is a non sequitur, which
physicists would reject, to slide from saying that to saying that we
co-construct reality itself. As for
the observer affecting the observed: of course, but that doesn’t mean that
there wasn’t something absolutely
independent of us to be observed (and affected) in the first place.[7]
E: Those are challenging ideas; I am not in a
position to reply to them. Hopefully, the people you have referred to will do
so.
But what I want to say about Gestalt is nevertheless something
directly related to what they have said: that the approach to ‘understanding’
which a field-theoretical Gestaltism takes is one which sees ‘individual
phenomena’ as arising from a bigger picture than one or two ‘causes’. In this
‘paradigm’, explanation or understanding leans away from the logical or
rational towards the poetic or transcendent. Ultimately, what I (and others) am
(are) putting forward is a species of understanding which defies or undermines
language-based questioning. This subversion of the limitations of
language-based seeking is seen most clearly in the dialogues of the Zen monks
and teachers. For example:
Question: “Why am I here?”
[Pause]
Answer: “Pass the salt.”
A dialogue in this vein would more
accurately reflect the fundamental thinking behind field-theory in Gestalt than
our current ‘question and answer’ style does. However, given the weight of academic
tradition and Newtonian thinking, it probably wouldn’t be published (or truly
understood!).
So;
I am engaging with you in this way because it is a linguistic communicative
convention. But in fact, I believe the relations between things are too complex
and too simple to be genuinely explicated through language at all, and perhaps
especially when used in this way.
R: Your suggestions in turn are interesting and
challenging. I am not certain, however, that your appeal ‘beyond’ language is compatible with your emphasis on the
theoretical knowledge, asymetrically-possessed professional expertise etc.
which supposedly licenses asymetrical financial arrangements. To my knowledge,
the great Zen masters, much like Socrates, and Jesus, have not sought to be
paid by the hour. I think that your approach, for all its appeal to wordless
poetry etc., retains within it some of the very kinds of thinking (mechanistic,
economistic, inauthentic, theoreticistic, scientistic) which you want to
transcend. My way of thinking is of course philosophical, political,
‘intellectual’. But to my way of thinking, Gestalt has already made too many
concessions, more than I would make, to the very ‘Positivistic’ ideas which it
wishes to oppose.
Asymmetry, hierarchy and mutuality
I am asking, in a nutshell, whether ‘mutuality’ --
and the kind of I-Thou meeting which I think you rightly believe is so vital to
the success of Gestalt therapy -- is possible at all given the assymetry introduced by money.
E: What is it about money that is so damaging (for
you) to an encounter?
R: As Marx argued,[8] money is not a transparent, neutral tool, but a
massive force in shaping and re-shaping society. Money transforms social
relations, and often distorts them. Those areas of our lives that are free of
money, that do not fundamentally ‘resolve’ relations between persons into that
of buyer and seller (a relation often extremely asymetrical in character,
especially if capital is unevenly distributed), are I think precious.
E: You may be right in many cases, but I am not
sure that what you call ‘distortion’ occurs as often as you think it does. So
far as money in psychotherapy is concerned, my own honest experience is that,
when the therapist is more of an ‘It’ to the client -- normally in the early
stages of a therapeutic relationship -- it still seems meaningful to pay. When
therapist and client start to truly meet as ‘Thou’s to one another, paying
seems stranger and perhaps quite out of place. But that moment in any case is
or should be the end of therapy. Successful therapy spells its own end.
R: But why not start
at the point at which you are saying we should end? I mean: why not start with mutuality. Don’t you
prejudice the possibility of being on an even footing, when you straightways
demand money in return for your ‘expertise’, when you set up the situation as a
hierarchical and inegalitarian one?
E: But notice -- and this still seems to me to
reflect our different ways of thinking -- that when I say the word ‘mutuality’,
I am not just talking about something situational. ‘Mutuality’ in the Buberian
sense refers to a highly-sophisticated -- and deeply simple -- way of being in
which one is powerfully present (not living out too many unhealed past
situations) and receptive to others.
R: To me, the word ‘mutuality’ connotes something
attainable between ordinary persons without
any complicated theories or training. Shouldn’t therapy be about exploding or
combatting the illusion that the client is an incompetent human being, rather
than ‘temporarily’ entrenching that illusion in order (allegedly) to eventually
overcome it? Shouldn’t Gestaltists be in the business of trying to get their
clients to give up the illusion that ownership of a body of psychotherapeutic
theory will set them free? And wouldn’t that entail placing the relationship on
a truly egalitarian footing? But wouldn’t that
entail no money changing hands?
E: You are wanting to ‘combat’ an ‘illusion’ that
is a manifestation of a task central to much of the work we need to do, namely,
growing out of illusions we create
around power, money, success, etc. . But the changes you are suggesting -- for
example the changes that have been made by co-counselling -- remain pretty much
cosmetic and would not actually resolve a client’s deep-seated tendency to feel
shamed or inadequate. (Furthermore, again, some people actually do have greater
power, knowledge or ‘success’-- it’s not always necessarily an ‘illusion’!)
R: It
may be partly a question of one’s fundamental ‘political’ values. Co-counsellors
believe in democratizing
counselling/therapy -- in transcending the cult of expertise, and ending the
practice of payment. Or think even of Sandor Ferenczi, the great psychoanalyst
who was repudiated by Freud and co. because toward the end of his life he split
time between his ‘patient’ being on the couch and him being on the couch being
analysed by his ‘patient’. (The question may be one of whether one ultimately
has faith in other people or not. If not, then one might as well give in to
totalitarianism and authoritarianism quite generally.[9] )
E: Well, Gestalt group therapy, especially when
there are ‘experienced clients’ (and even practicing therapists) in the group,
becomes very much like I would imagine Ferenczi’s ‘mutual therapy’ to have been
like. And personally, I will admit that I have found it strange to be in such
groups and for everyone to be paying one person who in fact may seem to play
sometimes a significantly lesser part than others in the group!
R: Then can you deny that the experience or
practice of mutuality is something which is (adversely) affected by roles,
titles, and so on? Isn’t there just something self-contradictory about the role
of ‘profesional psychotherapist’ -- someone who is the client’s ‘equal’ but yet
very different (‘Separate but equal’, and ‘Equal but different’ have of course
historically been slogans of racism and sexism respectively)... Is this not,
literally, an impossible profession?
E: I think you could reasonably claim that the
exchange of money encourages the kind of projections that most clients make; so
perhaps therapists are engaged in a contradictory mode of relation to clients
at least in this sense. Namely, that they say
they approach them as equals but also ask for money knowing that, broadly
speaking, people associate money and its exchange with expertise. And people
can feel shamed by feeling themselves to be the object of that ‘expertise’.
Perhaps this obliges a therapist to take this projection and association into
account. I’m not sure that the action to be taken is to stop charging, though.
Thematizing the exchange of money
R: Do you have in mind that the better thing to do
would be to go on exchanging money, but to thematize it as an issue?
E: Perhaps, and maybe to be continually aware of it
as a reality -- one of many. For example, gender differences may be more
figural for a particular client -- or even issues around height, or nose size.
A therapist with a very big nose could claim that most people are unaware of
issues around nose size. Would you suggest that she (and all other therapists)
always thematize nose size regardless of the client’s feelings about it?!
R: That’s a neat point... I guess I would argue
that the difference in the case of money is that the therapist is choosing to charge, and therefore that,
while facts about gender or height or even nose size remain more or less
constant and unavoidable, the exchange of money is an action, which has real
socio-economic consequences, and yet which is I think rarely made figural, at
least voluntarily by the therapist.
In
thinking of what it would be to thematize payment in therapy, to make it
figural, I’m reminded of a story I heard about Jacques Lacan; apparently, in
the end he didn’t give his analysands psychoanalysis at all -- he simply
charged them. In a bizarre kind of way, that may have had exactly the result
we’ve been talking of: the analysand, the client, having to sort out (for themselves) these issues of power,
projection, expertise and so on!
But perhaps any responsible and ethical form of therapy or counselling in which
money is changing hands should start with
the issue of that exchange. In Gestalt, one talks of and does ‘empty chair
work’. Maybe ‘empty wallet work’ should always come first!
E: An interesting idea indeed. But still I think
money is just one issue, one fact, among many salient to (and potentially
problematic in) the therapeutic encounter. We need must not lose sight of the
reasons why people seek any form of psychotherapuetic help in the first place. They
don’t come to a therapist just so they can talk to them about the issues that
arise in paying for therapy! People seek help because they feel lost or unloved
or damaged, or they wish to grow, or something like that. And in any case, the actual exchange of money is not the fundamental issue even around money; the more fundamental
issues are ones of power and projection, which cash-in-hand may mostly just
symbolize. Perhaps we could say that the paying of money is useful and even
essential for highlighting and representing issues of power and authenticity
and trust between therapist and client; but those issues are themselves the
real issue -- or in turn ‘representations/symbols’ of the real issue! -- in
most therapy.
Prostitutes, therapists, and objectification
R: We still need to confront head-on the question
of whether there can and should be payment at
all. Let me press you with my worry that paying for therapy and counselling
commodifies love, and with the direct analogy to prostitution.
I
think that love, for instance intimate serious physical sexuality, cannot
involve a mutual meeting, and ‘equal respect’ if it is paid for. I propose that
therapy is to genuine loving friendship as prostitution is to erotic love. (The
seller is selling herself or some
simulacrum of herself; the client is being cheated if this fact is in any way
played down or veiled.)
In
fact, one could go even further in likening psychotherapy to prostitution. For
prostitutes have frequently -- traditionally -- claimed to ‘be’ therapists, in
the sense of listening to clients’ [10] troubles, offering advice, etc. . Indeed, the
sociologist Everett C. Hughes [11] launched his influential ‘perspective via
incongruity’ approach by suggesting that sociologists should understand
doctors’ and therapists’ counselling activities by means of looking at
advice-giving in other contexts -- and he specifically instantiated the
‘counselling/therapy services’ given by prostitutes! [12] Hughes thought that we could learn a lot about
therapists’ and physicians’ work by looking at the surprisingly similar
occupational role of ... ‘prostitute’...
What you have in prostitution is sex, love, friendship, support, for
sale. Subtract the sex, and then what is the difference from psychotherapy?
E: Your analogy with prostitution -- or ‘sex-work‘
-- is shocking and interesting, but we need to deconstruct that shock. In
prostitution, I am not sure that the exchange of money is the fundamental
problem. The fundamental problem, I suspect, is the possibility of two-way damage
between two people being solely ‘objects’ for one another, compounded by the
secrecy, shame (and illegalities) for both parties. Taking away those contingent factors, perhaps we all
‘prostitute’ ourselves when we go to work or ask nicely for a favour or even do favours knowing it will further a
friendship, etc. . ‘Prostitution’ is then a form of exchange like many others.
Perhaps we all participate in such exchanges much of the time.
R: Powerfully put. What might be interesting would
be to investigate in a serious fashion the feelings of prostitutes and their
clients, and therapists and their
clients, about what they do. I wouldn’t be surprised if there were many
striking similarities. I think that this is quite a taboo -- I think that, if
one really managed to get therapists and prostitutes (and their clients) to be
honest, they would often express extreme reservations about the
commercialisation of personal relationships with which they are intimately
involved.
E: That piece of research would certainly give an
intriguing different meaning to the notion of a dialogue between psychotherapy and prostitution...
R: To return to the question: can it be right for
therapists to take money for their services? The way a prostitute does, for the
provision of her/his ‘personal services’...? I’m not at all sure that it can
be, even if the ‘contingent’ factors you describe above were altered: I think
that the commercialisation -- the ‘commodification’ -- of love has to be resisted, in therapy; whereas
it’s not nearly as problematic to commodify computer-repair or plumbing.
E: In our discussions, you seem to equate payment
with inelectable inauthenticity, ‘asymmetry’, and inequality. Why? I suppose it
is because -- to be specific -- therapists who sell an existential meeting are
thereby making something into a commodity which cannot be so without its
destruction. And this sounds very plausible! But what I’m saying is
that in all relationships there is
some degree of objectification (and thus, literally or metaphorically,
commodification) of the other. No relationship takes place purely with a
‘Thou’.
But let’s add to this a note of
practical realism. There is -- or should be -- reciprocity, and real dialogue,
between a therapist and a client. The money just doesn’t usually destroy this,
I think, the way it perhaps does in prostitution.[13] Most therapists etc. probably have genuine
feeling for their clients, and most sex-workers probably don’t. But if it
doesn’t turn out to be that way around, then perhaps the therapist’s activity is morally the more dubious!
The politics of therapy: some questions
R: This admission seems to me to make still more
salient the worries which I raised earlier around Gestalt’s ‘paternalism’.
E: You are referring I take it to the ‘authoritarianism’
purportedly involved in the asymmetry of the therapeutic dyad; but I would
counter by saying that there’s an inherent risk of an undesirable paternalism
in your position. For you are perhaps
paternalistically asserting that clients who consensually pay for therapy
should be discouraged from so doing.
This issue of paternalism reminds us
that therapy exists in a socio-political context, where, for example, the
therapist may (should) have thought more about and have more developed ideas
about, for example, paying for therapy. The question is, then, what should
Gestaltists do with those ideas when sitting with a client?
The
broader questions here are: Is it -- must it be -- within the endeavour of even
field theoretical thinking to explore political
issues, or just to ‘be aware’ of them? And what exactly is the difference
between these? If we start to explore them, should we try to be politically
neutral? If this is not possible, how do we deal with quasi-parental
‘transference’ that occurs and that may lead to introjection or rejection of
our ideas? Is your intriguing challenge to therapists in this dialogue one they
(we) must do something about?
Individually? Collectively? Through reflection or group action?
R: I believe that it is beneficial and liberating
for people to realize that many of their problems come from unjust political
arrangements. Therapy stays ‘politically neutral’ at the risk of harming
clients who are ‘encouraged’ to see their problems as personal or interpersonal
but not, as those problems surely sometimes are, as bluntly economic/political.
Some psychotherapeutic approaches (again, co-counselling is one) explicitly
recognize and act on this thought. Whereas Gestalt risks trying to stay
‘neutral’ here,[14] -- surprisingly, in a way, for, as you have
agreed, E, you Gestaltists of all
people should not and cannot ignore that any therapeutic encounter happens in a
social and political ‘field’!
As
for my ‘paternalism’; I admit that the things I am saying may be dangerous. But
I think that the commercialised therapeutic culture of modern times, while
perhaps inevitable, is itself much less than ideal -- i.e. ‘dangerous’. The key
question for me, then, is: What should we do about this (if anything)? Is there
any way in which one could effectively
decommercialise psychotherapy?
Conclusion: a radical psychotherapy?
E: I want to ask: What is the nature of the
distinction between a ‘politicised’ approach and an ‘existential’ approach to
therapy? And perhaps I should first ask: Is
there -- can there really be -- such a distinction? These questions arise
powerfully, as we have seen, when comparing therapy to prostitution.
R: I am willing to concede that this rather
unsatisfactory situation that we are presently in -- wherein people are often
actually performing a valuable service by prostituting their hearts and souls
(or their bodies), where ‘love’ in one sense or another of that word (perhaps a
rather corrupt sense) is -- apparently, paradoxically -- being paid for, where this is actually
sometimes a good thing -- I’m willing to say that this rather unsatisfactory
situation is perhaps as good as it gets for now, and that, while working on
changing it, we must fully acknowledge it,
as I think you for one are ready to do. A radical -- ‘politicised’ -- approach
to the ‘domain’ of the ‘existential’ and of ‘authenticity’ will fully face the
realities and hazards of the practice of psychotherapy, in its socio-political
‘field’. It will face fully, e.g., the much-less-than-ideal fact of payment for
‘love’. I feel that you and I are now able to agree on this point.
E: I think so; but we still fundamentally disagree
over the notion of ‘exchange’. I think you chronically underestimate the extent
to which all of life, of truly human
life, is a continually interleaved sequence of exchanges. Money is often simply
the mode -- the imperfect mode, admittedly -- through which many of these valuable exchanges are made. You are
wrong, I think, to think that there is something especially ‘tainted’ about
money.
As
for your latest allusion to prostitution: let’s re-focus on the real problem
with it, which is not taught embarassment about the body or sex, or even
payment, but out-of-control objectification. Objectification is indeed
something that is a common experience for both a prostitute and a therapist.
When a client sees or treats you as his lover or mother, or as some God-like
fount of knowledge, when ‘in fact’ you are just another adult, he is
objectifying you. Yes, sex-work and therapy have this in common. But a
prostitute depends on being
objectified, whereas a therapist works
towards its dissolution.
R: I hope
so.
But the dissolution of the needs for love etc.
that people feel, and that they pay to satisfy, may ultimately depend, I’ve
suggested, upon a real societal transformation. Now if that’s true, is it any
longer possible for (say) Gestalt therapists to behave as if they have no
responsibility for the state of our civilization, no political assumptions or
role?
E: You are highlighting the much wider (and often
neglected) aspects of the field -- and the institution of money is just one
such aspect -- in which Gestalt Therapy exists. This is valuable, even if difficult to handle. But perhaps it is a
lot to ask for therapists to also be agents of actual political change, rather
than ‘merely’ politically aware.
Gestaltism
has created a (rather wonderful) ‘community’, a sub-culture with its own
definite ways of interacting, thinking and apprehending experience. It provides
to some extent a scheme -- even if one with the concept of spontaneity at its
heart! -- of how to be-in-the-world. As such it must and does have moral and political aspects and
implications. As clients become more experienced, they start to participate in
our discourse. (I think Gestaltists do educate their -- our -- clients. It
might be better if this were overt.) What is happening in that process? Is it not
an existential and political re-orientation of the person? And if this is
happening, is this not political change on a small scale?
R: It is. Though the way you have just put it
sounds to me elitist (as if the only way that Gestalt can be usefully political
is by getting clients to talk the Gestalt talk), not democratic. Perhaps more
importantly, I want psychotherapists to do more to acknowledge their inevitable
political assumptions and implications than you have just suggested.
E: How can we take practical account of these questions of progress toward a better
world, questions of ‘commercialisation’ and ‘commodification’, of prostitution,
which we have attempted to discuss in this dialogue? What would we find through
further explicit acknowledgement and exploration of the social, moral and
political sources and implications of the Gestalt ‘world-view’? These are real
-- not just rhetorical -- questions. What could Gestalt writers, trainers and
practitioners do to explicitly ground their existential work in a political
context?
R: I would put it like this: if the subject-object
dualism and the mind-body dualism and the self-other dualism are illusions,
then so, assuredly, is the dualism between the individual and their political
setting, or between psychotherapy and its placement in a moral and political
context.
E: Very nicely-put. It seems that what you are
asking now is whether psychotherapy and counselling can be other than
reactionary if they are not explicitly ethically and politically radical?
R: Yes; co-counselling bites this bullet, and does
not claim to be politically neutral. It looks toward a transformation of society
-- as philosophers such as Kierkegaard, and Marx, and Wittgenstein -- in their
different ways -- very definitely did. Of course, if Gestalt Therapy takes a
similar risk, then you Gestaltists will risk losing any quasi-medical
‘respectability’ that you might have, and risk losing the kind of claim to a
body of value-neutral expertise which is the primary basis to which people in
our culture tend to appeal if they want, for example, to be paid.
If
we were to go more into this question, we would need among other things to look
harder at your promising thought that, if we understand the (you say)
unproblematic sense in which we all continually exchange things with one
another, and even ‘prostitute’ ourselves, then we need not understand paying
for psychotherapy as inherently unprogressive. But the broader issue will
remain a challenge: If you don’t explicitly connect the political and the
existential, aren’t you stuck in the conservative fantasy that therapy is in
the final analysis about ‘liberating’
yourself and ‘growing’ ... within a society that endlessly conspires
against such liberations and growth?
E: I think this last question is indeed very
challenging. It is easy (and necessary?) in existential and humanistic
therapies to claim to simply be ‘accepting and unjudgmental’ of people’s
‘personal choices’. But this is a seriously problematic claim. As
‘Intersubjectivists’ and Gestaltists such as Sapriel have argued,[15] there can’t be any such thing as ‘bracketing’
oneself out of any encounter. And, in a world that is shaped by all of our
actions and inactions, how can there be any such thing as ‘political
neutrality’ in an encounter between two people?
R: Part of our end-point of partial agreement --
for there is obviously much that we still disagree about -- seems to be this:
that no form of Psychotherapy, let alone Gestalt, could hope to be ethically
and intellectually respectable, if it failed to have an idea of what a better
world would be like -- and of how to start to get there.[16]
References:
Coulter,
J. (1975), “Perceptual accounts and interpretive assymetries”,Sociology 9, pp.385-396.
Coulter,
J. (1978), The Social Construction of Mind (London: MacMillan).
Hughes,
E.C. (1958), Men and their work (London: Free Press of Glencoe).
Marx,
K. (1961), Capital (Moscow: Foregin Languages Publishing House).
Masson,
J. (1999), “Still against therapy”, in Mindfield: The Therapy Issue
(London: Camden Press, 1999).
Mulhall,
S. (1998), “Species-being, teleology and individuality”, in Angelaki 3:1.
O’Neill,
J. (1971), Sociology as a skin trade: Essays toward a reflexive sociology
(London: Heinemann).
Posner,
R. (1992), Sex and Reason (Cambridge, Mass.: Harvard).
Read,
R. (2001), “Wittgenstein and Marx on philosophical language” (in Kitching and
Pleasants (eds.), Wittgenstein and Marxism (London: Routledge).
Roberts,
A. (1999), “The field talks back”, British
Gestalt Journal 8:1, pp.35-46.
Sapriel,
L. (1998), “Can Gestalt Therapy, Self-Psychology and Intersubjectivity Theory
be integrated?”, British Gestalt Journal
7:1, pp.33-44.
Watson,
R. (1994), “Some potentialities and pitfalls in the analysis of process and
personal change in Counselling and Therapeutic Intervention” (in J.Siegfried
(ed.), Professional and Everyday Discourse as Behaviour Change (Norwood,
NJ: Ablex).
Wheway, J. (1997), “Dialogue and
Intersubjectivity in the Therapeutic Relationship”, British Gestalt Journal 6:1, pp.16-28.
Wittgenstein,
L. (1998 (posthumous)), Culture and Value (revised ed.; Oxford:
Blackwell).
[1]
We have explored some of the same
issues in a strictly philosophical vein in a longer, earlier piece forthcoming
in Philosophy in the Contemporary World.
Our thanks to Malcolm Parlett, Mark Peacock, and (especially) Rod Watson for
their help and encouragement on and with the present piece.
[2]
R: There are no professional
co-counsellors; ‘co-counselling’ is by definition non-professionalized and does
not involve the taking of money for the provision of counselling services.
Instead, the two (or more) co-counsellors take turns counselling one another.
(A somewhat analogous phenomenon in the area of spirituality is Quakerism: Unlike virtually all Christian sects,
Quakers have (and therefore pay) no official / professional ministers; everyone is
free to minister, and people ‘take turns’ to do so.)
[3] Masson (1999), p.50.
[4]
R: There is sociological evidence
for this proposition. See for instance Watson (1994). See also Coulter’s (1975)
and (1978), which argue the case that the categories and actual methods of
psychotherapy and psychiatry are produced by means of (at best) a utilisation
of and (at worst) a reification of quite ordinary conversational and
interactional abilities and practices.
[5]
Quote from p.20 of Wheway (1997).
[6]
P.34, Sapriel (1998).
[7] R:
Wheway (1997, p.20) makes a similarly dubious move when he invokes Heisenberg,
who purportedly showed “universal scope and certainty” to be “chimerical” goals
of science. But Heisenberg’s “Uncertainty Principle” is understood by hardly
anyone who invokes it. (This Principle still allows one to be perfectly certain about the location or
velocity etc. of whatever physical item it is that one is trying to measure: it
only states that one cannot know all of these facts at the same time.)
It is I think this kind of misreading of
modern physics, as purportedly making it ‘impossible’ to get precisely in touch
with ‘objective reality’, or alternatively as casting reality as a product of human intervention/imagination,
which leads Sapriel (1998, p.37) to claim that we must abandon the “fallacy of
neutrality”, and ‘admit’ that “No therapist can ‘view objectively’ what is
going on within the patient”. This phrasing makes it sounds like there is
something here which we cannot do. But Sapriel -- like Stolorow, and unlike Heisenberg and co. -- never says what it is that we cannot do. What would
count as ‘viewing objectively’ what
goes on within the patient? Until we are offered an intelligible answer to that question, it will not do for us to be
told in a blanket fashion that it is ‘impossible’ for us to do this.
[8]
See for instance Marx (1961), and Mulhall (1998) p.89f. .
[9]
R: Cf. the fear of equality or
democracy manifested for example on both sides of the exchange of letters
between Coward and Sapriel (BGJ
(1998), pp.128-131). Sapriel quotes Stolorow: “The parity we ascribe to the
worlds of patient and analyst at the level of abstract conceptualisation of the
therapeutic dyad becomes, however, misinterpreted [by some] as implying
symmetry in that relationship at the level of concrete clinical practice.” In
other words: the truth about this asymmetry is that the ‘parity’ or ‘equality’
between therapist and client is merely
abstract. Stolorow continues; “[T]he authority ordinarily assumed by the
analyst collapses [[is this supposed to be obviously a bad thing??]], as the
patient is thought to acquire a voice equal to that of the analyst in setting
the conditions of the treatment ... the ultimate extreme of this overly
concrete misinterpretation of intersubjectivity theory is the loss of the very
distinction between patient and analyst... what is left to tell us which of the
two is the patient?” This final question, which to Stolorow (and Sapriel) is
the reductio ad absurdum of
‘symmetrizing’ therapist and client could be read exactly the other way around: as its central virtue and triumph.
(Incidentally, the serious risk which Gestalt runs if it draws more or less
directly from psychoanalytic -- authoritarian -- thinking, is here clearly
evident.)
[10]
Note the word
‘client’, the very same ‘high-powered’/empowering word as used in
psychotherapy -- prostitutes generally prefer the term ‘client’ to the
lower-level term ‘customer’.
[11]
In fact, sociology offers rich and varied resources for a deepened
understanding of the natures of prostitution and psychotherapy. For another
view, consider for instance the following quotation, from p.6 of O’Neill’s
(1972) essay, “Sociology as a skin trade”: “A special aura attaches to working
with people. The work of the priest, judge, doctor and missonary is regarded as
holy. The work of the prostitute, the pickpocket and the undertaker is
considered profane. In reality, these trades are all involved in dirty work
with people. Alternatively, with the exception of the pickpocket, all of these
trades may be regarded as holy occupations because of the sublimity of their
purpose, to restore and make whole the person.”
[12]
Cf. also Hughes’s “Psychology: Science and/or Profession”, in his Men (sic.) and their work (1958).
(It is worth
mentioning here the controversial work of Richard Posner, on Sex and Reason (1992). Posner’s economistic
‘rational choice’ model of prostitution includes among its consequences a
significant diminution of the difference between prostitution and marriage (see
p.131f.). Posner appears to believe that sex (and love) are commodified as much
in one as in the other. Only his conclusion from this is that this is what
rational people ought to believe and that they ought to behave accordingly, not
that such commodification ought to be resisted.)
[13]
E: Add to this that most therapists want to be therapists, whereas most
prostitutes probably don’t want to be prostitutes.
[14]
R: Even as it questions, if rather
unclearly (see note 7, above), whether it means anything to speak of
scientific-ish neutrality in the therapist-client relationship!
[15]
See for instance pp.33-44 of her (1998).