Paper presented at the 1st Annual Qualitative Methods Conference: "A spanner in the works of the factory of truth"
20 October 1995, University of the Witwatersrand, South Africa

The psychological imperialism of psychotherapy
Sharonne Isack & Derek Hook
This perspective distances itself from the 'authority' of the self-preserving 'criticisms' built on the institutionalized side of psychotherapy. It offers instead a perspective built on the other side of the power-divide: the 'binocular' one of our exposure as subjects of psychotherapy. As such it aspires to provide an extra-paradigm challenge to the ideology of psychotherapy. Our intent is less to deny that any practical interpersonal productivity can come of therapy, but rather to assert that the proposed eventual outcome, the proposed 'therapeutic' value posed by therapy, is by no means ethically validated by its prior manipulations, appropriations and exploitations.

Introduction and brief literature review
As early as 1952 Eysenck criticized the 'outcome problem' of psychotherapy, claiming that there appeared to be an inverse correlation between 'recovery' and psychotherapy; the more psychotherapy, the smaller the recovery rate. He substantiated this initial criticism a number of times since, maintaining not only that there is no good evidence that psychotherapy is any more effective than any reasonable placebo treatment, but also that all forms of psychotherapy fail to improve on the recovery rate obtained through ordinary life experiences (1960). Smail (1984) similarly attacked the supposed efficacy of psychotherapy, asserting in fact that the outcome of therapy is usually far more moderate than the claims of its proponents. He credits therapy only with the help it offers in terms of human comfort, which it seems, is not something that cannot be achieved elsewhere. Eminent psychotherapy contributors, the likes of Strupp (1973) have similarly surmised that psychotherapy never seems able to transcend the benefits of a normal constructive human relationship. Szasz (1979) complemented his own general anti-psychiatry tirade with The Myth of Psychotherapy (1979), in which he types psychotherapy as a self-congratulatory mechanic of coercion and deception that expropriates religion's apparatuses of contrition, confession, faith and inner resolution, amongst others. Thus, says Szasz, psychotherapy replaces sin with sickness, soul with psyche, and, if we may be allowed to elaborate, personal 'salvation' with psychotherapeutic ritual. Laing, likewise looks at the enterprise of clinical psychology as a disempowering and dehumanising project (1985); psychotherapy can even be compared to medieval 'witch confessionals' where the witch (client) is persecuted from a vulnerable, and in fact, an absolutely undefensible position.

Masson's battery contends that psychotherapy is an effort to convert undesirable ways of being, to change people according to the notions and prejudices of the therapist (1993). No psychotherapy is value-free he says, no therapist can avoid instilling or attempting to instill values into their patients, and for this reason, amongst others, psychotherapy is an indoctrinational and essentially corrupt profession (1993).

Foucault's perhaps somewhat larger scale uncoverings and archeologies are further fuel for our fire. Indeed, as Foucault has said, the social sciences developed at the same time as the emergence of the isolated, individual self and the modern state's need to control that self through study and calculated manipulation (1979). Examination of our culture's most insidious (least easily detected) and perhaps most proficient tools of control reveals that they're replayed daily, hourly in fact, in the essential forms of psychotherapy. There is the internal control of the intrapsychic self-discipline it irreconcilably urges us towards, and the external control of the culturally instituted confessional that it, so constitutionally is.

Psychotherapists are, says Cushman (1992), 'doctors of the psychological interior', with the cultural justification and the technological means to intrapsychic penetration. Furthermore, he says, the state's attempts to control a population of self-contained individuals provides psychology with a rationale for existing as an independent discipline (Cushman, 1992). Similarly, Sampson (1988) has written about how therapeutic psychology has become an ideology representing particular interests and values; and producing and reaffirming the existing nature of the social order. Hurvitz says "psychotherapy creates powerful support for the established order - it challenges, labels, manipulates, re-jects or co-opts those who attempt to change the society" (1974, 237).

In this way, far from being necessarily reparative, psychotherapy often 'interiorizes', re-establishes and reconstructs precisely the causes of the psychological discomfort that brought the client to the therapy in the first place (Sampson, 1988), (Cushman, 1990).

Richer (1992) similarly deconstructs the individualist, humanistic temperament of therapeutic psychology as technique of oppression:

"We imagine that by avoiding objectification and medicalization, the hermeneutic, psychodynamic and humanistic trends in psychology somehow transcend the job of social control that is explicit in other forms of psychology. Nothing could be farther from the truth. In the end, the prying interpretations of humanistic and psychodynamic approaches are far more efficient at normalizing than are either the anti-psychotic drugs of the medical approach or the shaping techniques of behavioursim. Psychology - all of it - is a branch of the police; psychodynamic and humanistic psychologies are the secret police" (Richer, 1992, 118).

Canguilheim (1980) reiterates the point and reflects insight into the parody of the discipline."Psychological utilitarianism is implemented by psychologists. By giving their work an evaluative aspect and a significance in terms of expertise it makes them into powerful professionals."

Some words on style; qualifying,contextualizing this attack
As students and subjects of the ideology of psychotherapy, we're in the position, versed sufficiently in the theory as well as in the personal experience, to offer genuinely destructive commentary. It is though, admittedly, virtually impossible for us, if not society at large, to properly break from the paradigm of psychotherapy."Every psychologist (patient) is an object of psychological discourse as well as an agent of it." (Canguilheim 1980) That though does not dispose the political, ethical and clinical accountability of that process. In short, although we're caught in the paradigm, we've by the same token inherited the obligation to its subversion: the responsibility to attack as profoundly and aggressively as possible the oppressions, flagrances and lies of the therapeutic process.

There are a number of reasons for the relative impotence of many of the anti-therapy attacks mentioned above. Many of them allow themselves to be too easily discredited by virtue of their own excessive styles, by the simplicity of their stereotyping of therapy. Unlike many of our predecessors in this kind of activism, the likes of Laing, Szasz and Masson, who would apparently sacrifice the whole body of psychotherapy because of its moral flagrances or because its self-preserving discourses obscure its fraudulent or corrupt character, we don't feel that it is our position to either recommend the holistic condemnation of the discipline, or, for that matter, to defend it. Neither standpoint lends to the credibility of this study. To sacrifice one's sense of balance (and subtlety), to adopt a hyperbolic tone, or a kind of exclusionary moral high-ground that'd typify psychotherapy as a kind of composite evil - would be myopic, and more than that, it'd be to play straight to the hand of the pro-therapy discourses.

Our intent is less to deny that any practical interpersonal productivity can come of therapy, but rather to assert that the proposed eventual outcome, the proposed 'therapeutic' value posed by therapy, is by no means ethically validated by its prior manipulations, dissentions, condescensions, appropriations and exploitations. And it is my intent to make explicit that therapeutic effect is embedded in the power of its discourses, that it cannot be understood as therapeutic in the traditional sense.

Despite these considerations though, there remains a tendency for such contra-therapy arguments to be turned into issues of an 'already reconciled debate'. Although there clearly is literature evidencing the politically and ethically unsavoury nature of psychotherapy, much of it however is 're-enlisted', given a subsidiary position, 'lip-serviced' as 'pragmatics of the process', and simply re-subsumed in the continuing campaign of the institution of psychotherapy. The deficit of any real ongoing, cutting and institutionalized commentary by the proponents, the administers of psychotherapy itself, would seem self-evident; it'd seem quite obviously self-defeating for them to do so. And for the opponents of the discourses of psychotherapy it seems that to properly oppose the paradigm is, frankly, to have no credibility. To even try and operate outside its discourse is to never really be allowed to be understood; to succeed in breaking from it, is to be practically unintelligible, practically nonexistent.

What one seems to require here, is an adequate re-conceptualization of the mechanics of the institution. Rather than to clumsily throw about words like 'ideology' and 'discourse', we need a more expansive understanding, we need explicate the culture of psychotherapy in order to engage it on less 'fixed', less 'loaded' grounds. This is because (to meld our sentiments with Said's (1978)) it's in the nuances, the mannerisms and sophistications between superstructural pressures and the details, because its within the 'facts' of the textuality that the hegemony takes place. And it is because of this that discursive excavations are so vital. They can unearth that which so trades off its insubstantiality. It is those infinitely subtle gestures of a discourse that'd call us into pettiness should we accuse them, those very tiny gradations that carry the fullest weight of that ideology, that cultural hegemony, because of their apparent in-convertibility. It is the very insubstance of these things, beyond their simple 'social-sanctionedness', it's their very status as 'nothing at all', their very calculated obscurity, that makes them so compelling, invisible, and ideologically competent.

Enabling the deconstruction; explicating the textuality
The spirit of this criticism is very much tempered with the influence of Derridean deconstruction and Foucauldian discursive analysis. Although it may not be in keeping with the more precise articulation of these tools, in the same spirit that Derrida uses the term "bricoleur" it does endeavour to 'make visible what is customarily invisible within a text' (to use Said's phrase, (1983)) In fact it would seem only via these revisionist, 'archaeological' temperaments that an effective and stable, extra-textual argument can be presented before the institution of psychotherapy without simply becoming cannon-fodder before it and re-substantiating it. The problem is, as Derrida has stated it:

"A text is not a text unless it hides from the first comer, from the first glance, the law of its composition and the rules of its game. A text remains, moreover, forever imperceptible. Its laws and its rules are not, however harboured in the inaccessibility of a secret; it is simply that they can never be booked, in the present, into anything that could be rigorously called a perception" (Derrida, 1981, 63).

Most arguments fall apart before the sophistication of this kind of hegemony. We are not totally powerless before them though; Foucault's work for instance shows us that "if the text hides something, or if something about that text is invisible, these things can be revealed and stated, albeit in some other form, mainly because the text is part of a network of power whose textual form is a purposeful obscuring of power beneath textuality and knowledge" (Said, 1983, 184).

Said goes on to conclude that in both Derrida and Foucault their work is meant to replace the tyranny and the fiction of direct reference - to what Derrida calls presence, or the transcendental signified - with the rigour and practice of textuality mastered on its own highly eccentric ground and, in Foucault's case, in its highly protracted persistence (Said, 1983, 185). That much of the incentive behind the current attack's deconstructionism elucidated, there is only one further point to make. Along with his 'discovery' that discourse did not simply disappear, but became invisible in order to practice a more insidious form of control, Foucault started re-conceiving the problems of language not in an ontological but in a political or ethical framework: the Nietzschean framework (Said, 1983, 219). Point being that to avoid the built-in trappings of the text, and to hence avoid approaching it directly, it would do us well to conceptualize the autocracies of psychotherapy in a similar kind of ethical or political framework. Or, to put it in a different way, we might present the text stripped of its esoteric or hermetic elements, make the text assume its affiliations with institutions, groups, academies, ideologically defined parties and professions as Said claims Foucault does; to so 'resemanticise' and forcibly redefine and re-identify the particular interests that text serves (Said, 1983, 212) - is to be able to confront it on terms other than its own.

The culture of psychotherapy
"In any society...then," says Said, "certain cultural forms predominate over others, just as certain ideas are more influential than others; the form of this cultural leadership is what Gramsci has identified as hegemony..." (Said, 1978, 7). The strength and durability of such a hegemony relies on its 'flexible positional authority', a phrase Said coined in describing 'Orientalism' (1978), in which 'the westerner is put into a whole series of possible relationships with the Orient without ever losing the upper hand'.

This kind of 'multi-discursive' understanding of flexible positional authority becomes a very valuable tool in our examination of the institution of psychotherapy. Now although it is in not clear that we need any kind of hierarchical categorization of the bigger and smaller systems of discourse; the versatility, or the competence to utilising a number of such systems of discourse in attaining a submission would seem to distinguishing a form slightly larger than 'a discourse'.

The discursive strands enveloping a system of ideology are often multitudinal. The fact that a discourse may arise from the intersection point of older, more foundational systems of discourse (perhaps through hegemonic give and take, perhaps through more refined, virtually invisible traces of power), hints that we need a new category in our conceptualization of social control. This, it seems, for all intents and purposes, is culture. As Said puts it:

"The idea of culture of course is a vast one. As a systematic body of social and political as well as historical significances "culture" is similarly vast...I shall avoid the details of these proliferating meanings and go straight to what I think best serves my purposes here. In the first place, culture is used to designate not merely something to which someone belongs but something that one possesses and along with that proprietary process, culture also designates a boundary by which the concepts of what is extrinsic or intrinsic to culture come into forceful play...In the second place there is a more interesting dimension to this idea of culture as possessing possession. And that is the power of culture, by virtue of its elevated or superior position to authorize, to dominate, to legitimate, demote, interdict, and validate... What is more important in culture is that it is a system of values saturating downwards almost everything within its purview; yet paradoxically, culture dominates from above without at the same time being available to everything and everyone that it dominates. In fact, in our age of media produced attitudes, the ideological insistence of a culture drawing attention to itself as superior has given way to a culture whose canons and standards are invisible to the degree that they are "natural", "objective", and "real"...its tendency has always been to move downwards from the height of power and privilege in order to diffuse, disseminate and expand itself in the widest possible range..." (Said, 1983, 9).

The diatribe from here on trades psychotherapy's own self-promoting discourses for a political awareness of those of its 'flexible positional authority'. Because both its positive public facade and its repertoire of domination are so broad, we've had to be selective in attack; the base of our attack, is as already mentioned, personal experience.

Language games
Our first line of attack is to revert to the philosophy of language. Wittgenstein proposes that the meaning of a word is connected to the language game it belongs to. Meaning is thus context dependent. He states that training (training invokes rules, practise and public) takes place when a learner grasps the 'progression' of the term and applies it. He adds that there are in-built dispositions geared toward preserving the status quo of the meaning. The meaning of a word is its use in language. When one understands or "grasps" one is in actual fact mastering a skill or technique. Although this may seem unnecessary academic warble we believe it is pertinent to the institution of psychology. Psychology has formed in its own language game. The validation and meaning of terms, words and concepts are dependent on its language game. The power bias, the belief in psychotherapy, the conditions of the therapy are all aspects of a language game which we must play by virtue of being in the therapy and by hoping to achieve the psychological ideals of the therapeutic language game.

The various techniques of building the comfort and security for guiding the client to 'autonomy' are guised in subterfuge and in a language which claims structural truth. A stable truth that need not be scrutinized, analysed or validated. The competence to converse in their terms becomes more the goal than does the therapeutic 'cure'. Our own psychology is thus in this sense imprisoned within their discourse. This situation endows the ideology of psychotherapy and the therapist with an illusive and somewhat autocratic powers. Many will purport successful therapeutic outcomes on both the client and the therapist's part. The question of successful outcome is therefore loaded; to even play their language game, to take part even in a single therapeutic encounter, is to accept the inherent ideals of the language game, of it's pervasive discourses. Despite the criticisms levelled (from both within and without its paradigms), although its bias and power structures have been elucidated, society remains trapped in the greater optimism of its paradigm. Even if we've never been to therapy, or have been out of therapy for 20 years, we are still, in some senses, subservient to it.

To properly oppose the paradigm is, frankly, to have no credibility. To even try and operate outside its discourse is to never really be allowed to be understood; to succeed in breaking from it, is to be practically unintelligible, quite practically, not to exist.

Psychotherapy's pathological potential
The first and greatest benefactor of the therapeutic interaction is the culture of psychotherapy itself, or in more direct order, to begin with, the psychotherapists themselves. The therapeutic interaction enacts an allegiance to the client whilst at all times staying 'within the fold' so to speak, whilst never giving up it's primary loyalty to the greater 'psychological'. The therapeutic space is always about 'psychologizing' before it is about me. This unavoidable system-isation, theorization, model-ization, 'coherantisation' if you will, of me into them, of me into their terms, however gently, integratively or meta-theoretically achieved, necessarily maintains a fair proportion of 'other-izing'. And even if we talk beyond the theoretical bases (no matter how expansive) that inform the therapy, the constraints of professionalism, we would argue, never allow the therapist to engage us as us, but, quite unavoidably, only as how their apparatus would construe us.

And to take the harder derivative of this argument, these proceedings are in a sense then constituent of their own species of pathology, in that they drive us into the psychological cul-de-sac of having to search for a more psychologically healthy self in the terms of their culture, within the conceptual (and institutionalized) framework of their greater machinery. This would seem a hazardous psychological exercise, despite the salience of an 'intra-paradigm' fit, despite the supposed stability that the aptness of such a greater 'within the culture' explanation provides, it remains a curious despoticism in which I can only be closer to myself, know myself that much better, through them. I'm disempowered by my own advocacy, and disempowered in the realms of my most personal relivings and intimacies.

The 'efficacy' of any therapy is contingent on whether the 'client' tows the line of that paradigm. And of course deliberate denial of what the authority says doesn't bode well for how I am made to view my own psychology. And the other option is likewise bleak: condescending to 'the clinician's view of psychology's view of me', so to speak, would seem an imperative if any psychological development of note is to occur in their therapy. This is a marvellous system of coercion; one that I, by virtue of my desire for psychological change, must buy into, if I am to 'know myself' or be able to change. Perhaps it seems a self-evident truism that the success of the process hinges on my faith in the credibility of that psychology; even so, isn't this kind of faith the prime prerequisite in any placebo effect?

This disempowerment with regards my own 'treatment', my very own psychology seems foundational in much psychological impairment. I become in a sense almost self-ostracised, alienated, a conformist in the conceptualization of my interior. As such psychotherapy may well be foundational to my own pathology. It takes away my ability to conceptualize myself in my own terms. It robs one of the independent agency to approach and treat one's own psychological ailment. As Foucault provocatively stated 'prisons are factories for creating criminals' (1991), so we might contend that arenas of psychotherapy are generators of pathology.

To motivate the same point in slightly more concrete terms Cushman says:

"The wish to overidealize and psychologically merge with an admired figure....and the pull to exhibit before and please the...figure are exceedingly powerful psychological motives. These impulses are regressive and destructive of critical thought", (Cushman,1992,607).

The damage that psychotherapy is capable of manifests on two levels. Firstly, ontologically, it is able to generate a far greater 'extended family' of original pathologies. Similarly, by providing benefits, healings, cures to the assumed pathology, by the positioning of a cure, of a psychological health, therapy by its very existence and its whole ever-growing endeavour cements and displaces a population of psychological illness that becomes its responsibility to deal with.

One function of pathology, of psychological maladjustment is to remain powerless, is, as the phrase goes, to "need help". Not to deny that no form of psychological maladjustment existed before the advent of institutionalized psychotherapy; psychotherapy simply creates a new proliferation of pathology, and capitalizes off the 'fact' that my pathology remains beyond the reach of my own efficacy. It is because of the existence of psychotherapy there is a staunch and active economic imperative to psychopathology.

The second level upon which psychotherapy is damaging, beyond the fact that it's fundamental form is abusive and exploitative, is, in the sense mentioned above, that, because one's own psyche, own's one psychological material must now be accessed through conventionalized, formularised channels, the therapy can recreate, far more effectively, many of the self-ostracizing, 'pathologising' elements of the outside world that seem to have necessitated therapy in the first place. As Cushman eloquently puts it:

" outwardly adhering to the practices of an objective technology and the ideology of self-contained individualism and the bounded self...[psychotherapy] perpetuates the social problems that caused the patient's wounds in the first place. This paradoxical situation undermines the helpful work of the therapy because it is unempathic (the therapist is choosing adherence to an ideology over the needs of a patient), harmful (it inflicts on the patients the discourse by which they have been previously harmed), and ultimately counterproductive for our society as a whole (it reproduces the present power hierarchy and economic structure that have caused out present suffering)." (Cushman, 1992, 607).

The 'psychological paternalism' of psychotherapy
One of the easiest ways to lampoon the supposed self-effacing 'humanism' presented us by the discourse of psychotherapy is with recourse to Rogerian jargon. What are we to make of 'unconditional positive regard', especially once it's paired off with personal genuineness, or 'congruency'? We're to be genuine and honest, yet at the same time to display love, warmth, a secure environment and unconditionality. In other words, we're to be virtually Christ-like. And all this in the name of being a non-coercive form of therapy... This is a calculated 'humanism'; beautifully coercive, one that makes the divinely understanding, accepting therapist. It is a 'thei-fication' of the therapist, that prompts a corresponding reification of the notion of 'the patient'. Once this patient status has been imbibed as real by the client, the despoticism of the therapeutic endeavour is able to continue ever more effectively because it has now also created itself from the internal position.

What we need is an awareness of the psychology of wanting to be a psychologist. The implicit superiority, the psychological scrutiny allowed such a position, the diagnostic power, the self-actualization, the ability to recognize the client's turmoils, to understand and interpret them, amounts to a new kind of patriarchy. Whether 'debriefing' trauma, dialogue-ing phobias, losses, griefs, whether talking-through, whether psychoanalytically distanced or not, whether humanistically proximal or not, the therapist is always 'secure', is always implicitly more psychological able. The therapist, in fact, is continually 'upshot' as psychologically capable, is continually remade and re-substantiated as (through the mechanics of a kind of cultural paternalism) the authority on matters psychological; is vitally, more of an authority, more of a credible witness on myself, than myself. The case is that therapist capitalizes, as Masson notes (1993), off of the client's suffering. Their relationship with their client can thus be typed 'parasitic'.

There are two basic instruments of the psychotherapist's unjustified empowerment: one is their possession of esotericized psychological knowledge and jargon, the other is "the client's" psychological 'ineptness'. And there'd seem a wonderful and addictive, paternalistic, empowerment resting with the continually reverberated and reinforced implication that I, as therapist am always more able to 'properly' negotiate life. Sure, many occupations grant one an 'expert' status of some kind, an arbitrary empowerment of some kind; few though operate across the value terms that the position of clinical psychologist does. We needn't perform a cultural archaeology to bare the glorifications of 'self', 'stability', 'psychological health', of psychology's hand-me-downs from religion; indeed those of the psyche from the soul.

The very existence of a discipline like that of psychotherapy, (and I think it is rightly, in the

Foucaldian sense, called a discipline) indeed of a psychology, as distilled from psychiatry, as suited and designed to receive a far wider, more holistic range of life-problems, testifies to our culturally-sanctioned inability to ever really be psychologically independent at all. The 'regularizing collectivity' (i.e. the discourse) of psychotherapy is a wet-nursing one that makes enormous economic investments in our very dependence and psychological self-incompetence. The cultural dispersal of psychoanalysis and then a multitude of psychotherapies has resulted, in the fact that the stations of the confessional are open in all quarters of society, entrenching not only our current inability, but also our future reliance on their systems.

We as "clients" though are always 'the other' of sorts within these processes. Whether it is the theoretical underpinnings, the interpretive model, the structuralism of the model, the process's unadmitted inability to see us through any other than it's once a week and systematized lenses, whether it's the very professionalism, it's very gravity to unearth what it wants to find, the therapist's projection onto their "client", their need to exhume their own 'pathology', to use the therapy to someway validate their own psyche, to use their own jargon, to 'actualize' themselves, or simply, the extraordinary, unnatural and artificial character of the therapeutic relationship that causes it, whatever it is, it seems undeniable that the therapeutic process profits its possessors a great deal more than it will ever admit.

The impotence of empathy
The neutrality and objectivity that especially trainee therapists, and indeed some whole philosophies of therapy advocate, that very professionalism negates and obfuscates the naturalness, the reality of the experience, the therapist's 'genuineness'. It can never become anything more than a contrived atmosphere. The same professionalism that it's therapy's 'ethical responsibility' to maintain would seem it's most secure impasse with regards any real connection. Not to demand that a 'real' connection should be made - just to make it perfectly clear that therapeutic empathy is a calculated, simulated experience, an artificial interaction through which we're supposed to benefit.

The typical 'you must be finding this very difficult' comment is blatant evidence of the fact that the therapist isn't. It is a distance. It is a counter-therapeutic display of the lack of any bond. The sympathy of a friend outweighs the empathy of the therapist. They fairly suffer with us; the strength of the human connection is powerful, and often reparative. The strength of the therapeutic relationship is manifestly artificial, always contingent on constraints of time, money, boundary, etc. Rather than reparative such a contingent empathy is often alienating, estranging itself. The therapist's lack of interpersonal investment is made all to plain in the textbook objectivity of the 'this must be hard for you'.

The insubstantiality, the non-reality of their contribution to my dealing with my situation omni-present. We can make a strong argument that this quality, this deliberate reticence to bond, is, in the right context, constructive. In other contexts though, it's other-izing. Point being that if do we regard true empathy as facilitative of psychotherapeutic benefit, we must remember that therapy is actually far more deficient in this respect than it pretends.

No therapist, no type of therapy is 'unconditional'. They're both in fact extremely conditional. The stalemate here's between the therapist's personal honesty and their displayed unconditional regard, between boundaries and empathy. As much as one might argue that there is some happy medium here, as much as we may try delude ourselves that the therapist may find some neutral ground with regards accepting the person but not the act, or by expressing a third-person or other-wise distanced structural remark without personal repercussion, in-therapeutic experience testifies otherwise. Therapeutic experience testifies to an unending vigilance of the assessment that therapy is, that holds the marginal empathy value that it does have, hostage.

We admit there are 'shades of grey', but refuse to admit that there are any definites with regards the non-condescension, the non-manipulation, the non-denigration, the non-self-serving nature of psychotherapy. These are just the values that its various discourse would suggest to us, be it through psychotherapy's standing as a humanism, by virtue of its very nature as 'therapeutic', with regards it's affinity to all its cultural dispersals, be they in the form of agony columns, pop-psychology or the general self-actualizing or 'feel-goodisms'. The importance of our argument is that no matter how well the therapists and the psychologists can counter us, can academically qualify, theoretically re-humanize or justify therapy, our actual in-therapy exposure cannot be disqualified in this manner.

Transferential violation and rape
The cornerstone of intimate revelation or disclosure has been challenged, however it remains inherent in the structure of therapy. Therapy never demands we tell all, it just continually compels it. As students and clients of psychotherapy we're taught, instilled, through subtle and more overt 'instructional' conditioning, about the unequalled power of intimate disclosure. The permeation of this supposition, its assumed curing ability of disclosure, need be reprehended. And here the 'parameter-shifter' starts to take effect: it seems by the conditions laid down by psychotherapy that we're sunk into the position, where the "client" need by virtue of any 'benefit' they hope to gather from the process, contribute to the process as genuinely as possible, seemingly, as vulnerably as possible. By the same therapeutic parameter, the therapist needs respect 'boundaries' of some kind. And we're up then against the condescension of the situation where for therapeutic benefit the client need bare themselves as much as possible, interact as honestly (almost as self-compromisingly) as possible, and where, equivalently the therapist must entrench a fair proportion of personal distance. This domination reaches something of a zenith in the transference, when the patient's conscious and perhaps more notably unconscious mind is mobilized by the calculated disinvestment of the therapist.

The reason for the potency of the therapeutic transference is precisely in that withdrawal of the therapist: it is because their contribution to the therapeutic space is so fraudulent that the need arises to imagine, to fantasize about what the therapist would be like in a more real, or more desirable state of affairs. It seems precisely the relationships where there is some apparent equal empowerment, i.e. friendships, perhaps less patriarchally loaded marriages, where transference is at a minimum, and the most power-stricken where the transference is at it's strongest. Transference is psychological interference that can never be ethical. It is a calculated abuse. Sure, it addresses itself as a functional abuse, one that must be in some way didactic, but it is in the transference where one of a person's most precious gifts, i.e. the ability to love for instance (and of course often too the erotic fantasy that goes along with it) seems so often exploited, toyed with, humiliated. These transferential functions, considered along with the sexual disclosure that therapy seems to so often essentially require, give us grounds for wondering whether psychotherapy is itself, by virtue of its very form, sexually abusive... Given more space we could embark on a catalogue of all the therapists who've 'had to deal' with clients either falling in love with them, or having sexual fantasies about them.

This exploitation is one that can never be seen as not impinging on the therapist's own psychology, as not constituting a new species of emotional appropriation, and rape. This structure, where client exposure is a pre-requisite, where the therapist is in possession of in some cases, the greatest intimacies the person can admit and where the client knows next to nothing about the person within whom so much has been invested, is a one-way appropriation of personal intimacies, a formal objectification intrinsically comparable to rape. The therapist's own power position is continually if not explicitly, reinforced. Their own psychological stability and 'psychological adeptness' is consistently re-supposed and re-gratified. They're possessive of highly intimate sexual and interpersonal revelations. They need surrender nothing; as Masson asks (1993): how can clients even every really know to whom they're talking? And, vitally, their own psychology, their own hang-ups, issues, needs, dispositions, less than being 'professionally absent' as the culture might have us believe, are always present, listening-in on the therapy, and, in so doing profiting (as Masson (1993) also claims) from the process. That lie of the 'objective, professional psyche' of the therapist is a very central one to the culture of psychotherapy. One purpose of likening psychotherapy to a discourse of rape is to bring out just this lie. It would seem a far more direct, far more honest 'truth' to sketch the therapist as the intersection of psychological voyeurism and despoticism; the therapist here starts to become indistinguishable from 'psychological rapist'. Ironically it is within the very language of the traditional paradigm that one senses this shift. Therapist = "the-rapist".

Granted, it is 'rape' with an important difference: its subjects submit willingly. But if we're to follow Foucault's (1991) sketchings of power from the monarchial forms of public, physical, demonstrative punishment to the more sophisticated and economic forms of disciplinary power (i.e. the self-surveillance of panopticism), then we have very little difficulty in terming psychotherapy a more insidious, albeit less traumatic, but more sophisticated and obviously far more culturally-sanctioned form of infiltration, and, not to mince words, rape. Far subtler, far too refined an infiltration to be physically violent. It is also a 'passive' rapist, diffusive in its responsibility (and here the therapeutic contract springs to mind); it 'indirects' the rape by creating a necessity to self-revelation on the part of the "client". It becomes the "client's" responsibility to self-exposure, at the threat of the failure of the therapy. And as such psychotherapy's more active and overt measures of control are consolidated with its more 'passive' ones, and in so doing it pulls off the neat trick of appearing to own certain mechanicisms of infiltration purely by default.

Therapeutic revelation has become such a socially condoned disclosure, so professionally anonymous and silent, (like the 'our little secret' of molester and their victim) that the real abuse it constitutes never sees the light of day above the covering positivist ethos. There is no way to justify this kind of intrapsychic penetration. No way except for it's own grounding. It simply can justify itself in no terms other than it's own. And those are no justifications at all.

Versatility and implications of the culture of psychotherapy
The 'flexible positional superiority' of the culture psychotherapy then lock its "clients" into a whole (and very wide) series of submissive relationships. Complicating the psyche, for example, is to the institution's benefit, as is the complexifying, in fact the 'esotericising' of the terms that are used to access the realm of the psychological. Some of these submissive relationships may be thought of as more productive than others, by far the greater majority are 'smoothed over' though, left unadmitted. Perhaps the biggest and most urgent of these 'neglected' details, is that psychotherapy is self-serving before it is in any way "client-centred". The goal of any system of discourse, as Said reflects Foucault's understanding of it (1983), is twofold: to confirm and maintain itself, and to manufacture its material continually. 'Its material' in this case is the appropriated psyche of its clients. And this 'appropriation' of the psyche is enabled through a wedge driven between me and my own psychology. That wedge is of, amongst other things, academic knowledge and psychotherapeutic initiation. It is an uncannily enabling 'wedge' too, stretching from the psychoanalytic resources that may be drawn on to identify my resistances, projections, reaction-formations, transferences, to an incredibly wide dispersal of other interpretations, structural, personal, even instinctual, which leave me as "client" at the bottom end of an extensive, disempowering vocabulary. Hence clients' criticism, or 'resistances' are seen as 'experiential growth', are fed-back into therapy until the "client" either buys into them, or one supposes, offers more 'resistance' or leaves therapy.

When Foucault says in Discipline and Punish that "the human body was entering a machinery of power that explores it, breaks it down and rearranges it" (1991, 137) we can, it seems, replace 'body' with 'psyche':

"the [psyche] was in the grip of very strict powers, which imposed on it constraints, prohibitions or obligations. However there were several new things in these techniques. To begin with, there was the scale of control: it was a question not of treating the [psyche], en masse, 'wholesale' as if it were a indissociable unity, but of working it 'retail', individually; of exercising upon it a subtle coercion, of obtaining holds upon it at the level of the mechanism itself... Then there was the object of the control: it was not, or was no longer the signifying elements of behaviour of the language of the body, but the economy...their internal organization; constraint bears upon the forces rather than upon the signs...Lastly there is the modality: it implies uninterrupted, constant coercion, supervising the processes... (Foucault, 1991, 137).

We have left in one mention of 'body' in order to accentuate the economics of how a psychological modality of control can spill over into wider (physical) realms of control. Also, Sampson's ongoing diatribe (1989) against the ideology of 'self-contained individualism' in psychotherapy is met nicely here in Foucault's re-conceptualization.

We use this passage chiefly to resonate some of the aforementioned hegemonies within the culture of psychotherapy, and to suggest, as I hope to have done through my earlier literature citations, that individual psychology, and thus the models of psychotherapeutic interaction may be considered prime ideological seeding ground.

We've hoped to indulge in a geopolitical endeavour (in the Foucauldian sense) in which criticisms are moved from considering just the signifier, to describing that signifier's place, a place, that as Said writes, is rarely innocent, dimensionless, or without the affirmative authority of discursive discipline (1983, 220). Indeed, if we are to grant the institution of psychotherapy the status of a culture, then we must remember that, as Said reminds us, we're dealing with a continual process of reinforcement (1983); to engage it simply on a moral (or any other singular) level is to forget that it has many discursive wings (be they academic, or of a medical model affinity) that function precisely to authorize and validate their colleagues.

A more exhaustive consideration of the transmissions of the culture of psychotherapy in this limited space would've been too sketchy. We opted instead to try a 'cross-sectional cut' through some of its discourses, i.e. tried to chiefly 'resemanticise' psychotherapy in the structures of rape. We hope in this way to have provided rather than the tone of moral outrage or of abolitionist condemnation, something of a minor 'counter-culture' that the institution of psychotherapy cannot simply over-ride and re-subsume.

The impetus for this paper as stated was a result of our in therapeutic experiences as well as academic exposure. The following text are highlighted excerpts from one of our papers. We feel this reflection of therapy is an insightful yet predictable consequence of therapy and it is from this perspective that we have attempted to deconstruct the institution of psychotherapy.

"this is not meant to be an authoritative work of absolute truth, more it hopefully acts as a glimpse into the journey of therapy from the other side... a position I often find myself in. Differing from accounts of individual recovery we are introduced here to the roller coaster of the therapeutic process, to the needs, to the desires, fantasies and phantasies that weave webs in patients leaving them tangled in a new relationship that possibly has the most potential for honesty if used correctly...... It is not only up to the client to use the relationship to change to grow, but partly the responsibility of the therapist to change, grow and react!

I believe that there is a common syndrome that many patients share.... I wish my therapist would do this, say this.....Being in therapy is not a simple issue. It is not only about the 1, 2 or 3 hours a week is much more about the relationship in ones head with him/her during the course of the week. I wonder how many therapists realize how much they are thought about. What would be of great comfort is to know that this part of the process of therapy could be discussed without embarrassment. The embarrassment arises out of the shame that one is in love with the therapist..... I believe this transitory love is healing......I hope to not find the answers in technique and procedure and textbook. I never want to forget what it is to be like the less powerful, hesitant scared embarrassed, angry unsure patient.

In order to understand the fragility of the interaction it is most of the patients I have had contact with wish that their therapist would unlearn..........Patients tend to understand intellectually that hugging is not part of therapy even when they are at there lowest ebb. They never demand to be hugged fearing the repercussions but they never stop needing to be comforted in a manner that is unambiguous and vital.

Reaction and action are inextricably linked in the world of the silent walls of therapy. Much of the therapeutic hour is devoted to action, be it silent or energetic in the hope for reaction. Ordinarily the hoped for reaction never surfaces.....It creates unanswerable questions about the relationship which are pivotally important as well as doubt, guilt and uncertainty about the oneself... the doubt created in therapy does not ease the situation. .... It would be satisfying to know for sure rather than continually being a player in the microcosmic guessing game.

The therapists shrouds him\herself in the guise of unattachment which thus creates a god like status..... The power schisms are heavily weighted.

This stage is reached far too late in the process where the damage has been created and surfaces as a result of the prohibitive relationship....the patient loses his\her humanity and the therapists humanity in the therapists own creation.... I do not believe that disappointment need necessarily be an essential part of therapy. Therapy is danger often one feels that there should be warning lights."


  1. Bergin, A.E, & Strupp, H.H. (1972). Changing Frontiers in the Science Of Psychotherapy. New York: Aldine
  2. Bloch, S. (1982). What is Psychotherapy? Oxford: Oxford University Press
  3. Bloch, S. (1986). An Introduction to the Psychotherapies. (2nd ed) Oxford: Oxford University Press
  4. Cushman, P. (1990). Towards a historically situated psychology. American psychologist. Vol 45, No.5 599-611
  5. Cushman, P. (1992). Psychotherapy to 1992: a historically situated interpretation. In Freedheim, D.K. (ed) History of Psychotherapy A century of change. American psychological association : Washington
  6. Derrida, J. (1981). Dissemination, trans. Barbara Johnson. Chicago: University of Chicago Press
  7. Dryden, W. and Feltham, C. (Eds). (1992). Psychotherapy and its discontents. Buckingham and Philadelphia: Open University Press
  8. Dinnage, R. (1988). One to one experiences of psychotherapy. London: Viking
  9. Ekstein, R & Wallerstein, R.S. (1991). (2nd ed). The Teaching and Learning of Psychotherapy. Madison: International Universities Press
  10. Eysenck, H.J. (1952). The effects of psychotherapy: an evaluation. Journal of Consulting Psychology, 16: 319-24
  11. Eysenck, H.J. (1958). Uses and Abuses of Psychology. London: Penguin.
  12. Eysenck, H.J. (1960). The effects of psychotherapy. New York: International Science Press.
  13. Eysenck, H.J. (1992). The outcome problem in psychotherapy. In Dryden, W. and Feltham C. (1992). (Eds). Psychotherapy and its discontents. Buckingham and Philadelphia: Open University Press
  14. Foucault, M. (1970). The Order of things: An Archeology of the Human Sciences. New York: Pantheon Press
  15. Foucault, M. (1991). Discipline and Punish : the birth of the prison. England: Penguin
  16. Gurman, A.S., & Razin, A.M. (Eds). (1977). Effective Psychotherapy: A handbook of Research. Oxford: Pergamon Press
  17. Hurvitz, N. (1974). Psychotherapy as a means of social control. In Journal of Consulting and Clinical Psychology, 40, 237
  18. Kvale, S. (1992). Psychology and postmodernism. London: Sage
  19. Kahn, M. (1991). Between therapist and Client: The New Relationship. New York: W.H Freeman and Company
  20. Kazdin, A.E. & Bass, D. (1989). Power to Detect Difference between Alternative Treatments in Comparative Psychotherapy Outcome Research. Journal of Consulting and Clinical Psychology, 57, (1), 138-147
  21. Kelly, A.T., & Strupp, H.H. (1992). Patient and Therapist Values In Psychotherapy: Perceived Changes, Assimilation, Similarity and Outcome. Journal of Consulting and Clinical Psychology, 60, (1), 34-40
  22. Kotler, J. A. (1991). The Complete Therapist. San Francisco: Jossey Bass Publisher
  23. Laing, R. D. (1985). Wisdom, Madness and Folly: The making of a Psychiatrist. New York: McGraw Hill
  24. Lewis, B. (1994). Psychotherapy, Neuroscience, and Philosophy of Mind. American Journal of Psychotherapy, 48, (1), 85-93.
  25. Masson, J. (1993). Against Therapy. London: Harper Collins
  26. Myers, M.J. (Ed). Cure by Psychotherapy. What Effects Change? New York: Praeger.
  27. Symonds, M. (1958). Dynamics of Psychotherapy. New York: Grune & Stratton
  28. Nietzsche, F. (1968). The Will to Power. Vintage Giant: New York
  29. Nietzsche. F. (1976). On Truth and lie in an extra-moral sense. In Kaufmann, W. (ed). The Portable Nietzsche. Vintage Books: New York
  30. Parker, I. (1992). Discourse dynamics: critical analysis for social and individual psychology. Routledge: London.
  31. Richer, P. (1992). An introduction to postmodern psychology. In Kvale. S. (ed). Psychology and Postmodernism. Sage: London
  32. Said, E. (1978). Orientalism. Pantheon Books: New York
  33. Sampson, E.E. (1981) Cognitive psychology as ideology. American Psychologist. Vol 36, No. 7, 730-743
  34. Sampson, E.E. (1989) The deconstruction of self. In Gergen, J.K. (ed) Texts of Identity, Sage: London
  35. Smail. D. (1984). Illusion and Reality. London: Dent
  36. Smail. D. (1987). Taking Care: An Alternative to Therapy. London: Dent
  37. Squire. C. (1989) Significant Differences:Feminism in Psychology. London: Routledge
  38. Strupp, H. (1973). Psychotherapy: Clinical Research and Theoretical Issues. New York: Jason Aronson
  39. Szasz. T, S. (1974). The Ethics of Psychoanalysis. London Routledge & Kegan Paul: London
  40. Szasz, T.S. (1979). The Myth of Psychotherapy. Oxford University Press: London
  41. Truant, G.S.& Lohrenz, J.G. (1993). Basic Principles of Psychotherapy. American journal of Psychotherapy, 47, (1), 8-32

Sharonne Isack & Derek Hook
c/o Psychology Department
University of the Witwatersrand
PO Wits

Paper presented at the 1st Annual Qualitative Methods Conference: "A spanner in the works of the factory of truth"
20 October 1995, University of the Witwatersrand, South Africa
critical methods society - -