NT: While you make reference to core principles in a number of psychotherapeutic approaches, it would seem from your case studies and explanation of your objections to the current dominant views that you also don't fit comfortably into one school of psychotherapeutic thought. How would you describe your clinical and theoretical allegiances and preferences?
EF: I consider myself a classical Freudian psychoanalyst in that I believe Freud's theory of symptom formation applies to all cases of mental illness, whether they involve chemical, neurological, and genetic factors or not: inner conflict over a disturbing unconscious emotion provokes anxiety (or shame or guilt) which then triggers either a successful recruitment of defenses to keep the disturbing emotion unconscious or the formation of a symptom to allow a disguised expression of the disturbing emotion without actually permitting it into consciousness.
I am also a classical Freudian in that I think of psychoanalysis and psychoanalytic psychotherapy as an intrapsychic process, a process of the unconscious becoming conscious that happens primarily within the patient. It 's a process that can only work if the patient is able to direct his or her attention inward to be able to discern what he or she really feels. I disapprove of the current fad of "relational" psychoanalysis which blurs the boundary between inner and outer in such a way that Adolf Grünbaum would feel vindicated because everything is suggestion and there is no way to ever know what's really true (and for some relational thinkers it doesn't even matter what's really true).
There are four basic theories of how therapy works:
a) There is an answer and the therapist has it (for instance, in cognitive therapy, the therapist supposedly knows what are inappropriate cognitions and what are the correct cognitions);
b) There is an answer and it is within the patient, to be discovered as the unconscious becomes conscious;
c) There is no answer and nothing becomes conscious but the therapist and patient make up a story that they can agree on; and
d) There is an answer, and it is (somehow-or-other) in the relationship, which (somehow-or-other) changes the patient.
I come down strongly on the side of theory b. Having said that, I must also say that the way I work is highly relational. I believe that the working through of transference, countertransference and transference-countertransference enactments is crucial for the patient to be able even to get to the point of consistently directing his or her attention inward. I think of the psychotherapeutic process as an inner process within the patient in which the unconscious is always exerting pressure to become conscious while being opposed by the tendency of the personality to avoid anxiety. When the patient engages the therapist in an interaction, he is interrupting a process within himself-the process of becoming conscious-because there is something disturbing about whatever he is on the verge of feeling at that moment and he needs to distract his own attention from it, keeping it unconscious, by turning his attention to the therapist.
To put it more succinctly, the psychotherapeutic process is an inner process of becoming conscious, in which the patient inevitably needs to resist the process by using the relationship with the therapist - the transference - to evade the awareness of disturbing emotions. But paradoxically that very resistance becomes the path to consciousness, because the transference always involves projection. What we can't tolerate feeling within ourselves we end up seeing (and also provoking) in the therapist. So getting in touch with our emotional reactions to the therapist is a crucial step toward getting in touch with our emotional reactions to ourselves. Ultimately, it leads to greater acceptance both of ourselves and of others, in a variation on Pogo's famous theme, "We have met the enemy and they is us!"
Two final points. First, the whole history of psychoanalysis can be viewed as a series of conflicts between proponents of the intrapsychic perspective (orthodoxy) and some form of relational perspective (heresy). In fact both perspectives are valid and they are complementary in the sense of Niels Bohr's principle of complementarity.
Second, there is a very nice summary of some of the other "general principles" I espouse, and an illustration of the integrative intent of my thinking, in a paper I wrote for the Cambridge Companion to Jung. The paper is entitled, "Me and my anima: through the dark glass of the Jungian/Freudian interface." It is an imaginary dialogue between me and a Jungian colleague which treats the common themes in Jung and Freud and discusses how, after their split, each man began quietly (and almost certainly unconsciously) incorporating the ideas he had been attacking in the other into his own evolving theory.
NT: You talk about symptoms such as those of depression and anxiety as evolutionarily adaptive mechanisms. How might you understand the increasing prevalence of both of these, both on the micro level of individual clients and the macro level of what they might be saying about our society?
EF: Modern western culture is relentlessly materialistic, relentlessly superficial and relentlessly short-sighted, and many indicators would suggest that it is relentlessly self-destructive as well. Anxiety and depression and other psychiatric symptoms interfere with the empty pursuit of "business as usual" and force us to pay more attention to what our culture encourages us to ignore: our inner lives. The more western culture goes out of control with mindless externally directed action (as in "the one who dies with the most toys wins"), the more the human soul will need to assert the corrective measures of anxiety and depression to shift the balance toward internally directed reflection (as in "the love you take is equal to the love you make").
NT: What changes would you most like your book to help effect in the mental health professions and in society at large?
EF: This is fantasy-land, but if I could have my wish, I would want the book to raise the bar for what is considered proper training in psychotherapy. Especially, I would like to see it become standard practice for all mental health professionals to have their own treatment in dynamic psychotherapy, as a training requirement and prerequisite for being licensed to treat patients. In psychiatry, I would like to see a reclaiming of psychotherapy as the core skill and the most important treatment a psychiatrist has to offer (etymologically, the word "psychiatry" means "healing the soul"), with medication reconceptualized as an adjunctive treatment.
In society at large I would like to see Big Science recognized for what it is: an emperor without clothes that is being used to rationalize all manner of dehumanizing destructive nonsense (like ten thousand quick-fix treatments, like listening to Prozac and like managed care, not to mention the technology of biological, chemical and nuclear warfare). I would like to see it widely publicized that modern brain science and modern psychiatric research operate according to an outmoded nineteenth century model of science that has been proven invalid by quantum physics. I would also like to see it widely publicized that modern brain science has never contributed anything at all-and never will-to an explanation of human consciousness. My hope is that if we understand this, we will then find it harder to avoid meeting human consciousness on its own terms, as we can actually experience and understand it within ourselves.
Copyright © New Therapist