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Psychotherapy and the consumption principle
In addition to concerns with maintaining the container and assuring the safety of our clients, there is the issue of competency to practice. Almost all of us were taught that how a client relates information is at least as important as what she relates. Posture and its changes, facial expression, positioning of the eyes, tone of voice, speed and volume of speech, as well as phenomena such as hesitation and blocking, are only a few of the cues we look for in deciphering what is the "communication". Net therapy, as noted above, would reduce this rich melange of sensation, perception and interpretation to simple written language. This is a sterilized operational field for anyone trained in current practices, and provides fertile ground for misleading conscious and unconscious manipulation, by both client and therapist, of the data with which the therapist must work. Any definition of competent practice under these conditions would have to rely on the adequacy of written linguistic communication as a reliable carrier of unconscious conflicts and emotional dysfunction. A writer capable of this level of sophistication is extremely rare, if she exists at all. The rest of us are much less adept, and opaque to ourselves. This threatens to drive a theoretical reorientation of psychotherapy of a much grander scale than that imposed under managed care, and would require almost all practitioners to obtain significant retraining. Interestingly, this shift to a focus on discourse and narration has already begun with "postmodern" therapists. In addition, those therapists are actively engaged in cutting identity loose from any representational or foundational ground. Perhaps a therapy tailored for global capitalism is already gestating, oblivious to the uses to which it shall be put by our institutional structures.
Psychotherapy and Global Capitalism under the Consumption Principle
One way of characterizing the growth of strong versions of discursive and narrative therapy is that of a shift from analogical to digital communication. These concepts come out of the Menlo Park Group in the 70's, and refer to the different functions of styles of communication. Analogical communication is that form appropriate to expression of emotional material, while digital communication is best used for the simple transmission of factual data.
Net therapy, with the focus on the written word through utilization of digitized communication, will, to a greater or lesser extent, digitize therapy. The technological and linguistic structures through which the practice is accomplished will drive this outcome regardless of the intentions of the agents in the process.
A client will present with certain symptoms, relate them in a composed format, and receive assistance and collaboration in modifying behavior (which includes internal narratives) so as to function at a more efficient level. In so doing we convert a human, analogical relationship into a digital exchange of information, recasting a paradigmatic human relation in terms consistent with the means of production in the Information Age, the digital transmission of information. The strong versions of narrative and discourse therapy stand in place, ready to define subjectivity in terms of free floating narrative structures. This, in turn, will impact societal constructions of what it means to be a self. There is a very real risk that the result will be a truncated version of humanity that is more readily assimilable to routinization and reconfiguration. Is the convergence of these practices and trends a simple coincidence? Or, is it the case that psychologists, in ignoring the material structures within which they operate become blind participants and allies in this convergence?
When you combine this new self-conception of digital malleability with the enhanced release of narcissistic fantasies occasioned under the current regime of net enhanced repressive desublimation, you achieve a highly functioning consumption machine. Identity floats free, subject to narrative reconfiguration, having escaped the gravitational pull of the "essential". Narcissism, nourished by a commodity market which appears, or is "virtually" poised, to meet every demand, inflates, demanding its' access to gratification. The principle of consumption joins these two elements, offering the promise, but never the reality, of narcissistic satiation, while simultaneously providing core structures, consumer products, around which the flux of multiple identities assumed by the consumer/client can constellate and receive affirmation. In this shell game, an infinite deferral of satisfaction is accomplished through the implicit promise that the next product/identity structure will bring the desired fulfillment.
The result is an infinitely configurable consumer, who can be shaped and reshaped repeatedly, all the while anchoring the synchronic and diachronic multiplicity of identities in the endless consumption of products around which those flexible identities are organized. We must ask ourselves if we wish to participate in this process, in full realization that regardless of our subjective intentions, there are material conditions that have a strong impact on the outcome of methods and techniques of therapy, and if we engage them we are responsible for the consequences.
The Current Status of the Transformation of Psychotherapy/Subjectivity
We are already complicitous enough in this process, as there exist at present mechanisms of material production which are positioned, and intended, to turn our work as therapists into grist for the mill of global consumer culture. I am aware that it can sound like I am frenetically shouting Jeremiads, but bear with me for a moment.
Recently my local paper published a syndicated opinion piece written by Robert Scheer. It concerned the repeal of the Glass-Stegall Act of 1933, and its replacement with the Economic Modernization Act of 1999, What can this possibly have to do with therapy, the net, and managed care? The earlier law prohibited centralization of insurance, banking and investment services under the same roof. It was believed, after 1929, that the conflicts of interest and various forms of malfeasance and misfeasance such conglomerates engendered were instrumental in the destabilization that resulted in the Crash of 1929. Many respected economists still believe so. Regardless, the 1999 law repealed those prohibitions. During legislative debate, there was vigorous discussion about the issue of consumer privacy. In the absence of privacy safeguards, these new conglomerates would be free to compile extensive composite portraits of consumers. Among the information that would be circulated in the absence of such protections were insurance company medical records. The Clinton Administration defeated the demands for safeguards. The Secretary of the Treasury presiding over the defeat was Robert Rubin. It worked out well for him, as he has since decided to leave government and earn his bread by the sweat of his brow in the private sector. You can buy a lot of bread for the $33 million that Citigroup, one of the first newly authorized conglomerates, is paying him for his first year of official service to them.
Why was cross-access to this information so vital to these new conglomerates? As they explicitly argued, access was essential to provide the data necessary to more effectively market to consumers. Moreover, the information is marketable to others concerned with compiling a portrait of you, for market purposes. The more they know about you - your spending habits, financial status, and medical records- the more they can present you with the "virtual reality" of a totally personalized market. Of course, medical records come in handy for a number of reasons. For example, what is the mortgage default risk for someone who is, or has been, treated for unipolar depression, given the actuarial incidence of suicide and substance abuse in that population? Under managed care, every time you presently file private or confidential information regarding a client you run the risk it will be used to target him for certain products, impact his financial ratings, and possibly impact employment In other words the infrastructure is already in place to utilize therapeutic information in the marketplace.
Under these conditions it would be unconscionable for psychologists to take part in the creation of net therapy without a full analysis of how that practice will relate to the larger institutional structures, social, political, and economic, in which it will be embedded. It is too late in the day for us, as a discipline, to continue to ignore the culture and society in which we practice, pretending that therapy somehow occurs in a vacuum, and is not a social practice which is intimately and reciprocally enmeshed with those other institutions, including economic and industrial forces Competent practice for someone attempting to practice our craft requires continuing education in not only psychology, but in politics, sociology, and economics. When we tire of the demands this places on us, we need remind ourselves only of how we stumbled into managed care, an arena from which we have yet to determine whether we, or our clients, will emerge intact.