Thursday, December 07, 2006

Therapist's Sex Shame...

Ok, now I’ve got your attention.

In case you can’t be bothered reading this story, it’s a sad and sorry tale of a sexual relationship between therapist and client which, inevitably, turned sour. I do not raise this issue in order to heap yet more shame on the beleaguered Ms Bouwman. She has, after all, lost her reputation and her livelihood, not to mention her erstwhile lover. And to be fair to her, she did demonstrate that she is at least on nodding terms with the ethics of her profession by ending the therapeutic relationship before commencing the sexual one. So why do I feel compelled to comment? Because it is so wrong. So very, very wrong.

The purpose of psychotherapy, as far as I can make out anyway, is *to understand how we form and maintain attachments and to learn to regulate our internal experience – including past and present unmet needs – so we can engage with the external world in a reasonably functional way. (Please note that there is no mention there of ‘how to get my needs met’, a phrase which sends me into a spiral of despair and is banned from my therapy room.) This (*to understand….etc etc) is rather more difficult than it might sound. It is much easier to fall in love with your therapist in the hope that this love will soothe away all of your internal conflicts. (I suspect we all have an unconscious desire to merge blissfully with an idealised other; think baby suckling at mother’s breast and you are on the right lines.) It is your therapist’s job (yes, job as in responsibility) to take this transference and use it therapeutically, thus enabling you *to understand…etc etc.

This, in a rather rambling way, brings me to the point of this post. Of course it is flattering, and sometimes, dare I say, exciting, when a client says they fancy you/love you/want to shag you on the couch. We are only human, after all. But in order to use this material therapeutically - in service of the client (rather than in actually servicing the client as in Ms Bouwman’s case) – the therapist must be able to monitor, regulate and then use their subjective experience. This means having personal therapy. And very good, frequent, therapeutic supervision. And more therapy. And an intensive, experiential training which requires them to undertake their own personal therapy. And did I mention the importance of owning your own stuff through personal therapy?

The United Kingdom Council for Psychotherapy requires all members to undertake personal therapy throughout the duration of their training, which is usually 4 or 5 years and therefore approximates 250 hours of personal therapy.

Counsellors, as far as I am aware (and I’m sure someone will correct me if I’m wrong) are required to undertake around 20 hours of personal therapy.

Clinical Psychologists and CBT practitioners are neither required nor encouraged to undertake personal therapy. Ms Bouwman is a Clinical Psychologist. I do wonder if there might be a link.

You may have gathered that I feel quite strongly about this. I confess that I am very suspicious of anyone who wants to be a therapist but is unwilling to trawl through their own internal world; it just smacks of wanting to tell people what to do, and that is no fun for anyone.

PS If you find yourself tempted, read David Mann’s Erotic Transference and Countertransference: Clinical Practice in Psychotherapy. It’s fab.


Clare said...
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Clare said...
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Clare said...

I deleted my comments in a fit of angst when I realised I just landed on your site and effectively slagged off your profession!

Psychotherapy can be a very useful tool, I do know that. I just had a bad experience of it earlier this year, and quite possibly blamed it for things that were not its fault.

Ms Melancholy said...

Hi Clare,

It’s a common argument, for sure, that psychotherapy focuses exclusively on reworking past experiences. It’s actually a bit of a misconception. I think the major difference between humanistic psychotherapy and something like CBT is that a psychotherapist will focus on the relationship in the room as a vehicle for facilitating change. We inevitably bring into the therapeutic relationship the exact same problems we experience in the outside world. If therapists can use that relationship in a skilled way, we start to experience ourselves differently in relationship, rather than just learning something about ourselves from a more cognitive place (known as the experience vs insight debate). I appreciate that different theoretical models have a different understanding of the process of change or cure. However, the bit that none of us can get away from is that the relationship will happen in the room, whether we want it to or not and whether it fits with our own theoretical perspective or not. My argument, then, is that we absolutely have to have the skills to use that relational experience in a therapeutic way. And in my experience CBT practitioners and psychologists simply try and avoid it (the relationship) because they don’t feel skilled to handle it. In order to develop a true relational style, personal therapy is essential.

I take your point that psychotherapy isn’t for everybody. It isn’t. However, I know therapists who work very successfully with people with mental illness so that in itself isn’t a contra-indication. I’m glad you know lots of mad people, but it doesn’t surprise me as you live in Manchester :) (I love Manchester, by the way, almost as much as I love mad people.) Fortunately, though, you have more therapists per square mile in Chorlton than in any other part of the country.

Wow. That got serious for a while didn’t it?!

Ms Melancholy said...

Oh Clare, I was just starting to enjoy the debate! Can you reinstate the comments? I certainly didn't feel you were slagging my profession, - it's good to have the discussion and I am made of much sterner stuff than to get upset at a bit of robust debate. (And also there are some not very good therapists out there, just as there are some not very good teachers, doctors, dentists and even novelists!) To be honest, a good therapist is a good therapist whatever their theoretical orientation, and a bad therapist will never be good. But most good therapists are good because they make the relationship work. Now I'm starting to ramble....

Not offended :)

Sue George said...

I just bumped into this site via your comments on Dave Hill's site and will now be visiting regularly. I have benefitted hugely from long-term (very long-term!) psychotherapy, am interested in psychology, and count some therapists among my personal friends.
I remain melancholic, however...
One of the things that interests me a lot is the way that Cognitive Behavioural therapy is supposed to be the answer to all ills. But how can challenging "distorted thoughts" help when it comes to looking at the really deep problems of life? We are all going to die, for instance. Dreadful things happen and life is never the same again.
No, it seems to me that a lot of CBT is about getting people off benefit and back to being economically active.
I could go on and on...

Ms Melancholy said...

Hi Sue,

Nice to see you here. I agree that CBT is much favoured by the powers that be as it promises reasonable returns for a small investment and is generally good at getting people off long term sick! I think the jury is out on whether pure, short term CBT effects any significant, long-term change though, and, as you so rightly point out, the world and our experience is much more complex than that.

I am interested in the way the therapy world is currently splitting on CBT vs relational psychotherapy. I do wonder if it is a false dichotomy. I think all psychotherapy has a significant component that is essentially cognitive-behavioural (ie how we make sense of the world, and how that meaning-making influences our behaviour.) Relational therapists just go a step further....

I could actually talk about this for hours.....

Thanks for comments, folks.

Clare said...


I just wrote an ENORMOUS long comment, and Blogger ate it. It has disappeared.

Fwiw, this has been happening regularly with Blogger Beta. I highly recommend you upgrade to the next version of Blogger asap!

I knew I should have copied it elsewhere before I hit Publish.

I'm sorry, it took me half an hour to type, and I'm supposed to be writing a novel... HOW VERY ANNOYING.

Can't type it again.

Very short precis:

1. Chorlton. VFI! Not in the least surprising.

2. Sorry, I can't reinstate my comments cos I didn't save them and you can't undelete. But if you have email verification on, you should have copies in your email software. You could forward the emails to me, and I'll post the comments again?

3. I used to suffer from Generalised Anxiety Disorder. It was crippling. Indescribably hideous. Living hell for six months. 24-hour bouts of heightened terror and dark dark despair. Far and away worst experience of my life. And CBT cured me. LONG TERM. It was ten years ago, and I'm still better. I don't believe psychotherapy would have shown those kind of results.

4. A friend was a little unhappy, underwent psychotherapy and became deeply disturbed and borderline psychotic. Stopped functioning. Became obsessed with the language and theory of psychotherapy. Physically attacked people. Very paranoid. Convinced everyone was abusing her, insisted that we were all also victims of abuse, and became abusive towards us if we didn't acknowledge it. She clearly wasn't stable beforehand, but if nothing else psychotherapy tipped her over the edge.

5. What's the point of being in therapy for years if you don't have any real benefits to show for it?

6. To say that CBT is to be doubted because the powers that be use it to get people back into the workplace, is nonsensical. It gets people back into the workplace because it WORKS. It cures people. There's nothing wrong with that!

7. Sorry for brevity of this post! I have to go and write my novel now. But I'm very glad I didn't offend you.

8. Am genuinely interested to know what scenarios you think psychotherapy is most effective in? And whether you would ever discourage a client from having psychotherapy because you thought it might be harmful to them?

9. And do you think there are circumstances where introspection and self-analysis can be unhealthy?

10. The relationship in the room: Don't you think there's an argument to say different forms of practice focus on different things? Thus you wouldn't expect an osteopath to start sticking pins in you. And CNT practitioners don't see the relationship in the room as being a worthwhile thing to focus on: in fact, it's distracting - and not relevant to the business of examining someone's behaviour and how to change it. A good practitioner will use interpersonal skills to put client at ease and explain things effectively, but will consciously and I think quite sensibly discourage any focus on the relationship in the room. Because CBT isn't about interpersonal relationships. Therefore it's not appropriate to practise in that way.

Lost count of numbers...

I'm going to copy this one before publishing!

Thanks, you just gave me a great procrastinatory opportunity...


Clare said...

P.S. I live with a psychologist, who points out that clinical psychology is much more rigorously regulated than psychiatry, psychotherapy, etc. Climical psychologists run the risk of being struck off. Whereas practically anyone can set themselves up as a "counsellor" with very little qualification. Thus professional abuse by clinical psychologists is less likely...

(Yes, you spotted the source of my bias in the CBT vs psychotherapy war, although I'm sure you're right that things have become unnecessarily polarised)

Clare said...

"anyone who wants to be a therapist but is unwilling to trawl through their own internal world; it just smacks of wanting to tell people what to do, and that is no fun for anyone."

What about all those doctors and nurses who are notoriously bad at looking after their own health?

CBT is a useful technique which can help happier / cope better with the world. So it's not really about teling people what to do so much as teaching them how to use a handy tool. The health of the practitioner is not necessarily relevant.

But I do of course still agree with you that it is BAD BAD BAD for a therapist to get into a relationship with their client.

Ms Melancholy said...

Wow, Clare - you feel as strongly about this as I do!

Just a couple of responses:

Psychotherapy is not just about introspection and self-analysis. It is about learning to be different in the here and now, which means we at least share some goals with CBT.

I don't think the difference between the two is as wide as you think, although they are important differences. (Unless you are talking about Analysis, which is whole different ball game.I am definitely NOT talking about Analysis.)

Yes, psychology is more regulated and that is a good thing. Psychotherapy is heading that way and it is about time.

If you came to me with a Generalised Anxiety Disorder, I would definitely use a cognitive-analytic approach. But I would also use the relationship in an implicit way. I have helped people to overcome such anxiety with psychotherapy and I maintain that psychotherapy gets results! (It would be a soul destroying job if it didn't.)

I am glad CBT worked for you. I also have clients who have had several bouts of CBT and in the end have come for therapy as they find the relief is only short-lived.

I think in the end a good therapist is a good therapist, and that is what helps people to recover.

That is more than a couple so enough, already!

Ms Melancholy said...

Ok, this might be getting dull now, but I just want to clarify something that I think may be confusing the issue. When I talk about using the relationship, I mean in an implicit way. I don't mean that every session is spent talking about what's happening in the room - personally, I would rarely do that as it does start to encourage self-obsession. What I mean is that the relationship is the most valuable source of information.

Clare said...

It's OK, I understood what you meant. But I do think that you don't have to take that relationship into account (apart from, of course, acknoweldging that it exists).

And I may well have been muddling analysis with psychotherapy! In the case of my friend though, I think it was psychotherapy.

It's horses for courses really, innit?

There's a lot of mental dysfunction in The Dying of Delight. I reckon you'd love it. ;o)

[Wanders off back into the depths of the internet]

Ms Melancholy said...

Hi Clare,

horses for courses - you are SO right! I agree with Yalom that we have a different therapy for every client that we meet.

I am so looking forward to reading your novel - it is on my christmas list, and christmas is a time when i spend hours and hours reading. I can't wait!

Liz said...

In the psychotherapy/CBT war I tend to be biased in the opposite direction to Clare. I tend to agree with Sue. The claims made for it sound to me like those made for any 'miracle cure'. Clare's comment that 'it works' is too sweeping in my view. If it worked for her then fair enough, and I'm sure it works for others. But not for everyone. It is not suitable for every person nor every problem and it's advocates have a very proselytising tendency in that they like to claim that it does. This has been implicit in some of Clare's comments, the expression that it 'cures' stands out the most. Psychotherapy as I understand does not make such sweeping claims, it is down to the client as much as the therapist to work on it.
Personally I'd be highly distrustful of somebody treating me who had not attempted to get their own internal house into gear - but that's just me.

From what I know about it is a mechanism for coping that can be learnt by oneself. I imagine it would be not be sufficient for deep emotional problems stemming from childhood, although it may give some temporary relief. I doubt if it will 'cure' long term problems. Perhaps a mixed approach should be investigated more, it shouldn't be an either/or thing, as Ms Melancholy points out. Psychotherapy may not be for everyone, true. But neither is CBT, Clare. Psychotherapy does involve addressing our internal demons, something that is not easy and may be unsuitable for some. But it does not promise miracles.

Again, I'm glad CBT worked for you. But it's worng to make sweeping claims about it for everyone. This is precisely what alienates me (and others) and contributes towards my aversion to it. It seems to address the symptoms rather than the cause. But each to their own. I have found traditional psychotherapy helpful before but I would not insist on it for everyone or make sweeping claims for it.

Liz said...

Oh, and nice blog, Ms Melancholy!