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Book Review: Post Existentialism and the Psychological Therapies: Towards a therapy without foundations

Pollard, R., 2012. Book Review: Post Existentialism and the Psychological Therapies: Towards a therapy without foundations. Reformulation, Winter, p.43.

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Isbn 978-1-85575-846-9  £22.99    
Del Lowewenthal 2011 Karnac.

If you have doubts about the usefulness of psychological therapy to individuals in distress given the current constraints on public provision and qualms about the political role the psychological therapies are being pushed into taking up in society as a whole, this book will reinforce them. Many of the ideas here are not new but brought together in this collection of articles they give a comprehensive if depressing overview of the current state of psychotherapy in the UK, particularly the insidious relationship between theory, research and the positivistic, managerialist, audit culture that is currently pervasive in the NHS.

The authors argue that all theories and the research that is done to prove that the theories work are a form of violence in that they fail to put the interests of the other – the client/ patient - before the interests of the researcher/therapist. Putting the other first is integral to genuine inter-subjective relationships according to Emmanual Levinas, whose philosophy the authors claim as the ethical basis of post-existential psychotherapy. Putting the other first in psychotherapy means that the other’s experience and their thoughts and feelings about their experience are paramount and that to squeeze these into the straitjacket of theory, whether psychoanalytic, cognitive behavioural or humanistic, may be a useful prop for the therapist/researcher but a profound disservice to the client. A therapy without foundations is one that is grounded in practice not theory and in the relationship between client and therapist not technique.

There seems to be a chasm opening up between the world of IAPT, NICE and the HPC, in which therapists are ‘trained’ to ‘deliver’ CBT in a prescribed manner to produce happy, autonomous and, crucially, economically productive citizens and the world of post-existential and post-modern alienation where anxiety and dread are not symptoms to be treated but part of the human condition.  The former sees the causes of mental ill health as lying within the individual and amenable to technical interventions designed to help people recognize their own contribution and take more responsibility for their own mental well being: the latter sees the causes of mental distress lying in the wider societal/political sphere and as being beyond the control and even awareness of the individual. The role of therapist then becomes more like that of a priest, that of witness to the other’s narrative of their experience and distress rather than an active promoter of individual responsibility and ‘autonomy’.  The post-existentialists would see the latter as peddling the illusion that wholeness and integration are actually possible. 

What seems to be missing in this book is any first person account of what patients or service users, to use the current jargon, actually want. There is also insufficient recognition of the demanding specialist services in which many therapists working in the NHS and voluntary organizations work and the differing needs of different groups of patients.   There is a danger in opposing, rigid and pathologising diagnostic categories and restrictive ‘treatment plans’, that therapists could be seen as promoting their own interests as much as they are defending those of their patients. One psychoanalytic therapist quoted in the book complains about having to inform patients in advance about what to expect in therapy rather than letting it be a mystery to all. Whereas another complains that most people don’t want to understand what goes on in them and between them and others. What therapists of any persuasion are charged with is the relief of distress and how they go about this is something to be negotiated with each individual. It is surely the patient’s right to decide whether they want to enter into the mystery of psychoanalysis or confront the darkness of post-existentialism or merely, for example, find ways to alleviate insomnia, anxiety and depression, or avoid being bullied. In opposing prescriptive and didactic forms of therapy the authors seem to be risking the imposition of yet another form of orthodoxy, a contradiction they are not unaware of, which is partly what makes this an interesting and provocative book.

Rachel Pollard

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Full Reference

Pollard, R., 2012. Book Review: Post Existentialism and the Psychological Therapies: Towards a therapy without foundations. Reformulation, Winter, p.43.

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