The four corner stones of transtherapy
In the Realm of Ideas
More and more advertisements for training are found in the professional magazines. Some of these use trademark signs to protect their product’s name. Some basic ideas or techniques are marketed as a “package”, that only those who buy it can call themselves “ a licensed so and so therapist”. Very often these businesses operate as a pyramid, where after “level I” one can train for “level II” – which entitles to train others for a percentage of the income.
Commercialization is evident whenever advertising industry gimmicks are used: liberally adding the adjective “new”, mentioning appearances in talk shows as proof of credentials and bringing “testimonials” from satisfied customers. Payment for training or workshops is completely legitimate. However, this is not the case with the commercialized kind of business enterprises, which sell titles or licenses without being an academic institution, and claim to teach techniques that are not published in any publicly accessible form.
I adhere to the following set of principles:
1. Therapists deal with constructs in the realm of language and ideas, and not with material technologies or production formula. I will not turn ideas into commodities. I will describe any development or innovative approach of mine in a public professional forum and in a manner enabling utilization and application. I will not condition their application on additional studies or payment. I will maintain copyrights of my written work, but will not protect my ideas by trademarks.
2. I will not “reinvent the wheel”. I will connect with intellectual traditions rather than perform “packaging”, i.e. rearranging some common ideas and “selling” them as something new. I disapprove of the historical poverty of the social science disciplines, where important past contributions are easily forgotten. I will do my best to find roots and affinity in the work of other thinkers and artists in different periods and places.
3. I realize that no psychological procedure must be carried out in one specific way. Dealing with rhetorical formulations and not with chemical formula, alterations and variations are always possible. Each therapist with adequate training and experience is the judge of his or her ability to apply any procedure, and of her or his need for additional studies or supervision.
4. I will not participate in any workshop or training, which is marketed and advertised commercially as a commodity - carrying a trademark sign, granting license or titles for money. I will avoid any approach that sells franchises, or is organized as a hierarchy, encouraging people to pay for non-academic higher ranks or titles, such as supervisor or trainer.
Neither Sickness nor Healing
Leonore Tiefer defined co-optation as “an appropriation or takeover of a previously independent group by a larger power in a kind of a bloodless conquest. For the smaller group the takeover offers certain benefits (e.g., increased recognition or protection) at the cost of intellectual or political
independence.” This author notices that the recent history of psychiatry shows how an entire field can be taken over by pro-pharmaceutical thinking and practice. She raises the question “Is sexology on its way to becoming a subsidiary of the pharmaceutical industry?” (Sexology and the pharmaceutical industry: The threat of co-optation. The Journal of Sex Research; New York; Aug. 2000).
Psychotherapy is in danger of being co-opted by the psychiatric and pharmaceutical industry. Our semantic sensitivity in the domains of gender and race is lost when we carelessly use terms such as symptom, patient, clinic, cure or healing (Am I a healer? Can I heal? Is my client sick?).
Medicalization consists of the following:
1. Seeing problems in living in psychopathological terms; assuming that clients suffer from some mental disease: subscribing to “the medical model”.
2. Using psycho-diagnostic measures, not to evaluate skills and abilities, but rather as an x-ray machine, for finding hidden pathology, affixing a diagnosis and assuming that such a diagnosis is necessary for therapy.
3. Accepting the DSM or other classification systems, not merely as an unfortunate necessity to insure reimbursement, but as one reflecting a true state of affairs (Essentialism). Indiscriminate use of diagnostic labels and abbreviations, especially while communicating with clients about their difficulties.
4. Advocating the use of psychiatric drugs, suggesting to clients or convincing them that they need such drugs. Being oblivious to the economic interests of the pharmaceutical industry, and its impact on research, journals, conventions and “mental health awareness days.”
5. Supporting involuntary mental hospitalization; Recommending or suggesting to clients psychiatric hospitalization.
6. Supporting or obtaining prescription rights for non-physician therapists.
I adhere to the following set of principles:
1. I respect the medical profession and approve of close collaboration with physicians for the benefit of the patients (theirs) – clients (ours). Health psychology, psychosomatic medicine, coping with chronic and life threatening diseases are areas that could only benefit from such collaboration. Therapists and physicians share, and can learn from each other, how to deal with uncertainties, described by Sir William Osler as: “this everlasting 'perhaps' with which we have to preface so much connected with the practice of our art.” I join the eminent physician Sir Robert Hutchison’s prayer:
From inability to let well alone; from contempt for what is old; from putting knowledge before wisdom, Science before Art and cleverness before common sense; from treating patients as cases, from making the cure of the disease more grievous than the endurance of the same, Good Lord deliver us.
2. I believe that Medicine, Litigation and Psychotherapy are different, legitimate and mutually exclusive perspectives. A physician has to diagnose a disease and offer an appropriate treatment. In this case, symptoms are looked for and are explained as proof of pathology. A legal perspective will also use diagnostic means to achieve rewards such as compensation or reprieve from punishment. A Therapist actually does the opposite – trying to see the normal in the ‘abnormal’, enhancing independence and responsibility. A therapist should not diagnose, neither prescribe medication, nor become a means for getting social rewards. A therapist does mostly one thing (in many different ways) – helping clients help themselves – this is done mainly through conversational means.
3. It is the client’s responsibility to choose which perspective to pursue. A person experiencing stress or unhappiness in marriage might approach a lawyer and ask for divorce, make an appointment with a couple therapist, or see a psychiatrist to ask for some anti-depression pills (or hire a private investigator, or find a lover). This person might decide to do all, or any of the above. It is the therapist’s responsibility to ascertain that the implications of the other perspectives are not counterproductive to the declared therapy goals. Thus, it is not the task of the therapist to recommend that a client should see a psychiatrist, or stop taking medication. Clients should only understand the different perspectives and their underlying conceptions. It is legitimate to encourage clients to be critical consumers - individuals who examine the advantages and disadvantages of each of these perspectives.
4. I recognize other therapists right to believe and practice differently. I will not criticize them directly, nor pass judgment on them in the presence of my clients. It so happens that I subscribe to transtherapy and others do not. When necessary, in contact with institutions or referring psychiatrists, I will use the expected medical terminology. There is no reason for me to be argumentative, or be portrayed in the professional community as incompetent. However, even in such situations, qualifying statements, e.g., “the picture fits the diagnosis of PTSD” rather than “he is an OCD case” will be in order.
Persons as Independent Agents
“[Sigmund] Koch’s big idea, his single basic concept, revolved around a fundamental shift in the history of thought and culture, which took place in the late 19th century and oriented all too much of the 20th century thought and culture. In briefest terms, that shift had to do with a change in emphasis from agency to rule, from a world in which individuals took greater risks, based on their own sensibility, creativity, and responsibility (agency), to a world in which thought and action are more and more rationalized, bureaucratized, and routinized (ultimately reduced to a set of rules). From free, fallible, and meaningful action, humans have turned toward more controlled, definitionally correct, and ameaningful behavior. This shift from open-ended, authentically responsive activity to prescriptive, rule-and-method-bound behavior was “the root pathology” of the modern world, and everything has been tainted by it.” (David E. Leary, One big idea, one ultimate concern – Sigmund Koch’s critique of psychology and hope for the future. American Psychologist, 2001, 56, 425-432).
Bureaucratization consists of the following agency restricting behaviors:
1. Turning the therapist-client conversation into an activity not protected by the right of free speech between independent people, but rather treated as a medical intervention with a helpless patient, necessitating careful documentation and high insurance rates against malpractice claims.
2. Becoming a rule conforming practitioner or a moralist, rather than being merely an ethical and moral person; Supporting and passive acceptance of the increasing regulation and standardization of “health care workers” by state, federal, regional and professional organizations.
3. Serving as expert witness or writing reports in order to gain some material benefits in compensation money, custody rights, or release from legal responsibility.
4. Compromising professional autonomy, confidentiality, privacy and professional discretion, for the sake of “managed care” considerations.
I adhere to the following set of principles:
1. The first therapists in the western civilization were the Greek philosophers and sophists. I am no Socrates, and yet my words to my clients are not different from his. Did Socrates need to take notes on all of his conversations with his students (Although fortunately Plato did)? Did any individual sue him for words he said or advice given? I will do everything possible to maintain the therapy interaction as one of two independent collaborating agents.
2. I believe in the basic difference between word and deed. I recognize that I have legal responsibility for my actions, and will therefore never do anything that might hurt a client. I will not be content with the ethical standards of professional associations. I will do my best to internalize and cultivate my own principles.
3. The current rules dominated situation creates tension and suspicion between clients and therapists, leading to defensive measures on both sides. I will try to reach a contractual agreement with my clients regarding all aspects of our encounter. Contract making is an essential part of therapy. During the therapy contract, all dual relations are forbidden. The only benefit due to the therapist is a fee. Otherwise, everything will be done only for the good of the client.
4. I reject the “mental insanity plea”. To begin with, I do not conceive any emotional or consciousness state as a disease. Secondly, malingering in this case pays off handsomely. Lastly, due punishment, with appropriate consideration of all circumstances is a tremendous didactic tool to teach people responsibility for their actions.
5. The use of psycho-diagnostic tests and the production of written expert reports are often contradictory to the goals of therapy. Therapy aims to help people be more independent and responsible for their actions. Steps taken to be recognized as a handicapped person and receive compensation often run counter to learning to cope with an injury or accident. Furthermore, representing one side in a dispute turns the practitioner into a sword for hire. I will avoid such professional services, and only agree to do so by court order.
Common Sense and Modesty
1. I well know that therapy is a complex endeavor. Sometimes we fail to help, despite our best efforts and intentions. Occasionally, our clients are exuberant with reported positive results, and we cannot understand the causes for change. Each therapist has both strong and weak points. No one is perfect; no one can succeed all the time with all clients. Yet a decent therapist knows that even though all his or her clients were not helped, none of them was harmed.
2. Therapists do their work in the privacy of their own offices. No person knows for sure what really happens there, and if anything at all happened. We have to draw conclusions from hearsay – a report given by therapists, whose motivation and reliability are unknown to us. We are all judged by and compete with our colleagues, and are afraid to appear as non-competent. It is only natural that some of us will narrate tales of brilliancy and magical results. Occasionally a group of disciples will cluster around a charismatic talented raconteur, and turn him or her into a celebrity, a super therapist – a ‘master’, equal to a guru, or a Hassidic Rabbi. In so doing, it is hoped that some of the magic will rub off on them. It does not take much to discover that most of the stories about such therapeutic might, are no more than stories, which quite often appear in different versions in different places.
3. It is only natural and worthwhile (and also unavoidable) for us to use theories or conceptual tools to better understand or derive some explanatory constructions for the benefit of our clients. However, to see these abstractions as an ultimate truth or build our identity around them is unacceptable. Theoretical hegemony should be rejected. Yet, it is to be expected that therapists will have different theoretical preferences.
I adhere to the following set of principles:
1. I will not weave stories about my work; I will admit doubts and failures. I will distance myself from ‘masters’ of all kind. I will not learn from traveling teachers, who base their claim for fame on some self-glorifying books. I will consider reports of almost 100% success rates, as equal to election results of 98.8% in favor of a dictator in some fake democracy.
2. I acknowledge that there are completely different criteria for articles and books. A cynic might say that in the former you have to invent data, while in the latter you have to fabricate a story. Many clinical books are based on a few case studies, and a plot or a style of delivery that can sell, but would not have been accepted for publication as an article. Many articles could not be made into a book, lacking in relevance to practice. I will not take any claims on face value. I will apply the same criteria to all published material and will search in all writing for a good argument, convincing evidence and practical significance.
3. I will not use “catch all” trendy terms, such as “spirituality”, “energy” or “body-mind” (as well as “body-mind-spirit”). I will strive to be professionally up to date. Nevertheless, a certain degree of untimeliness (Nietzsche) is much appreciated. I will prefer lean, descriptive and more specific words. I will always try to differentiate between observations and experiences, or reports about them on one hand, and theoretical notions and constructs on the other hand. I see myself as a “generic” therapist, emphasizing the common ingredients of all therapies. With all due respect, transtherapy committed practitioners (TCP) see all theories as tools only. They are theory-using therapists, rather than dogmatic subscribers to any one truth.
4. I see myself as a scholar-practitioner. I will continue to study my field but also the arts, sciences and the humanities at large. I will learn by all possible means: Individual reading, scholarly and scientific personal research, self-organized study groups as well as formal instruction or workshops.