Psychotherapy means, etymologically, ‘attending’ (therapy) on the ‘soul’ (psyche). True psychotherapy, therefore, is always existential. It means a contractual, consensual relationship between two autonomous adults, in which one of them attends on, accompanies and facilitates the other’s existential quest of self-discovery. Such a quest entails examining one’s life and deciding how to live.
It is impossible to say in advance where such a quest may lead. It may enhance health, but it may be hazardous for health. Psychotherapy is not a health profession. It is important to say this now, so that a flame is kept burning.
In saying this, I have been accused of ‘encouraging the split between body and soul’. This is a misunderstanding.
The point is simple. Ethics and health are not the same. But this does not mean they have nothing to do with one another. A difference is not a split.
In the existential psychotherapy that I practise, I do not assume that the client’s health is the primary theme or aim. This kind of psychotherapy is not part of medicine. Nor is it a discipline ancillary to medicine. What, then, is the theme and aim?
I help clients to clarify how they want to live, and how to live as they want to. This is a moral question. It is implicit in their coming to talk to me. It includes the moral question of the place of health in the client’s hierarchy of values.
In other professions, such as medicine or carpentry, the professional practises scientific or artistic techniques within a moral framework. In psychotherapy, at least as I conceive and practise it, the very heart of what one does is moral. One is helping the other to work out how to live, and this is a moral question. To do this without attempting to impose one’s own morality on the other is a subtle discipline that takes decades to refine. One has to learn to let the other learn, and this is a lifetime’s work, for both. The client leaves when he or she feels ready to continue learning without this particular therapist’s help.
However, it is quite true that, even though health may not be the client’s primary concern, or the primary theme of the ‘therapy’, in the course of psychotherapy the client’s health and physical fitness may improve in striking ways. Serious illnesses may disappear. A woman who has not menstruated for years may resume her periods and conceive. A man may take up dancing or football. One client mentioned that, although he had done yoga for ten years, after two years of therapy with me he had become physically stronger. I said: ‘You mean lifting weights and so on?’ He said: ‘Yes, that too, but also able to do yoga better.’ Neither of us had ever said a word before this about his physical strength.
A psychotherapist may help with a client’s health in other ways, too. I have often been consulted by people whose general practitioners had ‘diagnosed’ them as ‘hysterical’, ‘hypochondriacal’, ‘psychosomatic’, ‘manipulative’, and various combinations of this vague vocabulary of disapproval. The client has come to believe that she (usually ‘she’) is guilty of having fabricated an imaginary ailment, and asks me for help with this supposed ‘problem’ of hers. In such cases, I go carefully over the client’s complaint, and ask whether the doctor has examined her physically, or referred her to a specialist. Often the answer is negative. I ask whether the client accepts, without further evidence, the GP’s unsubstantiated assertion that her problems are merely emotional and psychological; and I explain that I do not myself unquestioningly accept it, although she is of course free to do so if she wishes. I do not remember a single case where, after such a conversation with me, the client did not choose to get herself properly medically investigated. In a number of cases, investigation by the Institute of Neurology, or by another hospital department, showed that my client had a serious physical illness, such as epilepsy or ulcerative colitis. The client then received appropriate treatment from specialists, but invariably chose also to continue psychotherapy with me, to work on her real emotional, interpersonal, moral and existential problems, such as her difficulty in trusting her critical faculties and asserting herself with doctors, rather than the imaginary problems which her doctors had invented for her, to cover their negligence.
It is wide of the mark to suppose that to emphasise that psychotherapy is not a health profession is to ‘encourage the split between body and soul’. I am, as it happens, a qualified Tai Chi instructor as well as a psychotherapist, and both activities engage me, as they do those I try to help, body and soul.
However, there is no guarantee that a client’s health will improve through psychotherapy. Apart from anything else, clients’ priorities differ. Some explicitly use psychotherapy to explore how they have been undermining their health. Others decide it is reasonable to risk their health in their search for fulfilment in love, mathematics, music, religion, sport, art, poetry, philosophy, mountaineering, journalism, guerrilla warfare, or whatever. A psychotherapist is entitled to raise the question whether the client has taken the risk to health seriously enough, but that is all. It is no business of the psychotherapist to try to persuade the client to make health his or her overarching goal.
That psychotherapy may facilitate the client’s health does not make the psychotherapist a ‘health professional’. Psychotherapists have facilitated clients’ achievements in literature, art, music, science, architecture, but that does not make the psychotherapist a literature, art, music, science or architecture ‘professional’. Children who have pets appear to develop better resistance to certain diseases than children who do not. Does this make pet-shop owners ‘health professionals’?
‘Health professional’ may be a reasonable term for certain psychotherapists who specialise in facilitating their clients’ quest for health, if this is an explicit part of the contract. But it is an inaccurate description for psychotherapists in general. It both inflates and diminishes.
The concept of ‘wholeness’ is seductive, but misleading in the present context. It blurs the distinction between ethics and health. The argument from ‘wholeness’ is dishonest, because if ‘wholeness’ is a kind of synthesis of ethics and health in which they are ‘as one’, this still does not explain why those who guide others towards ‘wholeness’ should be regarded, and regulated, as ‘health professionals’. Why not ‘ethics professionals’? Or indeed, why not any other sort of professional, since all are part of the whole?
To classify psychotherapists in general as ‘health professionals’ is, if the above analysis is correct, illogical. But it also has empirical consequences. ‘Health’, in the context of psychotherapy, is usually taken to mean so-called ‘mental health’. To speak of life in terms of ‘mental health’ is a kind of idolatry. It degrades language and life. It legitimises the coercion and forced ‘treatment’ of ‘mental patients’. But, more than this, it seduces and mystifies. The psychotherapists who like to call themselves ‘clinicians’ do not see that they have been corrupted.
For all these reasons, as a psychotherapist, I find it offensive and demeaning to be categorised as a ‘health professional’. This term cheapens the work that my clients and I do.
(For some idea of the conjoint work of so-called ‘psychotherapy’, see the page giving clients’ accounts of existential psychotherapy on this blogsite.)