(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, served as its president in the early 1990s, and chaired its Ethics Committee for from 1995 to 2010. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Because it sprung from the loins of psychiatry during the 1950s, clinical psychology, a bastard child, necessarily grew up in the medical model family. Medical discourse has since remained the primary way psychotherapists organize their professional work. But, truth be told, the actual work of most psychotherapists never really fit into this restrictive, logical positivistic viewpoint. Psychotherapists work within a societal medical system in which they don’t belong. As a result, they suffer a certain form of alienation.

As Thomas Szasz argued, medicine is organized around organ systems. Cardiologists focus on the heart, neurologists on the nervous system, and orthopedists on bones and ligaments. Psychotherapists, in contrast, work with persons’ subjective experiences – phenomena that cannot be reduced to physiological classification.  They read between the lines of patient’s concerns, searching for layers of meaning rather than underlying disease. They meet with whole persons – individuals living their lives, making choices, dealing with vulnerability. Their work eschews a focus on symptoms.  The medical model for providing “psychotherapeutic treatment” to persons is, well, a lie.

As I argued in an earlier column, even the word “psychotherapy” is absurd. It implies that a distinct entity – the psyche – has become diseased in some way and therefore in need of treatment – the therapy. This is patently inaccurate. The “psyche” betrays clear definition. Any “therapy” for it, therefore, becomes equally dubious. The term “psychoanalytic” is similarly problematic. In it, that awkward word “psyche” appears again, and is supposedly subjected to “analysis.”  The actual “psychoanalytic” process involves more synthesis and integration. Its essence is relating, not investigating.

If we are to strive for accuracy about so-called psychotherapy, a “procedure” now more than 100 years old, the phrase “transformational encounter” would be more accurate. Psychotherapists meet with real people with real life struggles. “Patients” seek help because, they believe, something needs to change. They may be uncomfortable with certain types of mental pain, i.e. they feel depressed, anxious, or hopeless. But at the same time some aspect of their lives has become untenable: They are dissatisfied with their work; they feel unfulfilled in their marriages; they have become alienated from others; they regret the way they have treated their friends. Even if “patients” complain because something is changing, i.e. they are aging, or their children dislike them, or their husbands have left them, they still seek transformation of some sort. They need help, ironically, with change itself.

Along the same lines, the more accurate word for psychotherapist would be instigator. Psychotherapists create perturbations in their patients’ experiences, facilitating a process that ultimately results in emotional, interpersonal, or cognitive alterations.  They instigate change either passively or actively. An initial session, or even a whole set of sessions, may consist of a grieving wife weeping over the loss of her husband. The psychotherapists’ role may consist of simply listening and facilitating the grieving process. This would be an example of passive instigation of change; it occurs, partially, just by virtue of the psychotherapists’ social role.

Psychotherapists also interpret, clarify feelings, offer empathy, and in similar ways become active instigators of transformation. In the example just given, the psychotherapist might take a more active role further down the road of the grieving process. If the wife is still intensely grieving five years after the loss, the psychotherapist or instigator might confront the woman with the ways that grief may have become a defense against facing certain fears, moving on with life, and so on.

These ideas may help reduce the sense of alienation psychotherapists feel, particularly as their highly complex, humanistic work comes under attack by a society that views humans in an increasingly mechanical fashion. If psychotherapists view their work as instigators of transformation within the broad spectrum of the human experience, perhaps they can begin to enjoy a professional identity more in line with the truth of their work.