(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 colleagues. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

In some unknown but dramatic way, I must have felt vulnerable the day I was suddenly crushed by counter-transference. I was obsessing about a new sports coat I’d just bought at Barney’s. It has Cashmere in it. I’ve never had a coat with Cashmere in it. I purposefully donned the jacket, and even a flashy orange tie, in preparation for the meeting with a new patient. The referral source told me he was an authoritarian, successful physician who had strayed in his relationship with his wife and strained the trust of his partners.

Just as I feared, the man proved to be “Mr. Perfection” himself. Aged around 40, 6’4” tall, sun-tanned and muscular, highly-educated and even better-compensated, articulate and charming—he was a perfect male specimen. And he was wearing a sports coat five times more expensive and ten times better-looking than mine. Worse, just as I prepared to hide behind my well-rehearsed professional role, Mr. Perfection hands me my signed informed consent form, downloaded from my website. He had attached a check for $1000 so he could “buy a number of sessions in advance.”

Reflexively I accepted the check and, in my best pre-adolescent voice, squeaked out my standard line, “Tell me something of what brings you and I’ll tell you about me and how I work.” He proffered various confessions, but they sounded more like conquests than failures. He showed little guilt or shame about his ethical breaches, and no anxiety or depression.

The first half hour was unbearable. I was drowning in feelings of inadequacy the likes of which I hadn’t felt for 45 years. I was in recess in elementary school, skinny and sickly. I was small weak unintelligent out of shape ignorant and even poor. He was so good-looking that I wondered if I was having homosexual longings. It wasn’t clear who was the patient and who the doctor.

Then, slowly, a few ideas broke loose from the swarm of self-doubt. He was no psychopath, but he clearly demonstrated that concept of externalization so popular in academic psychology these days. Rather than look inward at his intra-psychic dramas, he enacted them in the outside world. He was seeking my help because of problematic ethics, I told him, not because of mental pain. He admitted that, like a slight aching in a distant limb, he could feel guilt at the pain he’d caused his wife and partners only minimally. And even that discomfort was absorbed by the externalizing behavior of consulting me: he was seeking help, after all; he was actively solving the problem.

As we talked my gaze fell upon the informed consent form lying on my ottoman with the check neatly clipped onto it. Because he had paid for a number of sessions in advance, I suddenly realized that I was in truth indebted to him. He had turned the tables on me. Classic for those who externalize rather than internalize: he had projected the entirety of his vulnerability into me.

Adrenaline rushed through my system, and strength returned to my muscles (well, kind of). The dynamics suddenly became clear! Mr. Perfection here, just another wounded human being like all of us, had managed brilliantly to transform his internal emotional world entirely into external action. He had left no small number of burning wrecks in his past in the form of ill-informed patients, envious colleagues, cheated wives, and wounded children.  We had some serious work to do, and now I was finally engaged in it with him.

Counter-transference is always an interpersonal process, with your fault lines intersecting with your patient’s. Identifying these subtle reactive feelings ideally helps guide your work. But sometimes these feelings transport you to shadowy spaces long forgotten. My brilliant Mr. Perfection, with his dulcet voice and smooth rhetoric, carried me right back to painful elementary school years.  That Barney’s sports coat really was absurdly overpriced – all that Cashmere for protection against nothing.

The End

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By Alan Karbelnig, Ph.D.

(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 practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

By devoting this issue of Analyze This to politics, the editors advocate passionate action over quiet passivity. To become involved in an organization, to take a stand, to write or to speak out – these all constitute outward activity of some sort.  In contrast, professional psychology tends to be an unusually passive vocation, rendering its practitioners’ participation in political activities unusual or even rare, and for several distinct reasons.

Regardless of whether practicing psychological assessment, psychotherapy, or some other professional activity, we psychologists tend to work in isolation. We may practice in a suite of colleagues, but our days are passed working individually with our patients. Unlike our medical colleagues, we have few routine consultations with our peers. By virtue of the extreme sensitivity of our work, we share little if anything of the details of what we do with our family and friends. In essence, we work alone.  And as our colleague Rico Gnaulati pointed out, our work requires extreme concentration and focus. Arguably unlike any other professional, even surgeons or anesthesiologists, we cannot leave the room during a session, even to make a telephone call or use the rest room.

Also, since we are working towards helping others in virtually any aspect of our work, we can rightfully feel that we are contributing to society in some fashion. While legitimate on one level, this is a rationalization on another.  We may rely on this form of giving to avoid other forms of philanthropy. Why serve humanity in a broader sense when each and every day involves care for others?

Finally, the work is tiring. Except perhaps for those psychologists who solely perform assessments, psychotherapy is extremely intimate, satisfying some needs and exhausting others.  Some of us err (somewhat cheaply) by obtaining our needs for closeness through our work; this allows us to remain in an invulnerable position while enjoying high levels of interpersonal intimacy.  Ironically, the very personal nature of the work is likely the most exhausting element of it.  We often feel intensely fatigued by the end of the day or the end of the week.  Who can blame us for eschewing political action and instead taking refuge in hiking, theater, reading or other non-political pursuits during our precious free time?

Despite these basic truths of the isolated, helpful, and intimate nature of our work, we psychologists are nested in an unavoidable, larger social context.  Starting from within the field itself, we are under attack by insurance companies who would like to reduce or eliminate reimbursements for our services; we are surrounded by a mass media that typically misunderstands what we do; we struggle with a portion of medicine and of course the massive pharmaceutical industry which derogate our work and push “medicines” for help with any kind of mental pain.

If the circle opens even just a bit wider, well, then we face real horror: Haiti, the Middle East, Somalia, global economic recession, hunger within our own borders, and oh so much more. (A recent Gallup survey revealed that one in four Americans has trouble providing food for themselves and their families).

In the final analysis, then, and despite our good works, we should really escape from our offices and do something more for the society and the planet. Our Ethics Code suggests it, but even more powerful universal ethical principles demand it. We are blessed with involvement in a wonderful profession: How many offer an ability to help others in such an intimate way?  But the limited populations we serve just don’t make enough of a difference; we have skills that could have much broader impact, and for that the world awaits. So, whatever means works for you – volunteering, leading, writing, or shouting, please make sure that – in consonance with the theme of this issue –you venture away from your offices and share your talents with the wider world.

The End

(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. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

Problems of love should be deferred to the poets, or so the French Psychoanalyst Jacques Lacan believed. If you happen to be in the throes of feeling in-love, then you will agree that Lacan was oh-so-correct. Yet the psychoanalytic field of attachment theory – immensely popular during the past 50 years – delves precisely into that realm, and all from the perspective of the white-coated garb of the 20th century Man of Science. Attachment theory started with the work of John Bowlby during 1958. Later, led by Psychologist Mary Ainsworth and others during the 1960s and 1970s, it flourished. She proposed four basic patterns of “attachment:” secure, anxious, avoidant, or disorganized.

When approached from an observational perspective, attachment theory offers useful ideas. Simply by observing the body language, verbalization patterns, and similar phenomena at an airport bar, for example, the trained observer may well be able to discern whether a particular individual enjoys one or another attachment style. If you observe the pilfering of a wallet from an attractive woman’s purse, perhaps you may well be witnessing a manifestation of a disorganized attachment.

These are extremely useful ideas, but only in certain limited contexts. When making a referral to another therapist – let’s say because the psychotherapist’s attachment capacity has so collapsed that she becomes obsessed about retirement or suicide – some information about the patient’s attachment style may well be helpful. Subsequent psychotherapists would then have a response set to guide them in understanding how that person connects to others. Certainly this could be helpful in understanding patients’ interpersonal experiences, and of course even in the way they might form a connection to the psychotherapist.

But from the point of view of the patient, what matters is “love,” not attachment. This is one of the many problems resulting from the famous APA Scientist-Practitioner Model. Scientist-psychotherapists must beware of the immense gap between the external observation of human experience and internal, subjective experience. This massive fissure – between observed psychology and experienced psychology, between the “It” and the “I” – has been haunting professional psychologists since their profession limped away from philosophy during the last century. Descriptions of attachment are all well and good; but from the perspective of the patient with the rejecting mother, for example, or the distant boyfriend, what is missing is ….. LOVE! Real people feel fear, yearning, loneliness, and emptiness; real people do not experience “anxious attachment.”

Further, the training of professional psychotherapists immersed in this and similar 20th century logical positivistic models risks missing the real experiences of real persons. And these can only be ascertained by listening – and listening extremely carefully – to those consulting you. Again, ideas from attachment theory certainly help us to characterize and categorize; they help us to communicate with one another. But they also may interfere with our ability to really hear those seeking our help.

I have long believed that, if you want to work as a psychotherapist, for God’s sake don’t study science or psychology! Study the fields that best capture the human subjective experience – poetry and prose, philosophy and political science, history and anthropology. This is the literature of human subjective experience.

Staring into this immense chasm between objective observation of human experience, and subjective experience itself, poet W. B. Yeats wrote of his despair in ever finding comfort from the categorizations of the natural sciences. His words offer a fitting example of where the rational lexicon of scientific psychology ends and the artistic language of poetry begins. In The Circus’ Animal’s Desertion (1939), Yeats writes in a fashion that speaks to the real human experience:

Now that my ladder’s gone

I must lie down where all ladders start,

In the foul rag-and-bone shop of the heart

(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.

(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 15 years. 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.)

If you view psychological conditions as distinct “disease” entities, then you likely appreciate the existence of cognitive behavioral psychotherapists. They develop skill in categorizing aspects of human experience that comport with DSM IV disorders. They identify empirically validated mechanisms for treating such psychiatric entities. They research and publish studies on the effectiveness of their interventions. But even the most conservative cognitive behaviorists would not consider their approaches to be holistic, to involve the “whole person.” Instead, although they might use kinder words, they treat their patients like some variation of machines that, after some thought-adjustments, can be returned tranquilly to society.

Psychodynamic practitioners, in contrast, listen to the persons who consult them as whole beings, as sentient subjects. They realize that, whereas persons might seek help for “erectile dysfunction,” psychotherapy sessions may uncover more global relational difficulties. They understand that, whereas other persons might present with “depression,” the therapy encounters might reveal a profound disinterest in their life work, or previously unknown conflicts with their family or friends. Similarly, they might help persons with “anxiety disorders” discover that their nervousness betrays an insufficient sense of identity, meaning, or emotional security. All of these underlying subjective themes can become altered through the structured interpersonal process called psychoanalytic psychotherapy.

Despite their various inter-school conflicts, these psychodynamic practitioners share a focus on individuality. To one extent or another, they find guidance in the pursuit of what psychoanalyst and philosopher Jacques Lacan called the subject (who the person really is) rather than the ego (who the person thinks he or she is). This search for the subject is nothing less than a sacred duty, particularly in view of contemporary society’s near-destruction of individuality.

This threat to distinct personhood becomes readily evident when watching late night television. As you have likely witnessed yourself, television commercials pawn medications for every “ailment” – physical, mental, or cultural. They display actors showing a range of emotion, from sadness to nervousness to excitement to exhaustion; they then name these as depression, anxiety, mania, or fatigue; they then suggest that your doctor can provide you with the Lexapro, Xanax, Lamictal or Provigil to eliminate these “disorders.”

The process of naming various mental states, and even identifying them as abnormal, begins in earliest childhood. We are inculcated into the mythology of our families – regardless of our true natures. If the family values education and we struggle academically, then we are sent to tutors, offered special remedial materials, and shuffled off to private schools. If mild, compliant behavior is sought, and we are intense by nature, then we are referred for special education, or perhaps given psychoactive substances to modulate our passions.

Once we leave the family home, we become immersed in a more intensive, all-encompassing propaganda program. The mass media encourages the atrophy of all critical thinking abilities. We are barraged with information defining our experiences. We are told what bodily smells are bad, what behaviors are problematic, and what habits are self-destructive. These mass informational campaigns severely damage individuals’ capacity for finding themselves.

In contrast, psychodynamic psychotherapists focus more broadly on the search for individuals’ desires, feelings, thoughts, attitudes, memories, and dreams. They help the individuals who seek their assistance to find the meanings contained therein. As such, these practitioners will always be ill-equipped to target “diagnostically regulated groups.” They will always fit poorly into the evidence based medicine model. Their work towards the liberation of human individuality – ironically just like individuality itself – will never be subject to neat packaging comparable to “the little blue pill.” While the clarion calls for scientifically-based approaches dominate the popular discourse, these professionals will quietly continue to pursue meaning and individuality – features of the human experience that defy categorization and therefore measurement.

(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, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. 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.)

Unlike their more seasoned colleagues, beginning psychotherapists enjoy a terrific advantage in practicing their craft. They may feel fearful or even lost in the process at times, but beneath their insecurities lurks a profound potential. They start the treatment process the same as all psychotherapists, facing a dizzying array of choices for helping their patients. But they tend to view their patients with a wonderful freshness. Rather peering through the lenses of what they’ve learned from their own psychotherapy, from prior work experience, or from case studies they’ve read, they tend to do just this: Carefully listen. Listen!
Now, of course, as they look into their own minds, “treat” more individuals, and study, these beginning psychotherapists develop points of view. They acquire biases. Their journey often begins by deciding how deeply, if at all, they will probe into themselves – an expedition dominated by resistances impossible to totally overcome. Next they choose between the various types of psychotherapy. If they venture down the psychoanalytic path, they learn many different theories. These models are promoted as universal truths. In actuality they represent only the theorists’ personalities and the particulars of the patients they encountered. And as these psychotherapists accept certain models, some degree of corruption, of prejudice, or even of blindness begins.
If psychotherapists become enamored with Freud, then they view their patients through the lenses of drive, sexuality and aggression. If they find Klein appealing, they see envy, hatred, and aggression. If they like Fairbairn, they perform “exorcisms,” striving to release the drama in the crypt lying beneath the drama in the chancel. If Winnicott moves them, they create holding environments and act as transitional objects. If they like Kohut or Stolorow, they are gentle and maternal. If they like Bollas, or even our beloved local Althea Horner, then they hunt for “core relationship problems.” If they like Lacan, they carefully listen to language, to slips of the tongue, desperately seeking the “subject” in words and sentences alone. If they like Schore, Siegel, Fonagy, or Main, then they consider their patients as human robots prone to such mechanistic difficulties as affect dys-regulation or insecure attachment.
And what if they seek guidance in modern philosophy? Well, then, if they like Schopenhauer, they view death as the point of life, and deem all desire save aesthetics or theology as meaningless, repetitive struggles of appetite, satisfaction, and further appetite. If they like Nietzsche, they look for power. If Heidegger appeals to them, they hunt for authenticity. If they like Sartre, they find inescapable misery in every unavoidable, noun-like conception of verb-like self-images. If they like Camus, they wonder precisely why their patients are choosing not to kill themselves. If they like Derrida or Foucault, they see, well, nothing at all.
Ironically, all of these theories or philosophies, and of course all of psychotherapists’ own illusions about themselves and others, only distort these helpers’ capacity for fully receiving the persons who present for help. Yet what these patients initially need more than anything else is simply this: For their psychotherapists to really hear their stories, their versions of the world, their hopes, dreams, regrets, and more, with as little filtering or interpretation as possible.
Experienced psychodynamic psychotherapists therefore have something to envy in those who are just beginning in the field. Laden with so many clinical, theoretical, and philosophical points of view, they can tend to perceive their patients, as the old phrase has it, “through the glass darkly.” Neophytes, still new to these various perspectives on human subjectivity, can have an easier time seeing and hearing their patients undimmed and undistorted.
Whether in their first or thirtieth year of providing psychotherapy, practitioners of this art must of course practice, read, and study. But then, at the start of each and every session, they should forget all that they have learned. And they should forget themselves. Of course this is impossible; but they should strive to do so anyway. Only then, and maybe only then, can they really listen – slowly, carefully, deliberately, intensely – to what their patients are telling them. And only after truly listening can psychotherapists begin to offer real help.

Confusions of Freedom

April 20, 2009

(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, and served as its president in the early 1990s; he has chaired the SGVPA Ethics Committee for 14 years. 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.)

Although it may sound idealistic or even grandiose, the heart of our work as psychotherapists lies in enhancing freedom. More specifically, it lies in expanding freedom of choice. We help liberate persons from self-deception, from tyrannical internal dramas, or even from painful academic, occupational, or interpersonal situations.

The unfortunate name for our endeavor, “psycho-therapy,” implies a discrete entity, the “psyche,” for which a specific intervention, the “therapy,” is provided. This grossly distorts the truth of the matter. The psyche, unlike any other entity to which “treatment” is applied, arises only partially from the biological substrate; it also emerges from such non-material factors as early social relations, culture, language, and socio-economic status. Therefore, ethics and politics, and therefore ideas like freedom, lie at the core of the psyche. Comparing “therapy” for the psyche to “therapy” for muscle pain is patently absurd. The variables affecting the psyche approach the infinite; biological systems clearly predominate in the case of a strained muscle.

Whether patients are highly regressed or extremely mature, we psychologists strive to increase their autonomy. In cases of acutely distressed psychotic persons, for example, we tend to be more active, focusing on reducing distress and improving coping capacity. We might even work on basic activities of living and medication compliance. But we are still striving to increase their autonomy. With highly functional persons, the “problems” for which they seek assistance, whether depression, anxiety, substance abuse, or whatever, also cause restrictions in freedom. While we are of course working to reduce their pain, we are also helping them to freely be themselves, to get out of their own way, and to take actions like improving friendships, obtaining exercise, seeking spiritual solace – all intended to improve the quality and meaning of their lives. We build autonomy and thus greater freedom of choice.

This focus on freedom creates paradoxical problems for psychotherapists as licensed professionals. Due to the laws governing the practice of psychology, and to our society’s litigation-proneness, excessive responsibility falls on psychologists. For example, in accordance with the Tarasoff precedent, we psychologists must protect potential victims of violence. Since the Goldstein v. Ewing case, we must also now consider not only information from patients, but what we learn from patients’ friends or families. We risk being sued or imprisoned if we fail to do so. We have become agents of the state.

Or consider, more benignly, psychologists whose outgoing voice mail messages instruct callers to phone 911 in case of medical emergency. These messages insult the callers, and treat them as if they have no autonomy. They incessantly remind them of what an average two-year old knows: Call 911 or go to an emergency room if you are acutely ill!

These conflicts between the autonomy-enhancing role of psychologists, and the protection of society as a whole, require ongoing and serious consideration. Psychologists have been mandated reporters of child abuse since the 1970’s – another way they serve as agents of the state. But this is not without other societal consequences. Many child abusers, pedophiles, and others who prey on vulnerable children now avoid seeking help from psychotherapists. They view us, correctly, as informants. State legislators now contemplate making domestic violence a mandated reportable event. Where will it stop? Will we be required to summon the police the next time adolescents advise us they are smoking Marijuana?

This dilemma was brilliantly addressed centuries ago by the motto of the French revolution: Liberty, Equality, and Fraternity. Be all that you can be (liberty), be considerate of others as you do so (equality), and remember that we are all in this together (fraternity). In applying our method of enhancing personal freedom, we psychotherapists will always be emphasizing liberty for individuals, within their particular social context. Certainly we do our work in a broader societal context but, in the final analysis, our loyalty lies to the agency of the person, not of the state.