Dangerous Psychotherapy Language

Obsessive Ruminations #1

(Dr. Alan Karbelnig, who quietly slipped into his 50s last year and lost all decorum in the process, writes this regular column to provoke reaction from his SGVPA colleagues. Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Alan strives to avoid the pablum that characterizes most professional newsletters, and instead strives to serve up more zesty reading. Regarding his professional career, Alan is a long time member of the SGVPA, having served as president in the early 1990s; he has chaired the SGVPA Ethics Committee for the last decade. He practices clinical psychology, psychoanalysis, and forensic psychology in South Pasadena.)

I recently had lunch with two of my illustrious SGVPA colleagues who, in the course of discussing their clinical work, used words such as “attachment,” “affective attunement,” “activation,” and “dysregulation” repeatedly. I understood what they meant. They were describing the phenomena of being close to other persons, of resonating with them, of becoming excited, and of feeling overwhelmed. After lunch I returned to the office perturbed. My fellow practitioners know these words trouble me. Maybe they use them with more vigor when I’m around to demonstrate their attachment or attunement to me. Maybe they want to get me activated. But this time I just felt like shouting. I offer this rant for the SGVPA newsletter instead.

In the middle part of the last century, the psychoanalytic lexicon was rife with earlier versions of these words. Had you dined with psychoanalysts in, say, 1955, you would have heard about patients’ cathexis to their analysts, or about their ego weaknesses, or about the corruption of their superegos. If the patients were particularly emotional, perhaps you would have heard them described as overwhelmed by Id impulses that had perforated their repression barriers, over-riding proper ego functioning.

I suppose such language may suffice for communication between professionals, and therefore I should not be so dysregulated by it. But as Thomas Szasz used to say, we psychotherapists need to be careful not to literalize our metaphors. These interesting words – then and now – are chock-full of mechanistic, post-Enlightenment ideology. Used without caution – and this is the danger Szasz alludes to—these terms can violate sanctity of the human subjects who engage us in our consulting rooms. No disrespect to the Age of Reason, but our patients are not motorized contrivances we can deconstruct with a Newtonian calculus. They exist as real, fleshy, sentient human beings experiencing a near-infinite range of sensations, thoughts, feelings, and images, all of which swirl around in inter-relationship with one another, never to be reduced to finite categories. These persons demand to be received in all of their complexity and fullness

Attachment, a horrible word, sounds like a button, or a snap, or a piece of Velcro. What if, instead of affective attunement, we think about being present, as completely as possible, to the being of the person meeting with us? Attunement sounds like a melody produced by a mouth harp, or an mp3 file. Perhaps we could just strive to “be” ourselves instead of being attuned. Perhaps we could flow with others’ words, thoughts, fantasies, images, and feelings. The same holds true for “activation” or “dysregulation,” terms suggesting that a hose attached to your cooling system has come loose. These “technical” phrases are too constrictive as well as too robotic to describe the complexities of the human experience

Samuel Johnson once said that all professions are conspiracies against the public, and I suppose these automaton-like words represent part of the conspiracy of professional psychology. We take the intense richness of human experience and reduce it to a few scientific-sounding categories. That way we can design studies, pretending that we work in a branch of the natural sciences. We can imagine a human person reduced to a set of internal regulatory mechanisms that we can then “treat” according to certain algorithms that emerge from our studies. We can simply ignore the impossible richness of the living subject who will forever lie beyond our categories.

I am of course just as guilty as many of my colleagues. Since I also do some psychological assessment, perhaps I don’t notice my own use of terms such as “behavioral control,” “affect modulation,” or one of my favorites from the Rorschach, “a tendency to abuse fantasy.” I obviously like the phrase “obsessive ruminations,” which of course is also the title of this column, but maybe “ranting” would be more precise, especially if followed by an exclamation point!

So we should persist in our conspiracy, as we must, but since the real human experience is the focus of our profession, I think it would behoove all of us to remember that metaphor is metaphor, and that people live in a real experiential world of language and imagery and feeling. I enjoyed lunch with my distinguished SGVPA peers. I certainly came away feeling peeved, but neither activated nor dysregulated.