Thursday, August 5, 2010

Daphne Merkin Has Had Enough Therapy

Daphne Merkin has written a wonderful, informative article for the New York Times Magazine. Link here. Normally, I would refrain from commenting on an article by a personal acquaintance, as she is, but I will make an exception for an especially fine piece of work. And for an essay that contains many points that will illuminate one of the central topics of this blog.

Having spent over forty years in one form of therapy or another, Merkin has earned the right to give us a glimpse of what goes on behind the curtain.

With good reason she compares her presentation of New York's finest therapists to Dorothy's unveiling of the Wizard of Oz.

Merkin's view of therapy is, at the least, fair and balanced. It shows the good, the bad, and the ugly. She presents her own experience of therapy and therapists, allowing us to form our own conclusions.

To be clear, the kinds of therapy Merkin underwent seem mostly to fall under the category of either psychoanalysis or psychoanalytically-oriented psychotherapy. From an early age she was induced to look back toward her past in order to discover the causes of her present problems.

And she learned, as have many other analytic patients, to take those remnants of prior trauma and weave them into a coherent narrative.

In her words: "I learned...  to construct an ongoing narrative of the self... one that might have been more or less cohesive than my actual self but that at any rate was supposed to illuminate puzzling behavior and onerous symptoms...."

As she makes clear, this is not the same as treatment or cure. As she writes: "Therapy, as Freud himself made clear, is never about finding a cure for what ails you."

Better yet, she adds later: "[Sandor] Ferenczi noted in his clinical diary that Freud shared with him the harsh sentiment 'that neurotics are a rabble, good only to support us financially and to allow us to learn from their cases: psychoanalysis as a therapy may be worthless.'"

What were the clinical effects of this excursion into rabblehood. Merkin describes one of her experiences here: "I don't know whether this was because of the therapist's lack of skill, some essential flaw in the psychoanalytic method or some irreparable injury done to me long ago, but the last time I engaged in this style of therapy for an extended period of time with an analyst who kept coaxing me to dredge up more and more painful, even earlier moments, I ended up in a hospital."

If therapy does not cure, and if it seems to be nothing more than overpriced storytelling, why do people keep doing it? Merkin replies that if you really get into it, therapy is addictive. It provides a fix; it makes itself feel essential to your well-being; it convinces you that you cannot live without it.

One has to wonder whether there is a 12-step program for recovering analytic patients.

What does the patient get out of it? Merkin answers that it's all about the poetry. Listing a group of analytic shibboleths-- projection, repression, acting out, defenses, secondary compensation, transference, she observes: "... these words speak to me with all the charged power of poetry, scattering light into opaque depths, interpreting that which lies beneath awareness. Whether they do so rightly or wrongly is almost beside the point...."

But there is more than poetry here. If, as I believe, these words function like catchwords, they do not have to mean much of anything. Using them makes you a member in good standing of the analytic fraternity or sorority, the select group of individuals who have attained an extraordinary level of self-awareness.

Of course, if it's all poetry, then analysts should drop the pretense of being men and women of science.

Your membership in such a group does not hinge on your mental health; it hinges, I would say, on your ability bandy about such terms. At the least that was the case when I was involved in a French school of psychoanalysis.

Once you have defined yourself as a member of such a group, you must adhere to the group's rituals. If you should even encounter a therapist who does not follow the Freudian model of psychic archeology and catharsis, you become suspicious.

Even when, as happened to Merkin, the person was supposedly a believing Freudian. As she describes this therapist: "While she may have had the convictions of a Freudian, she also had the manner of a strategic adviser, cheering me on in my daily life. And yet, after seeing her for 18 months, I felt that I was doing myself an injustice by merely skimming the surface, leaving myself vulnerable to the kind of massive subterranean conflict I feared would sooner or later come out of nowhere and hit me hard once again."

Herein Merkin reveals, first, that some therapists who trained as Freudians are not really conducting psychoanalysis. They more closely resemble coaches.

But she also reveals that she had, from her experience with analysis, been convinced of the truth of the analytic myth. It had convinced her that repressed conflict had to be remembered, worked through and woven into the right kind of narrative, lest it torment and hurt you.

But Merkin has also come to realize that the therapeutic process has not been constructed for the benefit of the patient. In her words: "Looked at a certain way, the entire enterprise seems geared toward the needs of the therapist rather than the patient to a degree that can feel, after a certain amount of time, undemocratic, if not downright exploitative. With no endpoint in sight, it's possible to stay in therapy forever without much real progress; at the same time, the weight of responsibility is borne almost entirely by the patient, whose 'resistance' or lack of effort-making is often blamed for any stagnancy in treatment before the possibility of a therapist's shortcomings is even acknowledged."

To mention the obvious, giving people the silent treatment, refusing to converse with them, and refusing to look them in the eye... all of these are basically rude.

More than that, as Merkin notes, is the failure of reciprocity, the sense that these therapists are encouraging their patient to reveal the worst about herself while they are revealing nothing whatever about themselves.

In her words: "And for all the emphasis on therapy's being a place of intimate disclosure-- for all the times, in between shows of hostility, that I haltingly stated my feelings of deep affection or even love for my therapists-- none of them ever opened up about their feelings for me other than to convey a vague liking or appreciation of some facet of my personality."

Therapists fail even to reveal information that any ethical professional would not hesitate to share. Take an example from Merkin's experience. An elderly analyst one day told her that he could not accept her in treatment. He offered no reason or explanation.

In so doing, he was allowing his potential patient to imagine that she was not good enough for him, that she was not interesting or lovable, that she was incurable... the list goes on and on.

It was only later that Merkin discovered, by other means, that he was actually shutting down his practice and was not taking on any new patients.

Another therapist expressed another kind of rudeness by assaulting and insulting his patient with a litany of criticisms and complains about the way she was conducting her life.

Rude and discouraging, contemptuous and smug, this therapist was hardly in a good position to lead his patients to the kind of polite, considerate, engaged behavior that constitutes good character.

Clearly, analysts feel that their work involves undermining their patients, allowing them to think the worst of themselves and to blame themselves for any treatment failures.

Their silent treatment, their closed-off, distant mode is normally taken as criticism and rejection. It naturally provokes self-criticism in patients.

At the very least, they are showing their own bad character. One wonders how therapists can pretend to improve anyone's character when they seem locked into rude and insulting behavior themselves. Aren't they supposed to be the ones who have profited from the treatment they are offering?

When patients are encouraged to indulge their worst tendencies, when they are forbidden to converse normally with their therapists, they are not likely to improve their character.

As Merkin remarks: "Even to this day, I'm not sure I know anyone whose character has been genuinely transformed because of therapy. If anything, most people seem to emerge as more backed-up versions of themselves."

When she arrives at a place where she can evaluate therapy, Merkini seems to be of two minds.

In her words: "And yet it seems to me that the process itself, in its very commitment to interiority-- the attempt to ferret out primal causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present-- can be intriguing enough to stand in as its own reward."

And there is great truth here. Therapies inspired by Freud are not about curing what ails you. They are really about making you into a Freudian.

Yet, Merkin also has doubts about the root causes she has unearthed: "And yet, are these so-called causes helpful in navigating the present. Likely, they are not. I couldn't help wondering whether it kept me too cocooned in the past to the detriment of the present, too fixated on an unhappy childhood to make use of the opportunities of adulthood. Still, I recognized that therapy served me well in some ways, providing me with a habit of mind that enabled me to look at myself with a third eye and take some distance on my own repetitive patterns and compulsions. In the offices of countless therapists-- some gifted, some less so-- I sharpened my perceptions about myself and came to a deeper understanding of the persistent claim of early, unmet desires in all of us."

This is, of course, strict Freudian theory, stated far more elegantly and coherently than most Freudians can. Eventually, Merkin discovers that the forms of therapy practiced by New York's finest, have distinct limitations.

In her words: "If there were many things I wished I had done, there were also things I was proud of, but there seemed to be no room for them here, in this cloistered space devoted to unearthing the clouds behind the silver linings. Happiness, as we all know, can't be pursued directly, but what was the gain in tracking down every nuance of unhappiness, meticulously uncovering origins that left a lot to be desired but that could never be changed, no matter how skillfully you tried to reconstruct them?"

And finally, in her parting insight, Merkin says: "It was not that I found all my shrinks to be impostors, exactly, but it dawned on me that I no longer had the requisite belief in the process-- perhaps had never had it in sufficient quantity. After 40-odd years of trying to find my perfect therapist, I didn't want to explore my transferential relationship with Dr. F. or anyone."

You will note the reflexive addition of a phrase where Merkin considers that she perhaps not been enough of a true believer. The truth is, given the fact that therapy does not cure, there is no such thing as a patient who is enough of a true believer.


Anonymous said...

Hello Stuart,

Fascinating article! Having been a "fool for therapy" myself (albeit for "only" a period of about 10 years)I can certainly appreciate her experience.

I remember asking my first therapist--innocently-- why she refused to help me, which made her fly into a sort of rage, saying she was damned if she did and damned if she did't!

Another therapist flew into an even greater rage (and turned red in the face) when I used the term "indian-giver" (to describe my Father's behavior of offering me something wonderful, then withdrawing the offer), telling me that he found my use of the term " highly offensive" and a "slur against the American Indians (!!!)" He had nothing to say about my Father's behavior. or my reaction to it.

I was dumbfounded--"medusee" as they say in French! Later, when I recounted this episode to my boyfriend, he laughed and told me my analyst was an idiot because the term "indian giver" is a slur against the white man who gives to the Indian (and takes back), NOT against the Indian.

That put the "merits" of psychoanalysis into sharp perspective for me! Of no small importance,in retrospect, this therapist was ultra left-wing, and probably was seeking to reform me (although I was left wing too, at the time but I guess not enough for him).

In all fairness, I did see a very good Jungian analyst for one year the year after my sister died--we spent most of the time analyzing dreams---productively, I thought--because this truly helped me get a job I wanted.

Your idea of a 12-step program for recovering analysands is all too germane.

Thank goodness Ms.Merkin found some redeeming side--poetry-- to her 40 years of analysis!

I really think your next book should be a collection of interviews about peoples' crazy experiences with therapy!

All best,

Anonymous said...

She probably should have tried dialectical behavioral therapy at some point. Borderline patients don't do well with psychodynamic treatment approaches.

It is telling she idealizes the therapist she didn't really work with (who reminds her of her mom!) and almost always takes shots at other more invested therapists. And that she mentions a pattern of unstable relationships as a result of self-defeating and affectively unstable behavior. The rescue fantasies (being adopted or worse, seducing a married analyst) are similarly telling.

To me the article reads as venting - what is essentially a 40 year accumulation of cheap shots - disguised as a critique. And as for the notion she was exploited, give me a break. If you don't like what someone is selling, don't buy it for 40 years. Or at the least, don't end your article by saying you plan to go back to see someone at some point.

Stuart Schneiderman said...

Thanks, Susan and Anon, for those comments. I am always amazed to hear of what goes on in some therapists' offices.

If Susan's experience is an indication, it is stranger and more overly ideological than I had believed.

And that says a lot.

I would love to do a collection of bad experiences with therapy. Perhaps one day I'll figure out how to collect them.

Thanks, too, to Anonymous for suggesting dialectical behavioral therapy as a treatment for borderlines. At some point in a previous post I highlighted the work of Marsha Linehan in this field.

Of course, I didn't offer a diagnosis of Daphne Merkin, so I have no idea of whether your diagnosis fits.

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Anonymous said...

"The truth is, given the fact that therapy does not cure, there is no such thing as a patient who is enough of a true believer."

Fair enough, but what then are people in real pain with real symptoms supposed to do? I can tell you that my experience with cognitive behavioral therapy was a joke.

Good article.


Stuart Schneiderman said...

People in "real pain" should first consult with a psychiatrist. Medication is often helpful in alleviating some of the pain.

They can then couple the medication with something like coaching, or brief solution focused therapy, or even some types of cognitive therapy.

At the very least they should find someone with whom they can interact, with whom they can forge a human connection.

Unfortunately, such a connection was precluded with many of the analytically-oriented therapists Merkin consulted.

Anonymous said...

"At the very least they should find someone with whom they can interact, with whom they can forge a human connection."

I totally agree with this. I see a therapist who is psychoanalytically oriented for sure, but each session is a two way discussion - very dynamic - and the past is discussed mainly in the context of the present and the future.

And while my therapist don't disclose anything about himself really, the fact that he's totally accepting, patient, respectful and consistent has allowed a kind of real connection to be formed.

Thanks again for the article.

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