Jung At Heart Archive October 2007

Back to the battlefield

Yesterday, Phillip Dawdy of Furious Seasons -- which if you are at all interested in the battle for the mental health system you should be reading -- pointed me to a voice in the field I had not yet encountered. Bruce Levine, a psychologist who has a book out on dealing with depression, has been writing columns critical of psychiatry for Huffington Post . So I trundled over to Huffington Post to read what he has had to say. And indeed, his criticism seems to me to be on point. But, as I commented on Furious Seasons, I think the issue is quite a bit more complex than he makes it out to be.

It seems to me to be important to look at how not only psychiatry but the whole mental health field has been co-opted by insurance and Big Pharma. And this couldn't have happened had those of us in the field hadn't made it easy for them with our turf battles. Long before there were SSRIs, psychiatrists were near the bottom of the heap in income and prestige among physicians. The economic pressures to abandon therapy in favor of psychopharmacology are pretty easy to understand when, as it was reported somewhere a year or so ago, the latter can earn 57% more than a psychiatrist with a therapy focused practice. So money is an obvious factor, but there are more subtle ones at work as well.

Psychiatrists are no more immune to issues of self-perception and need for approval than any of us and many physicians have long viewed psychiatrists as not "real" doctors because of the perception that most of what they do is talk rather than procedures, tests and the like. And in the last several decades the field of therapy has had increasing numbers of players on it starting with psychologists, then social workers, psychiatric nurses, and counselors. What happens to the prestige factor when others can practice as  therapists with Master's degrees and less than 4 years of post-graduate training?

These persona issues are not cited much but surely they laid the groundwork for what has followed with the drive to a purely biological model which depends on prescriptions medications not talk. 

And Levine lets psychologists off the hook altogether when our hands are dirty also. Psychologists have been only too happy to jump on the brain illness train because shifting over to a biological model makes psychology scientific. And the inferiority complex of psychology is that it is not a hard science like biology and chemistry. So we see increased disdain for anything that cannot be measured and outcome studies raised to the level of the Holy Grail.

Those who regularly read here know that I stopped feeling a part of the mental health mainstream quite a long time ago. I still believe in the unconscious and in long term therapy, after all! But I can see that all of the players are part of the problem and are in the mess for what are largely unconscious or at least unspoken reasons. 

Oct 31, 2007 10:02 AM

Diagnosis or prejudice?

I've expressed my delight in the posts of The Last Psychiatrist several times before. He keeps it coming so here I am delighted again.

From his post on borderlines last week:

"But the sleight of hand is that it sounds like personality disorders are crappy and unreliable diagnoses and have little in common with their original meaning.  In fact, most psychiatric diagnosis are equally crappy and unreliable.  When you read articles saying "borderline is a pejorative term, and these patients are often really bipolar" what you need to understand is that "bipolar" is not a more valid or reliable diagnosis, it's simply another heuristic.  It isn't less pejorative, it isn't more "real."  It carries a different set of implications, but it isn't a more rigorous, more "biological" classification.  It's not like saying, "it's not a unicorn, it's a rhinoceros."  It is like saying, "it's not a unicorn, it's a pegasus."


This, by the way, is the reason why so many defenders of psychiatric diagnoses can't accept that  "borderline" and "bipolar" are equally subjective terms.  They say, "the diagnosis of borderline has very poor inter-rater reliability; bipolar has high inter-rater reliability."  But reliability is not the same as validity.  If you take twenty thousand members of the KKK, and ask them to "diagnose" the problem of contemporary society, their answer will be the same, i.e. reliable.  But it's wrong, obviously.  The diagnosis of bipolar is reliable, but in the same way as the KKK's diagnosis of society's ills was reliable.  It may be completely wrong, it may be completely right, it may be partly right, partly wrong, in some cases but not others, etc.

If you want to know why I've used racial analogies throughout this post, it's because these are all, in essence, prejudices.  "It's bipolar."  "It's borderline."  "It's poverty."  "It's bad parenting."  "It's..."  Well? It's not really any of those after all, is it?"

Oct 30, 2007 11:45 AM

Back again

A flurry of other demands kept from posting this last little while, but I'm back again. I will be posting some thought provoking quotes from Jung, writing more about therapy and continuing to respond to questions.

A reader asked what is the difference between a personal analysis and a training analysis. In the best of all possible worlds, the differences would be so minor as to be undetectable. But patients and analysts are human and so differences do appear despite good intention.

Basically a personal analysis is analysis undertaken by a person who wants analysis -- not to meet institutional or other requirements. And a training analysis is undertaken by trainees in analytic training centers as part of the requirements of their training. This means that likely they will have at least some contact with the analyst outside of the consulting room in classes, seminars, meetings and the like. Optimally in analysis, extra-analytic contact is limited.

I am not a trainee nor have I been so what I know is based on what I have heard and read in professional publications. Though the training analyst does not have input into the candidate's evaluation in the program, it makes sense, as I have read, that there does often hang over the analysis an awareness for both parties of the status of the analysand, who may be less open than in personal analysis because of the connections with the institute. How big a factor this is  of course varies widely.

I'm not sure what else to say on this topic. Those are, broadly sketched, the differences.

Oct 26, 2007 8:17 AM

When we make mistakes

I was asked by a relatively new therapist about how to deal with mistakes when we make them. So I thought I would share my thoughts on that with you.

how do we (as therapists) recover from mistakes? 

We recover by recognizing that of course we make mistakes because we are human and it is how we learn. I have been in this work for 35 years and I still make mistakes -- different ones, but mistakes nonetheless. We have to start with accepting the patient's feeling of having been hurt or otherwise affected by our error. Which means at least initially not trying to get the patient to understand or accept an explanation of our good intentions. Doing that -- trying to explain -- is  really for the therapist, an attempt to soothe ourselves and to see ourself again in a positive light. 

 Initially I need to be able to simply accept that I made a mistake, be willing to own that mistake. Optimally the relationship is solid enough that my mistake does not end it and we have the opportunity to work through it, to look at what happened and why and how it came to be experienced painfully. 

Sometimes the therapist's mistake breaks the relationship. What do we do then? Well, we have to sit with it, reflect on what happened to see what we can learn from it. Maybe got some supervision to see if looking at the situation with another pair of eyes illuminates it for us. We learn what we can from it and let the patient go. Pursuing trying to get her to hear the explanation starts to be its own problem.  

A wise supervisor once told me that we fail our patients in exactly the way they need to be failed and the trick is to be able to work through that. And he was right. Years ago I had a new patient come to me after having fired two previous therapists -- one who fell asleep in a session with him and another he found unsympathetic. So I knew i started on thin ice, that he was looking for me to fail him also. One day he called and left me a message that he had to reschedule. I called back and left a message saying only my name and a time he could reach me. He got furious and said I had violated confidentiality by leaving the message so his roommate could hear. Now i knew I had left no indicator of who I was or why I was calling, but it didn't matter because *for him* I failed. No amount of reasoning mattered. So we failed to work it through. I did learn to check with new patients about whether or not it was all right to leave a message if I had to get in touch by phone. 

But what about the instance when the therapist really likes the patient and believes that he can help him? Letting go of that is hard isn't it? 

It is hard to let go but what I want for a patient may not be what is best for her in her eyes -- and those are the eyes that count. If she came back, I would be able to feel good, vindicated in some way -- and sometimes patients do come back-- but for at the time, I have to live with the blow to my pride and my sense of my professional self. It is in these humbling experiences where we learn most. 

Liking a patient is important but in a way, we have to hold that in a different place from where we hold such things ordinarily. Because therapy requires of us a measure of sacrifice, of willingness to hold our needs and desires in abeyance, knowing we must meet them outside of our professional relationships. When we embark upon this work, we sacrifice being able to follow up on attractions in the same way we can when we meet people outside of our professional roles. It is hard sometimes. I have had more than one patient in the last 35 years that I would have loved to become good friends with. But I was in their lives in a different way, a way which unfolded into a different kind of intimacy and exchange.  


Oct 10, 2007 9:25 AM

Be sure to read...

I meant to post a link to this terrific interview on Furious Seasons last week, but I forgot. I certainly hope that anyone reading here is also reading him as he covers some of the troubling issues in mental health treatment today. He is a strong and important voice.


The interview, with Chrisotpher Lane, who has written a book about the medicalization shyness, touches on some of these difficult issues. A tidbit from the interview --

Well, let’s just say I’m far more concerned about psychiatry now than I was going into this project. After all, I reviewed literally hundreds of the psychiatrists’ letters and memos. I know every small and major reform they pushed for, including highly confidential recommendations that of course were never made public, but that had serious consequences behind the scenes. And much of what they did was very questionable.

Some of them pushed for their own disorders to get adopted. Some wanted to promote their friends or thwart their enemies, and openly joked about that. Some of their sample sizes were embarrassingly low—-in one case involving just one person the advocate of the disorder had himself treated! That’s no basis for saying a disorder belongs in the DSM-—especially not if you’re claiming the manual is highly scientific. Even one of the main players has since gone public, saying much of their research was “really a hodgepodge—scattered, inconsistent, ambiguous.” That tells you something, but it’s honestly not even the half of it.

It is very interesting to me that he is a professor of English. Interesting  but not surprising as there is a timidity within the field about critiquing something so basic as the DSM -- fears about being tagged as a renegade or unsound and damaging a career in the process. Most of the folks I know and respect in the field talk about the very issues he raises but none of us has undertaken writing about it. 

Oct 8, 2007 8:32 AM

What's the difference...

A commenter asked what the difference is between Jungian analysis and Jungian psychotherapy, which is a very good question. 

Legally there is no way to keep any therapist from calling herself a Jungian analyst or psychotherapist. However, a Jungian analyst should have trained and completed a course of study at a certified Jungian training institute and thus will carry the letters IAAP after their name. This indicates that they have met the criteria for certification as established by the International Association for Analytical Psychology. In their course of study, which is roughly equivalent to a doctoral program, they will have studied Jungian psychology, of course, mythology, fairy tales, and other areas relevant to Jungian practice. They will also have been in Jungian analysis at least 100 hours before beginning training and will have continued throughout their training. And they will have had considerable clinical supervision from Jungian analysts. Completion of such programs includes writing a thesis.

Unfortunately the IAAP has not established criteria for psychotherapists who wish to practice as Jungians. I think it is reasonable to ask of any therapist so describing herself what her background in analytical psychology is, because in my opinion it should approximate analytical training. A workshop or two and some reading are not sufficient in my view to call oneself a Jungian psychotherapist. I think it is reasonable to expect that such a therapist has experienced Jungian analysis as a patient, has read extensively in the Jungian literature, and participates in ongoing education via workshops and seminars made available through Jung institutes.

Academic degrees in Jungian psychology are rare and hard to come by. In the US there is one place to receive such education on the graduate level and that is Pacifica Graduate Institute. The University of Essex in the UK also has such programs. And there are programs in Australia. In the US, Jungian psychology is pretty much absent from psychology curricula on the undergraduate or graduate level.

In my own case, I have been in and continue with a long personal analysis. I worked for several years with a woman analyst and now work with a male. I have received clinical supervision over a period of 10 years from 4 different Jungian analysts. I have participated in hundreds of hours of workshops and seminars at Jung Institutes in Chicago, Boston, and Zurich. I have read widely and deeply in the literature of Jungian psychology. I seriously considered analytical training but at the time I wanted to go, the nearest institute was accepting very few candidates so I decided instead to get my doctorate in Jungian studies. I already had solid clinical training and 25 years of clinical experience. So I set out in my doctoral program to include the reading and coursework in areas other than clinical that analytical training would provide. In my view, my personal training course, pursued over many years, is pretty much equivalent to that of a graduate of any of the Jungian analytical programs. I do not call myself an analyst, however, because I am not certified and I honor that process.

In a session, the difference between a Jungian analyst and a Jungian psychotherapist, given some equivalence in background, is likely quite small. Certification and training is no guarantee of excellence nor that you will find a good fit with any given therapist or analyst. So I see. as always, the relationship as more critical than the training of the therapist. An exception to this comes if you are interested in eventually pursuing training as an analyst, because every program I know of requires at least 100 hours with a certified Jungian analyst.

So that covers the difference between Jungian analysts and psychotherapists. Both Jungian analysis and psychotherapy can involve one session a week or several. The patient may sit facing the therapist or analyst or lie on a couch. Issues of technique are variable for both groups and depend a lot on where the clinician locates himself in the post-Jungian universe. In both analysis and psychotherapy in the Jungian model, there is an interest in meaning of symptoms and problems over diagnostic labels, frequent work with dreams and other forms of work with the unconscious such as sand tray, active imagination, drawing and the like. There is a recognition that both parties to the work are changed by the work. I will explore more deeply the basic tenets of Jungian psychology in later posts.

Oct 7, 2007 10:10 AM

Therapy and suffering

I have been thinking about the following from Jung for a number of years.

... the principal aim of psychotherapy is not to transport the patient to an impossible state of happiness, but to help him acquire steadfastness and philosophic patience in face of suffering. Life demands for its completion and fulfillment a balance between joy and sorrow. *

This is not a message most people want to hear. It is tough to accept that suffering is part of life, that it is meaningful and unavoidable. It is hard for patients and often hard for therapists as well to stay with what is painful, to resist the urge to dart away into what is more comfortable, soothing, or easy. This way of understanding therapy also flies in the face of a feel-good orientation which seems to dominate American culture. We want to medicate, meditate or otherwise eliminate suffering, not face into it, sit in it and explore its meaning. 

Someone once said to me, "I think I have never told any therapist, and I have had a number of them, some of my darkest secrets, which of course are the reasons I'm going to therapy in the first place.. I want a cure for the way I feel now." That's a pretty common attitude but it is ultimately self-defeating. As I wrote here, it is the secrets which isolate us and cut us off from what we most need and want. The "cure" for what a patient feels now is doing exactly what is so often resisted -- saying whatever comes to mind and being open and honest and willing to find the meaning in the suffering.

* Collected Works, Vol. 16, p.81

Oct 2, 2007 2:44 PM

© Cheryl Fuller, 2007. All  rights reserved.