Psychotherapy and Side-Effects

Aeon, Psychotherapy is not harmless: on the side-effects of CBT  

The research cited in this article doesn’t sound all that robust, but it’s an interesting question to think about. Personally, I think therapists of all stripes are well aware that the process has side-effects, but they see it as part of the therapy and I’m not sure they always fully appreciate the potentially negative and unwanted impacts. One of the reasons why I ended my last course of therapy was because I didn’t feel that my therapist was taking my concerns about unwanted effects seriously enough.

When is it time to end therapy?

I’ve decided to bring three years of therapy to a close by the end of August. This is difficult because my therapist doesn’t really agree with the decision. She thinks we should continue and explore some of the more painful issues that I’ve largely avoided bringing into the room. She says she’s concerned that I may be “abandoning myself” by stopping therapy right now.

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Alison Bechdel, Are You My Mother? (2012)

There were moments, while I was reading this book, when involuntary exclamations would burst from me.  “Argh!” I would cry, and my partner, who had already finished it, would look at me sympathetically and nod her head.  Are You My Mother? came as something of a shock to my system, inducing far more powerful resonances with my relationship with my own mother than I expected to experience, and which I’ll be processing for some time to come.

This is Alison Bechdel’s second memoir; the first, Fun Home, took as its subject her relationship with her father who committed suicide when she was nineteen.  Her mother is a shadowy figure in that book, but in Are You My Mother? she takes centre stage (I use the cliché consciously – Bechdel’s mother is an actress).  One of the many things that impresses me about Are You My Mother? is just what a different book it is to Fun Home, in tone, style, structure and artwork.  It is most definitely not Fun Home ‘part 2’, but it’s clear that Bechdel is not someone who ever takes the easy route, in her life or her art.

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Irvin D. Yalom, Love’s Executioner and Other Tales of Psychotherapy (1989)

Though these tales of psychotherapy abound with the words patient and therapist, do not be misled by such terms: these are everyman, everywoman stories.  Patienthood is ubiquitous; the assumption of the label is largely arbitrary and often dependent more on cultural, educational and economic factors than on the severity of pathology. Since therapists, no less than patients, must confront these givens of existence, the professional posture of disinterested objectivity, so necessary to scientific method, is inappropriate.  We psychotherapists simply cannot cluck with sympathy and exhort patients to struggle resolutely with their problems.  We cannot say to them you and your problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together (14).

By the end of the ‘Prologue’ I already knew that I was in the company of a writer who was going to stay with me long after I finished reading the book.  Irvin D. Yalom is a renowned psychiatrist and existentialist psychotherapist who works at Stanford University.  Existentialist psychotherapy is one of the less well known strands in comparison to psychodynamic, person-centred and cognitive  behavourial approaches.  It is concerned with the “existence pain” that comes from our awareness of the inevitability of death, the terrors of freedom, our ultimate aloneness and the absence of any obvious meaning to life.  It is interested in finding meaning in what we do.

I’m not an existentialist and have no intention of training as a therapist in this particular tradition. Yalom also does quite a few things in therapy that I disagree with and hope I would never do if I was a therapist.  But I found his book profoundly moving as well as interesting.  In this world of “self-help” books and “positive thinking” in which we’re constantly bombarded with techniques we can use to make our lives better, happier, more profitable etc, it was so refreshing to read a book by a therapist that doesn’t propose any easy answers or quick fixes and acknowledges the fact that life is difficult and often painful, and that therapy does not necessarily cure everything.  Yalom depicts therapy as a deeply uncertain process in which two people work towards change. He assumes that change is the goal of therapy, but that the change which results may not be the one hoped for or anticipated by either party.

As a therapist Yalom is totally open to and engaged with his clients. Existentialist therapy does not accept the power relationship assumed in traditional psychoanalyses which sets up the therapist as the expert who interprets the words of the patient.  He is at times disturbingly honest about his own emotional reactions to his patients, but this honesty enacts his argument that the therapist is not superior to the patient.  He is also very revealing about the workings of transference, counter-transference and projection and how these dynamics can be put to constructive use in the therapeutic relationship.  Yalom often has to overcome his own prejudices in order to help his clients.

The client’s stories are fascinating.  Among them there’s Thelma, a 70 year-old woman with an all-consuming love obsession (Yalom totally botches her therapy too).  Carlos is dying of terminal cancer and believes that every woman he meets is irresistibly attracted to him.  Betty forces Yalom to confront all his prejudices about fat people.  Penny neglects her living sons because her favoured daughter died.  Marge suddenly manifests a completely different personality during therapy.  Marvin is an apparently boring and uptight accountant who has the most amazing dreams.  It is also interesting that the clients who present with the worst problems tend to do the best in their therapy.

Ultimately the stories affirm the incredible complexity and courage of people while demystifying psychotherapy and representing it as a deeply human encounter.