The story of William Butler Yeats about the mind of the poet is equally applicable to that of the psychotherapist. Yeats tells of Icelandic peasants who found a skull in a cemetery and suspected it might be that of the poet Egill. Its great dimension made them feel certain it was, but to be absolutely sure they placed it on a wall and struck it with hard blows of a hammer. When it did not break, they were convinced that it was in truth the skull of the poet and worthy of every honor. The therapist’s stubborn preconceptions and dogma far exceeds that of poets. For example, when it comes to reconciling the difference between what the patient thinks is the problem and what the therapist believes it to be, the therapist rarely considers first entering into the patient’s paradigm. As Carl Rogers has suggested, in a very significant sense the client and the therapist never know what the problem is until it is well on its way to resolution. I agree, but thick-skulled therapists would never concede it.
There is no absolute truth and reality anywhere else, so it should be no surprise that the same goes for psychology and its therapeutic formulation. The truth in therapy is a consensual process between therapist and patient as the treatment evolves. I’m not even sure whether there is any truth to this statement either. We have to sober up on the concepts of truth and reality. According to the parables of Gaul, the reality is incomplete, if viewed from any point of view, and it is incoherent, if viewed from all points of view.
A half-century ago Freud said that the relationship between therapist and patient rests on the love of truth as its foundation, that is, on acknowledgment of reality. Since change is a basic characteristic of reality, however, there may be no finite truth. Independent of its exactness, the truth, and the reality, in order to be received by the patient a particular insight must meet certain criteria: it should have consistency, continuity, and synchronicity. It has to be logically sound; it needs to be maintained within the theoretical framework of the therapy, and last but not least, it should represent microcosmic version of the mutual belief system between therapist and patient. The value of insight may reside in its form, aesthetic nature, and consensuality ― not in its content, not in its rightness or wrongness, especially what the therapist may consider as such.
In Act III of George Bernard Shaw’s Major Barbara, Undershaft says: “What! No capacity for business, no knowledge of law, no sympathy with art, no pretension of philosophy; only a simple knowledge of the secret of what puzzled all the philosophers, baffled all the lawyers…: the secret of right and wrong. Why, man you are a genius, and master of masters, a god!” This ironic praise is equally suited for therapists who pass judgment on the rightness or wrongness or truthfulness or untruthfulness of matters, including insight.
S. Ferenczi stated “Nothing is more harmful…than a school-masterish, or even an authoritative, attitude on the physician’s part. Anything we say to the patient should be put to him in the form of a tentative suggestion and not of a confidently held opinion, not only to avoid irritating him, but because there is always the possibility that we may be mistaken.” This position of doubt, nonetheless, may have its own drawbacks. In his cross-cultural study of persuasion and healing, J. Frank noted that interpretation is not merely the chief means by which the psychotherapist demonstrates his understanding of the patient, but perhaps equally important, it expresses his special expertise and command of the field. Skillful strategies arouse and maintain the patient’s confidence in the clinician as a master of a special healing art, thereby enhancing the patient’s hopes for help. The ability to make interpretations also reassures the therapist about his own competence. Alas, that is why those who are young and inexperienced ― or old and insecure ― are frequently tempted to display their savvy. This results in prematurely offering too rigid or too many interpretations and explanations. Frank says; “Comparison of psychotherapy with hermeneutics suggests, rather, that the criterion of the ‘truth’ of a psychotherapeutic interpretation, as of a religious text, is its plausibility ― that is, the ‘truest’ interpretation would be one that is most satisfying or makes the most sense to persons whose judgment one accepts. In psychotherapy, the ultimate judge of an interpretation’s truth is the patient.” In short, the power of an interpretation to carry conviction to the patient depends on many factors, among them its ability to make sense out of the material the patient has offered, the patient’s confidence in the therapist, and ultimately, its fruitfulness, the beneficial consequences of the interpretation for the patient’s ability to function and sense of well-being.
T. Byram Karasu, M.D. is the author of The Psychotherapist as Healer