Most psychotherapists today are trained to take a rather technical approach to treatment. CBT is a prime example of this standardized, manualized, mechanistic, technical type of therapy designed specifically to reduce or suppress a patient's symptoms and suffering as quickly and economically as possible. Psychopharmacology--the mainstay of contemporary psychiatric treatment--is another example of a bio-mechanical, medicalized, symptom-centered orientation. But is this what psychotherapy is really about? Is this all psychotherapy has to offer? Rapid, rote symptom-reduction? Drugging away or suppressing emotional pain or discomfort? Rationally rooting out and restructuring the patient's distorted cognitions? Modifying and "normalizing" or making more socially acceptable his or her aberrant, eccentric or maladaptive behavior? To be sure, timely pharmacological relief of intolerable and crippling psychiatric symptoms is practical, valuable and sometimes life-saving. But ought that be the end or merely the starting point of therapy? With the advent and wild popularity of psychopharmacological and brief cognitive-behavioral treatments today, is there any room or reason left in the therapeutic process to speak of esoteric subjects such as beauty, God, evil or death?
One of my former mentors, existential psychoanalyst Dr. Rollo May (1909 -1994), passionately argued that psychotherapy should be less about technique or what he pejoratively called "gimmicks" designed to subdue symptoms than about enhancing the patient's capacity to feel, experience, create, find meaning, and in general to become more receptive and accepting to life and love in both their positive and negative aspects. In some ways, this is a radically divergent view on the nature, meaning and purpose of psychotherapy compared to the conventional, symptom-centered approach of today. Dr. May's neo-Freudian, and especially existential attitude toward psychotherapy and his humanistic emphasis on the healing power of the relationship between patient and therapist over the primacy of technique is closely related to that of C.G. Jung, who quipped that psychotherapy "demands all the resources of the doctor's personality and not technical tricks." Clearly, real psychotherapy of any sort depends partly on specific techniques. But the utilization of such techniques is secondary to and never a substitute for the working relationship between patient and therapist.
Another former mentor of mine, Jungian analyst Dr. June Singer, taught that typically, the symptoms presented initially by patients seeking psychotherapy are not the primary problem, but rather represent, symbolize or mask a more fundamental underlying intrapsychic, interpersonal, sexual, existential or spiritual imbalance or conflict. Sigmund Freud, of course, was the first to formally recognize this fact and developed his own still controversial theory (psychoanalysis) to explain and resolve the intrapsychic source of these neurotic or psychotic symptoms. Freud famously focused on enhancing the patient's capacity to work and to love. One of his most innovative and ingenious techniques designed to unearth and reveal such conflicts was what came to be called free association: The patient, while lying on a couch, was encouraged to speak freely about whatever entered his or her mind at the moment. For Freud, the point of free association was to help make what was unconscious more conscious. During their free associations, Freud focused primarily (and seems to have been dogmatically fixated) on evidence of repressed infantile and childhood sexuality in his patients musings and memories.
But what happens when the psychotherapy patient spontaneously free associating starts speaking in treatment not of implicit or explicit sexual conflict, nor of his or her various symptoms or interpersonal problems, but rather of esoteric topics like beauty, God, death and evil? Is this still considered real psychotherapy? Certainly Jung and May both thought so. Some might say such subjects are inappropriate and superfluous--perhaps even taboo--in today's dollar-driven psychotherapeutic marketplace. But I wonder whether any mental health treatment which consciously or unconsciously excludes such basic spiritual or existential concerns can or should be considered real psychotherapy.
In his semi-autobiographical book My Quest for Beauty (1985), Rollo May relates his own rediscovery of beauty and its far-reaching therapeutic power. Finding himself as a very young man alone in a completely foreign culture for the first time and in the throes of a debilitating depression or "nervous breakdown," May accidently stumbles in this disoriented state of mind upon a gorgeous sea of wild poppies while wandering aimlessly in the hills of Greece, and experiences a life-altering epiphany: "I realized that I had not listened to my inner voice, which had tried to talk to me about beauty. I had been too hard-working, too ‘principled' to spend time merely looking at flowers! It seems it had taken a collapse of my whole former way of life for this voice to make itself heard." This sudden reawakening to beauty helped lift him out of his funk and propelled him toward a new, less regimented and rigidly moralistic, more creative, vital life.
This is sometimes a problem in seekers of psychotherapy today: They have lost touch with their transcendent sense of beauty, being so totally preoccupied with their worldly interpersonal problems and distressing symptoms. May, who later briefly became a minister and then a psychologist, shares the following excerpt from a therapy session with a woman he once treated who, up to this point, had been exclusively focused solely on her marital problems: "I stopped my car on the way here to look at the twilight. It was just beautiful, the purple hues with green hills, behind them. . . it is the most beautiful time of day. . . . I don't believe in a God, at least in a personal God, there is so much evil in the world, it makes it so pointless. But when I see such beauty, I can't believe it is by accident. . . . This time of day would be a good time to die, a good time to be alone. . . . I would like to die at this time. . . It is so peaceful here in your office. . . I keep noticing the beauty outside the window. . . ." Beauty, writes May, "is serene and at the same time exhilarating; it increases one's sense of being alive." The beauty of nature, for example, can inspire a profound sense of inner peace, joy and awe, helping to place our petty daily problems or even major life crises into cosmic perspective.
Now, some readers, including psychotherapists, might find this patient's talk of beauty, God, death and evil irrelevant to treatment, possibly a form of what Freud called "resistance," and her comment about wanting to die surrounded by such serene beauty perhaps alarmingly suicidal. Indeed, the patient herself, recounts May, "expressed her fear that she had said nothing today, maybe it was all superficial talk. I assured her that no topics could be more important than beauty, God, death." What did May mean by that? He meant that psychotherapy is not merely a process to "fix" or eliminate people's problems, symptoms and anxieties. Symptoms abate as their root causes are resolved. But we will always have problems. Psychotherapy is about helping people to become more present, more whole, more free, more responsible for themselves, more authentic, more creative, more resilient, more courageous, more capable of love, and more aware. It is about accompanying patients through and, when pragmatically possible, beyond his or her personal demon-filled hell toward discovering and fulfilling their destiny. Or, at least, getting them back on that path. This is a far cry from what frequently passes for psychotherapy today. The goal of real psychotherapy is to help the patient learn to stand on his or her own two feet, to face and accept the stark existential facts of life--difficulties, struggles, suffering, disease, loss, frustration, disappointment, evil, death--with dignity and courage, while at the same time appreciating and being fully present to life's sublime pleasures, wonders and beauty. It is about becoming more authentically ourselves and embracing both the hideous and beauteous, divine and diabolic, destructive and creative polarities of life May poetically called the daimonic.
The kind of psychotherapy I am describing here has less to do with the duration or cost of treatment than with how the psychotherapist views the nature and purpose of treatment itself. People have an innate need to ponder life's awesome mysteries. Real psychotherapy provides patients the opportunity, when needed, to grapple with these thorny questions--which are often closely, though unconsciously, related to their presenting problems. The goal of such therapy is to assist patients in finding their own philosophical or spiritual perspective in life, so as to be able to deal with future problems from a position of inner strength and stability. If psychotherapy continues to be viewed as a prescribed, predetermined, mechanistic cookbook recipe of techniques designed just to rapidly reduce or eliminate certain troublesome symptoms or behaviors, such topics will increasingly seem moot. Patients receiving such severely limited treatment today are tragically being deprived of a much-needed chance to consciously wrestle with what theologian Paul Tillich called "ultimate concerns" like the problem of evil, suffering, spirituality, meaning and mortality. We live today in a therapeutic culture that devalues talking or even thinking about such things. Today, psychotherapy patients are implicitly or explicitly discouraged to discuss or dwell on such soulful matters. But if psychotherapists and patients can recognize and respect the pragmatic therapeutic value, power and importance of addressing meaningful subjects such as beauty, God and death in treatment, then maybe psychotherapy--real psychotherapy--has some chance of surviving.