Book Review: There is No Such Thing As A Therapist: An Introduction to the Therapeutic Process

With the encouragement of David Smith I contributed a paper 'The Communicative Concept of Validation and the Definition of Science' to the International Journal of Communicative Psychoanalysis and Psychotherapy in 1992; it was perhaps indicative of their generosity of spirit and openness to inquiry and debate which allowed communicative therapists at that time to engage with people who had not identified with their approach to any great extent. Since then I have, I am ashamed to admit, neglected to keep abreast of all the important developments which have occurred in this field and so it was with pleasure that I began to read this new book.

Holmes is at pains to state at the outset that her text is not intended to provide an introduction to the communicative approach to psychotherapy. David Smith's 1991 Hidden Conversations continues to stand as the essential introduction. Rather, as her subtitle 'An Introduction to the Therapeutic Process' indicates, she is concerned to show the reader the significance each element of the therapeutic frame has for the therapist/client dyad and for the ongoing process, and to argue for the application of the central interpersonal concerns of the communicative approach.

This is an attractive book, both in terms of its striking cover and—more important—the accessible way in which Holmes sets out her arguments. I found her insights into the therapeutic process useful in shedding light on some aspects of my own work—surely the mark of a worthy text—and her discussion of the relationship between communicative therapy and the existential approach is thought provoking. She begins with a chapter on Ground Rules in which she discusses such fundamental aspects of the therapeutic relationship as confidentiality, fees and the physical setting in which sessions are to take place. This is not an exhaustive exploration, much more could be and has been written on these aspects by other commentators. The value of the chapter, for me at least, is that it provides a useful overview and also reminds me of the principles of the communicative approach.

The second chapter goes on to look at ways in which both client and therapist may communicate their concerns over the management of the frame. It is suggested that the client offers the therapist a 'model of rectification'; I wondered whether—given the interpersonal focus of communicative therapy—there might not be greater consideration of the ways in which the therapist supervises the client since the frame is co-constituted.

In Chapter Three Holmes argues that the creation of a holding environment—the frame—echoes the limits and boundaries which form the starting point for existential psychotherapy. In particular, attempts to establish a secure frame are thought to give rise to death anxiety issues. Smith noted in Hidden Conversations that "The concept of death anxiety forges links between the communicative and existential modes of analysis" (p253). The question for me is what sort of links these can be, since the two approaches are quite unlike in many respects. Christopher Dare says in his Foreword to the book that Holmes follows the developmental line of communicative therapy through Freud, Klein and Winnicott to Langs, with Ferenczi, Searles, and the existentialism of Sartre and Buber as additional reference points. I feel that existentialism plays, in fact, a major role in this text; Holmes focuses on the presence in the therapeutic relationship of all the main concepts of existential philosophy in the second half of the book, not just death anxiety, but also separation and isolation, freedom and responsibility, and the sense of the absurd. In this respect she goes considerably further than most writers on the frame and her communicative approach clearly sensitizes her to view therapy as an arena in which both client and therapist attempt to work with their respective existential concerns.

Some communicative ideas, for example the similarities between the two parties in the therapeutic dyad, will resonate strongly with existential practitioners since they have long stressed the importance of relationship and the impossibility of being fully with and for the client while also attempting to retain the role of expert. Others, among them the centrality to the communicative approach of notions of the unconscious and unconscious communications, and transference and counter transference, do not sit well with all existential approach. Holmes is surely right when she states "Although the communicative approach is primarily concerned with unconscious meaning, which is in direct opposition to an existential cv. position, the philosophy of the approach and the attitude of the therapist is very much in keeping with the significance of the interdependent and equivalent nature of the therapeutic dyad."

It seems to me that the communicative approach presents a strong argument for the need for all therapists to arrive at an enhanced understanding of the way existential concerns are present in the therapeutic relationship. In this respect communicative therapists and existential therapists are allies. We should not, though, overlook the fact that communicative therapy is not only fundamentally different from the existential approach, but it is also opposed to it. It would be a mistake not to treat Holmes' words with due respect. I am minded of the distinction drawn by Warnock between philosophical and non-philosophical existentialism. The two share a concern with existential issues, but they do not share a method. Only philosophical existentialism attempts to arrive at a systematic account of man's connection with the world via Husserl's phenomenology. I do not intend for a moment to suggest that communicative therapy lacks a method, but I do want to suggest that the method it employs is incompatible with existential therapy in significant areas, particularly those concerned with transference and the unconscious.

Existential therapists (among diem Hans W. Cohn in a recent text) have critiqued the concepts of transference and counter transference on the grounds that "Phenomenologically, there is no distinction between a real and a transference relationship ... The therapeutic relationship is always real but—as all reality—in need of elucidation" (Cohn, 1997:33). From this standpoint we probably would not agree with Holmes when she says that "...the past is considered to enter the present when the therapist mishandles the therapeutic alliance" (p7) since past, present and future are bound inextricably one with another; none waits in the wings ready to appear when prompted. The client's ability to live in time, and the way he or she attempts to make sense of life by dwelling on, say, certain aspects of childhood or aspirations for the future, is of great significance, but no causal relationship obtains whereby the past enters a session when the therapist does x or says y, or neglects to do x or say y.

Besides, I am dubious about the reasons for this constant focus on the therapist's failings in the communicative approach. For all the talk of bipolar fields I am sometimes left wondering who in communicative sessions is in therapy. Tupholme's remark appears cogent in this respect:

I wonder if those of us in the Psychotherapeutic field who have messianic tendencies are compelled towards the communicative approach because, at some level, we feel it is there that we will receive the most comprehensive healing for our particular type of wound? (Boundaries No. 11, pl2, 1998).

More important, perhaps, is the place accorded the unconscious by communicative therapists. On my reading of communicative therapy—and I am sure it is very incomplete—it is the sine qua none of the approach. Now, existentialists question this notion of the unconscious on two levels. First, on the grounds that Freud's inference of an unconscious psychic locality is, as he himself owned, "crude and fantastic and quite impermissible in a scientific account" (1917:295-6), and second, that we really do not need it and that if we slavishly attempt to account for the actions of clients, and of ourselves, via this 'crude' construct we will fail to recognise what they can tell us about our ways of being in the world. I think van Deurzen puts this very clearly when she relates how on a visit to Durham University she twice mislaid a paper which she had just given. Rather than interpret this as the expression of an unconscious desire, (and the fact that on both occasions she left it in the toilets might lend itself to this), she explores the sequence of events in detail and concludes her actions were both intentional and intelligible:

Although I would accept that my consciousness drifted into a new direction, and that I therefore became unconscious of my paper, I would not accept that the forgetting had a deliberate and mysterious, wilful, unconscious element. Unconsciousness, in this case, is to be seen as the mere negative of consciousness, and the nub of understanding the event is that of my shifting attention and purpose, not that of some secret motivation. (1997:217)

Faced with this very different understanding of the unconscious the therapist will best serve the client by assisting them to consider what they disclose to themselves, or to express it more simply, what they choose to focus on and relate to, and what they reject or disregard. This—admittedly reductionistic—consideration of the difference between communicative and existential theory inclines me to the view that they are substantial and probably unbridgeable. These two groups of therapists may share similar concerns but they address these concerns in ways which make concrete their different views of how human beings function, what human beings are.

I feel greatly indebted to Holmes for giving us a text which has spurred me to engage with these issues, however superficially. I believe that it will encourage others, too, to join in debate about the nature of the links which can be made between our two therapeutic approaches and I feel sure that her wise words on the therapeutic process will do much to promote greater awareness of the possible effect of frame deviations which we might otherwise disregard.

Simon du Plock

References

Cohn, H.W. (1997) Existential Thought and Therapeutic Practice.

Deurzen-Smith, E. van (1997) Everyday Mysteries: Existential Dimensions of Psychotherapy. London, Routledge.

Smith, D.L. (1991) Hidden Conversations: An Introduction to Communicative Psychoanalysis. London, Routledge.

Tupholme, J. (1998) "The Communicative Approach and Feelings of Superiority", Boundaries, No. 11, p 12.

Warnock, M. (1989) Existentialism. Oxford, OUP.