Book Review: Witness and Vision of the Therapists

The therapists contributing to this ambitious edition were given two briefs. First, to consider what, from their 'witness' of individual clients' stories, might be learnt about aspects of 'human nature' or the 'human condition'. Second, to draw out any wider, socio-political 'visionary' implications. From an existential stance, I would question the assumption that therapy can offer insights into something we might call human nature. As both Marx and Sartre emphasise, all that can usefully be said about the human 'species-nature' is that it is Protean - continually creating and re-creating itself. What I think can be learnt is how humans respond to the human condition - a concept with which I believe existentialists - like me - will feel more at ease. It may be that - as in the case of self-deception or bad faith - there are typical ways of responding to the existential 'givens' (birth ('thrownness'), suffering, anxiety, death, etc.) which could therefore (arguably) be assigned the status of 'human nature', but I do not feel anything useful is gained by calling it this. Throughout my training I have learnt that it is attending to how our clients and we interpret the world (uniquely and collectively, via mediating cultural categories) that is important. Therefore, there appears to be some tension between this emphasis on individual experience and wider social 'vision'.

As the editor states in his introduction, this book seeks an answer to the research question 'Does the witness of therapists imply or issue in visions of optimal mental health and in visions of social or spiritual change?' (p.1). As he points out: 'Each major founder of a psychotherapy school since [Freud] has drawn conclusions about what it is to be human, why we suffer and how we might individually and collectively come to live more productive lives.' (p.3). While I would want to question the use of the word 'productive', the point is valid. Self-reflection on the part of therapists - both trainees and practitioners - is assumed to be essential. It is perhaps less encouraged collectively as a profession. However, as the editor notes: 'Unless therapists at least grapple with their implicit aims, visions and personal theories, and lay these bare, they cannot make progress as an integrated profession or vocation.' (p. 7) This book is thus also a timely attempt at a reflexive look at therapy and its aims, raising the important question of what role (if any) do - and should - therapists have as agents of social change (Lee, 1999). Are therapists resistant to extrapolating from what is (descriptions emanating from their witness) to what ought to be (prescriptions for the 'good life' and how to achieve it)? Is individual empowerment or Rogerian 'actualisation' via the therapeutic process enough or should therapists do more in terms of actively promoting structural changes in social organisation, economic distribution and cultural values? Of course there are exceptions to this generalisation - gay affirmative therapy comes specifically to mind. (Todd Butler and Norman Leitman's contribution Therapy with gay men in the era of AIDS has some relevance here.)

As a relatively newly qualified and practising existential therapist, my impression to date is that much therapy has become largely insular, individualistic and in many respects elitist, with therapists apparently preferring to focus more on individual change (although this is explicitly questioned as a legitimate aim by many practitioners of an existentialist persuasion). I am sure many more experienced therapists may well disagree with this impression and I am willing to stand corrected. However, it seems the assumption is that the effects of therapy at this level may perhaps be trusted to have their own 'knock-on' effects in society at large.

As existential practitioners, however, aligned with a general philosophical position which stresses our interconnectedness and inescapable embeddedness within a material, social and spiritual world, surely we in particular are (and ought to be) sensitive to the relatedness and relevance of individual therapy to and for that wider context. In line with the attempt by some existential therapists (Cohn, 1997) to emphasise the implications of these existential-phenomenological philosophical underpinnings for the importance of working with groups, Ian Craib's paper in this collection: 'The lessons from group therapy', is highly relevant (although written from a largely psychodynamic theoretical stance).

In terms of other individual contributions to this edition, it is interesting to notice the differential weight given to either the 'witness' or the 'vision' offered by the authors. On the whole, the balance is in favour of the former - with notable exceptions. David Brandon and Jane Akister's paper on 'Psychotherapy and community care' focuses on therapeutic work in the community with traditionally marginalised groups - 'those with chronic mental-health problems, learning difficulties, multiple disabilities, those having physical disabilities, and elders' (p.29). As pointed out, such groups are seen as 'unattractive ... with very little money, power or influence' and consequently 'socially and economically excluded' (ibid). In addition, Bob Johnson's paper, 'Deeper dungeons, deeper insights', on his work with 'dangerous criminals' in Parkhurst Prison's Special Unit, provokes serious reflection on government views and policy on what constitutes appropriate responses to such individuals' disturbing behaviour. Colin Feltham's own contribution: 'In search of meaning and sanity' emphasises the spiritual and moral facets of therapy, as does William West's reflection on 'Therapy as a spiritual process'. Inevitably, the book's brief demands that we also consider the moral implications of therapy, inextricably linked as they are to our views on its aims.

In summary, this is a fascinating portfolio of individual therapists' accounts - many of which contain stimulating and thought-provoking considerations of highly important philosophical issues, e.g. the nature of suffering (Paul Gilbert) and mind and emotion (Bob Johnson). However, if anything it is perhaps overly ambitious. Maybe two 'companion' volumes - one addressed to Witness and the other to Vision - would have yielded more detailed treatises on the latter. This would perhaps necessitate consultation with a different cohort of therapists from those who, in this edition have largely provided the former.

Christina Bruckland

References

Cohn, H. (1997) Existential Thought and Therapeutic Practice. London: Sage.

Lee, C.C. (1999) Mental Health Professionals as Agents of Social Change in RACE Multi-Cultural Journal, No.19 pp 30-32.