5

Freedom and Responsibility

If people were no more than complicated machines, it would be reasonable to seek to 'cure' their neuroses by operating technically on whatever caused them. In other words, a mechanistic and deterministic stance towards psychotherapy would be appropriate.

Such a stance has, however, been rejected repeatedly in this book. It is now time that the somewhat abstract arguments which have been used to support that rejection are substantiated with rather more concrete suggestions about how we may view the processes of psychotherapy in positive terms. The particular concern of this chapter will be to provide an alternative to determinist explanations of how neurosis comes into being, and how it may be changed. The alternative offered is basically very simple: that is, that neurotic behaviour represents the personal strategies of those who enact it, and is based on free choice. This is by no means a startlingly novel view - we have already seen in Chapter 2 that several psychotherapies hold it in one form or another - but it does confront the thoughtful critic with a number of puzzling problems. For example, neurosis involves psychological distress - nobody could want to be overcome with panic every time he or she leaves the front door or gets on a bus; nobody could see hour-long rituals of compulsive hand-washing as something he has chosen to do. And if these and other neurotic behaviours are something that the person is responsible for, why can he not simply 'pull himself together'?

The difficulty with these problems and questions is, I think, that they rest on some grossly over-simplified assumptions contained in our culture. The most blatant of these is that if I do something deliberately and successfully, I am to be congratulated for the actions which I am happy to be responsible for. If, on the other hand, I do things which turn out badly or, more important, which cause me distress, I look for 'causes' outside my own agency which will make my actions 'not my fault'. Again, if I do something bad or distressing, the alternative to its being caused by something outside my control is for it to be seen precisely as being my fault. If the neurotic is not ill, he must be a liar, a coward or a con-man.

The task of this chapter, then, is to suggest a way in which we can conceive of neurotic behaviour as the personal responsibility of the individual who enacts it without involving ourselves in simplistic accusations of blame and guilt: for there is one thing which almost (though not quite) all psychotherapists are agreed upon, and that is that blame and exhortation are just about the most fruitless ways to approach psychological disturbance.

The point of this inquiry is no idle philosophical exercise simply to justify a personal dislike of mechanism and determinism. It is, on the contrary, vital to the resolution of one of the most confusing paradoxes of psychotherapy, and one which must surely have puzzled any experienced psychotherapist. For, billed as an expert in the treatment of psychological 'illness', the therapist finds himself occupying a social position - quite possibly in some kind of official institution - in which he is expected to ‘do something about’ the problems patients bring to him. His very raison d'être is based upon what may reasonably be expected of him as a skilled technician. He has degrees and diplomas, and it is considered just that he should be paid for his services. He exists in a culture which defines psychological disturbance as illness, and his very title suggests that it is in the cure of illness that his professional competence lies. And illness is, of course, something for which people can scarcely be held responsible. And yet the therapist soon finds that one of his most central concerns in his activity with his patients is to negotiate with them a view that only they (the patients) can change themselves: he has no psychological spanners with which he can adjust their misery. If they are to change they must do something.

Most psychotherapists have to some extent recognized this problem in one form or another, even when they themselves have subscribed to a basically determinist psychology. Freudian psychoanalysis, for example, is greatly preoccupied with the phenomena of 'resistance': the ways, that is, in which patients sabotage and evade the analyst's attempts to interpret their infantile aims and fantasies in a manner which will make open to them the possibility of behaving maturely and responsibly. In dealing with this 'resistance', however, the analyst has a problem, because he has to square what he experiences as the resistance of a person with the necessity of staying within the bounds of determinist science. A contemporary psychoanalytic paper¹ states the case for psychological determinism very clearly:

In the first place Freud took over the idea of determinism from the physical sciences and applied it to the psychological sphere. The assumption of psychological determinism is still a cornerstone of psychoanalytic thinking.

Briefly, it is the belief that every aspect of behaviour or subjective experience, and every aspect of the functioning of the mental apparatus, can be seen as the outcome of the events (psychological as well as non-psychological) which precede it. It implies that theoretically it should be possible to predict and to understand a psychological 'event' in terms of all the forces operative at the time and which have operated in the past. While this is theoretically so, practically such precision is impossible, although psychoanalytic psychologists make the assumption that every psychological manifestation or experience stands in a definite and theoretically explicable relationship to the whole of the person's psychological life. Psychological determinism has sometimes been referred to as the principle of causality. Determinism is, of course, an assumption which has been generally made in science.

And:

Psychological determinism has sometimes been seen as being in conflict with the idea of 'free will'. This conflict has, on the whole, been exaggerated. An individual may possess a high degree of internal security, and be in a position to exercise his judgment consciously in regard to which of a number of courses he will pursue. Nevertheless, the assumption of psychological determinism could still apply to his final decision, in that one could regard that decision as the outcome of the operation of many factors, including those entering into his assessment and judgment of the situation. However, because of the existence of unconscious mental functioning . . . the psychoanalyst would still take the view that many actions which appear on the surface to be a consequence of free acts of will are inevitably determined by the influence of unconscious psychological forces acting on the individual.

It would be surprising if this formulation did not place the analyst and his patient in an almost impossibly paradoxical situation. If the patient's behaviour is seen as being determined by 'forces' operating ‘on’ him, it seems scarcely reasonable for the analyst to characterize this to him as 'resistance'. And the patient himself might justifiably feel aggrieved at imputations of resistance to his conduct, when the theory itself suggests that his conduct is not conduct at all, but reaction to forces operating on him. Of the two, the psychoanalytic concept of resistance is far more valuable than that of psychological determinism, but to be useful it must be seen in the context of conduct, or activity, for which the patient is responsible. How it can be seen as such will, I hope, become clear as we proceed.

Patients themselves, once they have been through a psycho-therapeutic experience, seem less embarrassed about acknowledging their behaviour as responsible action than is often the case with their therapists. We have already noted in Chapter 3 that successful therapy patients accept the importance of 'facing' problems and 'shouldering responsibility'. Writers on the psychotherapeutic process, even when they agree with this view, are often more cautious, presumably because of their scientific scruples. Frank, in the book already referred to, speaks of the importance in therapy of enhancing the patient's 'sense of mastery', apparently balking at the prospect of actual mastery. Even behaviour therapists have become concerned with the conditioning of 'self-control' responses - showing thereby, perhaps, an admirable regard for the pragmatics of therapy, even if a blithe disregard for theoretical consistency.

In many ways, of course, the Unconscious of psychoanalysis and the conditioned reflex of behaviourism have been created precisely in order to preserve determinism in psychology and psychotherapy.

If the psychologist or therapist is to be an expert in something, it must be something in which his subjects or patients are not expert, something which can be known and manipulated by the expert for purposes of prediction and control. Thus, when the analytic patient claims that he is acting for some conscious purpose, he can be told that his actions are 'really' the result of some unconscious wish; he cannot successfully challenge the analyst's view, because only the latter understands the mechanics of unconscious processes.

Similarly, the behavioural expert controls the patient by controlling the 'reinforcement contingencies' (the rewards and punishments) which operate upon him.

These theoretical positions are, of course, no more than scientistic bluff. We have already seen that the psychological scientist is not in the same position as he imagines the natural scientist to be. If he attempts to predict and control his subject-matter (people), the latter is perfectly free to observe his operations and out-manoeuvre him. The psychologist can only possibly maintain his position by keeping his scientific theory and method absolutely secret: his predictions can only avoid deliberate refutation by being kept from their objects; his measuring instruments (intelligence and personality tests, etc.) can only be effective if potential subjects are kept in ignorance of their contents. While psychologists can, and do, manage to keep a measure of secrecy about their operations, this is not easy in face-to-face, relatively unstructured procedures like psychotherapy, and patients quickly learn what their therapists are up to. If the therapist resorts to bluff in this situation, if he attempts, as it were, to render his patients amenable to control by suggesting that they are unconscious in a way in which he is not, he is liable rapidly to find his bluff being called. The bluff can most easily be called by the response: ‘all right, then, cure me’.

The idea of psychotherapy as a technical operation on the causes of neurosis can in some ways, then, be seen as the upshot of a collusion between treaters and treated. It suits therapists because it accords with their social accreditation as experts, as well as with their idea of what it is to be scientific; it suits patients because the alternative would be for them to feel that their neurosis was their fault. This collusive idea is, however, negated in the actual course of psychotherapy, in which therapists find themselves, willy nilly, appealing in some way or other to their patients to take responsibility for themselves and change their behaviour, and patients, correspondingly, find themselves with the prospect of having to do something.

Partly because of social and cultural expectations, many of which have been deliberately fostered by psychotherapists themselves, and partly because it suits them, patients tend, on initial contact, to present their therapists with problems, in the anticipation that the therapist will find the corresponding causes and remove them through technical intervention. The problems which patients present vary in specific terms over a wide range, but in general terms they can perhaps be split into two or three broad categories. Most patients come to the psychotherapist via a chain of medical referrals, originating with the general practitioner and progressing through various contacts with psychiatry. This inevitably means that many of them will have every justification for seeing their problems in terms of illness, and they are likely to couch their description of them in terms of more or less physical symptoms. Anxiety, depression and fear are naturally describable in terms of their physical distress are often what the psychotherapist first hears about.

Stomach pains and nausea, headaches, dizziness, dryness of the mouth, palpitations and tension, inexplicable feelings of panic arising apparently out of the blue, uncontrollable weeping, all these are symptoms which may seem relevant to a primarily medical frame of reference, and patients may present them in the expectation that some kind of medical intervention will prove effective. By the time they reach the psychotherapist, however, it is likely that purely medical remedies, such as the use of drugs, will have proved more or less useless. In cases where the problem is cast directly in terms of psychological distress - fear, compulsion, lack of control, etc. - patients are likely to adopt a further hypothesis offered them by the experts: namely, that there is something causing their problem and that, if 'it' can be discovered, the problem will somehow go away. In this respect, they may expect the therapist to discover some forgotten childhood trauma buried deep in 'the subconscious', some psychological violence done them by their family, some deep-seated fear of which they are unaware, the unearthing of which will, like lancing a boil cause the distress to evaporate.

It is, therefore, often with surprise and resentment that patients learn that matters are not that simple; that, for instance, an understanding of the history and origination of a complaint does not automatically remove it, or that there is no wonder-drug for the removal of their symptoms. They may be puzzled and hostile if the therapist responds to their presentation of the problem by probing into its meaning for them, rather than by accepting it at face value and launching straight into a course of 'treatment'. If, further, he suggests that the significance of the problem may lie in what it is achieving for them, hostility may turn to outrage, and rejection of the whole therapeutic enterprise. As Landfield puts it² :

A psychotherapist who wishes to convince people that each person must bear some responsibility for his problems as well as his cure works against heavy odds. His underprivileged patients learn early that life has limitations.

They also learn that treatment for them is largely custodial and medical. His more privileged clients do learn that professionals will talk with them about their problems. However, they also learn from the pamphlets circulated by associations for mental health that an emotional problem is sickness…for which the person is often not responsible. A corollary to this type of logic suggests that if one is not responsible for one's problem, then one assuredly cannot be held responsible for one's own cure. To further complicate the therapist's task of encouraging his clients to assume more responsibility for their lives, the 'body' theorists attribute the cause of behaviour to genetics and spleen, while the 'environmentalists' attribute cause to external circumstances.

This, then, is the predicament commonly faced by the psycho-therapist who is willing to remain true to his experience. He has to convince his patients that their neurosis is something to do with their own agency, something which can only be changed through their acceptance of responsibility for it.

The predicament has not gone unrecognized. One approach quite widely adopted by therapists is to negotiate some kind of 'contract' with patients, in which the aims of treatment, as well as their own responsibilities, are stated as clearly as possible at the outset. In the hospital setting, for example, Cooklin³ has suggested how staff and patients may initiate the therapeutic process by examining and exposing any unrealistic expectations of passive 'cure', and agreeing aims of treatment which, with his active participation, it may be possible for the patient to achieve. Scott⁴ gives an account of the problems presented by the 'medical' expectations which patients often have. He sees these as bearing closely upon patients' wishes to see themselves as not responsible for their problems, but rather as victims of illness, of society, or of the family. He suggests ways in which the hospital ward setting can be designed to counter these expectations, or 'barriers to treatment', as he calls them, and lead to more adaptive and successful strategies. Staff may, for example, avoid 'doing things for' patients as if they were ill, or not responsible, and may resist also any attempt made by patients' families to define the hospitalized member's behaviour as 'sick' rather than, in some sense, intentional.

Which brings us back to the problem we must now face squarely. How can somebody want, or intend, to be psychologically disturbed? Can we justify a rejection of the humane notion of 'mental illness' and its replacement by a notion of personal responsibility?

No one, I think, would wish to maintain that an individual is neurotic 'on purpose', in the naive meaning of that expression. It is, nevertheless, a common experience of psychotherapists that patients resist getting better, and it is greatly to Freud's credit that he gave so much attention to this phenomenon. The resistance may be encountered, for example, in the form of patients failing to conform with suggestions from the therapist about how their treatment might be furthered (such suggestions might centre on things they could do easily enough, like keeping a diary of troubling events or symptoms, or learning relaxation techniques at home), or might simply be experienced in patients' failure to keep appointments, especially at times when some improvement seemed to the therapist to be imminent. Yet this does not seem to be a matter of simple dishonesty: there seems somehow to be both an apparently genuine wish to 'get better' and an apparently genuine resistance to getting better when it seems possible to do so. While the resistance may be denied by the patient (again apparently genuinely) his actions appear undeniably to be aimed intelligently, and often tenaciously, at just such resistance.

Perhaps a concrete example might at this stage help to clarify much of what has been said so far, as well as aid subsequent discussion. As in other clinical examples used in this book, it is based on my own experience, but for obvious reasons does not constitute an accurate account of the problems or circumstances of any one particular individual.

A young, attractive woman complains that she is sexually frigid. She has three small children (conceived in the interests of procreation only) and a husband who is sympathetic and understanding, and whom she 'loves very, very much'. He is the only person she has ever slept with, and they were married at an early age.

She has never enjoyed sex positively, either before or since marriage, although once, when they were on holiday in the Canary Isles, it was half-way bearable. Apart from getting no pleasure from sex, she finds it painful. Her first explanatory hypothesis is a physical one: she believes that she must be 'too small inside'. She goes to her general practitioner, who sends her to a gynaecologist. The latter examines her and assures her that she is anatomically normal. She goes back to her general practitioner who prescribes drugs 'to help her relax'. These are to no avail, so her doctor sends her to a psychiatrist, who prescribes different drugs. These do not help either. The psychiatrist now refers her to a psychotherapist who suggests that she come to a therapeutic group. She attends the group for six months. Both she and the group members are puzzled by her complaint: she is not unduly prudish or sexually inhibited in an obvious way, though she reflects that her parents are on the puritanical side, and that sex was a taboo subject at home.

Examination of this in the group is exhaustive, but discussion of the problem, in which she herself shows no undue embarrassment, leads to no improvement. A few weeks later she reveals, with considerable hesitancy and pain, that she was 'interfered with' by an elderly male relative at the age of five or six. The group members accept this revelation sympathetically, and one or two of the other women in the group confess to similar experiences. For some weeks this new information is examined for its significance in terms of what it may have done to her relations with men, and some discussion attaches to the rather seductive and yet rejecting, 'teasing' way she relates to the men in the group. This seems to clear the air a lot, but there is still no change in her sex life with her husband. After six months, the patient, the group and the therapist all feel that the best approach would be for her to have some marital counselling, together with her husband. The method to be tried involves discussion, as well as some quite practical counselling on sexual technique, as pioneered by Masters and Johnson⁵. She is enthusiastic about this, and consequently the therapist meets her and her husband for weekly sessions.

At this point, having in previous months run through a series of hypotheses about what 'it' could be, the first signs of resistance begin to emerge. The patient finds reasons why the sexual exercises to be conducted with her husband cannot take place, although there is a week between therapy sessions in which to find time for them.

Her husband strikes the therapist as an exceptionally tolerant and understanding man, who is doing conscientiously everything he can to co-operate in treatment. He is somewhat bemused by the development of his wife's apparent lack of enthusiasm, especially after her initial keenness. The therapist encourages the couple to continue, feeling that the wife's problem may simply be some fleeting embarrassment about the project. The following week she telephones the therapist asking him to see her on her own, to which he agrees. At this interview she bursts into tears (which she has never done before) and says that she has come to see her problem in an entirely new light. She is not sexually frigid and, she now realizes, never was. She does not love her husband, and never has. She finds him physically repulsive. She does love the next door neighbour, however, and always has. Nothing has passed between them, but whenever she sees him, her knees 'turn to jelly'. She realizes that she kept herself from recognizing the problem because of what it entailed: she does not want to become involved in the upheaval of breaking up her marriage - she has nowhere to go (as far as she can tell the next door neighbour is quite happy as he is), and she does not want to destroy the happiness of her three children, who love their father.

Suddenly, then, a 'symptom' becomes an acknowledged problem of relationship, an agonizing difficulty, but in no way a mechanical break down - either physical or psychological. Moreover, the realization of her predicament burst upon this woman like a bomb - up to that point her search for 'causes' had been as diligent as that of all those who, for a total of seven or eight months, had been therapeutically involved with her, and only the threatening 'cure' of her frigidity with her husband led to her recognition of the true state of her affairs. The 'cure', naturally, had to be resisted, as there was no real problem to which it corresponded: she was not 'frigid' at all.

Her 'frigidity', as long as it was left in peace, did, however, serve to keep her from an infinitely more difficult, though in no way pathological, predicament. Somehow or other, her left hand had managed to keep her right hand from getting to grips with that predicament, until the strategy became exposed by the direct challenge posed by marital counselling.

Somehow, then, and often in neurosis, a person may conceal from himself the motives of his own behaviour: he can attribute to external causes behaviour which is in fact purposive or intentional, and so escape responsibility for it.

To understand how this is possible, we have to correct the idea that actions are things which we perform in the full light of awareness, things to which conscious intentions and motives are particularly appropriate, while things we do 'without knowing why' are the automatic products of causes which we carry round like stones inside us, or which are imposed upon us by outside influences, and for which we cannot be answerable. In fact, satisfactory elucidations of this problem are readily available in the work of a number of philosophers, particularly those of the existentialist school. Much of what follows leans heavily on these ideas, and in particular on the views expressed by Jean-Paul Sartre in his Being and Nothingness.

The central point made in this context by Sartre, and others, is that human activity cannot be divorced from its meaning, and its meaning involves its intention. An action without a meaning ceases to be an action at all, but becomes simply a meaningless movement.

Actions, moreover, do not have to be carried out consciously - indeed, much of our meaningful, intentional activity is carried out without any conscious deliberation on our part. This is fairly obvious with trivial activities like combing one's hair or changing gear while driving, but is also true of the much broader 'projects' in which one might be engaged - I live my life as though it had meaning, but would be hard put to it to say what the meaning was. Movements have a quite different quality from voluntary action. If you jog my elbow, my spilling coffee on your carpet can scarcely be seen as involving intentional behaviour on my part. Acts are intentional, movements are caused. If, then, you wish to replace intentions with causes (as, for example, the behaviourist would) you render action meaningless. This, in many respects, is precisely what the neurotic tries to do: to negotiate a view of his activity as meaningless movement. Such a strategy is only persuasive if we insist that activity has to be consciously acknowledged.

To say that activity need not be consciously acknowledged is not to say that it must therefore be unconsciously caused. The activity is its meaning and its intention. We split off our intentions from our actions only when we reflect about them, and this is in many ways an artificial process. It is only when we reflect upon our activity that we ascribe conscious motives and intentions to it; we treat what is in fact an integral part of our action as if it were an antecedent cause it because, after we have done something, we can see that we had reasons for doing it. Sartre states the case as follows⁶:

It is in fact impossible to find an act without a motive but . . . this does not mean that we must conclude that the motive causes the act; the motive is an integral part of the act. For as the resolute project toward a change is not distinct from the act, the motive, the act, and the end are all constituted in a single upsurge. Each of these three structures claims the two others as its meaning. But the organized totality of the three is no longer explained by any particular structure.

Conscious motives and intentions are, then, constructs we invent to account for what we have done, they are not things which we necessarily have to consider before we can act. (I have on several occasions found it of practical help to make this point to patients who are poised on the edge of a rather anxiety-arousing course of action, but who interpose between themselves and it the necessity for 'making a decision', which they then find they are unable to do; which perhaps goes to show that philosophical points are not necessarily irrelevant to immediate practical concerns.) Action, in fact, must come before deliberation in at least one important sense, as Shotter makes clear⁷:

...before anything can be done with reason and deliberation it must first be done spontaneously; it is only as natural agents, not as self-directing persons, that we could discover any entirely new potential within ourselves. We cannot direct ourselves towards their discovery, as there is no way of knowing, before they are actualized, what our potentialities are. It takes what we have always suspected it takes . . . courage. For to actualize new potentials we have to cast ourselves into new situations, suffer the effects they have upon us, and counter them as best we can - all the time, as mere spectators, observing ourselves and noting the results, being determined the next time the situation arises to do deliberately that which in this situation was successful spontaneously.

Here, then, is an observation fundamental to our problem: viz., that, despite superficial subjective impressions, human action does not always follow deliberation, and quite often the explanations we give for our actions have to be found (almost invented) after the event. In this way, we frequently cast around for reasons for our actions much as we might for reasons for the actions of others. We arrest ourselves in mid flight in order to justify our course so far, and, having done so, we delude ourselves if we are not careful that our justifications are causes, and that our behaviour has all along been consciously planned. Of course, it is possible to plan one’s behaviour before enacting it, but that does not mean that one always does, neither does it make the plan a cause. And even in the case of planned activity, the reasons for planning it this way or that need not be, and indeed often are not themselves clear or explicit (in the case of obsessional behaviour, for example, long chains of carefully planned activity can be carried out for reasons which are totally obscured).

As Sartre points out, deliberation, far from being the ultimate source of our activity, the mainspring lying at its centre, need be no more than a relatively unimportant stage in our reflecting over our actions. And even when we do appear to will an action deliberately, there lies behind that will, as he says, 'a more profound intention' of which we are not aware. Consciousness of one's actions is always in the setting of a 'project' which is not conscious of itself in the same sort of way. Our ultimate projects are achieved, Sartre argues, by our living them, not reflecting about them. Much of Being and Nothingness makes somewhat impenetrable reading. The following passage, however, makes the point clearly enough:

I can assume consciousness of myself only as a particular man engaged in this or that enterprise, anticipating this or that success, fearing this or that result, and by means of the ensemble of these anticipations, outlining his whole figure. Indeed it is thus that I am apprehending myself at this moment when I am writing; I am not the simple perceptive consciousness of my hand which is making marks on the paper. I am well in advance of this hand all the way to the completion of the book and to the meaning of this book - and of philosophical activity in general - in my life. It is within the compass of this project (i.e. within the compass of what I am) that there are inserted certain projects toward more restricted possibilities such as that of presenting this or that idea in this or that way or of ceasing to write for a moment or of paging through a volume in which I am looking for this or that reference, etc. Nevertheless it would be an error to believe that there is an analytical and differentiated consciousness corresponding to this global choice. My ultimate and initial project - for these are but one - is, as we shall see, always the outline of a solution of the problem of being. But this solution is not first conceived and then realized; we are this solution. We make it exist by means of our very engagement, and therefore we shall be able to apprehend it only by living it. Thus we are always wholly present to have an analytical and ourselves; but precisely because we are wholly present, we cannot hope to have an analytical and detailed consciousness of what we are⁸.

Our activity, then, in so far as it is activity and not meaningless movement, is saturated everywhere with intention, as an integral part of it, whether or not we recognize it consciously.

The therapist's first task must then be to decide whether his patient's behaviour is activity or merely movement. The latter alternative is certainly not impossible - it may be that the nervous tic which a patient complains of is the result of organic disease interfering with his motor activity and thereby rendering aspects of it meaningless. If, however, the therapist decides that the patient's behaviour does indeed represent activity, his job then becomes one of helping the patient to investigate what he is intending by it, and to see that his conscious protestations and justifications, when these conflict with the intention of his actions, have in fact no impelling claim to be considered as more real or more genuine than, or in any way necessarily prior to or invalidating, the 'intending behaviour'.

A patient's activity, then, whether or not he is aware of it, has a meaning which can only be understood in terms of its intention. He has reasons for behaving the way he does, and while reasons may be a certain kind of cause, they are not causes in the sense of inexorable forces operating on the individual - they are causes he chooses.

Passive reflection is by no means the best method of discovering what one's intentions are - one has to learn to read off the meaning of one's activity (its intention) in much the same way as one reads the intentions of others, i.e. by observing the effects of their behaviour on the world around them. The relation between action and reflection is of course a complex one, and in our observation of ourselves we are constantly interpreting and reinterpreting the meaning of our actions (especially when they do not turn out very successfully). We shall be examining this problem in a little more detail in the next chapter, largely because it is a problem which lies at the very heart of neurosis: it is in the way we explain to ourselves the meaning of our actions that we have the greatest opportunities for self-deception. But for the moment, enough may have been said for us at least to be able to accept that it is by no means obvious that we can expect to know what the intentions of our actions are.

Of course the neurotic does not want the distressing mental and physical experiences to which his anxiety gives rise, but at the same time it is necessary to recognize that they are the result of strategies which he is carrying out, and which are directed at a certain end.

This is by no means to say that he wants to suffer for, say, masochistic reasons, but rather that the broader intention of his activity inevitably involves suffering. In order to avoid social confrontations (an aim which, for one reason or another, he is unable to acknowledge), he, as it were, makes use of the bodily accompaniments of anxiety (tension, gastric pain, etc.) to turn his fear into an illness which provides a social justification for not going to parties, facing difficult situations at work, and so on. Absence of the physical distress he experiences would, in other words, bring him face to face with a kind of distress he would be much less willing to experience. He clings on to his symptoms not out of any bloody-minded stubbornness (which perhaps the notion of 'resistance' is liable to evoke) but because he has very good reasons to do so. In order to change, he must find equally good reasons for abandoning his symptoms, and that is why he cannot simply 'pull himself together'. Being unable to change at the drop of a hat does not, therefore, imply that your behaviour is hopelessly determined by leaden causes, but that you have very good reasons - of which you do not have to be aware - for staying the way you are.

It is of course true that seeing that you have good reasons for being the way you are may go some way to convincing you of the possibility of change, and this presumably is the value of 'insight' in psychotherapy. But on its own it is not enough. Moreover, seeing what your reasons are may not even be essential to change. Accepting that you have reasons, even though you can't identify them may be the more essential first step towards change. This can, I think, be cast in terms of accepting responsibility for your conduct, even though you don't know why you do it.

In some ways, to ask somebody to accept responsibility for conduct they do not themselves understand may not be such an unusual request as it appears. It is not uncommon, for example, for a person to accept responsibility for a mistake. Mistakes are not something we make on purpose, and yet we still make them - if we are not ourselves responsible for them, who is? Again, if babies and small children were not held responsible for their actions, they would be unlikely to develop the kinds of skills we expect from them as adults.

In this way, perhaps, we can draw an analogy between neurotic behaviour and the behaviour of children which may go some way to clarifying the relation between responsibility and blame. This is particularly important if we are to provide an acceptable alternative to the 'illness' model of neurosis, that is, one which does not result in inhumane (and obviously inaccurate) accusations that neurosis is the individual's 'own fault'.

We do not expect small children to develop motor co-ordination and social skill without practice. We therefore do not blame them for being physically clumsy or socially gauche. And yet we do expect them to identify the source of such behaviour (as their own), and in this respect to acknowledge responsibility for it. A child who breaks a teapot because he is more interested in looking out of the window than attending to the angle of the tray (involved, that is, in a broader project than that of clearing the table, but one which nevertheless has consequences for the success with which the latter is done) may not be blamed for breaking it, but nevertheless may be forcefully reminded that it was he who did it. In this way, too, the adult readily recognizes the absurdity of the child's claim that 'it wasn't me', and will probably reflect that that claim stems from a fear of blame. In many ways this is precisely the position of the neurotic who fears that his behaviour, if seen as his, will carry an immediate imputation of blame. And yet, of course, he cannot be blamed any more than the child for behaviour over which, though he is responsible for it, he has not yet gained mastery.

The person, then, is responsible for his neurotic behaviour, and has good reasons for it. Having accepted this, he then has to do something about it; as well as developing reasons for abandoning it, he will have to involve himself actively in overcoming it, in mastering it. Just as it is possible, through reflection, to delude oneself about one's intentions, so it is possible to delude oneself that one can change one's intentions reflectively in a way which will result in new activity. 'Knowing what the problem is' does not, in other words, automatically enable the person to deal effectively with it. The foundering of New Year resolutions provides a common example of this observation. To challenge his symptoms, face his fears, learn new social skills, requires that the neurotic confront them bodily, and no amount of rumination can achieve this for him. And what he needs above all for this is courage.

If we were simply the victims of causes operating upon us, we should not need courage to deal with what we find psychologically distressing - we should simply need to seek out technical help in getting the causes of our behaviour identified and changed. Since, however, neurotic behaviour involves intentional activity, only the person himself can change it, and that requires effort (courage) on his part. The therapist's role in this then becomes not one of technical manipulation - he does not change the patient - but one of encouragement (here again one is reminded of the words used by patients themselves when describing what they find useful in psychotherapy).

In many respects this provides a more satisfactory theoretical framework in which to place what have largely been seen as therapeutic techniques than that afforded by traditional psycho- therapeutic and behavioural theories, since it reflects more closely what actually happens in therapy. The methods of behaviour therapy - systematic desensitization, social skills training, and so on - can in this way be seen as procedures of encouragement rather than as conditioning techniques, and indeed in this respect behaviour therapy has a great deal to offer. Such methods open up to the patient ways in which he can confront his problems bodily and deal with them actively and directly. Once we have jettisoned the simplistic dogma of science it is supposed to support, the behaviour therapist's emphasis on behaviour is in this way crucial, since it enables us to recognize the therapeutic necessity for the patient actually to do something, to operate actively on his experience. This is certainly an important advance on the idea that changes are made by juggling with the intrapsychic contents of the person's 'unconscious'.

There is perhaps a sense in which the procedures whereby a therapist may encourage a patient to get to grips with his predicament, to challenge his fears and actively to experience their resolution, may be seen as technical, but technical in a weak sense.

They do not reflect laws of behaviour or the determining influence of conditioned reflexes, but may be seen as flexible strategies which may or may not prove useful to the individual, and they must always be set in the context of the meaning he attaches to them. The bather may deal with the cold sea either by inching into it gradually (behavioural 'systematic desensitization') or by plunging in headlong (behavioural 'implosion'). The method he chooses depends on him, and to elevate either to the method would cause a lot of people a good deal of discomfort (not to mention the fact that it is also possible to stay on the beach, or to reserve one's bathing for heated swimming pools).

The therapist who sees his role as purely technical is likely to approach his patients with a kind of psychological tool-kit which, once he has exhausted its capabilities without success, will leave him despairingly bereft of ideas. On the other hand, the therapist who sees his 'technical' activity as flexibly in the service of the general aim of encouragement, will be able to adapt his strategies to the unique set of meanings generated in the relationship between himself and his patient - he will be able to make new tools without, for example, worrying about whether they conform to specifications established by the 'laws of behavioural science'. As long as they fit in with the patient's personal set of meanings, as long as he can use them, they will fill the bill quite adequately.

The patient who has the courage to face his problems, to confront them bodily, will discover his freedom to change in his own experience, and will acquire reasons for behaving in ways that he had formerly felt not to be possible. He may also, of course, opt for staying as he was before, but if so he can no longer deceive himself that he is not responsible for doing so - the choice is freely his.

All this, naturally enough, has implications also for the ethics of psychotherapy. If both therapist and patient are looked upon as each independently responsible for their own conduct - whether or not they are able consciously to specify their aims - it becomes, as we have seen, impossible to characterize psychotherapy as a technical procedure. The therapist becomes a guide rather than an expert, a fellow investigator rather than an authority. While he will certainly have influence, his job is not to influence his patients towards any particular ends, but to help them acknowledge their own freedom, to recognize that the responsibility for what they do resides with them, and not him. It is unlikely that anyone who accepts the validity of this standpoint will be particularly concerned with the removal of 'symptoms'. 'Illness' behaviour is likely to be seen as strategic, and the therapist will be much more interested in what the patient means by his symptoms than he will in simply removing them mechanically.

Indeed, he will recognize that, unless there are compelling reasons to believe that the patient's symptoms are in the strict sense unintentional and without meaning (because physically caused, for example), it would be absurd for him to try to remove them.

The therapist must also recognize that he is himself inevitably subscribing to a moral standpoint, i.e. that it is right for him to lead people towards a recognition of their freedom. Whether this is a worthier aim than that of, say, conditioning people to being contented and productive members of society, 'adjusted' in their work and play, is entirely debatable. But it is not a less valid aim in the sense of being less scientifically respectable or credible. Indeed, that people are free, that their behaviour is not simply determined by their biochemistry or conditioned through their 'reinforcement history', conforms more closely to the experience of psychotherapy, and hence to the model of science developed in the previous chapter, than do many competing views.

The therapist who adopts this viewpoint and this moral position is likely to be less concerned than many about what patients do with their freedom, and will be prepared for therapeutic outcomes which a few years ago, if not now, might have been frowned upon in more conventional psychiatric circles. A patient may, for example, come to see his or her marriage as hopeless, and get divorced; a person who expresses a wish initially to be 'rid' of homosexual feelings or behaviour may come to accept and value them.

Because of his belief that people's 'wants' and 'needs' are not necessarily a total account of their intentions, such a therapist is unlikely to accept patients' initial versions of their predicament at face value, and he will always run the risk of events unfolding during therapy which were not foreseeable. The most alarming possibility he has to envisage is perhaps that of a patient's suicide. It is clearly possible that a person could come, through therapy, to see that his 'neurosis' was hiding from him a set of circumstances which he now finds unbearable, and that suicide is a solution within the range of his capabilities. Few therapists are likely to see a patient's choice of suicide as a satisfactory solution, however, and this suggests that there may be more to therapy than just encouraging people to accept responsibility for themselves. In recognizing that he is responsible for his own conduct as much as patients are for theirs, the therapist is likely to make use of his experience to arrive at judgements about what a patient might do with his freedom in cases where a highly negative outcome seems possible, and to decide whether or not he should enter into therapy with him. He does not, after all, have to apply his theoretical and moral position absolutely inflexibly, and where neurosis hides a predicament of possibly unbearable proportions, he may decide that practical help and support may be of greater value than encouraging its recognition.

The suggestion here that therapists are not responsible for their patients, but only for their own conduct towards them, by no means lets them off any moral hooks. Indeed, feeling that you are responsible for what you do with people may make you considerably more concerned and cautious than feeling that you are directly responsible for them or for what they do. In the latter case you would place your trust in your technical skill in controlling the patient manipulatively; in the former you have to recognize that he is free to use your influence in ways you might not be able to anticipate.

1 Sandler, J., Dare, C. and Holder, A. (1972). Frames of reference in psychoanalytic psychology. III A note on the basic assumptions. British Journal of Medical Psychology, 45, 143.

2 Landfield, A. W. (1975). The complaint: a confrontation of personal urgency and professional construction. In D. Bannister (ed.). Issues and Approaches in the Psychological Therapies. London and New York: Wiley.

3 Cooklin, A. I. (1974). Exploration of the staff-patient 'contract' in an acute female admission ward. British Journal of Medical Psychology, 47, 321.

4 Scott, R. D. (1973). The treatment barrier. British Journal of Medical Psychology, 46, 45.

5 Masters, W. H. and Johnson, V. E. (1970). Human Sexual Inadequacy. Boston: Little Brown.

6 Sartre, J.-P. (1969). Being and Nothingness. Trans. H. E. Barnes. London: Methuen, p.437. Reprinted by permission of Philosophical Library, Inc. Copyright © 1956 by Philosophical Library, Inc.

7 This quotation is taken from an article (Psychology and Psychotherapy Association Forum, 1974) which is not generally available. Shotter has however written a very readable book which covers this and related issues in philosophical psychology: Shotter, J. (1975). Images of Man. Methuen Essential Psychology series.

8 op. cit., p. 462.

6

Self-Awareness and Self-Deception

In the previous chapter we considered how a person may be engaged in intentional activity while genuinely believing that his behaviour is due to causal factors beyond his control. In this way, there is a contrast between his actual activity and what he tells himself about the reasons for it. In this chapter we shall consider a related phenomenon: instead of looking at the reasons why a person behaves the way he does, we shall look at what he does, and how what he does appears to him as he reflects upon it.

In the discussion which follows we shall be examining the conditions under which a person may be said to know what he is doing, the main point being that sometimes he does and sometimes he doesn't, but that there is in any case no reason why he always should. Much of the time, in other words, we do not know what we are doing, and that in itself is neither unusual nor alarming.

Clarification of this issue is essential to an understanding of neurosis, for one of the most frequent strategies employed by neurotic individuals is to maintain that they are not doing what they appear to be doing, or, alternatively, that not knowing what you are doing constitutes an unusual or unsatisfactory state of affairs characteristic, for example, of illness. To complicate matters further, the fact that people can, in certain circumstances, know what they are doing is taken in some brands of psychotherapy to suggest that knowing what you are doing is a good thing. I shall argue that this, unless suitably qualified, is unfortunate.

Any psychotherapist with experience of neurotic patients is likely to have been impressed again and again by the extreme incongruity which often arises when a comparison is made between what a patient is doing and what he or she professes to be doing. The significance of the person's activity seems, that is, to be lost on the person himself. The ways this can take place vary, but at times the incongruity is so great that the therapist can barely resist the impression that deliberate deception is involved. For example, a woman claims that she has a 'phobia' of choking, and so is unable to eat anything solid. Her greatest fear, she says, would be occasioned by eating boiled sweets. And yet she arrives for only her second therapy session with a peppermint boiled sweet rattling cheerfully against her teeth. She does not claim to have improved, and is still as afraid as ever of choking. When asked about the sweet in her mouth she looks somewhat puzzled for a while, and then answers blandly that peppermints 'don't really count'.

Again, one can be faced with the kind of incongruity shown in the behaviour of some 'anorexic' patients, who may be resorting to the subtlest of subterfuges in hiding food or otherwise contriving not to eat it, but at the same time showing genuine terror at the prospect of approaching death from starvation. Less dramatic, perhaps, but no less puzzling, is the frequency with which patients simply fail to make connexions between their own activity and what, from their point of view, 'happens to' them. The man who is assailed by nausea every time he is due to become involved in a social engagement, and who is prepared to undergo surgery rather than consider the meaning of his predicament, even though the latter seems obvious to everybody but him; the woman who 'inexplicably' wanders off and loses her memory every time her mother and her husband fall foul of each other; the flamboyant redhead who becomes almost incoherently anxious and bemused after being sexually assaulted by three different men in the space of as many months, and yet still persists in the highly seductive behaviour which presumably led to the incidents in the first place. In its own way compulsive behaviour - rituals of washing or dressing, for example - is equally puzzling. The person 'knows' that his behaviour is 'silly', the fears on which it is based not really justified, and yet he feels compelled to persist. If he cannot simply stop washing his hands, must it not be because he is ill?

Our task, then, is to justify the suggestion that there is nothing fundamentally unusual or qualitatively different from normal about such incongruities as these, except that the neurotic is making a special kind of use of what is in fact a familiar condition of human psychology.

The classic psychological explanation of how somebody can be doing something of which he himself remains in ignorance is that offered by Freud in his concept of 'repression'. For one reason or another - usually because recognition of what he is doing would prove painful or threatening to his self-esteem - the person is protected from confrontation with the real nature of his enterprises through the operation of a defence mechanism which 'represses' its significance, i.e. renders it 'unconscious'. Freud distinguished between two types of repression: 'primal repression' and 'repression proper'. In the case of primal repression, unconscious mental contents are prevented from becoming conscious through the activity of a kind of mental 'censor', a metaphorical watchman who stands at the gates of the conscious mind with the purpose of rejecting or ejecting unacceptable ideas or impulses which seek to find their way into consciousness. Repression proper is the process by which contents of the conscious mind can be made unconscious. This is achieved by their having withdrawn from them the mental energy needed to keep them conscious.

Stated in this somewhat bald manner, there is clearly rather a simplistic mechanism about the concept of repression which leaves a number of important questions unanswered. How, for example, are the decisions to reject unconscious contents made, and how is withdrawal of mental energy achieved? What, indeed, does 'mental energy' consist of? How do unconscious mental contents exercise an influence over the person's actual activity? Unsatisfactory though Freud's answers to these questions may often seem to present-day psychologists, he does, in one particular passage,¹ elucidate the problem in a way which foreshadows a number of modern approaches, and which may considerably aid our own discussion:

We now seem to know all at once what the difference is between a conscious and an unconscious presentation. The two are not, as we supposed, different registrations of the same content in different psychical localities, nor yet different functional states of cathexis [mental energy] in the same locality; but the conscious presentation comprises the presentation of the thing plus the presentation of the word belonging to it, while the unconscious presentation is the presentation of the thing alone. . . . Now, too, we are in a position to state precisely what it is that repression denies to the rejected presentation in the transference neuroses: what it denies to the presentation is translation into words which shall remain attached to the object. A presentation which is not put into words, or a psychical act which is not hypercathected, remains thereafter in the Ucs [Unconscious] in a state of repression.

What Freud is saying, put simply, is that we can behave unconsciously as long as we do not attach words to what we are doing. What he fails perhaps to stress is that this is by no means only a pathological process, and that, furthermore, when we do succeed in attaching words to our activity, when we give a reflective account of what we are doing, the result is frequently for us to mislead ourselves as well as others.

Experience is prior to language. Language elaborates and reveals our experience and allows us to operate upon it, but just as it can be used positively in this way, so it can be used negatively by misidentifying the significance of our experience. This negative use of reflection is particularly evident when we seek to transform an understanding of what we are doing into a kind of identity.

This latter point is made particularly convincingly by Sartre in Being and Nothingness, where he develops his concept of 'bad faith'.

What people are, Sartre says, lies in their pre-reflective, continuously unfolding activity, and what they say they are can only be a particular version of themselves which they are offering for public, or even merely their own, consumption. What I say I am is always set in a broader activity in which I am engaged, and which I cannot at the same time comment upon; the "I" of ‘I am...' is always beyond what it is claiming to be, standing apart from it, so to speak.

Therefore, when I claim for myself some particular identity, or when I try to give some kind of total account of myself, I cannot escape misleading, and being misled - I am in 'bad faith'.

Not only, then, is it not unusual for people to do things without being able to give an account of what they are doing, but for them to succeed in doing so with any completeness is not even possible. As Harré and Secord put it²:

The standpoint from which one monitors one's monitoring of a performance, from which one gives commentaries upon the way one is doing something and with what aim, is not itself capable of figuring in an account, given from that standpoint. The commentator himself is not capable of description as a part of the psyche. He must necessarily escape observation, since he is the observer. Thus the standpoint from which commentary is made must always be one remove from experience, and cannot have attention focused upon it.

Our activity, then, comes before our reflection upon it, and reflection can tell us only what we have done, not what we are doing. The eye that is seeing cannot see itself. There is a tendency at least implicit in the thinking of many psychotherapists to see conscious awareness as somehow 'higher' than the unconscious mental phenomena from whose influence they seek to free their patients. However, our discussion so far suggests that this may be putting the cart before the horse. This is a point made by Hayek in an interesting paper which he calls 'The Primacy of the Abstract'³. In this paper, Hayek puts forward the idea that our experience may be organized by what he calls 'action patterns'. These are understood as kinds of templates which cannot in themselves be given to conscious awareness, but which determine, from 'above' as it were, what we actually experience:

It is generally taken for granted that in some sense conscious experience constitutes the 'highest' level in the hierarchy of mental events, and that what is not conscious has remained 'sub-conscious' because it has not yet risen to that level. There can of course be no doubt that many neural processes through which stimuli evoke actions do not become conscious because they proceed on literally too low a level of the central nervous system. But this is no justification for assuming that all the neural events determining action to which no distinct conscious experience corresponds are in this sense sub-conscious. If my conception is correct that abstract rules of which we are not aware determine the sensory (and other) 'qualities' which we consciously experience, this would mean that of much of what happens in our mind we are not aware, not because it proceeds at too low a level but because it proceeds at too high a level. It would seem more appropriate to call such processes not 'sub-conscious' but 'super-conscious', because they govern the conscious processes without appearing in them. This would mean that what we consciously experience is only a part, or the result, of processes of which we cannot be conscious, because it is only the multiple classification by the super-structure which assigns to a particular event that determined place in a comprehensive order which makes it a conscious event.

And:

The point in all this which I find most difficult to bring out clearly is that the formation of a new abstraction seems never to be the outcome of a conscious process, not something at which the mind can deliberately aim, but always a discovery of something which already guides its operation. This is closely connected with the fact that the capacity for abstraction manifests itself already in the actions of organisms to which we surely have no reason to attribute anything like consciousness, and that our own actions certainly provide ample evidence of being governed by abstract rules of which we are not aware.

The human being's most developed activity, therefore, is always 'out in front' of what he can say about himself. As we noted in the previous chapter, we tend to think of characteristically human behaviour, in the loftiest sense of the term, as being the result of some kind of conscious deliberation. What we find, however, is that such deliberation is in truth frequently more an account we give after the event. Not, of course, that we cannot do things deliberately. But what we do deliberately is done in the context of projects which we cannot know beforehand, though we may discover them as we go along.

There is, then, on the face of it nothing particularly unusual in the neurotic's inability to say what he is doing, nor is there necessarily anything ominously pathological about his failure to give an accurate account of his actions. What is interesting is the use which it seems can be made in neurosis of the phenomena we have been considering.

In his account of bad faith, Sartre gives an excellent example of the kind of use an individual might find for it:

… A homosexual has an intolerable feeling of guilt, and his whole existence is determined in relation to this feeling. One will readily foresee that he is in bad faith. In fact it frequently happens that this man, while recognizing his homosexual inclination, while avowing each and every particular misdeed which he has committed, refuses with all his strength to consider himself ‘a paederast'. His case is always 'different', peculiar; there enters into it something of a game, of chance, of bad luck; the mistakes are all in the past; they are explained by a certain conception of the beautiful which women can not satisfy; we should see in them the results of a restless search, rather than the manifestations of a deeply rooted tendency, etc., etc. Here is assuredly a man in bad faith who borders on the comic since, acknowledging all the facts which are imputed to him, he refuses to draw the conclusion which they impose. The homosexual recognizes his faults, but he struggles with all his strength against the crushing view that his mistakes constitute for him a destiny. He does not wish to let himself be considered a thing. He has an obscure but strong feeling that an homosexual is not an homosexual as this table is a table or as this red-haired man is red-haired. It seems to him that he has escaped from each mistake as soon as he has posited it and recognized it; he even feels that the psychic duration by itself cleanses him from each misdeed, constitutes for him an undetermined future, causes him to be born anew. Is he wrong? Does he not recognize in himself the peculiar, irreducible character of human reality? His attitude includes then an undeniable comprehension of truth. But at the same time he needs this perpetual rebirth, this constant escape in order to live; he must constantly put himself beyond reach in order to avoid the terrible judgment of collectivity. Thus he plays on the word being. He would be right actually if he understood the phrase, 'I am not a paederast' in the sense of 'I am not what I am'. That is, if he declared to himself, 'To the extent that a pattern of conduct is defined as the conduct of a paederast and to the extent that I have adopted this conduct, I am a paederast. But to the extent that human reality can not be finally defined by patterns of conduct, I am not one.' But instead he slides surreptitiously towards a different connotation of the word 'being'. He understands 'not being' in the sense of 'not-being-in-itself'. He lays claim to 'not being a paederast' in the sense in which this table is not an inkwell. He is in bad faith⁴.

What seems to distinguish neurotic 'bad faith', 'repression', or self-deception from a natural disjunction between words and actions (what one describes oneself as doing in contrast to what one actually does) is, then, its apparent purposefulness. In the normal run of events there are actions which cannot be accessible to reflective awareness or which cannot easily be put into words; on the other hand, in the case of neurotic self-deception, the person seems to be involved in an attempt to prevent his actions being put into words - he seems to be concerned to keep the significance of certain of his actions out of his awareness although he could do otherwise.

As has been pointed out, our most fundamental strategies, or, in Sartre's terminology, projects, are, at the time we are carrying them out, unknowable by us - though they may be apparent enough to somebody else. We may, again, be engaged in activities (like riding a bicycle, for example) the mechanics of which are hard to specify (you cannot tell someone how to ride a bicycle) although we are aware that we are carrying them out. Nevertheless, in pursuit of our projects, we may also at times call upon a repertoire of well-practised skills the nature of which is reflectively clear to us and which we can turn on or off at will. If we put these into action unthinkingly - habitually perhaps - we are, by reflecting for a moment, easily able to 'read off' their meaning: we can see what we're up to. The striking thing about the neurotic is that he seems to be engaged in relatively low-level strategic activities of this kind, the meaning of which seems clear to us, but which he seems to experience as unspecifiably - either he cannot say what he is doing (e.g. protecting himself from social encounters by means of symptoms) or is unable to criticize his own performance (e.g. cannot see that his social manner is unusually submissive). In other words he seems to treat his own behaviour as if it was of the kind we might accept as unspecifiable, although to others it looks rather like the kind of practised skill which we normally expect to be available to conscious awareness. What may make us particularly suspicious is that his concern that 'something is the matter' with him betrays a certain kind of awareness, a certain ability to evaluate his performance which, however, stops short of recognizing the obvious implications. This may be what distinguishes the neurotic from the eccentric - the latter simply gets on with his unusual activities, appearing to be 'lost' in them, while the former somehow stands outside his activities, and yet is unable to criticize them in the way which 'standing outside' would seem to permit.

In a penetrating study of the problem we are considering, Fingarette⁵ describes the kind of neurotic strategy we are concerned with as a failure of the individual to 'spell out' his or her engagements or activities in particular cases:

This is the situation in which there is overriding reason not to spell-out some engagement, where we skilfully take account of this and systematically avoid spelling-out the engagement, and where, in turn, we refrain from spelling-out this exercise of our skill in not spelling-out. In other words, we avoid becoming explicitly conscious of our engagement, and we avoid becoming explicitly conscious that we are avoiding it.

The question which immediately arises, naturally enough, is that of how someone achieves an intention not to spell out their engagements (and not to spell out that they are not spelling them out). To some extent, the ground has already been prepared for such an understanding, since it was established in the previous chapter that there is nothing unusual in people having intentions of which they are not aware. What we have to indicate specifically, then, is how somebody can not be aware of severing his activity from his reflective consciousness intentionally.

Sartre suggests that this can be achieved on an analogy with going to sleep:

Let us understand clearly that there is no question of a reflective, voluntary decision, but of a spontaneous determination of our being. One puts oneself in bad faith as one goes to sleep and one is in bad faith as one dreams. Once this mode of being has been realized, it is as difficult to get out of it as to wake oneself up; bad faith is a type of being in the world, like waking or dreaming, which by itself tends to perpetuate itself…⁶.

It is, of course, not easy to go to sleep on purpose. Sleep, as Fingarette suggests in his book, is something that happens to one rather than something one can make happen. And yet, I think, Sartre's analogy is an instructive one, since 'going to sleep' represents a special kind of alliance between what one can control and what one cannot. We learn the conditions which are conducive to sleep, and we take advantage of them; we put ourselves in the position in which sleep is likely to overtake us when the conditions are right (i.e. we go to bed, switch the light off, shut our eyes, etc.). In the same sort of way, the neurotic strategist puts himself in the position most suitable for remaining ignorant of what he is 'up to', and then allows, as it were, nature to take its course.

If the psychotherapist consults his own experience of his patients' self-deception, he will surely find clear instances of the kind of process under discussion. Indeed, the psychotherapeutic situation is one of the few in which neurotic self-deception can be observed closely - and indeed challenged - as it takes place. If the neurotic's task is one of misrepresenting to himself the significance of his strategies (for fear of what they will reveal to him), the presence of the therapist means that he has the additional problem of maintaining self-deception in the face of a critical consciousness (that of the therapist) which is not in an unspoken alliance with him; not only does he have to avoid his own critical scrutiny, but he also has to develop ways of avoiding the therapist's. Here, of course, we are back with the concept of resistance which was discussed in the previous chapter.

It is not difficult for the patient to misrepresent to the therapist (and himself) activity which has taken place outside the therapeutic situation, for in this case he can make use of straightforward 'bad faith' - he can confuse what he does with what he 'means' to do, or with what he 'thinks' he is doing. His behaviour within the therapeutic situation is not so easy to disguise, because, as has been said, he is under the critical gaze of the therapist. He can achieve his aim of non-recognition of what he is doing only by not looking at it, or by distracting his own attention when asked to look, or by steadfastly looking somewhere else.

Most therapists will, perhaps, be familiar with the way a person can 'not look' when his attention is drawn to what he is doing: he may suddenly become vague, in an odd way defocused, his eyes may literally become slightly glazed, his attention somehow scattered and imprecise, his thinking blunt and jumbled. In my own experience this kind of defocusing is the most striking, and perhaps the most common, method of maintaining self-deception in therapy.

The distraction of the person's attention from recognition of his strategies seems often to be achieved by means of symptoms, and it is to symptoms also that the patient may look when he wishes simply to divert his gaze from the direction indicated by the therapist to a (for him) less problematic area. On the whole these seem to be somewhat lower-level tactics than that of defocusing, and they are also, perhaps, from the patient's point of view, less successful. In the case of distraction, a patient may indulge directly in some kind of symptomatic behaviour - possibly but not necessarily connected with an obsession or phobia - in order to draw his own, and if possible also the therapist's attention away from his deeper projects.

In the second case he may just stubbornly insist that it is his symptomatology, and not he, which is the problem. If these methods of maintaining self-deception are less successful than 'defocusing', it is largely because they are more obvious, more easily pointed out by the therapist, and almost impossible after a time not to recognize.

Indeed, those patients who drop out of psychotherapy relatively quickly often seem to do so because their heavy reliance on either on both of these methods of maintaining self-deception is beginning to be eroded, and they are left with no alternative either to recognizing what they are doing or to leaving the situation altogether.

Defocusing, however, is a much more subtle tactic: precisely at the point at which it is most obvious (to the therapist) it is also most difficult to see (for the patient).

There are a number of points about this account which it is important to understand. In the first place, I do not wish to suggest that in all cases the therapist is in a position to see better than the patient what the latter is 'really' doing. He does not establish the 'real' reasons for the patient's behaviour on the basis of some kind of expert appraisal, and simply tell him of his findings. If he is struck by the contrast between the patient's avowed intentions and his actual activity, his task is to negotiate with him a view of his behaviour which may account more satisfactorily for the incongruities observed. Because people are not static entities, there can be no 'correct' view of what they are or final version of what they are doing. For this reason, patient and therapist have to come to an agreement about what is happening which seems a useful basis for further exploration. If he is guided by this principle of negotiation (about which more will be said in the next chapter), rather than by any notion of technical mastery of the situation, the therapist will have little cause to be worried about the 'accuracy' of his statements to the patient; the latter will determine the pace of their relationship as well as the degree to which he accepts the therapist's influence, and is unlikely to take the therapist's utterances, whether accurate or mistaken, at their face value. Therapists who get worried about whether they have said the 'right thing' frequently operate in a context in which they feel they ought to be omniscient, if not omnipotent.

A further point I wish to make is that, although much of the therapist's time may be taken up in attempting to agree with the patient an alternative view of what he is 'up to', and consequently in fostering in him an awareness which formerly he did not possess, the ultimate aim of therapy cannot be to make people 'aware'. Awareness of self-deceptive strategies is a means of achieving mastery over certain aspects of one's behaviour, not an end in itself. For, as we have seen, the totally conscious person is an impossibility.

It is at least arguable that psychology and psychotherapy have traditionally concentrated too one-sidedly on conscious awareness as an ideal of human nature. It may not, for example, entirely be a caricature of psychoanalysis to represent it as contrasting 'healthy', conscious behaviour with the sexually and aggressively charged impulses of our unconscious minds, and this would suggest that most of our actions which are not the product of, or immediately accessible to, our reflective awareness are likely to be, as it were, tainted with id. As far as it accounts for our pre-reflective activity by reference to the unconscious, psychoanalysis carries with it, therefore, inescapable moral overtones: there is something slightly deplorable - almost even depraved - about the man whose actions are not bathed in the light of consciousness.

Many of the more modern psychotherapeutic techniques also tend to carry with them an implication that 'knowing yourself' is the most important aim to which you can aspire. George Kelly's 'repertory grid technique',⁷ for example, provides one way in which a person can become aware of the ways in which he is interpreting ('construing') the actions of others, and the assumptions he is making about them. Briefly, the technique depends upon the patient specifying in what way any two people known to him are alike, and different from a third. This procedure can, of course, be carried out for an indefinite number of 'triads' of the patient's acquaintances, and is aimed at revealing to him the 'personal constructs' by means of which he orders his interpersonal world. Again, Kelly suggests that a person may learn a good deal about himself by writing a sympathetic autobiographical sketch of his life up to the moment of inquiry. It is probably true that the limitations of these technique were clear enough to Kelly himself, but the use to which they are frequently put by some of those therapists who have been influenced by his writing seems often to fail to recognize that they cannot tell the person 'what he is like'. For reasons which have already been elaborated, the person somehow slips away from the light of his own inquiry, even when he is earnestly trying not to; he is inevitably in important ways different from what he says he is. It seems, then, that if psychotherapy is characterized as a procedure for achieving self-awareness in any complete sense, it must be doomed to failure. Much of our most intricate and rich experience, many of our most complex skills, perhaps the majority of the rules which guide our action in day-to-day life, the very process of abstraction itself, may all, it seems, be out of reach of reflection. And if we succeed in pinning down and defining an aspect of our experience, or a strategy hitherto unrecognized, in the very process of doing so we become anchored in a standpoint which is itself unanalysable - we are being guided, in the terms used by Hayek, by new action patterns, or, in Sartre's, by new projects which are inaccessible to reflection. In so far as psychotherapy is aimed at self-awareness, then, it stands in danger of becoming an exercise in bad faith, and in so far as we try, as psychotherapists, to congeal our patients into a state of being 'understood' we are, to put it dramatically, denying them the very essence of their human nature. Whatever we are, we are not what we suppose ourselves to be or declare ourselves to be, and directly we know what we are (rather than what we were), we have fallen into self-deception.

However, there are some conclusions we should be careful not to draw from these considerations. I repeat that it is not my intention to suggest that self-critical reflection is a waste of time; that people are in all circumstances incapable of acting under the guidance of reflection; that therapy should be nothing but a prolonged indulgence in raw experience and wordless action.

If, however, as was concluded in the last chapter, people are free, and if the foundation of their being is unknowable in the sense we commonly use that word, then it would seem mistaken for psychotherapy to aim at any particular kind of frozen ideal of what people should be (for example, socially, sexually or vocationally 'adequate'; able to achieve 'heightened awareness' of themselves or others; well-rounded; outgoing; being at one with their physical bodies; free of 'unrealistic' fears; able to achieve 'peak experiences' with satisfactory frequency; able to be socially assertive; and so on and on). As ends, these aims are unsatisfactory if for no other reason than that, having achieved them, the person is still left going somewhere, and it would be unfortunate if he was led to feel that, for the sake of his 'mental health', he should know the name of his destination.

But if psychotherapy cannot set (final) positive and concrete aims for its patients, it can nevertheless make its intentions clear in a somewhat more abstract manner: that is, psychotherapy can be a procedure which helps people to clarify their misconceptions about themselves, and to accept that they are free to go where their actions, projects and strategies are taking them. Neurotic self-deception seems often to rest on the misconceptions which patients have about themselves, and human nature in general (for example, that anger is not permissible, that 'nice' mothers never feel irritation or rage with their babies, and so on), and which they maintain with great tenacity. At the centre of their misconceptions, often, is the finality which they perceive in them - they find themselves petrified, as it were, in a form which they experience as unbearable or unacceptable. For the therapist to offer them another, if different, final state to aim at is simply to supplant one neurotic solution with another, and is equally misconceived. It is, then, not the therapist's business to peddle miniature Utopias for individuals to inhabit, but, by negotiating with the patient a new view of his predicament, to help him free himself from his immobility and send him on his way.

An important part, but only a part, of the therapeutic process of negotiation, will be for the therapist to help the patient to an awareness of some of the strategies which he is using in the service of self-deception. In this context, the kinds of techniques advocated by Kelly, and others, may play an important role. There are of course several technical procedures which rely heavily on reflective awareness and which help to clarify to the patient, before his very eyes so to speak, the nature of some of his strategies (though, once the game is up, they will be replaced by new strategies which will in turn not be available to his awareness, until again substituted by new ones, and so on). An exercise developed by Mair,⁸ and based on what he calls a 'conversational model' of psychological relations, is a good example of such a procedure. In this, one person writes a character analysis of another which he is prepared to show him and discuss with him, and a further analysis which, initially at least, he is not prepared to show him, though as both parties gain confidence in the relationship they may reveal views which they were at first anxious to conceal. The insights which both parties may gain from this procedure (some of them, certainly, not easy to put into words) will be clear to anybody willing to try the experiment.

There are also, of course, many other techniques aimed at the clarification of interpersonal strategies, etc., but the point at issue here is that their value will depend on the context in which they are used: for example, is the patient supposed to discover only what the therapist thinks he should, or may he draw any conclusions he likes?

Is he being moved from 'neurotic' position A to 'healthy' position B, or is he, so to speak, getting help in freeing his propeller from weeds so that he can go where he wants?

It is in fact precisely in 'freeing' people that reflective psycho-therapeutic approaches can be most useful. Too often, however, reflective procedures (like psychoanalytic interpretation, etc.) are seen as bringing about understanding and self-knowledge of a kind which enables the person thenceforth to carry around with him an enriched version of himself from which he can, as it were, read off suitable responses at appropriate moments; choosing, in a controlled sort of way, actions to fit his circumstances in the bright light of full consciousness. Far from freeing the person, however, this is freezing him into the mould of what he currently accepts about himself.

With these arguments in mind, I think it possible to advance an alternative view of reflection and a rather different purpose for the kind of negotiating procedure which the psychoanalysts call 'interpretation'. The point of understanding what you are doing now is to enable you to do something else. This is exactly the point of interpreting neurotic behaviour - by seeing what his current projects are the patient is able to undertake new ones, not simply to add to his repertoire of conscious actions, or, more negatively, to stop doing what he was doing before.

Self-consciousness tends often to disrupt or explode what it reflects upon. Whether riding a bicycle or reading a book or talking to friends, if you become self-consciously aware of what you are doing you may well cease to do it effectively. 'Understanding', then, becomes a way of exploding the person's current projects and strategies, making them historical, and leaving him free to follow new ones. Paradoxically, then, the use of techniques for promoting self-consciousness in psychotherapy should be aimed at, and have the inevitable result of, allowing the person to become unself-conscious again. Frankl's technique (already referred to in Chapter 2) of 'paradoxical intention', for example, makes good use of this principle: patients who find themselves doing things they don't want to do (e.g. stuttering) are asked to do them on purpose, and, according to Frankl, frequently find themselves unable then to produce the unwanted actions. A similar approach has been used in psychotherapy with families as well as individuals by a group of American therapists⁹ who suggest to patients, again paradoxically, that they carry out with conscious deliberation interpersonal strategies which up to that point they had been practising unawares. The, perhaps often unspoken, psychotherapeutic ideal of the fully conscious person, performing his life with admirable virtuosity as, with his inner eye, he reads from the richly orchestrated score his self-knowledge has revealed, has, when one comes to think about it, something rather sickening about it. For it is impossible to act self-consciously and in good faith; the most successfully 'self-conscious' people of our time are probably confidence tricksters and television comperes. Where reflection gives us control over our behaviour it does so at the expense of its spontaneity and its honesty - the latter because we cannot in truth help being spontaneous, and to do something self-consciously is to hide from view our spontaneity, to conceal our real, unself-conscious intention.

It is a common observation in social psychology that people may become conscious of themselves only because they can be objects of the consciousness of others: you learn about yourself through the eyes of others. Just as the other's consciousness of you turns you into an object, so your self-consciousness turns you into an object for yourself. Frequently this is a disrupting experience, a 'project-exploding' situation from which you struggle to break free to a realm of unobjectified activity. Neurotic patients frequently describe experiences (surely not entirely unfamiliar to the rest of us) which seem to centre on this kind of fear of being 'objectified' by others - so much so that a patient may feel, for example, that he cannot function properly in public places; he feels frozen with fear, his facial muscles refuse to form the expression he strives for, he is unable to eat in restaurants under the gaze of others, and so on. On the other hand, the confidence trickster, the orator, those television performers whose whole aim is not to appear to be performing (pundits and 'personalities') try deliberately to arrange their activity to conform to the objectification which is imposed upon them by the viewers. Their conscious manipulation of the situation means, however, that they are necessarily dishonest as far as their self-presentation is concerned; their being is concealed - unless for example, through a producer's error, they are revealed by the camera in an unguarded moment.

The phenomena of self-consciousness have fascinated psychologists to an extent where many have become more concerned with the deliberate manipulation of appearances than with man's capacity to act as a spontaneous agent. An analysis of 'non-verbal communication', for example, in which it is noted that a person's gestures and facial expressions may be interpreted by others as signifying something about that person, may be used to train people deliberately to emit non-verbal cues designed to convey a particular message. This, obviously, is precisely the art of the con-man - he looks and behaves like a retired British army colonel, with all that that implies, though he is really an ex-convict in illicit pursuit of other people's money. The line between therapy and deceit is thus a very thin and delicate one. It is one thing to suggest to a person that he is conveying a certain impression of himself which conflicts with his actual intentions and so gets him into difficulties. It is quite another to suggest to him how to convey impressions which will conform to approved social expectations. The impression one gives, in other words, must, to be genuine, be linked to one's (ultimately) unself-conscious intention, not to certain concealed manipulative aims. Analyses such as those of Goffman¹⁰ of the ways in which appearances influence social intercourse, penetrating though they are, stand in danger of developing if we are not careful into a psychological technology of deceit.

The aim of reflection and interpretation (negotiation) in psycho-therapy, then, should be to free the individual from one project or set of strategies so that he can adopt new ones. Far from advancing an ideal of self-knowledge, we should in fact be using it as a means to an end - an end to which it is in fact paradoxically opposed. Instead, it might be (and often is) helpful to encourage patients to trust their non-reflective, unself-conscious activity, since the ultimate aim of psychotherapy can only be to enable the person to set off down paths he does not already know. Similarly, the therapist must at times trust himself to act unself-consciously within the therapeutic situation, and it is perhaps one of the greatest difficulties in conceptualizing and communicating about psychotherapy that so much of importance happens, when it happens, beyond the reach of reflection. Far from this being shamefully unscientific, it is inevitable that psychotherapy should have its tacit, unspecifiable aspects which can in no way be engineered before the therapeutic event, so to speak, and can only be characterized after the event, when they have become history. On the whole therapists do not yet seem to have come to terms with this satisfactorily, and beginning therapists are often ill-prepared to accept and exercise tacit skills and unrehearsed activity without feeling that they have departed disastrously from some kind of therapist's handbook, and entered regions which are reprehensibly unprofessional.

1 Freud, S. (1915). Standard Edition of the Complete Psychological Works. Trans. and ed. James Strachey. Vol. XIV, p. 201. London: Hogarth.

2 Harré, R. and Secord, P. F. (1972). The Explanation of Social Behaviour. Oxford: Blackwell.

3 Hayek, F. A. (1972). The primacy of the abstract. In A. Koestler and J. R. Smythies (eds.). Beyond Reductionism. London: Hutchinson.

4 Sartre, J.-P. (1969). Being and Nothingness. Trans. H. E. Barnes. p.63. London: Methuen. Reprinted by permission of Philosophical Library, Inc. Copyright © 1956 by Philosophical Library, Inc.

5 Fingarette, H. (1969). Self-Deception. London: Routledge & Kegan Paul.

6 op. cit., p.68.

7 Kelly, G. A. (1955). The Psychology of Personal Constructs. Vol. 1. New York: Norton.

8 Mair, J. M. M. (1970). Experimenting with individuals. British Journal of Medical Psychology, 43, 245.

9 See for example P. Watzlawick, J. H. Weakland and R. Fisch. (1974). Change. New York: Norton, and J. Haley. (1963). Strategies of Psychotherapy. New York: Grune & Stratton.

10 Goffman, E. (1971). The Presentation of Self in Everyday Life. Harmondsworth: Penguin Books.

7

Aspects of Negotiation

Although it is often referred to as such, psychotherapy is obviously not a 'talking cure'. Apart from affording temporary feelings of relief at having 'got things off one's chest', talking on its own does not seem to be a particularly fruitful way of dealing with one's problems. Nobody solves problems simply by juggling them in his head. Psychotherapy, then, is not just an armchair debate between two (or more) people, but an active relationship which has implications reaching out beyond the therapeutic setting. The patient does more than talk: he acts and experiences.

Nevertheless, for most forms of psychotherapy, talking is what therapists and patients seem to be doing most of the time, and verbal communication provides the vehicle for much of what happens in the therapeutic situation. Unimportant in itself, talking, therefore, seems to serve some important therapeutic ends.

It would not be possible in any book on psychotherapy to provide exhaustive coverage of all the things that can happen during the course of therapy; it may be that a therapeutic result could be brought about by entirely unexpected and unique sets of circumstances which could in no way be legislated for in advance.

On the other hand, some processes occur with such regularity that they seem almost inevitable. The process of negotiation - a concept already used several times in earlier chapters - is one of the most outstanding of the regular features of therapy, and constitutes one of the main reasons for talking.

Before the patient can do anything about his problems, he has to negotiate with the therapist a view of them about which both can agree; successful therapeutic work proceeds, at least in part, on the ground of experience which is shared between patient and therapist.

Each has to know, in other words, what the other is talking about. As we have already seen, it is no simple matter for a person to know what he himself is talking about, let alone someone else.

Except in some very basic areas of our experience, largely confined to our relations with the physical world, it is not obvious that we share a common view to any great extent: the meanings we attach to people, ideas and relationships are largely individual, even though our vocabulary often gives them a misleading appearance of objective identity. Moreover, even when we have our own meanings clearly in sight, they are liable to shift and change with new experiences. There is, therefore, no objective 'truth' about people which can be known; there is an indeterminate number of perspectives on any person, including his own, some of which may be more stable than others, but none of which can be said to be either fundamental or permanent. What a person 'is', or is doing at any point in his development, is therefore a matter of negotiation between interested perspectives. In psychotherapy, these are the perspectives of the patient on the one hand and the therapist on the other.

There seem to me to be two main elements of negotiation: understanding and persuasion. Clearly, if you are to find out what another person is talking about, it is important that you understand him; and if the significance of what he is saying eludes you at first, he may have to persuade you of its relevance. Again, if the therapist is to influence or encourage the patient to change, he may well find that merely understanding him is not enough - he may have to persuade him that alternative views of his predicament are possible.

On the whole the psychotherapy literature has concentrated on understanding far more than on persuasion (to conceptualize both as parts of a process of negotiation is rare in psychotherapy¹). The way in which the therapist may be said to 'understand' his patient has undergone a fairly radical change, theoretically speaking, over the years, and we shall consider this development shortly. That persuasion has not featured greatly in psychotherapeutic thinking until relatively recently may well reflect a certain nervousness psychotherapists feel about being exposed to accusations of 'influencing' people. It was at one time common for therapists to contrast the neutral freedom of 'psychological' therapies with the distasteful manipulativeness of behavioural methods. In the former case the therapist preserved his neutral mask, scrupulously avoiding imposing his personality upon the patient, for fear of using him for his own 'pathological ends', while the behaviour therapist, it was felt, surreptitiously manipulated the stimuli which would, according to his theory, determine the appropriate responses. Either type of therapist could, in fact, feel superior about the other: the psychotherapist could accuse the behaviour therapist of making damaging use of his powers, while the latter could sneer at the former for ignoring the fact that he is a determining stimulus in the patient's environment whether he likes it or not. Both these approaches, however, make the error of characterizing human relationships as determining. The behaviour therapist proclaims the error boldly, and so fails to see that his patients do not have to follow his influence; the psychotherapist implies a mistakenly deterministic view by trying so hard to avoid determining his patient's reactions. The result is that he fails to make rational use of the influence which is open to him.

As we have seen, patients' actions are not determined by their therapists, and therapists are not responsible for what patients do. The therapist's attempts to persuade his patients of the cogency of his perspective, or the usefulness of a certain possible course of action, may or may not be successful, and what the patient decides to do in the end is his responsibility. Nevertheless, the degree to which the therapist is able to influence the patient may be a crucial factor in the latter's arriving at a new perspective or setting out on a new course of action. This influence is, in the last analysis, an intensely personal matter, and one which the therapist must come to terms with, however much he might prefer to hide behind the guise of professional expert, impersonally applying a mechanical technique. How effective an influence he is will depend in part upon the extent of the basis of common understanding the therapist is able to establish with his patient.

In more orthodox psychoanalytic psychotherapy, 'understanding' was, perhaps, often seen as a largely one-way affair in which the therapist could understand the patient better than the patient could understand himself, largely because the therapist had access to the mysteries of the Unconscious and the patient did not. One of the tasks of therapy in this kind of situation was, then, for the patient to come to understand himself in the same terms as those used by his therapist. 'Interpretation' was, largely, the vehicle by means of which the patient was to be persuaded of the validity of the analyst's perspective.

In many ways, of course, this follows the technical model of medicine: the doctor knows what is good for the patient, and the patient gets better when he comes to accept and act upon the doctor's view. In psychiatry, certainly, it is this model which is used to determine the 'sanity' of the patient's perspective: in traditional psychiatric diagnosis it is not what the patient tells his doctor which is important so much as how he tells it. Is he slow ('retarded'), is his speech articulate and his logic clear, does he describe things in a way which makes conventionally good sense, and so on? The actual, 'interior' significance of what the patient means is of no interest to the psychiatrist, who is looking simply for symptoms and signs of 'illness'. The patient will be judged 'better' when the symptoms and signs have vanished, i.e. when the form of his communications is again in line with what is conventionally acceptable. Similarly, the psychoanalyst will be listening to the patient's free associations not for their surface meaning, but for indications of unconscious pathology according with Freud's formulations. The patient's ability to accept the analyst's interpretations of what he is actually saying for what he is 'really' (unconsciously) meaning, will be an indication of his improvement. In a nutshell, understanding in this sense consists in the therapist's reinterpretation of the patient's communications into a form which fits the former's theoretical framework, and this process is achieved with the help of some kind of technical lexicon. In recent decades this kind of approach to understanding has been radically challenged, and to a large extent replaced, by its polar opposite.

In psychotherapy, the writings of such theorists as Rogers and Kelly have led to a widespread acceptance among therapists generally of a view of understanding as 'empathy'. Rogers in particular stresses the therapeutic importance of the therapist's understanding the patient from the patient's perspective. In order to grasp the meaning for him of the patient's experience, the therapist has to put himself in the patient's shoes, to try his level best to see the world from where the patient sees it. Rather than the patient having to learn the therapist's language and theoretical system, the therapist has to learn the patient's. In this, he has to attend not so much to the patient’s words, as to their meaning for the patient.

As we have already noted, Rogers considers this kind of empathy to be one of the essential conditions for therapeutic change (the other two being warmth and genuineness). Kelly also makes the relativity of perspectives central to his psychology - to understand what another person is doing entails an understanding of the unique organization of his 'personal constructs', and such an under-standing can only be gleaned through painstaking inquiry with the person himself. To attempt, as psychologists often do, to explain others by 'measuring' them with questionnaires of introversion-extraversion, neuroticism, etc., is one-sidedly to impose upon them the psychologist's way of looking at the world. But people act on the basis of their conceptions, not those of the psychologist, and their actions cannot be understood in any other context.

In a rather similar vein, R. D. Laing² has striven to shift the attention of British psychiatrists from the formal conventionality of what patients say to the meaning for them of their communications. 'Psychotic symptoms', Laing suggests, may be the understandable, perhaps inevitable, result of patients' experience, rather than mere indications of disease pathology; 'psychosis' thus becomes a way of dealing with an 'unlivable situation' rather than a 'mental disease', a way which may, moreover, be understood by the psychiatrist who is willing carefully to investigate with the patient the significance of his experience.

The more modern view of 'empathy', particularly as expounded by Rogers, gave impetus to strategies of research into the accurate understanding of one person by another which had been a focus of interest in academic social psychology for some time. Much of this research, as pointed out in an earlier chapter, has a curiously mechanistic bias, and rests on the assumption that 'understanding others', is something like a skill, which some people are liable to have relatively more of than others. In the therapeutic situation, this becomes extended to the view that some therapists will be more empathetic than others, and that those who 'have it' will, following Rogers' views, be more therapeutically effective than those who do not. As we saw, there is a degree of evidence for this latter view, though it seems to depend more on how patients see their therapists than on an objective demonstration that some therapists 'possess' empathy while other do not.

The bias towards conceptualizing empathy as a kind of skill which people either have or do not have is probably a reflection of psychology's pervasive concern with 'traits' rather than with processes. Psychologists interested in the broad area of personality have - naturally enough, perhaps, and sometimes with fruitful results - tended to concentrate on those aspects of people's personal functioning which seem to possess considerable stability. A person is recognizable as the same person from one day to the next, and this depends as much on the familiarity and stability of his personal style as on the constancy of his physical appearance. Part at least of our definition of sanity rests on there being a considerable degree of predictability in personal behaviour. These relatively stable aspects of personality ('traits'), apart from their obvious intrinsic interest, have also been of particular concern because they are relatively easily measurable. What more natural in this setting, then, than to consider 'empathy' as yet another instance of a trait? (And what more inevitable than that psychological research 'findings' about empathy should reflect the assumptions which are made about it at the outset?)

In fact, research findings in this area are, as so often in psychological research, equivocal, and to provide a detailed review here would make tedious reading. In general, the stability of empathy as a trait which somebody can express at different times and in different situations seems to depend very much on the method which psychologists use to measure it, and, because psychologists rarely use the same methods in their research, results are conflicting. The evidence for a stable trait of empathy is thus not strong, though there is some work³ which suggests that some people may be consistently more accurate than others in judging what particular people are likely to do in particular situations.

Although a general, stable trait of empathy has not been convincingly demonstrated, there have been some interesting findings concerning the sort of people who have been found to have a measurable degree of accurate empathy in particular research studies. The interesting point about this research⁴ is that people who are better able to make accurate judgements about others tend not to be people who have a particular psychological theory about 'what makes people tick'. Conventional professional psychologists have in this way been found on the whole to make less good judges than have intelligent laymen, especially where the latter are people of wide-ranging - perhaps artistic - interests. Although one in the eye for the professionals, this is scarcely a surprising finding. The majority of psychological theories are - some might say necessarily - simplified models of human behaviour, appealing as a rule to a handful of singularly uncomplicated mechanistic concepts.

Though they may be of some use in marshalling the 'facts' of mass behaviour, they are unlikely to deal effectively with the complexities of the individual case, and it is small wonder that a reasonably intelligent and sensitive person is likely to make better guesses about others if he relies more on the skills he has spent his life developing than on the crudely insensitive conceptual equipment of traditional psychology.

The particular emphasis of this kind of research on empathy is, then, blatantly materialistic. Empathy becomes a kind of psychological possession which, in the therapeutic situation, therapists may possess to a greater or lesser extent. Since, as we have said, therapist empathy has been shown in some research studies (though the evidence is by no means consistent) to be related to positive therapeutic outcome, it therefore becomes important for therapists who have not 'got' empathy to acquire it through training - they may, for example, be instructed in the kind of therapeutic 'responses' which are judged by impartial observers to be empathetic. In this sort of procedure, the absurdity of psychological materialism is fully exposed, and in attempting to turn empathy into a technical skill, we have lost sight of its nature as a process of understanding; an active experience is substituted by an appearance. Having discovered that understanding is an important ingredient of psychotherapy, the technical therapist immediately becomes preoccupied with finding out how to appear to be understanding, overlooking the fact that understanding is an interpersonal process.

However, not all psychological research in this area has been quite as crass as I have so far suggested, and some consideration of further research findings might help to take our inquiry a step further.

Some of the earlier research studies in the area of 'person perception' - a concern in the field of social psychology closely related to the concept of empathy-noted⁵ that accurate judgment of one person by another is facilitated by actual similarity in personality between those involved. In other words, I find it easier to understand you if you are already like me in the first place. This finding has also received support in more recent research studies.⁶

In many ways, this observation makes good sense, focusing as it does on the process by means of which understanding is achieved through shared experience. Curiously, though, some of the psychologists carrying out the earlier studies somehow felt understanding on the basis of similarity to be cheating. Possibly because they thought that empathy should be some kind of, perhaps rather esoteric, skill, they seemed to feel that a person does not deserve to be called empathetic if he achieves accurate understanding of another simply because he is himself a rather similar person. 'Putting yourself in somebody else's shoes' should be a more effortful and clever procedure. They were also worried about the possibility that good judges of others might just be using social stereotypes which result in accurate description more or less by accident.

More recently, however, psychologists have come to the realization that there is nothing illicit about this kind of understanding⁷, and indeed it may only be on the basis of shared experience that understanding, or even real communication, is possible. Even so, one can understand that some uneasiness should be occasioned by such a view. For example, simply by assuming that everyone is like yourself you are bound to be right some of the time purely by chance, and yet this process looks more like what Freud called 'projection' than like true understanding.

What makes the difference, perhaps, between empathy and projection is that with the latter there is no readiness to compromise in situations where experience does not happen to be shared (combined, possibly, with the assumption that if people do not react like oneself, then there must be something the matter with them).

What distinguishes the empathetic person, therefore, may be, in cases where he does not happen to share the experience of another, a willingness to learn how the other has come to see things the way he does. Empathy (if it must be treated like a trait) then becomes a willingness to find out about others rather than an ability to make accurate judgements about them from the outset. The essential point, however, is that understanding itself can only be based upon a shared 'position', however this may ultimately be achieved.

There is little doubt that recent emphasis on the importance of empathy in psychotherapy, even if it has here and there been tinged with a degree of naive psychological materialism, has done much to minimize the violence which therapists could wreak on their patients. For the therapist simply to undercut his patient's experience and attempt to replace the conclusions it has led to with views derived from his own theoretical posture seems at best arrogant and at worst dangerous. The worst effects of such an approach can be seen most clearly in traditional psychiatric institutions in which diagnosis and the physical treatment of 'illness' are the central concerns of those involved. Psychologically, patients in such institutions are simply neglected: they are not people with problems, but objects with diseases. Nobody bothers to find out who they are; they are merely observed for the signs and symptoms they may emit or cease to emit.

And yet, again, understanding on its own is not enough. There is no obvious reason why 'being understood' should lead to great therapeutic change, although it may help someone to get a more objective view of himself and to become aware of activity of which he was formerly not aware. Understanding is, however, the necessary prerequisite for negotiation. Therapist and patient must learn each other's language if they are to be susceptible to each other's influence. Therapeutic communication consists of persuasion as well as understanding, an effort to learn as well as a sharing. In this respect, the therapeutic situation may be likened to that of master and apprentice. The apprentice learns the master's skills, comes to see, as it were, his point of view by exposing himself to the experiences which the master has been through. The master cannot teach him directly, but knows what position he should take up in order to find out for himself. Whether therapist or patient is master or apprentice will vary according to who is trying to learn what from whom; in the process of negotiation each may have to struggle to recast those elements of his experience which are not available to the other in terms of elements which the other does possess (or at least possesses partially), or deliberately to place himself in the position of the other to find out what follows from it.

Learning, understanding and communication take place in a context of lived experience, not in any abstract cerebral sphere. Things are known through the bodily relations one has with them, and having an abstract idea of principles is a long way from experiencing bodily what they were derived from. If the reader doubts this assertion, let him compare the theoretical 'knowledge' of changing a wheel on a car or a washer on a tap, or making an omelette, with the actuality of doing it. Who ever learned to play the piano by reading a treatise about it? This is well recognized in the acquisition of, and communication about, manual and artistic skills, but it is often overlooked by those who, like psychotherapists, tend to spend much of their education immersed in abstract ideas. And yet most students will recall a point at which what they had learned about in books suddenly 'came alive' - and underwent a radical change of meaning - when they confronted the problems in their embodied activity.

The psychotherapist who seeks to understand his patient's problems by mentally 'searching the literature' for similar cases and drawing abstract parallels is likely to go sadly astray. If he cannot find things within his own lived experience which match what his patient is telling him, he must resolve either to find out by becoming an apprentice, or to acknowledge his inability to say anything particularly helpful about it. Fortunately, therapists probably do share with their patients a knowledge of the kinds of distress which the latter complain of, far more than the 'pathologizing' influence of the illness model of psychiatry encourages them to admit. Who has not been afraid of what people think about them ('social anxiety'), superstitiously cautious and ritualistic ('obsessional'), suspicious of the opinions and intentions of others ('paranoid'), sexually unresponsive ('impotent', or 'frigid'), depressed ('depressed'), excited ('manic'), and so on and on? Any therapist who prefers a technical lexicon to his own experience rejects sharing with his patient for attempted manipulation of him, and runs the risk of cutting him off, perhaps cruelly, from the support he needs to pursue the therapeutic exploration further. What, indeed, may make the therapist a master worthy of an apprentice is precisely that he does share the patient's 'pathological' features, but is able to view them in a different light or use them in a different way. In this respect, it is of interest that comparison of the personalities of psychotherapists with those of psychiatrists inclined to physical treatment methods, in most research studies, reveals a greater amount of 'neuroticism' or 'psychopathology’ amongst the former group.

That understanding may arise from the bodily sharing of similar experience is a principle made wide use of in some of the techniques used by 'growth' psychologists, in particular in the 'encounter group' movement. 'Group cohesion' may be quickly established by encouraging participants to take part in certain exercises - exploring each other by means of touch, gazing into each other's eyes, etc. - or members may be told to act out physically the emotions they are talking about, and so on. Frequently members of such groups find these and related experiences illuminating and rewarding.

Sometimes, on the other hand, such 'encounters' seem to be tinged with a kind of evangelistic zeal which blunts the more critical, and self-critical, faculties of those taking part. This is perhaps particularly the case where such procedures are linked to some kind of 'growth' ideal about how people should be - e.g. that it's good to express emotions, essential to be in touch with your body, desirable that everybody should be warm and loving toward everybody else. In such cases, the pressure to conform to the social standards set by the group tends to sweep the participant beyond the point at which he can assimilate the effects of these 'experiential' procedures into his personal construction of the world, and, though he may find himself in a somewhat exalted and elated state for a few days, he is likely quickly to find himself back where he started. It is certainly part of the negotiating process for me to put myself in your position to see if I find what you found there; but I must still be free not to find what you found, and to negotiate the discrepancy with you. If you insist that I have got to find what you found, because you know what's good for people and I don't, the essential quality of negotiation is destroyed.

Understanding, learning, sharing and communicating are perhaps the inevitable goals of our negotiating with each other, and are central not only to psychotherapy, but to almost all human activities. But it might be unfortunate if we saw them as ends in themselves: if, for example, mutuality pure and simple came to be seen as 'the' therapeutic goal, or as the ideal form of human existence. There is no doubt that understanding and communication as pervasive characteristics of society would be welcome replacements for the kind of concealed tribalism and 'club membership' which characterize most modern social intercourse, but the question remains, what would they be for? What could we do with this warm mutuality, once we had got over the novelty of basking in it? When we negotiate, we are not negotiating simply in order to share, but to share something.

That 'something' seems to me to be very much to do with our individuality, the furthest reaches of our inarticulate activity, the unknowable vanguard of our projects. What we may eventually come to recognize through negotiating and sharing its validity with others, is inevitably born in isolation, and too much 'therapeutic' emphasis on the cosiness of empathetic mutuality (an emphasis which sometimes expresses itself in group psychotherapies as an intense hostility to individual activity) threatens to cut us off from the very source of our activity. The result is what Cooper