What is Autonomous Psychotherapy?
The Ethics of Psychoanalysis is a brilliant book on how to practice ethical psychotherapy. But, what is psychotherapy to a psychiatrist who does not believe in mental illness?
To author Thomas Szasz, psychotherapy is a private conversation where people two people talk about values, ethics and how to live a good life – things that Szasz refered to as “problems of living”. Psychotherapy is learning to free ourselves from self-imposed constraints on our freedom.
The role of the psychotherapist is primarily to be an educator. Szasz refers to this as meta-education. The therapist is not to give advice, but to serve as a catalyst for the client’s self-reflection and self-directed change.
For Szasz, therapy is a process of self-emancipation from self-inflicted symptoms. Szasz maintains that he cannot help a client move a client towards self-emancipation from symptoms if the therapy itself is coercive. He insists that it is the therapist duty to help the client achieve his goals and to enhance his freedom of choice in life.
It is not the therapist duty to get involved in his personal life such as keeping unhappy people married, preventing suicide, or prohibiting drug use. Rather, the therapist sole job is to analyze the client, to help him move towards personal autonomy.
Secular Cure of Souls
Szasz says that the modern analyst should be similar to that of a priest, in that priest help people find meaning. The analyst has the task of providing a space where people can explore meaning.
In an interview with Reason editor Jacob Sullum, Szasz
had this to say in a response to a query about his approach to
Reason: How would you describe your approach to therapy?
Szasz: I see psychoanalysis as a contractual conversation about a person’s problems and how to resolve them. I tried to avoid the idea, which seemed to be particularly pernicious, that the therapist knows more about the patient than the patient himself. That seems to me so offensive. How can you know more about a person after seeing him a few hours, a few days, or even a few months, than he knows about himself? He has known himself a lot longer!
To me the whole idea of calling it “therapy” is crippling. So there was a kind of understanding between the other person and me that we were having a conversation about what he could do with his life. That obviously involves adopting different tenets of sorts—different ways of relating to his wife, his children, his job. The premise was that the only person who could change the person was the person himself. My role was as a catalyst. You are making suggestions and exploring alternatives—helping the person change himself. The idea that the person remains entirely in charge of himself is a fundamental premise.
The major theme of this book was the idea that the therapist’s role is to listen, ask questions, but not to give advice. A therapist task is not to diagnose “illnesses”.
Is it possible to practice autonomous psychotherapy today? Probably not.
If a patient says he is suicidal, and end ups killing himself; the therapist could be held liable. Therapy, as practiced today, is more of an act of social control. Husbands and wives who disapprove of their spouses’ behavior send one another to therapy. Parents who disapprove of their children’s behavior, send them to therapy.
In many ways, we are freer than ever to improve ourselves. With the plethora of websites, books, blogs, podcasts, and YouTube channels, there are infinite ways to improve oneself without the need to seek out “therapy”.
To listen to questions addressed to Szasz in a symposium about psychotherapy, listen to the YouTube playlist below.