Authenticity and Psychopathology

I continue to find myself in my work reflecting on what it means to change our relationship towards that which we cannot easily change.  I think generally upon hearing that kind of language, most of the folks I work with think about it in terms of broadly external phenomena that often hold some sway over the structure of our lives—things like families of origin; the social, historical, or political climate into which we are born; physiological limitations; and on and on.  Those things are of course true.  There is often little we can do to change our history and what it has already chosen to present to us, though the various technologies of this world certainly continue to simultaneously amaze and alarm with the supposed solutions they come up with to many of life’s problems.

However, in speaking of this changing our relationship with those things which cannot be easily changed, what I am most often referring to are the clinical phenomena that we typically use to describe the why’s of how people end up in the consulting room.  The anxieties, depressions, obsessive compulsive tendencies, trauma responses, ruminating thoughts, delusions, and hallucinations that are often the objects of therapeutic concern, to name only a few.  This, of course, runs somewhat antithetical to the idea of psychotherapy as we generally speak about it.  Is it not the idea that through the conduit of these once-a-week hour-long visits to bare aspects of our soul to some stranger we are meant to experience some profound sense of change with regards to those features we have identified as being most pronounced in causing trouble in our lives?  Which I would respond to with a resounding “maybe”.

The practice of psychotherapy, for certain, has come to be understood increasingly in that kind of mold.  Symptoms are meant to have solutions.  The idea of technique as an aesthetic approach to working with another human being, an aesthetics characterized by moment-to-moment responsive attunement and evaluation of what might be happening in the relationship, has given way in many cases to an anti-aesthetic of manualized universal responses for a restricted set of presentations into which we are expected to fit the folks we are attempting to work with.  The idea of creative attunement and attention cedes ground to a narrowing of the perceptual field, thus hearing only what might fit into the predefined set of criteria we need to contort the client into to use the prescriptive methods we believe will be appropriate to their presentation.

This definition in and of itself sounds a lot like Rollo May’s way of describing the neurotic condition.  In his Discovery of Being (which I don’t have in front of me at the moment—and as such with have to go from memory) May describes neuroses as an attempt to narrow the world to make it more comprehensible and manageable.  However, this narrowing comes with the consequence of narrowing the individual’s capacity for experiencing the fullness of their existence, leading to anxieties of an existential variety.  There is a trade off or sacrifice that gets made.  Narrowing our perceptual relationship with the world defends against the overwhelming nature of existence and allows us to maintain a sense of centeredness in our own being.  However, this centeredness is limited and, much like Freud’s “return of the repressed”, will bring about its own set of phenomena which will demonstrate the profound disconnect that comes from too much of a narrowing of this field, leading to experiences of constitutional dullness, apathy, and anhedonia.  In being too prescriptive in our approaches to treatment, we do something of the same and—though elements of this can be made up for by folks who can comfortably go off book and do bring some person-centered elements to the work—facilitate a therapeutic experience which runs the risk of being sterile and inert, even if it does bring about some kind of “change”.

There is another way of working, I think one that is difficult for those who want textbook and manualized approaches, that to me feels all the more powerful for the ways in which it refuses to rely on methodologies rooted in interventions and instead takes cues from processes dictated by relational attunement.  This other set of approaches are anti-prescriptive and therefore, by necessity, must be anti-pathologizing.  An existential phenomenological approach grounded in experiential relational technique is exactly that.

I know I started this by saying something about the process of change, so let’s get back to that.  As a presupposition, if one is going to practice from a position that is not inherently interested in pathologizing a client’s experience (a disinterest based on the fact that no pathology is needed in this model to determine progression of treatment or goodness of fit) than the idea that the client would be showing up to change such and such a feature of their existence is one that can be accounted for and responded to, but with a responsiveness which is as much about observing the perceived desire to alleviate the experience of the so-called “symptom” as it is about interpreting pathologizing features.  Perhaps, what we are often actually desiring is the capacity to authentically engage with our lived experience and grieve the relentlessness of the desire for the possibility of eliminating suffering from our lives.  We strive for the sense that we can bring back to life parts of our existence that have been rendered inert in the service of protecting ourselves against the onslaught of some previous environmental threat and rewrite in the firmament of our being some new understanding of what it means to be.

This is in part why I think the notion of authenticity is so powerful in the work of therapy and why it’s having been co-opted and perverted in the current forms in which it is understood is so damaging.  Philosophically speaking, authenticity is not about this idea of an uncontemplative “being yourself” or making choices that eliminate the reality of the fact that those choices have consequences and may have some negative bearing on ourselves or the world around us.  This authenticity to me often carries the sense of being a kind of response that is intended to eliminate the anxieties and sufferings of what it means to bear the unbearableness of our existence.  It is an impulsive doing in the guise of a choosing which claims fealty to some unreflective self that just is.  This kind of choosing could not be more inauthentic, for it fails to take account of that which we authentically are, which is in some part an anxious conglomeration of various neurosis, defenses, and desires for the fulfillment of some persistent sense of not quite being complete that can never quite be unburdened from the project of being itself.

For me, this is the beauty in blending and borrowing from both the existential and psychoanalytic traditions.  When used phenomenologically (and to that extent somewhat metaphorically) psychoanalytic theories of development, pathology, and what it means to be in interaction with other humans offer some of the richest descriptions of what it often feels like to exist as an entity in this world which has the capacity for psychological self-reflection.  Both are also quite skeptical of the idea or notion of “cure” in any traditional medical sense of what that word means.  I know I have been drawing on him quite a bit lately, but I continue to be won over by Levenson’s remark about any successful analysis being one that has failed the client, in as much as the client has come in to do exactly what I outlined at the start of this post: make the symptoms go away so I can otherwise keep going on being as I’ve been going on being.  By inviting steady, sincere, and supportive structures for contending with the desires, wishes, needs, and fantasies that drive our supposed pathologies, we make space for a “resolution” to these phenomena located within the possibility of learning to bear them with resoluteness and equanimity.   We can invite life’s hardships with awareness, insight, and the capacity to contain the full presence of what it means to be with these phenomena as the arise, both because they cannot be gotten rid of or discarded in the grand scheme of the project of being who we already are, but because when we can learn how to hold them they become a critical component of what it means to live out the richness of existence.