Therapy Beyond Modernity: Deconstructing and Transcending Profession-Centred Therapy (Book Review)

Title:  Therapy Beyond Modernity: Deconstructing and Transcending Profession-Centred Therapy
Author:  House, Richard
Publisher:  Karnac, 2003
Reviewed By:  Tobin Hart, Fall 2003, pp. 40-41

In this provocative text, Richard House suggests that the greatest danger with much of contemporary therapy is not the occasional rogue therapist but professional therapy’s “regime of truth” (p. 12). The therapy discourse creates and reinforces power imbalances and identities—therapist and client—that can engender infantilization and dependency and ultimately produce its own iatrogenic illness. In many ways he follows the spirit of Ivan Illich, indicating the danger inherent in “the disabling of the citizenry through professional dominance” (cited in House, p. 34). This results in individuals unwittingly giving their power away to those in culturally legitimated professions. His attempt in this book is to “rescu(e) the soul of therapy” from the professionalizing tendency of modernity; and in so doing reclaim those essential values and ways of being that are in the genuine service of helping.

His well-reasoned argument is against “the grossly naïve pretense that psychotherapy become a valid science” (p. 212). He suggests that current modernist practice is more about making sense of people through various theories, than actually about helping them. He challenges the modernist notion of objective truth and the privileged position of knowledge that emerges from an interpretive dependant style of therapy, whether in classic psychoanalysis or in cognitive-behavior theory. The therapist’s use of interpretative frames can be abusive, resulting in an enculturation of clients (and therapists) into a worldview that they must adhere to in order to be “cured.”

As an alternative, the author advocates a deconstructive psychotherapy, one that is always in process … “rather than a stabilized set of teaching” (p. 46). The work of therapy may be best served in the borderland of order and chaos rather than from behind an orderly theoretical construct (p. 40). He argues against psychotherapy becoming an efficiency-based “scientized,” and/or “medicalized” practice in favor of a meaning-based, even artistic, activity, wrestling with questions of living. Post-professional therapy emphasizes human potential development and diversity in the face of a hegemonic professionalism.

In chapters 3 and 4, the author deconstructs what he refers to as self-serving categories. He treads on untouchable, or at least taken-for-granted, givens of therapeutic discourse. For example, is resistance “acting out” the client’s neurosis, or is it the patient’s unconscious commentary on an infantilized discourse? Is the therapeutic relationship understood as an emergent dialectical encounter, or is it an ordered systematized meeting obsessed with lines and “boundary-speak” (i.e., the assumption of professional distance and role definition)? Does the emphasis on boundaries have more to do with protecting the therapist from vulnerability than it have to do with client needs? Is the therapeutic container (the notion of “holding”) a safe transitional space for clients, or is it a narcissistic mutual identification, infantilizing the client and fostering the notion of omnipotent therapist? Does supreme emphasis on confidentiality offer client safety or a “privatization of distress” (p. 65) reinforcing an individualizing, isolated, modernist approach to difficulty?

Following this potent deconstruction, in part II (chapters 5, 6, 7) the author highlights the experience of three former clients and authors who have described their own therapy: Rosie Alexander’s Folie a Deux, Ann France’s Consuming Psychotherapy, and Anna Sands’ Falling for Therapy. This brings many of the abstractions of part I down to earth in a compelling way. What is conveyed is not overt client abuse but the iatrogenic abusiveness that is inherent in the “professionalized” therapy described. As Rosie Alexander explained, “I did not suffer from the aberrant condition described in the book and have not done so since recovering from the experience (of therapy)” (cited in House, p. 125). House paints a picture of an unconsciously insidious practice through which healing is achieved only through conforming to the therapeutic worldview, and thereby the therapist’s definition of client’s pathology. Helpful therapy is often about finding and creating fresh stories through which to understand our lives, but the problem, House implies, is in the imperialism of the therapist’s story as imposed upon the client. Anna Sands asks, “Whose truths do we investigate during therapy? The client’s, or that of the therapist, or of the particular school of thought which the therapists follows?” (cited in House, p. 160).

When and how is theory useful, and when does it serve as a “substitute for, and a defence against, the existential ‘terror’ of being fully in the here and now of immediate lived experience?” (p. 204). Perhaps his case against theory is a little one-sided. Theory can help us look in ways that we may not have considered before. Theory can serve to expand perspective as well as to limit it. But its utility, as he understands very well, is as a transitional object of sorts. The problem is not theory per se but the reification of it as a closed system of truth. He reminds us that length of training one has, and the school of thought one adheres to, have a low correlation with success in therapy—something else seems to make the difference.

A post-conventional ontology and a more improvisational therapeutic approach may rescue the therapy project. He draws the epistemic and ontological ground for this revision from what he describes as “New Paradigm” thinking including that of Krishnamurti, Bohm, Steiner, and also the kind of science that Goethe pointed to. He suggests that this “explicitly and unashamedly spiritual worldview (is) absolutely central to the philosophy and authenticity of psychotherapy and counseling” (201).

The author also draws from the fascinating German poet-turned-physician, Georg Groddeck, a contemporary of Freud, whose remarkable vision of, and success in, therapy offered a view of therapy ahead of his time. He anticipated psychosomatic medicine, holistic treatment of disorders, and the healing power of relationship and love: “Without the arrow of Eros no wound can heal, no operation succeed” (cited in House, p. 181). Groddeck eschewed theory in favor of immersing himself in clients’ experiences and understanding their meanings.
Like Groddeck, House understands therapy not as an assemblage of techniques or theory, but a rich encounter and exchange between persons. This post-modern, post-conventional approach seems to come near the spirit of Carl Rogers and Rollo May—the direction of the human potential development blended with the power of post-modern deconstruction and the challenge of Lacan.

This therapeutic stance is grounded in an ontology that recognizes that human life is better considered a mystery than a series of problems to solve. It challenges the basic assumptions of modernity, the expectation for objective knowledge, certainty and control. As Groddeck wrote, “It is absurd to suppose that one can ever understand life, but luckily one does not need to understand in order to be able to live or help others who want to live” (cited in House, p. 195).

What we are left with from Therapy Beyond Modernity is a notion that the authority of therapy needs to be fundamentally reconsidered. Instead of standing on a well-crafted theoretical orientation, therapy is more authentically grounded in the authority of the embodied experience of being, an organic ethic geared toward intersubjective exchange. This is risky territory, one requiring capacity for constant deconstruction, authenticity, deep reflection, maturity, an ethic of care, and the Eros that Groddeck mentions. In the end this remains fluid, hard to pin down, and certainly hard to train for. This is not an easy, convenient or prefabricated solution (or profession). Instead, it is one that is precisely congruent with the fluid nature and mystery of life.

Richard House has succeeded in forming an erudite and passionate argument against “profession-centred,” modernist approach to therapy. This is equally a challenge to what constitutes valid knowledge; they are inextricably bound to one another. He has also pointed in the direction of a reorientation in therapeutic premise and practice that will require a shift beyond the modernist constitution of being and knowing. Regardless of the theoretical orientation one takes, this book is a powerful contribution to the dialogue of what therapy is and does, for better or worse. It provides just the kind of dissonance that forces a reconsideration of assumptions and actions. And it does so without a club, but with the skill and knowledge of an astute and authentic guide. For aspiring and practicing therapists, this book offers a provocative pause, inviting a radical reconsideration of our assumptions about knowing and helping. It is an important and articulate contribution to the dialogue on what therapy should and shall become.

Karen Zelan has written extensively on the psychology of children’s learning. She is the author of Between Their World and Ours:Breakthroughs with Autistic Children.

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