Efficacy of Psychotherapy - Coursework Example

Efficacy of psychotherapy: Effects on patient dignity, autonomy and freedom Introduction There has been considerable amount of debate regarding the appropriateness of psychotherapy as a mode of therapy, with many critics focusing on its practical weaknesses. The focus on the aptness of the matter is not a new development though as pioneers in the field of psychology such as Freud himself have been quoted expressing their ambivalence on the matter, stating that psychotherapists indulge in analysis for two reasons: ‘to understand the unconscious and to earn a living’ (Frosh, 1997). Subsequent critics have gone further in contributing to the debate focusing on the appropriateness of psychotherapy and the role of psychotherapists by trying to distinguish between the strengths of psychotherapy as a theory and the weakness as a mode of therapy especially in terms of the role of psychotherapists. Those arguing against psychotherapy such as Jeffery Masson (1989) have pointed out that psychotherapy is a form of social control that deprives the person who comes for help his or her autonomy, freedom, and dignity. The premise of the argument is that, regardless of the intentions of the psychotherapist, the process of psychotherapy as a theory is intended to assault on the freedom of the client and coerce them to behave in a manner dictated by the therapist. This is indeed the case given that for psychotherapy to be deemed effective, the client must have behaved and changed his attitudes in accordance to principles dictated by the psychotherapist. Although it is easy for those practicing psychotherapy to dismiss Masson’s claims as mere criticisms, he brings to the forefront an issue of great concern. However, numerous arguments also exist in support of the effectiveness of psychotherapy, which try to counter the arguments made by critics that psychotherapy indeed diminishes the freedom, autonomy and dignity of an individual. The purpose of this paper is to offer a critically discussion regarding the effectiveness of psychotherapy, in particular its effects on the client concerning whether the autonomy, freedom and dignity of persons who approach psychotherapists for help is actually diminished during the process. In order to offer a critical analysis, the paper looks at the arguments in support of the argument that psychotherapy has serious weaknesses as a mode of therapy, and those opposing this view. Arguments against psychotherapy Several critics of psychotherapy have questioned the truthfulness of the intentions of psychotherapy, particularly concerning whether it is intended to diminish the dignity, autonomy and freedom of the client. Masson (1989) questions the intentions and viability of the theoretical claims of psychotherapy especially concerning its impacts on the individual. The author claims that psychotherapy does not appreciate the true needs of the client as they are struggling with their own heritage and present conditions of existence. Psychotherapy is therefore viewed to digress from the intended purposes of empowering those who seek therapeutic help to dismissing and abusing the client. Masson unequivocally states that this mode of therapy, regardless of the kindness of the psychotherapist, ultimately writes off the client’s actual experience by shifting the authentic source of responsibility for the client’s distress from societal factors to the client (Smail, 2001). The therapeutic relationship that exists between the client and the therapist entails forms of power although this power is generally seen to lie with the therapist. First, the therapeutic relationship is of client hood whereby the client seeks the services of a trained expert, a situation that consequently creates a level of dependency and subordination on the part of the client (Rose, 1999). This not only diminishes the autonomy of the client, but also impacts negatively on the self-esteem of the client because the situation forces him into some kind of subordination. The financial nature of psychotherapy also plays a major role in contributing to the destructive effects of psychotherapy, especially on the freedom, autonomy and self-esteem of the client. The financial aspect renders the process to be a tutelary relationship rather than a contractual one since it gives the therapist powers over control of the pace, nature and language of the interaction. Psychotherapy, therefore, bestows power and influence over the relationship on the therapist while diminishing the autonomy of the client by limiting hiséher influence over any aspect of the therapeutic relationship (Fitzsimons and Fuller, 2002). As Frosh (1997) asserts, psychotherapists are thus involved in sort of power games at the expense of the client by converting the actual aspects of the oppressive and abusive nature of the social world into figments of the client’s own imagination. In this way, the psychotherapist, no matter how kind he or she might be, finds himself abusing the dignity of the patient. The psychotherapist, while treating the patient, interprets the client’s real accounts of traumatic events as symbols of unconscious impulses that he is obliged to decode. Psychoanalytical doctrines dictate that the memory of the client is never to be trusted, but rather to be treated with utmost doubt and suspicion. Consequently, the psychotherapist is ideologically forced into confusing the client so that she or he is no longer able to appreciate the true source of their distress (Smail, 2001). Although this might not be the intended effect of psychotherapy, the therapeutic approach the process takes ultimately diminishes the dignity of the client by ‘forcing’ them to believe that they are the source of their current struggles and disturbance (Tormey, 2001). Instead of focusing on a non-transparent in internal, psychic world that is hidden to the client, the psychotherapists should clarify and analyse the real accounts of the client if the purpose of the therapy is to help the patient overcome his or her struggles and current distress. On the contrary, as Masson aptly states, psychotherapy is structured in a manner that, intentionally or unintentionally, ‘diminishes the dignity, autonomy, and freedom of the person who comes for help’ (Masson, 1989), irrespective of the intentions or character of the psychotherapist. Another argument that questions the efficacy of psychotherapy cites the stigmatization of patients as ‘mentally ill’. When a client is stigmatized as ‘having issues’ that requires the intervention of a therapist in dealing with current distress, the therapist is automatically forced to remain deaf and disregard any opinion or memories of the client. The client is therefore made to believe that he has a problem, and the therapist has the solutions to their problems. The autonomy and freedom of the client is severely jeopardized, rendering psychotherapy a method of control, and an institution meant to abate the freedom and autonomy of the client, perhaps inadvertently. Arguments in support of psychotherapeutic efficacy There are several counter-arguments to the claims made by those questioning the efficacy of psychotherapy, and whether it is actually structured to harm the client. The main argument fronted by those in support of psychotherapy is that the process leads to development of beneficial therapeutic relationship. The premise of this argument is that the initial intention of psychotherapy is to create a setting of interaction between two people who attempt to understand one another, with the specific goal of achieving an outcome that is beneficial for the complaining person, and helps them in overcoming with their struggles and distress. Therapy is therefore regarded as an empowerment process that focuses on the strengths and potentials of the client rather than their weaknesses or pathology, and is aimed at helping the client accomplish what is important to her or him (Procter, 2002; Rolvsjord, 2004). The therapeutic relationship developed is essential in generating positive therapy outcomes when psychotherapists employ the core provisions of unconditional positive regard for the client, empathy, and congruence (Jordan and Hartling, 2002). In this regard, psychotherapy stipulates the conditions necessary for facilitation of positive therapeutic outcomes (Frosh, 1997). The core conditions are not meant to harm the client or diminish her or his dignity, autonomy or freedom but rather to help the client in dealing with their current disturbances. Moreover, the therapeutic relationship developed between the therapist and the client is a contributing factor to the improvement of the client. The positive influence that the relationship between the therapist and the client has on the improvement of the latter is supported by evidence from studies, which show that the empathic attitude and positive regard the therapist has toward the client does not harm the patient but rather helps him or her in by raising his or her self-worth. Several critics of psychotherapy have argued that the financial aspect of the therapeutic relationship between the therapist and the client limits the influence and autonomy of the client. To counter this argument, others have powerfully argued that the fact that money exchanges hands during the relation is a liberating phenomenon. Given that the client pays for the services offered by the therapist, he is liberated from dependency, consequently giving him power and over the therapist and establishing legitimate control over other aspects of the relationship such as expected quality of service, period of therapy, and so forth. The financial relation therefore is seen as a way of establishing equivalence between the therapist and the client, so that the autonomy and dignity of the latter is not diminished (Rose, 1999). Another prominent argument supporting the efficacy of psychotherapy cites informed consent that is intended to respect the personhood, autonomy, and self-determination of the client during the psychotherapeutic process. By clearly informing the client of the nature of treatment and goal of therapy, the client is not coerced into by either the therapist or other social factors into indulging in the process. This way, the autonomy and freedom of the client is assured since the decision to agree or refuse to accept the therapist’s services and opinions lie with the client. This argument plays down the claims made by critics of psychotherapy by asserting that providing the clients with an opportunity of making an informed decision concerning involvement in the treatment process is a clear indication that the dignity, autonomy and self-determination of the client is respected (Fisher, 2003). Conclusion The efficacy of psychotherapy has always come under question with many critics arguing that the mode of therapy is not structured to help the patient in overcoming his current struggles and distress, but rather is bound to diminish the dignity, autonomy, and freedom of the client. The arguments in support of this notion claim that psychotherapy is an oppressive form of social control that forces patients to act or behave in a manner dictated to them by the therapist. The client, therefore, has no control or choice over what she or he does, but depends, and in most cases believes in what is dictated to him. In this sense, psychotherapy fails to work because it creates an imbalance of power between the psychotherapist and the patient by giving the former the authority of judging, and sometimes condemning the patient’s actions, thoughts, and feelings as undesirable. This not only lowers the dignity of the client but also deflates the self-esteem and respect of the client. On the other hand, there are also numerous arguments that are in support of psychotherapy, citing cases when psychotherapy has proved effective in helping patients deal with their disturbances. These arguments are generally based on the principle that psychotherapists are required to interact with their patients with empathy, and show genuine concern for their distress. Psychotherapists are, thus, involved in the overall improvement of the client through unconditional positive regard for their opinions and concerns. Although the arguments in support of the efficacy of psychotherapy cite several cases as evidence, is essential to acknowledge and investigate the claims made by critics regarding this mode of therapy. The acknowledgement that psychotherapy may at least at times, and perhaps inadvertently, end up destroying or harming those it is intended to help. Indeed, as presented by the arguments, there is a live possibility that psychotherapy may harm those who seek help by diminishing their dignity, autonomy, and freedom. References Fisher, C. B. (2003). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage. Fitzsimons, S. & Fuller, R. (2002). Empowerment and Its Implications for Clinical Practise in Mental Health: A review. Journal of Mental Health, 11(5): 481-499. Frosh, S. (1997). For and Against Psychoanalysis. Routledge, London. Jordan, J. & Hartling, L. M. (2002). New Developments in Relational Cultural Theory. In: Ballou, M & Brown, L. S. (Eds.). Rethinking Mental Health & Disorder. Feminist Perspectives. London; The Guilford Press. Masson, J. (1989). Against therapy. HarperCollins Publishers, London. Rose, N. (1999). Power in Therapy: Techne and Ethos. Available at http://www.academyanalyticarts.org/rose2.htm  Procter, S. (2002). Empowering and Enabling-Music therapy in non-medical mental health provision. In: Kenny, C. & Stige, B. (Eds.). Contemporary Voices in Music Therapy. Oslo: Unipub Forlag. Rolvsjord, R. (2004). Therapy as Empowerment Clinical and political Implications of Empowerment Philosophy in Mental Health Practices of Music Therapy. Nordic Journal of Music Therapy, 13(2):99-111. Smail, D. (2001). Why Therapy Doesn’t Work and What We Should Do About It. Routledge: London. Tormey, S. (2001). Agnes Heller: Socialism, Autonomy and the Postmodern. Manchester University Press, Manchester. Read More