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Book Review - Power Games Influence, Persuasion and Indoctrination in Psychotherapy Training

Power Games: Influence, Persuasion and Indoctrination in Psychotherapy Training

Edited by Richard Raubolt

New York, NY: Other Press, 2006. ISBN-10: 1-59051-173-5; ISBN-13: 978-1590511732 (paperback), $32.00. 320 pages

Reviewed by Steve K. D. Eichel, Ph.D., ABPP

Like many other psychologists, my first exposure to the field was through psychoanalytic theory and concepts. Psychoanalysis was daring and bold, and delved into the psychic depths that behavioral psychology dismissed as an unknowable and irrelevant “black box.” Psychoanalysis was science with a human face. It dealt with people, not behavioral contingencies and schedules of reinforcement. Although I later “converted” to a psychology that is more inclusive than dogmatic, I will always have strong if mixed feelings for the faith of my ancestors.

Edited by Richard Raubolt and containing a broad range of contributors, Power Games: Influence, Persuasion, and Indoctrination in Psychotherapy Training is a dense and highly important work. It is not for the lay reader. In purpose, scope, and terminology, the book is clearly intended for graduate-level mental-health professionals or others well acquainted with psychotherapeutic and, especially, psychoanalytically oriented theory and practice.

The volume is divided into three sections, beginning with several personal accounts. In Section I: Supervisory Experiences: Personal Reflections, the first chapter describes a therapist's involvement with the Center for Feeling Therapy. The second chapter tells of a therapist's wife's experiences with the Bar Lev Educational Association. Then the third chapter presents the therapist/husband's responses to the content of chapter 1 and chapter 2, by his wife.

These accounts clearly set the tone for many, but not all, of the subsequent chapters in the book. Many later contributors painstakingly reveal their experiences as therapists in training, some within well-known therapy “cults,” but others within traditional psychoanalytic training.

Fortunately, although the book is rich in “complaints” (narrative, theory, and conceptualizations of the problem), it also contains some thoughtful solutions in its third and final section. Throughout, the book rarely descends into “cult-baiting” or pejorative or pedantic rationalization. Some of the stories are difficult to read because they are so multilayered, and they attempt to probe into such deep and subtle social psychological processes.

The irony of psychotherapy training is that, to become proficient and expect one's clients to trust and be vulnerable, the trainee must do the same in her training. Yet, just as the goal of psychotherapy is the facilitation of mature identity, independence and interdependence (healthy attachments), and productive work/creativity, the goal of psychotherapy training is the facilitation of the trainee's growth into an independent, mature, and wise clinician. Annette Richards tackles this paradox in her discussion of submission vs. surrender. Submission implies a static, one-way interaction in which the personhood of the trainee must submit to that of the trainer, with little or no mutuality. Surrender, on the other hand, is “more of a state of mind, a yielding, a letting-go, which is the expression of an open system” (Richards, p. 31) in which both trainer and trainee are equally vulnerable.

Daniel Shaw's chapter 4 in the first section, “Narcissistic Authoritarianism in Psychoanalysis,” is noteworthy. Like Richards, Shaw tackles an aspect of the training relationship that is difficult to nail down. In distinguishing between “everyday narcissism” and “malignant narcissism” in psychoanalytic training, Shaw explains how “normal” narcissism can degenerate into an “everyday” yet authoritarian narcissism that consists of “minor intrusions of the analyst’s narcissism in his role as teacher and supervisor” that, over the span of psychoanalytic training, accumulates until it causes the trainee to “develop a ‘false supervisee self’ based on compliance... [greatly increasing the likelihood] that the supervisee will go on to elicit similar results in his patients” (Shaw, p. 75). The authoritarian demand for compliance in psychoanalytic training results in “suppressing individuality and creativity in [psychoanalytic] candidates in favor of compliance and accommodation ... the Orwellian version of psychoanalysis, of which we should all be afraid” (Shaw, p. 76). This form of authoritarian narcissism is more subtle and therefore more difficult to counteract than the malignant narcissism found in cultic groups. “The malignant narcissist,” Shaw notes, “acts in conformance with the underlying belief that she is perfect, superior, and ultimately entitled, and therefore any means will always justify the end—the end being the fulfillment of the delusion of omnipotent perfection” (p. 79).

In chapter 5, Marty Livingston discusses and comments on the previous chapters, focusing primarily on the concept of charisma. Charisma in and of itself is neutral; at best, it encourages and invites “surrender to a process within a safe surround,” which leads to “vulnerable moments” that are “windows for change.” The passion of the charismatic leader (or therapist) can lead to a forcefulness that, on the one hand, can allow him or her to enforce safety and containment in an environment that promotes vulnerability and therefore can invite potential abuse (in group therapy, for example). On the other hand, “the force of the leader’s personality and conviction can be potentially damaging” because vulnerability can also lead to “shame, disorganization, and unhealthy influence” (Livingston, p. 84).

In Section II, Theoretical and Technical Considerations, Theodore Dorpat begins chapter 6, “Covert Methods of Interpersonal Control” with the great analogy that “fish don't know they swim in water until they are out of water.” That is, until people experience caring, reciprocal, and healthy relationships, they typically don't know “how much they have been covertly manipulated, controlled, and abused by others” (Dorpat, p. 93). Dorpat goes on to eloquently describe covert methods of interpersonal control in therapeutic situations, including “gaslighting” (the deliberate undermining of a client’s own judgments), questioning/interrogation, confrontation and interpretation of defenses, abrupt changing of the topic, and other methods of fragmenting a client’s experience. He compares and contrasts therapeutic manipulation with covert methods of interpersonal control in everyday life, such as covert verbal abuse and the use of unspoken presuppositions (the use of subtle underlying assumptions that can direct how an individual thinks). He also critiques the “idealization of power and mastery over people,” the use of indoctrination by large institutions, and behavior modification therapies. He correctly compares the denial of abuse often seen in some cult victims with the denial therapists often see in people who have been physically or sexually abused as children. However, Dorpat's statement that “covert methods of interpersonal control are used more extensively by nonpsychoanalytic therapists than by psychoanalysts and psychoanalytically oriented psychotherapists” (Dorpat, p. 115) is not backed up by research. He incorrectly notes that psychoanalysts are trained to be neutral and nondirective, when there has been considerable evidence in therapy-process research that there is no such thing as “nondirective” therapy. (This evidence is why Carl Rogers ceased referring to his therapy as “nondirective therapy” in favor of the more accurate descriptor “client-centered therapy.”)

Recalling his early years as a psychologist at a large mental hospital, Patrick Kavanaugh in chapter 7 seems to echo Erving Goffman (1961) in his description of the psychoanalytic institute as a total institution. He cautions against psychoanalytic candidates being coerced into becoming a “Lobo Brigade” (a term used to describe lobotomized patients who were hospital lawn keepers) who must show absolute obedience to the theoretical orientation of their institute. His chapter weaves together the interconnections among ideology, power, and knowledge, and ends with the conclusion that “psychoanalytic education in the twenty-first century must be premised and organized around the freedom to question the structures of our traditional social institutions” and the basic assumptions and values of culture (p. 151).

As a context for my comments about Michael Lariviere’s chapter (8) on mimetism, or “institutional cloning,” I will say I am admittedly not a big fan of Jacques Lacan. What I do understand of Lacan has long seemed fairly obvious to me and, in my opinion, has been better expressed by others (even sociologists!). I do not understand a great deal of what Lacan has written and spoken (I have watched—or tried to watch—a few videotaped lectures and interviews). I find myself lost in his use of vague language and overly esoteric references. I had the same reaction to Lariviere’s chapter. While he attacks the tendency of psychoanalysts to mimic their conceptualization of Freud and Freudian thinking (a process often humorously depicted in the sitcom “Frasier”), Lariviere seems to do just that with Lacan. To this admittedly weak reader of Lacan, his chapter seems very “Lacanian.”

Richard Raubolt’s chapter 9 on “coerced discipleship” is entirely unlike Lariviere’s contribution. Raubolt’s chapter is concise and to the point. He builds on the classic article on iatrogenic psychotherapy cults by Temerlin and Temerlin (1982). He characterizes indoctrination as occurring by “seduction or force” and as possessing five essential components (p. 171): (1) charismatic, authoritarian, and dominating leadership; (2) dichotomous and stereotypical thinking; (3) affiliation with an institution or group that fosters conflicting relationships; (4) cycling of trauma and retraumatization; and (5) theft of language. He provides several clear examples of each component, and his discussion of the different kinds of coercive leadership styles is especially illuminating.

Section III of this volume is titled “Supervisory Alternatives.” Here, in respective chapters, analysts Paula Fuqua, Conrad Lecomte, Joan Sarnat, and Arthur Gray share their experiences as supervisors struggling with the authority and power inherent in the psychoanalytic training process. Then in the next chapter, Gershon Molad and Judith Vida tackle the difficult issue of identification and introjection in training. The final two chapters, the first by Irene Harwood and the last by volume editor Raubolt, attempt to synthesize and address these issues and provide suggested solutions.

In chapter 11, it is relieving to read Fuqua’s description of “a dilemma full of emotional and ethical challenges” (p. 212) she experienced with two supervisees. Her theoretical approach, which combines Kohutian self-psychology and intersubjectivity, is one I can deeply appreciate. One case in particular resonated with some of my own experiences. I once supervised a promising but very emotionally damaged young therapist who was initially painfully honest with me while she hid her true feelings and thoughts from other supervisors. Like Fuqua, I attempted to “create an empathic bond... [and] divert some of her mirroring selfobject needs into our relationship” (p. 216). My situation did not end as successfully as Fuqua’s, however. In part because I failed to exercise my power and authority, my supervisee eventually decompensated, and her subsequent behavior almost cost me my job (to this date, she has not obtained her license). In Fuqua’s example, her supervisee eventually broke off dysfunctional relationships with her husband and her iatrogenic therapist. As Fuqua aptly concludes: “In the end, the supervisor’s authority and expertise [are] a double-edged sword. [We] have the potential to foster growth or create pain, harm, and havoc, and we don’t always know which will result” (pp. 217-218).

Conrad Lecomte begins chapter 12 by reminding us that training centers tend to advocate one of three approaches to supervision. Some programs attempt primarily to teach mastery of specific strategies and techniques. Many cognitive-behavioral-oriented programs probably fall into this category. The second type of training emphasizes proper and thorough patient assessment and diagnosis. The “therapist-focused” programs rely heavily on exploring the therapist’s internal process and experiences as primary contributors to the therapeutic enterprise. Lecomte advocates an integrative training model that “fosters an empathic-introspective, affect-attuned approach of listening to and exploring the therapist’s experience” within a “reflective space in supervision” (p. 236). Developing and conveying this “safe” space during supervision is primarily the responsibility of the supervisor, who must continuously struggle toward increased competence, which Lecomte defines as “the self-awareness and regulation of one’s own ongoing organizing activity in interacting with similarly and differently organized perspectives” (p. 239). To me, Lecomte seems to be arguing for deep awareness and appreciation of intersubjectivity. Supervision of supervision may be necessary; the ultimate goal for both supervisee and supervisor is the development of an “internal supervisor” (see note).

I found Joan Sarnat’s chapter on authority relations (chapter 13) interesting and highly approachable. Working from a relational perspective, Sarnat encourages the supervisory relationship to be one of “mutual vulnerability.” Over the years, I have found my most meaningful supervisory relationships (both as supervisor and supervisee) to be those in which both parties take risks and become engaged in a growth process that might occasionally be very uncomfortable. Sarnat implores supervisors to challenge their supervisees’ enthrallment with an “authoritative” clinical theory, but also to be open to their own conflicts, to seek peer consultation, and, on occasion, to share the struggle with their supervisees. Disclosure can model and “demonstrate a self-analytic process, by speaking about the workings of [the supervisor’s] mind as it shows up on [the supervisory] relationship” (p. 265). Recognizing the inherent extra vulnerability of the trainee, Sarnat also urges the supervisor to adapt him/herself to the supervisee’s “narcissistic vulnerability” (p. 268).

In chapter 14, Arthur Gray presents a structured group-supervision model as a means of both leveling the field and making training more efficient. His six-step group-supervision model begins with a presentation of the situation, followed with a discussion of the presenter’s approach to the situation. The problem to be addressed in supervision is then presented, and the group discusses whether this approach addresses the problem. In the last two stages, the group considers alternative approaches to the problem, and then concludes with a discussion of what has been learned. The result, according to Gray, is that the group creates the supervision experience together; all participants have the opportunity to become empowered. Gray’s structured group process seems logical and forthright, but I can see how it can easily be undermined by a charismatic/authoritarian group leader and the creation of “in” and “out” subgroups within the larger group. Gray’s chapter would be strengthened by a discussion of how to recognize and deal with the dynamics that might lead to an iatrogenic group-supervision experience.

Chapter 15 by Molad and Vida attempts the difficult task of differentiating identification (including identification with the aggressor) and introjection. Both processes can involve love, but the former is the result of aggression and fear in which the “victim” capitulates to, and joins with, the “aggressor.” In contrast, introjection involves a “surrender and giving-in (yielding) [and is] more suggestive of something quieter, like devotion” (p. 298). Distinguishing between two kinds of love that might involve very similar feeling but are ultimately very different processes is a daunting task that may be too subjective for any meaningful generalizations. Unfortunately, in my opinion, this chapter is undermined by its over-reliance on psychoanalytic theory and terminology, to the point of becoming almost inaccessible to the “common” therapist with a minimum of psychoanalytic training.

Power Games’ concluding chapters 16 and 17 take different approaches to achieving closure. Harwood comments one by one on the third-section authors’ chapters. Her approach is personal and self-reflective. To me, hers is a model of the self-analytic process that clearly underlies all the solutions presented in this volume, and I appreciate her honesty and willingness to open her process to so many unknown readers. I found myself in agreement with her support for Gray’s group-supervision process, and I shared her difficulty with the chapter by Molad and Vida. Finally, volume editor Richard Raubolt returns to some of the warnings in this book’s earlier chapters. He discusses behaviors and signs that might suggest that supervision has become a traumatic process, or may be triggering retraumatization. He seems to echo Fuqua’s use of a self-psychology perspective, quoting E. Wolf’s admonition that “one of the most basic aspects of supervision or consultation should be the reduction of the [student’s] fragmentation anxiety” (p. 336). The goal should be “the strengthening of the student’s self ... teaching has to merge into healing before it will result in learning” (p. 337). Raubolt concludes with his own set of nine carefully thought-out training/supervision recommendations designed to encourage the search for “paradigms in professional education that focus on finding ‘truth’ in the supervisee and in the supervisor through the mutually developed relationship between them” (p. 338).

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Note: Interestingly, although never cited, a recent work by experiential psychotherapist/trainer Jeffrey Kottler (2003) makes the very same recommendation, and provides considerable practical advice about how to develop an internal supervisor.

References

Goffman, E. (1961). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York, Doubleday.

Kottler, Jeffrey A., & Jones. W. Paul. (2003). Doing Better: Improving Clinical Skills and Professional Competence. New York: Brunner-Routledge.

Temerlin, M., & Temerlin, J. (1982). Psychotherapy cults: An iatrogenic perversion. Psychotherapy: Theory, Research, and Practice, 19, 131-141.

Cultic Studies Review, Vol. 7, No. 1, 2008, Page

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