Opinion: A Response to Anna Sands’ Falling for Therapy

I read the guest editorial in December's Counselling with much interest, as I have recently finished reading the book Falling for Therapy, from which the excerpt is taken. Like Colin Feltham, I have an interest in those books which critique therapy from a client's perspective and found both Carter Heyward's book When Boundaries Betray us and Rosie Alexander's book Folie a Deux interesting. It certainly behoves those of us who earn our living and base our reputations on psychotherapeutic practice to listen to disaffected clients. They may well offer us something on which to chew, however uncomfortable that might be for us to have dearly held beliefs and practices questioned.

However, I disagree with Colin Feltham's affirming comments on Anna Sands' particular contribution to this debate. I think that the book is principally an expression of unquenchable anger against her former therapist, which I personally found quite chilling. There was no humour, insight or self reflection in it that I could discern.

It was not surprising that she felt 'unheard' by his professional body as her therapist had done nothing whatsoever which was unethical. Her main criticism seemed to be that he often maintained silence when usual social intercourse would have dictated a more active response and that he did not reassure her in the way a friend or relative might, but sought to uncover with her what underlay her presenting way of being in the world and with him.

She claims to be mystified by this but I find it hard to believe that an educated and articulate woman like Anna Sands would have no idea at all of the ways in which an analytical psychotherapy might be different from ordinary social exchanges. 

At no point in the whole book did I find one comment which indicated that she might take some responsibility for the difficulties which ensued between herself and the therapist. She appears to blame him relentlessly for her distress, her breakdown and her failure to benefit from the experience.

At one point she recalls that he brought up an incident between the sessions when she had telephoned him and shouted and swore at him. He noted that she had been 'belligerent', which she concedes. However, because she felt deeply ashamed by his mentioning the incident, she appears to blame him for this uncomfortable feeling and to imply that he was remiss in even bringing the incident into the session.

I wonder which therapist or counsellor would agree with her that it was inappropriate to bring up her 'belligerence'. I would myself consider myself so collusive as to make me question whether I should be in practice at all if I failed to mention so important an event. Within usual social intercourse if one is verbally abused by another there are usually consequences. Within therapy however, there is hopefully less to lose by such behaviour because the therapist is willing to bracket his or her own hurt and anger at this treatment and try to discover the particular meanings this might have for the client. This, it appears, her therapist tried to do. 

If the client will not even begin to take responsibility for his or her behaviour, this will not work, however compassionate and holding the therapist is. In this instance, Anna Sands seemed unwilling to take responsibility for her actions or for the feelings which ensued when (apparently gently) confronted by the therapist.

She goes on to write glowingly of her therapy with Kate, a humanistic practitioner, with a more open, warm and affirming style. However, this more productive encounter did not seem in any way to help her to reach a more self-reflective place within herself. Indeed, much of what she writes about her two therapists' respective merits could be summed up as an Orwellian slogan: Humanistic Kate - Good; Unnamed Analyst - Bad. It was almost as if the therapy with Kate served to prove to Anna Sands that she was right all along, her first therapist had indeed been a cold, useless person, with his own agenda, who had somehow mystified her to the point where he gave her a breakdown.

Much of what Anna Sands notes as being particularly productive in the therapy with Kate seems to be when Kate goes beyond or outside of what is usually considered to be the therapeutic frame. Once she makes a cup of tea when the client is particularly upset; on another occasion she thanks her for what she, Kate, has gained from the session.

I can appreciate that it can be these poignant demonstrations of the therapist's real concern and appreciation that deeply touch the client and move the therapy along in unexpected ways. But I wonder here if they are cited less in a spirit of genuine gratitude and more as a way of showing that the first therapist's boundaries were, as suspected, useless and unnecessary.

I partly wonder this because I can see no sign, within the book, that Anna Sands has completed a therapy that really worked for her, in a way that I can understand. I would suggest that a successful therapy with any kind of practitioner leaves a client aware that she and others are imperfect and disappointing; however, there is genuine humour to be found at one's own wish for perfect understanding, there is forgiveness for self and others at the muddles we get ourselves into, above all, there is a capacity for self-responsibility which does not solely blame the other when things go wrong. I do not find this awareness, humour, forgiveness or self-responsibility at any point in Falling for Therapy.

 References:

Alexander, Rosie (1995) Folie a Deux: An Experience of One to One Therapy Free Association Books, London

Heyward, Carter (1993) When Boundaries Betray Us HarperCollins, U.S.A.

Sands, Anna (2000) Falling for Therapy: Psychotherapy From a Client's Point of View Palgrave, U.K.