‘At its very core, the flow of therapy should be spontaneous, forever following unanticipated riverbeds; it is grotesquely distorted by being packaged into a formula that enables inexperienced, inadequately trained therapists (or computers) to deliver a uniform course of therapy. One of the true abominations spawned by the managed-care movement is the ever greater reliance on protocol therapy in which therapists are required to adhere to a prescribed sequence, a schedule of topics and exercises to be followed each week.
In his autobiography, Jung describes his appreciation of the uniqueness of each patient’s inner world and language, a uniqueness that requires the therapist to invent a new therapy language for each patient. Perhaps I am overstating the case, but I believe the present crisis in psychotherapy is so serious and therapist spontaneity so endangered that a radical corrective is demanded. We need to go even further: The therapist must strive to create a new therapy for each patient.’
The Gift of Therapy: Irvin D Yalom, Piatkus, London 2002
We do not use language like ‘patient’ in this service. Indeed, the writer has increasingly turned away from the word ‘client’ as well, preferring the more cumbersome ‘person I am working with’ – itself a piece of learning from a person she is working with (about equality and empowerment)….
That linguistic difference aside, Irvin Yalom’s comments are as accurate now as in 2002 – even more so perhaps, because since 2002 we have seen an increasing march towards standardized, protocol-driven ‘therapy’, deontological or rule-based ethics, and prescriptive, punitive ‘professional’ codes. Pressures on therapists to conform exist not merely within the medical model context, but increasingly in parts of the therapeutic world that use humanistic language – up to a point – whilst still advocating a view of therapy that includes ‘mental health’ terminology, is pro-regulation (with no adequate or convincing evidence base), and conceptualizes a definable ‘proper’ way to practise therapy, that can appropriately be tested using multiple choice questionnaires and coercively imposed both on therapists and those they work with.
We hear depressingly few voices raised in dissent, in the more mainstream therapeutic community, nor do we often hear any depth of debate around the profound ethical, philosophical and therapeutic issues this approach raises. Instead it seems most often characterized by anti-intellectual, and often aggressive, assumptive thinking. Expressing dissent can be a risky undertaking, as can practising from Yalom’s starting point, rather than in conformance with the external locus ‘rules’ for ‘best practice’. So we do not think Yalom was ‘overstating the case’.
At this service we do indeed look to ‘create a new therapy’ for each unique human being who walks through our doors, through the offering of a deep human relationship characterised by the core conditions and presence/encounter. There is decades worth of evidence that this works, and we have 18 years’ experience at this service of the remarkable possibilities for healing and growth such an approach offers. The task of becoming a therapist who can offer such a relationship is, for sure, no small one – and a lifelong undertaking. The potential rewards – for all of us – are immense.
Here’s an excellent essay on differing approaches to ethics in therapy:-
And here’s a link to Irvin Yalom’s book:-
Palace Gate Counselling Service, Exeter