The ten deadly sins of psychotherapy.
Abstract: The author considers a number of issues that are overlooked in psychotherapy, with the result that its identity and purpose are endangered.

These are: 1. Authenticity, sincerity and honesty to oneself as the path to real life, rather than just the mere disappearance or alleviation of symptoms of mental illness. 2. The reduction of the human being and his illness to an organism defined in natural scientific terms instead of a concept of the human being based on the immediate authentic and unreduced experience of existence. 3. A failure to think the moral aspects of mental illness through. 4. The tendency to succumb to natural scientific paradigms and abstract generalisations instead of keeping to the exploration of the unique. 5. The alienation of the language of psychotherapy from immediate experience and so from communication in the vernacular speech of a given culture. 6. Interpretation as a deepening understanding addressed to and deriving from what discloses itself of itself, as against interpretation narrowed down to pre-established, final and closed theoretical systems. 7. The banalisation of psychotherapy by closed and artificial systems and its opposite, which is able to create the newness and freshness of an open relation to everyday reality. 8. An approach to human lives, events and moments that conceives these as merely the external expressions of something "behind" or "underneath", i.e. forces, laws, or rules standing outside this reality, instead of seeing them in terms of the immediate and unclosed reality of being in the world, which is the proper source of anthropological diagnoses. 9. A failure to understand culture as the natural environment of man, which is instead seem as a "virgin" nature without human beings. 10. A tendency to forget the real roots of psychotherapy in the spiritual tradition of Western civilisation, and ungratefulness to the virtues and values that our ancestors discovered and introduced into everyday reality.

Key Words

Psychotherapy, ten sins
Article Type: Essay
Subject: Psychotherapy (Analysis)
Identity (Analysis)
Author: Ruzicka, Jiri
Pub Date: 07/01/2011
Publication: Name: Existential Analysis Publisher: Society for Existential Analysis Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 Society for Existential Analysis ISSN: 1752-5616
Issue: Date: July, 2011 Source Volume: 22 Source Issue: 2
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 288874222
Full Text: In my paper I shall not be talking about specific violations of the psychotherapeutic professional code and I shall disappoint anyone who is expecting me to discuss the psychotherapeutic ethic. In any case, I fear I would annoy them even if I did, because I would have to consider morality in the fundamental sense and not in the purely practical terms of professional ethical codes. I mean that I would have to start by interpreting their premises, and so most probably I would start at the same point as I am starting now.

1. A. K. Wucherer-Huldenfeld (2006) notes that as early as 1897 Freud wrote the following lines to his then friend Fliess (Freud, 1986):

And he continues:

In his "New Series of Lectures on the Introduction to Psychoanalysis", Freud--as Wucherer reminds us--grasped the basic purpose of open testimony and so also recommended psychoanalysis not primarily for its curative effects but

In this light the therapeutic effects emerge as "by product", as it were. The interest of psychoanalysis is not then transference, conflict and the constellation of instinct, or the bringing of the unconscious to consciousness, but a sincere openness raised to the highest degree--an openness towards oneself, and honest and sincere testimony about one's life. And an openness despite the obstacles consisting in lack of courage, inexperience and fears of what all the manifested facts may mean and how they will be judged by the listening therapist or other participants in treatment, and by the self. This effort demands not just honesty, but also the courage of the therapist and patient or client, and faith in the significance and value of truth. (Wucherer ibid, compare Wucherer 2003). What heals a human being in psychotherapeutic treatment is a relieving reliance on the value of truth and the knowledge that mental illnesses curtail the individual's ability to exist in the truth of his own life. It is not enough just to discover this truth; the patient needs to rise to the challenge of authentic living of his life (Ruzicka, 1984a). Thus what is known as authenticity of life has nothing to do with some universal rule, or pre-established moral norm, let alone any so-called "objective" truth derived from measurable quantities.

Up to the seventh chapter of his epoch-making The Interpretation of Dreams of 1900 (Freud, 1936) Freud kept to the field of immediate life experience, which for him is the first possibility of the interpretation of difficulties, and he does so by interpretation based on these experiences in themselves. From the seventh chapter on, however, the work breaks in two and Freud is no longer capable of maintaining his own insight that what gives us access to the truth is constitutive for human existence and therefore part of the essence of human being. Although Freud never explictly renounced this insight, he never managed to defend it explicitly as a priority in his later work. This was because he was writing before the groundbreaking discoveries (philosophical) that showed the so-called "objectivity" of the world to be secondary and derived from the reality that is immediate, living, ever changing, always subjective and unseparated from the world. In other words, Freud lived and worked in the context of the natural scientific world view in which subject was divided from object, creating a fissure between them that the paradigm then tried to bridge with causal connections. While in our immediate, everyday, ordinary experience we are from thevery beginning still living outside, as it were, relatedly in the world in relations (and in ideas, fantasies and dreams), viewed in terms of subject-object positions we are confined somewhere in an abstract psyche (psychological apparatus), from which we then, secondarily, using some antennae, move out into the world, on which we have causal effects or else it has causal effects on us. The original unity of our being in the world, which prevails in reality, has been broken.

2. If the first serious danger to psychotherapy arises from the fact that while its founder never renounced the conditions of truthfulness, sincerity and openness to oneself and to what encounters us in the world, he soon effectively replaced them by the unconscious, conflicts and defences (which are objectified experiences of certain states of our relations), the second threat arises from a lack of the courage to resist in the face of the powerful influence of natural scientific paradigms. Freud himself succumbed to them and already in the Interpretation of Dreams, as in subsequent work, man is reduced to an organism, an animated object, which as subject is always divided from the world by the very nature of its objective definition. In reality, however, as is the case in our living experience, our being in the world including our physical being, cannot be objectively defined in this way. Our physical being, which is an aspect of our integral (whole)-being, does not end at our skin, but is a part of our constant engagement in the world, and reaches to wherever we find ourselves in our whole-being (Boss, 1974. Condrau, 1998). For example, when we are walking along the street we are already, with our steps, in the wood where we are heading. Not objectively, obviously, but we are not objects, we are not machines! A machine is always only in the place where it is located as an object. But man is an intentional being (Husserl, 1993), and so we cannot define his movement without his intention otherwise than as objectively, as mere object, and so in a way not congruent with the anthropological. Only by looking away from the whole of being (integrity of being) can we see our feet objectively, but if we do this we become unable to see their human meaning residing in the intentionality of walking, and we cannot even define them as feet. We cannot understand feet in their full sense, which is walking to something, for something, from somewhere to somewhere, for this is evident only from the whole of the being of man. Even thoughtless and aimless wandering is understandable, because it is one of the essential possibilities of the meaning of human existence and the loss of the path to meaning. Only by reason of our integral-being, which is always also related to the world and relational in the world, does our pulse quicken when in our minds we are somewhere at an exciting event we took part in yesterday, or we are chilled when, reading the foreign news, we are with victims of human cruelty somewhere at the other end of the world. The meaning of life does not then consist in the fulfilment of our so-called bodily needs, but quite the reverse. We do not exist to feed our organs, because we are in this way determined by abstract natural scientific laws, even though undoubtedly we are bodily beings and we should take appropriate care of our physical being. The reason why we eat (not the cause of our eating) is so that we can meaningfully exist. And it is the same with the other so-called instincts and needs. Psychotherapy turned away from the original experience of authenticity and integral being and succumbed to the power ambitions of the natural sciences and the unfulfillable promises that they make to us. They offer us the illusion that thanks to new scientific discoveries we will became supermen who with new methods in genetics and biological engineering will become (practically) immortal, (almost) omnipotent and using artificial intelligences and ever improving technologists will control an even greater piece of nature (Heidegger, 1995, Fromm, 1979, see Nietzsche, 1995, 2001).

3. Medicalisation has meant that the problems of life have been conceived as symptoms. What are complex and disproportionately difficult life situations and parts of a life gone astray have been pathologised--and so taken out of the original order of human existence. Medicine is orientated to the symptom and its structure, while psychotherapy is orientated to the structure of the human being in the contexts of his existence. We are also aware, but have somehow set aside the knowledge, that mental problems are not just expressed as subjective states, but that the way of life and behaviour of mentally ill people to other people and the world around them are an inseparable part of these problems. Let me offer some concrete if rather oversimplified illustrations: the "orally dependent", by their inability to live independently, exploitatively fixated on other people and so restrict their personal freedoms and rights. The depressive, on the other hand, make us responsible for their own inability to cope with losses and the incompleteness and imperfection of the possibilities of life, which can never be completely fulfilled. The obsessive as a rule objectify themselves and others and create an inhuman formality out of life, with rules for rules' sake that can apply only to objects and not people. The paranoid not only make extreme demands on their surroundings--demands not corresponding to reality but try to exercise power and contol over people and the world in line with their ideas and fantasies. How the dependent enter the world of others is generally known. Psychotherapy does not neglect these aspects. It neither moralises about them nor punishes them. Ever since Freud and Breuer proved able to cope, if with serious difficulties, in the treatment of the beautiful, intelligent, educated but enticing and manipulative A.O., other psychotherapists have been doing the same. Is this a psychotherapeutic sin? Certainly not. Both men behaved in a model way, sympathetically and courageously. They did not allow themselves to be seduced, or to be put off, and they perseveringly continued in treatment.

But why am I talking in this context about sin, when here we we have before us a positive example. Life brings paradoxes in psychotherapy as elsewhere. It was through the bracketing off of patients from their real behaviour and their detachment from guilt about it that psychotherapy founded its own existence. A new anthropological discipline was born that made it possible to understand, develop, cure and educate people and human communities using a method and means previously unknown. A field was established that made it possible to comprehend, help and treat, to develop and liberate people in a way and to an extent previously unknown and unattainable. Yet in recognising this, no one should imply that the other non-medical realities that are part of mental illness do not exist, that they are just secondary marks of illness and that they are not connected with real everyday life, or with the disorder itself. Mental illnesses, as is clear, do not mean only subjective difficulties but are also the problem of the other people who are involved in them, since mental illnesses do not arise in the brain (even though without the brain there can be no living creature, nor human being) but in human communities. They also cause troubles for those who become the victims of the behaviour of mentally ill people. (Ruzicka, J. 1984b, 2008). Troubles that are not illnesses, and sufferings that are not diagnosed and have been excluded from medicine as diagnosis. This ought not to be neglected. There is an lack of "institutions of repentance, atonement, forgiveness and reconciliation" in the psychological, spiritual and socio-cultural sense. We have here a socio-ethical, cultural, but also objectively professional problem, which (in relation to family therapy too), psychotherapy has forgotten.

4. Another sin of psychotherapy is its failure to pay enough care and attention to what it says and proclaims. Instead of constantly reflecting on its own proper nature in a critical, i.e. an independent and well-founded spirit, it tries in a quite undignified way to copy the disciplines and imitate the approaches that have made of man a pure object among objects, a calculable phenomenon, a predictable and so a controllable being, Psychotherapy does not behave with sufficient self-confidence and responsibility to itself and the community in this respect. In this craven and imitative line it threatens everything that makes it unique and irreplaceable. It is afraid to commit itself thoroughly to the belief that it proclaims, but constantly forgets, i.e. that it is a true science, a science of the unique being and his or her being, and this is every individual human existence with its unique life destiny and mission, own choice and will, with all that it involves. Each of us is unique and in psychotherapy we have been able to explore this using a method that is unattainable for other disciplines. This experience cannot be in any way exchanged for or replaced by doctrines about the universal which, as we know, was founded as concept by Aristotle. Psychotherapy is not, however, a natural science. The natural sciences are remarkable, but are forms of knowledge abstracted from the immediate experience of the natural, unbounded, inexhaustible, changeable world, unreduceable to partial and derived disciplines, that Patocka calls the natural world. Psychotherapy not only helps people to discover the natural world, but also restores it to them. That is the true mission of psychotherapy. Psychotherapeutic models cannot be turned into objective and predictable objective systems, but are instead various forms of analogy, metaphor, hyperbolic pictures and representations. If psychotherapy develops foolish natural scientific ambitions, it does not become one of the natural sciences, but an ideology and also something peculiar, neither fish nor fowl, which rightly arouses distrust and embarrassment among natural scientists.

5. The ideologisation and indoctrination of psychotherapists and those in charge of psychotherapy are other transgressions of psychotherapy. Both patients (clients) and psychotherapists themselves have to adopt (of course, to different extents) the jargon of a certain movement or school, using which they are supposed to interpret problems which belong to an everyday reality in which everyone uses ordinary language, vernacular Czech (German, Spanish, English etc.). The psychological jargon includes misleading interpretational constructs such as unconscious mechanisms, models of behaviour, defences etc etc ... Therapists and patrients use and learn to us alienated titles and artificial terms for teir real life problems and the real world, and not to interpret them on the basis of reality itself, but to try to interpret reality on the basis of constructs. In a debate with representatives of different psychotherapeutic movements my colleague Palousova gave a completely clear answer when someone asked how could communicate between themselves: in ordinary speech. But how is that possible? Because we live originally in a common natural world which we also originally all understand and this understanding is human, because in language, says Patocka. (Patocka, 1992). If we can communicate on this basis and in this way, why do we use complicated theoretical models and constructions that are alienated from natural reality?

6. Language, symbol and interpretation in psychotherapy are the most important tools that the therapist has at his disposal. Heidegger (2002, 2006) regards speech as the "home of being". What does that mean and how does this phrase relate to psychotherapy? It means that the world, as it appears to people and in which we live, the natural world, is accessible to us in speech in such a way that we can not only enter into it, but through words, and so in a human way, settle in it. If we did not have language (I mean primarily the language of words) we would not have a human world. With language we as it were unlock the world, by language that which we regard as something determinate such that we can name it and grasp it, emerges. The way that we talk about a thing determines its quality, form, character, its definition. We cannot separate things from the interpretation in which they show themselves to us. The world is composed out of speech like music or a puzzle. Speech in a certain sense presents the world, and the mode of presentation is also its interpretation. Interpretations that take the abundance of immediate experience and force it into a ready-made closed and in all directions defined space are reductive interpretations. The richness and newness of a thing is transformed into a pre-established sphere of possibilities. Such interpretations are considered reliable, always predictable and repeatably demonstrable. In the natural world of our every day reality, however, we find realities that are always the same in meaning, in no way unusual and repeating, to be banal. Birth and death, love and hatred are rendered banal. We see that they are uninteresting, superficial and therefore boring. Even if they relate to important findings. If we convert real human life into abstract constructs, we deprive them of the spirit of the thing, the uniqueness of a moment, the bloom of originality. Creations that are alienated from living reality and deliberately separate from it and that aspire to be more real than real reality are a historical, and so asocial and for the same reasons dangerous for the human being.

7. What does banalisation mean in the case of psychotherapy? Natural scientific formalisation renders its subject banal. Over time the formalised life becomes superficial, boring and trivial. Calculable life is stereotypical, known in advance and emptied out. There are two possible ways of avoiding this state. One is open the world so that it appears plainly, immediately, unexpectedly and always new, but in doing so it is true that we expose ourselves to the insecurities and incompleteness that it brings. Or else we choose the other way of reparticularising the over general--this is sensation. Sensation is a continuation of the banality of life. As soon as the novelty grows stale, grows old, it no longer posseses anything that makes it special and unique. Psychotherapy that is closed in such a system is boring, and trivialises the extraordinary open existence of the human being. And in order to keep going, we need a new dose of excitement, we need a new sensation. As in life, so in psychotherapy sensation is close to modishness. The newness of a thing does not, however, consist in sensation, but in how the thing manifests itself in that which it really is. In the way that being itself manifests itself. Psychotherapy is tiring and exhausting but it is never boring. It enriches, it refreshes, surprises and astounds by each moment, each event. We always have something to discover from our patients or clients, also from ourselves--something to learn, something to astonish and surprise us, to be shaken and affected. I believe that the real reason for the syndrome of burn-out is banalisation and the consequent boredom and emptiness, and not real psychotherapeutic engagement. I also think that the very term "burn out" mixes together different "syndromes" that have different origins and reasons.

8. When we spoke of speech, we touched on the question of interpretation, which is key in psychotherapy. To interpret means to illuminate, to show in the true luminosity and meaning that is peculiar to given being. It means to understand and grasp in a way that allows the interpreted being to manifest itself, to emerge truthfully and in its essence. Speech is not, however, simply an instrument. Speech is the human mode of being, which makes it possible for this being of the manifest to appear to us in its changeable meanings, by which it discloses itself and announces itself through speech (Gadamer, 1999). What manifests itself is true reality, with nothing else behind it. Freud sought to identify instincts, and others other various needs "behind the reality of the natural world". Others have looked for biochemical or neurophysical processes "behind all that". But in what manifests itself to us in psychotherapy we are not dealing with a reality that is unchanging, permanent and standing behind changeable phenomena, because there is no being of this kind behind reality unless we ourselves install it there. Nor do natural laws stand behind things, although we can see such laws in them. In our natural world, in the world of people, we essentially understand things in a way that means we cannot convert them into rules or laws standing "behind or under". The abstract laws of our life are instead meant more to help us see being in a different light without in any way replacing being or declaring it a secondary relaity and so of a lower order. We might take Oedipus and his story as an example. If we understand it and interpret it as a game of imagined realities, i.e. realities extracted, altered, redefined and artificial, e.g. so-called instincts, the whole text of the Oedipus myth is secondary and in fact only camouflages another lived reality. But immediately we interpret the myth on its own terms, on the basis of the events and actions in it and their connections, the relations and conditions in the family, between people and in the state--as soon as we undertake an interpretation by thinking through Oedipus's life in contexts, we have before us the completely comprehensibly excavated reality of Oedipus's fates. This is because we see not only Oedipus's role but also the life of his parents and the conditions prevailing between them. We see how these conditions influenced the life of the child and the impact of the marital and social quarrel not just on Oedipus but on t he whole community (Ruzicka, 2009). In short, any interpretation that is a reinterpretation of realities in terms of powers in the background deprives the stories, fates and events of our lives of their true being and makes them virtual. The human existence, our life, gets lost in such interpretations instead of manifesting itself in them. This is why it is objectively inappropropriate to say that unconscious instinctives, instinctual drives or needs are behind action, behaviour, symptoms and deeds. These terms are virtual constructs and not reality of a higher order. If they were the higher reality, our life would be without hope or meaning. Human freedom, responsibility, love and everything else that means reality and its values for us would be only empty words and the whole of this text and conference, or seminar at which it w as or will be presented would be a tragic and wretched attempt to particularise and appropriate a pre-established "superior movement", which is in fact none of our business. Fortunately this is not the case, as life itself shows. Psychology is precisely concerned with the renewal of this life and not with the restoratuion of the abstractions we have mentioned.

9. False myths have also appeared in the practice of psychotherapy. I would like to mention one that is related to so-called "human nature". It is derived from our hypothetical animal origin. A kind of nostalgia or more accurately a naive romanticism sees the life of man in the most primitive possible conditions of raw nature as original and true, while it proclaims civilisation to be a kind of decline, or mere froth on the sea of animality, and European society as a kind of decadence that ought to be replaced by some sort of new Utopia. Yet all solid cultural anthopological, historical and archaeological research shows that the natural environment of man is not virgin nature but culture. Starting with primordial cultures and ending with the cultures of the present day. This is because man is himself culture. We are people whose way of life, as in a peculiar and proper home environment, we have engraved in our names and under our skins and in our bone marrow, on tombstones, writings, buildings, creations, languages ... and so what are we if not cultural beings? The return to the virgin forest or steppe with all it entails would mean the end of homosapiens. For this reason care of man is also always care of his culture. And what we are today we owed to the way that our predecessors were. The fact that masses of people are not moving from Europe and North America to other parts, and the situation is the complete reverse, demonstrates that despite its many shortcomings and definite imperfections, our West is one of the best civilisations that mankind has hitherto managed to build. Any such inherited value must be cultivated and cared for with commitment and perseverance.

10. The final sin may be characterised as the neglect or even rejection of the fact that human mercy cultivating love, compassionate consideration and an understanding participation is the fons et origo of specialist psychotherapeutic activity--and not economically instrumental or professional interest in applying some technology or technique used in psychotherapy. We are comprehensively succumbing to technocratic assaults that are always at their most intense when psychotherapy justifably adheres to its motto that good and the virtues arising from it, like pity, sympathy, solidarity, readiness to help and love for others are the original motive and active factor in help for others who are suffering or deprived. That what truly heals, teaches, liberates and devolops (and should not be absent even in the prescription of pills) is hope and faith in a meaningful future. The achievement of Freud and Breuer at the beginning of their career (which is being forgotten) was the basis for their further discoveries and conceptions. They accepted the challenge not to succumb to the erotic manipulations of Miss A.O, to refrain from exploiting her for their own pleasure. For if they had succumbed, if they had lost compassion and pity for the wretched patient, if they had not renounced their personal interests to the benefit of this young woman, not only would they not have cured her of her problems, but they would have defrauded what for at least two thousand years we have seen as the value of sacrifice. And they would also have made impossible the birth of a new and powerful movement of help and care for mentally ill people, a current that opened new perspectives on human life, and new educative, autonomy-promoting, curative, communicational, developmental or social activities. Their achievement was not just scientific but moral and emotional. When we go through the life testimony of the great psychotherapists, we always encounter true interest and a selfless effort to free people of suffering and mental poverty. On this occasion we need to remind outselves that the feelings and relations of patients or other people to their psychotherapists are real, if as yet not freed to become the independent and mature relational possibilities that they are seeking on their healing, educational, developmental path. The discipline that psychotherapy involves springs from understanding of the human heart. Psychotherapy is understanding of this kind not simply because it is an understanding of the soul, as its subject, but also because it is based on virtue and love for people and is built on caring compassion, tender feelings for those who are close, masculine and firm solidarity and feminine patient and maternal loving kindness and unfailing, universally humane Samaritan concern (Tavel, 2009). The goods springing from love and virtue are in a peculiar, original and unique way also the central themes on which our Western civilisation stands. That psychotherapy arose precisely in these circumstances is neither accidental not hard to understand. This is because historically linked with it and prefiguring it are the self-sacrificing efforts of our Jewish and Christian predecessors, who in the Judaeo-Christian tradition struggled all their lives for the realisation of the goods of love, justice and equality of all people. Psychotherapy springs from our distinctive roots and their spiritual currents going right back to antiquity, which gave us the cultural, social philosophical and scientific riches from which the order of the West blossomed. I regard the forgetting of these roots as the sin that informs the ten transgressions I have described, which are part of our lack of respect for our own civilisation. This does not mean, however, that we should ignore the good things that have come and still come from other civilisations and cultures of our shared world.

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Jiri Ruzicka is a clinical psychologist and daseinsanalyst. His first training is psychoanalytical, Dynamic Community-Group psychotherapy, Rogerian, Jungian, Psychedelic training, Balint and International training of Supervisors. He is head of Psychotherapeutic and Psychosomatic Clinique ESET in Prague and rector of Prague college of Psycho-Social studies. Address: Prague College for Psycho-social studies, Hekrova 805, 149 00, Prague, Czech Republic. www.viap.cz Email: viap@viap.cz, pvsps@pvsp.cz
To be honest with oneself is a good exercise that is reminiscent of
   the Greek ascesis, the Latin exercitio, which is nothing other than
   the practical development of self-understanding and the learning or
   training of self-understanding and the art of practical life so
   that a man can become autonomous and independent. And become so
   because he has successfully gone through an education to the truth
   about himself. It is precisely in this sense that psychoanalytical
   treatment is based on honesty.


It is largely in this that its educational effect and moral value
   resides. It is dangerous to abandon this foundation

Wucherer (ibid) cites Freud when he wrote elsewhere that:

   The basis of treatment consists in exercising "truth to oneself",
   corresponding to which is the fundamental rule that exhorts the
   analysand to honesty and t o unprejudiced truthfulness towards
   everything and about everything that he encounters in the course of
   treatment.


because of the value of truth, because of the explanation that it
   gives us about the primary concern of the human being.
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