The End of Therapy
There are many pressing issues facing present and future therapists, and the therapeutic professions seem to be in the throws of the most difficult period in the history of therapy. Government, insurance companies, and corporations are poking their heads into the consulting room, and not as patients, as we might hope. More and more new laws are being written telling therapists both what they can't and must do in the therapy room, and there is overwhelming pressure on both patients and therapists to heal or fix psychological problems as quickly and cost-effectively as possible and with increasing disregard for psychology's original concern, the logos of psyche.

Many therapists feel that these problems are disruptive to the true work of therapy but that they eventually will be worked through. I believe that they are mere shadows of psychotherapy's inevitable fate, they are harbingers of the doom looming ominously in the not so distant future of psychotherapy.

The field of psychology was originally birthed from the field of medicine when medical doctors (most memorably Breuer and Freud) found that there were certain symptoms which could not be medically explained and which did not respond to any known medical treatment. However, in the last one-hundred years the science of medicine has made tremendous progress, especially in the areas of neurology and physiology, and the gaps in knowledge are rapidly narrowing.

Now medicine is telling psychology that, because more and more of these behavioral and emotional symptoms are being explained medically, psychology is becoming a less and less appropriate system for treatment, as if psychology were a temporary measure which modern science has now outgrown and has no further need of.

A fantasy of medicine may be that one day in the not so distant future, all DSM diagnoses will have been traced back to neurological or physiological bases. We will have found the neurological malfunctions responsible for Paranoid Personality Disorder (301.0), Kleptomania (312.32), Frotteurism (302.89), Depersonalization Disorder (300.6), Exhibitionism (302.4), and all the rest. The pervasively recurrent phrase "Not better accounted for by physiological effects of substance or general medical condition" will have been replaced by the appropriate pharmacological remedy, complete with brand name and dosage.

The most obvious problem that the actualization of this fantasy would cause for therapists is that we would be completely out of business. Psychological writings would be removed from universities' science libraries and placed in the literature section, and perhaps later, by future anthropologists, in the primitive mythology section. Any therapeutic practice still daring to exist would carry a stigma similar to that of modern palm reading or the Psychic Hotline. The future physician would regard the modern psychologist as the modern chemist regards the ancient alchemist: scientifically confounded and pitifully naive. Our future does not look bright.

So what am I doing about this? I am giving up hope. I am accepting the fact that the fantasy is real, there is no solution. So I am getting ready.

I am putting fiction into my psychology today, before Psychology Today is put into the fiction section. I am taking fantasy very seriously, because soon all psychology will be regarded as fantasy, and I want to be a leader in my field. I am writing my psychology with a literary quality, trying to make it appealing to the future literature lover, make it enflame passions and inspire imagination, so that my book will be picked up from the shelf instead of dry old Winnicot, or Bollas, or some abuse recovery manual, or statistical analysis of behavior. I am also beginning to read the ancient alchemists in order to get a sense of why, after so much time has passed, and even bearing the shame of science's scorn, their work is still on the shelf. Perhaps if I can put a little of what they had into my work, mine will also stand the test of time - if only in obscurity.

The reader may have already noticed a thinly veiled desire for immortality shining through my preparations for the future, but this desire is not only mine. It is part of the inescapable medical fantasy which psychology is heir to. I, as a psychologist, am indelibly involved with the promotion of life, but since the future of my field will find itself only in fantasy, it is fantasy life that my duty entreats me to promote.

Copyright ©1995 The Ares Press


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