Families and therapeutic authority
Therapy part 2
We can find solutions to atomization in the very origins of therapy, which would have us realize and affirm the family’s authority.
Thanks to everyone who sent me feedback on my last therapy post on individual dosing. Now, we can explore the accumulated social effects of the new therapeutic authority. Just as an overly therapeutic mindset can hamper an individual, this mindset accumulated over many people destabilizes a society. So, this post will discuss the right place for therapy to benefit the family and the community by looking at psychotherapy’s roots.
Therapy has a high level of authority over our interpersonal behavior in the West. We see it works when we have assertiveness training and a partner or boss takes our requests more seriously, or when we learn to manage social anxiety and get to go out more often through exposure and cognitive behavior therapy.
But nowadays, we evaluate more and more of our personal lives through the therapeutic, the default interpretive lens for anything affecting our emotional states. Labeling behaviors and people “toxic,” or cutting off family members for lack of affirmation and various traumas appeal to popular (if inaccurate) imports of therapeutic ideas. Sometimes these actions are warranted. And every competent therapist would refrain from directly endorsing them or engaging in labeling. Yet, these behaviors have become widespread in the West by appealing to therapeutic concepts.
The therapy-state alliance
A more direct exercise of therapeutic authority comes through the state’s ability to mandate types of individual or family therapy. Previously, abusive family dynamics fell under the censure of traditional authorities in the community. Interventions came from religious or extended and older family members, albeit imperfectly. What changed is the state’s selection of psychology as the authority that informs judgment and mediates punishment.
While psychology continues to develop as a science, it would be naive to assume the state uses psychological power more objectively than traditional authorities used their powers. We tend to think that through scientific reasoning, we can avoid human error and messiness, but we really just shift authority to another set of biased actors. Thus, motivated actors may designate culturally diverse ways of raising children or relating to spouses as pathological. These behaviors and relationships are therefore to be eliminated (e.g., APA’s guidelines on men and boys or the Duluth Model). To engage in some behaviors is to incur punishment by the state once the therapist diagnoses the vicious party.
Through the therapist’s alliance with the state, therapy gains the ability to dissolve the family under some circumstances. Therapy can influence the division of assets and children among different parties. This authority to dissolve becomes authority over the family in our personal and cultural understanding. Hence the appeal to therapeutic ideas like trauma and attachment that we use to guide our increasingly anxious family interactions. The family becomes fragilized before the threat of therapeutic correction.
The transfer of authority from the family to psychology occurred gradually through changing social norms but also was cheered by influential social theorists, who supported an alliance between clinical psychology and the state. The critical theorist Herbert Marcuse, drawing on psychoanalytic theory, rejoiced in the prediction that psychotherapy would overthrow the tyranny of the family, symbolized by the despotic father. More ambivalently, Michel Foucault railed against the authority of both family and psychiatry and noted the repressive power of one would give way to the state’s surveillance through the other.1
For many, this transfer of authority from the family and traditional community to the state, via the medium of psychology, has led to more loneliness: our connections are overseen by vast impersonal structures instead of authorities we personally know. However, we can find solutions to this atomization in the very origins of therapy, which would have us realize and affirm the family’s authority.
Family inspires psychotherapy
Therapeutic techniques have their roots in the normative behaviors of the family. A fundamental aspect of therapy is unconditional regard for the patient, a belief in the patient’s basic goodness and ability to make positive change. Carl Rogers, a formative figure for psychotherapy, was a sometime seminarian before coming to renown as a psychologist. His description of unconditional positive regard stems from two sources: the influence of Christian (particularly mainline Protestant) understandings of love and stable family upbringing.
This regard stems from the givenness of the relationship. Nothing I can do will change the fact I was born from my mom. Naturally, the behavior of my parents towards me takes the form of unconditional love, or rather, love conditioned on an irrevocable fact. The therapist’s regard for the patient is modeled off this other type of relationship.
Likewise, Freud based the concept of transference on the relationship one has with one’s parents, especially one’s father. Transference is the client’s attribution of attachment relationship qualities to the clinician. This means the client relates to the therapist as to a father or mother figure and invests trust in the therapist. In return, the client receives a safe relationship in which to explore experiences and develop emotional regulation. The quality of this transference happens to be the decisive factor for any therapy’s effectiveness.2
Therefore, we can see that the family is normative for models of therapy and not the converse. The authority of families comes before psychology in terms of what we should trust by default. Developmental psychology and neuroscience also show that in the family we develop our sense of self (Kopp), empathy for others (Kohlberg), and our relation to objects in the world, i.e. how we go about exploring and gaining knowledge. When these relationships are broken, therapy can come into play like a prosthetic version of these foundational developmental relationships. A prosthetic leg isn’t the best model for a leg, but it’s helpful when the original is missing. The prosthesis can help the patient rehabilitate to regular life. A goal of therapy then is to “graduate” the client from therapy and help him or her form stable attachments with new chosen family members and friends.
If family and friendship are the source of most of our long-term stability, how can we renew these natural institutions in a therapy-supervised society? We should remember the basics. On a personal level, we can maintain the integrity of sibling and parent-child relationships. Biblical and Chinese wisdom traditions advise honoring the benevolent authority of parents throughout life, even if some friendship-like aspects also develop with age.
We can avoid bringing clinical language into our everyday relationships. Likewise, we can refuse to normalize pathology or treat families as regularly pathological: while each family has its challenges, we shouldn’t use popular terms like “family trauma” casually as though pathology were a normal part of family life.
Finally, psychology can become a useful repository for what makes relationships run smoothly. In an increasingly atomized world, community wisdom is harder to find. Like breastfeeding and child-rearing, getting along with family is a natural but difficult skill that experienced elders used to pass down, hands-on, in multi-generational families and communities. These settings are rarer, but some of their wisdom has been preserved in scientific disciplines. As we look to renewing communities, we can retrieve that refined knowledge as a tool to build up, not threaten, our families and friendships from which that knowledge comes.
New developments:
The Hippocratic Society is a new organization devoted to renewing medicine and helping physicians pursue virtue. I’m involved with the group and am excited for the vision! We recently started several new chapters in different cities and universities. Check out the newly launched website.
Thanks to friends and readers who’ve started sending me research articles to comment on. I always enjoy chatting about new studies offline and plan to write some commentary soon.
See Foucault’s Discipline and Punish and Psychiatric Power.
Cognitive behavior therapy tends to downplay transference as a concept (see Wright et al, Learning Cognitive-Behavior Therapy 2nd ed. (2017), 39). In this case, we could use the term “therapeutic relationship” similarly to the analytic/dynamic term of transference.