when is enough enough?
May 11, 2008
When is enough enough? San Francisco based Psychoanalyst Dr Owen Renik says
The profession is in a great decline, and I predict the decline will continue. The reason for it, and the reason a corrective is needed now, is that although psychoanalysis began in a spirit of open-ended inquiry, with an orientation above all to be helpful to the patient, it took on a self-perpetuating guild mentality that was its ruin. The possibility is still open to reverse the decline, but it will be necessary to escape the clutches of an establishment that, unhappily, has increasingly gotten away from the original scientific enterprise.
He goes on to say
There is a tendency among psychoanalysts to pursue self-awareness as a goal in itself, rather than a means to an end. Originally, the idea was that the self-understanding that arose as a result of psychoanalysis was unique and impressive and valid because it afforded relief from symptoms that were otherwise impossible to treat.
If you don’t require that self-awareness be validated by symptom relief, there are two destructive consequences. The first is scientific. You have no independent variable to track; you set up a circular situation in which it’s the analyst’s theory that determines what is found in analysis. Many critics of psychoanalysis have recognized this.
The points he raises are interesting in themselves, but they also relate to any kind of inter-personal and professional relationship – when is enough enough? And what kind of methodologies do you use to determine if you your intervention is (a) appropriate? (b) working? or (c) past its sell by date? There is always the temptation to keep clients wanting more. I don’t see coaching in particular as an endless process. There comes a time when you have to say goodbye – often times it’s the coach who has to determine that if a client appears to be too reliant on their coaching process and reluctant to move on and it’s sometimes the case that a client is ready to move on long before a coach or consultant is willing to let go.
Renik goes on to say
You should have a criterion for judging whether the outcome is satisfactory, which leaves you free to judge by trial and error. If the treatment seems sufficient, you stop. You can always resume the therapy when and if there’s a need. What might also happen along the way, you might become aware of other things that then you define as symptoms, and you want to address those. Let’s say you have trouble dating, for example. We discover when we look into it that you have trouble asserting yourself, and that applies in a number of areas, including your work life. So we go on, until you are able to make progress there. If you’re not having symptom trouble after that, there’s no reason to keep analyzing stuff. That’s it. You’re done.
I think the same is true of any kind of coaching or consulting, particularly if it’s a one to one relationship and where the identity of the consultant gets tied up with the assignment. If the job is done, it’s done and it’s time to move on – dealing with the personal nature of ending and rejection is something that consultants need to integrate into their practice. I know when I was working as a therapist I had regular supervision where I addressed endings and beginnings on a regular basis. Now that I’m consulting I try to build in some kind of formal ending process with clients – be that a review or other – to mark the transition.
But as Renik says –
there’s no reason to keep analyzing stuff. That’s it. You’re done.
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In part, I agree with this article. However two powerful forces:
* Evidenced-based practice
* Quick-fix cures
are influencing therapies – from early psychosis to analysis -, and I don’t believe it’s to create a more robust, effective therapy. Nor do I believe it benefits the consumer/client/patient.
The fact is, change is hard. And another, interpersonal issues need more time than most phobias/anxieties (which are often better treated with CBT anyway).
For those of us working in “evidenced-based” settings, the reality is that, even in the CBT world, our clients remain in our programs much, much longer than the theory would suggest.
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