Archive for February 10th, 2010

Here’s further evidence that Sigmund Freud didn’t invent the concept of psychotherapy out of thin air:

There was a precursor, and his name was Charles Dickens.

Way back in 1843, thirteen years before Freud was born, Dickens wrote a book summing up the process of psychotherapy.

The title of this scholarly tome?  You’ve probably read it – or perhaps you are familiar with one of the film versions.  My personal favorite stars the legendary Scrooge McDuck.

I’m only half-kidding.  So let’s review the storyline of A Christmas Carol, and see how it relates to the process of psychotherapy.

The plot should be familiar to most of us:

It’s Christmas Eve, and the old miser, Ebenezer Scrooge, is at his office, being unpleasant to everyone around him.  Scrooge scoffs at his nephew’s invitation to a Christmas party, refuses to donate to charity and scolds his employees, letting everyone know his top priority is money, not relationships with other people.

The diagnosis is pretty clear.  Scrooge is unconsciously clinging to money as a surrogate for love.  He doesn’t feel cared for by anyone, and perhaps he believes he is undeserving or incapable of attracting the love he needs.  Scrooge discharges anger indiscriminately at whomever is nearby, chasing away anyone who attempts to offer him care.

Eventually Scrooge leaves his office and heads home, where he is confronted by the ghost of Marley, his old business partner, who has organized an intervention. Marley informs Scrooge in no uncertain terms that he has to do some work on himself or he’ll end up just like Marley did – dragging metaphorical chains around, miserable and unloved.  Marley recommends psychotherapy.

Plenty of my patients come to me on the advice of friends.  There’s something about hearing from a good old comrade for the one hundredth time that you “really should think about seeing a therapist” that eventually brings someone around.  That’s especially true when – like Scrooge – it’s clear that you’re miserable.  It also helps when the friend, like Marley, admits he’s had some of the same issues himself.

Marley goes so far as to recommend his own therapists – and to make the appointments.  He lets Scrooge know that three ghosts will be dropping by that night for some serious counseling work, and that it will be very experientially-oriented, probably with a Gestalt focus and incorporating some aspects of psychodrama.  Marley has even paid the fee in advance.  There’s friendship for you.

Scrooge is skeptical – after all, he’s never done psychotherapy before, so he figures he’ll play along, but doesn’t expect much.

The first ghost arrives – the ghost of Christmas past.  He’s an old school psychoanalyst and wants to start right off with deep psychodynamic exploration – digging deep into Scrooge’s past, examining the environment in which little Ebenezer grew up and how it shaped his patterns of behavior and the assumptions he makes about the world around him.

Scrooge learns that his fear of risking authentic contact – opening himself up in a way that would permit meaningful contact with others – resulted in his fleeing to money as a replacement for the love he needed.  Instead of being generous and open-hearted like old Fezziwig, his first employer, and containing his anxiety, Scrooge acts out on his unexamined feeling and flees from Belle, the girl he loves.  Scrooge ends up surrounding himself with money – a compensation for feeling that he is unloved and unlovable.

The next therapist (er, ghost) to visit is representing Christmas present.  This guy is probably from the Albert Ellis Institute – his orientation is clearly cognitive-behavioral.  He has no time to waste digging into the past and finding precursors for Scrooge’s behavior.  This therapist wants to work horizontally, not vertically – in the here and now, examining Scrooge’s thinking as it affects his daily behavior.  He takes Scrooge to see the folks who populate his life – Tiny Tim and Bob Cratchit at their humble home, and Scrooge’s nephew at a Christmas party.

Scrooge realizes he’s been self-isolating.  This is depression – Scrooge has been acting in on unexamined anger he’s long harbored at not receiving the care he needs.  His cognition – “money is the only thing I can trust” – needs to be reality-tested, and counter-thoughts formulated, such as “maybe people are important, too” and “perhaps if I stop being such a grump people might give me a chance.”

The third and final therapist arrives looking like he means business.  This guy is hard-core, probably one of those French existential types who reads a lot of Lacan and takes no prisoners.  This guy isn’t messing around.  He puts death front and center – the eternal inevitability at the conclusion of every life ever lived.  Scrooge sees what death really means – that his life is nothing more than a brief opportunity for joy – and that human connection is crucial to attaining that goal.  He realizes that this isn’t a dress rehearsal – it’s his one chance at existence, and he doesn’t get another run-through.

That does it.  The session with the French guy cracks Scrooge’s resistance, and new awareness arrives fast and hard.  He wakes up a new man.  With consciousness comes the desire for change.  Now that Scrooge can see himself – the roots of his patterns of behavior, the distortions in his current cognition, and the pressing insistence of his mortality – he longs to express his authentic self, his best self – to become the man he truly is.

Voila!  Another happy customer.  Psychotherapy changes another life for the better…thirteen years before the birth of Freud.

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