What are our psychotherapeutic theories and practices producing?

ABSTRACT

In this paper, in a Foucauldian argument, I draw attention to how psychotherapy is both produced and productive. I argue how psychotherapeutic theories and practices can contribute to generate hegemonic versions of subjectivity that limit the scope of alternative ways of living and feed into individualism. As Rose contends, the psy sciences, including psychotherapy, are highly influential in informing how we make sense of ourselves, and thus in how we produce ourselves. Psychotherapy – through assuming that its theories only reveal psychic mechanisms and that psychotherapeutic practice only helps people to know themselves better and develop – becomes extremely powerful in producing subjectivities whilst believing that it is only a matter of self-discovering. On this basis, I stress the need for questioning psychotherapy. In particular, I explore how engagement with authors associated with the so-called ‘post’ theories can transform psychotherapeutic theories and practices, including questioning the very existence of psychotherapy. As a psychotherapist myself, I attempt to stay uncomfortable and to allow myself to be moved while I grapple with what psychotherapy might become.

ABSTRAKT

In diesem Aufsatz bediene ich mich eines Foucaultschen Argument um Aufmerksamkeit darauf zu lenken wie Psychotherapie sowohl produziert als auch produktiv ist. Ich argumentiere, dass psychotherapeutische Theorien und Praktiken dazu beitragen können hegemoniale Versionen von Subjektivität zu erzeugen, die den Spielraum alternativer Lebensweisen einschränken und Individualismus foerdern. Wie Rose erklaert, haben die Psychowissenschaften, einschließlich der Psychotherapie, einen großen Einfluss darauf wie wir uns selbst verstehen und wie wir uns selbst erschaffen. Psychotherapie – indem sie unterstellt, dass ihre Theorien psychische Mechanismen aufdecken und psychotherapeutische Praxis den Menschen hilft, sich selbst besser kennenzulernen und sich zu entwickeln –ist sehr einflussreich darin Subjektivitäten zu produzieren und gleichzeitig zu suggerieren, dass es nur eine Frage der Selbstfindung ist. Auf dieser Grundlage betone ich die Notwendigkeit, die Psychotherapie zu hinterfragen. Insbesondere untersuche ich, wie die Auseinandersetzung mit Autoren der sogenannten „Post“-Theorien, psychotherapeutische Theorien und Praktiken verändern kann. Dies beinhaltet fuer mich auch die Anzweiflung des Wertes der Psychotherapie. Als Psychotherapeutin versuche ich unbequem zu bleiben und mich bewegen zu lassen, während ich mich damit auseinandersetze, wie sich die Psychotherapie weiter und/oder neu entwickeln kann.

RESUMEN

En este artículo, siguiendo los argumentos de Foucault, pongo atención a como la psicoterapia es producida y productiva. Argumento que las teorías y prácticas psicoterapéuticas pueden contribuir a generar versiones hegemónicas de subjetividad que limitan las posibilidades de formas alternativas de vivir y que potencian el individualismo. Como sostiene Rose, las ciencias psy, incluyendo la psicoterapia, son muy influyentes en informar cómo hacemos sentido de nosotros mismos, y en consecuencia en cómo nos producimos a nosotros mismos. La psicoterapia – cuando asume que sus teorías solo revelan mecanismos psíquicos y que su práctica solo ayuda a las personas a conocerse mejor y desarrollarse – es extremadamente poderosa para producir subjetividades mientras cree que es solo un asunto de autodescubrimiento. Tomando en cuenta lo anterior, recalco la necesidad de cuestionar la psicoterapia. En particular, exploro como el conversar con autores asociados con las teorías ‘post’ puede transformar las teorías y prácticas psicoterapéuticas, llegando incluso a cuestionar la función de la existencia de la psicoterapia. Como psicoterapeuta trato de sostener mi incomodidad y de permitirme ser movida mientras considero como la psicoterapia se puede transformar.

RIASSUNTO

In questo articolo, in un’argomentazione foucaultiana, attiro l’attenzione su come la psicoterapia sia un prodotto e sia allo stesso tempo produttiva. Sostengo come le teorie e le pratiche psicoterapeutiche possano contribuire a generare versioni egemoniche della soggettività che limitano la portata di modi di vivere alternativi e alimentano l’individualismo. Come sostiene Rose, le scienze psicologiche, inclusa la psicoterapia, sono molto influenti nell’informare il modo in cui diamo un senso a noi stessi, e quindi nel modo in cui produciamo noi stessi. La psicoterapia – partendo dal presupposto che le sue teorie rivelano solo meccanismi psichici e che la pratica psicoterapeutica aiuta solo le persone a conoscersi meglio ea svilupparsi – diventa estremamente potente nel produrre soggettività pur credendo che sia solo una questione di auto-scoperta. Su questa base, sottolineo la necessità di mettere in discussione la psicoterapia. In particolare, esploro come l’impegno con gli autori associati alle cosiddette teorie “post” possa trasformare le teorie e le pratiche psicoterapeutiche, inclusa la messa in discussione dell’esistenza stessa della psicoterapia. Come psicoterapeuta io stesso, cerco di non sentirmi a disagio e di lasciarmi emozionare mentre mi confronto con ciò che potrebbe diventare la psicoterapia.

ABSTRAIT

Dans cet article, dans une argumentation foucaldienne, j’attire l’attention sur le comment la psychothérapie est à la fois produite et productive. Je porte des arguments sur la manière dont les théories et les pratiques psychothérapeutiques peuvent contribuer à générer des versions hégémoniques de la subjectivité qui limitent la portée des modes de vie alternatifs et alimentent l’individualisme. Comme le soutient Rose, les sciences psy, y compris la psychothérapie, ont une grande influence sur la façon dont nous nous donnons un sens, et donc sur la façon dont nous nous produisons. La psychothérapie – en supposant que ses théories ne révèlent que des mécanismes psychiques et que la pratique psychothérapeutique n’aide qu’à mieux se connaître et à se développer – devient extrêmement puissante pour produire des subjectivités tout en estimant qu’il ne s’agit que de se découvrir. Sur cette base, j’insiste sur la nécessité de questionner la psychothérapie. En particulier, j’explore comment l’engagement avec les auteurs associés aux théories dites « post » peut transformer les théories et les pratiques psychothérapeutiques, y compris en remettant en question l’existence même de la psychothérapie. En tant que psychothérapeute moi-même, j’essaie de rester mal à l’aise et de me laisser toucher pendant que je me débats avec ce que la psychothérapie pourrait devenir.

ΠΕΡΊΛΗΨΗ

Σε αυτό το άρθρο, στηρίζομαι στον Φουκώ με σκοπό να επιστήσω την προσοχή στο πώς η ψυχοθεραπεία παράγεται και παράγει. Υποστηρίζω πώς οι ψυχοθεραπευτικές θεωρίες και πρακτικές μπορούν να συμβάλουν στη δημιουργία ηγεμονικών εκδοχών υποκειμενικότητας που περιορίζουν άλλους τρόπους ζωής και τροφοδοτούν τον ατομικισμό. Όπως υποστηρίζει η Ρόουζ, οι επιστήμες της ψυχικής υγείας, συμπεριλαμβανομένης της ψυχοθεραπείας, έχουν μεγάλη επιρροή στον τρόπο με τον οποίο αντιλαμβανόμαστε τον εαυτό μας και, επομένως, στο πώς παράγουμε τον εαυτό μας. Η ψυχοθεραπεία - υποθέτοντας ότι οι θεωρίες της και η πρακτική της περιορίζονται στο να αποκαλύπτουν ψυχικούς μηχανισμούς, στην αυτοανακάλυψη, στην αυτογνωσία και στην ανάπτυξη - γίνεται εξαιρετικά ισχυρή στο να παράγει υποκειμενικότητα. Σε αυτή τη βάση, τονίζω την ανάγκη να διερωτηθούμε σχετικά με την έννοια και τον σκοπό της ψυχοθεραπείας. Συγκεκριμένα, διερευνώ πώς οι λεγόμενες «μετα» θεωρίες μπορούν να μεταμορφώσουν τις ψυχοθεραπευτικές θεωρίες και πρακτικές θέτοντας ακόμα το ερώτημα του ίδιου του λόγου ύπαρξης της ψυχοθεραπείας. Ως ψυχοθεραπεύτρια, προσπαθώ να μείνω με τα ερωτήματα και να επιτρέψω στον εαυτό μου να μετακινηθεί καθώς ερευνώ τι μπορεί η ψυχοθεραπεία να γίνει.

KEYWORDS:

• critical psychotherapy
• subjectivity
• experience
• assemblage
• productive

SCHLÜSSELWÖRTER:

• Kritische Psychotherapie
• Subjektivität
• Erfahrung
• Assemblage
• Produktiv

PALABRAS CLAVE:

• psicoterapia crítica
• subjetividad
• experiencia
• agenciamiento
• productivo

PAROLE CHIAVE:

• Psicoterapia critica
• Soggettività
• Esperienza
• Assemblaggio
• Produttivo

MOTS-CLÉS:

• psychothérapie critique
• subjectivité
• expérience
• agencement
• productif

ΛΈΞΕΙΣ-ΚΛΕΙΔΙΆ:

• κριτική ψυχοθεραπεία
• υποκειμενικότητα
• εμπειρία
• συνάθροιση
• παραγωγική

Psychotherapy is culturally endowed as a place where we can understand ourselves better, make sense of our feelings, develop emotionally, etc. The psychotherapist might be considered knowledgeable about emotional and relational difficulties and well-being. Rose (1996) describes this kind of relationship as a discipleship. ‘The relation between expert and client is structured by a hierarchy of wisdom, it is held in place by the wish for truth and certainty, and it offers the disciple the promise of self-understanding and self-improvement’ (Rose, 1996, p. 93). This social positioning might make us psychotherapists particularly influential in shaping how our clients make sense of themselves.

As psychotherapists, we might categorically react against these assertions and think about them as misunderstanding what psychotherapy is about. After all, we are so careful to not impose meaning! Take person-centred psychotherapy. How can the client be a disciple when, according to Rogers (1967), therapy is led by the client and a main objective is for the client to be in contact with their organismic experience? Take a psychoanalytic perspective. How can the therapeutic relationship be a discipleship when we hope to enable a way of relating wherein we can tolerate uncertainty and process raw sensations (Bion, 1970), hoping to be able to give back to clients what they bring (Winnicott, 1971)?

Foucault (1978), argues that the practice of confession (in its wider meaning as telling another about our experience) is so thoroughly ingrained in us that we do not perceive it as a constraining effect of power; however, it is, indeed, a highly effective way of forming subjectivities precisely because it appears to simply be the uncovering of the confessor´s truth. Challenging what appears to be this univocal nature of confession, Foucault proposes that the truth of confession is constituted in two stages: initially, incomplete in the speaker and then assimilated and made truth by someone authorised to interpret it. Drawing on Rose (1996), I think of therapy as an assemblage of theories, spatial arrangements, therapeutic practices, conventions, etc. where the client in the moment of confessing their feelings and thoughts is producing their identity in coherence with a therapeutic knowledge and authority.

Rose (1996) contends that the psy disciplines (e.g. psychiatry, psychology, psychoanalysis, psychotherapy) have been particularly influential in how subjectivities are assembled over the past century. Psy disciplines have enabled people to relate to themselves in particular ways. For example, I think humanistic psychology has been relevant in what Rose describes as people relating to themselves as agents who are free and capable of choice, looking for self-actualisation and self-realisation over the second half of the twentieth century. Following this argument, no previously formed self then is understood by psychotherapeutic theories and helped by engaging in psychotherapy; the self is articulated within particular social practices where psychotherapy has great influence.

In this paper, I contend that if we regard our theories and practices in foundational ways – that is, without considering how they are emergent products of a wider context – we might be less open to question our theories and practices. What is more, if we do not consider how our psychotherapeutic theories and practices collaborate to produce particular subjectivities, we miss the opportunity to become more response-able (Haraway, 2016) for what we contribute to generate. I want to stress that this foundationalism forecloses the creation of novel paths for our clients and ourselves, unwittingly contributing to shape normalised subjectivities.

I join Loewenthal (2015) and collaborators in stressing the need for critical psychotherapy. I think psychotherapy needs to be interrogated from the ‘outside’ by critical theories. By critical psychotherapy I mean a constant questioning and transforming of psychotherapy. I draw from Foucault (1982) who thinks theory operates by objectifying and fixing what it attempts to know. Instead of using fixed theories, he proposes to engage in an ongoing process of conceptualisation. ‘And this conceptualization implies critical thought – a constant checking’ (p. 778). In this paper, I draw substantially on Foucault, Rose and other authors often labelled as ‘posts’ in order to question psychotherapy and continue thinking about its concepts and practices.

In what follows, I first address the fear that with the influence of post movements psychotherapists run the risk of not taking seriously the experience of our clients. Then I articulate how psychotherapy is produced and productive. And finally, I open space to think about how questioning our theories and practices might enable different and novel ways of living. At different points in the text, I explore how this questioning has transformed my work as a psychotherapist.

Do the posts risk negating emotional experience?

Some psychotherapists (Frie, 2015; Frie & Orange, 2009; Gendlin, 2003; Teicholz, 2015) have made their worries about the influence of ‘post’ authors in psychotherapy known. They agree that what they call ‘postmodernism’ has some important points for psychotherapy, but risks relativism, in the sense of reducing everything to language and not taking seriously the experiences – especially traumatic experiences – of clients. Frie and Orange (2009), for instance, argue that the pain of the patient is ‘something to understand and to heal, not to deconstruct or co-construct’. (2009, p. xi)

It seems to me that what underlies this worry is the notion that the ‘real lived experience’ of clients is a foundational ground that needs to be symbolised. It is raw experience – as the emotional reality of a person – that needs to be articulated. In this endeavour, taking experience as not foundational risks disrespecting or bluntly negating the ‘reality’ of a client.

I argue that not taking experience as a foundation is different from negating its impact. With Foucault (1990), experience is generated by three axes: knowledge, normativity (or regulatory practices) and particular ways of relating. With Butler (2005), our experience is produced through cultural discourses/practices that frame the limits of intelligibility of what can appear as a discernible experience or reality in the first place. In that sense, these ‘post’ authors do not negate experience, but they open space to interrogate it because they think about it as produced and not as foundational. For instance, Butler (2010) does not negate affective experience or trauma but interrogates how certain ‘kinds of people’ can experience their losses and pains as valid and recognisable and others do not.

What we experience is produced and this does not mean that it is less real. ‘That which is invented is not an illusion; it constitutes our truth’ (Rose, 1996, p. 3). Drawing on Deleuze and Guattari (1987), this production is not made by a sovereign subject but by an assemblage of different forces. For example, not only my actual and past personal relationships, but also, say, the forms that I am required to complete and that will determine my suitability for a service; how clean and silent my neighbourhood is; the way in which people share spaces with me; how they try to guess what my nationality is, and so on, shape both my felt experience in each moment and how I make sense of it.

Importantly, Frie (2015), Gendlin (2003) and Teicholz (2015) do not make explicit reference to any of the authors widely associated with postmodernism. What are these authors referring to by the term ‘postmodernism’? Butler (1995) criticises how ‘postmodernism’ is used in a generalising fashion and how this places it as something that can be either embraced or disregarded. In the next sections, I elaborate on how my reading of ´post´ authors helps me to conceptualise psychotherapy as produced and productive and how this understanding can allow us to continuously challenge and transform psychotherapy.

Psychotherapy is produced and productive

The notion that psychotherapeutic theories and practices are historical is well known. For example, Mitchell (2001) reflects on the historical and contingent ideals and notions of a ´good life´ in psychoanalytical practice. He gives the example of how American psychoanalysis, with the influence of ego-psychology, conceived ‘integration’ as an ideal between the fifties and the seventies. However, afterwards, when multiplicity theories are more influential, excessive integration is conceived as psychopathological.

Even if it might be relatively easy to think about psychotherapeutic theories and practices as historical, we might still tend to hold on to our central concepts in foundational ways. For instance, Mitchell (2000) responds to postmodern critiques that the concepts of psychoanalysis are relative to culture by situating the concept of relationality as foundational. He agrees with the notion that culture is pervading but he further argues that if things are culturally relative it is because culture is embodied in our caregivers who are crucial to our development as humans. Thus, he conceptualises relationality as universal.

What I think Mitchell is overlooking is that the particular way in which relationality is conceptualised does depend on wider cultural frames of intelligibility. This situates the conceptualisation of relationality within a cultural frame, opening the possibility of it being articulated otherwise. Does relationality need to be about the Western notion of family? Does it need to be restricted to relationships among humans?

Foucault (1980) specifies that the task is not to make a history of the subject but to think about how the subject itself is constituted in historical frameworks. Rose (1996) contends that the concept of self is inextricable from the psy sciences. He argues that the psy sciences were produced as disciplines in Western societies that conceive the person as a self with internal capacities, beliefs, emotions, and so on. At the same time, he stresses how psy has greatly contributed to constituting this regime of the self prevalent in Western liberal democratic and capitalist societies. At first glance, entrenched as we are in this society, we might wonder: how else could we think about the person? what could be wrong with conceptualising the person as a self? Rose articulates that the psy sciences contribute to generating this Western regime of self where it is assumed that we all have the potential to be free but to achieve that, we must work on ourselves according to therapeutic principles. These principles are a new and very powerful authority because they seem to be the discovery of the truth of ourselves and not an imposition. This regime makes us perceive that our lives, our decisions, our relationships, and so on are the products of our personality or inner experiences, making invisible the social, cultural and material assemblages that we are part of and making invisible how they produce this self that we take for granted. I see how this can, for example, pathologise unprivileged populations as if the prevalence of mental health difficulties reflected something essentially problematic inside them. Furthermore, it can prevent us from opening to other ways of living because we assume that we need to be ‘true to ourselves’ not questioning how our sense of self, values, desires and fears emerge in the first place.

Rose (1996) argues that even if some theories have questioned the self (e.g. Lacan) they are still theories of the psyche and so they contribute to this particular regime of self. As I see it some theories have challenged the notion of a bounded self. I think about Gendlin’s (1997) felt sense which is not bounded to the individual, Bion’s (1970) notion of thought as impersonal, Stolorow’s (2013) emotional experience that emerges in relationship, Mitchell’s (2000) relationality that acknowledges that we are always already in relationship, to mention a few. However, these theories tend to stay in the realm of personal relationships and keep the meaning-making persons as the main characters of the story. Drawing on Deleuze and Guattari (1987) the cultural and material forces that are always in assemblage with people (and not external factors that people make sense of) are not sufficiently accounted for.

When I see clients, I think not only about how they make sense of, say, their social situation but how their social situation – the buildings they inhabit, how they are greeted, the material resources available to them, cultural imperatives, and so on – makes a direct impact on their experience and on how they make sense. I will give a hypothetical example. Let´s say a client tells me they are haunted by a sense of disappointment about how little they have achieved in life and their career. Alongside exploring how they relate emotionally to themselves and their achievements, and how significant others have been influential on that way of relating, I would also explore how discourses about what is considered successful in our society, concrete practices of recognition and reward in their career and social circles, and so on, might help to produce their making sense (cognitively and affectively) of their life and career as disappointing. If I frame their affectively charged interpretation of their circumstances and interactions as the only focus, I would be collaborating to produce a sense of individualism, furthering the impression that all that needs to happen is an ‘internal’ change.

As mentioned earlier, Foucault (1990) thinks about experience as constituted through 3 axes: (1) sciences that refer to it, (2) systems of power that regulate it, and (3) forms in which the individual recognises themselves as a subject. Foucault by the end of his life shifts his interest to study this third axis, that is, how individuals relate to themselves and thus form themselves as subjects. This relation to oneself can only be understood in the context of the previous 2 axes. The relation to oneself is a form of self-knowledge that draws from ‘all the techniques of moral and human sciences that go to make up a knowledge of the subject’ (Deleuze, 2006, p. 103). Rose (1996) focuses on how the psy disciplines have been integrated into the way in which people make sense of themselves.

Psychotherapeutic theories and practices provide ways of relating to ourselves, ways of making sense of ourselves that constantly collaborate to produce this very self. In my conceptualisation of reflexivity (Serra Undurraga, 2020), whenever we make sense of ourselves, we are unintentionally relating to ourselves in particular ways. These ways of relating draw from the material-discursive practices (Barad, 2007) available to us (including psychotherapy) and they are producing the very self that we take ourselves to be.

This is not about a direct causality in either direction between internal/self/experience and external/society/psy sciences but about how self, society, sciences, culture, material configurations and so on are in co-constitutive entanglement (Barad, 2007). The notion of a bounded self where ‘external’ factors are made sense of prevents us from realising how the very notion of self, our experience, our sense of purpose, etc. takes shape in relation to cultural, material and relational configurations; and affects, in turn, these configurations. I worry about how the notion of a bounded self as an individual therapeutic project of knowing and working on ourselves can make us too busy with our ´development´ that we fail to see, as Ahmed (2010) makes clear, that our striving to ´be happy´, far from being ´authentic´ and ´personal´, can be, to a considerable extent, a social product which encourages us to be in line with hegemonic versions of subjectivity: happily married, successful at work, raising children, owners of property, discovering ourselves in trips, enjoying life through following trendy lifestyles, and so on. What alternative ways of living are being inhibited? Other ways of making kin (Haraway, 2016), different from the traditional family unit, might be prevented from emerging. In the next section, I explore the importance of questioning psychotherapy and re-conceptualise its main tenets.

Thinking otherwise

If psychotherapy and the self are produced and productive, we cannot rest on them as foundations. We are invited to continuously question them. To be more mindful of how we inevitably reproduce dominant narratives and to consider how we might allow space for thinking otherwise (Foucault, 1990). As Butler (1995) makes clear, it is not simply about denouncing all knowledge as constructed but about interrogating what the different knowledges are producing and foreclosing so as to open the possibility of producing differently. Parker (1999) writes about deconstructing psychotherapy by critically reflecting on our own position, theories and practice as part of the system and thus part of the problem. This interrogation of our work – which is an affective and cognitive endeavour – allows movement and transformation.

Questioning psychotherapy requires more than thinking about our approach as already political. For example, Schmid (2012) drawing on Rogers (1978 in Schmid, 2012), stresses that the person-centred vision of the human as free, autonomous and naturally tending towards development (actualising tendency) has the political effect of empowering clients and potentially challenging social structures that are detrimental to the development of the human being. However, this is precisely the notion of self that Rose (1996) evidences as collaborating with the liberal discourse of capitalist societies that thrive with the notion of a self that only needs to work in themselves to be free and who they really are – thus, leaving to the side any questioning about the cultural, material and political forces that constitute our current possibilities of becoming a subject. My invitation is to interrogate what are our theories and practices doing and not simply to sing their praises. What ways of relating is the actualising tendency (Rogers, 1967) facilitating and what others is it preventing? Besides eclipsing the strength of social forces in articulating who we think and feel we are, I think it might enable a way of relating to the client that can tend towards paternalism in putting ourselves as therapists in the position of facilitating the environment that is needed for the client to grow.

Some psychotherapeutic authors use critical theories to interrogate main concepts and practices of psychotherapy (e.g. Bazzano, 2021; Benjamin, 2015; Davies, 2015; Loewenthal, 2015; Proctor et al., 2006; Samuels, 2017; Shomron-Atar, 2018; White, 2009; Winslade, 2013). I believe all these works contribute to keep psychotherapy alive and responsive.

For example, Davies (2015) uses Butler’s conceptualisation of gender melancholy (Butler, 1997) to re-conceptualise the oedipal complex as oedipal complexities. There are homoerotic and heteroerotic configurations that can be split off from our conscious identifications and desires. Davies does not hierarchize these configurations in a normative developmental framework towards heterosexuality (as more mature) but thinks of them as possibilities. When a therapist uses Davies’s re-conceptualisation in their work, they are facilitating the client´s making sense of their same-sex desires as an experience that does not fix in advance what their gender identity and sexual orientation is and does not judge whether they are more or less mature.

Shomron-Atar (2018) uses Deleuze and Guattari to think about how psychoanalysis can stop being complicit with what they call fascism. Shomron-Atar is wary of using concepts as hegemonic categories – e.g. developmental frameworks – that make us think that we can grasp the client. In this grasping, we might think that we recognise something in the client but without any risk to ourselves and any challenge to our approach. ‘It is the unwillingness to be transformed by the other that is fascist’. (Shomron-Atar, 2018, p. 61)

When, as psychotherapists, we believe that our theory captures the truth of human nature, we do not open space to think otherwise. Furthermore, we close ourselves to the otherness that clients, different disciplines, other cultures, etc. can bring. It is this otherness that can transform our theories and practices, thus allowing space for different ways of living.

I would like to introduce a caveat at this juncture. I am not arguing for questioning psychotherapy and generating a ´critical´ psychotherapy as a ready-made product. I think of critical as an approach or way of doing things rather than an adjective. There is a critical approach to psychotherapy when we engage in the continuous practice of questioning it. A ´critical´ theory in psychotherapy can easily be put to use in dogmatic ways, closing down thought and possibilities. Thus, the crucial aspect is how we relate to psychotherapeutic theories and practices. What is needed is to attend to what the use of a particular therapeutic concept or practice is producing in concrete encounters; to question who does that serve; and to wonder whether it would be beneficial to think about it in a different way. Elsewhere, I have called this questioning device performative meta-reflexivity. (Serra Undurraga, 2022)

Conclusions

In this paper, I have argued about the necessity of questioning psychotherapy as a practice that becomes part of how people relate to themselves and thus how they produce themselves. What makes psychotherapy particularly powerful and influential stems from the notion that it only helps to ´uncover´ a truth about ourselves, not acknowledging itself as produced and productive practice. For example, Foucault (1997) analyses how psychoanalysis emerged in contrast to Charcot who could be accused of influencing his patients and ending up producing ´false´ illnesses. Psychoanalysis then protected itself from this accusation by ensuring a voluntary contract between patient and analyst, and focusing on the discourse that emerges freely from the patient. In this way, psychoanalysis becomes more effective in producing truths because it appears to come from the depths of the patient. As Foucault says, ‘a power that cannot be drawn into any countereffect, since it is completely withdrawn into silence and invisibility’. (p. 47)

Foucault (1982) speaks of pastoral power as a form of power having its first form in the Christian figure of the pastor and then being spread out in diverse social roles. This way of exercising power is not forceful or authoritative but operates by knowing the other intimately to assist with their well-being. This power makes a person a subject in the two senses of the word: it subjugates to another who is authorised to have knowledge about them, and it makes the person a subject, that is, it makes them have an identity and a sense of knowing themselves. Because for becoming a subject we need to be subjected to this authorised knowledge, pastoral power has a totalising (and individualising) effect: it constrains what we might become.

When I argue that, as psychotherapists, we can be influential in producing clients´ subjectivities I am not suggesting that we exercise power over the client and they are simply passive receptacles. For Foucault (1982) power requires that the person on whom it is exercised is recognised as a person who acts and that can potentially react, reverse or transform the power dynamic in unexpected ways. However, when the power of psychotherapy and of therapists is made invisible because we assume we are just revealing the psychic truth of clients, this power becomes harder to challenge and transform. Questioning psychotherapy as produced and productive makes its influence more visible and urges us to be more mindful about how we do exercise power.

Thinking about psychotherapy as produced/productive has increased the response-ability that I feel to my clients, the necessity of questioning whether I am reproducing hegemonic discourses with my interventions and preventing other ways of living and relating that I might not validate or be able to imagine at the moment. For example, am I unwittingly directing the process of clients toward what I consider autonomy and healthy independence not opening myself to consider with them other ways of making relationships? How can theories of development be challenged to give way to alternative ways of relating?

Furthermore, this critical engagement has led me to question the practice of psychotherapy in itself. I used to think that if everybody went to psychotherapy, the world would be a better place. Now I wonder whether it would further individualism and hegemonic forms of subjectivity. How is psychotherapy eclipsing possibilities of communitarian action?

Questioning psychotherapy is changing my way of practising. I feel strongly about how crucial it is to bring to the sessions the material and cultural aspects that are impactful in shaping the experience and ways of making sense that my clients and I have. Bringing these dimensions inside the room can open possibilities of transformation that go beyond ‘internal’ change. Continuing with the hypothetical example given earlier in this text, if we acknowledge how concrete practices of reward and recognition might contribute to a client experiencing their career as disappointing, we might open space for the client´s questioning of social practices.

As a psychotherapist, I am in a role that contributes to shaping clients´ way of relating to themselves. The inevitable judgments I have about what a good life looks like are part of how I am with the client – even if I am careful to hold my judgments in check, they are present in what questions I formulate, what I am moved by, and so on. Sometimes I would like to be sheltered in the belief that I am just helping the client find their voice. However, that would make my influence as a psychotherapist invisible, and thus more powerful. I emphasise the importance of continuously making my assumptions explicit (even if only for questioning them myself); of being willing to hold my favourite theories tentatively, challenging and transforming them; and of interrogating the ways of relating I find myself enacting even against my best intentions (Serra Undurraga, 2022).

Conceptualising psychotherapy as produced/productive leaves me in what I feel is an uncomfortable but generative place. It is uncomfortable to recognise the power I exercise as a psychotherapist in influencing how the subjectivities of my clients are shaped. It makes me wear the ‘psychotherapist’ identity label in a much more tenuous way, aware of the social sanctioning that it carries and the enabling and detrimental effects that it has. It is generative to think of psychotherapy as produced because it makes me more open to be challenged and transformed in my psychotherapeutic thinking and practice by my clients, other disciplines, political movements and more. Conceptualising psychotherapy as produced/productive opens space to invest energy in rethinking psychotherapeutic theories and practices to open the scope for new forms of subjectivities and validated ways of life. It leaves me humbled to think about the many other possibilities that could better help my clients. However, starting from where we are in this highly psychologised culture, it enables me to consider how I might disrupt psychotherapy from my privileged position as a psychotherapist.

Acknowledgments

I appreciate the encouraging and thoughtful feedback from the anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Jacqueline Karen Andrea Serra Undurraga

Jacqueline Karen Andrea Serra Undurraga is lecturer in counselling and psychotherapy at the University of Edinburgh. Currently, her research inquires into rethinking psychotherapeutic theory and practice with post theories. Previous research includes reconsidering how we make sense of ourselves through reconceptualising reflexivity and experience; exploring narcissism as a relational and embodied phenomenon and discussing the relationship between philosophy and the humanistic approach in psychotherapy.