Psychotherapy's Role in the Wider World

The Case for a New Kind of Self

William Doherty

At this time of fragmentation and division, therapists need to recognize that we’re in the glue business. We know something about helping people connect, about how to form a healthy “we” out of self and other. We also know something about how to depolarize conflict. But first our society needs us to recover our conviction and passionate intensity as a profession, our belief that we have something to offer beyond symptom reduction, something that embodies wisdom about what it means to live a fulfilling, purposeful life in healthy families and communities. We need a new image of the self to counteract the Consumer Self of hyper-individualism, which, because the individual alone is impotent in a mass society, easily falls prey to the tribal loyalties.

Fortunately, our field seems to be moving past our decades-long embrace of expressive individualism toward a focus on attachment and connection. This shift can be seen in work as diverse as couples therapy (with its emphasis on attachment bonds), trauma therapy (with its emphasis on connection and community in the healing process), mindfulness therapies (in which self-attunement leads to attunement with others), and interpersonal psychoanalysis (which attends to current relationships as well as past ones). New therapy masters like Susan Johnson, John Gottman, and Daniel Siegel teach that bonds of connection can strengthen the individual, rather than diminish or threaten personal freedom. In a world of centrifugal forces, where politicians talk of building walls, our field has a message of engagement across differences. We’re evolving an image of the self in which connection is central.

But we need something more. As law professor Tim Wu points out in his book The Attention Merchants, consumer capitalism is the most creative force in the contemporary world, able to hijack any personal or collective ideal by turning it into consumer desire, encouraging us to feel entitled to the best possible relationships that require low maintenance and offer high rewards. So the Connected Self must have an ethical dimension. It must embrace commitment, by which I mean sustained investments in something outside oneself, to relationships and causes that transcend us, extend us, challenge us, and require continual struggle to balance and manage. It’s both feet in, not a toe in the water. Dare I say that commitments require sacrifice—a dirty word in my training (forgive me, Fritz Perls). This Connected/Committed Self is an antidote to the Consumer Self that honors no past obligations unless they promise future rewards.

The vision of the Connected/Committed Self as the underlying foundation of therapy is already becoming more and more evident in the therapy field. John and Julie Gottman, for example, emphasize the role of commitment in couples therapy. “Commitment,” they write, “means believing (and acting on the belief) that your relationship with this person is completely your lifelong journey, for better or for worse (meaning that if it gets worse, you’ll both work to improve it). It implies cherishing and reinforcing your partner’s positive qualities and cultivating gratitude.” Michele Weiner-Davis’s work has long emphasized commitment in marriage, often bucking the tide of expressive individualism in the field. Steven Hayes named his model Action and Commitment Therapy, an approach that helps clients access their deepest values about what it means to embrace a flourishing life, and supports them in being committed to live by those values.

The idea of the Connected/Committed Self reflects an emerging conceptual shift to seeing relationships as part of the self, as inherent in the very idea of the self—not self in relationship, but the relational self. This was a core principle of family systems theory that got diluted when family therapy became just one intervention among several to treat DSM disorders. It’s at the heart of interpersonal neurobiology and attachment therapies. It resurrects the premodern idea that the fully separate self doesn’t exist—there’s no I without we—but with a modern twist, which highlights both the complexity and the agency of the individual person and the embeddedness of this person in a web of family, friends, and community. Emphasis on commitment adds the idea that long-term embeddedness comes only when our closest relationships—and our relationships to community—involve a strong dose of ethical commitment.

New therapy ideas usually emerge by rejecting what came before. But I propose doing it differently this time. Embracing the Connected/Committed Self doesn’t mean that we abandon the wisdom of therapy’s previous models of self; in fact, we can claim the enduring wisdom of Freud and humanistic psychology. Starting with Freud’s two major life tasks—love and work—we can see our personal relationships and our work not just as venues for the Consumer Self (how much love am I getting, and what’s in my paycheck?), but as places where we commit ourselves to people and to meaningful tasks, and where our lives become larger.

For the most part, psychotherapy has split the public world off from the personal world, with the consequence that most of us don’t know how to support our clients’ civic engagement beyond its being a source of social support for them. What about healing the self and healing the world as twin processes, with synergies as well as tensions between them?

The Road Ahead

In today’s fragmented and polarized world, the ideal of the Connected/Committed Self must involve engagement with community. The link between personal healing and giving to others who have suffered has been well established in feminist-informed therapies for many years, as witnessed in Lisa Goodman’s work with small groups of depressed, low-income women who engage in collective social-change projects as a way to solidify and expand their personal healing. Ramon Rojano’s Community Family Therapy invites those who’ve found their way above water to receive leadership training in their communities. Jack Saul engaged community resilience in New York after 9/11 and more recently with the Liberian community in Staten Island. Alcoholics Anonymous has the 12th step of sponsoring someone newer in recovery. And of course the great religions of the world got there a long time before the advent of psychotherapy: healing the self and healing the world are deeply interconnected.

But the idea of clients as citizens of larger communities, as contributors to their larger world and not just as receivers of social support, hasn’t entered the mainstream of therapy. I had a wakeup call on this some years ago, when I was finishing up work with a couple who’d found their way back from an affair, chronic pain, and struggles over stepfamily life. I can’t recall how the information came up, but I discovered that 20 years before, this couple had been behind the creation of a major children’s institution in our city. They’d been sitting in their kitchen wishing their children had an opportunity (I’m keeping details light to protect their privacy), and they decided that it should be available for all the local children. A dozen years later, with lots of others on board, it happened. I frequently took my own children to participate in it. What struck me was that despite working with this couple for more than a year, I’d known nothing about their commitment to their community. It was deeply relevant to who they were as individuals and a couple, but it had remained hidden from therapy because our focus was on their personal world and on how their near environment (like work) affected them.

I’m sorry to say this experience didn’t make me change how I’d work with clients in the future. I couldn’t see a way to bring a citizen dimension into therapy without “changing the subject” when clients came to sessions with personal concerns or environmental stresses—this despite the fact that in another part of my career I’d been engaging fellow community members in social-action projects. My therapist identity was cut off from my civic-activist identity. Therapy was about personal and relational healing based on the agendas clients brought, not about having conversations about public issues, unless those issues, like racism, were directly impinging on clients. And it certainly wasn’t about how clients could make a difference in the world.

A catchphrase of the feminist movement was the idea that the personal is political. Democracy, as I’ve come to see it in my public practice of community organizing, is about collective agency, the ability of people to work together to solve problems and have an impact on their world. It’s only secondarily about elections and government, because without we-the-people having a sense of joint efficacy, democratic forms of government are hollow and given to authoritarianism and oligarchy. Democracy, in John Dewey’s terms, is a way of life. It’s about ordinary people deliberating across differences and taking responsibility for their future together—before, during, and after electing their public officials.

One link between psychotherapy and democracy is that personal agency, which is necessary for collective agency, is at the heart of psychotherapy—we help people create meanings and act in accord with their aspiration and values. People without a sense of efficacy in their personal lives will have trouble maintaining a democracy. The link between psychotherapy and the public domain, I now realize, is through seeing therapy as a form of democratic practice that starts in the consulting room. Our clinical work prepares people to be active shapers of their personal lives and also, if they choose, to join with others—in the Hebrew phrase, tikkun olam—to repair the world.

In truth, this work can be anxiety-producing for therapists, so we need a lot more therapists developing the craft of these personal/public conversations in therapy. When is it therapeutic, and when does it become a way to avoid real work? How and when does the therapist share personal views and reactions to public issues? What happens when the therapist gets triggered by a client’s polar opposite—or even offensive—public views? What resources can therapists provide clients who want to engage in civic action? How do we avoid letting therapy be seen as part of a partisan political agenda? How do we avoid sending messages to clients that our regard for them depends on whether they agree with us politically?

On one hand, all of this reminds me of other big shifts in what we do in the therapy room: at first they seem antitherapeutic, maybe even unethical, as when therapists began to treat marital distress by having both spouses in the same room. On the other hand, feminist therapists and other social-justice therapists have been pushing this envelope in therapy for decades, so it’s not really new. Maybe what is new is the democracy theme, which assumes that everyone has a stake in the public domain, can be affected by public stress, and can be part of the solution through personal action (such as talking about issues in their social network) and collective action (by joining with others to work on change).

Clearly, we have work to do. Each of us will need to decide how far we’re willing to extend ourselves into the world beyond our consulting room. Our world needs what therapists have to offer. We’re connectors, glue makers. We understand the complexity of the human spirit. We know that embracing differences is difficult but life-enhancing. If we raise our sights and keep in mind that we’re in this culture and not above it, our profession can contribute to a flourishing democracy, where people can be agents of their own lives and builders of the commonwealth.

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This blog is excerpted from "Psychotherapy's Pilgrimage" by William Doherty. The full version is available in the January/February 2017 issue, The Connected Self: Psychotherapy's Role in the Wider World.

Photo © Michael Houghton Photography/Getty Images

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Topic: Cultural, Social & Racial Issues

Tags: acceptance and commitment therapy | activism | bill doherty | community | community mental health | Cultural, Social & Racial Issues | culture | politics | volunteer | volunteering

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1 Comment

Saturday, June 22, 2019 5:39:09 PM | posted by Il Be
In a perfect world, all citizens would step up to further the cause of society in a positive way. To think that one profession has a greater responsibility to foster understanding among a diverse group of people, is egotistical at best and condescending at the very least. To suggest that members of certain professions have greater responsibilities to blend their professional lives with their private lives, is unrealistic and not necessarily a value to society.