A psychotherapeutic method: what do you think?

The two passages below come from Borderline Personality Disorder New Perspectives on a Stigmatizing and Overused Diagnosis by Gunn and Potter.  I think the book has a number of merits that should recommend it to the feminist reader in particular.  It is impotant that they see BPD largely as untreated trauma and a socially constructed illness.  BPD as a diagnosis tends to frighten therapists away, which the authors take to be a very faulty  reaction.  They have a nice account of how BPD has been viewed through the ages; they include burning witches at the stake as an earlier intervention.  I really cannot say how historically accurate their account is, but it is oddly satisfying.

There is a passage, though, which I find problematic.  You’ll see it below.  It concerns a therapist using their reactions to understand a client/patient.   There are at least two ways to understand it.  On one way it is about increasing one’s empathetic closeness.  The client is discussing a frightening experience; the therapist feels something like a ghost of fear and uses it to fill out the story.  On a second way, the therapist uses their reaction to get a more accurate diagnosis or better ideas for treatment.  E.g., the therapist feels something of a sexual nature and takes the client to be trying to act seductively.

I think that when there are significant cultural differences, the latter approach can be a source of great problems.  The the case I described is an example from my own experience, many, many years ago as an undergrad at Berkeley.  I had ‘grown up’ in the quite formal atmosphere of a military child who went to convent schools in Washington, DC.  Among others things, I NEVER lit a cigarette if a man with matches or a lighter was around.  No more so than I would have opened my car door when a man was around.  So, when I went to see a UC therapist as I coped with the transition from convent schools to Berkeley in the 60’s, I eventually discovered that the little toad (as I described him) I was seeing thought I was in love with him.  He met my incredulity with the comment that  I always had him light my cigarettes.

That is not, in my experience, a kind of a tale restricted to the past.  There can be huge cultural differences in all sorts of cases.  it is bad enough that humans in general prejudge each other in terms of stereotypes, but it can be much worse when someone fails to fit the standard stereotype.  And maybe even worse again when a client is unaware of the stereotype.  For example, a philosophy professor may have very different ideas of epistemic authority from those of therapists, and as a consequence upset someone quite use to be taken as an authority.  She might quite mistakenly think they were having a discussion among equals, at least until he says, “all my other clients think my ideas are worth taking seriously,” where that apparently does not include pointing out why  some are wrong.  So he will see her as having quite a social problem.

I hope I’ve managed to delineate a potential problem.  So here goes:  what do you think?  Is there a reason here to be cautious of psychotherapy?

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