Sometimes I feel like Jerry Garcia. The leader of the Grateful Dead used to question himself in an enviable way. The rock group that was the biggest selling live act of the 1980s, that made ground-breaking music for 30 years, was treated as a religion by ardent fans, and supported and offered a living to hundreds of people: band members and their families, road crew, administrative staff, tour managers, merchandising personnel, sound engineers and construction and transport et al was spearheaded by Garcia and arguably without him (and this was evidenced following his demise in 1995) was finished. Yet Garcia felt courageous enough to ask, "Is the Dead a good thing?" Some feel that he felt unable to disband the Dead organization corpus on the basis of abandoning his conscience in serving such a huge community, who depended upon him and the band for their livelihoods.

Now, cut to the analogy: I have many times questioned and re-questioned therapy and it's stated and implied goals, wondering essentially if it works and, mimicking Garcia, asked "Is therapy a good thing?" Of course I am not the only one to do so.

From Crocodile Dundee, who spoke with the voice of the common man when he remarked about someone seeking counseling "What, ain't he got no mates?" to the renowned, rebellious Jungian analyst James Hillman, who co-authored the book "We've had a hundred years of psychotherapy and the world's getting worse", psychotherapy has had its detractors in droves.

The criticisms are legion, well-known and well-stated: Can people really change? Don't therapists simply try to make their patients/clients think and feel like them? They are only after your money. What do they know anyway?

In one early study Hans Eysenck concluded that two-thirds of psychotherapy patients/clients improved or recovered by themselves, whether they had received psychotherapy or not.

Certainly the history of psychotherapy is wrought with suspicious examples of so-called cures. From the acclaimed "treatment success" of Anna O by Sigmund Freud, about which Jung declared that it was "nothing of the sort" (she was institutionalized following arguably being misdiagnosed in analysis) to the modern day account of Paris and Donovan's verbal and emotional power abuse at the hands of an abusive therapist (see Richard Zwolinski's book Therapy Revolution), reasons to doubt or at least be wary of therapy would seem to make sense.

So back to Jerry Garcia's question concerning the Dead. To paraphrase: "Is therapy a good thing?"

As a therapist I am naturally biased. But I am also by nature curious and integrous. I really don't want to waste my time in a pursuit that doesn't have a positive affect, which I cannot pursue in good conscience, which is fundamentally flawed in its approach and effectiveness.

Sometimes therapy doesn't work - or doesn't appear to work. But this is a difficult matter, difficult to measure and to follow-up and assess. I recall a guy in a personal growth group with whom I had an incident in which we 'fell out' resulting in his leaving the group. A failure? Some months later he wrote to express his gratitude to me. In the intervening time he had realized that he had transferred (originally a psychoanalytical term meaning to redirect feelings to another person) his father complex onto me. The incident in the workshop had opened up all kinds of useful inner material, which he had addressed in individual psychotherapy and transcended, resulting in a profound healing for him. So was this a failure which turned into a success?

But at other times it really doesn't work and mistakes are made. I recall a client who ironically became the focus of my supervision sessions. My supervisor, an analyst with a wealth of therapeutic experience, encouraged me to pick one of my clients and focus on him each week. The idea was that receiving intense supervision on a single therapy client this would have an effect on my overall practice.

The result however was that I, as a young, ambitious and aspiring therapist, became over-focused on this client. I started to care too much about him as the supervision deepened my involvement in his life. One day he appeared in my consulting room looking ghastly and I asked him what had happened. He explained that he was trying out a new pharmaceutical, as yet not entirely safe or tested, for an allergy he suffered from. I was outraged, not so much at him, as at the medical authorities that would allow such a practice. The medication was clearly doing him no good at all. I told him, to my lasting regret, to discontinue the medication. He stormed out of the room. I had walked straight into the transference of his parents who always told him what he should do and denied his right and ability to choose in matters concerning his own life. Following a vituperative final session, he left and I never saw him again.

We have no way of knowing of course whether or not this client subsequently had some insight or clarity, like the previous one who transferred his father onto me, and so benefited in the long run from my over-caring. Likewise we have no way of knowing whether or not the client who had benefited subsequently took a negative turn in the long run to his detriment.

And what of the grateful client? Perhaps people who have been in therapy keep quiet about it today when the stigma of seeking help has reinstated itself in direct contrast to the Seventies self-proclaimed and shared glory in personal and collective consciousness raising. But my walls have been covered and overlaid with cards containing elated proclamations of gratitude over the years. Today emails tend to replace the cards of course. But recently when I was putting my website together and my web designer was grappling with the weight of testimonials, we made the joint executive decision to minimize and use a select few so as not to appear too "full of ourselves". And this in spite of the fact that by and large most clients who have therapeutic success in all likelihood don't write or email their therapists.

My point is not to show how great a therapist am I, rather that therapy does work and when it does it may not necessarily be shouted from the roof tops by the beneficiary, or grateful client.

Having said this, we must be painfully aware that not all therapists are any good. It is beyond the scope of this article to go into what we should or can do about that when short-term, inadequate trainings produce therapists and healers of many descriptions and the general public is wholly ill-equipped to distinguish between them and a multiple-qualified, effective and gifted practitioner. Neither is the new requirement of a university degree as a requirement for psychotherapy training liable to inspire greater confidence in the user of therapy services. Most therapists are aware that untrained therapists may be wholly capable and often of higher quality than trained ones; such is the nature of the work that compassion, wisdom and intuition, which are arguably essential, are probably impossible to teach.

My conviction has lain in my ongoing objections and criticisms of the field of psychotherapy. I have maintained a surgical approach to unhelpful, murky theory, approaches and methodologies that I felt were suspect. Luckily I have spread myself so thickly around the area of therapeutic endeavor that as the years rolled on I have, through writing (no better way to expose unclear thinking) and therapy practice with individuals, couples, groups and communities, formulated my direct experience into an understanding that comprise a philosophy and psychology of how therapy works and I have summarized these as the three stages of awakening.

BLOG entry #109