Collective Mothering and the Medical Model

A Response to Emmy van Deurzen-Smith’s article

“The Future of Psychotherapy”

Abstract: The author disagrees with Emmy van Deurzen-Smith’s proposition that the future of the psychotherapeutic profession should be built on the idea that it can contribute to society by taking on a function of professional mothering.Whilst agreeing with the recognition that this is a role psychotherapists acquire, this is seen as an expression of the malaise rather than the ‘solution’. In contrasting the ‘mothering’ paradigm with the medical model, and suggesting that psychotherapy has been and is torn by a necessary allegiance to both, it is proposed that the most solid basis for the profession is to embrace the continuing conflict inherent in the cultural and archetypal background between so-called masculine and feminine, mothering and fathering ways of being and relating, as essential to the work both on a theoretical and a clinical level. 134 words

I would like to make some comments about Emmy van Deurzen-Smith’s article ‘The Future of Psychotherapy in Europe’ in the first issue of this journal. She suggests that modern psychotherapy and counselling are now fulfilling that social and collective role within Western culture which was traditionally occupied by motherhood. Whilst I fully agree with her that this is how we are perceived (not always consciously) I would tend to see the equation psychotherapy = professional mothering as a projection onto our profession which could turn out to be quite dangerous to us in the long run. I agree it is a collective function we are given or acquire, but I certainly would not want to take it on board as a self-definition, and assuming that I’m not alone in this I question whether it could provide a sound basis for the future of the profession.

Emmy van Deurzen-Smith formulates a development of mothering skills “from craft, through art and religion to science” - scientific evidence being considered necessary to prove that psychotherapy works in order to be seen as accountable. In my view, the whole idea that we should need to validate our work scientifically in the first place arises because we have come to take it for granted that mothering is invalidated in our culture. Feminists have made it quite explicit over the last 30 years that our culture has a split and ambiguous relationship to mothering: both a controlling idealisation (how mothers should be) and a contemptuous, and essentially hateful, dismissal (when the mother-object fails that impossible expectation)1 .

I have collected newspaper and magazine articles on therapy for a while and looking at the common themes, it seems to me that psychotherapy and counselling have increasingly been on the receiving end of exactly this split reaction: idealisation versus dismissal. Like Emmy van Deurzen-Smith, I read this reaction as indicating that in the public imagination we are seen and expected to - often ‘magically’ - provide mothering to a culture which through systematic neglect and de-valuing of nurturing and emotional relatedness has created a gaping hole of need at the heart of its social fabric. There is a devastating malaise which desperately calls for nurturing, but unlike Emmy van Deurzen-Smith I have not got much faith that society is ready to be ‘nurtured’ if only we - as the ‘mothers’ - can prove scientifically that we are equipped to do so.

In my view it’s not scientific evidence or information which determine whether people trust our profession. Because the bigger the need and the idealisation, the greater are also the hate and the dismissal. And in all the articles I studied, whenever there is dismissal, it is invariably based on some comparison between therapy and the medical model 2. Judging by the admittedly superficial response in the media, the scientific paradigm which Emmy van Deurzen-Smith wants to use to prove our efficacy is mostly used to discredit us - it is after all the same paradigm that devalued all the human faculties and skills which mothering depends on as too subjective, irrational, ‘un-scientific’ in the first place3 .

If we want to make use of Emmy van Deurzen-Smith’s contribution, I think we need to contrast the mothering function of therapy (as described by her) with the fathering function of the current scientific medical model. The relationship between these two paradigms follows the same underlying patriarchal dynamic between masculine and feminine which still tears our culture apart. Although it may appear in numerous and various guises, the undervaluing of the feminine can be seen to occur on all levels: intrapsychic and emotional or interpersonal and familial or social, political and cultural. Essentially, we are talking about the relationship between an objectifying, unrelated and superior masculine and a colluding, undifferentiated and indulging feminine stereotype. In the microcosm of the family as well as in the macrocosm of modern Western civilisation the full potential of both polarities in this archetypal battle of the sexes is lost in their interaction.

There is a wealth of literature in the Jungian and Archetypal Psychology tradition which informs the - far from original - perspective I am rehearsing here. From this perspective it seems unwise in the current cultural climate to let psychotherapy be identified with a mothering function which leaves it playing the role of the silly ‘irrational’ feminine in relation to medicine’s superior role of the dominant father.

Instead I would like to explore whether we can base our response to how we are seen publicly on our own paradigm. Maybe we can deal with collective transference onto our profession in the same way we work with it individually ?

When a client/patient projects a very split mother-image onto us, along with the corresponding intense ambivalence, idealising us as their potential saviour in a rather desperate life situation whilst maintaining an attitude of skeptical dismissal towards the work itself, what do we do ? How do we respond ?

The client/patient I’m imagining clearly does expect us to supply the care that is somewhere vaguely experienced as missing, but before they open up to us they want to be assured that our approach will work, that we have a convincing strategy. They are communicating in no uncertain terms that they are going to withhold that deeper need (and the pain surrounding it) until we have proven that we can definitely do something about it.

This is where in my view the ‘medical model’ comes at us: we are expected to provide for the whole human being, including mental and emotional aspects, the same apparently predictable procedure which medical practitioners are seen to provide for the body. In this situation one of the first things I am alerted to is the danger of archetypal inflation. It has often been observed that when patients need the illusion that science and medicine have got it all ‘under control’, doctors are treated as ‘gods in white coats’. The hope and expectation that they can command the mysteries of life and death implicitly confers god-like status onto them. The equivalent expectation in therapy amounts to a demand for a guarantee against any kind of emotional-mental pain and distress - instant soothing on tap. It can therefore be argued that the demand for a medical cure administered by such a powerful therapist (which is what clients often think they are paying for) is rooted in an infantile need for symbiotically attuned mothering, and is both an expression of that need and a defence against it. If therapy does not fulfil that implicit need, if the soothing isn’t forthcoming, if the ideal mother can’t be omnipotently controlled, then the rage comes to the fore, masked as a dismissal of the whole painful realm of feeling and relating in general and dependency on mothering in particular.

I suggest that the same dynamic is at work collectively, and forms the basis both for the increasingly common quasi-religious faith in therapy as well as for the cynical assumption that if we have the power to exploit the vulnerable, through ignorance or malice we usually will. The conclusion is: if therapy as mother will exploit and let you down and betray you anyway, it’s best to make do without it / her 4.

Rather than conceiving of the therapist’s position as resting in a mainly motherly presence, in practice, I think it’s more accurate to say that we are caught between the ‘nurturing’ and the ‘medical’ paradigms like millstones. As indicated above, my view is that most clients in some way expect us to perform some pseudo-medical psychological ‘operation’ on them and we need to do justice both to their quite valid, but also essentially objectifying expectations (of themselves and us)as well as the human and relational needs which are being ignored in this ‘procedure’. The conflict between archetypal mothering (as we know it) and archetypal fathering (as we know it) is essential to our work and needs to be lived with each client/patient again and again.

Many therapists are inclined (and trained) to take sides in this conflict, and promptly deliver what they consider ‘the right intervention’. For some this may be a behavioural correction with a more medical flavour, whilst for others it may be a person-centred reflection belonging more to the mothering mode of therapy. In both cases the information inherent in the therapist’s conflict is then lost. Along with therapists from a wide variety of schools, I would consider the therapist’s full experience of being torn between conflicting modes and therapeutic impulses as one of the main avenues into meaningful contact with the client. A therapy without such a perspective is liable to enact rather than contain the client’s individual scenario as well as the underlying collective suffering.

As a psychotherapist my intention is to NOT let myself be exclusively identified with archetypal positions, especially not in their stereotypical, patriarchal expression, but to BE in the conflict, to be the whole conflict. In my view, the full potential of psychotherapy as a profession is accessible only when we define our role as based on being in conflict. On an archetypal level this means embracing the pain of the conflict between masculine and feminine ways of being and relating. This is difficult, and more so because many of us have initially chosen this profession in pursuit of some idea that we might find ways of ‘conquering’ such conflicts in ourselves.

In summary here’s my plea: let’s not accept a definition of our profession as doing the mothering in society. That burdens us with an omnipotent idealisation which we have always already failed and need to be hated for. Instead I suggest as our self-definition a role which embraces the conflict and pain which is necessarily inherent in the therapeutic position, especially in terms of the war between masculine and feminine, fathering and mothering aspects of the therapeutic profession. Our profession is an expression of that painful struggle, not just one side of it. We are a symptom of the struggle, and as is often the case, the symptom has the remedy in itself, but only if we can embrace the pain of our position.

My hope for the future of our profession is that together we can recognise and own our dilemma - and our task - in relation to this fundamental issue of our modern cultural and social malaise.

For a longer article on the same theme: Collective Mothering and the Medical Model

Last Updated April 5, 2005