The Therapy Delusion

The delusion is that any particular psychotherapy is based on fact, not metaphor.

All psychotherapies can be reduced to these four equations:

E + R = B
B + R = I
I + R = T
T + P = C

Where:

E = Explanation
R = Ritual
I = Input
B = Belief
T = Therapy
P = Practice
C = Change
In other words:

Explanation plus Ritual equals Belief
Belief plus Ritual equals Input
Input plus Ritual equals Therapy
Therapy plus Practice equals Change

Whiche of the 400 or so psychotherapies you choose you can be sure there is a Ritual involved.

Three examples:

1. The Ritual of classical Psychoanalysis associated of:

Patient lying on a couch
Free association by the patient
Mostly silence from the therapist

2. The Ritual of Emotional Freedom Techniques [EFT] consists of:

Finger tapping on or by the client on meridians in her body
Before and after measurement of discomfort on an imagined 1 – 10 scale.
Active involvement of the therapist.

3. The Ritual of Hypnotherapy consists of:

An induction Ritual [words, music and / or breathing techniques]
Positive suggestions for change and use of the client's imagination
Active involvement of the therapist

All three therapies (and all others) are preceded by an Explanation.

This Explanation may be offered directly to the client or patient or it may be implied. Books, movies, plays, TV and the Web frequently provide cultural expectations of what to expect in a therapist's office.

These expectations coupled with the relationship of therapist and client (arising from the 4 equals) are what bring about change. [This special relationship is also known as "Psychotherapeutic Eros"]

The Explanation rests on a Theory.

In the case of psychoanalysis it was theorized that free association (letting the patient talk freely about whatever came into her head) would eventually help to resolve inner conflicts among her id, ego and superego.

In the case of EFT the theory is that there is an imbalance in the energy that runs in the client's body through a bundle of meridians.

In the case of hypnotherapy the theory holds that the client is basically governed by her subconscious and that hypnotic techniques provide her with direct access to her subconscious mind.

No meridians, ids, egos, superegos or subconscious ** minds can be seen under a microscope. In other words, they do not actually exist. But believing that they do – or at least behaving as if they exist – encourages Belief.

And with Belief we have the beginnings of successful psychotherapy. Because the fascinating fact is that Belief in any particular Ritual can bring a successful result.

In other words, the ritual itself is therapeutic because the client or patient, and often the therapist, believes it will be.

Let's look at another therapy: Rogerian. In contrast to classical psychoanalysis, the client faces the therapist. Whatever the client says is fed back to her in similar words thus demonstrating the therapist's understanding of the client.

'Unconditional positive regard' is a key element of the Rogerian Ritual.

The theory undering the Ritual of Rogerian discussion is that inner strengths in the client will be fostered as long as the therapist continues to reflect the client's words to her while at the same time displaying total acceptance of her as a person.

Another example of the 4 equations is EMDR, which is basically a form of hypnosis.
Is CBT [Cognitive Behavioral Therapy] different? Clearly, when CBT works, change in thoughts and behaviors is real, not metaphoric. But what enables one client to benefit from CBT and another not? It's the 4 equations herein presented.

** Donald Robertson answers the question: Is there actually such a thing as 'the subconscious'?

"I do not think so. The use of this term, in fact, really highlights one of the major problems in the field of hypnotherapy. only imported later by Pierre Janet – and 'the unconscious' by Freud and his followers. It's a slightly metaphysical and pseudoscientific concept that is not normally used in mainstream psychology, having fallen out of fashion about half a century ago.

Hypnotherapists often incorporate elements of seriously outdated psychological or psychotherapeutic theories into their work. They do this simply because they tend to attend courses which steer them away from modern research and toward slowly cultish or fadish 'pop psychology' approaches such as NLP, or towards very old books written before the 'cognitive revolution' in psychology penetrated psychotherapy.

Obviously, there are things which we are not conscious of at any given time, and things which we can not easily be aware of, such as certain internal processes of our body and nervous system. It seems clear, though, that people do not just mean 'brain' by 'subconscious mind' but something much more speculative.

Conveniently, the subconscious mind ends up being defined as a 'realm' which can contain almost anything and which can be directly observed by either therapist nor client. Unsurprisingly, therefore, it has become a magnet for pseudoscientific theories.

They say that flawed theories often collapse under their own internal contradictions. Freud thought the unconscious was the seat of the Oedipus complex, Adler thought it was the inferiority complex, Jung the archetypes, Klein the internalized breast, Rank thought it stored birth trauma, etc., etc. Therapists of all persuasions used it as a repository for whatever they wanted to project into it – because nobody could check.

There are, in fact, many different conceptual problems with the 'subconscious mind.' (The subject of my master's dissertation!) So perhaps the simplest point to make is that it's fallen out of use as a concept in most modern psychology, and has been replaced by reference to specific non-conscious neurological processes, etc.

To pick just one of the issues at stake, however, for anyone vaguely interested in philosophy of science … Aristotle warned nearly 2,500 years ago against the tendency to take "potential 'entities and treat them as' actual' ones – a common fallacy in primitive science.

When Freud and many hypnotherapists talk about 'the unconscious mind' or 'the subconscious', they are often simply referring to the potential that a person has to experience certain emotions or memories, etc.

If I am 'regressed', for example, and recall an event in childhood, the hypnotist often says that it was stored in my subconscious mind. The appeal of that is that it's close to a figure of speech we use in ordinary language. However, even in common sense 'folk psychology' people also recognize that by 'stored' they often mean that traces or elements of an experience exist which are reconstituted at a later date.

The memory or emotion could be stored, in other words, in the same form (like a picture in the attic) or in potential, in another form (like music stored on a hard drive). It's generally recognized now that when people try to recover memories they usually embellish them. The more vague or distant the memory, the more embellishment that occurs. That's because we're not simply 'missing' a picture in the attic, but re- assembling it from a few ingredients each time we re-experience it, and filling in the gaps with guesswork.

If we think of potential memories or emotions as being 'hidden' inside the subconscious awaiting being uncovered then we're usually led into many other similarly false conclusions about the nature of human experience and psychotherapy.

For instance, if we think of 'repressed emotions' as lurking hidden from view in the unconscious mind then it encourages the notion that 'venting' them should be the therapeutic, a notice which makes little sense if we think that potential emotions do not actually exist except in the form of a predisposition to respond under certain circumstances. In fact, there's a general consensus among researchers that 'venting' is of little long-term therapeutic value, and trying to 'vent' anger often makes it stronger, rather than purging it from the mind. "

Donald Robertson
College Principal & Executive Director
Senior Clinician Hypnotherapist (NCH)
Registered Psychotherapist (UKCP)
Member of the European Register of Psychotherapists (ERP)
Fellow of the Royal Society for the Promotion of Health (RSPH)
The UK College of Hypnosis & Hypnotherapy Ltd.

A great historical example of therapy delusion was published in The Skeptical Inquirer November / December 2012: The now near-dead therapy of Phrenology was exposed as "hugely influential permanently being totally invalid."