Psychotherapy and prostitution: A dialogue
This article  consists of a dialogue constructed around the following questions: Is psychotherapy truly the prostitution of friendship and love? That is, is there not a more than superficial similarity between the psychotherapist’s selling of love, and the prostitute’s selling of ‘love’/sex? If there is something problematic about the latter, then oughtn’t we to be equally disturbed about participating in the former?
One of us (R) is a philosopher (and an amateur co-counsellor). The other of us (E) is a practitioner of and advanced trainee in Gestalt psychotherapy. Both of us have been /are the ‘recipients’ of Gestalt therapy.
This dialogue speaks from and to the way we have faced these questions, these dilemmas, not only intellectually but also in the concretion of our actual lives, our experience.
Introduction: Money for love?
R: The question I would like us to debate is:
Under what circumstances can it be right to take money for the provision of love, in the form of psychotherapy?
Or to put this ‘awkward’ question even more bluntly:
Are those who take money for love prostituting themselves, and thereby doing something which is contrary to their/our deepest potential for humanity and authenticity?
These questions could in turn be seen as part of a more wide-ranging investigation of what therapists’ role in society should be. Are therapists -- should therapists be -- ‘neutral’ quasi-physicians with a professional expertise? Or tacit political activists? Or paid friends?
I submit that the forms of therapy which any right-thinking person would take to be ‘valid’ do not really have at their core a theoretical body of knowledge. They are deliberately informal and non-systematic. Like a friend (we might think of friendship as a kind of expertise, a kind of skill, only a very informal, non-systematic kind) or a lover, a real psychotherapist will work on the basis of their own and the other’s experience. It is true that, like loving, therapy is something which can be done well or badly -- but it would be absurd to say that ‘lovers’ can be ranked according to their possession or otherwise of a body of expert knowledge. Consulting a good therapist or counsellor is not like consulting (say) a computer technician -- when one pays for the expertise and theoretical know-how which the technician has and which one does not oneself have. It only looks that way in highly-theorized and arguably over-complex and authoritarian forms -- such as most (all?) versions of Psychoanalysis. If one looks rather, at Gestalt, with its emphasis, in part inherited from Phenomenology and Existential Philosophy, on the here and now, and on the therapist being truly present as a person in the ‘dialogue’ of a therapy session, rather than at (say) Kleinian Psychoanalysis (which to me is a paradigm of over-interpretation and over-therorization), then one doesn’t find an activity remotely resembling that of being a computer technician, or even a doctor. Rather, one finds an activity which is centred in attention toward another; in really being present with them as one talks with them; in loving.
I think that the psychotherapist is placed in an unavoidable dilemma or paradox: the more human-centred and non-intellectualistic their therapy is, the better -- but, at the same time, the less tenable and comfortable it is for them to ask to be paid.
I think we need to ask directly what one is being paid for, if one offers one’s services as a psychotherapist. If it turns out that one is being paid in order to be a friend, or a ‘lover’, then we need to ask: Is it right to be paid for that?
E: I think you are right to talk about the importance of the compassion, intuition and heartfelt presence of the Gestalt therapist. But these qualities are informed and guided by a theoretical body of knowledge. And it is for the artistic and scientific weaving of this knowledge with humanity that a client pays. Psychotherapists are not, therefore, being paid solely for love.
Before we go on to look in detail at why therapists are paid, however, I want to note that your approach is partly about what’s right, about how things (society, people) should be. That’s interesting, because we therapists do not often deal with such issues directly. People don’t contact a therapist because they want society to be different. (But a truly field-theoretical approach may demand some aware views about society.) So your approach does I believe remind us of something potentially radical and useful, something we should not lose sight of.
There are two sides to the coin: How society should be, and how we have adjusted (often at our cost) to how it is. Which of these should the therapist concern themselves with?
R: I am going to try to emphasize that it’s one coin: that its ‘two sides’ have to be integrated. I am going to argue that how society should be is: less dependent upon money changing hands. Why should it be that the socio-ethical role of ‘psychological healer’ is one that is hierarchically segmented and that some people pay others for?
Why are therapists paid?
E: There are some simple short answers to this question.
Firstly, the ‘psychotherapeutic healer’ is paid for their availability to the client. That is, for being open, tolerant, patient, caring, forgiving etc. . Also, for being authentic in all this, and for bringing that authentic response into the dialogue.
R: But can you be authentic toward someone, while stopping yourself from responding as you really would want to, if you let yourself? I mean: say you felt like just telling the client to go away?
E: You are being authentic within a role. Actually, all authenticity and spontaneity is surely best seen as framed within some constraints. When we choose to say something, we are constantly also choosing to ‘stop ourselves’ saying something else. This doesn’t make us inauthentic.
So: all this is part of the artistry, the deliberateness, of working as a therapist. The deliberate engagement with a client is not or at least not primarily one of ‘love and friendship’, but it can still be regarded as a relationship, and (at best) an authentic one.
R: As yet, I am unconvinced that authenticity is possible in the specific circumstance of a professional therapist or counsellor facing a client. My doubts can perhaps be illuminated by my introducing the following quotation, from Jeffrey Masson:
“We do not care what kind of a person a plumber is. Nor does a plumber have to claim that he is there because he loves plumbing and is dying to help. It is just a way to make a living.
Therapy is different than any other profession in this regard. Therapy is not just a way to make a living. Anyone who said, honestly, that this was the reason he wanted to be a therapist would never be accepted for training at any institute, even though this is the motivation for many therapists, or it soon becomes the motivation. Clients have to be kept in the dark about this ...[This] is an impasse, and I see no way out...” 
E: Masson applies his objections wholesale across all therapy and counselling, whereas surely we need to be specific about what is of value or otherwise in different approaches. I think that Masson raises serious issues, which therapists must address; but I can think that Gestaltists, at least, can successfully address most of them. Partly because we link psychological growth directly with ‘spiritual’ growth, and with what you are calling ‘love’. I think it is important for a therapist to be loving: it is the unteachable and fundamental quality to which people are attracted if they want to heal themselves in the presence of another. But it is not (only) the loving which they are paying for -- it is rather, as I alluded to at the beginning, one or another specific form of theoretically-informed intervention. This theoretically-informed expertise is a second -- and crucial -- reason for payment being appropriate.
You said earlier, R, that there is not even a remote resemblance between a computer technician (or a plumber!) and a therapist. I disagree; I say that we synthesize an I-Thou approach with an I-It application of the theoretical principles of a given therapy. ‘I-Thou’ does not have to contradict ‘I-It’.
R: I suppose I can see how it might be useful sometimes to treat a client as an ‘It’: to observe them, and say, “I notice that you always put your hand over your mouth, when you try to speak about x”, or whatever it may be. I suppose some of this, and some knowledge about the importance of breathing, posture, etc., is in a way teachable. I am not sure that it would be well-described as the application of a theory, though, if the word ‘theory’ is to mean anything like what it means to scientists or engineers. It sounds to me more like the deepening of a capacity for caring and sophisiticated interaction with others. When one ‘observes’ another in a loving and deeply-interested way, one does not I think treat them as an ‘It’, and does not look upon what they are doing as a symptom of a problem.
If you call what you do the application of a theory, then you run the risk of falling into a formulaic ‘interpretivism’ (like in some Psychoanalysis) or, worse, a formulaic ‘explanationism’ (like in much Bio-Psychiatry).
E: I think that a Gestalt psychotherapist need not explain positivistically, nor over-interpret, but can still be well-described as applying her knowledge to a given situation. In addition, one gains expertise, as one becomes a more experienced therapist, in keeping an overall view of the shape of therapy, and thus of when, for instance, to make such-and-such a kind of strategic intervention, and when not.
R: I think that being intelligent about the shape of a process of mutual supportive interaction is something which good therapists can just do -- just in very much the same way that good friends (and lovers) can do it. I think that the way that (good) therapists talk and relate is through and through ordinary and commonplace  (I intend this as no insult!). If you say any different you may, incidentally, have to face an uncomfortable question: Should Psychoanalysts (e.g.) be paid more than Gestaltists, for example, because they have a more complex theoretical framework? The psychoanalysts seem to think so! But I very much doubt it -- I think that most Theory-centred therapy is worth much LESS than therapy which is really based in love, attention and equality.
E: I quite agree that many people, lay and professional, have good ‘meta-awareness’ of process (though many don’t). And the assumption that complexity (verbal, intellectual, interpretational) is more valuable than simplicity is based on a whole world-view which I am out of sympathy with. People resolve their personal problems, in the main, not because complex theories or texts are applied to them, but because of a loving atmosphere, because of a respectful I-Thou stance from another, because of simple things like feeling heard and seen in one’s dark moments.
R: That is just what I have been saying.
E: Well, I admit that you are (at least partly) right. In Gestalt, we talk about love and dialogue, we practice presence and inclusion: the relationship per se is the primary arena for healing. You could therefore say that we are primarily (like prostitutes) selling a relationship. And you could say that if it is love that we are selling, then that involves us in an even more tangled and perilous enterprise than that of prostitutes, who only claim to be selling something ‘clinical’!
R: The therapist doesn’t -- mustn’t -- literally kiss their client, but I for one find the ‘metaphorical kiss’ which the therapist gives their client in return for ‘love-money’ perhaps more repulsive than the paid attentions -- the literal sex -- that a prostitute gives their client (such attentions, notoriously, do not normally involve literal kisses, either).
E: I don’t agree with your way of putting it; but I do agree that the situation of Gestalt is especially uncomfortable. In conventional psychology and/or in dynamic psychotherapy, which foreground scientific explanation, or at best interpretation, and even when working with feelings in the encounter call them ‘transference’ and ‘counter-transference’, practitioners are not claiming to be ‘loving’ or ‘authentic’ and then selling that love. But that is what Gestaltists do. So you could say that we are doing something potentially worse than what prostitutes (or conventional psychology and psychiatry) do.
In stepping out of the old expert-patient dyad, we do seem to be in hot water if we sell what we want to call an existential encounter. Still, the fact somehow remains: most people I know who have experienced this healing say it is worth paying for.
R: Just as the fact remains that people often collude with their own oppression. (Perhaps that’s too harsh a word; perhaps not.)
I am worried about the commodification of something which it would be better not to commodify. What is most important is love, empathy etc. ... and these are not -- should not be -- commodities. To commodify these things is, ceteris paribus, to facilitate continued tutelage and oppressive social relations.
E: It would be difficult to dispute that love and empathy are best not commodified. But I do not agree with your implication that therapists keep clients in tutelage. This takes me naturally to a third aspect of what one is being paid for, as a therapist or counsellor: the focus being primarily on the client. The roles in a therapeutic relationship are somewhat ‘assymetrical’ -- it’s not like two well-adjusted lovers in private life. We do not maintain a rigid expert-patient hierarchy in Gestalt -- but there is nevertheless a deliberate assymetry to the encounter between therapist and client, an asymetry intended to be for the client’s benefit.
R: Yes, but to use that as your premise just begs the question against what I have been saying. Co-counselling, for instance, questions this assymetry that we find across the shop from Psychoanalysis to Gestalt or Philosophical Counselling. It asks whether you can really have a dialogue -- two people really listening to each other, and present to each other -- if that degree of asymmetry is built into the situation. Whereas, if there is symmetry after all -- and this point applies especially to Gestalt, which of course does not hold that the focus should be exclusively on the client, for it holds that the therapist must endeavour to be truly present in the encounter -- then why is money changing hands?
E: Co-counselling doesn’t wipe out the asymmetry -- it just allows the asymmetric roles to alternate.
Anyhow, It’s not quite as you say in Gestalt: Neither ‘the client’ nor ‘the therapist’ are separate entites, but rather they are inter-linked phenomena co-created by the two people in the room. Obviously, this view implies a reassessment of the nature of the ‘asymmetry’ you are speaking of.
Whereas you seem to be rigidly equating payment, correlated to titles or ‘roles’, with asymmetry. (And a similarly simplistic version of ‘(a)symmetry’ seems to be in play in co-counselling, at least as you describe it.)
This leads me to think that there is something dividing us which is more fundamental than the particular issue which we are debating. Before we go any further into the specifics, I want to try highlight this deeper general division -- by means of saying something about the form and content of what you are doing here, in our dialogue.
Different models of thinking: Philosophical versus psychotherapeutic?
It seems to me that you bring a particular type of thinking to this discussion which is fundamentally different from the ‘field’ thinking which informs Gestalt. It seems to me as if the implications of your model of thinking are that of the “prevailing public ideology” of positivistic science which insists that “only proceedures scoured of possible bias, properly regulated and scrutinised are ethically and intellectually sound.”  This pervasive, highly rationalistic approach is one which even the natural sciences are now questioning as a wholly valid paradigm. Field-theoretical ideas propose a fundamentally different approach to how we apprehend or understand the connections between phenomena, between things (in this case, money and ‘love’). To classic Western thinking, Gestalt’s is an approach that could seem irrational and unconvincing. E.g. The very notion of ‘understanding’ is understood by mainstream Western thinking in a thoroughgoingly logical and ‘objectivistic’ manner -- unlike in Gestalt.
R: I would want to question your picture of ‘field’ thinking, or at least question whether in reality it has any foundation in or any very close relation to the bits of modern physics which metaphorically it draws upon. Let me quote from Lolita Sapriel, writing in this Journal, to instantiate an example of what I am worried about: “Field theory is a part of the paradigm shift that has occured in physics, medicine, psychotherapy, infant research, quantum mechanics, and psychoanalysis... . This paradigm shift represents a move away from a belief in a mechanistic, observable objective reality, to one where the meaning of reality is understood as co-created and co-constructed. In this paradigm, the concept of the observer affecting the observed is understood and accepted.” 
I think that physics, including quantum mechanics, is being completely misrepresented in this quote. Sure, we can all probably agree that the meaning of reality is rightly understood as ‘co-constructed’ by us and reality. After all, ‘meaning’ is through and through human -- reality would have no meaning in a universe devoid of intelligent life. But from that, it does not follow that reality itself is not objective, not observable. Ask a physicist: I’m sure they will have no trouble agreeing with Sapriel at least in general terms on ‘the meaning of reality’, but it is a non sequitur, which physicists would reject, to slide from saying that to saying that we co-construct reality itself. As for the observer affecting the observed: of course, but that doesn’t mean that there wasn’t something absolutely independent of us to be observed (and affected) in the first place.
E: Those are challenging ideas; I am not in a position to reply to them. Hopefully, the people you have referred to will do so.
But what I want to say about Gestalt is nevertheless something directly related to what they have said: that the approach to ‘understanding’ which a field-theoretical Gestaltism takes is one which sees ‘individual phenomena’ as arising from a bigger picture than one or two ‘causes’. In this ‘paradigm’, explanation or understanding leans away from the logical or rational towards the poetic or transcendent. Ultimately, what I (and others) am (are) putting forward is a species of understanding which defies or undermines language-based questioning. This subversion of the limitations of language-based seeking is seen most clearly in the dialogues of the Zen monks and teachers. For example:
Question: “Why am I here?”
Answer: “Pass the salt.”
A dialogue in this vein would more accurately reflect the fundamental thinking behind field-theory in Gestalt than our current ‘question and answer’ style does. However, given the weight of academic tradition and Newtonian thinking, it probably wouldn’t be published (or truly understood!).
So; I am engaging with you in this way because it is a linguistic communicative convention. But in fact, I believe the relations between things are too complex and too simple to be genuinely explicated through language at all, and perhaps especially when used in this way.
R: Your suggestions in turn are interesting and challenging. I am not certain, however, that your appeal ‘beyond’ language is compatible with your emphasis on the theoretical knowledge, asymetrically-possessed professional expertise etc. which supposedly licenses asymetrical financial arrangements. To my knowledge, the great Zen masters, much like Socrates, and Jesus, have not sought to be paid by the hour. I think that your approach, for all its appeal to wordless poetry etc., retains within it some of the very kinds of thinking (mechanistic, economistic, inauthentic, theoreticistic, scientistic) which you want to transcend. My way of thinking is of course philosophical, political, ‘intellectual’. But to my way of thinking, Gestalt has already made too many concessions, more than I would make, to the very ‘Positivistic’ ideas which it wishes to oppose.
Asymmetry, hierarchy and mutuality
I am asking, in a nutshell, whether ‘mutuality’ -- and the kind of I-Thou meeting which I think you rightly believe is so vital to the success of Gestalt therapy -- is possible at all given the assymetry introduced by money.
E: What is it about money that is so damaging (for you) to an encounter?
R: As Marx argued, money is not a transparent, neutral tool, but a massive force in shaping and re-shaping society. Money transforms social relations, and often distorts them. Those areas of our lives that are free of money, that do not fundamentally ‘resolve’ relations between persons into that of buyer and seller (a relation often extremely asymetrical in character, especially if capital is unevenly distributed), are I think precious.
E: You may be right in many cases, but I am not sure that what you call ‘distortion’ occurs as often as you think it does. So far as money in psychotherapy is concerned, my own honest experience is that, when the therapist is more of an ‘It’ to the client -- normally in the early stages of a therapeutic relationship -- it still seems meaningful to pay. When therapist and client start to truly meet as ‘Thou’s to one another, paying seems stranger and perhaps quite out of place. But that moment in any case is or should be the end of therapy. Successful therapy spells its own end.
R: But why not start at the point at which you are saying we should end? I mean: why not start with mutuality. Don’t you prejudice the possibility of being on an even footing, when you straightways demand money in return for your ‘expertise’, when you set up the situation as a hierarchical and inegalitarian one?
E: But notice -- and this still seems to me to reflect our different ways of thinking -- that when I say the word ‘mutuality’, I am not just talking about something situational. ‘Mutuality’ in the Buberian sense refers to a highly-sophisticated -- and deeply simple -- way of being in which one is powerfully present (not living out too many unhealed past situations) and receptive to others.
R: To me, the word ‘mutuality’ connotes something attainable between ordinary persons without any complicated theories or training. Shouldn’t therapy be about exploding or combatting the illusion that the client is an incompetent human being, rather than ‘temporarily’ entrenching that illusion in order (allegedly) to eventually overcome it? Shouldn’t Gestaltists be in the business of trying to get their clients to give up the illusion that ownership of a body of psychotherapeutic theory will set them free? And wouldn’t that entail placing the relationship on a truly egalitarian footing? But wouldn’t that entail no money changing hands?
E: You are wanting to ‘combat’ an ‘illusion’ that is a manifestation of a task central to much of the work we need to do, namely, growing out of illusions we create around power, money, success, etc. . But the changes you are suggesting -- for example the changes that have been made by co-counselling -- remain pretty much cosmetic and would not actually resolve a client’s deep-seated tendency to feel shamed or inadequate. (Furthermore, again, some people actually do have greater power, knowledge or ‘success’-- it’s not always necessarily an ‘illusion’!)
R: It may be partly a question of one’s fundamental ‘political’ values. Co-counsellors believe in democratizing counselling/therapy -- in transcending the cult of expertise, and ending the practice of payment. Or think even of Sandor Ferenczi, the great psychoanalyst who was repudiated by Freud and co. because toward the end of his life he split time between his ‘patient’ being on the couch and him being on the couch being analysed by his ‘patient’. (The question may be one of whether one ultimately has faith in other people or not. If not, then one might as well give in to totalitarianism and authoritarianism quite generally. )
E: Well, Gestalt group therapy, especially when there are ‘experienced clients’ (and even practicing therapists) in the group, becomes very much like I would imagine Ferenczi’s ‘mutual therapy’ to have been like. And personally, I will admit that I have found it strange to be in such groups and for everyone to be paying one person who in fact may seem to play sometimes a significantly lesser part than others in the group!
R: Then can you deny that the experience or practice of mutuality is something which is (adversely) affected by roles, titles, and so on? Isn’t there just something self-contradictory about the role of ‘profesional psychotherapist’ -- someone who is the client’s ‘equal’ but yet very different (‘Separate but equal’, and ‘Equal but different’ have of course historically been slogans of racism and sexism respectively)... Is this not, literally, an impossible profession?
E: I think you could reasonably claim that the exchange of money encourages the kind of projections that most clients make; so perhaps therapists are engaged in a contradictory mode of relation to clients at least in this sense. Namely, that they say they approach them as equals but also ask for money knowing that, broadly speaking, people associate money and its exchange with expertise. And people can feel shamed by feeling themselves to be the object of that ‘expertise’. Perhaps this obliges a therapist to take this projection and association into account. I’m not sure that the action to be taken is to stop charging, though.
Thematizing the exchange of money
R: Do you have in mind that the better thing to do would be to go on exchanging money, but to thematize it as an issue?
E: Perhaps, and maybe to be continually aware of it as a reality -- one of many. For example, gender differences may be more figural for a particular client -- or even issues around height, or nose size. A therapist with a very big nose could claim that most people are unaware of issues around nose size. Would you suggest that she (and all other therapists) always thematize nose size regardless of the client’s feelings about it?!
R: That’s a neat point... I guess I would argue that the difference in the case of money is that the therapist is choosing to charge, and therefore that, while facts about gender or height or even nose size remain more or less constant and unavoidable, the exchange of money is an action, which has real socio-economic consequences, and yet which is I think rarely made figural, at least voluntarily by the therapist.
In thinking of what it would be to thematize payment in therapy, to make it figural, I’m reminded of a story I heard about Jacques Lacan; apparently, in the end he didn’t give his analysands psychoanalysis at all -- he simply charged them. In a bizarre kind of way, that may have had exactly the result we’ve been talking of: the analysand, the client, having to sort out (for themselves) these issues of power, projection, expertise and so on!
But perhaps any responsible and ethical form of therapy or counselling in which money is changing hands should start with the issue of that exchange. In Gestalt, one talks of and does ‘empty chair work’. Maybe ‘empty wallet work’ should always come first!
E: An interesting idea indeed. But still I think money is just one issue, one fact, among many salient to (and potentially problematic in) the therapeutic encounter. We need must not lose sight of the reasons why people seek any form of psychotherapuetic help in the first place. They don’t come to a therapist just so they can talk to them about the issues that arise in paying for therapy! People seek help because they feel lost or unloved or damaged, or they wish to grow, or something like that. And in any case, the actual exchange of money is not the fundamental issue even around money; the more fundamental issues are ones of power and projection, which cash-in-hand may mostly just symbolize. Perhaps we could say that the paying of money is useful and even essential for highlighting and representing issues of power and authenticity and trust between therapist and client; but those issues are themselves the real issue -- or in turn ‘representations/symbols’ of the real issue! -- in most therapy.
Prostitutes, therapists, and objectification
R: We still need to confront head-on the question of whether there can and should be payment at all. Let me press you with my worry that paying for therapy and counselling commodifies love, and with the direct analogy to prostitution.
I think that love, for instance intimate serious physical sexuality, cannot involve a mutual meeting, and ‘equal respect’ if it is paid for. I propose that therapy is to genuine loving friendship as prostitution is to erotic love. (The seller is selling herself or some simulacrum of herself; the client is being cheated if this fact is in any way played down or veiled.)
In fact, one could go even further in likening psychotherapy to prostitution. For prostitutes have frequently -- traditionally -- claimed to ‘be’ therapists, in the sense of listening to clients’  troubles, offering advice, etc. . Indeed, the sociologist Everett C. Hughes  launched his influential ‘perspective via incongruity’ approach by suggesting that sociologists should understand doctors’ and therapists’ counselling activities by means of looking at advice-giving in other contexts -- and he specifically instantiated the ‘counselling/therapy services’ given by prostitutes!  Hughes thought that we could learn a lot about therapists’ and physicians’ work by looking at the surprisingly similar occupational role of ... ‘prostitute’... What you have in prostitution is sex, love, friendship, support, for sale. Subtract the sex, and then what is the difference from psychotherapy?
E: Your analogy with prostitution -- or ‘sex-work‘ -- is shocking and interesting, but we need to deconstruct that shock. In prostitution, I am not sure that the exchange of money is the fundamental problem. The fundamental problem, I suspect, is the possibility of two-way damage between two people being solely ‘objects’ for one another, compounded by the secrecy, shame (and illegalities) for both parties. Taking away those contingent factors, perhaps we all ‘prostitute’ ourselves when we go to work or ask nicely for a favour or even do favours knowing it will further a friendship, etc. . ‘Prostitution’ is then a form of exchange like many others. Perhaps we all participate in such exchanges much of the time.
R: Powerfully put. What might be interesting would be to investigate in a serious fashion the feelings of prostitutes and their clients, and therapists and their clients, about what they do. I wouldn’t be surprised if there were many striking similarities. I think that this is quite a taboo -- I think that, if one really managed to get therapists and prostitutes (and their clients) to be honest, they would often express extreme reservations about the commercialisation of personal relationships with which they are intimately involved.
E: That piece of research would certainly give an intriguing different meaning to the notion of a dialogue between psychotherapy and prostitution...
R: To return to the question: can it be right for therapists to take money for their services? The way a prostitute does, for the provision of her/his ‘personal services’...? I’m not at all sure that it can be, even if the ‘contingent’ factors you describe above were altered: I think that the commercialisation -- the ‘commodification’ -- of love has to be resisted, in therapy; whereas it’s not nearly as problematic to commodify computer-repair or plumbing.
E: In our discussions, you seem to equate payment with inelectable inauthenticity, ‘asymmetry’, and inequality. Why? I suppose it is because -- to be specific -- therapists who sell an existential meeting are thereby making something into a commodity which cannot be so without its destruction. And this sounds very plausible! But what I’m saying is that in all relationships there is some degree of objectification (and thus, literally or metaphorically, commodification) of the other. No relationship takes place purely with a ‘Thou’.
But let’s add to this a note of
practical realism. There is -- or should be -- reciprocity, and real dialogue,
between a therapist and a client. The money just doesn’t usually destroy this,
I think, the way it perhaps does in prostitution. Most therapists etc. probably have genuine
feeling for their clients, and most sex-workers probably don’t. But if it
doesn’t turn out to be that way around, then perhaps the therapist’s activity is morally the more dubious!
The politics of therapy: some questions
R: This admission seems to me to make still more salient the worries which I raised earlier around Gestalt’s ‘paternalism’.
E: You are referring I take it to the ‘authoritarianism’ purportedly involved in the asymmetry of the therapeutic dyad; but I would counter by saying that there’s an inherent risk of an undesirable paternalism in your position. For you are perhaps paternalistically asserting that clients who consensually pay for therapy should be discouraged from so doing.
This issue of paternalism reminds us that therapy exists in a socio-political context, where, for example, the therapist may (should) have thought more about and have more developed ideas about, for example, paying for therapy. The question is, then, what should Gestaltists do with those ideas when sitting with a client?
The broader questions here are: Is it -- must it be -- within the endeavour of even field theoretical thinking to explore political issues, or just to ‘be aware’ of them? And what exactly is the difference between these? If we start to explore them, should we try to be politically neutral? If this is not possible, how do we deal with quasi-parental ‘transference’ that occurs and that may lead to introjection or rejection of our ideas? Is your intriguing challenge to therapists in this dialogue one they (we) must do something about? Individually? Collectively? Through reflection or group action?
R: I believe that it is beneficial and liberating for people to realize that many of their problems come from unjust political arrangements. Therapy stays ‘politically neutral’ at the risk of harming clients who are ‘encouraged’ to see their problems as personal or interpersonal but not, as those problems surely sometimes are, as bluntly economic/political. Some psychotherapeutic approaches (again, co-counselling is one) explicitly recognize and act on this thought. Whereas Gestalt risks trying to stay ‘neutral’ here, -- surprisingly, in a way, for, as you have agreed, E, you Gestaltists of all people should not and cannot ignore that any therapeutic encounter happens in a social and political ‘field’!
As for my ‘paternalism’; I admit that the things I am saying may be dangerous. But I think that the commercialised therapeutic culture of modern times, while perhaps inevitable, is itself much less than ideal -- i.e. ‘dangerous’. The key question for me, then, is: What should we do about this (if anything)? Is there any way in which one could effectively decommercialise psychotherapy?
Conclusion: a radical psychotherapy?
E: I want to ask: What is the nature of the distinction between a ‘politicised’ approach and an ‘existential’ approach to therapy? And perhaps I should first ask: Is there -- can there really be -- such a distinction? These questions arise powerfully, as we have seen, when comparing therapy to prostitution.
R: I am willing to concede that this rather unsatisfactory situation that we are presently in -- wherein people are often actually performing a valuable service by prostituting their hearts and souls (or their bodies), where ‘love’ in one sense or another of that word (perhaps a rather corrupt sense) is -- apparently, paradoxically -- being paid for, where this is actually sometimes a good thing -- I’m willing to say that this rather unsatisfactory situation is perhaps as good as it gets for now, and that, while working on changing it, we must fully acknowledge it, as I think you for one are ready to do. A radical -- ‘politicised’ -- approach to the ‘domain’ of the ‘existential’ and of ‘authenticity’ will fully face the realities and hazards of the practice of psychotherapy, in its socio-political ‘field’. It will face fully, e.g., the much-less-than-ideal fact of payment for ‘love’. I feel that you and I are now able to agree on this point.
E: I think so; but we still fundamentally disagree over the notion of ‘exchange’. I think you chronically underestimate the extent to which all of life, of truly human life, is a continually interleaved sequence of exchanges. Money is often simply the mode -- the imperfect mode, admittedly -- through which many of these valuable exchanges are made. You are wrong, I think, to think that there is something especially ‘tainted’ about money.
As for your latest allusion to prostitution: let’s re-focus on the real problem with it, which is not taught embarassment about the body or sex, or even payment, but out-of-control objectification. Objectification is indeed something that is a common experience for both a prostitute and a therapist. When a client sees or treats you as his lover or mother, or as some God-like fount of knowledge, when ‘in fact’ you are just another adult, he is objectifying you. Yes, sex-work and therapy have this in common. But a prostitute depends on being objectified, whereas a therapist works towards its dissolution.
R: I hope so.
But the dissolution of the needs for love etc. that people feel, and that they pay to satisfy, may ultimately depend, I’ve suggested, upon a real societal transformation. Now if that’s true, is it any longer possible for (say) Gestalt therapists to behave as if they have no responsibility for the state of our civilization, no political assumptions or role?
E: You are highlighting the much wider (and often neglected) aspects of the field -- and the institution of money is just one such aspect -- in which Gestalt Therapy exists. This is valuable, even if difficult to handle. But perhaps it is a lot to ask for therapists to also be agents of actual political change, rather than ‘merely’ politically aware.
Gestaltism has created a (rather wonderful) ‘community’, a sub-culture with its own definite ways of interacting, thinking and apprehending experience. It provides to some extent a scheme -- even if one with the concept of spontaneity at its heart! -- of how to be-in-the-world. As such it must and does have moral and political aspects and implications. As clients become more experienced, they start to participate in our discourse. (I think Gestaltists do educate their -- our -- clients. It might be better if this were overt.) What is happening in that process? Is it not an existential and political re-orientation of the person? And if this is happening, is this not political change on a small scale?
R: It is. Though the way you have just put it sounds to me elitist (as if the only way that Gestalt can be usefully political is by getting clients to talk the Gestalt talk), not democratic. Perhaps more importantly, I want psychotherapists to do more to acknowledge their inevitable political assumptions and implications than you have just suggested.
E: How can we take practical account of these questions of progress toward a better world, questions of ‘commercialisation’ and ‘commodification’, of prostitution, which we have attempted to discuss in this dialogue? What would we find through further explicit acknowledgement and exploration of the social, moral and political sources and implications of the Gestalt ‘world-view’? These are real -- not just rhetorical -- questions. What could Gestalt writers, trainers and practitioners do to explicitly ground their existential work in a political context?
R: I would put it like this: if the subject-object dualism and the mind-body dualism and the self-other dualism are illusions, then so, assuredly, is the dualism between the individual and their political setting, or between psychotherapy and its placement in a moral and political context.
E: Very nicely-put. It seems that what you are asking now is whether psychotherapy and counselling can be other than reactionary if they are not explicitly ethically and politically radical?
R: Yes; co-counselling bites this bullet, and does not claim to be politically neutral. It looks toward a transformation of society -- as philosophers such as Kierkegaard, and Marx, and Wittgenstein -- in their different ways -- very definitely did. Of course, if Gestalt Therapy takes a similar risk, then you Gestaltists will risk losing any quasi-medical ‘respectability’ that you might have, and risk losing the kind of claim to a body of value-neutral expertise which is the primary basis to which people in our culture tend to appeal if they want, for example, to be paid.
If we were to go more into this question, we would need among other things to look harder at your promising thought that, if we understand the (you say) unproblematic sense in which we all continually exchange things with one another, and even ‘prostitute’ ourselves, then we need not understand paying for psychotherapy as inherently unprogressive. But the broader issue will remain a challenge: If you don’t explicitly connect the political and the existential, aren’t you stuck in the conservative fantasy that therapy is in the final analysis about ‘liberating’ yourself and ‘growing’ ... within a society that endlessly conspires against such liberations and growth?
E: I think this last question is indeed very challenging. It is easy (and necessary?) in existential and humanistic therapies to claim to simply be ‘accepting and unjudgmental’ of people’s ‘personal choices’. But this is a seriously problematic claim. As ‘Intersubjectivists’ and Gestaltists such as Sapriel have argued, there can’t be any such thing as ‘bracketing’ oneself out of any encounter. And, in a world that is shaped by all of our actions and inactions, how can there be any such thing as ‘political neutrality’ in an encounter between two people?
R: Part of our end-point of partial agreement -- for there is obviously much that we still disagree about -- seems to be this: that no form of Psychotherapy, let alone Gestalt, could hope to be ethically and intellectually respectable, if it failed to have an idea of what a better world would be like -- and of how to start to get there.
Coulter, J. (1975), “Perceptual accounts and interpretive assymetries”,Sociology 9, pp.385-396.
Coulter, J. (1978), The Social Construction of Mind (London: MacMillan).
Hughes, E.C. (1958), Men and their work (London: Free Press of Glencoe).
Marx, K. (1961), Capital (Moscow: Foregin Languages Publishing House).
Masson, J. (1999), “Still against therapy”, in Mindfield: The Therapy Issue (London: Camden Press, 1999).
Mulhall, S. (1998), “Species-being, teleology and individuality”, in Angelaki 3:1.
O’Neill, J. (1971), Sociology as a skin trade: Essays toward a reflexive sociology (London: Heinemann).
Posner, R. (1992), Sex and Reason (Cambridge, Mass.: Harvard).
Read, R. (2001), “Wittgenstein and Marx on philosophical language” (in Kitching and Pleasants (eds.), Wittgenstein and Marxism (London: Routledge).
Roberts, A. (1999), “The field talks back”, British Gestalt Journal 8:1, pp.35-46.
Sapriel, L. (1998), “Can Gestalt Therapy, Self-Psychology and Intersubjectivity Theory be integrated?”, British Gestalt Journal 7:1, pp.33-44.
Watson, R. (1994), “Some potentialities and pitfalls in the analysis of process and personal change in Counselling and Therapeutic Intervention” (in J.Siegfried (ed.), Professional and Everyday Discourse as Behaviour Change (Norwood, NJ: Ablex).
Wheway, J. (1997), “Dialogue and Intersubjectivity in the Therapeutic Relationship”, British Gestalt Journal 6:1, pp.16-28.
Wittgenstein, L. (1998 (posthumous)), Culture and Value (revised ed.; Oxford: Blackwell).
 We have explored some of the same issues in a strictly philosophical vein in a longer, earlier piece forthcoming in Philosophy in the Contemporary World. Our thanks to Malcolm Parlett, Mark Peacock, and (especially) Rod Watson for their help and encouragement on and with the present piece.
 R: There are no professional co-counsellors; ‘co-counselling’ is by definition non-professionalized and does not involve the taking of money for the provision of counselling services. Instead, the two (or more) co-counsellors take turns counselling one another. (A somewhat analogous phenomenon in the area of spirituality is Quakerism: Unlike virtually all Christian sects, Quakers have (and therefore pay) no official / professional ministers; everyone is free to minister, and people ‘take turns’ to do so.)
 Masson (1999), p.50.
 R: There is sociological evidence for this proposition. See for instance Watson (1994). See also Coulter’s (1975) and (1978), which argue the case that the categories and actual methods of psychotherapy and psychiatry are produced by means of (at best) a utilisation of and (at worst) a reification of quite ordinary conversational and interactional abilities and practices.
 Quote from p.20 of Wheway (1997).
 P.34, Sapriel (1998).
 R: Wheway (1997, p.20) makes a similarly dubious move when he invokes Heisenberg, who purportedly showed “universal scope and certainty” to be “chimerical” goals of science. But Heisenberg’s “Uncertainty Principle” is understood by hardly anyone who invokes it. (This Principle still allows one to be perfectly certain about the location or velocity etc. of whatever physical item it is that one is trying to measure: it only states that one cannot know all of these facts at the same time.)
It is I think this kind of misreading of modern physics, as purportedly making it ‘impossible’ to get precisely in touch with ‘objective reality’, or alternatively as casting reality as a product of human intervention/imagination, which leads Sapriel (1998, p.37) to claim that we must abandon the “fallacy of neutrality”, and ‘admit’ that “No therapist can ‘view objectively’ what is going on within the patient”. This phrasing makes it sounds like there is something here which we cannot do. But Sapriel -- like Stolorow, and unlike Heisenberg and co. -- never says what it is that we cannot do. What would count as ‘viewing objectively’ what goes on within the patient? Until we are offered an intelligible answer to that question, it will not do for us to be told in a blanket fashion that it is ‘impossible’ for us to do this.
 See for instance Marx (1961), and Mulhall (1998) p.89f. .
 R: Cf. the fear of equality or democracy manifested for example on both sides of the exchange of letters between Coward and Sapriel (BGJ (1998), pp.128-131). Sapriel quotes Stolorow: “The parity we ascribe to the worlds of patient and analyst at the level of abstract conceptualisation of the therapeutic dyad becomes, however, misinterpreted [by some] as implying symmetry in that relationship at the level of concrete clinical practice.” In other words: the truth about this asymmetry is that the ‘parity’ or ‘equality’ between therapist and client is merely abstract. Stolorow continues; “[T]he authority ordinarily assumed by the analyst collapses [[is this supposed to be obviously a bad thing??]], as the patient is thought to acquire a voice equal to that of the analyst in setting the conditions of the treatment ... the ultimate extreme of this overly concrete misinterpretation of intersubjectivity theory is the loss of the very distinction between patient and analyst... what is left to tell us which of the two is the patient?” This final question, which to Stolorow (and Sapriel) is the reductio ad absurdum of ‘symmetrizing’ therapist and client could be read exactly the other way around: as its central virtue and triumph. (Incidentally, the serious risk which Gestalt runs if it draws more or less directly from psychoanalytic -- authoritarian -- thinking, is here clearly evident.)
 Note the word ‘client’, the very same ‘high-powered’/empowering word as used in psychotherapy -- prostitutes generally prefer the term ‘client’ to the lower-level term ‘customer’.
 In fact, sociology offers rich and varied resources for a deepened understanding of the natures of prostitution and psychotherapy. For another view, consider for instance the following quotation, from p.6 of O’Neill’s (1972) essay, “Sociology as a skin trade”: “A special aura attaches to working with people. The work of the priest, judge, doctor and missonary is regarded as holy. The work of the prostitute, the pickpocket and the undertaker is considered profane. In reality, these trades are all involved in dirty work with people. Alternatively, with the exception of the pickpocket, all of these trades may be regarded as holy occupations because of the sublimity of their purpose, to restore and make whole the person.”
 Cf. also Hughes’s “Psychology: Science and/or Profession”, in his Men (sic.) and their work (1958).
(It is worth mentioning here the controversial work of Richard Posner, on Sex and Reason (1992). Posner’s economistic ‘rational choice’ model of prostitution includes among its consequences a significant diminution of the difference between prostitution and marriage (see p.131f.). Posner appears to believe that sex (and love) are commodified as much in one as in the other. Only his conclusion from this is that this is what rational people ought to believe and that they ought to behave accordingly, not that such commodification ought to be resisted.)
 E: Add to this that most therapists want to be therapists, whereas most prostitutes probably don’t want to be prostitutes.
 R: Even as it questions, if rather unclearly (see note 7, above), whether it means anything to speak of scientific-ish neutrality in the therapist-client relationship!
 See for instance pp.33-44 of her (1998).