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Psychoanalytic thinking has always been at odds with societal norms. In this guest article, Lorrie Goldin, LCSW, critiques our culture’s predilection for positive thinking and explores the question of what it means to offer depth therapy against such a backdrop.

False Positive

A nasty virus flattened me recently. Awash with green tea and self-pity, I curled up with Barbara Ehrenreich’s latest book, Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America. As a psychodynamic therapist who often feels alienated from the prevailing smiley-face craze, I was glad to find someone who shares my alarm about our current cultural obsession with positivism. Bright-Sided offers a tonic for these hollow, manic times.

Ehrenreich was inspired to write Bright-Sided after her experience with breast cancer. Barraged with pink ribbons, support groups that banished terminal patients, and advice to adjust her attitude when she expressed anger or fear, Ehrenreich came across the insidious pathology of positive thinking:

[What cancer] gave me, if you want to call this a gift‚ was a very personal, agonizing encounter with an ideological force in American culture ... one that encourages us to deny reality, submit cheerfully to misfortune, and blame only ourselves for our fate. (Ehrenreich, 2009, p. 44)

The virulent aspects of positive thinking have metastasized far beyond the cancer wards in American society. Ehrenreich notes their destructive influence in the workplace, religion, psychology, mass culture, foreign policy, and the current economic and housing calamities. A terrible insecurity underlies the ascendancy of the false positive. Today’s climate of fear and uncertainty induces a collective reaction formation.

What does it mean to be a depth psychotherapist against this backdrop of positive thinking run amok? It often feels like open season on the type of treatment we have been trained to provide. The emphasis on medication, managed care, and evidence-based practice makes it easy to doubt oneself. Therapists and clients alike feel pressured to show quick results and are readily demoralized if they don’t. Sometimes I feel ashamed of seeing clients for years, worried that I’m dragging them down in analytic quicksand. My misgivings are amplified when suspicions abound of therapists fostering dependency, self-indulgence, and victimization to feel needed or to sustain a cash cow.

Occasionally we are guilty as charged. Even though such judgments usually reveal a simplistic misunderstanding of psychotherapy and human nature, skepticism compels scrupulous self-examination.

The psychological landscape is strewn with transference and countertransference pitfalls that ensnare us. For example:

Many clients have needed to sacrifice autonomous strivings to safeguard important attachments; unending therapy may recapitulate that dynamic.
We face our own professional developmental challenges, such as over-identifying with feelings of anger, exploitation, and helplessness during our years of unpaid training.
We may lack the courage to confront the cozy rut of a stale treatment that signifies burnout or complacency.
Exploring every analytic cul-de-sac may indeed pertain to the therapist’s economic and dependency needs.

Such possibilities must be explored. Grappling with legitimate criticism keeps us honest, challenges assumptions, enlivens with fresh perspectives, and clarifies the value of our work. Moreover, the field has benefited enormously from greater emphasis on wellness, strengths, and resiliency. I know that I have become a better therapist by incorporating the more heliotropic influences of CBT, DBT, and mindfulness. Such practices are helpful to many people, giving them a sense of self-worth, direction, perspective, and control.

These interventions are not, however, the exclusive domain of a new approach. Dynamically oriented therapists regularly use cognitive techniques, upward interpretation, positive reframing, fantasy, and the exploration of positive intent within maladaptive defenses. Viewing positive and depth psychology as antagonistic creates a false dichotomy.

The contemporary analytic purpose has always been to help clients achieve authenticity, self-acceptance, and meaning. Depth therapists shine a light on the dark, repressed places of the past and the unconscious. But, we also routinely engage clients in a process of tunneling – working simultaneously from the inside out and the outside in. For example, we may help a depressed client by devising practical small steps and by exploring childhood antecedents. Insight is insufficient without action; and, action is insufficient without insight. The precepts of positive psychology offer additional but not new wattage for illuminating the way out.

Why, then, has depth therapy been so maligned? Why are we so dominated by the quick-fix promise of the false positive?

America is a young, can-do society, uncomfortable with ambiguity. It is no wonder that action-oriented, simplistic measures imbued with magical thinking have emerged during the last decade in a counter-phobic response to anxiety about the global economy and terrorism.

It is useful to consider Melanie Klein’s notion of psychological development from the infantile paranoid-schizoid position to the depressive position. In the face of primitive anxieties, good and bad remain split, preserving both omnipotence and a fragile sense of goodness in the face of malevolence. Gradually, under adequate circumstances, we achieve the capacity for ambivalence, integrating good and bad, mourning the loss of the ideal, and tolerating disillusionment and uncertainty. The danger of being stuck in the paranoid-schizoid position is action without reflection. The danger of being stuck in the depressive position is reflection without action.

This fear of paralysis is the fear (and sometimes a warranted critique) of interminable analysis. But, must it catapult us into an “eternal sunshine of the spotless mind,” in which suffering and memory are so obliterated that the self evaporates into bright nothingness? Such radiance promotes magical thinking and the false self. Clients are endangered by believing they can short-circuit inner experience and external reality through mindset alone. They often blame themselves – or the therapist – when they can’t.

At an agency where I supervise, therapists implored, “Can we please just talk about The Secret?” Clients were mesmerized by the bestseller, which promulgates the “science” of attracting what you want through positive thinking and visualization. The Secret claims: “The power of love and gratitude will dissolve all negativity in our lives ... Without exception, every human being has the ability to transform any weakness or suffering into strength, power, perfect peace, health, and abundance.” (http://www.thesecret.tv/) Secret subscribers either wanted to quit therapy altogether or visualize their way to fulfillment without doing any internal or external work. Worse, they believed they had brought illness, childhood abuse, and other suffering upon themselves through the laws of attraction. Therapists were viewed as unwelcome naysayers, if they disagreed.

Such a facile approach has fortunately fallen into disfavor as we survey the wreckage from the last decade’s burst manic bubble. But, residual effects remain. Many clients now demand tools and an action plan to escape a pattern of suffering clearly rooted in unresolved and unconscious issues from the past. Yet, they don’t want to dwell on the negative, are suspicious of invitations to explore, and wonder why they don’t feel better right away. This is nothing new in therapy, of course, but it has gotten far more pronounced in a culture under the influence of the false positive.

Sanitizing emotion and experience traps people in blame, complacency, and inauthenticity:

A young woman arrives in my office in tears because of a failed romance. She feels even worse, because she cannot just will herself into acceptance and friendship, as her ex and their harmony-seeking community propose. What is wrong with her that she is so jealous and enraged and sad?
Another young woman is very adept at positive affirmations. They have kept her trapped in a romance that would be better off failing. Again and again, she blunts her hurt and anger into self-blame, acquiescence, and forgiveness.
A client banishes her grief and rage about a friend’s murder by believing that he must have willed it.

Society’s horror of deep pain causes shame and splits people off from themselves and others. It’s as if we expect people to be unaffected by suffering. Many clients are only too willing to comply by obscuring important dimensions of their authentic selves.

This is not to suggest that we renounce the false positive altogether. Life would be unbearable without illusion. Consider the 2007 film, Lars and the Real Girl, in which a reclusive man is healed when his doctor advises the entire town to go along with his delusion until he no longer needs it.

Depth therapists are no strangers to this paradox. We uphold fantasy by not stripping away defenses against overwhelming reality. We offer positive reframes that clients don’t quite believe, helping them escape the malevolent forces of depression, anxiety, and trauma. We are the guardians of hope when all seems lost. Like the wise doctor in Lars, we assess how much anxiety clients can handle, titrating reality and illusion in accordance with their needs.

It is crucial, however, to be honest about who is served by the false positive. When it benefits the client, as in Lars, illusion is life-saving. Contrast this with the new film, Up in the Air, in which corporations hire outsiders to fire employees. Unfeeling consultants dispense glossy brochures and upbeat platitudes to the devastated workers. In this context, positive thinking is the executioner’s hood.

Similarly, clients often correctly perceive attempts to focus on the positive as benefiting someone else at their expense. It can be difficult to work with clients who seem attached to their misery; therapists may impose a positive outlook to retaliate or relieve their own distress. But, we must remember that people often have been badly damaged. Suffering and identity cannot simply be overthrown by a fiat of will or false cheer.

Many clients come from families who are intolerant of their pain. The therapist’s emphasis on positive emotions may unwittingly recapitulate the client’s forced submission to the needs of oppressive or fragile parents. Seen from this perspective, negativity is akin to protest as a normal developmental advance. Clients fear that letting go of misery lets derelict people off the hook. Self-defeating as this may be, it is an attempt to uphold autonomy, identity, and truth. It’s not that clients want to feel angry and unhappy, but premature surrender is like a thin coat of whitewash that seals in the toxins and obstructs justice.

Clients have read the pop literature, too, though. They know the hazards of lingering in the muck. Shouldn’t they at least try to put on a happy face? Fake it ‘til they make it? If only it were that easy. These days, clients not only feel miserable but also guilty for making themselves sick, trapped by their inability to feel better.

Beleaguered clients and therapists might find relief in research contradicting the conventional wisdom. According to a recent study, people with poor self-esteem felt worse after repeating positive affirmations and better after they were allowed to express negative self-talk. The researchers concluded, “Repeating positive self-statements may benefit certain people, but backfire for the very people who need them the most.” (The Problem with Self-Help, 2009)

Must we force people to choose between positive and negative, hope and despair? Or, must we put them on a strict regimen of positive prescriptions, like kids ferried from one self-improvement activity to the next? Clients, like children, need woods and basement time to flourish – the unhurried, unstructured exploration of wild, hidden places where imagination and free play reign. Depth psychotherapy offers leisurely, unscripted space to explore the many facets of the interior landscape. Free to roam, clients discover all aspects of self, integrating the splits that keep them from being whole.

The Picture of Dorian Gray by Oscar Wilde portrays a man who is literally cut off from himself. He leads a dissolute life with no apparent physical or psychic taint. After his death, a forgotten portrait is found in the attic, depicting a horrifyingly disfigured Dorian Gray. All the split-off darkness – the repressed shame and id impulses, we might say – of his seemingly unblemished life mars the canvas. Anesthetizing experience with a kind of false-positive Botox may create an unscathed façade. Yet, we cannot keep whole parts of ourselves stashed away in the attic.

In 20 Weeks to Happiness, Richard Handler chronicles the pursuit of happiness from Thomas Jefferson to Martin Seligman, father of the current Positive Psychology movement. Handler describes his experience in a telecourse taught by Seligman. He benefits greatly from the lectures, discussions, exercises, and homework focused on positive prescriptions. Yet, a growing feeling of loneliness and shame gnaws at him week after week:

It sometimes felt that the strategies of Positive Psychology ... were being used as amulets to ward off life’s inevitable miseries.... [T]he full range of human mood seemed to be something to be engineered out of your soul.... In this, there’s an odd parallel between Freud and the positive psychologists: repression, said Freud, is at the heart of civilization. And it’s at the heart of Positive Psychology. (Handler, 2006)

Handler, who clearly respects the many contributions of positive psychology, reminds us of what makes us human: “… [W]e’re filled with internal quirks, psychic peccadilloes, and unaccountable likes and dislikes, including many “negative” traits and predilections. Altogether, they’re what make us distinctive, identifiable to ourselves as ourselves.” And yet, when such traits were referred to in the class, it was to renounce them “... as castoffs from an old personality – primitive throwbacks to an earlier, less evolved self we ... should [be] learning to transcend.” (Handler, 2006)

Handler notes:

One of the great advances made by the much maligned therapeutic culture is that it actually allows people to look compassionately at their own pain and gives them the vocabulary to describe it. Therapy helps them eliminate the necessity of suffering in silent shame. For all the powerful insights of Positive Psychology, it won’t advance the cause of human happiness if it too enthusiastically endorses the antiquated ethic of the stiff upper lip. (Handler, 2006)

I think of my client who is finally able to grieve her lost marriage, as well as a childhood marred by tragedy. Week after week, we sit together as she goes in and out of despair. The deeper she allows herself to go, without managing away her negative feelings, the more strongly and authentically she comes out the other side into the light. “It’s amazing how this works!,” she exults as she lets herself unfold.

Like the great Renaissance artists, depth therapists are masters of chiaroscuro – the interplay of contrasting darkness and light that adds texture, vitality, and depth to otherwise flat surfaces. This is the balance we hold as we sit with our clients, listening, interpreting, challenging, cheerleading, bearing witness through tears and laughter in the unhurried, unscripted space of therapy.

Bibliography:

Begley, Sharon (2008, February 11). Happiness: enough already. Newsweek. (http://www.newsweek.com/id/107569)

Ehrenreich, Barbara (2009). Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America. New York: Metropolitan Books, Henry Holt and Company.

Halpern, Sue (2008, April 3). Are you happy? New York Review of Books, 55. (http://www.nybooks.com/articles/21197)

Handler, Richard (2006, January/February). 20 weeks to happiness: can a course in positive psychology change your life? Psychotherapy Networker. Washington. Retrieved from (http://www.psychotherapynetworker.org/populartopics/positive-psychology/528-20-weeks-of-happiness)

McWilliams, Nancy (2004). Psychoanalytic Psychotherapy: A Practitioner’s Guide. New York: The Guilford Press.

The problem with self-help books: the negative side to positive self-statements. (2009, July 3). ScienceDaily. (http://www.sciencedaily.com/releases/2009/07/090702110503.htm)

Wilde, Oscar (1981; originally published in 1891). The Picture of Dorian Gray. New York: Oxford University Press, Inc.

(http://www.thesecret.tv/)

(http://www.contextualpsychology.org/the_pursuit_of_happiness)

(http://www.npr.org/templates/story/story.php?storyId=19008602)

(http://www.authentichappiness.sas.upenn.edu/Default.aspx)

Lorrie Goldin, LCSW (www.lorriegoldin.com), has been in private practice for 25 years in the San Francisco Bay Area with offices in San Rafael and Berkeley. She is a CAMFT-certified supervisor and has long experience supervising, teaching, and consulting.