ETHIC

Perhaps it would have been better to call this section "My Ethics" because in the end, everyone has their own.

Ethics in general aims to indicate how human beings should behave, act and be, among themselves and towards their surroundings.

In my own case, it is a question of defining what my behaviour, actions and motivation as a psychoanalyst should be when faced with a person who comes to meet me, asking for support, comfort or help. The question seems easy, at first sight, and yet it is not.



The (famous) neutrality of the psychoanalyst:

I have long wondered about the "best" and "most effective" for the person sitting in front of me, always keeping in mind that psychoanalysis aims at relieving suffering.

My natural inclination is for sincere empathy and warm kindness because I am sensitive to the efforts (both psychological and financial) that this person makes to engage in a psychotherapy or sex therapy relationship. 

I am not the only one who thinks that. Long before me, Sandor Ferenczi criticized the psychoanalyst's overly "professional" attitude and lack of humanity. He introduced the reparative dimension correlated to the relational dimension. This entry of empathy into psychoanalytic analysis has earned him Sigmund Freud's wrath, but personally, I am grateful to him! 

 

 

Suffering people, patients, clients (?):

When a people comes to meet me, I am perfectly aware that they are offering themselves to me in all their pain, suffering or uneasiness.

The trust they place in my hands requires a counterpart that should normally go without saying: absolute listening and discretion. But not only that. The analytical pact that binds us also contains the assurance that I will do everything in my power to help and support it. This request for support implies that I too must be able to ask myself questions. Over time, the help I have been asked for has become more concrete, more grounded in reality and often challenges my own practice and its mechanisms. Because in the end, the therapist must never lose sight of what the person sitting in front of him comes looking for: that the fog clears and that finally the light appears. Am I in a position to promise him that blue sky? To promise what does not depend solely on me would be to deceive her. But promising him that I'll be there to help him get rid of that fog, yes, I can. I have to. Because that's what binds her and me when the consultations begin.

The term client is therefore very inappropriate since it indicates either a dependency relationship or a commercial relationship but in no way a therapeutic alliance. However, it is really about an alliance because I am the ally from the outside who unites with the patient to win the game.



Know your limits:

It is certainly the greatest sign of respect but also of honesty that I can offer to people who trust me and come to me for consultation. I do not believe, but it is only my humble opinion, that there is a psychotherapist who can claim to relieve all the troubles that shake the human soul. Why? Why? Because no single therapy can claim to address all mental disorders on its own. We know, for example, that phobias and obsessive-compulsive disorders are better supported by cognitive-behavioural therapies. On the other hand, the harmful (and unconscious) patterns that some people repeat again and again in their emotional or professional lives are more likely to be "overcome" by psychoanalytic psychotherapy. However, no psychotherapist can claim to master all theoretical and clinical approaches. Why? Why? Because some of these approaches are in perfect contradiction with each other. Cognitive-behavioural therapies are the opposite of psychoanalytic therapies. We cannot belong to two such radically different schools of thought, even if we must be able to appreciate what each brings to the relief of suffering (which is particularly true in the field of addictions). So sometimes I have to tell a person that I can't start psychotherapeutic work with them.

I always try to explain as clearly as possible that this impossibility is not due to the person but to my inability to help him/her and that referring him/her to another practitioner or institution is not a rejection but on the contrary my participation in a therapeutic "chain" that is being set up to help him/her. Similarly, a person suffering from acute melancholy attacks, not taking any medication, cannot engage in psychotherapy. 

o clean in front of his own.



The title of psychotherapist is now legally regulated. Only psychologists and psychiatrists can wear it (from 2011). Even if they didn't do psychotherapy themselves. Even if they don't know how to practice psychotherapy. But the most incongruous and confusing thing is that all non-physicians and non-psychologists who practiced (for 5 years) before the implementation of this law, preserve their title of psychotherapist. So, in short, when a patient legitimately believes that a psychotherapist can only be a doctor or psychologist, that is not true. This will be true when all psychotherapists (non-physicians, non-psychologists) currently working are retired.

 

Institutes? Federations? Colleges? Companies? Schools?  These are the organs that are supposed to train and control psychotherapists. There are a lot of them. Who can guarantee that the "psychologist" duly equipped with his sesame (sometimes acquired at a golden price) will be able to be efficient?

 

Vast debates I was saying, since if we knew a way to protect anyone from charlatans, it would have been known a long time ago!....



So my only advice is this: always use "word of mouth". Nothing beats the lived experience of someone you know. If this is not possible because you do not want to inform your family and friends that you are looking for a psychotherapist, or if you do not know anyone in your family and friends who may have used the services of a psychotherapist, talk to your doctor. And as a last resort, if you don't want to tell anyone, trust your instincts, trust yourself. Remember the words of Pierre and Sylvie Angel, full of common sense: "Ideally, the first interview should leave you with a feeling of well-being. You feel reassured that (for once...) someone is really listening to you, trying to understand you and trying to help you. The setting, the welcome, the availability, the punctuality and even the physical appearance of the therapist are factors that make you trust him." "("How to choose the right shrink" - Robert Laffont - 1999)



The payment: 

The cost of analytical psychotherapy remains a very divided subject: on the one hand, analytical psychotherapists and on the other hand, patients.



On the side of psychoanalysts, payment should not be (or at least is assumed to be) a "problem". Understand, the shrink must have an unscrupulous relationship with money. If he does, it's because he hasn't been properly trained. 

It is accepted in the professional psychoanalytical world that payment must "cost" the patient. Yet the experience of institutional psychotherapy has shown that patients can benefit from "free" analytical psychotherapy. The urgency for people with significant mental dysfunctions is to overcome them. The "frustration" and "sacrifice" associated with payment are secondary.

 

On the patient side, many people go to a psychoanalyst to be listened to, welcomed, in order to find a place that leaves them a little in peace. Many also expect that their psychotherapy will not be too expensive. Some people have a real desire for change, but the budget needed for psychotherapy can put their fragile financial state at risk.

What can I say to them then?

Sometimes they are no longer able to pay for their weekly session(s) (the cost, once bearable, is no longer bearable) and they are unable to "negotiate" with their "shrink" (and when there is a negotiation, it often leads to an interpretation as if the money circulating during an analytical cure was automatically converted into "psychoanalytical reality", thus avoiding any principle of reality). Is payment a sine qua non condition?

I obviously don't think so. If payment is an imperative that makes possible break off to prevent the indefinite repetition of archaic links, then this would mean that all those who consult a psychiatrist-psychanalyst cannot obtain any significant change. Indeed, the care sheet completed under a neuropsychiatric consultation (CNPsy) should in fact constitute a "resistance to analysis", an impossibility to "frustration" and therefore a major obstacle to the continuation of psychotherapy (psychoanalytic).



It is therefore a clever balance between payment that makes it possible to modulate psychology/patient dependence and payment that does not suffocate the patient.

Because without any dogmatic consideration, the person who does not pay for his psychotherapy or sex therapy takes the risk of becoming "indebted" to his shrink. I don't need to tell you how harmful this can be. That is why it is necessary to talk about "money" with your therapist. You owe him a payment but under the term "payment" a certain flexibility can be arranged: sessions at a lower price, a suspension of payment for a while, etc... The psychotherapist must take into account this "extra-analytical reality" of the payment of the therapy.

Cécilia Commo

 

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Cécilia Commo - Psychoanalyst - Sex Therapist - Couple Therapist - Psychotherapy and Sexology Practice in Paris - Copyright protected 

Face to face sessions in Paris and online via video. Email me for more information.