It is generally accepted that no theory of the self can exclude the powerful forces of the environment, the society, the culture, the world. Not everything that disrupts or befuddles us is due to one part of the mind messing with another part. Not surprisingly, Freud located a place in his theory of personality for experiences that could terrify an individual, experiences that resulted in what he called normal anxiety. There is, after all, nothing neurotic about fearing a tornado, war, or terrorist attack.
Which brings me to the clinical psychologists office, a place where people come to deal with, well, the sort of things they trust and mistrust, the sort of things about which they occasionally experience unbearable levels of anxiety. As irreal as the relationship between therapist and client may be, irreal being Freuds term, actually, to describe the unusual nature of this sort of friendship, trust and mistrust remain essential ingredients. No matter how one views this delicate, almost sacred relationship, it would seem to develop only in a context of trust, and hope.
But the psychotherapeutic context is hardly delineated by the walls of the therapists office. The context is also the family of therapist and client, not to mention the society and culture of therapist and client. Thus, when clients seek out therapy, as they do now in greater numbers than ever before, they come with the fright of the world sitting alongside any frights they may have carried all their lives. They come with a wounded hopefulness, perhaps, not because of ill advised acts on the part of their parents, teachers and clergy, but because they cannot study the events of the modern world and not know some degree of anxiety. Only logically their sense of faith has been rattled, and they experience disbelief in the face of what their own eyes and ears tell them.
In truth, what many are bringing to therapists offices are the same forms of trembling and disorders people have forever brought to this irreal sort of counsel. Indeed, there are sessions where nothing of the outside world is mentioned, and participants even find moments for humor. But a growing number of people, apparently, are bringing hopelessness and dread to these same offices. In some instances they are learning that earlier experiences of repudiation and shame only exacerbate the fright caused by following world events. In other instances, however, people are coming to learn that previously constructed views of self and the world are not holding up all that well in light of these same world events.
Predictably, insurance companies have started to examine the reasons behind the sudden increase in requests for psychological consultations. Significantly, reporting in the Journal of The American Medical Association, William E. Schlenger and his colleagues indicate that the number of people seeking psychological consultations following the September 11 attacks have increased greatly, especially, not surprisingly, in the New York and Washington areas. Are all these patients, suddenly so worried, genuinely in need of professional treatment? Can therapists legitimately justify a diagnosis of anxiety? A significant number of additional reimbursements is yet another reason to abhor terrorism. Who knows, perhaps a new conspiratorial theory will advocate that psychotherapists have underwritten terrorism in order to revive lagging businesses.
But there is something new about the contemporary clinical consultation, something that I suspect is changing the nature and spirit of the consultation as much as any invasion of the insurance industry. It is that therapists too, are frightened by what they are reading and witnessing. Therapists too, are experiencing challenges to their own sense of hope. Therapists too, are seeking to make sense of it all, and wondering what will become of them.
It is hyperbole to suggest that since that fateful September 11th morning everything has changed. Everything hasnt changed, for everyone that is, but some things have, and they are not at all subtle. I speak only for myself when I say that childhood experiences of trust or mistrust aside, I find it far more difficult than ever before to put aside my own fears, my own fright as I go to greet these special friends who come to me, quite frankly, to deal with some of the very problems I too once confronted, and now, in an altered configuration, confront for the first time.