Psychotherapy

Psychotherapy and Changing Structures

Tony Kushner’s play, “The Intelligent Homosexual’s Guide to Capitalism and Socialism with a Key to the Scriptures,” like its title is sprawling, broad in its reach and immensely thought provoking. I was fortunate to see it at Berkeley Rep (playing till the end of June). There is a lot that one can say about it. Like his other plays, it presents a riveting story set against historical forces, showcasing human frailty, conflicts and acts of love. This play, like many great works of theatre, centers on a family. It explores family dynamics, affiliations and identifications, and in particular dilemmas a family faces when a parent is aging or in this case wanting to end his life. And as in his other works, there are strong social forces – it is set at the time of the recent economic collapse –influencing people and their decisions.

It is also a profound and deeply psychological work. From a psychological perspective, the play touches on a subject dear to the work of psychotherapy and psychoanalysis: an examination of the structures that a human being will cling to for a sense of stability and a way of orienting to the world. The structure in focus here is Marxism. And the play examines what happens when that structure breaks down, is not as useful as it was in the past, or is too firmly held on to. The main character, a Marxist his entire life, has an eloquent speech where (to paraphrase) he speaks of how that particular orientation allowed him to see the world in ways that others did not see, to organize the world when there was disorder, and to be able to guide his actions accordingly. Given this ideology, this structure, he knew how to fix what was broken; he knew how to be in the world. But now that particular structure has broken down, globally as well as individually for him. It is as if a particular set of glasses he had used his entire life had been smashed and the world is no longer in focus. What actions he should take are no longer clear. He has lost his purpose and direction, and he is profoundly despairing.

A key focus of psychotherapy is to examine the psychological structures that people have built in order to understand them and their function, see how well they are working, if they are needed now, or if there may be other more advantageous possibilities. What do I mean by psychological structures? There are many types: some function to provide a person with a sense of purpose, meaning, and security. Others, while at one point serving a useful function, are outdated, no longer needed, or actual impediments to the person living a fuller life. A person may have constructed an edifice of an overly inflated sense of self. That structure may serve to protect a fragile and vulnerable ego. Many people come into therapy with a fiercely critical part of themselves (an inner critic), a structure that may serve various functions including a way to make use of anger by turning it inward. Another person may have, based on early experiences of rejection or neglect, developed psychic walls to keep people out, to preserve a buffer between him and the world. Such a person may live a well-fortified, albeit lonely, life to prevent further hurt and disappointment. And addictions, while complex in their meaning to an individual, may be a structure a person relies on to foster a sense of predictability and soothing when other resources are not available. There are many types of psychological structures.

Often a person comes into therapy because these structures, at one time providing something needed, now hamper his life, cut off a sense of vitality or inhibit him from living more freely. The goal of psychotherapy is not simply replacing the structure, but developing more dexterity, flexibility, and greater options for how to live. In a sense, therapy becomes a structure used for this rebuilding effort. The structure of therapy is founded on the dynamic relationship between client and therapist and includes the regularity of meeting as well as the consistency of the therapist as a nonjudgmental and compassionate presence in the client’s life. It is a relationship that allows the client to explore and better understand himself, to experience himself in new ways, and to let go of outdated structures that no longer benefit him.

Will the character in Kushner’s play be able to survive the collapse of his structure, to find a renewed sense of direction, purpose, and vitality? I won’t give away the answer. But I will say that people, when facing such a profound question, need help from others to navigate those challenges. And that is where psychotherapy and psychoanalysis become helpful structures for promoting positive change.

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