Relational psychotherapy, anti self-improvement and cross cultural psychiatry

I am writing a book on self-improvement. You can learn a bit more about it on my Book Index page.

I am also engaged actively in my own self-improvement (I think it would be a bit hypocritical if I wasn’t).

My main goal for self-improvement in 2020 is to read more in my field of psychology. I want to broaden my knowledge, but also road-test my own ideas against what other people are writing.

I’ve managed to get off to a decent start on this goal, despite it not quite being 2020 yet. I’ve read three books recently, all of which I have enjoyed and which I have provided brief descriptions/reviews of below. If they sound interesting to you, feel free to pursue further.

I’ll use this blog to profile other books that I have read. I have also fired up my Goodreads account again. It, along with LinkedIn are the remains of my social media purge. Please note that the links to the books are Amazon affiliate links. Feel free to use these or search for them independently.

The Talking Cure: normal people, their hidden struggles and the life-changing power of therapy – Gillian Straker and Jacqui Winship

The Talking Cure consists of a series of fictional therapy cases (amalgams of real cases) from two Sydney-based psychotherapists.

Each case shows how the relational dynamics that trouble people in their everyday lives are inevitably brought into the therapy room, providing the opportunity for healing and repair and a justification for this type of psychotherapy (that focuses on how people relate to others).

What is a relational dynamic? It is simply a consistent pattern of relating to other people. For example, I consistently use humour to distance the topic from anything difficult or too personal. Or someone might constantly be on the lookout for any sign of criticism from others.

What the book demonstrates neatly is that these dynamics will play out in therapy and that attuned therapists notice these dynamics and find opportunities to use them in therapy. This means the client gets to practice, in the therapeutic relationship, how to deal with people in ways other than their standard dynamics. This can be incredibly healing.

Each case described in the book is supplemented with a section at the end of the case that gets you, the reader, to reflect on whether the dynamic described in the case is one that you struggle with as well. I challenge anyone to read this book and not see themselves in at least one of the cases. Guidance on how to overcome some of the dynamics is provided.

A pervasive theme across many of the cases was that the client had constructed a social ‘self’ that they were using to interact with others, that hid the vulnerability of how they were feeling inside. I would say this is incredibly common and not necessarily a problem. It becomes a problem however if the person is becoming increasingly distressed inside, but persistently hiding it from others, such that it is never addressed.

This is a great book if you want to get a peak into one type of psychotherapy in action. It is also a great book if you find how people relate to each other (friends, families, parent-child) fascinating.

Crazy Like Us: The globalisation of the American psyche – Ethan Watters

Crazy Like Us describes four case studies of where American (Western) views of mental illness, have been transferred to other cultures, mostly to their detriment.

Anorexia in Hong Kong

PTSD in Sri Lanka

Schizophrenia in Zanzibar

Depression in Japan

What this book puts forward is that mental illness, which in western cultures we tend to treat as well-defined medical conditions (we have the DSM), are actually culturally and socially defined and maintained.

The frightening implication is that it is possible to dramatically increase the prevalence and incidence of different mental illness in a culture, without any actual shift in underlying pathology.

If you make it culturally/socially appropriate for distress to be expressed in a certain way, (e.g. adolescent individuation manifesting as body image concerns and starvation), then you increase the number of people expressing it in that way. It is why we see shifts in how distress is manifested over time, as our cultures change.

Or more frighteningly still, if you change existing cultural understandings of emotional states, you can create ‘mental illness’ where it wasn’t there before. The case study of depression in Japan is an example of changing the underlying cultural representation of low mood as a way of creating a market for anti-depressants.

The book is a cautionary tale for anyone in the mental health area to be highly skeptical of mental illness diagnoses and treatments as applicable across all cultures.

For me, it is a reminder that the diagnoses and treatments for mental ill health that we hold as true, here in Australia, are as much a function of our culture, as they are of genuine scientific truth. Whilst all cultures have suffering as a reality, how that suffering is understood and addressed differs between cultures. Imposing one culture’s views on another is not necessarily the way to help them with their suffering.

Stand Firm: Resisting the self-improvement craze – Svend Brinkmann

I was particularly excited to read this as it is mostly in direct opposition to my views on self-improvement. I encourage anyone to actively challenge their own views every once in a while.

Brinkmann is not happy with the culture of self-improvement, growth, innovation and self-development that has gripped many.

His book is a psychological antidote to this self-improvement fascination. It encourages activities like saying no, dwelling on the past, focusing on the negative, suppressing feelings, sacking your therapist/coach and reading novels, not self-help books.

Ironically, I think reading this will make you a better person. It will direct your attention away from the pursuit of ‘self’ and instead towards the greater context in which you exist (other people, places, events, structures, systems etc). You’ll realise that introspection and a focus on ‘you’ has limits, serious limits. You’ll see that growth, for growth’s sake is a never-ending slippery slope.

I worried at first that reading this book might lead me to abandon my focus on self-improvement. It created a lot of cognitive dissonance.

I resolved that dissonance by committing to exploring some additional ideas in my self-improvement writing:

  • self-improvement needs to be considered in context – personal and social and cultural. I can make myself a better person purely for my own benefit but I can also do it so I can make a better contribution to my family or community.
  • self-improvement has to be done with purpose in mind – why am I making these changes? what is it I hope to achieve? Am I pursuing something realistic and appropriate?
  • self-improvement may actually involve slowing down and backing away from damaging efforts at change. For some people, the best changes they can make are to let the ‘self’ rest for a while and focus their efforts externally. To be a better person might involve abandoning excessive efforts at change.
  • we must understand our past when attempting to make changes to who we are. It is part of formulating what we want to change and why. This includes acknowledging that if we have the luxury of considering self-improvement, then that luxury was created by the efforts and sacrifices and hard work of others.
  • self-improvement should mostly be incremental, in order to not break things that are already working.

I don’t know if Svend’s intention all along was to make people better by telling them not to focus on being better, but I suspect that is the effect it will have.

His ideas will certainly feature in my work.

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