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Full-frontal therapy
How much good can psychotherapy do? wonders Minette Marrin
The Impossibility of Sex by Susie Orbach Allen Lane/Penguin Press, pounds 16.99, 215 pp
People inclined to the view that psychoanalytic therapy is all about sex will have their prejudices confirmed by Susie Orbach's The Impossibility of Sex. They may have many other, better-founded, doubts about it confirmed as well. Her new book is an account of this kind of therapy, from the point of view of the therapist: a collection of fictional case studies of patients with various sensational emotional problems is followed by broader reflections.
Although the patients are imaginary, the "I" of the female therapist, according to Orbach herself, is "as close to me as it could possibly be". She is herself a psychoanalytic therapist, and this, after a short introduction, is her opening sentence: "I felt twitches in my vagina, pleasurable contractions. It was a sunny Sunday afternoon in spring, two years after I had stopped seeing Adam. I was chopping some fennel when he not so much entered my mind as he tapped on my body, as he had so many times during the course of a five-year therapy."
It is true that Adam is not a real person, but there is something shocking all the same, as Susie Orbach is well aware, in a therapist expressing such intense sensations of sexual desire for a patient. However, this desire is not, the reader cannot help feeling, for Adam, the sex-addicted "vampire Casanova" of the consulting room. What is actually being expressed in this fully frontal way is Susie Orbach's lust for attention, for publicity, for celebrity. And put like this it conveys, like so much of the rest of the book, a vulgarity and a teasing of popular taste, that is at odds with the author's ambitious intellectual aspirations.
So we get both vaginal twitches and learned footnotes. Perhaps that suggests something about the divided self of the author; alternatively it might suggest something about a broad market strategy.
For an experienced writer and self-publicist like Susie Orbach - the woman behind Fat is A Feminist Issue, emotional literacy campaigns and the vengeful Panorama Diana - this sensational beginning is obviously commercial. So, obviously, is the marketable title, as is the arresting choice of make-believe patients - the white English Jewish cum black American lesbian couple (creative, caring and chic), the food-addicted black trade unionist man (gracious, truthful and lovable), the wretched sex-addicted Adam, the glamorous self-mutilator with a knife, and so on.
Yet it seems that Susie Orbach, at the same time as making a splash in the shallow end and capitalising on her celebrity, is trying to paddle out towards some wilder shores of psychoanalytic theory - towards a new erotic. These are treacherous waters; they seem to tempt many wise people, as well as all kinds of charlatans, well out of their depth.
The reason, obviously enough, is that there are many profound intellectual problems surrounding psychoanalytic theory and practice. The central one is fairly well expressed by Ms Orbach herself, writing about a woman patient. "How could I say this?" she asks. "How could I assess the quality of her regrets, her capacity to trust and pass judgment on whether she was feeling what she needed to be feeling sufficiently? What authority gives the psychotherapeutic worker the right to evaluate deeply the depth and veracity of another's emotional life? What evidence do we supply? What measure to we apply?" Well, ipsa dixit. That about sums it up. How damning to the entire enterprise.
Undaunted, however, Orbach goes straight on. "This contentious question for psychoanalysis is rarely answered satisfactorily as there is no empirical data to draw on. Clinicians must continually rely on their subjective experience." And she has no hesitation in doing so, with great confidence and at great length.
Ms Orbach has many degrees and qualifications, but I hardly think it matters. There are, by definition, no academic or scientific qualifications for passing subjective judgment upon someone else; in the same sense, there can be no qualifications for deciding what therapeutic relationship ought to be set up, and for what purpose.
The entire enterprise is wholly unscientific, and if it proves to be therapeutic in any one case, that must be simply a matter of luck - of happening on a really wise person, as one might hope to do in ordinary life. Besides, the success of the cure must lie in the eye of the beholder; look at what Orbach's therapy did for the Princess of Wales.
As it happens, I suspect that Susie Orbach has a great deal of insight into people. I suspect she is at times unusually honest. She sounds as if she would be very good at manipulating relationships with her clients, just as she has been very successful in manipulating her public image.
But the therapist's skill is not the only important question. Even more important is the question of her goal. Whatever doubts about the therapist's authority Susie Orbach may admit to, she is entirely confident about her own, and about her goals. She is an active campaigner for "emotional literacy" and is said to take pride in the "confessional culture" of the "new" Britain, to which she has contributed a great deal.
However, recent studies in the United States suggest what has been obvious to common sense for many years: that the therapeutic claims of psychotherapy are often unfounded. Talking cures and indulging one's feelings may be worse than useless; grief counselling may actually increase children's distress. Adults appear to benefit from self discipline, a little old fashioned stoicism and a dignified silence, as Freud himself occasionally suggested.
The Sunday Telegraph | Sunday, May 16, 1999
