In Search of the Good Psychotherapist

In Search of the Good Psychotherapist

By the CICNS - February 2011

On 31 January 2011, the parliamentary channel broadcast an instalment of its series “État de santé” entitled: Psychotherapies, how to sort the wheat from the chaff? The journalist Elizabeth Martichoux had invited onto her set Doctor Serge Hefez, head of the family therapy unit in the child and adolescent psychiatry department at the Pitié-Salpêtrière hospital in Paris. Georges Fenech, president of the MIVILUDES, appeared in the filmed report shown during the programme. Let us recall that the parliamentary channel has entered into a partnership contract with the MIVILUDES.

We reproduce below a partial transcription of the programme’s dialogue, which illustrates the way the MIVILUDES evaluates bad therapists and the way Doctor Serge Hefez evaluates good ones.

Georges Fenech, never hesitating to speak on subjects he does not appear to master, places the relationship of dependence at the heart of the dérive sectaire. On the basis of testimonies received (2,000 complaints received against “deviant therapists”, according to the MIVILUDES, whose relevance and admissibility one may seriously question if they are of the same nature as those reaching our association from people who believe they are contacting an anti-cult association; the French administrations have moreover demonstrated on several occasions the small number of complaints reaching them), he performs the amalgam: “relationship of dependence” equals “mental hold” equals “dérive sectaire”.

Lucid and competent on the psychotherapeutic approach, Dr Serge Hefez places the relationship of dependence, on the contrary, at the heart of the healing process. The abuse arises if the therapist uses, to his own benefit and dishonestly, the ascendancy created in the course of the therapy. From then on the question arises: what guarantees the practitioner’s ethics? Dr Serge Hefez’s very unconvincing answer would be that the diploma, because it is recognised by the French State, would be a pledge of morality. One can only remain perplexed before such an assertion. A person’s ethics, even granting that they improve in the framework of a university education (and it would remain to be verified what place that teaching holds in the curriculum of a psychiatrist, a psychologist or a psychoanalyst), depend on many other things than what can be said in a lecture hall. They depend on the complete history of the person concerned. It is entirely arbitrary to suppose that a therapist whose training is not recognised by the French State is more likely to be deviant; the proof, in any case, is not supplied by the MIVILUDES, which contents itself with peremptorily placing the therapists who unsettle established knowledge in the “guru” category. As for the “scientific knowledge” of which official diplomas are supposed to be the guarantors, it is obviously useful. But if, as Dr Serge Hefez rightly observes, the patient’s relationship with his psychotherapist is above all “affective”, then it brings into play human qualities which are not developed primarily in university lecture theatres. To claim from there, implicitly, that these qualities are less frequent in people who have not followed an official curriculum is once again arbitrary.

In this filmed report, the MIVILUDES is in its habitual role of simplistic denigration of “guru psychotherapists belonging to cult movements” (that is to say, the whole alternative therapeutic milieu), a discourse in the service of an official therapy whose considerable economic circuits, for their part, must be preserved.

For their part, the psychiatrists, psychologists and psychoanalysts, in the brawl generated by the drafting of the Accoyer law governing the title of psychotherapist, have above all demonstrated a parochial spirit (the analogy with the religious world is not incidental) having little to do with the patient’s interest in his therapeutic choice.

Transcription of part of the programme:

At about 7’00

GFenech: Charlatans have rushed into this new care market, into ??? psychotherapy, because they have a financial interest in it, and through these treatments or pseudo-treatments, it was realised that many charlatans were exercising a mental hold over their patients and then led them to do whatever they wanted with them… it is becoming a phenomenon that is exploding in France, one must be aware of it.

(…)

At about 10’40

Journalist: So help us, Serge Hefez, how can one spot good practitioners?

SHefez: Well, first of all, you need to know that you are indeed dealing with someone who has a title that is worth something, that is to say someone who is, once again, either a psychiatrist, or a psychologist, or recognised as a psychotherapist, so who is already affiliated to a group, who has followed a curriculum.

Journalist: (…) So one should not look at the small ads in the newspapers?

SHefez: No, above all not, I strongly advise against it.

Journalist: They are enticing, they promise well-being.

SHefez: Obviously, promising well-being is the easiest thing in the world… No, obviously not, you should ask around among your friends, ask your general practitioner.

Journalist: You also need to land on someone who suits you, that is fundamental?

SHefez: But that is the most fundamental thing, because you know, what heals in a psychotherapy is not so much the method employed as the person of the psychotherapist, and I have been practising long enough to know that one does not suit everybody, for example; and that a history with a psychotherapist, if you will allow me the analogy, is almost like a love story; there has to be something…

Journalist: Should one avoid transferences that are too strong?

SHefez: On the contrary, it is the transference that heals, it is precisely that very particular affective relationship played out with a person who will know precisely how not to play on that affective relationship, as we see in your reports, those people, they land on false psychotherapists who manipulate the relationship, whereas the honour, I would say, of a psychotherapist is at once to be able to lean on that transference but precisely in order to allow the patient to be freed from his chains, and not in order to manipulate him, to take him where the psychotherapist feels like taking him.

Journalist: So one must have a strong relationship, which one senses is not being used, exploited.

SHefez: There you are, that’s it, that is to say…

Journalist: But it is complicated when one is, after all, destabilised, in periods of analysis… It is difficult.

SHefez: Quite so, it is complicated, and that is a little the paradox of psychotherapy, which is that one places oneself, with respect to the other, in a state of dependence in order to get out of one’s need for dependence on the other, for example, or out of being subjected, enslaved to an all-powerful other; so one passes through this very strong and very particular relational state in order to be able to live out with the psychotherapist a whole set of emotions, a whole set of repetitions of bonds one has lived through in one’s life, in order to be able to untie oneself from them. That is the paradox of psychotherapy.

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