Psychotherapy and Loneliness


By Ger Murphy

In this article I want to situate psychotherapy in the struggle against loneliness which is a basic human struggle. Many different systems have been appealed to in attempting to heal the ache of loneliness. For example, religion – implying the companionship of a God, and politics – implying the solidarity of the communal body. Psychotherapy may be explored as having a particular viewpoint and therefore potentially something to offer in exploring the theme of loneliness.

It is important firstly to debunk a particular view of psychotherapy and its relationship to loneliness. It can been seen that psychotherapy offers a relationship to the client which has the effect of a befriending function, thus relieving loneliness. In this psychotherapy can be seen as essentially a befriending service. This is not the task of psychotherapy, though it can be a legitimate task of other services, more of a befriending and supportive nature. Exploring the role that psychotherapy can play in dealing with loneliness, one has firstly to see what psychotherapy aims to achieve. We can see this best by asking how a psychotherapist might view the goal or end-point of a psychotherapy. One can see psychotherapy as a process in which the individual engages whenever a particular level of personal distress and psychological conflict arises. Thus one could have many “episodes” of psychotherapy, each with a particular defined goal. I find it somewhat more useful to see a psychotherapy as a process with a particular destination or end point in view. Thus while one may work at different times, the line of continuity may be drawn through the work which allows it to be seen as a particular change process with some characteristic outcomes. How such an end point is articulated is extremely complex and varies widely between different theoretical orientations in psychotherapy. However, at the risk of over-simplification, it may be useful to articulate such a point as being when the individual can both bear to take up his/her own life and can countenance death, such an individual has to be able to deal with this paradox, living in the present, embracing both life and death intimately. I will attempt to outline what I mean by this, and then to relate it to the starting question of loneliness.

Developmental Map

Firstly in saving that the individual needs to be able to take up his/her own life, what do I mean? I would here draw on a developmental map of the individual as outlined by Winnicott and others (1). In this map. Winnicott sees the potential self of the infant as weak and needy of support, having been born unlike other animals in a particularly vulnerable and premature state. What develops, some coherence and sense of self, is seen to be the initial illusion which the baby develops of being all-powerful, a necessary bastion against the powerlessness of its state.

In this power illusion, the baby fantasises the breast-feed or need-meeting experience and when this illusion is confirmed by the consistent and appropriate “good- enough” mothering, baby will feel a sense of safety and omnipotence. In this lies the seeds of later creativity within the individual. Such a reliable presence of the other can offer the individual infant a particular mirror. Casement (2) speaks of self-esteem arising out of the infant’s seeing its ability to bring delight into the eyes of the mother. Hence the sense of oneself as esteemed can be taken in to bolster one’s own sense of self. Of course, conversely, having been held in low esteem in infancy and childhood can set down the basis for later self-criticism and low self-esteem. One of ten attempts to avoid just such an inner attacker or internal saboteur in the words of Fairbairn (3) by clutching to belong or be saved by the company of another.

The next developmental step outlined by Winnicott involves the process of disillusionment as a parallel to the primary illusion spoken of above. It is useful to remember that while these steps are outlined as appropriate to childhood, we as adults continue to deal with a variety of levels of these basic issues. In the disillusionment, the infant will experience being left for short periods. Winnicott speaks of the necessity for such disillusionment as without it the infant would remain in a narcissistic or inflated state – the petulant spoilt child inside many of us demanding that one’s illusions be fulfilled. With enough consistent holding, such disillusionment can be tolerated, raged against and grieved. With this gradual process it can be seen that the individual may come to tolerate being alone without sinking into a sense of non- being. In this context, loneliness can be seen as the suffering inherent in an inner sense of incompleteness where one cannot have sufficient inner resources to last until the next contact (feed).

Psychotherapy as Holding

Psychotherapy can be seen as offering the holding necessary for the developmental process of maturation to occur where this has not taken place fully in the emotional and psychological realms. Thus a psychotherapy can be seen as a relationship where the required developmental work can take place. Psychotherapy, in being a dependable, reliable structure, can provide the container for the individual to develop the inner resources to be alone which is often absent in those presenting for psychotherapy. In addition to this reliable presence, a psychotherapy can be seen from different perspectives as aiming to bring about fundamental changes in self-structure to allow being alone in the world to be tolerated. For example, Carl Rogers in speaking of psychotherapy outcome in Koch (4) outlines the sought-for changes in self-structure:

1. His self is more congruent with his inner ideal self. In this I understand him to mean that the individual’s view of himself is moderated to be less at odds with his experienced self. This leads to Rogers’ second requirement:

2. As a consequence of the increased congruence of self and ideal self and the greater congruence of self and experience, tension of all types is reduced, physiological tension, psychological tension and the specific type of psychogenic tension defined as anxiety.

One can place such an aim alongside Winnicott within the ambit of taking up one’s own life as referred to earlier. Rogers’ concept can be seen in a sense akin to Winnicott’s concept of illusion. The individual can feel safe to live without anxiety in an ever-changing and often dangerous world.

Facing One’s Own Death

Alongside this aim of Rogers and Winnicott’s developmental model, it is useful to view the psychotherapy end point from the perspective of facing one’s own death. The Lacanian conception of the end of a psychotherapy I believe represents the viewpoint well. This view can be seen as outlined by Dunand in Feldstein, 1995 (5) where she states the criteria necessary for the end of a psychotherapy to be:

1. Destruction of the basic fantasy; 2. Identification with the symptom; 3. Destitution of the subject.

Taking these concepts briefly in turn, we can see the concept of the destruction of the basic fantasy as relating to the giving up on one’s fundamental story. This relates to how one sees oneself as a character in one’s own life-story, for example, as the perpetual victim, winner, etc. Such a story is our attempt to develop an ego-position from which to meet and manage the world and to defend us against our helplessness and ultimately against our powerlessness over death. Similarly the concept of identification with the symptom seems to speak to our willingness to tolerate and listen to our symptoms, rather than an ego based intolerance of our imperfections. In this we open ourselves to hear the wisdom which our symptom may have encoded in it. Thus a psychotherapy has a wider agenda than symptom elimination, although such a request for symptom elimination can often be the presenting issue when one goes for psychotherapy. In fact the conflict between the ego position where we want to be in control and the unruly symptom is often the presenting conflict, where the help of the psychotherapist is sought to quell the “internal rebellion.” Often in the course of a psychotherapy, this conflict is mellowed through the valuing of the messages held in the symptom, making it unnecessary for the symptom to persist, or to persist in a way that can be accommodated by the individual.

Finally, Dunand’s final criterion of destitution of the subject alerts us to the necessity of bursting the bubble of our narcissism. The narcissism I speak of here is in the sense outlined by Symington (6), where he contrasts the narcissistic option and the option of choosing what he calls the Life Giver. The narcissistic option can be seen as the position where we are excessively concerned with ourselves to the exclusion of the other or in Freudian terminology where the ego takes itself as erotic object. Such an option is often a result of poor early experience where we learned to defend our fragility against grief and loss but in the process remain outside of the melting-pot of life. This is often experienced as an inner deadness where we lack the initiatory capacity to create change in our lives. To do so we need to throw ourselves upon the arms of life and this implies accepting our limitations, our finiteness and our death.

The Lacanian view appears implicitly to embody the acceptance of our own mortality and death and a profound surrender to loss and change. Such a view combined with the Winnicottian and Rogerian views of taking up our own life, appears to me to encapsulate something of the end-point aim of psychotherapy. Such an integrative conception of psychotherapy seems in line with Freud’s conceptualising in his later article, ‘Analysis, Terminable and Interminable’ (1938), where he identifies his own theory with the classical Greek view of Empedocles which revolved around honouring both love and discord as the poles with which the individual has to grapple. While a person may stop psychotherapy at any point, to finish or end a psychotherapy, I believe, implies having grappled with the two poles of life and death which are articulated alternately by Winnicott and Rogers and Dunand and Lacan, among many others.

Loneliness

Returning now to the question of loneliness. Psychotherapy to be of use, must do two things. These are:

1. to assist the individual in having enough inner sense of self to take hold of his/her own life, including mobilisation of the inner creative power, to initiate in one’s world and bear the at times necessary aloneness involved in this.

2. to help the person come to terms with his/her death and the many little deaths along the way.

In helping the management and development of these two capacities, psychotherapy can profoundly affect the state of inner loneliness experienced by many individuals. One can view the felt experience of loneliness as an ungratified demand for circumstances to be different, a demand for change in the unchanging panorama of this particular moment in the individual’s life. The urge for change and absence of surrender can be seen as contributors to the torture of loneliness. When we are in this stuck position, we are a far cry from T. S. Eliot’s espoused position in his renowned Four Quartets:

“I said to my soul, be still and wait without hope,
For hope would be hope for the wrong thing.
Wait without lore, for love would be love
Of the wrong thing: there is yet faith
But the faith and the love and the hope
Are all in the waiting.”

One has to have what I would call a death consciousness and an embracing of life. Such a combined and paradoxical awareness is embodied in the processing of experience in the present. Fundamentally existing in the present moment one can accept the necessary death of the past and savour the only available experience - now. Perhaps this ability to be deeply in the present is both a good yardstick for the successful completion of a psychotherapy and a good antidote to loneliness The psychotherapy process, when successful, can help relieve anxiety and loneliness through the movements outlined briefly above.

Transformation

From here we can glimpse the possibilities of moving beyond the cycle of hope and disappointment, and illusion and disillusion. Of course, for this to be more than a glimpse one needs the further practices of meditation and stillness to bring one back to the possibilities of contentment, joy and bliss. Herein one could say lies the only thorough answer to loneliness, where one contemplates beyond the duality of self and world. In this one hears echoes of St Augustine and the many sages of all perspectives: “My heart will not rest ’till it rests in Thee.”

It appears appropriate to let the last word relate to loneliness in a brief quote from Harvey Cohen [8]: “You are not here to be lonely. You are here to discover the magnificence of yourself, appreciate the wonder of your uniqueness and to love the divine presence that you are of – and out of your self-discovery, self-appreciation and self-love, loneliness is transformed into intimacy.”

Notes:

1 D.W. Winnicott, Through Paediatrics to Psychoanalysis, Hogarth Press, London 1958.

2 P. Casement, On Learning from the Patient, Tavistock Publications, 1985.

3 P. Fairbairn, Psychoanalytic Studies of Personality, Routledge Kegan Paul, London 1952.

4 C. Rogers, in S. Koch (ed), Psychology: a Study of Science Vol 3, Formulations of the Person and the Social Contract, McGraw Hill, New York 1959.

5 A. Dunand, in Feldstein (ed), Reading Seminar XI, New York University Press 1995.

6 N. Symington, Narcissism, A New Therapy, Karnac Books, London 1993.

7 S. Freud, Collected Works, Vol XIV

8 H. Cohen, The Incredible Credible Cosmic Consciousness Diet, AhHa Dynamics Press, California 1994.

Ger Murphy works as a psychotherapist, supervisor and trainer at the Institute of Creative Counselling and Psychotherapy