With trepidation...
Not sure where I'm going with this, so I will just write and see..
Someone pointed me in the direction of Kendra, a woman who posted a succession of films about falling in love with her psychiatrist.
I've only watched two YouTubes about her story so far - one from an expert in AI who was commenting mostly on how the 'magic mirror' quality of LLMs can reinforce error, as Kendra took to talking to two AIs about what happened. And the other YouTube is from a Dr in Seattle, who likewise picks up on Kendra's convictions that her beliefs and feelings, are real, and the problematic effect of AI.
Briefly, Kendra's story begins this way:
Kendra believes that her psychiatrist had feelings for her, and 'bread crumbed' her into staying in therapy with him for four years. So, it is vital to try to understand if boundaries have been crossed.
But what if all the usual questions about boundaries and ethical conduct fail to address the real issue that underlies the problem?
The assessments made by the people in the videos, focused mainly on two questions:
- Was Kendra deluded or not.
- Was the psychiatrist's behaviour ethical or not.
They are reasonable questions and yet, as I try to understand this story I keep hearing this phrase in my mind, the operation was a success but the patient died.
The only things I can be fairly sure of from this story, are that:
- Kendra believes she experienced "weaponized neutrality".
- An AI expert believes that now Kendra is being led deeper into psychosis by AI chats.
- Posting to TikTok, means that Kendra can make some money from what happened!
The Dr in Seattle didn't recognise a term Kendra used: weaponized neutrality. Because the only harm the Dr was concerned about would have come from the therapist breaking his ethical code, and it sounds as if he really didn't do that if we define breaking the code as only physical contact. My argument is that deprivation of information, the neutrality much favoured by those of a psychodynamic orientation, can be harmful. We are back to epistemic injustice here: neutrality can be the withholding of information to maintain an unequal power dynamic.
Is an unequal power dynamic harmful? Obviously there are situations where inequality of power is warranted. Is this one of those situations?
I don't believe so.
Epistemic injustice destroys informed consent. Hence Kendra's view that her psychiatrist was withholding information to keep her hooked and paying him.
That is a serious allegation, and it highlights an error on the part of the psychiatrist, even if everything he did was for good reasons because an argument can be made to support Kendra's claim. Even if what happened to Kendra was unintentional consequences derived from the work of Freud. I maintain that the withholding of critical information is unethical behaviour on the part of the psychiatrist when it causes harm.
People associate the term catfishing with complex narratives designed to create an alternative reality. But when I remember the original meaning, that catfish (or cod? No idea!) were kept in special tanks that kept them swimming so they weren't flabby and soft when brought to market...then Catfishing fits Kendra's narrative.
Withholding critical information keeps the client swimming, trying, trying harder to get to the truth, trying, trying harder to prove what a good match they are, trying, trying so hard to make something meaningful out of some gesture or word that could be interpreted as significant if the ambiguous hoped for context is true..
Then when it is over, having been so powerless it is easier to stay in that place telling ourselves that uncomfortable details about reality don't matter. Self blaming, self attack. How to make sense? There is the knowledge that something happened but there is no way to assess what that actually was...it leaves a mess.
In my case, Kit's refusal to talk about his feelings, and indeed blushing when I asked him directly to be more open with me, certainly didn't do me any good! As much as I understand the constraints of the profession, at some point there needs to be more openness about the fact that therapy techniques such as neutrality, can cause harm.
Diverting a subject, sidestepping, avoiding, acting as if one doesn't feel?
Isn't this equivalent to ghosting?
It's impossible to know what happened with Kendra and her psychiatrist. But I assume that his neutrality felt defensive, hence her term: weaponized... because it felt wounding.
I mean neutrality isn't meant that way, but we need to be really careful in how it is received. I do it to give me space to think. Sometimes I need to add a gap so I can moderate my reactions. But, if I understood what a client was requesting from me, and I didn't feel able or willing to give it, would I keep on diverting and pretending to be neutral? I hope not. I trust that I'd ask questions, of myself and of the client. But not the cliched, 'I'm curious about why you ask me that'. Actually, maybe clients should ask therapists that question!
I remember being told by a client who had spoken of things that he blamed himself for, that I couldn't be as nonjudgmental as I appeared to be. He said, exasperated by my neutrality that it wasn't possible for me to be nonjudgmental. He said 'You must judge!' and I didn't reply by asking him what he thought might be the reason for his question. I told him that I certainly do make judgements! But it depends on circumstances, I said that if I came home and saw the front door open, a man with an axe standing in the hall...and blood on the floor I'd judge and run! I might judge myself as a coward too...whose blood is that, shouldn't I try to help? But I have learnt that I have limitations, so I'd phone the police! But most of the time my life really isn't like this. When the situation isn't so dire, I have time to think and to understand. It is my judgment that I can't judge a person without first knowing more about what's happened to them. But also, what am I to judge against - against my values of good, bad, safe, dangerous, right and wrong? I'm entitled to judge, but I need to get my facts right before I take action, unless there is blood and an axe!
Anyway!
It is my judgment - so yes this is the equivalent red-alert status, as if there is a man in the hall with an axe - that there are problems with certain techniques in psychotherapy, a story like mine, or Kendra's points this out. A lot of why the problems are maintained is because the psychodynamic model still has some traction. Everything will be blamed on childhood experiences. The therapist will try to create reparative relationships. And so the current and alive narratives of the client are coerced into arcane and twisted fantasies of the therapist's design. Basic human honesty continues to be drowned out by a compelling explanation that explains nothing, and this sad and sorry process can be dragged out for years...
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