Power in Therapy: Freudian or Feminist Approaches

I created this critical commentary for my graduate theories of human development class at the University of Rochester. The professor asked us to read "Collaborative Reading of Medical Records in Psychotherapy" from Fors and McWilliams (2016), which looked at a feminist approach to sharing medical records in therapy with the client, and "Chapter 11 - Freud's Psychoanalytic Theory" from "Theories of development: Concepts and applications (6th edition)" by Crain (2016) which looked at a traditional Freudian approach of therapy which by contrast has less sharing.

Power in Therapy: Freudian or Feminist Approaches

This week, I engaged with Crain’s Chapter 11 on Freud's Psychoanalytic Theory and Fors & McWilliams' work on Collaborative Reading of Medical Records in Psychotherapy.

Crain’s chapter, whilst giving a fair summary of Freud, offered me limited new insights. However, it reminded me of how great Freud’s courage must have been to explore taboo subjects like sexuality in his conservative era.

“Freud was increasingly finding that the central emotions that hysterics blocked from awareness were sexual ones— a finding that Breuer sensed was true but which he also found personally distasteful and troubling. Moreover, the sexual theory brought ridicule from the scientific community, and this hurt Breuer deeply. Consequently, Breuer left it to Freud to investigate this new area by himself.”

Having read a little of Freud's work, including “Three Essays on the Theory of Sexuality” and “Civilization and its Discontents,” I found him an excellent writer, a very clear and insightful thinker. I imagine how hard it was for Freud to apply his ideas, whilst also having to face ongoing criticism of the technique.

Fors & McWilliams' work provided me with fresh insights. As someone with a background in software and a passion for psychotherapy I have often wondered how we merge the benefits of technology with psychoanalysis. Fors & McWilliams propose using collaborative medical record reading to enhance therapeutic interactions, and as I see it, turn a human relationship into data that can be shared and benefited from.

This to me is a wonderful idea, and I would love an online portal where I could review all the details, transcripts, summaries etc of my therapeutic engagements. We could add AI to it and generate insights, for example, sentiment analysis, entity extraction or geolocation mapping. We could use data mining to identify trends in the people, places, and things that influence mood changes.

Fors & McWilliams looked at this from a power perspective. Fors & McWilliams felt that by removing some of the power imbalance in therapy, the client could be more bought-in and the therapist would become more responsible, vulnerable and caring.

I see this as an excellent point. The catch though I think is summarized by this quote,

“They found that most of the records included insensitive, disrespectful, or potentially confusing or harmful entries: 68 out of 80 records were judged to be written in a patronizing and disrespectful way. One may be less likely to write that the patient is, say, manipulative, promiscuous, or hypochondriacal if one knows that the patient will read one’s writing.”

If we as therapists are writing summaries of our clients' treatment, we are creating knowledge, this knowledge, like all knowledge, can be used for good or for bad, to help or to harm. If we are experts in a topic and our client by comparison is ignorant, we may want to describe phenomena we observe that to the client may seem problematic or unsettling. The client may misunderstand the information we provide and then use it in harmful ways.

So should we write in layman's terms? Should we withhold information that could harm the client? If so, then what if our academic peers wish to review the data? Will parts that require expert comprehension be redacted? Then what is the use of this censored knowledge?

While I recognize the tremendous opportunity in Fors and McWilliams' approach, I am also mindful that knowledge is power, and in the wrong hands, it can cause harm. I hope we can explore ways to safely empower the client with the right information.