Michael Karson, Ph.D.

A Simple Test of Therapy

I used to ask groups of graduate students a couple of questions about their own therapies, the answers to which left me so disheartened that lately I’ve just skipped the exercise. They went like this: Can you think of something your therapist did that annoyed you? (Everyone answers yes.) Did you tell your therapist about it? Only one student ever answered yes to the second question. So I almost never got to ask how the therapist managed the information.

Two people cannot be in the same room for more than a few minutes without experiencing some conflict (incompatible goals). (Freud would say the same of one person.) They certainly cannot spend much time together in a power differential like therapy without encountering the problem of whether the patient is going to be marginalized or disqualified for having an agenda different from the therapist’s party line. In therapy, the duty of the person in power with respect to the marginalized voice is paramount. This is because so many therapy patients are in therapy because they were marginalized by others and now marginalize themselves; one way or another, therapy patients are constantly telling some part of themselves to shut up and go to its room (or worse). The cure for this way of treating the self is a welcoming attitude toward all that is human in us. The cure is accomplished by developing a therapeutic relationship in which all aspects of the self (if represented verbally and emotionally) are welcome. This leads the patient to developing a welcoming attitude toward herself when she is on her own, because she learns in exposing these marginalized identity elements that they are not so aversive after all. (The attitude of acceptance will transfer only if the therapist is ambiguous enough; otherwise, the patient concludes that the therapist is especially accepting and not that the patient is acceptable.)

This is the second major frame element in psychotherapy, a welcoming attitude. It’s what Frieda Fromm-Reichmann meant when she said, apocryphally, “Wear old clothes,” after a trainee asked her what to do when the patient wants to smear feces on you. As noted, the kind of therapy I am writing about is one that requires patients to stay in their chair and use words and minor frame deviations to express themselves. So “wear old clothes” stands as a metaphor to describe an attitude, not literal advice.

Good therapists communicate that the patient’s complaints are important—not by asking for complaints, which usually garners assurances that everything is fine or attempts at obedience by reporting very minor annoyances. Good therapists inhabit a welcoming posture, and they detect complaints even without being told, through empathy. They use the content of complaints to explore the meaning for the patient, partly to reflect on the patient’s problematic patterns and partly to understand exactly and specifically how the patient experienced the annoyance, so that any ensuing remedies are specific to what needs remedying. Then, the therapist changes the things that ought to be changed (in the direction of fostering a therapeutic frame), helps the patient reconcile herself to the things that constitute a therapeutic frame, or helps the patient reconcile herself to the deviations in the frame that cannot be remedied.

So if you want to know if you are in a real therapy, complain about something annoying and see what happens. The same goes for democracy, by the way, which is why the right to complain is in the First Amendment, along with freedoms of speech and religion and assembly. You never know if you are in a democracy until you complain and discover whether you will be listened to or silenced.

Kinds of Individual Psychotherapy (technical note)

Before specifying other aspects of a therapeutic frame, we have to consider what kind of individual therapy it is.

Ellis’s version of ABC to describe behavior was Activating Event, Belief, and Consequence. You open the fridge looking for OJ, find none (A), and feel crushed (C). Perhaps the belief that accounts for your feeling crushed was that your romantic partner doesn’t value you enough to leave you some juice. That might hurt, but would it crush you? Perhaps beneath that B is another B that nobody really loves you. That would be crushing. The hallmark of a useful speculation about a B is that if anyone believed it, they’d also feel crushed (or they’d do whatever C they are trying to explain). It’s only in cognitive-behavior therapy (CBT) that B’s are beliefs. Instead, B can just stand for “Between.” The idea of a Between honors the fact that we don’t all respond the same way to the same situations. Although ABCs unfold as such in life, in therapy the process usually goes C-A-B: some consequence is noted as interesting (an emotion, thought, or overt behavior); the therapist tracks down the activating event (if the C is something that happened in the session, the therapist has the advantage of direct access to the activating event); then the therapist works with the patient to understand the Between that connected the two.

The Between may be a thought or belief after all, but it may be self psychology’s organizing principle, system theory’s family pattern, behaviorism’s learning history, ego psychology’s unconscious conflict, and so on. I find verbal beliefs to be of limited use as Betweens; they are typically too generic (“I am unloved”) and convey too little information. Instead, a picture or a movie makes a better B. A picture might be the person’s image of himself as a pimply teen who just farted in class. This comes to him when he sees there’s no OJ, and he’s crushed. A movie might be a memory that plays in the background of his mom promising him a chocolate cake on his sixth birthday and then producing a box of cookies expecting him not to complain in front of his friends. The movie might be an old memory, a dream, a fantasy, or an event from the recent past. If you want to work with Betweens, you need a therapeutic frame that facilitates his disclosure of the image or the movie.

Not all therapies are about Betweens. There are also A therapies and C therapies. An A therapy solves the patient’s problem by changing the situation directly, such as removing temptation or avoiding “triggers.” A C therapy addresses unwanted consequences directly, rather than changing the person so they won’t occur as often. Drugs, meditation, and distraction are typical C therapies. When someone says that golf is her therapy, she means that it relaxes her, a C therapy, not that golf illuminates her old patterns and introduces her to alternatives. The great advantage of a C therapy is that you don’t have to understand what’s going on to treat a symptom. Someone with a fear of flying has to get on a plane for some reason; give him a beta blocker and let him go back to his A approach (if avoiding plane flights is not that great a burden). The great disadvantage of C therapies is that, unlike medicine where the symptom is always the bad guy, the problematic consequence of anxiety or depression may be the only thing motivating the person to improve herself or her situation. Remove the anxiety or depression with pills and you remove the motivation to make things better. I should add that there are some B therapies that don’t need understanding, such as exposure to planes. Each kind of therapy needs its own sort of frame.

Psychologically-minded therapy is about Betweens. In such a therapy, the idea is to change the person, not just the situation or the problematic outcomes. This is the kind of therapy that works best and longest, but not quickest. When I describe the implicit rules of therapy that foster disclosure and interpretation, I’m writing about psychologically-minded therapy.

Turn in the Direction of the Skid

This old driving advice is the tagline of my blog. What does it mean?

When the rear of the car slides to one side, your impulse might be to slam on the brakes and grab the steering wheel to brace yourself. This resistance worsens the skid, and soon you’ll be careening down the road sideways or even backward. Instead, the thing to do is to turn towards the skid, after which you can drive normally.

We mess ourselves up by fighting life’s skids or by merely resigning ourselves to them. Embrace your fate, said Nietzsche. If you don’t get the internship of your choice, the mate you are crushed out on, or the physical health you once had, you will only make things worse by imagining otherwise and refusing to move on. Grab your remaining abilities, your next mate who will return your love, the work you can actually get, and enjoy the wild ride. This is what is meant by the Buddhist idea that what really counts is the grace with which we let go of things not meant for us. Of course, I resist the “meant for,” but the idea is the same without the fatalism. It’s what Kipling meant by saying that the saddest words of all are “what might have been.”

Skids happen; if you embrace them, life will be an adventure instead of a tragedy. Turning towards the skid doesn’t mean passively drifting through life, any more than the Taoist ideal of wu-wei (avoid purposive action) is a call to complacency. Instead, the idea is that fighting reality (usually by imposing an idea onto it about how things ought to be) wears you down, interferes with your effectiveness, and irritates other people. Move deftly within the actual landscape, not the landscape you wish you were in. Consider Russia’s celebrated General Kutuzov, who defeated Napoleon by avoiding battles (except Borodino, which Kutuzov lost). How is it possible to defeat the greatest army on earth by avoiding battles? Read War and Peace to find out.

“Turn in the direction of the skid” can also be read to mean, “Head toward slick areas.” If your goal is to get there without incident (fine for driving, but this is a metaphor), then dry roads will suit you. But if your goal is to become an expert driver or to live fully, look for icy patches.

Overpowering a skid is Apollinian in Nietzsche’s sense, admirably orderly and even beautiful, but tragically doomed to fail; turning with it is Dionysian, unplanned and uncontending, but vital and resilient. Why not be both? Celebrate order and chaos. (Our present culture has such vast pathologies of order and caution that I don’t need a reminder to value structure.) When hurt, don’t say, “You can’t hurt me”; say, “Ouch.” The latter expresses hurt but also, by demonstrating that the hurt is expressible, in Nietzsche’s phrasing that whatever doesn’t kill you makes you stronger (metaphor alert: syphilis didn’t make him stronger). If you have to take a punch, take it drunk (metaphor alert). Once you get good at rolling with the punches, you will seek them out, like a martial artist looking for improvement or engrossment by sparring with experts.

Rather than stick with the prior plan for steering, let the terrain guide the driver, the patient’s reactions guide the therapist, the child’s reactions guide the parent, and the beef guide the butcher. If you want to change the world, or even yourself, think judo, not boxing. Of course, if you want to dominate something you can actually control—like a stubborn lid on a pickle jar—go ahead and kick its butt, but if it’s alive, don’t be surprised if some day it kicks yours.

After driving in Michigan and New England most of my life with rear-wheel drive, I became proficient in snow and ice. I also developed an appreciation of the landscape by attending to the grade of the roads I was on. Now I have a heavy, four-wheel-drive Wrangler, and I have forgotten how to navigate slick spots. If you have an anti-skid device (metaphor), throw it away; it’s making you stupid. Anti-skid devices include not talking in class and already knowing how the therapy is going to unfold.

So make messes and clean them up. Don’t avoid making messes by claiming to be on top of things you can’t possibly be on top of (like other humans … or yourself). If you never skid, you’re not driving fast enough (metaphor!).

And that’s a basic aspect of the therapeutic frame, an implicit rule to explore the icy patches and, within the boundaries of the rest of the relational rules, to approach rather than resist the sense of confusion. (In fact, the rest of therapy’s rules help make icy roads into roller coasters and bumper cars.) Many people come for therapy because of the stress they feel from trying to control themselves as a result of living in situations that demand hyper-control. “Turn in the direction of the skid” is my way of remembering that it is impossible to tightly control complex systems. Human beings are complex symptoms.

The Therapeutic Frame, Part 1

Every relationship has implicit ground rules that serve the participants’ goals, that further their agendas about what kind of relationship they want or expect. For example, marriages vary in the extent to which the partners keep each other up to date about the daily vagaries of work. If you want to know what kind of marriage a couple has (or that you have) on this score, you can get a lot more information by probing the implicit rule about downloading work details than you can by asking them what kind of marriage they want to have. If you try the latter, two very different couples might both tell you that they want a marriage that’s a true partnership that’s playful and vital, and that they keep spouses up to date about work. Instead, you will learn more about the couple if you can determine whether they tell each other about major conflicts at work, about puzzling problems with colleagues, or about whether the coffee room ran out of skim milk. (This is an example of the more general directive in psychology to get examples.) A couple that describes itself as faithful can condone an enormous variety of sexual behavior with other people. You can learn more than the description by probing the rules about flirting—are full out affairs allowed? Internet or phone sex with strangers? Sexual validation by trolling for passes? The occasional sparkle in the eye? Revealing the face in public? Marital disputes that seem to be about “trust” and “respect” can often be focused, and resolved, by negotiating the rules. (But don’t forget power theory: the rules only at first foster the goals of the couple; eventually the rules become enshrined and need to be re-evaluated as goals change.)

Implicit and explicit rules define all sorts of relationships, including those between friends, colleagues, and even restaurant servers and diners. A list of rules shared in a geographic location is called a culture; a list of rules shared in a relationship is called a frame.

An important rule in any interaction concerns the amount of information you are supposed to consider in performing the role you are in. The classic example is not noticing a stutter, but old acquaintances also, for example, don’t bring up adolescent indiscretions when they find themselves working together. (They might, later, though, when rebuilding their friendship after work.) In this respect, the set of rules that govern a relationship are like the frame of a painting; the frame of a painting tells you the kind of thing it is and how much of it to consider.

A widespread rule is that you don’t tell people what you are really thinking, not about the seasoning on the meals they prepare, not about the wild sexual and aggressive thoughts that go through your head, and not about the ugly secrets from your past. This rule facilitates most social interactions (that is, it fosters the goals in almost all relationships), but it leaves people hungry for intimacy if they don’t have any friends, lovers, or family members who really get them. (One reason widowers have so much the harder time of it than widows in our culture is because when the wife in a straight marriage dies, the widower has often lost his only intimate relationship.) The inverse of the rule against intimate disclosure is that you are generally forbidden from commenting on the behavior of other adults if the comment identifies aspects of the self behind the social mask.

Many forms of individual therapy depend on access to thoughts, wishes, and memories normally kept behind the social mask. Good therapy also authorizes the therapist to comment on the patient’s behavior. The frame of therapy—its set of implicit rules—is designed solely to facilitate these two relational goals, disclosure and interpretation. Much is known about which rules lead to disclosure and interpretation and which inhibit them (which I will discuss in a subsequent post). The social rules against disclosure and interpretation are so pervasive that the frame of therapy must set it apart from all other types of social relating. The rules around professional relationships (as opposed to a therapeutic relationship)—learned in relation to doctors—push the therapist into an expert role that inhibits the interpersonal process. The therapist wants to be neither social nor professional, and yet the therapist and the patient are just two people trying to have a conversation (social) and the therapy is indeed a professional service. These are the Scylla and Charybdis of therapeutic relating, and the therapeutic frame requires an extraordinary effort. Of course, that’s like teaching an only child how to act like a sibling, and if the therapist has never experienced a therapeutic frame, it’s hard for her to believe that such a thing exists.

Defending Your Parents

People use psychological maps to navigate situations. Some maps are like diagrams of how things stand, some are like small movies about what is likely to happen (these are called memories), and some are verbal guides telling you what to do or how the world works. In many situations, maps just get in the way, like following a recipe for the amount of salt to put in a stew instead of tasting and adjusting. In many situations, the problem is that you’re using the wrong the map, a map of how things used to be, of how to relate to different people in outmoded situations.

If you are using a map of Denver to get around Washington, it doesn’t take you long to realize that the map is no good. That is because the information on the map is fairly clear and the feedback you get from the Washington landscape is fairly clear. The street signs aren’t right, the landmarks aren’t right, and the sun isn’t even setting in the right direction when you’re driving on 14th Street. Psychological maps are harder to invalidate. Everyone agrees with a statement like, Hey, the Lincoln Memorial isn’t supposed to be there, but not everyone agrees with a statement like, Your righteousness is supposed to make other people obedient but it just irritates them.

The other big problem with psychological maps is that you’re attached to them. It’s as if you were personally a member of the Rand family, the McNally family, or the AAA family. To discard the map as erroneous is to question your loyalty to the people who gave you the map. In this respect, psychological growth is to family loyalty as science is to religion. Every new bit of knowledge derived from science contradicts some folk wisdom about how things work; when that folk wisdom is associated with loyalty to God or your family, it’s hard to relinquish.

The upshot is that people defend their parents from accusations of imperfection and incompetence by trashing the feedback from reality and sticking to the map. Ironically, the more incompetent the parent, the more the child idealizes him, since only the most incompetent parent insists he is always right. Also, competent parents produce children who don’t think their well-being is hanging by a thread, a thread held by the parent. When you are totally dependent on something, you have to believe it’s perfect.

Perhaps the most insidious way we defend our parents is by becoming the person who justifies their conduct. If they were brutal, we are annoying, proving as it were that anyone would treat us poorly (or we are equally brutal when annoyed, to prove that brutality is normal). If they were hyper-emotional, we obsessive-compulsively drive people to emotionality (or we’re equally emotional, to prove that’s the only way one can be). If they were domineering, we are childish (or equally domineering). If they were neglectful, we act as if we don’t need much, and neglect our own needs and insist that dependency is a form of whining. If they responded warmly only when we were brilliant, then we act as if brilliance is the only thing that matters. If they told us we were especially wonderful, then we bark at anyone who says we’re merely ordinary. You get the idea.

The greatest value in science is falsifiability, the acceptance of only those propositions that might not be right, that can be tested against reality. All other propositions are either tautologies or religious convictions. It’s true that some laws of nature become convictions, such as the conservation of energy in a closed system and the fact that punishment only seems to work to the punisher. But in science, even these convictions could ultimately be falsified. I sum up this scientific attitude in one word: oops. “Oops” captures the recognition of a mistake with an attitude of fixing it rather than devastation. This conveys the best approach to take when you realize your map, regardless of its origins, has led you astray. But it’s an attitude that develops best under robust parents who don’t get angry or defensive if questioned.

In therapy, the cure for tendencies developed to defend parents is not to join with the therapist in attacking parents. Instead, the cure is to have a therapist you don’t have to defend, a therapist who owns up to mistakes, explores rather than dictates your reactions, and takes your changing psychological states in stride. With such a therapist, you can discover who you are independent of having to protect someone else’s investment in who you are.

Bedtime

One of the most important skills you can teach your child is how to go to bed. The main reason bedtime is so important is that it’s very hard to be a good parent. The constant attunement, frustration management, limit-setting, and concern for your child’s well-being will grind you down. The only way to be a good parent all day long is to know when the day will end. If you know with a reasonable degree of certainty that the day will end at 7:30 sharp, it’s a lot easier to stay on top of your game right through 7:29. It’s hard to wear the mask of an interested student when the teacher lets the lesson drag on past the official end of class; it’s hard to wear the mask of appreciative audience when someone speaking in conversation outlasts the local cultural norms on how long you can talk uninterrupted. Any complex task that requires concerted effort is made easier if you know when you can stop.

Bedtime is important also because it teaches the child a key skill (falling asleep at a set time) for physical and mental health. Lack of sleep adversely affects physical and emotional functioning. The night before a job interview or a major surgery may be exceptional, but most nights ought to be taken in stride. This will not only endow your child with many good nights’ sleep for the health benefits, it will also teach your child that the bumps and potholes of life can be ridden out calmly. Sure, “rage against the dying of the light” in the metaphorical sense of living life fully up to the last minute, but not in the literal sense of staging protests against bedtime. Bedtime teaches children the invaluable lesson of living life as if it will last neither a week nor forever, but as if it will last for whatever your life expectancy is, an approach that fosters good decisions for the long haul. Staying up late makes good sense if you are likely to die tomorrow, and letting kids stay up late communicates that life is unreliable and short. If you expect to be alive for more than a few months, then the best strategy for a human is to get plenty of sleep, so as to fully enjoy wakefulness. A regular bedtime sets your child on the road to managing existential angst.

Children should sleep in their own beds. I recognize that poor people all over the world are sharing beds with children and calling it culture, just as places where meat is scarce treat vegetarianism as a kind of sacrament. If you can’t afford to give your children protein or their own beds, don’t beat yourself up over it; but if you can afford it, provide it. When children sleep with parents, they have to endure getting kicked out when the parents finally want to be alone again. Often, such parents get divorced and then don’t want to sleep without children again until they meet someone to sleep with instead. Do you really want to introduce your new partner to your child as the person who is taking his place? Children, like adults, get hazily and vaguely sexually excited while half asleep. Do you really want to be lying in bed with your child while she’s turned on? Finally, children who can’t go to sleep on their own are not welcome for overnights at other people’s houses, and they become aware that there is something creepy about their sleeping arrangements at home. Spare them this.

The three big maltreatment areas are abuse, neglect, and spoiling. Abuse occurs when parents lack skills and become frustrated by their ineffectiveness. They attack children like someone not knowing how to work a Coke machine attacks the machine. Neglect occurs when parents put their own needs ahead of important needs of their children. Bedtime protects against abuse and neglect because parents can regroup and meet their own needs once the little maniacs are down for the night. Spoiling is a special version of neglect in which the parental need to avoid immediate conflict outstrips concern for the child’s long-term adjustment. The parent’s reasons usually involve a lack of skills (they don’t know how to put a child to bed or they don’t understand the importance of exercising authority consistently); an explanatory belief that the child is unusually or especially clinging, demanding, or powerful (which lets the parents off the hook but dooms the child to be especially clinging, demanding, or powerful); or a horror over being cast as the bad guy (the authority, the bearer of reality). Generally, a parent who is extremely reluctant to be seen as the bad guy communicates to the child that the parent must really be harboring some violent thoughts about the child to make any insignia of villainy so toxic. Does the word “authority” remind you of spanking or teaching?

When life is fun, you sleep best when you sense that it will all be there tomorrow waiting for you. When life is scary, you sleep best when you know that you’ll be safe. Either way, you need someone in charge who has things under control. A parent who can’t even organize a bedtime is not a parent to rely upon to make fun dependable or to keep monsters at bay. Children of such parents are worried at worst and at best they feel they have to grab all the goodies they can get.

Everything I’ve said here about bedtime can be applied to starting and ending psychotherapy sessions on time, where the immediate goal is taking off masks rather than getting a good night’s sleep.

Morality Does Not Come From God

I think it’s best to reserve the word “unethical” for behavior that violates the written standards of a profession, the word “unprofessional” for behavior that violates the unwritten standards of a profession, and the word “immoral” for behavior that violates the standards of God. Since there is worldwide dispute about what God demands of us, I typically suggest that we not use the word, “immoral.” Instead, if someone does something you disapprove of, you can say you don’t like it.

Still, I acknowledge that there is another sensibility, one that I agree with, that is often associated with the words “ethical” and “moral.” This might be described as not exploiting others, or adhering to something like the Golden Rule or the categorical imperative. General rules like these don’t work in practice, however, because one person’s idea of exploiting others is another’s idea of expecting them to pay their fair share or do their duty. As for the Golden Rule, there are many people who don’t wish to be treated as I do. And a rule that I would recommend for all occasions may be one that you’d just hate. I’ve resisted such declarations of morality because as soon as you agree that forcible rape is immoral, someone somewhere will tell you that masturbation is, too. And then you’re back to personal opinions.

For now, though, I am assuming that when people claim that a belief in God grounds their morality, they mean by morality their reluctance to abuse, exploit, or harm others. I readily agree that the sort of morality meant by a disinclination to masturbate is rooted in faith. But now I am disputing the idea that treating other people well—that morality—is based on a belief in God.

If a man refrains from raping women because it’s wrong to do so in the eyes of God, I don’t want that man anywhere near me. I like men who would not rape a woman whether it was wrong or not, simply because of the effect on the woman. If a woman refrains from beating a child because it is wrong, I don’t want that woman anywhere near my grandson. I don’t want him to have to cope with her rage or her experience of him as beating-worthy whether or not she acts on them. I don’t really think that people who believe that morality is based on religion construe themselves and others as rapacious, brutal sociopaths who needs strict rules to keep them in line. It’s a cute argument, but the truth is that people who believe that morality comes from God just haven’t thought it through. They associate good behavior with images of Jesus or passages in the Koran or the temple in which kindness was praised; they connect their good intentions with associated images.

Morality comes from empathy and identification, not faith. [Behavioral aside: People act morally in this sense as a result of reinforcement of prosocial behavior. The well-being of others becomes a conditioned reinforcer.] If you appreciate the harm done to others, and if you see them as members of your group (as objects of your concern), you won’t hurt them; you won’t want to hurt them. We learn empathy and identification by being empathized with and identified with, and we apply empathy and identification to others according to lessons we are taught about who is in our group and who is not. That’s why gang members can treat each other exceedingly well and outsiders exceedingly poorly—ditto for members of a religion. One way to understand the members of PETA is that they identify with animals almost as much as they identify with humans, so for them, it is immoral to mistreat a pig. I don’t know how I feel about that, because I definitely believe that we are pretty closely related to pigs, but eating them just doesn’t bother me. I know how I feel about other humans though. They are all in my group, objects of my concern.

If you pee in the pool and your dad reproaches you, you stop peeing in the pool when your dad’s watching you, but we don’t really consider that to be moral behavior. You’re worried about getting caught, not concerned with the well-being of the other swimmers. If someone who cannot possibly get caught goes to the trouble of getting out of the pool, drying off, getting to the bathroom, and returning to the pool, that’s what we mean by morality. It’s not moral if you act that way only when you’re being watched. If you believe in a God who watches everything you do, then far from being a basis for morality, the presence of God makes it impossible to be truly moral.

Milgram’s Subjects Were Right

In a famous experiment you probably studied in school, Stanley Milgram demonstrated the average person’s obedience to authority by inducing two-thirds of his subjects to administer what they believed were extremely painful shocks to other subjects in what they believed was a memory training exercise. None of the subjects checked on the welfare of the screaming and moaning “subject” in the next room; none demanded that the experiment end. Milgram wondered if the Nazi horrors were partly explained by widespread obedience to authority, in this case a scientist in a white lab coat, even when instructed to do something that conflicted with the person’s value system. Generally, the experiment stands for the proposition that either New Haven adults at the time are too obedient to authority or, for the less squeamish, for the proposition that we all are too obedient to authority. “Obedience to authority” might be translated as a belief that the authority knows better than the individual how to behave.

Here’s another interpretation of the results: When someone who is clearly a bona fide scientist assures you that no harm will come from a procedure, you can trust science over your own lying eyes. The great, often overlooked fact about Milgram’s experiment is that, indeed, no harm came to the apparently suffering person in the next room—the scientist could be trusted after all. In other words, the belief that scientists know better than the individual remains true after the experiment in which, as advertised, no one was hurt.

Science is always telling us things about the world that conflict with our own perceptions—the molecular composition of ordinary objects, the movement of the earth that feels stationary, the finite speed of light, the irrelevance of the previous outcomes in games of chance, for examples. In this respect (and in darn few others), science is like any other belief system; it asks members of its community to defer to community standards. Of course, in the culture of science, the community standards are supposed to be based on evidence and logic, whereas all other cultures hold some tenets (based on tradition, revelation, faith, and so on) more dear than those based on evidence and logic. The culture of science—not always all scientists, who are all-too-human, but science itself—is concerned only, in Skinner’s phrasing, with generating statements that lead to effective action. This limited purpose assures that, in science’s name, intentional harm to other people is rare (but it does happen, as in the Tuskegee experiments). When it does happen, it’s only in the name of science if the intent of the harm was to increase knowledge; otherwise, it’s in the name of power.

So I draw two inferences from the fact that Milgram’s subjects were right, after all, to trust the scientist. One, evidence and reason often produce truths that make us uncomfortable, but evidence and reason teach us to trust the process (think of all the good that has come from science including, probably, your very existence if medicine ever saved or agricultural science ever fed one of your ancestors). Two, if you are going to trust someone in authority, first inquire into the overt, stated, openly endorsed values the person espouses. You should subsequently find out about the authority’s covert values, but many, many authority figures can be disqualified on the overt ones, especially on the issue of how they suggest treating outsiders. If outsiders (people who don’t obey the same authorities you obey) are to be treated badly, now or in the hereafter, you know you are dealing with a tribal system, medieval at best, designed to empower one group of people over others. This is what Dostoyevsky meant by saying that you can tell how civilized a society is by looking at its prisons, criminals being people who are restricted for not obeying the state’s authority but who otherwise need not be treated badly.

Cultural Humility

A new study claims that cultural humility leads to better therapy outcomes. It’s defined “as having an interpersonal stance that is other-oriented rather than self-focused, characterized by respect and lack of superiority toward an individual’s cultural background and experience.” I’m all for other-oriented therapists, and I don’t know what the word “respect” means, so I have no quibble with it. [I think it usually means “obedience,” as in, “my boyfriend disrespected me,” but it also means “avoidance,” as in, “I respect your opinion.” But I don’t know what it means in the context of a background or experience as opposed to a belief or a right. I respect your rights by not infringing on them; I respect your belief by adopting it as my own or by citing evidence against it. But what does it mean to respect an experience? I suspect it means something like, if it’s important to you, then let’s talk about it, in which case I’m for it, but if it means something like, if it’s important to you then we shouldn’t change your orientation to it, then I’m against it, especially in therapy, which is supposed to change people’s narratives about their experiences.]

The heart of the matter is in the word “superiority.” Of course my cultural values are superior to those of other cultures! If they weren’t I would switch my cultural values.

Before going on, let’s dispense with the study. What these researchers measured was not cultural humility but the ability to disguise your cultural superiority from the client. Just as a physician doesn’t tell the Latina that her cultural belief in rubbing onions on a burn is stupid, and instead teaches her how to treat a burn without making her defend her culture, we do the same thing with all the distorted ideas that clients have that cause them pain or impede their happiness. My other criticism of the study is that the authors seem not to recognize that cultural humility is a cultural value, and it’s one that they think is superior to other cultural values.

Before getting all humble about other people’s cultures, I need to ask a few questions about that culture’s treatment of people with less power than the rule-makers. Parenthetically, there is no such thing as American or Irish or Muslim culture, because no rule of conduct is preferred in groups by all Americans, Irish people, or Muslims; so I’m talking about what are often called subcultures. (Subcultures are cultures that don’t have enough publicity to make it to the A-list.) Also because cultural values are implemented by humans, no culture lives up to its values, so I’m talking about whether repressive behavior is celebrated or questioned.

Back to my questions about a culture before adopting a stance of humility before it: How are women treated? Are pleasure centers cut off their bodies? Can they testify in court and own property? Can they pursue love and work and hobbies? Is rape condoned or criminalized? Can their families murder them with impunity if they are suspected of having sex? How are people treated who look different from the normative person, especially with respect to skin color? Are they derogated? Enslaved? Deprived? Scared? How are gay people treated? How are atheists, apostates, and infidels treated? If you can tell me your culture—your implicit and explicit rules of conduct—treats these people well, then I will express humility towards it (or adopt it as my own—and if it’s a culture that an outsider is not welcome to adopt, then my own culture remains superior, because in science, everyone’s welcome). Otherwise, I am merely hiding my contempt, which it is important to do sometimes, especially if you have to work with the person.

How is my cultural absolutism different from absolutist cultures that kill, enslave, condemn, or despise people like me under the banner of their absolute sense of superiority? The difference is that my culture (call it enlightenment values or science, with an emphasis on civil liberties, critical thinking, pleasure, humor, and social justice) condones force only in response to force or the threat of force, and otherwise promotes free speech in the marketplace of ideas for resolving differences between cultures. A culture advocates hurting me (now or in the hereafter) or controlling my wife, and I’m supposed to honor it?

Sing the Rage

One of my first cases in the child welfare system involved a Puerto Rican mother whose 6-year-old son was removed from her care after the son alleged sexual abuse by the mother. Well, that’s not what happened at all. What happened was that the son was undergoing a confusing and pointless lesson, imposed in those days by schools, on disclosing sexual abuse by encouraging young children to tell the authorities whether they had ever experienced “bad touch.” This, you may be startled to learn, was a vast improvement over the previous—and sometimes still employed—practice of simply asking children, “Has anyone touched you?” The questioner assumes that the child understands what is meant by “touched” or “bad touch.” This particular Puerto Rican boy told his teacher, “Yes.” She asked who had given him a bad touch and the boy said, “You and my mom.” The teacher knew she herself was innocent, so she decided that the boy just meant his mom.

When the case worker went out to the home, the other son was found to be naked as the day he was born and lying on top of the mother. This other son was only six weeks old at the time. The nudity seemed to the caseworker and a consulting psychologist to confirm the allegation of sexual abuse, so the six-year-old was removed, just to be safe.

This was my first week in the system, and when I attended a Friday meeting on where to go from here, I said that the child should be returned home and that the case should be closed with an apology. I added that if the boy was not back home by Monday, I would not be returning to DSS. “You can have him or me,” I said, “but not both.”

The administrator who had convened the meeting announced that the boy would be returned home right away. Afterwards, he took me aside and thanked me for my participation. “But,” he said, trying to be helpful, “you get too angry.”

Eleven thousand cases and three decades later, I am still angry. I am angry whenever people with power exploit others, whenever the hegemony without justification beyond maintenance of the hegemony marginalizes other parts of the system by refusing to question itself. If I weren’t angry, I would find something else to do besides advocating for abused children, silenced voices, and psychotherapy patients. (It’s true that if I found something else to do, I might not be so angry.) What I have learned in 30 years is not to be less angry; what I have learned is that to be effective, I have to strategize which battles to fight and how to fight them. There is no glory in defeat.

The means do not justify the ends. Calm, nicey-nice therapies do not justify bad outcomes and neither do noble, intrepid speaking styles that make other people stop listening.

When asked whether I am a gay ally (or any other sort of ally), I have to say, it depends. If it’s a situation where gays or women or blacks are being marginalized by a self-serving hegemony, then the answer is yes. But if it’s a situation where gays or women or blacks are marginalizing me or someone else because of race, sex, or sexual orientation, then the answer is no. Inclusion, not turnabout, is fair play.