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In treatment, the psychotherapist is in a position of power. Often, this power is unintentionally abused. While trying to embody a compassionate concern for patients, therapists use accepted techniques that can inadvertently lead to control, indoctrination, and therapeutic failure. Contrary to the stated tradition and values of psychotherapy, they subtly coerce patients rather than respect and genuinely help them.
The more gross kinds of patient abuse, deliberate ones such as sexual and financial exploitation, are expressly forbidden by professional organizations. However, there are no regulations discouraging the more covert forms of manipulation, which are not even considered exploitative by many clinicians. In this book, noted psychiatrist Theo. L. Dorpat strongly disagrees. Using a contemporary interactional perspective Dorpat demonstrates the destructive potential of manipulation and indoctrination in treatment.
This book is divided into three parts. Part I explores the various ways power can be abused. Part II examines eleven treatment cases in which covert manipulation and control either caused analytic failure or severely impaired the treatment process. Cases discussed include the analyses of Dora and the Wolf Man by Freud, the two analyses of Mr. Z by Kohut, as well as other published and unpublished treatments. An interactional perspective is used to examine the harmful short- and long-term effects of using indoctrination methods as well as to unravel conscious and unconscious communications between therapists and patients that can contribute to manipulations. Part III shows readers how to work using a non-directive, egalitarian approach in both psychoanalytic psychotherapy and psychoanalysis.
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Theo L. Dorpat, M.D., received his medical training at the University of Washington School of Medicine and completed his psychiatric residency at the University of Cincinnati School of Medicine. He was the first graduate of the Seattle Psychoanalytic Institute (now called the Seattle Institute for Psychoanalysis) where he is now a training and supervising psychoanalyst. He maintains a private practice of psychoanalysis, psychotherapy, and forensic psychiatry in Seattle.Review:
Theo Dorpat has given us an important book on a subject that clearly and deeply concerns him. It is about the various subtle ways that the psychotherapist, including the psychoanalyst, indoctrinates the patient without knowing that he is doing so. Dorpat shows us how the therapist, using widely accepted techniques such as questioning the patient, may raise doubts in the patient's mind about his (the patient's) own perceptions, and induce the patient to accept the therapist's sometimes erroneous ideas. Also, Dorpat tells us how the therapist can judge from the patient's responses to his interventions whether the patient feels set back or helped. Dorpat's work is based not only on his wide experience in psychoanalysis and related fields, but also on an extensive and detailed study of process notes, in which he carefully analyzes patient-therapist interactions. This book provides a much-needed critique of current clinical practice. (Joseph Weiss, M.D.)
This provocative and disquieting study of the role of covert processes of indoctrination and interpersonal control in therapeutic failures is an important contribution to the growing literature challenging the mythology of therapeutic neutrality and objectivity. Dorpat's recommendations for making these unconscious influence processes conscious will be invaluable to therapists and analysts in their efforts to discriminate between patterns of compliance and genuine therapeutic change. (Robert D. Stolorow, Ph.D.)
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