There is a difference between a ‘fabricative realist’ (one who invents a reality for the purpose of manipulating or holding control over another) and a ‘deluded realist’ (one who believes in the reality that a person with more power convinces them to believe).
Neither fabricative realism nor deluded realism is realist realism: it is a situational realism that forms between two parties in a relationship that is built on a significant power differential, a power differential primarily based on access to information.
A perfect example of this might be found in the traditional therapist-client relationship. The therapist (fabricative realist) manipulates and controls the deluded realist client’s understanding of the “reality” of their relationship by creating the fabricated reality of trust, leading their client to believe that the reactions and feelings of the therapist are real in a therapeutic setting – when in fact they are fabricated for therapeutic purposes: which are to diagnose (based on an invented diagnostic manual), to treat (based on a diagnosis based on an invented diagnostic manual), and to receive a form of payment for doing so.
The therapist, as fabricator, is given the task of earning the trust of the deluded client – the trust which is predicated on the careful nurturing of that deluded belief in the client: that they are inherently equals. It is only in relationships in which two parties consider themselves equals-in-dignity-and-humanity that trust can be nurtured properly, and so the therapist, whose job it is to use trust to exploit the client, must give the client a feeling or belief that they share a common idea of reality when in fact the therapist sits atop a metaphorical pedestal or mount, having a grander (as in more “situationally-informed”) view of the therapist-client relational reality than the client. They share a reality, but two different kinds of it; however, their relationship is predicated on the fact that the therapist must have an awareness of both the fabricational and delusional reality while the client must only have an awareness of the delusional reality – and cannot be aware that is it is what it is (hence: the delusionality that must be fostered by the therapist).
Is that to say a therapist can never be genuine and honest? No. But it makes it rare because in situations in which a power imbalance is fundamental to the formation of a relationship, the controlling fabricator-deluded dynamic is likely to occur.
We must ask: in what kinds of situations does this result, who does it affect, and how?
It inordinately affects the individual with inordinately less power: the deluded realist. Power is what created the ability for the individual with a lot of it to become the fabricator of a situation-specific fabricated reality dependent on delusionality-dependent therapy. The party fabricating the reality of the therapist-client relationship may, in fact, be affected, but the consequences of the effect are different because they are the one creating the reality.
By contrast, the individual who holds very little of the egalitarian ‘power of knowledge’ in the relationship experiences most profoundly the effects of it. Access to information and the flow of information within therapist-client relationships is a significant part of how the bifurcated relational reality of therapy is imposed. When a counselor is trained, s/he is trained into a position of power and authority that is granted based on her/his reception of information, adoption of information, and willingness to adhere to informational rules reflecting the norms of the practice of psychology or psychiatry.
A therapist, during their training (e.g., a master’s degree program in community mental health that involves certification) is given information that is specifically expected to increase their power – but it requires the withholding (or fabricationally-inadvertent exclusion) of information from clients. It makes one wonder: if a client had every piece of information that a therapist (or doctor) had, what purpose, then, would the therapist (or doctor) serve?
The very foundation of therapeutic practice is based on the accepted belief that therapists know something that clients do not know – as well as based on the accepted belief that therapists are able to know more than clients are able to know. This is based on the underlying assumption that somehow a therapist’s capacity to know is greater than a client’s capacity to know (domination and submission are prerequisites of the therapeutic relationship).
If information and knowledge were free to every individual, then what would be the role of the therapist?
If you take away the hierarchically institutionalized dissemination of knowledge (the holding and withholding of knowledge) within the therapeutic relationship, what is left?
A carcass of capitalistic power with no purpose other than to justify itself.
Knowledge has become institutionalized in order to increase power in some and decrease power in others – it is a parasitic capitalist enterprise in which the low exists to sustain the high. A client, or a consumer, is one who buys a product. Why, then, do those who identify themselves as “clients” (consumers) accept the false belief that those imparting their information-based knowledge are “therapists” – do-gooders, healers? If a therapist is a healer of some kind, and a practitioner of therapy, why diagnose? Diagnosis was meant to medicalize healing but it was also meant, in doing so, to generate a body of consumers for the “field” to monetize itself and generate profit.
Because of the institutionalization and corporatization of healing, we no longer have healers and seekers of healing; we have, instead, those who call themselves “therapists” and those who are not informed enough to question the nature of the “reality” of the therapeutic relationship – i.e., clients. Without the client, there would be no therapist. Or, there would be a therapist without a client, one who would then have only himself/herself to diagnose and treat.
More than this, without the client, there would be no bifurcated reality. Without the client, there would be only one reality: the reality of equality.
A radical transformation of the therapeutic relationship requires the tossing out of these labels and roles altogether. There are those who are suffering and those who offer healing. If healthcare was universal and free, anyone who was suffering or confused could seek healing and knowledge – and the healer would not have to delude the sufferer by fabricating and distorting reality in order to “help” them.
So what about trust, what about trust in the therapeutic relationship?
Many mental health professionals are trained to earn their client’s “trust” – this is done in order to strip down the client to a state of comfort and honesty in order to make her/him vulnerable to accurate diagnosis and treatment.
Let us call it what it is: deception.
Trust based on falsity is trust but is it misplaced and broken trust. Often, in therapeutic settings, in order to earn a client’s trust, a therapist must be deceptive. They must privately break the client’s trust, by writing private notes about their subject – notes that their subject must never see but this is never knowable to the client in order for the therapy to be carried out “properly.”
This is knowledge-witholding and it is an act of deception that many mental health practitioners carry out when they keep notes that reflect a different reality than the one that they share with their clients. If a therapist nods and listens to a client, or offers kind words and suggestions, while writing down diagnostic information that they do not also verbally share with their client (justified as being part of the practice of good medicine), they are being deceptive.
The idea that a mental health/psychiatric patient/client cannot know the details of their own “illness,” or what their practitioner/therapist thinks about their supposed illness, is outrageous. In what parallel world would it be okay for a medical doctor, treating a patient for a physical disease or condition (like a flu or a broken shoulder) to purposely withhold information from said patient? It would not be okay. It would be considered malpractice. But somehow we continue to allow psychologists and psychiatrists to withhold information from clients and patients with the absurd justification that it is “in the best interest of the patient/client” that they NOT know the details of their diagnosis or that they are INCAPABLE of knowing and understanding the details of their diagnosis. Not only is this malpractice, but it is malpractice based on the assumption that psychiatric and therapeutic clients are subhuman, not deserving of the same kinds of treatments that are expected of and reserved for those with physical conditions and ailments.
Consider the common psychiatric justification for treatment-over-objection: that the patient shows “little insight into her condition/disease.” This is the epitome of non-sense-making and institutional self-justifying. A patient is not given information about her/his supposed condition/disease because it is purposely withheld from her by the practitioner – and then the practitioner justifies the treatment using the very situation that he/she created. It is a trap and it is inhuman and unethical. This is the pinnacle of institutionalized illogic, applied on a daily basis in therapeutic and psychiatric settings all over the United States today.
There is no therapeutic trust. Any therapist who believes that s/he has earned it, under the false pretenses of the practice, is deluded.
With openness and honesty comes trust. That means: transparent note-taking and full-disclosure on the part of therapists. Until that happens, the relationship, like the field in which it is situated, is broken.
Jessica Lowell Mason
Co-founder, Madwomen in the Attic