Thomas Szasz on Psychotherapy

Thomas Szasz was a psychiatrist who opposed the practice of coercive psychiatry, called mental illness a myth, psychotherapy a myth, and even said the mind was a myth. Given this, how did Szasz go about practicing so-called psychotherapy for the majority of his life?

Szasz seems to have befuddled the rest of his colleagues. He viewed psychotherapy not as a medical intervention, but as a type of education in philosophy, applied ethics, and a conversation about problems in living.

He believed, that by taking psychotherapy out of the medical model, he was placing it back in its rightful role as the “secular cure of souls”.

Szasz tried to be very clear about the type of psychotherapy he was selling. He was offering a conversation about life’s difficulties. He offered the client alternative explanations and hypothesis to consider as potential new ways to live or deal with life’s difficulties.

Szasz maintained that there are no psychotherapy patients, only persons. For Szasz, persons seeking help through psychotherapy fell into two camps. They either sought to evade their responsibility by becoming a patient or sought new strategies of living by accepting more responsibility and freedom. Szasz viewed the client seeking to adopt the “patient” role in psychotherapy as a way to evade responsibility for his life.

Szasz said:

People seeking help from psychotherapists can be divided into two groups: those who wish to confront their difficulties and shortcomings and change their lives by changing themselves and those who wish to avoid the inevitable consequences of their life strategies through the therapist’s magical or tactical intervention in their lives.

Szasz maintained that the aim of psychotherapy, which he called autonomous psychotherapy, was to help make the client become more aware of his choices in life. Szasz sought to help clients assume more responsibility for their symptoms and to understand the role they were was playing in their own suffering.

Reading Szasz is a therapeutic endeavor, to say the least. Therapeutic, in the Szaszian metaphorical sense, of course. I highly recommend reading The Untamed Tongue as a starting point for connecting with Szasz.

I wish that Szasz had written more about his method of psychotherapy, but alas we are left with a few interviews, lectures, and one book called The Ethics of Psychoanalysis.

In Szasz’s own words regarding psychotherapy:

If he practices autonomous psychotherapy, the therapist must support the client’s aspirations toward freedom from coercive influences. This does not mean that he must encourage the client to behave in any particular way —for example, to rebel against a domineering parent, spouse, offspring, or employer. But it does mean that the therapist must candidly acknowledge and interpret the nature of the client’s significant relationships, leaving him absolute freedom to endure, modify, or sever any given relationship….he does not “take care of him.” The client takes care of himself. Furthermore, the client realizes that he is “expected to recover,” not in any medical or psychopathological sense, but in a purely moral sense, by learning more about himself and by assuming greater responsibility for his conduct. He learns that only self-knowledge and responsible commitment and action can set him free. In sum, autonomous psychotherapy is an actual small-scale demonstration of the nature and feasibility of the ethic of autonomy in human relationships…The aim of therapy is not to achieve happiness or even well-being but to learn about one’s self and develop personal autonomy.

We are fortunate to have a few audio recordings where Szasz answers questions about his methods of psychotherapy. I have included a playlist to some of the audio in a YouTube playlist below:

One thought on “Thomas Szasz on Psychotherapy

  1. I like Szasz’s definition of ‘recovery’ as one involving the patient’s recovery of morality and responsibility.

    There is also the very real phenomenon of the pervasiveness of ‘the medical model’, not just in psychiatry, but in the minds of persons who come to therapy. The NHS is particularly bad for setting up the medical paradigm in the entire referral process. But in any case we live in a world that has so pathologised emotional distress and disturbance (via psychology, psychiatry and general medicine…oh, and the popular narratives) that it is rare for me to ever see anyone in therapy who hasn’t already some quite ingrained ideas that have problematised their experiences in psychiatric terms. Indeed, in the initial stages doing so promises many a form of validation and relief, even though the promise of a ‘cure’ to their ‘illness’ is often one that is sorely disappointing at the end of the day. As I’ve saiud elsewhere it’s my belief that the pathologising of our distresses is a feature of our dysfunctional society and serves to deter scrutiny of the dysfunction by focussing ‘responsibility’ entirely upon the minds of the suffering individual.


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