Victor Kagan: “Is it an easy job? No. But happy»

Psychologies: What, in your opinion, has changed in Russian psychotherapy compared to the time when you started?

Victor Kagan: I would say that people have changed first of all. And for the better. Even 7-8 years ago, when I conducted study groups (on which psychotherapists themselves modeled specific cases and methods of work), my hair stood on end. Clients who came with their experiences were interrogated about the circumstances in the style of a local policeman and prescribed the “correct” behavior for them. Well, many other things that cannot be done in psychotherapy were done all the time.

And now people work much “cleaner”, become more qualified, they have their own handwriting, they, as they say, feel with their fingers what they are doing, and do not look back endlessly at textbooks and diagrams. They begin to give themselves freedom to work. Although, perhaps, this is not an objective picture. Because those who work poorly usually don’t go to groups. They have no time to study and doubt, they need to earn money, they are great in themselves, what other groups are there. But from those whom I see, the impression is just that — very pleasant.

And if we talk about customers and their problems? Has something changed here?

VC.: In the late 1980s and even in the early 1990s, people with clear clinical symptoms more often asked for help: hysterical neurosis, asthenic neurosis, obsessive-compulsive disorder … Now — I know from my own practice, from the stories of colleagues, Irvin Yalom says the same – classical neurosis has become a museum rarity.

How do you explain it?

VC.: I think the point is a global change in lifestyles, which is felt more acutely in Russia. The communal Soviet society had, it seems to me, its own system of call signs. Such a society can be compared to an anthill. The ant is tired, he cannot work, he needs to lie down somewhere so as not to be devoured, thrown away like ballast. Previously, in this case, the signal to the anthill was this: I am sick. I have a hysterical fit, I have hysterical blindness, I have a neurosis. You see, the next time they send potatoes to pick, they will take pity on me. That is, on the one hand, everyone had to be ready to give their lives for society. But on the other hand, this very society rewarded the victims. And if he had not yet had time to completely give up his life, they could send him to a sanatorium — to receive medical treatment.

And today there is no that anthill. The rules have changed. And if I send such a signal, I immediately lose. Are you sick? So it’s your own fault, you’re not taking good care of yourself. And in general, why should one get sick when there are such wonderful medicines? Maybe you don’t have enough money for them? So, you don’t even know how to work!

We live in a society where psychology ceases to be only a reaction to events and more and more determines them and life itself. This cannot but change the language spoken by neuroses, and the microscope of attention acquires ever greater resolution, and psychotherapy leaves the walls of medical institutions and grows by counseling mentally healthy people.

And who can be considered typical clients of psychotherapists?

VC.: Are you waiting for the answer: «bored wives of rich businessmen»? Well, of course, those who have the money and time for this are more willing to go for help. But in general there are no typical clients. There are men and women, rich and poor, old and young. Although the old people are still less willing. Incidentally, my American colleagues and I argued a lot in this regard about how long a person can be a client of a psychotherapist. And they came to the conclusion that until the moment he understands the jokes. If the sense of humor is preserved, then you can work.

But with a sense of humor it happens even in youth is bad …

VC.: Yes, and you have no idea how hard it is to work with such people! But seriously, then, of course, there are symptoms as an indication for psychotherapy. Let’s say I’m afraid of frogs. This is where behavioral therapy can help. But if we talk about personality, then I see two root, existential reasons for turning to a psychotherapist. Merab Mamardashvili, a philosopher to whom I owe a lot in understanding a person, wrote that a person is “collecting oneself”. He goes to a psychotherapist when this process starts to fail. What words a person defines it is completely unimportant, but he feels as if he has gone out of his way. This is the first reason.

And the second is that a person is alone in front of this state of his, he has no one to talk about it with. At first he tries to figure it out himself, but he can’t. Tries to talk to friends — doesn’t work. Because friends in relations with him have their own interest, they cannot be neutral, they work for themselves, no matter how kind they are. A wife or husband will not understand either, they also have their own interests, and you can’t tell them everything at all. In general, there is no one to talk to — no one to talk to. And then, in search of a living soul with whom you can not be alone in your problem, he comes to a psychotherapist …

…whose work begins with listening to him?

VC.: Work starts anywhere. There is such a medical legend about Marshal Zhukov. Once he fell ill, and, of course, the main luminary was sent to his home. The luminary arrived, but the marshal did not like it. They sent a second luminary, a third, a fourth, he drove everyone away … Everyone is at a loss, but they need to be treated, Marshal Zhukov after all. Some simple professor was sent. He appeared, Zhukov goes out to meet. The professor throws his coat into the hands of the marshal and goes into the room. And when Zhukov, having hung up his coat, enters after him, the professor nods to him: “Sit down!” This professor became the marshal’s doctor.

I tell this to the fact that the work really begins with anything. Something is heard in the voice of the client when he calls, something is seen in his manner when he enters … The main working tool of the psychotherapist is the psychotherapist himself. I am the instrument. Why? Because it’s what I hear and react. If I sit in front of the patient and my back starts to hurt, then it means that I reacted by myself, with this pain. And I have ways to check it, to ask — does it hurt? It is an absolutely living process, body to body, sound to sound, sensation to sensation. I am a test instrument, I am an instrument of intervention, I work with the word.

Moreover, when you are working with a patient, it is impossible to engage in a meaningful selection of words, if you think about it — therapy is over. But somehow I do it too. And in a personal sense, I also work with myself: I am open, I have to give the patient an unlearned reaction: the patient always feels when I sing a well-learned song. No, I have to give exactly my reaction, but it must also be therapeutic.

Can all this be learned?

VC.: It is possible and necessary. Not at the university, of course. Although at the university you can and should learn other things. Passing licensing exams in America, I appreciated their approach to education. A psychotherapist, a helping psychologist, must know a lot. Including anatomy and physiology, psychopharmacology and somatic disorders, the symptoms of which may resemble psychological … Well, after receiving an academic education — to study psychotherapy itself. Plus, it would probably be nice to have some inclinations for such work.

Do you sometimes refuse to work with a patient? And for what reasons?

VC.: It happens. Sometimes I’m just tired, sometimes it’s something I hear in his voice, sometimes it’s the nature of the problem. It’s hard for me to explain this feeling, but I’ve learned to trust it. I must refuse if I cannot overcome the evaluative attitude towards a person or his problem. I know from experience that even if I undertake to work with such a person, we most likely will not succeed.

Please specify about the «evaluative attitude». In one interview you said that if Hitler comes to see a psychotherapist, the therapist is free to refuse. But if he undertakes to work, then he must help him solve his problems.

VC.: Exactly. And to see in front of you not the villain Hitler, but a person who is suffering from something and needs help. In this, psychotherapy differs from any other communication, it creates relationships that are not found anywhere else. Why does the patient often fall in love with the therapist? We can talk a lot of buzzwords about transference, countertransference… But the patient just gets into a relationship that he has never been in, a relationship of absolute love. And he wants to keep them at any cost. These relationships are the most valuable, this is exactly what makes it possible for the psychotherapist to hear a person with his experiences.

At the very beginning of the 1990s in St. Petersburg, a man once called the helpline and said that when he was 15, he and his friends caught girls in the evenings and raped them, and it was terribly fun. But now, many years later, he remembered this — and now he cannot live with it. He articulated the problem very clearly: «I can’t live with it.» What is the task of the therapist? Not to help him commit suicide, turn him in to the police or send him to repentance at all the addresses of the victims. The task is to help clarify this experience for yourself and live with it. And how to live and what to do next — he will decide for himself.

That is, psychotherapy in this case is eliminated from trying to make a person better?

VC.: Making a person better is not the task of psychotherapy at all. Then let’s immediately raise the shield of eugenics. Moreover, with the current successes in genetic engineering, it is possible to modify three genes here, remove four there … And to be sure, we will also implant a couple of chips for remote control from above. And all at once will become very, very good — so good that even Orwell could not even dream of. Psychotherapy is not about that at all.

I would say this: everyone lives their life, as if embroidering their own pattern on the canvas. But sometimes it happens that you stick a needle — but the thread does not follow it: it is tangled, there is a knot on it. To unravel this knot is my task as a psychotherapist. And what kind of pattern is there — it’s not for me to decide. A man comes to me when something in his condition interferes with his freedom to collect himself and be himself. My task is to help him regain that freedom. Is it an easy job? No. But — happy.