Olga Balla -Gertman (Russia) Interview with psychotherapist and poet Viktor Kagan

Viktor Kagan is a psychiatrist, psychotherapist and poet; a man of two cultures – Russian and American.  He holds M.D. and Ph.D. in medical psychology and psychiatry and has authored many books in psychiatry and psychotherapy as well as four books of poetry. His poetry, prose, scientific papers and essays have been published in many printed and electronic formats in Russian and International press. He has formulated and develops his original professional approach as transmethodological psychotherapy. In 1999 he moved from Russia to the United States, where he worked as a licensed psychologist. He is a well-known trainer in psychotherapy. He presented his views on his professional experience and modern psychotherapy in a conversation with Olga Balla of the magazin Znanie – Sila (4, 2010). It was five years ago but it sounds lively and important.

– … On the one hand, there are as many types of psychotherapy as there are psychotherapists. A psychotherapist works through himself; his individuality inevitably transforms any known technique and directs the therapy.  On the other hand, we all have our ambitions and want to define what we do – with luck it might become a methodology. That’s how transmethodological psychotherapy was thought up in early 1990s.

– … It has two key points. In my mind, psychotherapy is impossible outside of a state of trance. Let’s say, a patient goes to a classical psychoanalyst – to lie on a couch. … However, during the session with a psychoanalyst the patient is in a modified state of consciousness, especially in the moment of insight.    … Second point is another meaning of trance: trans – through, and a therapist works through methods and techniques, using all instruments at his disposal. … And it doesn’t matter what that instrument is called: psychoanalytical, behavioral, or something else. If these two conditions are satisfied – psychotherapy is happening.

– …Life creates problems, and we have to deal with them. Perhaps, a better wording is not “fight life” but “cope with life”.  Basically, what is life? – A chain of problem solving, changes, acceptance of novelty. You are one of the links in that chain. Your life remains yours, but something else always clings to it, and one often needs to work with it.

– …The image that works best for me: a psychotherapist is a corner. A while back trumpeters rehearsed in a corner: the sound resonated from the corner, and they could hear themselves. I need to be such a corner, flexible and movable, which would provide a reflection all the time. Somewhere in the process a moment of psychotherapy happens – and the patient changes. … I can only lead the patient to this moment. … Tamar Kron called it “the moment of dialogue”. … Most important for me is not to hinder the process. It is difficult not to interfere, especially when you think they are going in a wrong direction. Besides, there is a temptation to think that you understand the problem, when in fact you have no clue. … You never know what will work in a particular situation.  … There are always a million of additional factors affecting the process, either impeding or assisting. … I could not have possibly planned it. There is always a mystery in therapy.

– Actually, the 20th century is the history of psychotherapy in its current form, if we leave aside hypnosis and initial baby steps in psychotherapy at the end of the 19th century. Everything is fruitful here: time after time something new and important was filtered in. Everyone contributed something unique. One may or may not accept psychoanalysis by itself, but it is only because of Freud that we started listening.  … Freud was the first who started listening to the patient; the notion of “active listening” grew out of Freud. … The second undisputable achievement of psychoanalysis is representation of the unconscious, as can be understood in the simplest (not necessarily Freudian) sense: at any given moment in life we have access to only 2% of the psyche in the field of our active consciousness. …Today the entire field of psychotherapy is penetrated by it. In answer to “sexual phantasies of Grandpa Freud” came “behaviorists” and showed: instead of thinking up new theories we need to do simple things. But then, in order to ground these ideas, they had to come up with their own theory.  … But I don’t want to work in behavioral therapy. Well, I do use behavioral methods where and when appropriate, but working with only these methods I would feel like a tamer, not a psychotherapist.

– … For me there are three interesting tendencies of the 20th century. First – integration. Even when separate directions were developing – they were still leaning towards integration: certain vectors were clearing up, forming the spectrum of the future as a whole. … Second – feminization. And I don’t mean that there are many female psychotherapists these days. What I mean is: medical psychology, as it arose from the depths of laboratories at the end of the 19th century, was strictly result-oriented: elimination of symptoms (targets). This is a masculine style: instrument – result. Over time a more feminine approach accentuated the process. If the process moves as it should (although nobody knows how it should move, it develops along with the therapist-patient relationship), if we allow it to move, guiding it instead of forcing it into a narrow aim-oriented track, it leads to the result in its own ways and does it much more reliably. And the instrument used is not as important. … Third: psychotherapy is no longer a prerogative of medicine; it became a subject of psychology – it develops not in the image of exact sciences, but rather as an independent domain of humanities – as “psychological practice”, not “applied psychology”.

– Most of all I dislike two things in modern psychotherapy. … First one is weird eclecticism, when psychotherapy is composed of various tools that the therapist has not mastered. A devilish mix of bits and pieces of different trends in psychotherapy and shamanism, infused with pseudo-meditation to the beat of African tambourines, jingling of Indian bells, chanting “O-o-o-o-m-m-m”, or something like that. … Second is “orthodox psychotherapy.” I have never heard of Catholic, Protestant, Judaic or Muslim psychotherapy. Simply because, when psychotherapy begins with these adjectives, it violates its main principles. Psychotherapy is not against religion, but one of the parameters of psychotherapy as a profession is preservation of its secularity. You can be orthodox and psychotherapist, but you should not pull religion into professional matters.

– I don’t understand and don’t accept modern psychiatry. When I see one patient stamped with multiple diagnoses, such as  autism, schizophrenia and schizoaffective psychosis, I can’t understand how it is possible simultaneously. In the introduction to “The Gift of Psychotherapy” Irvin Yalom wrote that psychiatric classifications are similar to a Chinese buffet menu: it offers 40 items, and you combine them, pouring into your plate what you want – sweets together with crab legs… In a word, I’m not drawn toward psychiatry. I do work once a week in an institution for the mentally ill, but as a psychotherapist. I’m more interested in that rather than prescribing drugs.

– … For me psychotherapy and poetry are close: poetry allows one to phrase accurate expressions of what mundane language fails to express; it helps me understand myself, and easily intertwines with therapy. … I use somebody else’s poetry in my psychotherapeutic practice. It is great. I am working now on my new poetry book – it’s a mix of philosophy, psychology and poetry. …They have different names, but in fact they are all facets of the same.