The Talking Cure: From Confession to Modern Therapy (Does it Work?)

Is there really a benefit to talking things through? Or, have we been taught to expect benefits, making it as effective as a placebo? It has long been suspected that ‘authority’ plays a significant role in the act of healing; which is why hypnotism was so resolutely maligned by the medical establishment:

The fear of the more astute of those who attacked hypnotism was not that it was ineffective, nor that it was immoral; rather, they anticipated that the success of a psychology of hypnotism would reveal that the doctor was always only effective in so far as he was immoral, in so far as the real drug that was being prescribed was he himself, in one of his social incarnations (John Forrester)

If we are told that talking helps, then there’s a good chance that it will. However, there are certain situations that preclude ‘the talking cure’; one of them being, as Bessel van der Kolk argues, trauma:

For a hundred years or more, every textbook of psychology and psychotherapy has advised that some method of talking about distressing feelings can resolve them. However, as we’ve seen, the experience of trauma itself gets in the way of being able to do that. No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality

Contrary to what Freud claimed back in 1893, remembering trauma does not necessarily resolve it. Nor is there an obvious ‘end’ to the talking cure (as Freud himself discusses in ‘Analysis Terminable and Interminable’).

Why then, do we continue to act as though talking is an effective remedy?

It’s likely because the roots of this mindset run deeper than nineteenth-century psychology. As Michel Foucault argues in his History of Sexuality, the West is a ‘singularly confessing society’. Since at least the Middle Ages, we have ‘established the confession as one of the main rituals we rely on for the production of truth’:

It plays a part in justice, medicine, education, family relationships, and love relations…