BOSTON - It is generally accepted that no theory of the self can exclude the powerful forces of the environment, the society, the culture, the world. Not everything that disrupts or befuddles us is due to one part of the mind messing with another part.
Not surprisingly, Freud located a place in his theory of personality for experiences that could terrify an individual, experiences that resulted in what he called normal anxiety. There is, after all, nothing neurotic about fearing a tornado, war or terrorist attack.
Which brings me to the clinical psychologist's office, a place where people go to deal with the sort of things they trust and mistrust, the sort of things about which they occasionally experience unbearable levels of anxiety.
As "irreal" as the relationship between therapist and client may be - "irreal" being Freud's term to describe the unusual nature of this sort of friendship - trust and mistrust remain essential ingredients. Regardless of how one views this delicate, almost sacred relationship, it would seem to develop only in a context of trust, and hope.
But the psychotherapeutic context is hardly delineated by the walls of the therapist's office. The context is also the family of therapist and client, not to mention the society and culture of therapist and client.
Thus, when clients seek out therapy, as they do now in greater numbers than ever before, they come with the fright of the world sitting alongside any frights they may have carried all their lives.
They come with a wounded hopefulness, perhaps, not because of ill-advised acts on the part of their parents, teachers and clergy, but because they could not study the events of the modern world and not know some degree of anxiety. Only logically their sense of faith would be rattled, and they would experience disbelief in the face of what their own eyes and ears tell them.
In truth, what many are bringing to therapist's offices are the same forms of trembling and disorders people have forever brought to this "irreal" sort of counsel. Indeed, there are sessions where nothing of the outside world is mentioned, and participants even find moments for humor. But a growing number of people, apparently, are bringing hopelessness and dread to these same offices.
In some instances, they are learning that earlier experiences of repudiation and shame only exacerbate the fright caused by following world events. In other instances, however, people are coming to learn that previously constructed views of self and the world are not holding up all that well in light of these events.
Significantly, reporting in The Journal of the American Medical Association, William E. Schlenger and his colleagues indicate that the number of people seeking psychological consultations since Sept. 11 has increased greatly, especially, and not surprisingly, in the New York and Washington areas. Are all these patients, suddenly so worried, genuinely in need of professional treatment? Can therapists legitimately justify a diagnosis of anxiety?
Predictably, insurance companies have started to examine the reasons behind the sudden increase in requests for psychological consultations.
There is something new about the contemporary clinical consultation, which I suspect is changing the nature and spirit of the consultation as much as any invasion of the insurance industry. It's that therapists, too, are frightened by what they are reading and witnessing. Therapists, too, are experiencing challenges to their own sense of hope. Therapists, too, are seeking to make sense of it all and wondering what will become of them.
It is hyperbole to suggest that since that fateful Sept. 11 morning everything has changed. Everything hasn't changed - for everyone, that is - but some things have, and they are not at all subtle.
I speak for myself when I say that childhood experiences of trust or mistrust aside, I find it far more difficult than ever to put aside my own fears, my own fright as I go to greet these special friends who come to me to deal with some of the very problems I, too, once confronted - and now, in an altered configuration, confront for the first time.
Thomas J. Cottle is a clinical psychologist and professor of education at Boston University.