Not All Therapy Is Created Equal

A quick glance at recent trends across shows that therapy is becoming increasingly mainstream. Entertainers and athletes are ever more apt to speak out about their mental health issues and subsequent forays into counseling. The historical stigma associated with therapy is disappearing and is being replaced by well-intentioned advocacy for mental health. By and large, this is a genuinely positive trend; the assumption being that as more individuals seek support for their mental health, their mental health is going to improve. Regrettably, this is not always the case. Not all therapy is good therapy. Not all therapy results in the improved quality of a client’s life. There are cases where the opposite is true. If we can begin with the admission that not all therapy is going to be effective, we can be better attuned to those instances where it fails to meet the mark, resulting in, at best, a maintaining of the status-quo and, at worst, a damaging of the client.

NOBODY NEEDS THERAPY

Therapy is not a basic necessity. As a client, if I believe that I need therapy, then I put myself in a basically powerless position where my therapist is more critical to my well-being than I myself am. I have a view of myself as a fundamentally problematic, screwed-up person. A person, in other words, who is in need of being saved. It is the therapist’s role not only to avoid falling into the trap of trying to save the client (such an undertaking, though attempted repeatedly by many a well-intentioned therapist, is always doomed to failure) but to break entirely the misconception that the client needs saving.

Unfortunately, this doesn’t always happen. Therapists are people too. We come with our own baggage, conscious intentions and unconscious agendas. The role of the savior is appealing. Intoxicating, even. It allows us to satisfy our own narcissistic needs - to feel good about ourselves - while pulling a veil over our eyes. Some part of us is satisfied by the client who pretends that they need us. We get to feel big, powerful, adequate, needed, functional and a mark of a successful human being in relation to our needy, dependent, clingy and suffering client. As such, we work to save them, thus supplying them with further credence that they need to be saved. Therapy gets nowhere. Indeed, the initial setup ensures and requires that no real change occur. The client becomes increasingly victim-like and the therapist, frustrated in their efforts, doubles down on their savior role.

As the therapist, if I operate my practice from the grounds that my clients come to me because they need me and that they can’t make it without me, I commit the injustice of stripping them of their personal power. On the surface of it, I am doing all that I can to help my client, but my resistant client just isn’t changing (even while they get to claim that they are dealing with their issues because they continue to come to therapy). It really is a wonderful setup for both parties. The client doesn’t have to do anything differently in their life (that would be scary) and the therapist benefits from a steady income stream while they get their dependency needs met.

THE PROPER THERAPEUTIC STANCE

The proper therapeutic stance is one in which the therapist rightly sees that, beyond being incapable of saving the client, the client doesn’t need to be saved. The therapist views the client as a capable and functional adult individual, even if current signs point to the contrary. The therapist works with the client to help them generate the confidence to no longer feel that they need the therapist. They therapist helps the client adopt the distressing and radical notion that they are fully responsibility for every aspect of their life.

Such a therapeutic framework removes the therapist from the temptation of the savior position and, in so doing, treats the client as though they are entirely capable of leading a positive, productive existence. Treating the client in this way is testimony to the client that they can be that way - that they can be more than the currently are. When the therapist treats the client like a impoverished child, there is no bigger vision for the impoverished child to grow into. When the therapist treats the client like a fully capable and effective adult, the client, even though they may see themselves as an impoverished child, begins to develop a vision of what they can become.

Similarly, the therapy will have a quicker impact if the client sees that they are responsible for dealing with their own life, recognize that their therapist can’t deal with it for them, and relate to therapy as something practical and useful, but not fundamentally necessary. The sooner that the client adopts a mindset of personal responsibility, the sooner high-impact work can begin. (Oftentimes much of the initial work is bringing the client into touch with their personal responsibility and supporting the client as they increasingly buy into the disturbing notion.) A client that sees therapy as a potentially useful tool is less likely to see it as an absolute necessity. It is a hammer that helps to build the house. It is not the house itself.

SIGNS THAT THERAPY IS OR ISN’T WORKING

Many clients come to the therapist’s office with the goal of feeling better in mind. An effective and useful session is, therefore, one where they leave ‘feeling good’. Less anxious, less sad, less angry, more happy, more content. This can be a pleasant by-product of therapy, but it is far from the point. When both therapist and client work to generate more positive feelings and less negative feelings, one risks feeling better at the cost of getting better. Getting better is oftentimes going to entail work that is disturbing, uncomfortable, objectionable and challenging. This can create emotional upheaval, at least initially. Further on down the line, the disturbance starts to change; or, more precisely, the client’s relationship to their disturbance begins to change. And, from there, their life.

RESULTS OF SUCCESSFUL THERAPY:

  • Increased confidence (the confidence that I can handle all of my life circumstances, that I can rise to the occasion, that my well-being is 100% in my hands)
  • More choice (an ability to choose between multiple options - even scary ones - without being pigeonholed into one way of responding to the world)
  • Self-activation (going out and making something of my life; pursuing what is important to me; dropping what isn’t)
  • Spontaneity (the confidence to rely on myself and my affect from moment-to-moment)
  • Self-entitlement (the belief that I am worthy of appropriate experiences of pleasure - worthy of what I want - and capable of going out and getting it)
  • Commitment (ability to choose and remain committed to my choice when it gets difficult to do so)
  • Intimacy (capability to show up fully in relationship without being run by a fear of abandonment or a fear of engulfment)
  • Responsibility (the acceptance that this is my life and the quality and direction of my life is ultimately up to me)
  • Acceptance of limitations (I cannot have it all - I realize that and work within those very realistic, albeit objectionable, limitations)
  • Contain emotional reactivity (I am not lead by my emotions, I choose when and how to share them)

SIGNS THAT THERAPY IS NOT PROVING SUCCESSFUL:

  • I increasingly see myself as a damaged/problematic person (a long and exhaustive list of things that are wrong with me, thus providing me with more hall passes and excuses as to why my life isn’t great/why I can’t succeed)
  • I rely on my therapist to regulate my well-being to an extent that is not conducive to my well-being (i.e. I feel that I need them in order to be ok)
  • I become more self-absorbed over time, instead of less so
  • I become increasingly close-minded, instead of increasingly open-minded
  • I rely on my therapist to make important decisions in my life (not just to process them, which is reasonable)

In brief, the role a therapist plays in the life of a client is transitory. Even if a client sees their therapist for years or decades, it is out of a place of practicality and not out of a place of necessity. It is from a place of choice and not a place of compulsion. A practical want and not a desperate need.

It is a crude overgeneralization to claim that all therapists want to feel needed, but there is at least some degree of truth to the statement. The field attracts those of us who like to help and we benefit from the help that we offer. We are not as altruistic as we’d like to think ourselves to be. Therapists can undoubtedly be genuinely helpful and effective. Simply put, that isn’t always the case. The more in tune a client can be as to the effectiveness of the therapy they are receiving, the more the stigma of the equally troubled, self-absorbed and ultimately ineffective shrink should continue to fade into the distant past.  

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