How does therapy help? There are a number of standard answers to this question:
- Therapy makes the unconscious conscious.
- Therapy enables people to adjust their ideal image to something more realistic, and achievable.
- Therapy allows people to accept themselves and their imperfections,
- Actions and emotions that seemed “crazy” are given an understandable context, from the person’s past.
- Therapy helps people to “separate” from key figures in their past, so that they can forge their own identity,
- Therapy frees individuals from brutalizing self-criticism.
All these answers have their truth, and if I go through the clients I have treated over the years, I can find good examples of each of these “cures.” Indeed, many – even most – of my clients have been helped by “all of the above.”
So, in what may become an occasional series here, I’m not planning to rewrite “the book” on how therapy helps. Rather, I’m going to emphasize shifts, some major, some less so, that seem to characterize successful therapies, or the moments in which therapies become more successful.
I’m going to start with something that is often considered frivolous and feeble — curiosity. I’m increasingly struck by how uncurious my clients are about what brings them to therapy, even though they have chosen (by approaching me) a therapist who is involved in the talking cure, and who explicitly says and shows that I think understanding the past causes to current dilemmas is an important part of finding a new way forward.
It’s not that this lack of curiosity surprises me – I’ve come to expect it. In fact, I regard it as a cause of people’s suffering. Let me backtrack a little.
The vast majority of people who come to therapy are in pain. Their main goal is for the therapy to relieve their suffering. There is talk, in psychoanalytic circles, about the good old days, where clients came to five times a week analysis because they wanted to get to know themselves better. But these halcyon days, if they ever existed, were before my time. Therapy is now regarded as a rather expensive and time-consuming treatment. For this reason, it’s often a last resort, one sought after everything else has failed.
A big part of what brings people to therapy is the immediacy of their suffering. People come to therapy because, for the most part, they experience their pain like a thorn under the skin.
No one would deny that sadness/anxiety/terror/depression/guilt/doubt/shame/self-hatred can feel like unbearable thorns. But part of what makes this the case is the lack of distance between the perception of the feeling and the person’s judgments on it/themselves.
Another part of the immediacy of pain is the way the pain is followed instantly by a demand for action, for relief. The equation is: pain followed by Do Something. This makes sense when referring to a physical thorn. But human pain, however immediate, is much more like an interpretation than a thorn. Sadness/anxiety/terror/depression/guilt/doubt/shame/self-hatred are all understandings of one’s situation.
If seen this way, the appropriate response to pain is one in which these feelings are seen as having meaning and history, as being comprehensible, even if, in the moment, they are maddening, mysterious, even crazy-seeming.
In a way, the art of being a therapist is that of enabling someone who wants an answer and wants it now — pain followed by Do Something! — to pause for reflection. There are many ways to achieve this. One of my favorites is humor. I sometimes find myself remarking how strange it is that the clearly intelligent person in front of me has just done something he/she knows from experience will result in precisely the disaster they have just experienced (and, from which, they are now demanding immediate relief…) Often, this occasions the laughter of recognition, and a desire to make sense of how they could have been so “stupid.”
Of course, the heart of the therapeutic enterprise is understanding, and the changes that come about naturally when some event/feeling/stance/relationship is understood compassionately.
But many of the gains that come with understanding can arrive earlier, with the beginning of curiosity about oneself and one’s reactions. This curiosity fundamentally changes your relationship with your self. The more energy that goes into it — into thoughtfulness, wondering, and openness to spontaneous thoughts and impressions that accompany the pain — the less there is to go into self-criticism, self-hatred, and empty and pointless demands for action/movement (from yourself and the others who you take to be causing your pain).
Curiosity seems such a small and feeble thing. And yet, in my experience, for every ounce of energy that goes into curiosity, you get a pound of relief of pain. But, you don’t have to take my word on this. Try it! Spend an hour (or better a day) curious about your depression/unhappiness. Then see how this compares to a similar period of time in which you experience your pain as a thorn. I’d be interested to hear what you observe…