Had Enough Therapy?

Doesn’t the title of this article have a somewhat familiar conceptual ring? Dr. Richard Friedman, writing in the Atlantic, has entitled his article: “Plenty of People Could Quit Therapy Right Now.”

In fairness, the expression is clunky, about what you would expect from a physician. But, he could, if he had read more widely, have quoted my blog, entitled: “Had Enough Therapy?” Considering that I have been writing this blog since 2008, I have given members of the therapy profession enough time to consider it.

Anyway, I am slightly torqued to be ignored, but still. 

As it happens, Dr. Friedman considers therapy as a medical treatment. He sees patients as suffering from an illness. He sees therapy as a way to treat that illness. He suggests that after the illness is defeated or treated, all will be well. Thus, it might be a good time to leave therapy.

Somehow or other, he does not mention that Freud himself introduced the notion of interminable treatment in a late paper. The famed Viennese neurologist suggested that patients failed to complete their treatment because they refused to accept the higher truth of Freud’s interpretations. For Freud, it had nothing to do with being symptom free.

Be that as it may, Dr. Friedman fails to notice a certain number of complexities. Among them the recent studies about resilience, whereby therapists have discovered, for example, that a large proportion of people who have been molested or abused manage to get over their trauma without undergoing very much treatment. 

Of course, there are multiple therapies, offered by decidedly different practitioners. You have the touchy-feely therapists, the kind that will want you to explore your emotions. You also have cognitive and behavioral therapists, who address specific issues in few sessions.

As it happens, Dr. Friedman gets stuck on the analogy with medicine. He sees therapists as doctors treating illnesses. This effectively misses the point. While it is true that getting over the flu will allow you to get back into your life, the analogy does not hold true of therapy.

For example, he recounts a case where a patient has been engaging in small talk, using his therapist as a friend.

Instead of working on problems related to his symptoms, he and his therapist chatted about his vacations, house renovations, and office gripes. His therapist had become, in effect, an expensive and especially supportive friend. 

As though there is something wrong with that. The problem with the analysis lies in this-- for patients who feel alone and isolated, having another friend, one in whom you can confide when necessary, is worth the trouble. If you only see such a friend when you are in trouble, you are depriving him of the tools he might need to understand how to deal with your problem. 

One needs to mention that small talk is an important social skill. If you use therapy sessions to learn how better to make small talk, that is not a waste of time.

Another objection Dr. Friedman makes involves what he calls tangible actions. This is a clunky expression. How many intangible actions can you think of? Doesn’t the Atlantic have editors?

Excessive self-focus—easily facilitated in a setting in which you’re literally paying to talk about your feelings—can increase your anxiety, especially when it substitutes for tangible actions. 

At the risk of being repetitious I would note that therapy should not be about expressing or even processing emotion. If you refuse to look at the specifics of your life situation and do not draw up a plan to deal with them, you are probably wasting your time.

If your neurotic or depressive symptoms are relatively mild (meaning they don’t really interfere with your daily functioning), you might be better served by spending less time in a therapist’s office and more time connecting with friends, pursuing a hobby, or volunteering.

Again, to repeat myself, learning to master the art of small talk in therapy might well be helpful in connecting with friends. The one does not preclude the other.

Therapists and clients alike, along with celebrities and media outlets, have endorsed the idea of going to therapy for extended stretches, or when you’re feeling fine. I’ve seen this myself with friends who are basically healthy and think of having a therapist as somewhat like having a physical trainer. The problem is, some of the most commonly sought versions of psychotherapy are simply not designed for long-term use.

You can solve that problem by not going to a therapist whose techniques are designed to be short term. As for thinking of a therapist as a physical trainer, what is wrong with that?

As you go through life, regardless of how good you feel, you will be encountering numerous situations that you may need to examine with someone who offers counseling or even coaching. Business executives have executive coaches. People who hold responsible jobs often bounce their ideas off of counselors. Admittedly, the people who perform these tasks are not whining about their feelings, but that simply shows that therapy, as it exists today, is not very useful or effective.

My rule of thumb is that you should have minimal to no symptoms of your illness for six months or so before even considering a pause.

As I mentioned, Dr. Friedman is wedded to the medical analogy. Surely, it is not helpful to consider patients to be sick, needing medical treatment, possessing symptoms. At times, people are overwhelmed by a complex set of circumstances and are unable to deal with them without guidance. 

Mental illness is not like having the flu. Dr. Friedman can whine about how cure will allow people to thrive-- whatever that means-- but there he has merely trafficked in one of the greatest misconceptions of therapy. That would be, as soon as you are cured of what ails you, whether by overcoming your depression and anxiety, you will naturally know how to conduct your life constructively. Nor will you automatically know what to do and what not to do by resolving your infantile attachment issues or overcoming your childhood traumas. If you have been getting it wrong, and if getting it wrong has isolated you from others and produced a depression, overcoming the depression will certainly not show you how to get it right.

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