Scenes from the World of Therapy

We feel duty bound to keep a finger on the pulse of therapy. We are naturally interested in a disgruntled therapy patient’s letter to CarolynHax in the Washington Post. I will assume, for the sake of argument, that the patient is a woman. I trust that you will agree.

Herewith, the letter:

How do I get the "most" out of therapy? I want to start feeling and living better ASAP, and I know it's a process so I'm trying to be preemptively patient. But the two other times I've visited therapists, I feel like everything I never talked about in childhood jumped to the surface. None of it was relevant to what I was experiencing at the time.

I'm in a pretty low place right now, and I don't want to spend the first three sessions crying about my family dynamics. However, I'm not the expert! Should I just trust the therapist to navigate to the root of the problem?

In the old days everyone would have accepted unthinkingly that the purpose of therapy was to uproot the root causes of problems. That meant, talking about childhood trauma and development issues. Therapy has always imagined that the past repeats itself in the present and that escaping the past will magically allow patients to deal with their present problems.

It was a lie. It was a stupid lie. It did not work. Still and all, the letter writer has managed to find several therapists who cling to this lie, and who want to discuss matters that are not relevant to current concerns. She seems to understand that discussing the past will not magically lead her to negotiate the difficulties of everyday life. 

It would be like saying that you will find the right move in the chess game by regressing to infancy and recalling the bad mothering you received.

So, I am with the patient, and not with the therapists who continue to practice this way.

Hax has a more therapeutically correct opinion. She wants the patient to tell the therapist that she does not see the value in rehashing past traumas. Thus, Hax advises the woman to criticize the therapist's approach. How well do you think that that will be received?

Dare we mention, and perhaps even underscore, that cognitive and behavior therapies, now in the ascendant, do not pretend that your past life determines your present conduct. From the time of Aaron Beck, cognitive therapists have rejected that form of causality. It is not an accident that more and more patients are seeking out cognitive therapists… or even coaches.

Hax rushes to the defense of therapy, perhaps because she is prone to defend the institution. Perhaps she does not know any better:

Get the most out of therapy by saying stuff like this to your therapist out loud, upfront. If you get knocked off your point easily when the conversation changes direction — common problem — then either say that right away, or write it down and hand it over.

It’s okay if that feels weird. It’s therapy! It’s safe to be weird.

And, apologies for overstepping: If your past keeps resurfacing, then maybe it is connected to your present distress.

Certainly don’t “trust the therapist” to know intuitively what you need; be vocal about your treatment goals. From there, do trust the therapist to find a path for you, but speak up as needed.

Last thing, a general comment: The way to get the least from therapy is to hold back. Tell! The! Truth!

Good for you for getting the help process started. That can be the hardest step.

At times, there is nothing wrong with holding back. At times, being overly garrulous is a bad idea. Of course, the defenders of therapy have made a fetish of truth telling. They insist that they only want patients to do so in treatment. Yet, once you tell people always to tell the truth, and that it’s therapeutic to do so, they are very likely to follow the rule outside of treatment.

Hax does not understand that when a patient says that she does not want to forage through her buried past, many therapists will accuse her of resisting the truth. They will say that she is afraid to face the truth. They will not simply allow the patient to discuss things that the patient cares about. They do not allow patients to question their authority. And they do not allow patients to tune out of their mental processes in order to deal with real world problems. From the time of Freud therapists have bullied patients into getting out of their lives and into the fantasy world of therapy. 

Keep in mind, most therapists would not know how to help a patient to negotiate a difficult and complex moral dilemma. Their bailiwick is feeling. Their expertise runs from recovered memories to fantasies to dreams to desires. They do not know how to deal with reality because they do not know anything about reality. Thus, they are obliged to pretend that cleaning out those childhood memories will naturally and automatically make you a great negotiator or a great chess player. It is a ruse to dupe the gullible. The patient is correct not to fall for it.

Even if, as another commenter on the Hax site notes, you tell your therapist what you want to discuss in session, the therapist will most likely want to show you how your present dilemma repeats a past trauma or some such.

Then, a real therapist writes in to offer a more cogent piece of advice:

If they think the only way to deal with the present is a long psychological study of your childhood, then they are not the one for you. There are plenty of therapies that are solution-focused for the here-and-now.

Good news indeed.

Of course, there’s one in every crowd, so one person writes into Hax to explain how her awareness of the past cured her of her depression.

She writes:

I was suicidal for my entire life, until one day I suddenly realized my mother wanted me dead. As soon as that thought hit my gut, the suicidal feeling stopped. I had internalized her desire to kill me into my "desire" to kill myself. Twenty years of therapy with two highly recommended therapists didn't budge the core issue, my being suicidal, an inch. Because all the current stuff really reflected one core, deep, yet-to-be-realized issue.

If you start talking about your childhood the moment you get to the therapist's office, stop trying to force the "current" stuff. What's current is whatever is blurting out of you the moment you get to talk.

How much credence do you want to grant to this testimony? It is bizarre, to say the least. The woman—I am assuming that she is a she—spent two decades in therapy and remained as suicidal as she always had been. Yet, she was also alive, so let’s not be too critical of these highly recommended therapists.

And then, apparently, she had an epiphany. She recognized that her mother wanted her dead. At that point, the clouds lifted and she stopped feeling suicidal. If it sounds too good to be true, it probably is. We know nothing about this person. We know nothing about what is happening in her life. We do not know where she is from or where she is going. That is, we do not know what else in her life that might have led her to cease wanting to commit suicide.

Thus, this is anecdotal, no more and no less. Without possessing any special expertise in the latest suicide prevention therapy, I am convinced that waiting for an epiphany about your mother’s desire to kill you is not on the list of cures.