Category Archives: Psychotherapy Process

Why People Often Choose Misery Over Change

Human beings are constantly faced with making the choice between two paths: One path that keeps them in the safe and comfortable straits of what they know, and another that entices with a different way of being, less restricted and more promising.

Which way should I go? Should I stay in my comfort zone or venture down the path of novelty?

This question becomes heightened for every person who chooses to come to therapy.

The Price We Pay for Staying Safe:

The decision to see a therapist is by definition the decision to heed the murmur from deep inside that begs of the person to leave the safety of the familiar and take a turn towards something new.

Why does the person want to do this? 

Because the familiar, for all its safety, is often also a great source of suffering.

A few examples will illustrate this:

  • I live most of the time in my head where I can plan and feel in control of my life, but this is also my curse, for I cannot really surrender to my feelings and cannot really feel much passion or excitement in my life.
  • I live most of my life in the pursuit of achievements so I can finally become popular or accepted by others, but this relentless striving is also the source of my sense of being a failure and not being good enough or lovable just the way I am.
  • I bottle up my emotions and consider sadness and the need for others a sign of weakness, but this also keeps me isolated and alone and causes anxiety whenever my sadness is never far around the corner.

In these examples, the Faustian bargain to preserve my integrity, my self-esteem, my pride, or my security, came at a price and this price is what brings me to therapy:

I am not happy, I am not at peace with myself, I worry about unknown threats from the inside, or look around me and find that my life looks more restricted than that of my friends or my neighbor.

I am growing tired of the price of safety. My desire for growth and for change now has the upper hand.

Why Do We Often Choose Misery over Growth?

However, as I enter the therapy room, my sense of safety comforts me where novelty frightens. I feel new things, but these feelings are strange and alert me of a danger. My therapist gently asks me to get out of my head and into my body where feelings live, and I all of a sudden feel out of control, unsure of my direction, and vulnerable to harm.

I start to think, maybe my Faustian bargain was not so bad after all. The path of novelty is filled with dragons. Better the devil I know!

It is tempting at this moment to retreat and to make peace with a lesser life.

As the Danish existentialist philosopher Soeren Kierkegaard rightly says in one of his essays:

“In addition to my other numerous acquaintances, I have one more intimate confidant. My depression is the most faithful mistress I have known — no wonder, then, that I return the love”

Kierkegaard’s depression, like my anxiety, or your deadness have been the bedfellows of our lives. For all the misery they bring to us, they are after all compromises intended to ward off something worse, and protect us from the dangers of a life without them.

Sound strange?

Well, it is more logical than one would think.

Why Are We Reluctant to Give Up Misery?

Every person who comes to therapy has an innate need for self-preservation and an innate need for growth.

The need for self-preservation got activated early on in life to help us deal with unpleasant experiences and ruptures in our relationships with others.

We went into our head, numbed ourselves to sadness, or befriended our self-critical voice, because we needed to do so to stay safe and minimize the risk of harm.

However, now as adults, what we could not deal with as children or as adolescents, is no longer the same kind of existential threat to us, and yet we continue on with the same old coping that helped us survive when we knew no better.

Now in our therapy when our therapist wants us to venture outside our customary coping to see if the dragons are still there, we instinctively want to coil back and stay inside the cardboard box we have constructed to stay safe, but which has also become our prison.

We all Resist Change at Some Level:

In therapy, we have a word for this desire to sacrifice our growth for a life of a certain kind of misery. We call it resistance.

Resistance is not a conscious decision. It is the decision our organismic need for safety makes for us, even if we consciously complain of the very life patterns we secretly gravitate towards.

Resistance keeps us away from the real pain, the real fears, and the real sacrifices we have made, and thereby prevents us from having new experiences that would help us resolve old wounds and make us leave therapy transformed.

We all Want Change at Some Level:

Luckily, we have another voice inside, another striving or drive that will not be silenced and will continue to remind us that we are limiting ourselves, until we aren’t anymore.

Psychologist Diana Fosha has named it our transformance striving, and it is just as powerful of a contender as our resistance. If we don’t heed it, it will nag us like a kind of existential guilt, the kind that will make us filled with regrets about what we could have done or should have done when we look back at our life in old age.

How Therapists Help People Grow:

The role of the therapist is to appease the resistance while allowing more room for the transformance.

The therapist does so by providing enough safety and comfort for the person to attempt something new, and helps the person reflect on and experience the benefits of their little excursions outside their comfort zone.

They align with the transformance striving which gradually becomes loud enough to defeat the resistance.

When the resistance is no longer keeping the person stuck on the same fearful path that have limited their lives for fear that they could not cope with the alternative, the person realizes that they have more resources and capabilities than they previously thought.

They are now free to choose the path of growth over the path of safety at the cross roads of their lives.

At the Edge of Your Experience: How Therapy Creates Change

What happens in good therapy is hard to explain to someone who has not yet experienced it.

Why is that? Because the person who enters the therapy room often isn’t the person therapy will reveal her to be. Her very goals and definitions of who she is belongs to her pre-therapy self.

If she is like most people she is used to the idea that life consists of a series of problems to be solved. She views herself as a kind of processing machine that takes in information or challenges, uses logic and planning to tackle these challenges, and produces an output or performance. Her score card is life. She asks herself: Am I married? Do I have a good job? Can I deal with stress at work? Am I happy in my relationship? And if the answer is no, she extrapolates, it must be because she isn’t doing things right, isn’t using the right logic, doesn’t have the right attitude.

She feels like a machine that is broken; a person who cannot deal as effectively with life’s problems as the the next person. She feels deficient, lacking skills that others seem to have, and needing knowledge that will help her deal with life in ways that will make her feel effective and successful again. She needs to get fixed!

However, this is the person’s ego speaking: the ego who believes she is the queen of her own castle, who problem-solves, who plans, and who thinks she is in control.

Therapy, however, is not for the ego.

Encountering a Different Self:

Therapy does not focus on who you are and what you want. Instead it seeks to give you an experience of who you do not know that you are and what you did not know that you wanted.

Instead of focusing on providing knowledge about well-defined problems, therapy seeks to take you to the unclear edge of what you do not yet know. Here at the edge, your own experience can teach you something new. Here you can access feelings you had not previously been aware of, or rediscover fragments of your experience which you had previously forgotten.

Here at the edge of your own experience, you encounter a different you; a “you” that is larger and more complex than your well-defined ego, or image of self. And as you bridge this abyss between who you have been thinking about yourself as, and what you are becoming, change happens to you: Therapy becomes therapeutic.

Will You Trust Me?

It is hard to explain this process of metamorphosis to someone who thinks the solution to their problems lies in techniques, knowledge, or wisdom that they can receive and implement in some rational and planful manner. Because what I am saying, this part of the self cannot understand.

And so you must trust me enough to dare to leave your preconceived notions to the side. You must take me up on my invitation to speak freely, to speak what you do not want to say, to speak about that for which you have no words, that which is farfetched, childish, has no form, makes no sense, or is slightly beyond reach. And here at the edge, is where new experiences take shape; where the self is in the making.

The Role of the Therapist:

Your therapist is there to help you stretch beyond your own capacity, push you towards insights that is slightly beyond reach, notice where the body betrays a consciously held view, where the voice stammers, where emotion hides, or where novelty lurks.

Therapy is not the doing of the therapist, nor the doing of the client. It is the happening of the unseen, the unsaid, and the unfelt from a place “between” the two; the arising of something that neither could have produced on their own.

Therapy is also not the linear execution of a solution to a predefined problem. Change in therapy is not something you implement, it is something that happens to you. And it happens to you always from a place that was initially outside your awareness.

What is Good Therapy?

Therapy is therefore about welcoming in experiences that lead to a revision of previously held understandings or that help you discover something about yourself from a place that was not previously accessible.

Therapy is about growth, revision, becoming. It is about gaining contact with an aliveness and self-evidence in your own experiential depths that will change how you feel about yourself and who you can become.

We don’t know the answers, nor the outcome, before you enter therapy. Therapy itself is the pursuit of these answers. It is through therapy that the mysteries of your existence, of your choices, and of your hang-ups shall be unraveled. Not from a place of universal knowledge, but from an experience of your own personal truth.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, Texas. To read more about my approach to therapy, visit my website: www.bettertherapy.com.

 

5 Common Things People Say to Avoid Seeing a Therapist

The vast majority of people who are contemplating seeing a therapist will be marred by doubts and reservations that may ultimately get in the way of following through. Some of these concerns may be quite rational and practical, but others are typically roadblocks we put in our own way because we are afraid…

Resistances to Therapy:

Therapists have long referred to these rationalizations in defense of our fears as “resistances”. Resistance is an expected part of every therapeutic journey. What Freud determined quite early on is that people want change from a distressing situation, but are also deeply afraid of change and of the process that is going to get them there. A part of each person therefore actively – albeit often unknowingly -resists the process of therapy. These resistances often start before the person has even walked in the door and may prevent them from ever picking up the phone and scheduling that first appointment…

Here are five of the most common resistances people have to seeing a therapist and some reasons why they might be rationalizations that cover up underlying fears: 

1. I Should Be Able to Solve My Own Problems…

This resistance to seeing a therapist is quite common. Many people have learned that the hallmark of skillful and confident people is that they are able to manage life without relying on anybody else. They think they must be weak or inadequate if they have to see a therapist; that this means that they are not competent or skillful like everybody else, or that they can’t cope with life.

Fact is that underneath an overly self-reliant attitude are often deep-seated fears about depending on others. Many people develop the attitude that they must manage life on their own, because they are afraid that others would ultimately not be there for them in their hour of need. Reaching out to others and admitting that you need them can sometimes activate the feeling of becoming a child again who cannot fend for him or herself and who is utterly at other people’s mercy. Although we all have deep seated wishes to return to a state of being taken care of again, such wishes have often had to be squelched as part of growing up, and we may now judge ourselves as “childish” or “immature” for having them. And yet when we fall in love and develop strong relationships with others, we are confronted with the fact that these needs never went away. The ability to endure the vulnerability of depending on others is thus a necessary skill to have in order to form strong bonds and feel intimate with others.

It is now easy to see why some people may not allow themselves to even contemplate therapy. They don’t feel comfortable getting in touch with the child within and enduring the risk of rejection and let-down that comes with having to depend on others.

 2. Therapy is Too Expensive – I Can’t Afford It…

Finances are often used as a prime reason why therapy is not an option for a person. Sometimes embarking on therapy would truly be a bad financial decision, especially if you are struggling to meet your many financial obligations. At other times, however, concerns about finances may serve as a convenient way to appease certain underlying fears about the therapeutic endeavor itself. It is for example not uncommon to find that people will go on expensive vacations or remodel their kitchen, but not feel they can spare the expense to see a therapist.

Many times, a concern with financial means to pay for therapy conceals a variety of underlying concerns. These can include: guilt feelings about making yourself a priority, minimizing and deprioritizing your mental health, or resentments about the idea of having to pay for someone to listen. Many people are okay spending money on others, but feel uncomfortable with making themselves a priority. Therapy for them is the ultimate self-indulgence and may feel like a selfish need. Others, who feel quite okay spending money on material possessions like a new car, a new kitchen, or expensive jewelry, may not feel that spiritual things like their own mental health is of equal value. Finally, whether people admit to it or not, there is often some anger or resentments that people experience for having to depart with a treasured belonging (money) in order to get somebody to care or to listen. Rather than examine the variety of these concerns, it is often easier to chalk them up to the statement that therapy is simply too expensive.

 3. Seeing a Therapist Means I’m Crazy…

Many people find it difficult to square the idea of going to therapy with their need to feel normal. We have a very powerful social instinct that wants nothing more than to blend in with everybody else. We are afraid to stand out from the crowd in any negative way and we convince ourselves that therapy means that something about us is wrong or defective; that we have stepped outside of the acceptable limits of our society.

This resistance to the idea of therapy and what it must mean about ME or my self-concept is based on the illusion that “normal” people don’t need therapy. Fact is that every human being develops certain bruises to their self-esteem, experiences certain personal limitations in their interactions with others, and don’t know how to cope at various points in their life. Psychoanalyst, Nancy McWilliams, quips in her famous textbook to therapists, that the question to ask oneself is not: Am I nuts? But: How nuts am I? And nuts in what way?

People who go through life adhering to an illusion of normalcy can only do so by pushing their struggles to the side and pretending that everything is fine. Over the long term this actually produces more psychological distress than dealing with your issues head-on. Ironically, trying hard to be normal can be crazy-making, and allowing yourself to confront your irrationalities and “craziness” can make you feel normal again. Dismissing therapy as something that is only for “crazy” people is thus a way to express discomfort with who you are, and not acknowledging that it is human to suffer.

 4. It is Weird to Air My Dirty Laundry to a Stranger…

It is not uncommon for people to convince themselves that talking to a therapist will feel too awkward or uncomfortable. They might say to themselves that it is unnatural to talk to a professional about your problems, and that a therapist really offers nothing that a friend or family member couldn’t offer. In addition, they say, it is not comfortable to share their deepest darkest secrets with someone they hardly know and who doesn’t reciprocate by sharing something about their own personal life.

These resistances to embarking on a therapeutic journey serve as  deterrents to having to face one’s fears of opening up and becoming fully known to someone. One naturally feels quite “naked” and exposed when one is asked to divulge thoughts and feelings to someone who is not responding in kind. However, discomfort about opening up to a therapist is often about confronting one’s own shame about admitting to the full scope of one’s human emotions, thoughts, needs, and wishes.

The same qualities about the therapist that are often cited as deterrents to opening up, are also the qualities that ultimately allow people to go deeper into their issues and be more honest than they can be with a friend:

  • Because the therapist does not divulge much about their own personal problems, the client is free to focus exclusively on their own issues without having to be concerned about taking care of someone else.
  • Because the therapist is not part of the client’s life, a client can feel safe to genuinely express themselves without fear of repercussion for their everyday relationships.
  • Because the therapist is not a friend or family member, and has no self-interest in the client choosing particular actions over others, a client can discuss concerns without feeling an implicit pull to make particular decisions.

At the end of the day, the therapeutic set-up, while initially a foreign concept, actually ends up making it easier rather than harder for a person to share their thoughts and feelings freely.

 5. It Will Be Awkward if I Don’t Like My Therapist

Some people may hold themselves back from scheduling an appointment because they don’t want to get themselves into a situation they can’t get out of. They may be concerned that a therapist won’t be right for them and that it’s going to be uncomfortable to tell their therapist that they would prefer not to come back.

These kinds of fears of getting stuck in a bad situation often hide over discomfort with assertiveness and ultimately with anger and aggression. Some people feel that they would hurt their therapist’s feelings if they truly expressed their mind and feel like their only choice is to go along with whatever their therapist is telling them so as to not incur their therapist’s wrath. This of course leads to fears of being swallowed up in the relationship and losing one’s autonomy and independence.

It may be of great comfort to such people to know that therapists receive training in how to manage a client’s negative reactions, and that working through negative reactions is part and parcel of good therapy. Therapy is about creating space for clients to be themselves fully, which means creating space for negative as well as positive emotions. No therapy can ever be completely successful if a person has not been able to express and work through their anger, disappointment, fears, and frustrations as they pertain to their therapist as well as significant others. It is quite liberating to have the experience that one’s therapist can withstand one’s fury without retaliating or rescinding their support.

About me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I help people confront their fears and live more genuine lives. If you have fears and concerns about therapy that I have not addressed in this article, please feel free to send me an e-mail with your questions. For more information about the process of individual therapy click here.  

A Beautiful Truth: Why Good Therapy is Like Art

The Beauty of Therapy:

My many years of experience as a therapist have taught me that therapy is a beautiful experience.  People change by finding connections between memories, thoughts, and feelings, forming beautiful new patterns out of the fragments of their life.

Suffering on the other hand is ugly. It is a sign of a pattern that has not yet emerged, of a thought has that been severed from a feeling, or a feeling that seems isolated and without meaning.

Beauty has flow; suffering is disharmonious.

Good Therapists are Artists:

Good therapists are more like artists than technicians. They don’t seek to produce a predetermined outcome through their interventions, but seek to join with the client, to help the musical harmony of the client’s life come to expression.

I often think of myself as a jazz musician who has to jump into a musical piece that is already being played, the goal being to add a guitar string here, and add a drum there. I think of my therapeutic interventions as producing resonance, along the lines of French philosopher Gilles Deleuze, who said, “You should not try to find whether an idea is just or correct. You should look for a completely different idea, elsewhere, in another area, so that something passes between the two which is neither in one nor the other”.

What is needed in therapy is not an accurate interpretation of facts, but movement in a client’s capacity to think new thoughts and access new experiences. The words and observations of the therapist have to make new connections possible. The most skillful way to do this  is to insert a new element into the client’s speech or experiences that makes something resonate in a way that wasn’t possible before.

The therapist must hear something between the lines or outside of the client’s conscious awareness; something that has fallen outside of the structure of the clients conscious story line.

A client might be speaking in a way that repeats the significance of the word “eight”, which seems to pop up in multiple contexts unbeknownst to the client. The client has been in a relationship for eight years, the client likes the brand of mint chocolates After Eight, and the client complains of being overw-eight. The therapist hears the refrain that has fallen out of the clients awareness, and asks the client to talk about what happened around the age of 8. If this question resonates, the client will be able to access new important memories or feelings. Maybe his parents got divorced when he was 8. Maybe she was eight when her cousin sexually abused her. Or maybe nothing at all comes to mind, in which case the intervention would fall flat.

The point is that the therapist’s job is to listen for the music that is being played, and to re-introduce elements that might make new thoughts possible. When such connections are made, beauty or harmony is the result.

A Joint Master-Piece:

The therapist is not some master mind who offers universal truths and prescriptions, but someone who knows how to jam with the client. The therapist must receive the beauty from the client’s life story, and help the clients play their music.

Good therapy is never about applying eternal truths and knowledge to universal problems, but about creating something unique and new from out of the always particular elements of a particular person’s life.

As a result, good therapy happens not as transfer of knowledge from the therapist to the client, but as a veritable co-production.

Therapy as Creation:

In therapy, as in life, there is no clear sense of the end goal from the outset. One must discover what is possible by being open to what happens. What happens is never something that can be predicted in advance; it represents a possibility beyond one we can control and plan for. Turning towards this “unknown” happening, and cultivating it by paying attention to it, is probably where the real work of therapy happens. It is where client and therapist each become capable of receiving something new, which they had not known before. It is the place of pure creation: therapy as art rather than science.

Therapy as art allows us to receive a future that is not conditioned by the past, and to envision new goals of which we were not in possession prior to the actual therapy.

If you would like to read more about the connection between therapy and art, read my article: On Cultivating the Therapeutic Moment. To schedule a therapy appointment please visit my therapy website.

 

Psychotherapy: The Shortest Distance is Not Always a Straight Line

In psychotherapy the shortest distance between two points is not necessarily a straight line. The laws of math that apply to the physical world often seem to be suspended in the therapist’s consulting room.  And yet the geometry of straight lines has an orderliness to it that makes it appealing to clients and therapists alike…

The Therapist’s Fascination with Straight Lines

Were you to peek inside most “behavioral health” agencies today, you would see the logic of straight lines applied everywhere. The fascination with geometric rationality is here so dominant, that you would be excused for wondering if their psychotherapists had a background in engineering, rather than psychology…

Psychotherapy in these settings has become a very rational and well-planned endeavor that is usually centered around a geometrical road-map, also called “the treatment plan”.

Guided by the dictates of the treatment plan, therapists in these settings are asked to first identify the client’s problem, next help the client set some goals, and finally devise a plan to most quickly and efficiently achieve those goals. From then on therapy is supposed to follow the plan in a straight line from start to finish. Any deviation from the road map is considered disruptive and tangential. It threatens the geometric principles of treatment.

In line with this approach you can hear well-respected cognitive behavior therapists (the engineers of the field) speak of “potentially therapy-disrupting behaviors” that include “attempts [by the client] to overly control the pace of topics of conversation during the interview” (Wright, Basco, and Thase). You can also hear statements such as: “One of the challenges in this treatment is to avoid getting distracted by discussions of other problems the client may be facing” (Safren). In short, we must straight-jacket the process to make it fit with the plan. We must shape the territory to make it look like the map!

Two Different Views of Psychotherapy

So what is wrong with this picture? To the rational mind, planning psychotherapy ahead of time and directing treatment with an authoritative hand toward definite goals can seem very intuitive and appealing. And yet, I would argue that it misses the point altogether…

Psychotherapy is not about getting somewhere that is known in advance. In fact, therapy is itself a process by which we discover where we want to go and what we want. To determine the goals in advance of the therapy is thus much like putting the carriage before the horse…

If we use the metaphor of a road-trip to describe what psychotherapy is, then we can perhaps compare the two approaches in the following way:

In the first more “planned” approach, we are trying to get the fastest way possible from New York to Los Angeles. We therefore take the freeway in a straight line to the destination, missing all the sights along the way. We end up in Los Angeles in record time, but have learned very little along the way. We have reduced the journey to a simple means of transportation to get us from point A to point B.

In the approach I advocate, we might also begin our journey toward Los Angeles. Instead of zooming past all the sights, however, we allow time to get off the beaten path and leave ourselves open to new experiences along the way. What might then happen is that we discover that we would rather go to Cleveland, or that it isn’t really so important to get to Los Angeles right away. Maybe it is more interesting to make a detour to the Grand Canyon, or to follow our chance encounters.  We may even decide that our whole enterprise has been a mistake and return back home.

I am speaking metaphorically here, of course, about the nature of the human psyche: Contained within us there are many unexplored territories, and many memories and experiences that can teach us something new about what we really want in life. Going in a straight line may therefore not be the fastest way to get where we ultimately want to be…

Psychotherapy and the Dance of Life

The irony is that when we plan psychotherapy too much, we miss out on all the key therapeutic moments. The real “stuff” of psychotherapy is not about getting to the destination, but about all the little surprises that happen along the way. The goal of psychotherapy is not to get us from point A to point B in the most direct way possible, but to help us undergo a journey where the destination itself can change as we discover new things about ourselves. In fact, even if we ultimately end up in the same place, from a therapeutic perspective it matters how we got there. If we took the freeway, likelihood is we bypassed all the realizations and all the emotional twists and turns that would have given us the true conviction that Los Angeles is where we need to be. We would have exchanged one place with another without being none the wiser…

The intellectual insight a person can have in session 1 can also be the one they ultimately end up with in session 20. However, it took the twists and turns of therapy, to make the person know what they knew, in their gut. To the outsider it may look like nothing much has happened, since after all the person is back just where she started. And yet to the person who did the traveling, this place is completely changed now, and it feels like she has made a quantum leap in her understanding of herself.

Trying to bypass the journey to simply get to the result is to mistake intellectual insight for an emotional experience of truth. It is to cut out the “therapeutic middle” which is where all the action happens…

On this point, I am reminded of a very insightful video, based on the teachings of Buddhist philosopher Alan Watts. In the video we are shown how a linear pursuit of higher and better accomplishments ends up being a failed strategy in the end. Once we arrive at the promised destination, we realize that there is always another goal to be accomplished. Once we finally reach the top of the mountain in our final age, we discover to our dismay that all we are really left with is a sense of emptiness and hollowness; a bitter realization that it was all for naught…

Why? Alan Watts reminds us: Because life wasn’t about getting anywhere. It was about a dance. The point of a dance, as with a musical piece, is not to quickly get to the end. It is about the dance, and about the music. Therapy is also a dance, and if we get somewhere too fast, we might just end up missing the point…

To read more about the perils of a rational/planning approach to  psychotherapy, download my article: Cultivating the Therapeutic Moment: From Planning to Receptivity in Therapeutic Practice.

About me: I am Rune Moelbak, a psychodynamic therapist in Houston, Texas. Click here to visit my website.

Sources:

Safren, S. A., Perlman, C. A., Sprich, S., & Otto, M. W. (2005). Mastering your adult ADHD. A cognitive-behavioral treatment program (Therapist guide). New York, NY: Oxford University Press.

Wright, J. H., Basco, M. R., & Thase, M. E. (2005). Learning cognitive-behavior therapy. An illustrated guide. Washington, DC: American Psychiatric Publishing.

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