When people come to therapy it is usually because they have identified some behavior, some feeling, or some aspect of their life which they find problematic and want to change.
Yet psychotherapists have long known that clients usually resist the very changes which they consciously claim they want.
For example, I know I should not procrastinate in school or at work, but even though I can list all the rational reasons why procrastination works against me, I still cannot simply make a rational decision not to procrastinate anymore.
Resistance to Change:
In therapy this force within me that is working against myself is referred to as my resistance.
My resistance confronts me with the fact that I am not always the master of my own house. It tells me that all the logic, reason, and will-power in the world often isn’t enough to bring about change. It reveals to me the presence of motivations within me that do not fall under the purview of my rational self.
These motivations that work against me oftentimes do their work outside my conscious awareness. They are not parts of my personality, which I identify with. It is this that makes them my most formidable adversary, for how can I win a battle against forces that are mostly invisible to me?
The Benefits We Derive from Symptoms:
The part within a person that resists change is considered by psychodynamic therapists to be motivated by secondary gain. It derives comfort from the very symptom the rational part of me wants to get rid of.
When looked at from the perspective of the rational mind this of course does not make any sense. Why would I for example not want to stop procrastinating? What possible benefit could I get from sabotaging myself?
The secret to understanding this conundrum is to begin to unlock the unconscious logic that makes procrastinating a successful bulwark against greater fears or threats to a person’s psychological safety.
Could it be that I am afraid to succeed because I at some level don’t believe I am worthy of success? Could it be that I am afraid that if I truly try and ultimately fail, I will get affirmation of this fact? Or could it be that a part of me resents the fact that I have taken on a career or a field of study which I thought would make my parents proud, a fact that I cannot openly acknowledge to myself, or which would require me to live with the guilt of openly disappointing my parents?
From the perspective of the unconscious, these would all be excellent reasons to procrastinate. My resistance to change is here the last bulwark against an unconscious and unacknowledged conflict, which must be kept out of my awareness to spare me much psychological turmoil and anxiety.
Keeping Unconscious Conflicts at Bay:
Oftentimes when we seem to not be able to wrest ourselves free of a depression, or change a self-destructive habit that keeps us stuck, it is because of the presence of an underlying unconscious conflict, which motivates us to resist a change to the current status quo.
Although being depressed, for example, is pretty miserable, it is often unconsciously preferable to being assertive and risking other people’s rejections or wrath, or confronting the realization that I need to change career or get a divorce. Depression sometimes keeps me from drawing the unpleasant conclusion of a realization that would cause too great of an upset to myself or to others.
It is often safer to stick with the devil we know.
And so it is that approaches to change that only address the conscious rational side of a person are almost always destined to fail. Although willpower and logical reasoning can get us far in life, they cannot win the battle over our secret fears and unacknowledged conflicts. To truly change oneself is thus ironically to first truly accept oneself: to honor our resistance and let our resistance reveal its logic to us, which means to become more aware of who we truly are and what is truly motivating us not to change.
Perhaps we should become a little more like Soeren Kierkegaard who instead of declaring warfare on his symptoms, acknowledged with a degree of self-compassion: “My depression is the most faithful mistress I have known — no wonder, then, that I return the love”.
About me: I am Rune Moelbak, Ph.D., a psychologist and psychodynamic therapist in Houston, TX. To read more about my approach to therapy, please visit my website: www.bettertherapy.com
One of the most frequent objections I hear as a therapist, is the objection by clients who don’t see what the point is of re-experiencing unpleasant memories and emotions from the past.
“How is feeling sad going to help me?” they ask.
Or: “How is getting angry at people in my life who mistreated me really going to serve me?”
Here is my answer to their concerns…
The Desire to Be Rid of Negative Emotions:
Anger, sadness, loneliness, emptiness, despair, grief; these are all emotions that many people don’t know what to do with, and would most of all like to dump in a dumpster or bury deep underground.
And so they typically do…
They try to quarantine pockets of unpleasant experiences from the rest of their life, and spend much of their time trying to actively repress, ignore, rationalize, or minimize how they really feel.
Why Emotions Should Not Be Pushed Away
Of course emotions don’t go anywhere just because we don’t want to feel them. The more we fight them, the more havoc they generally wreck on our lives:
You don’t want to be overcome by grief at the passing of your beloved mother, so you push your grief away. Now the grief instead becomes a depression and the loss, which can never be mourned, a perpetual companion rather than a passageway to a better place.
You don’t want to feel angry at your parents for the mistreatment you felt as a child, so you tell yourself it really wasn’t that bad. Now instead your unexpressed anger interferes with your ability to have a REAL relationship with your parents, or gets pushed down so far that when it finally erupts, it erupts as rage.
You don’t want to get in touch with the loneliness and emptiness that haunts your marriage, so you try to distract yourself by going on expensive trips, redecorating your house, or having another child. Now instead the emptiness becomes a perpetual hollowness, and the lack of satisfaction in your marriage the cause of a manic frenzy of activity that never quite fills the underlying void.
The Price We Pay for Ignoring Our Emotions:
As a general rule the more we fight our emotions, the bigger and “badder” they become. If we don’t allow ourselves to feel them and to hear what they have to tell us, they will keep haunting us until we finally get their message. Fighting them is a losing battle and we always pay a price for denying their reality.
As long as we are not at peace with ourselves, but must deny aspects of our emotional reality in order to feel good, a sense of genuine happiness, calmness, and self-acceptance can never take root.
By getting rid of the “bad”, we also ironically get rid of the “good”.
Why? Because we divert our energy from a path of genuinely accepting ourselves, and replace it with a perpetual fight to deny the realness of our own experiences, which means denying the reality of who we are. Happiness constructed on such as a deceitful basis is not real happiness, but a flight from ourselves that can only lead to perpetual unrest.
The Benefits of Our Negative Emotions:
Contrary to what many people think, all emotions are adaptive and purposeful when experienced accurately and expressed appropriately.
Anger, which to many people can feel scary and unsafe to express, is a signal to us that our boundaries have been violated or that we feel mistreated in some way. If we allow ourselves to experience our anger, examine what boundaries might have been crossed, assess the accuracy of our evaluation of the situation, and express our concerns in a calm and constructive manner, our anger will have served its purpose. Our needs can now become known to others, disagreements can be resolved, relationships can be repaired, and we can command respect even when relationships need to be severed.
Sadness also serves a purpose. It tells us what matters to us, or alerts us to what we are missing. If we can allow ourselves to feel it, we will become wiser about our needs and longings, or the things we missed when growing up. Sadness can lead to self-examination, and can lead to greater acceptance of that which we cannot change. It can also lead to greater clarity about what we really value in life and how we should move ahead. When expressed to others in an appropriate way it can bring others closer to us, invite comfort and caring, and make us feel that we are less alone.
Emotions are Really Movements not States:
The myth about unpleasant emotions is that they are rather static experiences that simply take us over, dominate us, and keep us stuck. However, emotion is really more accurately described as a process or a movement. It is derived from the Latin verb “movere” which means “to move”.
Emotions help move us or motivate us, they give us direction, help us to clarify our thoughts and priorities, and serve as vehicles for making changes to our life. Only when we do not allow ourselves to move with them, do they become static road blocks: obstacles rather than passageways.
So to those clients who wonder, “why should I feel my unpleasant emotions?”, my answer is, “to let them move you to a different place”.
By moving into them, you move through them, and by moving through them, they move you to a different place.
By not fighting your negative emotions, you will be transported to the other side, where they no longer bother you, because they have now served their purpose and set you free.
About me: I am Rune Moelbak, Ph.D. a psychologist in Houston, TX who believes good therapy involves a transformation through your emotions. To read more about the process of therapy, visit my website.
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.
About 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.
The Past Never Lasts: Changing the Past from the Future
“The past never lasts”. Such was the slogan posted on a colleagues’ bulletin board, when I worked in a treatment center for traumatized adolescents. My colleague used it to remind her young clients that things might seem bad for now, but that any memory that brings pain is but a fleeting experience. Here today, gone tomorrow. The past, in other words, is always a viewpoint from the present.
However, there is another reason why the past never lasts, and that is that the past has not been written yet.
One of the hallmarks of being human is that events in time are not just something that happens to us. Their meaning has always yet to be determined, and that means that they are malleable.
If I look back at events in my life with regrets, wishing that they would never have happened, I do so from the perspective of today. However, something might happen tomorrow, or a year from now that will change the significance of those events or how I look at them.
Working with the Past in Therapy:
Sigmund Freud, the father of psychoanalysis, noticed this phenomenon in his work with therapy clients and referred to it as “nachtraeglichkeit”: Something that happens now changes what happened in the past. In English this is often referred to as “retroactive determination”.
To Freud this temporal phenomenon by which something that will happen changes what has happened is one of the key curative factors in therapy.
Therapy is not about rehashing old events. It is about encountering something new that you have not yet thought about or felt before. As your present awareness is enlarged or changed, new futures become possible. And with these different futures, the meaning of our past will change.
Changing the Past from the Future:
Existential philosopher, Martin Heidegger, believed that our future is defined by a “for the sake of which”, or a why:
Why do I get up in the morning? Why do I go to this particular job? To do what? To accomplish what?
When pursued to its end, this line of questioning will lead us through a series of “in order to’s” to an ultimate “for the sake of which” which gives us the final meaning to our existence: the reason why we do things..
Hence, I go to work to make a paycheck. I make a paycheck so I can pay my bills. I want to pay my bills so I can eat and have a roof over my head.
Actually I make more money than what I really need to pay my bills. My work is also a status symbol, a testimony to my worth as a person. It is important to me to be a good provider, not just for me but for my wife or for my children. It matters to me that they respect me, that they are proud of me. Without that admiration I might not have anything to give them and I would feel terribly vulnerable. Perhaps my wife might leave me, or my children would think of me as a terrible father. I might not really have the personal qualities that suffice to keep my family happy, so I must provide a different kind of material value. At my core, am I really lovable? Am I really worth staying for? Do I really merit attention and respect?
Now we are getting somewhere!
Beneath all the practical reasons for why I have to do stuff, there is a hidden for-the-sake-of-which to which I am enthralled.
This for-the-sake-of-which colors my entire past. It keeps memories present in my mind of not fitting in and not being good enough during my high school years. It makes recollections relevant of harsh criticism of my personality received in childhood. It provides me with a common denominator to tie together past examples of being left or rejected. “I am not good enough, or interesting enough” is the past which I am living out of from the perspective of this particular future which guides my actions in the present.
If we can change this future, if you can arrive at a new for the-sake-of-which, these elements of the past might no longer be relevant. A different perspective on yourself and on your future, will make new aspects of your past present, and will let others fall into oblivion.
This is the work that gradually unfolds in therapy. Therapy helps you change the past by changing your future, or giving you a new for-the-sake-of-which. This is just yet another meaning to the words, “the past never lasts”.
Psychologists in the field of psychotherapy like to engage in debates about scientific proof. Oftentimes this leads to arguments about which therapy has achieved the status of an “empirically supported treatment”…
An empirically supported treatment is a therapy that has been proven to work for a particular mental health condition. If you have received a diagnosis of social anxiety disorder, for example, an empirically supported treatment would be one that has been found to reduce social anxiety with a reliability higher than that of no treatment or an alternative treatment.
So what’s wrong with that?
To answer that question, we have to dig a little deeper…
The Mechanics of Empirically Supported Treatments:
The mindset that underlies the movement toward empirically supported treatments and the scientific quest for proof is a mechanistic one.
Therapy is perceived as a set of procedures the therapist “administers” to the client in order to achieve some predictable result.
For this to work, the therapist must agree to deliver interventions according to certain fixed procedures that show “fidelity” to the specific treatment that is being tested. The therapist, in other words, must simply become the tool or vessel for the treatment.
The client on the other hand must be reduced to the passive recipient of the “treatment”. It is not even clear that their subjective experience really matters. What matters is the “end result” or effect that the treatment produces. The client is, in other words, just a set of mental and physiological reactions that can be manipulated or caused in some predictable way.
In short, the philosophical underpinnings of the movement towards empirically supported treatments are mechanistic: The client becomes an object in the causal chain of action and reaction that makes up the physical world, and the therapist becomes the engineer who figures out how to induce change in the object.
Empirical proof in this model is found through observing or measuring mechanical changes in the client who after treatment may or may not feel anxious anymore, may or may not report feeling depressed, or may or may not function better in their relationship.
This kind of proof separates cause (treatment) and effect (results) and looks to some external reality for validation that the treatment has had a positive effect.
Why Therapy is not a Mechanical Process of Change:
In reality therapy is an interpersonal process where the therapist learns from the client, just as much as the client learns from the therapist.
The therapist will often entertain multiple hypotheses about the dynamics that could explain the client’s difficulties, but these can be overturned, altered, or refined based on what the client shares and how the client reacts to certain interventions.
The assumption that the therapist unilaterally administers treatment as some engineer aiming for a predictable result, is therefore flawed. Therapy is about learning, not about producing.
The sign of a good therapist is not the ability to be true to a certain therapy modality, but his or her ability to deviate and change course in response to what they learn from the client and jointly discover through the therapy itself.
This also means that the therapist cannot be guided by specific goals or predefined interventions, because what a client wants or needs, and what would be effective, changes depending on the moment and the context of each interpersonal encounter and each specific interaction.
Oftentimes what is therapeutic about therapy is precisely that it overturns previous knowledge and makes new possibilities and hypotheses appear.
A problem or disorder is thus not some “static” thing like a tumor or a bad tooth, but a temporary stopping point on a journey toward a much more complex understanding of various life issues that inevitably end up becoming the real “object” of the therapy.
Evidence of Change in Psychotherapy:
One of the biggest compliments I have gotten from a client was someone who told me, “the longer I keep coming here, the more uncertain I feel about what my problem really is”.
This client had initially defined their problem as a specific anxiety disorder, but was coming to the realization that anxiety is really shorthand for a host of unique and highly personal life experiences. It is not a “disorder” that calls for the administration of a specific empirically supported treatment, but a very personal sign of other life issues or problems which the person has yet to confront.
Good therapy helps clients dislodge themselves from preconceived notions of their problems and helps them discover needs and desires they were not aware of from the outset.
This also means that the empirical proof we are after is not some preconceived end goal to be measured only at the conclusion of the therapy.
When therapy goes well, goals and priorities change, problems get overturned, and new issues become salient. This dynamic process of change has to be allowed to unfold according to its own rhythm and logic, and should not be hijacked by a preconceived agenda or a heavy-handed attempt to steer the therapy in a predetermined direction.
The change in this kind of therapy is not external to the therapy, to be validated only by measurements or observations after the fact. Instead it happens as an immediate experience of something resonating in the here and now that changes the client’s view of themselves in a very real and irrefutable way.
This kind of therapy is not about fitting a client into a machine-like production of change, but about facilitating a personal journey where the benefits lie in the discoveries made on the journey itself.
About me: I am Rune Moelbak, Ph.D., a clinical psychologist in Houston, Texas. I treat people, not problems. To read about my views on therapy, visit my “about me” page, where you can also schedule a therapy appointment.
For consumers contemplating seeing a therapist, there are many types of therapy to choose from. One of the most widely practiced forms of therapy, is psychodynamic therapy. But what does psychodynamic therapy really mean?
What is Psychodynamic Therapy?
Psychodynamic therapy starts from the assumption that people are caught in multiple struggles between opposing demands, impulses, fears, and wishes.
A simple and humorous example of this can be found in the following cartoon, which illustrates the vicissitudes of the human psyche:
The person here is damned if he does – and damned if he doesn’t: A typical dilemma, in which we humans find ourselves…
He likes the freedom that comes with being an adult, and abhors the alternative, which would mean being a dependent child without autonomy and choice.
However with the pleasant realization that he is an adult, comes the unpleasant realization that freedom comes with responsibility. He is now parenting himself and has to set boundaries on his own desires. The price he pays if he transgresses is: guilt.
And yet, he fights back against his internal doubt and asserts his free will to do as he pleases…
But when he now chooses to eat his ice cream, he can no longer enjoy it without an intense feeling of shame for having done something wrong.
A Lesson in Psychodynamics:
This simple storyline, humorous as it may be, conveys very well what psychodynamic therapy is really about.
According to a psychodynamic viewpoint, we are often in internal battles with ourselves, having feelings, thoughts, and wishes that pull us in opposite directions all at once.
The result of being such a house divided against ourselves is a sense of anxiety and inner unrest, which only human beings can feel. Since this anxiety is such an aversive feeling to us, we will subsequently go to great extent to avoid it or to find some kind of solution that will silence the conflict within.
To solve our conflicts we will defend against one of the feelings so as to create psychological balance where there previously was none. The way we do this is by deploying psychological defenses that distort the facts of reality for the sake of keeping our inner peace.
Defenses against Internal Conflicts:
Our ice cream lover could attempt to defend against his anxiety in a number of different ways, each of which would reduce the conflict in some way:
He could subject himself to his own rigorous parental authority and create rules for how virtuous he has to be to truly earn his ice cream: “I will allow myself an ice cream only on my birthday, and only if I have achieved my goals at work”
He could take on the identity of a “rebel” and push away all respect for authority in an attempt to minimize his own “guilty boy” syndrome: “I am not going to follow any rules because authorities don’t know what they are talking about”
He could rationalize his sinful enjoyment, by looking only at the evidence against the validity of current research: “Health fanatics always change their mind about what’s healthy and what’s not. They will probably discover that ice cream is healthy in just a few years.”
He could also punish himself after enjoying his ice cream, so as to atone for his sin: “I am going to not eat for a week, in order to make up for my weight gain”
These are but some examples of how the human psyche works to help us resolve our internal conflicts.
The Price We Pay for our Defenses:
The bad thing about defense mechanisms is that they have to twist reality in order to make certain feelings, wishes, or thoughts go away. Hence, the more internal conflicts we experience, the more out-of-sync with reality we end up becoming. Gradually we come to live in a reality where certain feelings, wishes, or thoughts get dimmed, shunned, distorted, or repressed. We substitute a fictional reality for the real world in order to preserve our psychological safety.
Another bad thing about defense mechanisms is that if they are challenged in any way, the anxiety is looming right beneath them. This means that we often don’t really have a choice to act any differently than we do. Hence, we are forced to punish ourselves after eating an ice cream, because if we don’t, our anxiety, our guilt, or our shame will return. We are thus not really in control of our life, but are controlled by our desire to escape from unpleasant feelings which threaten to besiege us.
Our Conflicts Are Often Unconscious:
Most people who come to therapy don’t enter the consulting room with the understanding that they have unresolved internal conflicts. Nor do they know that the symptoms they are experiencing might be the result of defense mechanisms that serve to keep anxiety at bay. Instead they simply feel depressed, anxious, unable to enjoy certain things in life, or besieged by feelings of guilt, shame, or inhibitions.
The goal of psychodynamic therapy is to help people understand the dynamics underlying their most troublesome symptoms so they can begin to make sense of why they feel compelled to starve themselves for a week, why they can’t enjoy having sex with their partner, or why they have become depressed in their marriage.
Often at the first therapy session, symptoms such as these do not make sense, and seem entirely arbitrary.
This is good news for the medical profession, which is quick to jump on this to suggest that the cause is purely biological or brain-based, a conclusion which can seem quite legitimate to the person who suffers without reason.
It is also good news for cognitive-behavior therapists who can readily get buy-in for the idea that symptoms have no deeper meaning or logic, but should be treated as if they themselves were the problem.
Yet, when clients are helped to become curious about their life and begin the work of talking freely and openly about the full range of their experiences, more clues begin to appear that will eventually allow both client and therapist to discover an underlying logic of the distressing symptom.
An Example of Psychodynamics at Work:
A depressed immigrant from India initially entered psychodynamic therapy because his wife was not happy with him and was thinking about divorce. As his therapy progressed, it became clear that the client had defied his parents’ wish that he enter into an arranged marriage. Although the client initially experienced his choice for a love marriage as a victory for his own autonomy, it was as if another part of him continued to feel guilty about his choice and unconsciously acted in ways that sabotaged his love marriage.
From a psychodynamic perspective, the client was not simply being irrational or self-destructive. Instead he was trying to resolve an unconscious conflict between retaining autonomy and not upsetting his parents.
The solution he had found helped him equalize his guilt feelings, while at the same time preserving his conscious sense of autonomy. He was simultaneously choosing to be in a love marriage and choosing not to be in one, thus appeasing both himself and his parents.
To make this solution viable, of course, he had to deny that he was pleasing his parents in any way. However, he also had to turn a blind eye to the fact that he was acting in ways that were destined to make his marriage fail.
His depression was a defense mechanism in the sense that it protected him from looking at his own subjective agency in choosing whether or not to make his marriage work. His despondency and perceived powerlessness helped him avoid confronting an underlying conflict that would give him anxiety.
Psychodynamic Therapy Helps You Get to the Root of Your Problems:
Psychodynamic therapy helps people uncover the conflicts underneath their symptoms so they can reclaim control of their lives.
In the case of the Indian spouse, discovering the underlying conflict would make it possible for him to confront his guilt feelings so he wouldn’t have to unconsciously punish himself by making his marriage fail. By increasing insight into his psychodynamic conflicts, he would be able to address the real issue underlying his depression and his marital problems.
The Effectiveness of Psychodynamic Therapy:
Helping people get to the root of their problems, is precisely what makes psychodynamic therapy such a powerful treatment.
Research on psychodynamic therapy shows that not only is it effective in helping people resolve their problems, it even continues to increase its benefits after treatment ends. Because it does not only focus on immediate symptom relief, but allows people to confront what motivates their symptoms, psychodynamic therapy helps people gain control of what causes their distress.
By helping people gain insight into underlying causes that make it difficult for them to enjoy their life, psychodynamic therapy works much like the old proverb that says, “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime”.
Rather than just feeding you a solution, psychodynamic therapy helps you get in touch with what produces the problem, so you can finally claim ownership of it rather than continue to pursue temporary “quick fixes” that only serve to cover the real problem up.
This is why I believe psychodynamic therapy.
About me: I am Rune Moelbak, Ph.D. a psychodynamic therapist in Houston, Texas. I help people get to the root of their issues. To book a therapy appointment, visit my website at: www.bettertherapy.com
The question followed the death of beloved actor, Robin Williams, who was reported to have been seeing a therapist for his depression in the period preceding his eventual suicide.
Robin Williams himself starred as a therapist in the award-winning movie Good Will Hunting, where his character touched the heart and mind of a troubled young man through the kind of talk therapy the article is wondering if might be disappearing.
Talk in talk therapy is of course a lot more than talk. It is about facilitating the kind of speech that evokes forgotten or suppressed feelings, and may never have been spoken before. It is creative or novel speech, not simply the rehashing of old events or the telling of stories. In and through speech people discover what they really think, just as is suggested by the expression: “to know what I think, I must first see what I say”. Speech, when it is therapeutic, or spoken from the right place, is a lot more powerful than we give it credit for…
We Are a Culture of “Doers”:
Unfortunately we live in a culture that does not value speech. The expression, “she’s all talk and no action” communicates that what matters in life is to act, and that thinking and talking are simply pre-stages to actions.
When Democrat John Kerry ran for president a while back, I remember with amusement, how Fox News spun his trip to France as an indicator that he was an “intellectual” not a “doer”. In America we don’t sit around thinking lofty thoughts like the “French”, the newscasters suggested, we “get things done!” Ludicrous as this spin was, it likely struck an emotional cord with most Americans, who have been brought up in a highly competitive capitalist society and have been taught to value productivity and accomplishment above all.
This kind of action-orientation has also found its way into the field of mental health. The popular understanding of problems of living is that they can be mastered just like another work-assignment. Barnes and Noble is full of self-help books that promise amazing results through easy steps and suggestions for whipping oneself back into shape. They espouse the idea that thoughts can be “engineered” and that you can choose to act differently through various mind-tricks.
The Engineering of Depression Therapy:
This mentality has of course also found its way into the ranks of therapists who are quick to embrace this popular view of psychology as a toolbox of tips and tricks to master one’s issues. Undoubtedly driven by a popular demand for this kind of solution- and action-oriented approach to problems, therapists have been eager to adopt a new line of “technical” treatments for mental health problems.
CBT or Cognitive Behavior Therapy is quickly replacing the kind of relationship-based “talk therapy” that helped the character Will Hunting confront his depression. Therapists eager to meet the popular demand for quick solutions, and training programs eager to turn therapy into a technology, have rushed to embrace this newer more modern alternative to traditional talk therapy. Research studies are often touted as showing the superior benefits of CBT, and psychiatrists now prescribe it, like they prescribe a pill.
The Problem with CBT for Depression:
Unfortunately, the kind of therapy that benefitted Will Hunting, would not have been accomplished through CBT. A person does not experience a transformation in how they feel about themselves by filling out worksheets, or approaching their problems by becoming more rational about them.
The cure of Will Hunting was an emotional cure. Robin Williams was attuned to Will Hunting and was able to work with him so that Will was able to speak new words, and speak them from a new place within.
This new place within has to be accessed and discovered in and through a gradual and unfolding process, where a person first has to become vulnerable. Will had to trust his therapist, not by some rational command to do so, but by having a new experience of relating to another human being.
In the process of deepening his trust, Will had to be made aware of all the barriers to letting his guards down, including his fears of his emotional pain, his anger at others, and a host of other feeling and reactions that this kind of therapy process evoked in him.
And of course, along the way, Will had to speak of these new or sometimes “old” (but forgotten) experiences so as to make them part of himself and part of his own spoken reality.
Our Reality is Made of Words:
As cultural beings, we live in our words. Our human reality is a spoken reality: a reality of meanings brought forth by words and ideas.
Existentialist philosopher, Martin Heidegger, talked about language as “the house of being”. By this, he meant that language gives our ambiguous reality a kind of permanency that we are able to live within. This kind of permanency can consist of a “common sense” understanding of the world, that we are not even aware of, but that we take for granted when we approach ourselves as a technical machine in need of a quick fix, or think of our problems as “issues” that should be managed, mastered, and controlled.
Will, however, needed to let go of control, not increase it, and he needed to speak from a place that was different from the place he inhabits in his day-to-day life. He did not need his issues to be turned into problems to be mastered like another work-assignment. He needed space and patience, so he could begin to hear the voices of his subdued and suppressed feelings. He needed therapy to be an experience, not a set of procedures or dictates convincing him to be more rational or act opposite to his feelings. He needed to stop “doing”, and start “listening”. He needed to let go of his need for mastery, so he could begin to receive a different wisdom from within.
The Best Therapy for Depression:
The kind of talk therapy provided to Will Hunting is in my opinion the superior therapy for depression.
Depression may temporarily be mastered through consciously challenging and rectifying irrational thoughts, but it cannot be cured until the emotions fuelling the irrational beliefs are experienced and reworked in and through the therapy.
What motivates us to act is not simply will-power and logical understanding. We are driven to act and to repeat patterns in our relationships by our feelings, not our thoughts.
CBT rests on the assumption that feelings are simply the bi-products of ways of thinking and that a conscious choice to think differently will also make us feel differently.
I believe this way of thinking is overly simplistic. Most times people can quite readily see that their depressive thoughts are quite irrational, but that does not change a thing. Simply telling somebody or telling oneself that one’s thoughts or feelings are not rational, or replacing them with a more rational alternative, does not have the power of conviction needed to truly transform how we feel about ourselves. The goal of therapy should therefore not be to increase mastery of our feelings through our reasoning. Instead it should be to bypass our reasoning altogether, so we can effect change directly at the emotional level.
Why Talking May Be Disappearing from Depression Therapy:
The problem with the kind of therapy “Will Hunting” received for his depression is that it is hard to sell to someone who has not yet experienced it. It is a bit like describing how great a hamburger tastes, or telling somebody how thrilling a roller-coaster ride will be, to somebody who has never tasted a hamburger or been on a roller-coaster ride. To truly understand it, you must experience it, and until you have, it won’t make much sense.
In addition, because people don’t understand talk therapy until they experience it, they don’t know to ask for it, nor do they even know they want it. This makes it a much harder sell than CBT, which readily fits with our common sense understanding that our problems are best solved by will power or by technique.
And yet at the end of the day, Will Hunting was transformed, not by doing, but by slowing down and getting in touch with something stirring within. His was a talking cure , not a technological intervention.
Many people who are considering therapy for their psychological difficulties, may wonder how effective talking about their problems is really going to be… So let’s examine the question: Does therapy work?
What’s Wrong with Talk Therapy?
The concern about whether or not therapy works, might not be assuaged by reading a recent Time Magazine opinion piece, that questions the legitimacy of longer term talk therapy. In the piece, entitled “The Trouble with Talk Therapy”, neuroscience journalist and author, Maia Szalvitz, argues that most therapists have no clue about the latest and most effective treatments for common psychological problems. Instead they want to “go deep” to uncover unconscious feelings and motivations, which she says, has not been found to be effective in treating problems like Obsessive Compulsive Disorder, Depression, Anxiety, and Post Traumatic Stress.
The problem, she says, is not that effective treatments don’t exist for these problems, but that therapists either don’t know of them, or choose not to make use of them. She cites Alan Kazdin, who is the former president of the American Psychological Association, for saying that “Most of the treatments used in clinical practice have not been evaluated in research. Also, many of the treatments that have been well established are not being used.”
As a result, Szalavitz claims, she has a hard time knowing where to refer herself or her friends for effective treatment, for as she concludes, talk therapy has an “evidence” problem…
What’s Wrong with Szalavitz’s and Kazdin’s Argument?
Psychological distress cannot be separated from who you are as a person:
Szalavitz and Kazdin are asking the right questions, but on the basis of a wrong understanding. Their assumption is that psychological problems are “disorders”, and that “disorders” can be treated like one treats a medical illness. Hence there should be one best treatment for depression, one best treatment for OCD, one best treatment for anxiety, and so forth.
The problem with that understanding is that it is based on ignoring the subjective meaning and function of our psychological distress. What makes a problem psychological is precisely that it involves the life of the person. This means that I can be depressed for different reasons than you and that your obsessions and compulsions can serve a different function in your life than they do in mine. OCD and depression are therefore not phenomena that exist in some objective reality where they can be treated using some standard method that gets applied the same way to each person. Instead they are surface manifestations of underlying psychological conflicts and issues that are highly particular to each individual. If we want to get to the root of the problem, we must therefore make these particular conflicts and issues the real focus of the therapy.
Psychological issues are intertwined, not separate from each other:
Szalavitz and Kazdin also make another mistaken assumption. They believe that problems like anxiety, depression, obsessions, and compulsions exist independently from each other, making it the case that one can focus treatment on a single problem and select the best treatment technique for each problem.
In actuality, however, most people who come to therapy have a variety of psychological issues that cut across identifiable “disorders”. They bring their life to the therapy, not an illness. Any therapist is likely to agree that the longer one works with a client in therapy, the harder it becomes to provide a diagnosis. As the complexity of our understanding of our clients increase, so does the inadequacy of any particular label or diagnosis. People are first and foremost people and as they expand their own understanding of the interconnections between their symptoms and themselves, the need to localize and separate their problems from who they are as people tends to disappear. As the now deceased Dutch psychologist, J.H. Van den Berg, has pointed out, people come as wholes, not as fragments, and one cannot focus on a single area of a person’s life without implicating all the others. One cannot lift the corner of a carpet, without lifting the whole carpet…
Psychotherapy focuses on subjective truth, not objective knowledge:
A third mistake Szalavitz and Kazdin make is that they fail to appreciate that there are two different truths and realities in life. Science deals with objective truth and objective reality. It deals with “facts” based on unbiased observations and treats these facts as universal truths rather than contextual truths.
Psychotherapy, however, deals with subjective truth and subjective reality. Subjective truth and subjective reality are not a lesser truth or lesser reality. In fact, our subjective experience is often what is most instrumental in motivating our behaviors.
To illustrate the difference, let me provide an example: If a male client can’t grieve the death of a close friend, this is not because he is objectively incapable of grieving or crying, but may be because he subjectively believes that “real men don’t cry”. This subjective reality, which he may or may not be aware of at the start of the therapy, can explain his lack of ability to grieve. It also provides “evidence” for why he may objectively present as depressed. Natural grief that is being suppressed may turn into a heaviness that cannot be released and may lead to a lack of contact with vital emotions that manifests as symptoms of depression.
In therapy, however, the client may not initially be aware of this subjective belief, nor would the therapist know of it simply by looking at the client’s objective symptoms. The secret to understanding the client’s depression thus lies in a subjective truth that must be discovered, not in an objective knowledge that can be said to be universally applicable each time somebody shows up as depressed.
Why Psychotherapy Cannot be Standardized…
What Szalavitz and Kazdin don’t understand is that therapy is not factory work and is not about providing prefabricated treatments of objective problems. It is about understanding the unique subjective causes that motivate and explain surface level symptoms that may look the same, but have widely discrepant reasons for being. This means treating the “person”, not the “disorder”, for the person explains the disorder and not the other way around.
So Back to Our Original Question: Does Therapy Work?
I believe the answer is yes, but it works in a very different way than a coffee maker works to make coffee or an oven toaster works to make toast. It helps people discover their own subjective truths, and not simply to change a behavior. Following Szalavitz’s and Kazdin’s advise is to apply a logic that may very well work in the realm of machines and objective cause and effect, but is very ill suited for the likes of us…
About me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, Texas. If you are interested in learning more about how a psychodynamic approach can help you get to the root of your problems, click here.
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.
On my recent trip to Nicaragua, I learned at least two things: 1. That when looked at from a Venezuelan/ Nicaraguan socialist perspective, the US is a country of police brutality and moral decay, and that, 2. Spirit Airlines are not stingy with their amenities, they are just engaging in “frill control”. Funny how reality changes when you tell a story differently…
A Cultural Lesson on the Power of Story-Telling:
Nicaragua is currently a country that receives a lot of financial aid from the Venezuelan government, due to their mutual sympathies toward a kind of socialism practiced by the now deceased political leader, Hugo Chavez. For that reason, you can find posters that pay homage to the former Venezuelan in places all over Nicaragua. You can also, I discovered, watch unadulterated TV transmitted straight from Venezuela.
When I would settle in at night after a long day of sightseeing in the tropical heat, I would turn on the TV in my air-conditioned hotel room, and would find myself fascinated by one particular Venezuelan station and the entirely different world-view presented there.
The US was on this channel depicted as quite morally depraved. The evening’s news included a segment on police brutality against civilians in various places in the US, presented as if it were breaking news.
The news was followed by a theme show featuring all the wonderful socialist initiatives of the Venezuelan government: First you saw how many modernized apartments were being built through the decree of the government, and then coverage followed of other government initiatives: workers would now be able to pay fair prices on everyday goods due to government intervention, the environment was now being saved through nation-wide programs to plant trees…. The initiatives were seemingly never-ending…
Every segment introduced one hopeful initiative after another, and the clips were always of people doing things together – collectively – making political decisions about what kind of society and destiny they wanted. This was a society that valued people and community over and above raw capitalism, and it reminded me a little bit of the Obama campaign’s “Yes, we can!”, which had that same kind of optimist spirit, before it lost its fizzle.
After watching this Venezuelan station for just 30 minutes I was left with an indelible impression of optimism, although a part of me of course knew that this was quite a different spin on reality than the one I had typically been presented with. From a North American perspective, Chavez was always depicted as somewhat of a selfish dictator, and socialism, of course, always depicted as bad.
However, crossing cultural boundaries, not just geographically, but mentally, is quite eye-opening. It made me think of the power of stories as a mediator of the reality we experience, the emotions we feel, and the actions that become conceivable. It also made me think of the tendency of stories to hide their story-like nature behind a presentation of facts.
The Venezuelan news station was not consciously telling stories, but merely reporting facts, and many of the stories we tell in the US media, to ourselves, and to others, have that same pretension to transcend their story like nature.
The Story of Psychological Disorders
The idea of the unadulterated fact is, however, itself the product of a story: the story of the enlightenment or of science. According to this story, we can access reality purely as it is in itself outside of the logic of a certain story line and pre-understanding. And yet, as hermeneutic philosopher Hans Georg Gadamer has pointed out, even science takes place within a prior understanding of the world. There is never such a thing as approaching the world without making certain pre-judgments or assumptions about it.
A research study about the effectiveness of a certain therapy for Bipolar Disorder for example, may seem like it is only reporting facts (looking at quantifiable variables and measurements of probability), but it is assuming an illness model of psychological distress which is not itself part of what is studied. An illness model, of course, is a story about why people suffer that attributes the suffering to a disease process or cause underneath the actual life of the person, and is by no means the only possible story.
The medical or biological view of psychological distress has a particular strong-hold in our current North American and European zeitgeist. People are always wondering: Do I have ADHD? Am I Borderline? Do I have a psychological disorder? …As if assigning a label and naming one’s suffering as a generic underlying “thing”, solves the problem, and alleviates the discomfort of figuring out why I suffer in some more human or existential sense.
And yet, these “entities” which we like to label ourselves with are themselves largely the product of stories. What appears to be science and is presented in an officially sanctioned diagnostic manual (DSM) as if it were, is really the product of a political process of debating different research studies, naming conventions, and inclusion criteria. Psychological Disorders are voted into existence. The other side of a disorder is all the contentious opinions that had to be tabled in order for the construct to appear as an independently existing noun.
Therapy as Story-Telling
Rather than try to fit people into categories of a medical story, therapy offers a space where alternative stories can be told. Therapy as a “talking cure” is really about telling your own unique story. A person is helped to unearth memories, feelings, and experiences that sometimes pose challenges to existing stories, and require the reorganization of one’s understanding of oneself and of the world. The medical narrative is here often a hindrance that disallows people from pondering the idea that symptoms exist for a reason, that feelings contain useful messages, and that our bodies express that which we cannot yet say.
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And so it is that a trip to Nicaragua made me wiser about the power of the stories we tell and about the need to examine the stories we live as our own personal and cultural truths.
The Venezuelan government has their story…
Spirit Airlines has theirs…
What’s your story?
About me: I am a psychologist in Houston, Texas who likes to think outside the box and is committed to helping people find their unique personal truths. Read more by visiting my website.