Friday, April 01, 2005

What is therapy?

Ever since I decided to enter the field of marriage and family therapy, I have been struck by the great number of misconceptions that exist about MFT and therapy in general. Many people either think of the Freudian couch, which is very outdated and almost never used anymore, or they think of Dr. Phil, Dr. Laura, or some other pop-culture half-wit that tries to yell at and guilt clients into change. Nothing could be further from the truth.

Dr. Phil, for example, seems to have his theory down pat. Everything I've seen of him indicates that he can conceptualize a problem and pinpoint the reasons for difficulty, but his methods of "helping" the couple/family change are atrocious. He attempts to guilt, shame, and humiliate his clients into changing. This has been shown over and over as being completely ineffective at helping people change. (After all, isn't that often what they're already doing to try to solve the problem?) Normally, I would role my eyes and let it go and another example of sensationalism in the media, but I have found that Dr. Phil and those like him are influencing the way the public understands relational therapy and therapy in general.

So, I have taken it upon myself to thwart some of these misconceptions and describe what therapy is and more importantly what it is NOT. I understand that everyone's experiences in therapy is different, and many people have experienced the bad and little of the good aspects of therapy. That is unfortunate, but the points I am trying to make reflect what I belief are the goals of therapy. This is what I strive for as a therapist, and this is what the field as a whole upholds as what all therapists should do.

Therapy is NOT:

  1. Giving advice. Chances are that clients have enough people giving them advice. Therapists don't want to be one more. Even if others aren't giving them advice, raw advice probably isn't what they need anyway.
  2. Telling clients about themselves. I've often heard people say they don't want to go to therapy because "They don't know me, and I know myself better than they ever will." Of course! Thank fully, most therapists recognize this too. Any good therapist is not presumptuous to think that they know clients better than they know themselves. Therapists are trained in theory, technique and family processes, but the client is and always will be the expert on his/her own life.
  3. Directly trying to change clients. Even though many clients come to therapy wanting something to change, they are afraid of change, especially at the hands of a virtual stranger. Overtly trying to change the client is often counterproductive to therapy and is often resisted. While change may be an end product of therapy, only clients can change themselves. Therapy helps to motivate them to change and discover how and when they want to change.
  4. The client listening to someone "smarter than" himself/herself. Without getting into the misconceptions about intelligence in general, therapists are certainly no more or less intelligent than their clients on average. The fact is that we are all human with human failings. One such failing is that we all become somewhat short-sighted, fatalistic, and closed when it comes to our own problems. Therapists attempt to address this with clients (This is explained in greater detail below.), but this has nothing to do with intelligence. It's all about the therapist being able to see the problem in a way that perhaps the client has neglected.

Therapy is:

  1. Helping the client understand his/her life better. This isn't something that the therapist attempts to tell or show the client. It's something that the client discovers. Therapists are trained to help clients think about their lives in a new way, while the client is the expert on his/her life. The analogy is that of a dark room. You know the room; you live there; it is your life. Therapists are electricians who can find the light switch. We help you find the light switch so that YOU can turn it on and YOU choose what you want to do with the light on.
  2. Recognizing destructive routines that clients may get into. Our problem are often perpetuated by our attempted solutions, but we are too close to the situation to notice it (i.e. we can't see the forest for the trees). Consequently, we (and I include both therapists and clients in this) are short-sighted, fatalistic, and closed to potential solutions. It often takes the perspective of an unattached third party (i.e. a therapist) to help us see the problem and the potential solutions in a new way. Therapy helps clients step back from the situation and get a better perspective on life. We take the blinders off the horse. Only the client sees what the client sees, and only the client can choose what to do when the blinders are removed, but we usually can't remove the blinders ourselves. Therapist, though, can help.
  3. Providing a framework to understand the patterns and processes of clients' life experiences. We, as emotive human beings, experience feelings based on the way we interpret of our experiences. While those feelings are important resources and adaptive responses, they can sometimes cloud how we think about our experiences. As continue to have difficult experiences, we begin to see everything with the expectation that the difficulties will continue. Consequently, they often do. Because of the lack of proper perspective, though, we are often blind to the patterns of our lives. We have achieved a sort of comfort in our misery, and it is difficult to imagine anything else. Therapy helps us to identify this pattern and determine alternatives that we hadn't considered. Therapy helps people see that the arguments, disagreements, and hurt feelings usually aren't a result of the stated problem but are a result of the underlying meaning that we attach (i.e. the process). Knowing this allows us to address the real problems that often undergird the presenting problems in our lives. These real problems often go unrecognized and unaddressed, thereby perpetuating problems despite our best efforts. Therapy can help bring them to light and allow for meaningful change.

I understand that many people may read this and still have a negative understanding of therapy. I understand that many of the points I have made may still dissuade people from engaging in therapy. My hope, however, is that I have provided some answers to some of the misconceptions about therapy. At its core, therapy is about helping the client. The therapist should have little or no personal agenda other than that. The client knows his/her life, and the client knows what will make that life better. The charge of the therapist is simply to help the client achieve that goal.

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