What would you say now about how psychotherapy is used, what it is good for?
It is an encounter between two human beings, one of whom is trained in the workings of the mind and is committed to help the other find a way to make better use of her mind and to live better. In the medical model, the “patient” is not able to negotiate the demands of reality, not able to be productive and effective in his life.
Some of us suffer and struggle more than others intending to our hearts and making use of our minds. And psychotherapy is a very particular space and mechanism for regaining the use of the mind and repairing the heart.
In the past 10 years I have noticed a different use: People who reach for therapy do not really have a psychological disorder. People who seek treatment nowadays are not “mentally ill.” But they “need someone to talk to.” They are not happy with who they are or how their lives are going. I commonly hear the complaint of “my life is not working” or “I am tired of feeling stuck” and the request of “I need to process my experience. I need to talk it over and figure out.”
What does this mean about what people are struggling with?
The need “to talk to someone” speaks of the longing for connection, companionship, and for meaningful dialogue. This need confirms for me the sense of alienation and disorientation that is a casualty of the fragmenting, de-humanizing modern world. To connect, to talk to someone, to tell another of our private story, and to contact another person’s story –that is so fundamental, vital, necessary to being human. And it is not surprising that people ask for it.
As for the need to “figure things out”, I see it linked to so much confusion about life. Life should be simple and joyful, and living should be a gift of discovery. And yet to so many people living is set up to be such an endurance course, a race, a minefield. You know, the “one wrong choice and you are eliminated from opportunities” kind of mentality. It’s all so scary, complicated, daunting, this business of living. And people are beaten up and lost in the brutality of capitalism and technocracy. So of course, they would need help to “figure it out.”
How should life be “simple”? What kind of discovery?
We are born, we take sustenance from our caregivers, we take steps away from them when we grow, we work and love in order to sustain ourselves, and then we die. I challenge you to find one person, one human life, who does not conform to that trajectory. Nobody escapes it.
But it is the in-between that is a mystery: each person’s own “why” and “how” to exist. That is the discovery: who you can be, who you are meant to be, and figuring out how you can be in this life. And in that discovery can be a great deal of joy and empowerment.
How do you think about psychotherapy then, in relation to this process of discovery, to this “business of living”?
I have gone through my own discovery about being a psychologist. To me, psychotherapy comes down helping people live/be the life that they wish for. To aid the struggle that all of us engage in: Being human, being alive, being happy.
Two most common complaints that people seek therapy for: Depression and anxiety. Now, how do we think about that?
Someone comes to you with a twisted, blistered foot. She is in pain; she has a hard time walking right. Doesn’t want to walk the road anymore. That is depression.
But her walking dysfunction comes from wearing the wrong shoes –her life structure. She ails because her living hurts her. Most people are depressed –deformed, twisted, defeated in their heart and mind– because they have been walking in the wrong shoes.
Also, someone comes to you lost, scared about walking the path of life. He walks in circle, panics about what is ahead, behind, around the bushes etc. That is anxiety. He is deemed “dysfunctional.” What if his “dysfunction” in from being on the wrong path? From not feeling in tune and safe on it? And here you see that most people are anxious, stressed out because they are stuck on a path that they feel is taking them far away from where they want to go but don’t know how to redirect themselves to the place of true safety and fulfillment.
There is an epidemic of loneliness in the US. More people are stressed out and insecure about their future than ever before. Everybody has mood “disorder.” 1 out of 6 Americans is on meds. Does this mean that the mental illness has increased? No! It means that we are not living well. Humans are meant to be ALIVE, CONNECTED, and in pursuit of joy and learning. It is not our inherent nature to be disconnected, numbed out, stressed out, stuck.
We need to do something much simpler than pouring millions into the next cure-all pill or some “life-altering” therapeutic program. The simple task is: Look at the shoes that we choose to wear, at the road that we are conditioned to get on. Are we wearing the right shoes? How are we walking on the road? Who do we choose to walk with? Where do we choose to go? Does it fit and does it allow us to walk upright on the road toward the existence that is meant for us?
Psychotherapy can be a resource in people’s effort to be human and live well. Psychotherapy should assist people in figuring out how to be fully alive, to do meaningful work and to love well in a culture that tells you to focus on fear, to aim for acquisition and security, and offers zero support or wisdom for how to BE, for how to embrace each other in our beautiful mortality, how to strive for connection and peacefulness.
How does this translate in practice? What do you do with, for, your patients?
I focus on capturing their humanity. And I focus on how to support their business of living. Who is this human being before me? What is he trying to do with his life? What is the existential quest that he is on? How does he live, exist? What does he want out of this life? It is a dialogue about how to live in the most joyful, meaningful, graceful way that is available.
It is amazing how, if we engage in this kind of examination, the trouble with depression, anxiety, etc. becomes secondary. Bigger fish to fry!
I no longer make a premium of asking “What is the problem?” I now ask, “What are you trying to do for yourself, in this life?” I want to know where the person got lost, where she wants to go. I ask the patient to do the work of reflecting on why she is not there, in that life that she wants to be. And I help her take account of what she is, and is not, willing to do to live the life that she says she wants.
I see my job as a guide-companion-ally-witness in people’s quest for living. I hate to limit myself to treating disorders. My offering, my commitment, in psychotherapy is toward the full humanity of the whole human being.
When people feel in emotional difficulty and look for help, what should they ask for then?
Do not ask for help with your “disorder.” Tell the therapist about what you have been aiming to do for yourself in life. Don’t limit the conversation to your symptoms. Talk about how you have been to live/love and what you fear. Tell about your hopes and dreams. And ask the therapist how she would address these questions and how she can help you fulfill the task of living.
Do NOT ask if she “specializes in XYZ disorder.” When you do that, you short-change yourself. And you limit what you can access of the therapist.
In your view then, what should one look for in a therapist?
Look for a human being! Nowadays, everybody has a brand, a specialty, credentials, prestigious affiliations. Of course, the therapist must be educated and trained. But that is not all. Not enough. You must bring in your humanity. Be willing to deeply engage with the patient’s existential struggle. Be INVESTED in how she exists. Look into the therapist’s life experience, her view on the struggle of living, her willingness and compassion toward your struggle.
“Compassion” is a deceptively simple term. Compassion speaks of deep awareness of the struggle of the other AND a skillful, committed engagement with that other person’s suffering. In “compassion” is “company” and “passion.” Look for that. Ask the therapist how she has lived, what it means to her to be human, what she hopes for you. The therapist’s answers show you her qualifications to be your companion and support. And if she evades, in the name of being neutral, professional etc., move on.
How does change happen for people then, in therapy?
The cornerstone of psychotherapy is self-knowledge. Psychotherapy is wedded to the idea that self-awareness leads to control and mastery. And therefore, insight and awareness lead to change. Know yourself so that you can control yourself.
That is not enough. Insight alone is not enough. You must DO things differently. Your life will be different only when you do things differently. You must be willing to step into new experiences, to do your life differently. The new experience generates new knowledge. New muscles develop. New desires can emerge. New sense of self comes into play. And that is change.
Healing happens through transforming a wound into new skin. When someone struggles or is stuck, he needs help to step into new, un-claimed ways of being. Change is hard. Change takes work and courage. The job of the psychotherapist is to lend skills and support in that endeavor.
What do you consider success in therapy?
Those priceless moments when the person says, “I can see. I know who I want to be. I am going to do what is needed.” And when the person says so without any concern about the outcome –because she has grabbed hold of what must be.