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Does psychotherapy make you worse?

Is psychotherapy making you worse?

Therapist: What do you think it means when I say, “Uh-huh…” or “Hmmm…” or “Yes?”
Patient: That you understand and agree with what I am saying.
Therapist: You are half correct. It does mean that I am understanding what you are saying and in addition that I am signaling you to keep talking. However it doesn’t mean that I agree with what you are saying or that I think your perceptions are accurate.

There is a actually a much greater chance that your perception is not correct and that it is your perception that is causing most of the problems you are having with the situation that brought you into therapy. Furthermore, it is more likely that you are trying to convince your therapist and yourself that you are right when you and your therapist know that you’re probably not.

If you are in psychotherapy and disagree with the above, check it out with your psychotherapist.

Unless you are seeking pure enlightenment for its own sake, insight without action is a waste of time and money (and one of the legitimate reasons that psychotherapy is widely ridiculed and viewed as self-indulgent). If you leave a therapy session feeling relieved, but with no plan or steps for effectively dealing with the stress or distress that brought you into the session, there is a much better chance that you are being enabled to remain stuck in your problems than that you are being helped to solve them and get past them.

The purpose of therapy is not to agree with you and your perception of the world. It is to help you:

  1. accept the reality that every day things happen that will frustrate, disappoint, anger and upset you and hurt your feelings
  2. learn to calm and center yourself after inevitable upsets occur and then effectively respond in your outward behavior.  How well you learn these skills will determine how successful and happy you will be, how much respect from others and yourself you will gain and in the end how much self-esteem you will feel (if feelings of low self-esteem are one of your problems)

There is no such thing as human nature; there is only animal nature and the possibility to not give into it and to rise above it. The purpose of psychotherapy is to help you rise above your animal nature and respond to life’s stressors by "taking the hits" from the world without striking back at it and by making the situation better vs. “having to be right” and making it worse.

One of the ways to learn to "take the hits" that life throws you, calm, recenter and then respond to the world in an informed way is to use the Seven Step Pause (that is at the core of my two books on overcoming self-defeating behavior, Get Out of Your Own Way and Get Out of Your Own Way at Work):

  1. Physical Awareness – when you’re feeling stressed, think to yourself, “I am physically feeling __________ (what) in my _______________ (where in your body).”
  2. Emotional Awareness – “And emotionally I feel _______________ (Angry? Frustrated? Scared? Sad? Disappointed? Hurt? Upset?) and how _____________ (fill in the emotion you just named) is ________________________ (somewhat, very, extremely).”
  3. Impulse Awareness – “And feeling ________________ (name the physical feeling), and ____________________ (name the emotional feeling) and feeling it _________________ (name the level of intensity), makes me want to _________________ name the impulse.”
  4. Consequence Awareness – “If I act on that impulse the most likely immediate consequence will be ­­­­­­­­­­­­­­_________________________ and longer term consequence will be ________________________ .
  5. Reality Awareness: "While I am holding off (for now) on acting on that impulse, an other and more accurate perception of what might really be going on is _____________________ [seeing the world as it actually is, can further help you not react to the way it isn't].
  6. Solution Awareness – “A better thing for me to do instead would be to _____________________ (fill in alternate behavior such as count to ten, wait 24 hours, think of what I want the outcome to be immediately and in the long term and what I need to achieve those).
  7. Benefit Awareness – “If I try that solution the benefit to me immediately will be __________________ (for example, “I won’t make things worse” or “I won’t do more things that I’ll regret and then have to apologize to people for”) and in the long term will be _______________________ (for example, “I’ll be on my way to making things better” or “I’ll have more respect for myself and gain more from others”).

If you are a person in who positive affirmations or self-talk do not work (I am such a person), imagine doing the above exercise with someone who cares or cared about you (I imagine my deceased parents and deceased mentors going through the Six Steps with me).

This is also a great routine to get into with your children to help them master stress and for them to internalize a way of pausing, calming and centering themselves later on in life.

A similar technique, but is more of a crisis intervention, when you're trying you're hardest to resist an irresistible impulse is the "Three Strikes, You're Out (of Danger)" technique.  Use it whenever someone has said or done something to provoke you.

  1. Think very clearly of the first thing you want to say or do, take a deep breath and let it out and then don't say or do that (this is your "fight or flight" reaction and it's about protecting yourself).
  2. Think very clearly of the second thing you want to say or do, take a deep breath and let it out and then don't say or do that (this is your emotional reaction and it's about retaliating).
  3. Think very clearly of the third thing you want to say or do, take a deep breath and let it out and then do say or do that (this is your thinking reaction and it's about finding a solution).

Freud many years ago said, "Where id is, let ego be."  He meant that to mean that where our id (which is the part of our personality that acts according to our drive to seek pleasure and avoid pain) is running our responses to the world, let our ego (which is the part of our personality that acts according to reality) take over.  In essence it means responding to "what is" vs. reacting to "what isn't."

Interestingly, Freud took one too many "hits" himself after the 1980's and as a reaction society has thrown away what was useful along with what was useless.  As a result it set our collective id free, but that probably has caused more harm than good.

Stay tuned for the two words that therapists are afraid to say to their patients/clients, that will help them get better faster.

Mark Goulston, MD, is the author of the new bestselling book Just Listen: Discover the Secret to Getting Through to Absolutely Anyone.

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