Here are some myths and misconceptions about psychotherapy. Ironically, they are believed by many therapists and are likely hampering their clinical effectiveness.
Myth Number 1: Depth of therapy is more important than breadth of therapy because change requires an understanding of a problem's origin.
Adherents of "depth therapy" believe that drilling deep into the past, and into the presumed unconscious mind of their clients, will lead to transformational insights or intense cathartic reactions that are seen as necessary for true, therapeutic change. A process I call "psycho-archeology" that is of dubious benefit for most people.
The fact is, when therapy is conceptualized as a psychoeducational process rather than a "psycho-archeological" one, clients improve more rapidly and durably. Thus, when therapy covers many bases in the here and now by teaching clients specific skills (e.g., assertiveness, emotional regulation, habit control, effective communication, to name a few) people really benefit without necessarily making any deep, psychological discovery about themselves or their past.
Myth Number 2: It is all in the relationship.
While it is true that the therapeutic relationship is often the soil that enables specific techniques to take root, it is usually essential to do a lot more than develop a good rapport or a strong alliance. The curative nature of the therapeutic relationship, per se, is most often associated with Rogerian or Person Centered therapy wherein nonjudgemental, empathetic reflection is seen as foundational. The fact is, however, when people present with specific deficits, and/or maladaptive thoughts and behaviors, purely supportive, nondirective therapy is unlikely to prove helpful. Hence, the therapeutic relationship is best thought of as necessary in most cases but hardly ever sufficient.
Myth Number 3: Changes automatically generalize.
Therapists should not assume that changes a client might demonstrate in session, or in limited arenas, will automatically transfer to other important zones. For instance, a person may be more assertive at home but not necessarily at work, or vice versa. Or, a client might be able to resist compulsive rituals during a therapy session but still engage in a lot of avoidance and ritualizing almost everywhere else. Thus, it is important for therapists to address therapeutic generalization explicitly rather than assuming it has happened.
Myth Number 4: Don't transgress therapeutic boundaries.
Many therapists practice defensively, because they fear litigation; adhere to rigid, therapeutic boundaries because of Licensing Board regulations; or maintain strict boundaries because their approach is very boundary-based (e.g., psychoanalysis). Thus, many therapists will not answer simple questions ("Where are you going on vacation?"), disclose anything personal about themselves ("I was born in Johannesburg, South Africa"), or even accept a small gift from a client.
This topic is so huge that it requires a post unto itself. Suffice it say that sometimes a therapist can learn more helpful information about someone outside of the consulting room than in it. Of course, any therapeutically helpful boundary transgression must never involve sexual, exploitative, or manipulative conduct. But driving a stranded client home (who doesn't have AAA and whose car won't start), escorting people during anxiety management exposure, or merely accepting a small gift is more likely to enhance therapeutic outcome than hinder it. The interested reader is referred to A. Lazarus's and O. Zur's excellent 2002 book, Dual Relationships And Psychotherapy.
Myth Number 5: Noncompliance or nonadherence to therapeutic recommendations is a sign of "resistance."
When a client doesn't do specific assignments, does it mean that he or she is deliberatley or unconsciously "resisting" therapy? In this case, it is helpful to consider the "law of parsimony" which says an explanation should have the fewest assumptions and be as uncomplicated as possible. Albert Einstein famously stated the law of parsimony when he said, "Everything should be made as simple as possible, but not simpler."
So, when a therapist attributes noncompliance to resistance in the way Freud did, he or she is explaining a client's behavior on the basis of deep, repressed, conflictual, largely unconscious, complex, intrapsychic processes that are basically beyond the realm of disproof or verification.
But if a therapist first considers simple reasons (i.e., the assignment wasn't explained adequately, it's importance wasn't emphasized enough, the client might not have seen the value in it, it was too much too soon, etc.) he or she will usually be correct. Thus, a simple course correction can occur rather than a deep dig into the unconscious processes of a person's mind. Therefore, when there are two competing theories that aim to explain a phenomenon, it makes sense to choose the simpler of the two. At least I'm pretty sure that's what Albert Einstein would have believed.
This is also important because the notion of "resistance" basically blames the client for therapeutic failure rather than putting the onus on the therapist, too.
Remember: Think well, act well, feel well, be well!
Copyright by Clifford N. Lazarus, Ph.D.