6 Common Misconceptions Of Therapy
Don't let them stop you from getting the treatment you need.
Posted Dec 20, 2019
The holiday season often evokes in us complex and difficult feelings, leading people to seek out a therapist just before or just after it. In a past post, I wrote about cultural forces like insurance companies and quick-fix promises that make it difficult for those suffering emotionally and psychologically to get effective therapy. I was pleasantly surprised that many people—friends and strangers—reached out to express wanting a therapy of depth, relationship, and insight like that described in the essay.
But they echoed concerns that I’ve heard from many patients over the years. It’s worth dispelling some of the most common fears about these therapies so that they don’t stand in the way of a good treatment.
Therapy is about blaming parents.
The biggest misunderstanding maybe is that therapy absolves the patient of personal responsibility and instead blames parents. In fact, an effective therapy aims for the opposite. It’s true, many therapists believe one’s early caregivers have a huge impact on who we are in relationships today.
Some of the many things we learn from those relationships are: how we elicit care, what we can expect from others, our willingness to trust, our sense of how to act when someone is angry with us, what of our own anger can be tolerated, how we perceive ourselves, our experience of succeeding and failing, how we manage envy and being envied, and so on. But therapy helps us work through the difficult relationships and our perceptions of poor or unfair treatment, of feeling hurt, dismissed, misunderstood, unloved.
And yes, with these memories and experiences come anger, sadness, guilt, shame, and a host of other feelings that may be connected with parents. For real and lasting change, a person must grapple with these insights about the past, and ultimately take responsibility for the troubling behaviors that grew out of it. In a good psychotherapy, the helpless sorrow we often feel is replaced by problem-solving.
Therapy is self-indulgent.
Therapy is indeed about acknowledging our needs and desires, but not to encourage selfishness. In reality, when we feel free to have our own needs met, we are less likely to exploit others and more able to love and to be generous. Time and again, I witness people become more engaged with the world as therapy progresses. No longer consumed by worry, depression, anger, or distrust, the desire to give back manifests through volunteer work, creativity, kind gestures, and openness.
Going “there” makes things worse.
It can be extraordinarily anxiety-provoking to revisit the past or a dark time in our lives. Over the years, I’ve heard patients describe the terror of doing it as: “opening a can of worms/Pandora’s box,” ”uncorking a tornado,” “feeding the monster,” “choking on an undigested hairball.” When suppressed or repressed feelings resurface, we worry we’re going to disintegrate or “go to pieces.” We worry that we’ll get so mad we won’t be able to forgive someone important to us. In short, that we’ll get stuck in the anguish.
It’s true that sometimes it gets worse before it gets better. After all, we’ve often chosen, consciously or unconsciously, not to think about certain events, relationships, and feelings, because they were too overwhelming or confusing. But in my experience, wading through those hard feelings with someone compassionate and curious and making sense of the trauma helps people release the burdens they’ve carried and feel better.
We must sometimes unravel to get the knots out. Of course, if someone isn’t ready, is pushed too hard, and isn’t properly supported, it can be re-traumatizing. But a skilled therapist will take cues from her patient about a tolerable pace and guide them into painful material safely.
Therapy is a one-way conversation.
The therapist, while sometimes quiet, is never passive. When therapists are silent, deep listening and meaning-making are occurring. Though the therapist is an expert, s/he doesn’t pretend to have privileged access to truth. This is very different than the technician-like therapist who already knows the answers and simply needs you to “take as directed.”
It’s much easier to give advice and prescribe behaviors than to practice the self-discipline of speaking only when you believe it will draw the patient out or lead him to greater insight. No doubt, it can be exasperating when therapists ask questions instead of giving answers, but they do that both because they are seeking a thorough understanding and nudging the patient to look more deeply into themselves, their behaviors, and the meaning of their symptoms.
Doling out advice and wisdom may feel satisfying to the therapist, but it doesn’t show respect for a patient’s sense of autonomy. Increasing that sense is an important goal of therapy. In my experience, most people don’t really want advice; they want to be understood. Even if a therapist had a crystal ball with all the healing solutions, the truth of the patient’s experience has to come from the patient, or it is essentially useless.
Therapy is for people with a mental illness.
Human suffering is ubiquitous. Nobody escapes it. Sometimes, people seek treatment because they are unable to function in the world. But a seemingly fully-functioning adult may still be hurting and in need of treatment.
Grief, anger, adjusting to life changes, problems in relationships, poor self-esteem, and substance abuse are common reasons people seek treatment. If these symptoms go unchecked, they can get worse. It often takes a certain amount of emotional maturity and courage to accept that we need another’s help. Effective therapy can not only help reduce our symptoms but also help us grow into our best selves and live more fully.
Therapy must be called “evidence-based.”
Most unfortunately, the public has gotten caught in the crossfire of the Psychotherapy Wars. On one side are those who view techniques as the curative agent. These are generally therapists who think and practice in cognitive and behavioral terms. Techniques like deep-breathing and positive self-talk are taught, and worksheets and homework may be assigned. The therapy is usually short-term and focuses on reducing symptoms.
In the other camp are those who believe relationship factors are the healing ingredients. These are generally therapists who practice from a more psychodynamic or humanistic approach, and they rely on highly attuned empathy, rapport, active listening, and meaning-making. The therapy is open-ended and focuses on helping patients understand their feelings and behavior, increase their self-worth, improve their relationships, and shape their identity.
We all want treatment that has been shown to work. The good news is, most of the mainstream therapies out there are supported by research. The bad news is, the term “evidence-based” is being used as a marketing tool, like using “healthy choice” on packaged foods.
“Evidence-based therapy” is a term that can be applied to psychodynamic therapy, but has been used by the cognitive-behavioral camp to imply their treatments are the only empirically supported ones. That is just not the case. In fact, meta-analytic studies that cull large amounts of data from many research investigations show that it is relationship factors, not exercises or skills, that drive effective psychotherapy (1). And effect sizes for Psychodynamic Psychotherapy are as large as those reported for “evidence-based” therapies and, in some cases, have longer-lasting gains.
The bottom line is that most therapies do not fall squarely into one camp or the other. Therapists in the real world tend to adjust their approaches to the needs of each patient. While an open-ended therapy that values depth, relationship, and insight is better suited to help people change lifelong dysfunctional patterns and complex emotional problems, it may not be for everyone. But don't let it be the false premises that keep you away.
(1) John C. Norcross, ed., Psychotherapy Relationships That Work: Evidence-Based Responsiveness, 2nd ed. (New York:Oxford University Press, 2011)