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Essential Secrets of Psychotherapy: The Healing Power of Clinical Wisdom (Part One)

Secrets psychotherapy patients hear that you haven't--but need to.

What really happens in psychotherapy? The answer to that question is complex. And depends in part on the particular type of psychotherapy one seeks. But one thing that psychotherapy can, in my experience, convey to patients are certain tried and true, essential secrets to living a more rich, fulfilling, meaningful, contented, creative, balanced and psychologically healthy life. What are some of these well-kept secrets of psychotherapy?

For more than a century now, psychotherapists have been ministering to our psychological, existential and spiritual suffering with considerable success. Psychotherapy has deep roots in many fields, including medicine, psychiatry, psychology, biology, neurology, as well as philosophy, sociology and theology. Starting with and subsequently building upon the depth psychology of Freud and Jung, psychotherapy patients have been privy to a treasure trove of traditional psychological, philosophical and spiritual secrets that help make sense of and navigate safely through life's inevitable traumas, crises and suffering, setting them on the path toward healing and wholeness. In the psychotherapy world, we refer to such secrets as "clinical wisdom."

Clinical wisdom is an archetypal collection of accumulated and hard-won psychological, philosophical, existential and spiritual knowledge collectively drawn and distilled from psychotherapeutic practice or research, as well as other healing traditions. (In the field of psychopathology, for instance, despite its drawbacks, the DSM-lV-TR is a contemporary cornucopia of immense and invaluable clinical wisdom regarding the descriptive symptomatology, typical course, demographics, diagnosis and treatment of mental disorders.) This precious clinical wisdom has been handed down from master psychotherapist to apprentice or disciple, from training analyst to trainee, from professor to pupil, from supervisor to supervisee, from author to student, growing more refined, developing, evolving and transmuting over time. Some of this time-honored clinical wisdom is common-sensical, pragmatic, concrete and mundane, while some may seem more esoteric, arcane, spiritual or philosophical. Reading about such secrets is certainly no substitute for real psychotherapy. But each of these essential secrets contains powerful, potentially helpful clinical wisdom for those receptive to it. And, hopefully, these randomly selected seven secrets (the first of several planned postings in this series) can stimulate interest in what, for many, is the obscure, intimidating, mysterious process of psychotherapy.

For example, in Cognitive-Behavioral Therapy, probably the most popular psychological treatment today, patients are taught that how we think influences how we feel and how we behave.That is very valuable clinical wisdom of which we all need to partake and apply in our daily lives. But it is certainly not novel. Nor is it unique to CBT. Psychodynamic psychotherapy has long known the power of unconscious cognitions, distortions of reality, or "guiding fictions" as Alfred Adler called them. So has philosophy. As the first-century A.D. Greek Stoic philosopher Epictetus said, "Men are not influenced by things, but by their thoughts about things." Or later, as Shakespeare has Hamlet muse, "For there is nothing either good or bad but thinking makes it so." We are responsible for monitoring and restructuring our irrational or distorted cognitions. Changing how we think about things, how we interpret events, counteracting the automatic narratives, schemata or "tapes" that constantly run in our heads, can change how we feel about ourselves, others, and how we perceive and respond to life's difficulties. Are they daunting difficulties, or creative challenges? But first, we must somehow become more aware or conscious of our own habitual thought patterns. (See my prior post.)

Here, then, in no special order, are six additional highly distilled secrets, potent little therapeutic capsules of clinical wisdom, which, when willingly swallowed, digested and psychologically assimilated, can help you create a more conscious, satisfying life in the New Year--and beyond.

What we don't know can hurt us. The "unconscious," as Sigmund Freud professed, is the "unknown" or "not known." That portion of subjective experience which is obscured, invisible to consciousness, at least "at the moment." It consists largely of the parts of ourselves we deny, dissociate, despise, denigrate, dread and generally repress. What we repress comes back to haunt us with a vengeance. Philosopher Friedrich Nietzsche spoke of this phenomenon as "the return of the repressed." Denial or dissociation are repressive defense mechanisms, and serve some necessary function in terms of preserving mental health. But when some significant aspect of ourselves is chronically denied or dissociated (i.e., repressed and made unconscious), the proverbial chickens eventually come home to roost. If, for instance, someone always denies their anger, these feelings will some day resurface tenfold, especially under stress, though the reason for and intensity of their rage may be unclear and inappropriate to the current circumstances. This dark and treacherous territory to which these repressed "chickens"--or, more descriptively, "demons" are banished--is what Jung referred to as the "shadow." It is related also to what Rollo May called the "daimonic." The daimonic, according to May, "is any natural function which has the power to take over the whole person. Sex and eros, anger and rage, and the craving for power are examples." The daimonic, can, by definition, be both destructive and creative. When the daimonic is habitually denied, it becomes more negative and dangerous. But when we acknowledge its presence and reality, it can be the life-giving source of energy, strength, power, spirituality and creativity. This can be said of the unconscious in general. So it is vitally important to learn to listen to one's unconscious carefully, and to what it has to say about what's happening in the psyche now and what needs to happen if the future, both inwardly and outwardly. Meditation, mindfulness and dream work are all methods of listening to and discerning the unconscious.The secret is to take the unconscious (and its complexes) seriously, treating it with the respect and sense of mystery, awe and wonder it deserves. And to recognize the ultimate futility of repression, rather allowing one's self to consciously experience emotions as they arise, while at the same time learning to pause between stimulus and response rather than reflexively acting on them. We have both the freedom and responsibility to choose how we respond to our feelings. But that, like any other skill, takes practice.

Life is not necessarily fair. This is something clinical psychologist Albert Ellis, creator of Rational Emotive Therapy (RET), Rational Emotive Behavior Therapy (REBT) and one of the founders of Cognitive-Behavioral Therapy, made painfully clear to his patients.This is also something the Buddha talked about millennia ago: To the extent we expect (or demand) life to always be fair, for example, we are unwittingly setting ourselves up for frustration, anger and disappointment. Buddha's solution--and Buddhism can be seen as both a spiritual and psychotherapeutic system--was to become less "attached" to or "desirous" of life being fair--or any other way, for that matter. Life is as it is. It's best to take life as it comes, without too many expectations or preconceptions. Life may sometimes be fair, and at others, unfair. Good and evil. Joyous or tragic. Meaningful or meaningless. The naive, misconceived New Age notion of karma--what goes around comes around--doesn't always play out in reality as we believe it should. Much as we may wish it did. (See my prior post.)

Suffering is part of living. C.G. Jung once wrote that "Neurosis is always a substitute for legitimate suffering." We tend to try to avoid pain and suffering however we can. And see suffering as something that shouldn't be part of life. But it is, and always will be. The secret to dealing with suffering or pain is being willing to courageously accept and experience it rather than constantly avoiding it, which only creates additional suffering in the form of various psychiatric symptoms. As in the case of addiction, for instance. So accept suffering when it comes your way, and see what it has to teach you about yourself, others and life. Feel it. Medically manage it appropriately when necessary, as in the case of chronic physical pain, panic attacks or severe depression. There is no need to masochistically create suffering, since life provides plenty to go around for each of us. The secret is to choose to suffer consciously. Courageously. Willingly. The more suffering we can accept and tolerate, the more compassion we become capable of, and the stronger we internally become. To cite Nietzsche, "What does not destroy me makes me stronger." (See my prior post.)

Anxiety is not always neurotic. Mental health is not defined by the absence of anxiety. The experience of anxiety is universal. No one is immune to it. Anxiety is an inevitable part of the human condition. As anthropologist Ernest Becker proposes in The Denial of Death (1973), the fear of death is archetypal and pervasive, and underlies, either literally or symbolically, directly or indirectly, all other forms of anxiety. While there is much truth to Becker's thesis, I disagree that all anxiety can or should be reduced to "death anxiety." In any case, the key is how we deal with anxiety, or what existential therapists call "existential anxiety." Trying to run from the experience of anxiety hinders growth, retards development, limits intimacy, stifles creativity, and is typically what addiction and phobic behavior are about. Chronically avoiding or repressing existential anxiety gives rise to neurotic or pathological anxiety, such as phobias and panic attacks. The secret to dealing positively with anxiety is to accept it, tolerate it, listen to its message, and learn to channel it's immense energy constructively. Anxiety can, when correctly utilized, motivate, energize, invigorate and vitalize. And it is closely connected with creativity of all kinds. As philosopher Soren Kierkegaard recognized, "Anxiety is our greatest teacher." He also called anxiety "the dizziness of freedom." The trick is first to transform your negative attitude toward anxiety. To normalize rather than pathologize it. To welcome rather than run from it. To, whenever practically possible, tolerate rather than medicate it. To embrace rather than escape from it. To try to understand rather than dismiss out of hand its psychobiological, spiritual and existential significance. That can make all the difference in dealing with both "normal" and "neurotic" anxiety. (See my prior post here.)

There is a difference between fate and destiny. Personal responsibility is something psychotherapy patients struggle with daily. How much of what happens in my life am I responsible for? Some take on too much responsibility. Others too little. For example, all parents have flaws, shortcomings, weaknesses. As well as strengths. Some are more flawed than others. That is the luck of the draw, or what I call one's fate. We don't choose our parents. Or siblings. Nor do we choose to be born. We are, as existentialists say, "thrown" into the world, and have no choice or responsibility in the matter. The parents and family we are born to comprise part of our fate. As does our genetics, gender, temperament, talents, limitations, vulnerabilities, etc. Fate consists of the immutable givens with which we are born--and the fact of being born itself, in a particular place at a particular point in history. As well as the inescapability of death. But destiny is different. Destiny is what we do with our fate. Destiny is how we play the cards we were dealt. Our parents bring us into this world. Our genes determine much about us. But who we have become by the time we leave this world is up to us. We are not responsible for our fate. But we are responsible for our destiny. (See my prior post.)

We can't get water from the moon. This is an old Japanese saying. The moon, so far as we know, is an arid desert, a lifeless (albeit beautiful) ball of dusty rock orbiting around the Earth. To try to extract water from the moon would be folly. In much the same way trying to get "blood from a stone" is foolish and futile. But this is exactly what many of us do when it comes to intimate relationships. We try to force others to give us love. We manipulate. We pretend. Or we beg. And demand. Or we patiently wait, desperately hoping that some day, the love we thirst for will be provided. Meanwhile, we frequently settle for crumbs. In the language of Behavior Therapy, when such persistent seeking behavior is reinforced randomly and intermittently, it becomes highly resistant to extinction. (Conversely, the clinical wisdom of behavior modification tells us that to get someone to stop pestering you, you must stop all random and intermittent reinforcement of their unwanted behavior, e.g., sometimes answering the telephone.) What we often don't realize is that this individual from whom we seek love and support is, for some reason or other, emotionally unavailable, and will never consistently give us what we want. This is typically what occurs when emotionally crippled or uncaring parents are unable or unwilling to give their children the love they need and deserve. These love-starved kids compulsively keep trying to get "water from the moon." If one is truly looking for a drink of water, the moon is probably not the place to go. No matter how deep one drills and searches, there is simply no water to be found there. Better to look elsewhere for the water of life. No matter how hard we try, whether in matters of the heart or other pursuits, often our very best efforts, patience, kindness and perseverance never pay off. Other times, it can. As one psychiatrist put it pithily in discussing his love-sick patient's persistent pursuit of a woman despite her long-standing rejection: "Sometimes you put your quarter in the machine, and nothing comes out." Or as the old Kenny Rogers country-western tune The Gambler goes, "You got to know when to hold 'em. Know when to fold 'em. Know when to walk away. And know when to run." (See my prior post.)

So those are the first seven essential secrets of psychotherapy for your consideration. Another seven nuggets will follow in Part Two and Part Three. And possibly more over the next few weeks. (Depending on reader response.) Readers who would like me to include clinical wisdom applicable to a specific (but generic) issue, situation or problem are invited to make requests. If any of my colleagues care to add a secret to this eclectic collection of clinical wisdom, I would welcome their clinically-informed contributions.

This posting is derived and distilled from Dr. Diamond's forthcoming book, Essential Secrets of Psychotherapy: The Healing Power of Clinical Wisdom. All rights reserved.

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