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Psychotherapists: Mechanics, Surgeons, or Rehab Workers?

Understanding the real job of the psychotherapist.

Have you ever noticed that people often think that psychotherapists are like car mechanics? It reminds me of an old boyfriend of mine who used to give nicknames to the women he was dating. My nickname was “crazy mechanic girl.” In his tongue and cheek way, he coined the nickname because he thought that, as a psychotherapist, I fix crazy people.

This idea is a misconception at so many levels! First of all, going to therapy doesn’t make you crazy and, second of all, therapists don’t fix their patients. But I think the misconception stems from the hope that a therapist actually could fix you. After all, you come to therapy because you feel broken. So it is understandable that you would expect the kind doctor to whip out his tool kit and fix things. With a good diagnosis, it shouldn’t be too difficult to do a little tweaking here and a little adjusting there. “Think this, not that; do this, not that.” And then off you go, back to your life mostly as you left it; only now the engine runs better.

The mechanic model doesn’t quite capture real psychotherapists, though. It falls short because people are not really like cars, refrigerators, or washing machines. You are not a crazy person who needs to be fixed. You are not a passive machine that needs a tune-up. You are a complex dynamic subject, actively engaged in the process. Psychologically speaking, you do not get “worked on.” You have to do the work yourself.

As an alternative to the mechanic model, many of my patients think of me as a kind of psychological surgeon. They bring their unwanted parts—their tumors, cancerous growths—the toxic parts of their personalities. And they have every expectation that I, like a good surgeon, will get rid of the unwanted parts for them. Cut it right out. Excise it. Then they can go on their way, just taking the healthy and working parts with them.

I don’t blame them. I have that wish sometimes, too. But the trouble with the surgical model is that the psyche doesn’t work that way either. You can’t really get rid of anything. Every part of the personality belongs to you. Trying to get rid of it is like throwing a boomerang; it comes right back. I think that, just like physical matter, psychological matter is indestructible. You can change its form but not its existence. Every part of you belongs to you. Forever.

The model that I like the best is that a psychotherapist is like a mental health rehabilitation worker. A psychotherapist helps a patient develop strength. He teaches you to work with your weaknesses. You have limitations—based on your personality make-up, genetics, upbringing, experiences later in life. While you try to do your best with what you have, you need some help doing better. You need some guidance to find new ways of doing things, to gain new strength that you never had or to find strength that you once had but have lost.

I like the rehab model because it does justice to the key elements of psychotherapy and the work that psychotherapists actually do. It is a slow, painful process. As the patient, you must do the work for yourself; no one else can do it for you. But you also need someone to guide you, to encourage you, to correct your form, to suggest more challenging exercises.

Physical rehab is about developing the body—bit by bit, step by step, slowly over time. A good psychotherapy is a similar kind of process with the mind. It helps develop mental and emotional muscle: courage, patience, tolerance, flexibility, strength, persistence, endurance, and acceptance. These are the qualities that truly help you better deal with life’s challenges.

While I like the rehab model, there are probably lots of good ways of thinking about the work of psychotherapists and the process of psychotherapy. The key is to honor the fact that each patient must ultimately do the work for him or herself. A good therapist promotes self-development in the spirit of the proverb: “Give a man a fish, he eats for a day; teach him to fish, he eats for a lifetime.” A good psychotherapist helps you build strength and skill for a lifetime.

Copyright 2012 Jennifer Kunst, Ph.D.

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