Can Talking Cure? And If so, How?

The many languages of talk therapy

Posted Jul 12, 2017

By ROBERT HUFFSTUTTER [CC BY 2.0], via Wikimedia Commons
Source: By ROBERT HUFFSTUTTER [CC BY 2.0], via Wikimedia Commons

Assume you are a therapist doing what is known as ‘talk therapy.’ A client presents the following issue:

“I am constantly bothered by this colleague at work. I’m totally disgusted and frustrated by her. I try to ignore and avoid her but I just cannot escape her screeching voice and loud laugh around the office. I am sure that everybody can tell I hate her. But I can’t help reacting negatively to everything she does.”

What would you make of this complaint? And how would you respond?

The answer will depend in part on how you believe talk may heal human suffering. And, as it turns out, psychologists differ on this question.

To understand the different perspectives on how talking may cure we first need to think a bit about words in general. Language is a dynamic, evolving communication system that uses a set of symbols with shared meaning. On the bright side, talk helps us to connect with others, form and maintain strong social and interpersonal relationships, communicate, and cooperate—all of which are essential for human survival. On the dark side, words can be used to obscure rather than clarify meaning; increase distance rather than facilitate closeness; mislead rather than guide; hurt rather than soothe; create conflict rather than solve it, etc.

So words are powerful. But how should that power be harnessed in the context of talk therapy? The term “talking cure” was in fact coined by Freud’s famous patient Anna O. (real name: Bertha Pappenheim), who used it to refer to her habit of making up stories and fairytales to soothe her symptoms of hysteria. Freud, of course, was early to recognize the power of words: “With words one man can make another blessed, or drive him to despair… Words call forth effects and are the universal means of influencing human beings. Therefore let us not underestimate the use of words in psychotherapy.” 1

Freud believed that our conscious lives—what we say and do and the reasons we give for what we say and do—are actually shaped by unconscious motives and conflicts that operate outside our awareness. Therefore, people’s surface expressions (their actions and words) often are coded messages from the unconscious. The work of therapy is to decode the surface expressions and reveal their true deep meaning, to make the unconscious conscious, so that one’s inner conflicts may be observed and resolved.

Words therefore cannot be taken at face value. Instead they should be examined for the unconscious, symbolic meaning they convey. For example, if a client notes that a person looking after a sick dog could get bitten, get infected, and possibly die, a Freudian therapist might interpret this as a symbolic expression of an unconscious concern: The client fears that she will damage the therapist, that her problems are contagious.

For Freud, nothing we say is incidental or random. The content and process of speech, as well as the inability to speak, signal hidden underlying desires, fears, and conflicts. This notion is exemplified by the idea of  the ‘slip of the tongue’ which Freud saw as unconscious processes interfering with the conscious intent of speech. “It is…the influence of thoughts that lie outside the intended speech which determines the occurrence of the slip and provides an adequate explanation of the mistake.” 2 

One famous example:

She: What would you like, bread and butter or pancake?

He: Bed and butter

Clearly, argues Freud, the speaker has something other than breakfast on their unconscious mind.

Words represent and illuminate (bring into awareness) the deep unconscious processes that shape our mental state. According to Freud, speech, “brings material in the ego into a firm connection with the…residues of visual, but more particularly of auditory, perceptions.” 3. In other words, the mind assimilates perceptual information through language. We are able to make sense of our perceptions by putting them into words.

Words perform the magic of turning one thing into something else, making the invisible visible. They give us the power to see hidden wounds, and treat them. “A layman will no doubt find it hard to understand how pathological disorders of the body and mind can be eliminated by 'mere' words. He will feel that he is being asked to believe in magic. And he will not be so very wrong, for the words which we use in our everyday speech are nothing other than watered-down magic. But we shall have to follow a roundabout path in order to explain how science sets about restoring to words a part at least of their former magical power.” 4

Emerging in the 50s and 60s in part as an alternative to—and a rebuke of—Freudian formulations, the Humanistic perspective focuses on conscious, subjective experience, emphasizing the uniquely human qualities of free will, freedom of choice, courage, and self realization. The humanistic approach focuses on health, not sickness, emphasizes the present and future, rather than the past, and privileges self-knowledge and self-direction over statistical prediction or expert opinion. The most influential therapist in this tradition was Carl Rogers, and his view of the uses of language in therapy differed markedly from Freud’s view.

Unlike the dark, deterministic Freud, Rogers believed that human beings are at their core rational, trustworthy, and well meaning. "The core of man's nature is essentially positive.” 5. Rogers saw the drive toward self-actualization as the singular “force of life,” a built-in motivation present in every life form to develop its potentials to the fullest extent possible.  "The organism has one basic tendency and striving - to actualize, maintain, and enhance the experiencing organism.” 6

Rogers used the term “Organismic Valuing Process” to refer to the internal voice that allows the individual to know whether an experience is in line with the self-actualizing tendency.

Rogers valued experience above any other way of figuring out a person’s way in the world. “Experience is, for me, the highest authority… No other person's ideas, and none of my own ideas, are as authoritative as my experience…Neither the Bible nor the prophets -- neither Freud nor research…can take precedence over my own direct experience.” 7

For Rogers, the aspect of your being that is founded in the actualizing tendency and follows the organismic valuing process is your “real self.” Your “ideal self,” on the other hand, is your sense of how you wish to be, and it is prone to societal influence. When social dictates about how you should be are out of synch with your actualizing tendency, a gap, which Rogers called “incongruence,” opens between the real self and the ideal self, the “I am” and the “I should be.” “If the individual dimly perceives such an incongruence in himself, then a tension state occurs which is known as anxiety.” 8

Mental health, for Rogers, is the process of active participation in the discovery of one’s actualizing tendency. “This process of the good life is not, I am convinced, a life for the faint-hearted. It involves the stretching and growing of becoming more and more of one's potentialities. It involves the courage to be. It means launching oneself fully into the stream of life.” 9. Therapy works to facilitate this difficult process.

Rogers called his approach “Person-Centered Psychotherapy,” asserting that the client is the expert on their problems and the solutions. "It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried.” 10

Rogers was one of the first to study the therapeutic exchange scientifically, by recording his sessions and pouring over transcripts of these recordings to gleam patterns and dynamics. Rogers concluded that for change to happen in therapy, the therapist must possess three core qualities: Empathy (the ability to sense the client's private world as if it were your own); Unconditional Positive Regard (extending a warm acceptance to each aspect of the client's experience); and Congruence (being genuine, real, honest, and open).

In therapy, Rogers would avoid diagnosis, advice, judgment, education, or labeling, relying instead mainly on the technique of reflection, or verbal mirroring, in order to achieve an accurate understanding of the client’s inner world and the emotions being conveyed and create an atmosphere of acceptance, safety, and understanding. Therefore for Rogers, the client’s words are more curative than the therapist’s, since it is the client who’s the expert, and has the knowledge of how to proceed toward their truth. Specifically for Rogers, the client’s words heal when they are listened to intently. “When a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, ‘Thank God, somebody heard me. Someone knows what it's like to be me’….It is astonishing how elements that seem insoluble become soluble when someone listens, how confusions that seem irremediable turn into relatively clear flowing streams when one is heard. I have deeply appreciated the times that I have experienced this sensitive, empathic, concentrated listening...When I have been listened to and when I have been heard, I am able to re-perceive my world in a new way.” 11

Cognitive Therapy, a more contemporary approach to talk therapy, operates on the assumption that how you think shapes your feelings and actions. According to Albert Ellis, one of the founding fathers of the cognitive approach, “psychotherapy starts with the hypothesis that human emotion is caused and controlled in several major ways and that for all practical purposes, the most important of these is usually by thinking.” 12

Distorted thinking habits need to be identified, challenged, and replaced. Cognitive therapy, according to another founding father, Aaron Beck, “seeks to alleviate psychological stresses by correcting faulty conceptions and self-signals. By correcting erroneous beliefs we can lower excessive reactions.” 13

The cognitive approach to therapy minimizes exploration of childhood, explors daily concerns, and focuses on the direct, common sense meaning of problems rather then relying on symbolism. It places primary importance on thinking processes, not unconscious motives or drives.

Our cognitive architecture according to Aaron Beck has several components: Core Beliefs – unconditional beliefs that serve as a basis for evaluating experiences (for example, “I’m no good.” “Others can’t be trusted.”). Dysfunctional Beliefs – conditional beliefs that shape one’s response to experiences (for example, “If someone gets close to me, they will discover the ‘real me’ and reject me.”). Interpersonal Strategies – underlying assumptions about ways to influence others (for example,” “If I want someone to like me, I must be nice to them.”), and Automatic Thoughts – the cognitions that spontaneously flow through one’s mind in the moment (for example, “Oh crap! Now I’m really screwed.”). Together, those elements of the mind make up the client’s basic 'self-Schema.'

According to Beck, one goal of therapy is to challenge and neutralize common “cognitive distortions” that serve to protect faulty, self-defeating schemas by canceling out any information that is contrary to core beliefs, leaving the person in the dark about any disconfirming evidence from the environment.

 Such Cognitive Distortions include:

1. ALL-OR-NOTHING THINKING: You see things in black-and-white. If your performance falls short of perfect, you see yourself as a total failure.

2. OVER-GENERALIZATION: You see a single negative event as a never-ending pattern of defeat.

3. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

4. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they "don't count” for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

5. MAGNIFICATION OR MINIMIZATION: You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections).

7. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true!”

8. ‘SHOULD’ STATEMENTS: You try to motivate yourself with shoulds and shouldn'ts, as if you had to be whipped and punished before you could be expected to do anything.

Working with similar assumptions about the centrality of thought to mental health, Albert Ellis (1913-2007) popularized The A-B-C Model of cognitive therapy, in which A stands for Antecedents (events that happen in the environment), B stands for Beliefs (interpretations, self talk, thoughts), And C stands for Consequences (how you feel and what you do). According to Ellis, A doesn’t cause C. B causes C.  In other words, we react not to events, but to our interpretation of events, and those interpretations are often irrational, nonsensical, and rooted in what he called “Common Irrational Beliefs,” ideas that make people who hold them miserable, among them:

• I should be thoroughly competent at everything.

• It catastrophic when things are not the way I want them to be.

• I have no control over my happiness.

• I need someone stronger than myself to be dependent on.

• My past history greatly influences my present life.

• There is a perfect solution to human problems, and it’s a disaster if I don’t find it.

Cognitive Therapy in the tradition of Beck and Ellis teaches the client to think about their own thinking, looking for distortions and false beliefs that may skew their interpretations of the events of their lives. Clients learn to treat their thoughts as hypotheses, not facts, and as mind events not world events. They are taught to identify automatic thoughts habits (“What am I telling myself that is making me react in this way?”); generate alternatives (“What else can I tell myself here?”); compare, based on evidence (“Which one of the thoughts I have is more likely to be true?”); pick the thought that is backed by evidence, and act from the chosen thought. The words that matter most, in this approach, are those we tell ourselves. To heal, we need to recognize our inner speech habits and learn to practice sound ‘mental hygiene’ by making sure what we tell ourselves is likely to be true, and has some evidence to back it up.  

Having said all this, let’s return to our initial challenge. How would you respond to the client’s complaint?

“I am just so bothered by this woman at work. It’s total disgust and frustration. I try to ignore and avoid her but I just cannot escape her screeching voice and loud laugh around the office. I am sure that everybody can tell I don’t like her. But I can’t help reacting negatively to everything she does.”

Clearly, the three perspectives will have different answers. For the Freudians, words matter as symbols. Their unconscious meaning, decoded in therapy, will reveal to us the true source of our problems, thus providing the insight and emotional relief necessary for change and healing to occur. A Freudian therapist may suspect that the client’s aversion to the woman is due to the fact that she is giving expression to unconscious needs the client himself has but is afraid to own; or wonder whether the woman’s behavior elicits echoes of the client’s own mother, toward whom he feels suppressed anger.

For the Rogersian Humanists, words matter as means of encouragement and support, as well as self-exploration. To the extent that talking is based in acceptance and leads to empathic understanding, it may create an environment in which we will feel safe enough to experience and express ourselves authentically, and figure out how to change, grow, and heal ourselves. Rather than offering interpretations, the humanist therapist is more likely to reflect the client’s words and emotions back to them: “So you are very perturbed by this woman at work. Her presence upsets you. You feel like you cannot control your negative reaction to her. And you feel that others are noticing your dislike of her.” The client, feeling safe and understood, will then proceed to figure out for himself what it is that makes him react the way he does.

For Cognitive psychologists, words matter mostly as they constitute our “self talk,” the thinking habits that determine our actions and emotions. Therapy helps us examine our own thinking process to identify and change self-talk habits that are distorted or destructive. The cognitive therapist will inquire with the client about his thought process upon encountering the woman. “What do you tell yourself when you hear her laugh?” Or, “Let’s assume you cannot manage this stress at work, what will happen then?” Once the client reveals his catastrophic thoughts (“I will go crazy and end up in a mental hospital”) the therapist may then move to challenge these catastrophic predictions (“What are the real odds of this happening? What else may happen?”). As the client learns to replace catastrophic predictions with more rational ones (“This situation is more of a nuisance than a crisis”), their mood and behavior will change for the better.

So, what kind of therapist would you be?  What kind would you want to have?

References

1. Freud, S. (1920). From a series of 28 lectures for laymen, Part One, 'The Psychology of Errors'. Lecture 1, 'Introduction' collected in Sigmund Freud and G. Stanley Hall (trans.), A General Introduction to Psychoanalysis, p. 3.

2. Freud, S. (1973). Slips of the tongue. Fromkin, V.A. (ed.), p. 65.

3. Freud, S. (1940). An outline of psychoanalysis. W.W. Norton & Co., 1969; p. 35.

4. Freud, S. (1905). Psychical (or Mental) Treatment. In James Strachey (ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (1953), Vol. 7, p. 283.

5. Rogers, C. R. (1961). On becoming a person. Boston: Houghton Mifflin, p.73.

6. Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications and theory. London: Constable. p. 487.

7. Rogers, C. R. (1961). On becoming a person: A therapist's view of psychology; p. 23-24.

8. Rogers, C. R. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Journal of Consulting Psychology, Vol. 21, pp. 95–103.

9. Rogers, C. R. (1961). On Becoming a Person: A Therapist's View of Psychotherapy. P. 196.

10. Rogers, C. R. (1961). On Becoming a Person: A Therapist's View of Psychotherapy. p. 11.

11. Rogers, C. R. (1980). A way of Being. Haughton Mifflin Co; pp. 10-12.

12. Ellis, A. (1957). Rational Psychotherapy and Individual Psychology. Journal of Individual Psychology; p. 38.

13. Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. International Universities Press, p. 216.