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Therapy

Why and How in Modern Counseling and Psychotherapy

Learning how is more important than learning why in therapy.

Key points

  • The development of skills is more important than insight in modern psychotherapy.

Humans want to know why. Why do I feel so crappy? Why do I feel so anxious? Why do I keep getting angry? Why do I keep drinking too much? Why can’t my partner and I get along?

The theory behind psychoanalysis and many traditional psychotherapies suggested that you could get answers if you understood “why” and gained insight into your past. Freud and others believed that what had happened in your childhood was so awful that you deeply repressed it. And it was so well defended against that you only got clues into what was going on through slips of the tongue, dreams and, sometimes, resistance to therapy. For example, you came late or forgot to come to the session or were thinking about stopping therapy entirely.

Therapy provided hope. If you kept going to therapy, things would get better. But if you were not finding it helpful and you said that you wanted to stop, that was clear evidence that you were actually getting close! And humans so want to understand themselves and their feelings and behaviors that some patients stayed in therapy for years and years.

But supposing the causes are not buried in your unconscious? Buddhists and mindfulness folks would tell you that it is how you are evaluating and judging what you observe that is the problem. Practicing mindful compassion for yourself and others and practicing “radical acceptance” offers the path to a more peaceful and fulfilling life.

They are not interested in why. They are interested in how. How can you learn to live a better life? This is a major difference between traditional counseling and psychotherapy and modern counseling and psychotherapy. The emphasis is on how, not why.

Cognitive Behavior Therapies (CBT), such as Rational Emotive Behavior Therapy (REBT), also emphasize how. Instead of focusing on gaining insight, they encourage clients to learn new skills. The ABC technique is a good example. It helps people learn how to better manage their thoughts, feelings and behaviors. The technique encourages you to uncover – maybe with a therapist but also on your own – what unhelpful, automatic, or irrational thoughts/beliefs contribute to your problems. For example, if you are having panic attacks, you might ask yourself, “What am I telling myself to make myself so anxious?” Or you might ask, “What kind of automatic thoughts are coming into my head and making me more anxious?” Although many factors outside may be triggering your anxiety, CBT encourages you to look at what part you play in making things worse. Through CBT, you can learn how to better manage such thoughts, how to calm yourself down and how to respond more effectively to many, many situations.

Dialectical Behavior Therapy (DBT) also teaches clients how to manage their lives better. The “dialectical” part encourages people to be both accepting of their feelings and behaviors and, in some cases, at the same time, to be willing to work very hard to change. Putting yourself down, criticizing yourself and shaming yourself – the opposite of accepting – for the emotions and behaviors that you may have developed to cope with an extremely difficult childhood will not help. DBT believes that clients often suffer from a combination of genetic predispositions and an “invalidating environment.” Such environments often tell you that what you are feeling and thinking is not what you are feeling and thinking. Child: “I have an upset stomach and a headache.” Parent: “No you don’t. You just don’t want to go to school.” Eventually, you can’t trust what you think and feel and hardly know who you are. DBT encourages clients to learn how to use mindfulness in addition to many of the standard CBT tools.

Acceptance and Commitment Therapy (ACT), a newer, different and popular kind of cognitive behavior therapy, encourages you to learn how to deal with your thoughts, emotions and behaviors in a different kind of way. Clients may make things worse by engaging in “experiential avoidance.” They avoid whatever might cause discomfort and, in the long run, make their lives much worse. ACT also encourages clients to use various mindful techniques to deal more effectively with their thoughts, feelings and behaviors.

Most psychiatrists do not buy into any of these theories. But they offer you another path to figuring out how to manage your feeling lousy or behaving in ways you are not happy with. The causes of your problems lie in your neurochemical system. Changing that system will get you the results you want. And, in fact, psychopharmaceutical medications may help you learn how to better manage your problems the same way insulin helps a diabetic.

Currently, there are over 400 “schools” of psychotherapy, each offers clients hope that they will “cure” a potential client’s problems. Some are convinced that if you gain insight into what happened in your past, you will do better. Others believe that if you learn various strategies and techniques, you can use them to do better. And some suggest that if you take various medications, you will do better. In fact, some combination may work best.

However, if you want to feel and do better, relying solely on gaining insight – on understanding why – will probably not do the trick. And only taking medication will probably not be sufficient, either. You need to learn how to feel, think and behave better. I remember when I was first studying Spanish. I asked the professor, “Why do they say ‘casa blanca’ and not ‘blanca casa’?” He looked at me with a very annoyed expression and asked, “Do you want to learn how to speak Spanish or do you want to be a psycholinguist?” I got his point.

If you are trying to learn how to ski, you may want to know why you fell, but more likely, you want to know how not to fall again. The same thing is true of cooking, dancing, and learning how to play an instrument. Learning why is fascinating and sometimes extremely enjoyable but learning how is key to feeling, thinking and behaving better. It may not seem reasonable to compare skiing, cooking, dancing, and making music with learning how to live a more fulfilling, enjoyable life, but they are very similar indeed.

References

Linehan, M. (2014). DBT? Skills training manual. Guilford Publications.

Westbrook, D., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behaviour therapy: Skills and applications. Sage.

Dryden, W. (2009). Skills in rational emotive behaviour counselling & psychotherapy. Sage.

Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists. New Harbinger Publications.

Headstuck! What is Experiential Avoidance? https://www.youtube.com/watch?v=C-ZuqeyxULM

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