There Is Only "One Therapy"

Life will change you. You might as well direct that course of change.

Posted Jun 13, 2018

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All that we are is based upon our biological inheritance and learning—sophisticated patterns of wiring in our neural networks—some of which is hard wired and some of which is soft wired. Learning doesn't just happen in the brain, it happens throughout the body, i.e., the immune system–it learns. Even a callous or tan is a form of learning, not technically, but it's a reaction to a stimuli, a reaction to keep us safe. And that's why we learn; because it keeps us safe. All that being said, people often never ask the most basic questions: Why do we have brains? Why do we think? Why do we have skin? Why do we love? The answer is always the same: It improved our survival as a species. Every structure in our brain had a selective advantage to improve survival. Every aspect of our being from social hierarchies to our fingernails had a selective advantage for survival. That's it. And the construction of "self" is a necessary psychological process in the service of survival. And this sense of "self" as a static and unchanging thing is a necessary illusion. It increases survival, but there is no "you" in your brain. And I totally feel like there is a me inside my brain too. It's a necessary illusion. But I know that if I remove part of my frontal lobe, I'd immediately be a different man. I am a process, a network, changing and dynamic, just like you. And this is the crux of why therapy works because we can and do change. Stay with me. I'll lay it all out.

What we call “Self” is an amalgamation of heritable traits, a mammalian body of skin, bones, and organs, and the conscious awareness of learned and inherited behavioral responses (wired deeply into our DNA like fear of snakes or sexual orientation).  And this thing we call "self" is more than just a genetic bag of tricks. It is a highly modifiable and adaptive process at every level of being social, psychological, and biological. Epigenetic changes modify gene expression. And learning can happen suddenly like avoidance of a food that causes us to become profoundly ill, or more traditionally through mechanisms like operant, social, or classical processes.  But this learning still changes us. It changes our sense of self. Self is a changing process and not a permanent thing–lock that in. Self is a changing process. That is the key to understand how psychotherapy truly works. If we couldn't change this thing we called "self," why even do psychotherapy? We do it because we believe we can change.

And here is the next big key: Most of what we are, what we identify as "Self," is based upon a learning that had to be practiced—taught to us by our parents, early childhood, early development. We learned to brave, funny, courageous. We learned to be loving and kind. And we learn to be monsters or damaged.  It's built. It is constructed. There is no "you" sitting in one particular area of your brain—it is just a necessary illusion. It's just wired patterns of being that make you—you. Knowing this to be true is freeing. You can and will change. You're not static. I am not the boy I was 30 years ago—parachute pants and a mullet is not a good look in my 40s. And when I look at others, those that I admire and those that I fear, I know that I would have been them if not for a biological lottery, not my own doing, and the circumstances I was given—again, not my own doing.

Next big key: Play and imagination are necessary requisites for change. Boys and girls play as children. They practiced identities and roles. They practiced becoming future constructions of self. Some of us practiced being small, victims, learned from threatening homes. Yet, some of us learned to be integrated, connected, competent, and resilient.  Some of us matured to become adults capable of solving our problems of living. And some of us are still waiting to arrive, to become.

Practice being sick and you’ll stay sick. Practice health and resilience and you’ll suffer less.

In essence, we practiced becoming us, becoming who we are, who we think we are, in the ways that we think, feel, and act. All therapies that work, work because of practice. And if we are going to change, we have to bring insight to these patterns, ways of being, so that we can discover new ways of being.  But we must practice.  Knowing you're conflict avoidant doesn't fix it. You must practice standing in the pocket of fear and speaking your truth--measured and proportionate to the situation.

Method actors get this. Narrative therapy touches this process. Cognitive behavioral therapy begins a process that changes these patterns. Couples therapy is the act of a practice where partners learn new ways of communicating. Psychodynamic processes give us some insights into outdated ways of being. And trauma-based therapies help us to process our fears and to learn new ways of living. Trauma can be transformed from suffering into meaning. And when that happens, we change. We go from sick to better.

But insight is never enough.

Psychotherapy that relies upon insight only misses the most important aspect of change—repetition. We must practice being built anew if we are ever going to discover better, healthier, and more integrated ways of being. Life will change us. You might as well direct that course of change.

Self is built. Self changes. And a new self can only happen by learning, by practice. Therefore, there is and can only be "One Therapy." The neural network is wired. And neurons that fire together, wire together. Practice is the key to wiring new ways of being. You build and construct a new you until it becomes non-conscious--just like riding a bike. We can expedite the psychotherapeutic process when we understand what we are truly doing in that room. Therefore, I push people to use their imagination, seeing new ways of being. Role play. Script it. Rehearse it. Repetition. Repetition. Repetition. Rinse and Repeat until it becomes non-conscious. Practice in the mirror. Practice in your mind. Practice in the world.

Yes, we must have insight into our patterns, or what we call defenses, triggers, trauma, and then we must change, face, practice, and learn to become a new person.  If an athlete had a coach that just helped them to figure out their mistakes and didn't coach and teach them to practice a more competent way of being, then that's not a coach. That's just an observer, a critic. 

Final key: Call it what you want. Grab onto one of the 500 psychotherapies that are out there if you must, but understand what you're truly doing. As a therapist, you're training others to change their constructions of self. And if you're in therapy, you're learning to become a new you.