When Therapy Hurts You
In therapy, what makes the most sense is often the most harmful.
Ever since deciding to become a psychologist, I’ve enjoyed listening to horror stories from friends and acquaintances about their therapists. Not only does this help me learn what people need—and don’t need—from therapy, but I get to laugh at the terrible state of the field. This, if nothing else, has fertilized my delusional self-belief. When I say that I’m the greatest living psychologist—and I’m not even a psychologist yet—it’s not due to my intelligence, rather the lack of it in my peers.
Here are a few hilarious therapy gaffes I’ve heard:
The emphasis of “mindfulness”—a buzzword that means awareness without mention of what to be aware of. Mindfulness in psychology is like rivets in architecture. If an architect admonished us to use rivets in a skyscraper, without reference to how many or where they go or how they fit within the context of the building, we’d rightfully think he doesn’t understand the point of rivets.
The use of meditation during the session. Meditation is one of the most personal practices someone can do—to practice it during the limited therapy session is as bad as having children read during school.
Therapists who say their theoretical approach is “eclectic”—which is therapist-speak for “I have no thoughts of my own so I’m hedging my bets.”
Constant validation of patients without providing useful feedback or perspective of their situation—for fear of offending them.
Male therapists who are so effete they make Mr. Mackey look like Jack Palance.
Female therapists who look like groupies for the Grateful Dead. I get it, you’re a modern-day shaman in Marin County, but that doesn’t mean brushing your hair is a waste of time.
One ubiquitous blunder that is especially painful is when the therapist gives advice. Therapists will even make patients take the advice right there in the clinic—for example, call about a job (if they’re afraid of doing that), or go online shopping (if they’re afraid of spending money on themselves).
The therapy advice and its corollary assignment may seem innocent enough, if not beneficial. Doesn’t it help to have a definite plan as opposed to a vague yearning? After all, the therapist probably knows what the patient needs to do, so why not tell him?
Though a certain action may be correct, assigned action is worse than incorrect. Advice and assignments show a lack of understanding of the nature of psychology and the therapeutic process alike—they show a lack of empathy as well. If meditation is the equivalent of reading in class, advice is watching a movie—not only is it a waste of time, but it reinforces avoidance of the real work that needs to be done.
When we have a problem with our lives, it’s not because we’re taking certain actions as opposed to others. This may seem nonsensical but it’s essential to understand if you want to truly change and grow. Sure, a particular action may be the symptom, but it’s not the cause. The cause is the inability to do what we want to do—or the inverse, the inability to stop doing something we don’t want to do. It’s a subtle distinction but it’s important.
We know we need to talk to our boss or ask out that girl or confront our father. But we still cannot do it. That’s the insanity of neurosis—not the lack of knowledge but the lack of will. Western Civilization has figured out a great many things, like individual rights and industrialization, but one blind spot for us to investigate is how we can have free will yet still have our decisions be constrained by emotional issues in the short-term.
As such, therapy is rarely the first option for people. There is a stigma around therapy, but contrary to what therapists think, the stigma is because of the field’s perceived ineffectiveness and lameness—which isn’t unfounded. It’s doubtful there would be stigma around therapy if it actually worked. But we see our friends and family in therapy and they don’t get any better. Most of the time, they get worse. For the average person to even step inside a clinic, therefore, usually represents what they consider to be a great moral defeat.
The patient has come to therapy out of desperation. Advice in this context is tantamount to a doctor advising a cancer patient to simply “get better”—it’s worse than useless and often one of the most subtly annoying interactions someone will ever experience.
A failure to understand why advice misses the point exposes a fundamental confusion about the nature of psychology, and how it relates with philosophy. To put it succinctly, philosophy concerns what to do, and psychology concerns how to do it. If what to do implicated how to do it, then philosophy and psychology would be one in the same.
Therefore, when a psychologist gives advice, the attempt is to cover what they don’t understand with something they do understand. This has typically been excused because it’s commonly believed the correct action, when done consistently, will eventually fix the underlying cause. But this only works in the short term, if at all, and psychology has known this for such a long time that any ambiguity here indicates, at best, ideological rigidity or worse, dishonesty—or super worse, stupidity. It may work for dog training, but not for human training.
It’s the failure to connect the “what” and the “how” of action that baffled Socrates. For the next 2500 years, this subject was ignored as psychology was an implied aspect of philosophy. To distinguish this “how”—and its implied “why”—from the “what” was the impetus behind the demarcation of psychology towards the end of the 19th Century. The field, however, soon got distracted from this fundamental, “how-what” distinction with shiny experiments that implied the “what” is an illusion anyway.
The essence of therapy, therefore, is to become aware about why we don’t do what we want to do, from which the how is derived. The reason most therapists don’t do this is there’s no theory on why people don’t do what they want to do, or why they stop making decisions in the first place—or at least there’s no theory that doesn’t resort to circular reasoning.
The how-what dichotomy often comes up when a patient doesn’t know whether to break up with his girlfriend. He may want the therapist to make this decision for him, but what’s more helpful is for him to discover what keeps him from making the decision for himself. The patient ultimately needs to become aware of threats he’s avoiding, this helps him to manage his anxiety and so build a boundary—and then a stronger identity. From such a state it’s more likely for him to make decisions for himself.
In (one of) the graduate programs I attended, we did indeed learn not to give patients advice. However, the reason for learning this had nothing to do with the impotence of advice, rather the alleged subjectivity of advice. It was a perspective based on the Rogerian approach, which is postmodernism in therapy. When right or wrong—healthy or unhealthy—are nothing more than man-made precepts, advice is tantamount to fashion. Self-effacement is taken to the nth degree, which makes us wonder what would be the point of therapy in the first place. It wasn’t an understanding of therapy that criticized advice, rather a poor philosophy.
Subjectivism in the clinic is silly, of course. The implication of getting better is there is a definite better. If the therapist has no idea what the patient needs to do, then he has no business being a therapist. Hopefully, it only takes no more than few sessions to determine what is the next, right step for the patient. But this, as we discussed, is nowhere near the point of therapy.
Advice is so counterproductive in therapy that even bad advice is preferable to good advice. If the therapist gives bad advice, the patient tries it, finds out it doesn’t work, and then he’s less likely to ask for advice in the future. He’s also less likely to think therapists know what they’re doing, which may be a helpful heuristic.
Conversely, when the therapist gives good advice, and the patient tries it and it works, then this would cause more damage in the long term. The patient implicitly learns he only got better because he listened to someone else, not himself.
The pervasive detriment of good advice doesn’t reveal itself until years later when the patient finds himself at a stage in life where he doesn’t belong. Let’s say you marry your girlfriend because your therapist told you to do so. You’re married now, yes, which many would consider to be a healthy milestone. Except you don’t have the psyche of a guy who’s right for a long-term relationship because you never went through the process of looking at your issues from which a self-made decision stems. A man in such a fiat position will be more likely to ruin the relationship with immature behavior like passive-aggressiveness, dishonesty, and aimlessness. The point of commitment isn’t to make a commitment, it’s to be the kind of guy who can make a commitment.
It’s the same reason why banks won’t give you a business loan until you have a history of making money. A business, at least a successful one, is a machine that makes money. You put $100 in one side of it through product development and marketing, and you get $150 out the other side through sales. The bank won’t give you a loan before you develop this machine because money doesn’t make the machine—ideas and strategy make the machine. Dumping money onto the problem doesn’t solve the problem like dumping advice onto the neurosis doesn’t solve the neurosis.
In this way, a healthy psychology is like a healthy business. You take in an array of information through your senses, and then use your perspective and emotional regulation to create valuable interactions in the world. Therapy builds this machine through awareness and regulation—advice will only overclock it, eventually causing it to break down.
Advice damages the psyche on an even more fundamental level than this—it steals the joy of growth.
About ten years ago I was stuck in a crappy copywriting job, which was still good for me because my typical MO was to not have a job. I knew I needed to do something with my life, and soon. I was headed into my late 20s, which is around the time you begin to realize you’re going to die. Thankfully, I didn’t turn to therapy to solve this problem, because my experience with it had been awful up to that point in my life. Instead, I journaled and meditated. Six months of this regimen, combined with the aforementioned desperation, and a light went off—literally. I was reading Jung in my bedroom when the broken light in the hallway sparked on. Psychology was going to be my path. Nothing could have been more obvious, nothing could have brought me more enjoyment than to see my life as it unfolded and how it was clearly leading me to become a psychologist.
It wasn’t the decision that mattered to me but the creation of that inner resource of self-sufficiency. Desperation, pressure, death—these were okay to feel. In fact, they were necessary to feel if I was going to make a decision that would be aligned with reality. Real growth isn’t making a good decision, it’s getting good at making decisions. And it’s not going to come from the mouth of someone else, no matter how wise or intelligent they may be.
The most advice I would ever give my clients is general facts about their situation reflected back at them. If they’re in a particularly precarious situation and they’re unaware of this, I’ll let them know. If they’re unaware of red flags flying high from their new girlfriend, I’ll let them know. If they’re acting in a way that I would be alarmed by if they were my neighbor, I’ll let them know. My job is to be a highly polished mirror that allows them to see their life and situation with more clarity.
The patient is a separate person—either they develop on their own or not at all. If the therapist doesn’t understand this, then he’s confusing himself for something he’s not.