Sunday, 27 May 2018

What is Therapy Actually?

Researching the therapeutic process in advance of attending a session, most of what I found was to me unbearably vague - as was my therapist. They talk about integrating personalities and getting in touch with your feelings. They talk about how they won't give you the answers, the answers come from you. They talk about a moment of realisation and personality change. They talk about a lot of things, but the total message to me was something like a magician explaining that what you just saw was a trick. He'll show you this incredible outcome, you ask how he did it, and he says 'Oh, it wasn't really magic, there was a trick to it' then refuses to tell you the trick. You're left knowing that this person is pulling the wool over your eyes, and wondering what advantage it is to them to do so. Why not just talk straight?

I'm the guy that wants to know what the trick was, and I'm going to do my best to describe my experiences directly. This is no parlour trick (though some tricks are employed in the process).


To be honest, while I've read a bunch of psychology texts since, I haven't actually read anything aimed directly at therapists and how to therapise people, so this is my best guess. I assume the literature is out there for the curious.

Note that I'm always discussing regular, off-the-peg talking therapy, not clinical psychology or more specialised therapies. Obviously there are many chronic and acute psychological conditions which are treated quite differently.

My therapy seemed to work in this way: by asking clients questions about their feelings, needs, beliefs and observations. By answering these questions out loud and having answers reflected back at them, clients intrinsically encourage themselves towards internal consistency. To achieve this end it is necessary the client trust the therapist and feel safe and unjudged when they express themselves. Sometimes the therapist will provide theoretical or anecdotal data to help frame a situation. More or less everything a therapist says is shooting in one of these directions. There are of course lots of fun exceptions. Therapy is 'complete' once the client attains internal consistency and self-acceptance which they can carry forward to help address the new problems that inevitably form with a more balanced psychological state. The sense of realisation and personality change is a direct result of this.

I also think that therapy, along with religion, music, philosophy and just about anything else you can think of, is aimed at a kind of accepting, non-linguistic understanding of our place with the world that we might, if we had a penchant for the dramatic (I do), call the philosophy of Everything is Connected, or Everything is Okay, or just plain Everything. But that's another story.

So it's my belief that that is the magic trick. There's a reluctance to explain the trick perhaps because it is so simple, as the best ones are. It is, in fact, very similar to how good relationships work in the real world - just more narrow, formalised, self-aware and one-directional. Understanding, acceptance, curiosity, wisdom. And thank god the two are so similar, otherwise we'd all need to go to therapy!

But what does all this mean in practice, and why exactly does it work?

Let me be as bald as I can. The therapist's first job is to gain your trust, so that you will be honest without fear of the repercussions you have often suffered for being honest in the past. They sit you down and tell you humbly how experienced, kind and non-judgemental they are. Then they ask some routine questions about your problems and your childhood. When you answer these questions a good therapist is supremely careful (or supremely practised) in reflecting back the feelings you're expressing, which ideally demonstrates to you that they are listening and understanding, and not saying anything that may be interpreted as a judgement or advice. You're not going to tell the truth if you think you'll be punished for it (which is incidentally why it almost never works when you try to send someone else to therapy, because they probably already see it as a punishment). For therapy to work you have to know it's in your interest to be honest.

I was really surprised about the advice bit. I bloody went there for advice, all I wanted was my problems explained, why should I go through the charade when you could just treat me with intellectual respect and explain it all to me? Of course, the reason it works as a magic trick is that you don't get the pay off from the pure theoretical understanding, any more than you can ride a bike by reading a book about it. Part of the problem you are trying to solve is your own ability to listen to yourself, and when you're trying to tell yourself what to do to fix a problem you're not really listening. On the list of invaluable things I learned in the last two years, not trying to fix problems (mine and other people's) and just listening to how they're feeling has been one of the most satisfying (and challenging).

So anyway, if all went well you're now sitting in front of what might be the first person ever in your life to listen to how you're feeling and to respond with empathy rather than judgement. So you're ready to open up. For me at this stage there was roughly 31 years' worth of tears, and months of just talking through my experiences and getting a sense of support and acceptance. And a lot of writing that was purely for me.

What the therapist is doing, consciously or not, is I think seeking your internal conflict. Being a wordy guy I think about it this way. Everything a human ego is is propositional (it's not really, I just pretend). It's all just complicated symbols for things we believe. It's intrinsic to how we are to try to make the symbols fit together neatly. Sometimes they get out of whack. The gay kid who lives straight because they know homosexuals are evil; the molecular scientist who lives as a housewife because they know it's a woman's place. These conflicts come in as many shapes and sizes as people do, and we all have them, somehow.

If that conflict is too big, too central and too insurmountable-seeming we spend an inordinate amount of psychological capital either obsessing over it, or repressing it - but either way it's turning into a tumour. It's ricocheting off the inside of your skull at an ever increasing pace and you've got to let the steam out or it's going to kill you. But you're terrified to do that because of what you might find.

The therapist is looking for these conflicts and reflecting them back to you in non-judgemental language. Surely there are all sorts of different schools of therapy which have all sorts of different theoretical frameworks, but they're all coming at the same place from different angles (as everything is). Hearing your own symbols reflected back at you emotionally neutrally helps you to understand them, accept or replace them and, ultimately, fit the puzzle back together again, thus allowing you to concentrate on what you really enjoy instead of worrying about what is retrospectively bullshit (but very real at the time).

A concrete example

Once she had a rough picture of how my relationships had been in the past, my therapist asked me about a particular one. In the course of describing it I described a thing I did that put strain on it. She knows its salient because I didn't mention it for nothing. She asked me how I felt about it. I felt guilty. She asked me about the events that lead up to it. She observed that some of those events were in my control, and some weren't (which she knew I would agree to). She asked me whether I thought my partner had done anything wrong and I said no. And then she asked why I felt guilty.

Since I don't have authoritative morality to reach for I can't get out of this question by saying I did something morally wrong. I don't believe in moral wrong. But I do feel guilty, so I have to do some fast philosophising. I said something like this:

"I should know better than to make mistakes. I do know better. I knew it was a mistake at the time and I did it anyway. I'm older/smarter/wiser so I should hold myself to higher standards."

"Okay," I imagine her saying, though I don't recall, "but why do you need to feel guilty about that?"

I do remember saying, "Because it's useful. I need to be better. Guilt keeps me on my toes."

She said, "I think that's a good place to leave it for today."

But it felt like a good place to leave it.

On my way out of the room I said (to myself more than anything), "I don't believe in bad people." She said, "Neither do I". Hearing someone else say it. Man. My brain was grateful. I'd never heard someone else say it before.

So this is another angle on the whole thing. The astounding lengths our brains go to to explain retrospectively why we feel the way we feel, and how having our thoughts reflected back at us we can sometimes see that the edges don't fit.

A philosophical angle

There's obviously a lot more to it. One thing I've glossed over entirely is that I suspect there's a common philosophy between all therapeutic disciplines which is something like the Everything is Okay philosophy. In other words the denial of the authoritative, blame-based morality which tells us the world has problems we need to fix, in favour of the belief that everyone and everything is where it's meant to be, that there's no such thing as bad people, and that 'sin' is best treated with kindness and compassion. What else can you believe when your calling as a therapist is to look at people's darkest secrets and help them realise it's okay?

The crazy thing is it's just old testament versus new. Eye for an eye, or turn the other cheek. Same patterns, different Everything.

This puts therapy in a curious place: its key selling point is that it is morally neutral in practice, yet therapy as a discipline is not morally neutral. It gets away with it in my view because, as with the magician, the audience is usually glad for the misdirection.

Beyond this there's a stronger overlap between contemporary western psychology and humanism. It blew my mind when I read this page on the psychology wiki. It's a list of the basic philosophical premises that underpin modern psychology, and it is almost blow for blow the topics I studied in my years of philosophy. Each of the answers I'd sought on my quest for Whatever It Is. What really knocked me out about this whole thing was that I pretty much had all the theoretical knowledge I needed to piece together my puzzle. What I lacked was the first-hand qualitative data that came from paying attention to my own psychological experience.

There's an analogy that I liked to draw for myself (there were a lot). In the old days it was like I was in a self-driving car which just took me places. Over time I learned to look at where it took me and construct patterns and theories so that I could predict with some confidence where it would take me next. My experience of therapy was of opening up the computer and looking at the code. It's far too complex to know with certainty where I'm going (nor would that be any fun); but I'm no longer just a passenger along for the ride (or maybe, I'm still just along for the ride, but now I have faith in the driver).

I like that analogy.

Oh, and there's another thing, the qualitative realisation. I haven't really read up on this, I presume it's a thing. There was a moment, an evening a few weeks into therapy where my world turned inside out. It was what I just described, but the experience of it being so instead of just the words, and it coincided with seeing for the first time a big internal conflict. I kinda knew it was there in theory, but I had never watched it happening before. It wasn't an out of body experience because I couldn't see the back of my own head, but it was like it in that I felt like I was an observer of my own self. It felt like everything was happening automatically without my control and I could sit back and watch, or think about the thinking. And I don't believe that that is accidental. In fact, I think it's all connected.

Next time: Everything is Connected? Or something less cliche if it comes to mind.

If you're considering exploring therapy you can find the NHS page here: https://www.nhs.uk/conditions/counselling/ . Going private will cost roughly £50 per hour (best money I ever spent bar none) and you can find an accredited counsellor here: https://www.bacp.co.uk/

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