Psychotherapy can be a useful tool
Freud’s concept of repressive neurosis where he presents the notion that a person’s normal development can be repressed by a traumatic experience has held sway for many years. More recently, new techniques have been proposed to help the therapist reach deeply into the patient’s emotions either for better effect or for information that is more accurate. Therapies such as NLP are meant to offer better ways for the therapist to access information and standardize his/her position as guide/advisor. Other therapies such as Transactional Analysis, Hypnosis, or Gestalt help the therapist influence the patient’s response so a better outcome can be reached. Nonetheless, the traditional therapy where the patient is permitted to discover himself/herself through hours of passive exploration of past issues has remained the standard for most therapists. All our efforts have been directed at how the therapist can gather information about their patients and use it to guide, manage, or influence them to effect a positive change in their symptoms or behaviour. This presumes both an inability on the part of the patient and ability on the part of the therapist to use the information when it is deemed sufficient or appropriate. Is it not more effective, instead of bringing the disease to the attention of the knowledgeable person to bring the knowledge to the attention of the diseased person and show them how to use it? Let us see how this can be done. Too often we assume that, just because a person shows weakness in one area of life, they are incompetent in every other area, especially in understanding how to explore difficult themes and expanded responsibilities.
The Objective of Psychotherapy
Common guidelines on psychotherapy define it as “any form of treatment for mental illness, behavioural maladaptation, and/or other problems that are assumed to be of an emotional nature in which a physician deliberately establishes a professional relationship with a patient for the purposes of removing, modifying, or retarding existing symptoms, or attenuating or reversing disturbed patterns of behaviour and of promoting positive personality growth and development.”
Thus, it appears that the general objective is the healing of an emotional problem and removal of disturbed behaviour through the professional attachment to a more stable person. This assumes that professionalism bestows stability on the person who is the therapist. This can be a heavy burden as any therapist is no less vulnerable to the stresses that can sideline the patient as is the patient. There is also the assumption that through the modification of symptoms or reversal of disturbed patterns of behaviour, the emotional integrity of the person will be coincidentally restored. This may be true, but mainly for the person whose emotional state is not vulnerable to other stresses or who is naturally able to access a reasonable range of experiences to apply to these other existing stresses. For poorly prepared or chronically disturbed people, however, psychotherapy will take on the added burden of having to teach an expanded range of skills or insights to deal with the expanded range of problems that is normal in today’s society.
Nonetheless, the higher percentage of people who seek psychotherapy does not include those who are so chronically disturbed that they have little resources on which they can rely. More often, they are the normal people who become progressively distressed because of the unrelenting or inescapable stress from an external event arising from work demands, family or relationship conflict, or health concerns. In these cases, the disturbance, though temporary, is no less painful than the more serious mental conditions. Behaviour is distorted, not deranged, and will return to normal when the stress is relieved and the wounded emotions are healed. In these people, psychotherapy can be done in a highly efficient and effective manner if approached as an attempt to enlighten the person to better understand their stresses rather than the simple purpose of treating or modifying behaviour. It can be just as productive to apply this same process to the more disturbed or fragile ones since it can be rationally determined that they are simply people whose resources are so limited that even under natural stresses, their weaknesses are displayed.
Thus, the most important questions to be answered might be, “would persistence of the stressful event cause relentless progression of the illness?” “Would new events also create new difficulties and new wounds, just as easily or even more easily than were caused by the last one?” “Is this person simply less resilient to normal stresses and thus more prone to becoming chronically ill under relatively normal conditions?” “Is there, then, a sub-group of uncategorized people who, though not diagnosed with a mental illness, are yet so fragile that they require prolonged assistance in order just to function?”
It is the fear of this last concern that allows many people to hide symptoms or deny the presence of distress. Please let us put this fear to rest. In these times of political, social and economic unrest, it is highly possible for anyone to reach a state of emotional or mental exhaustion and require help getting out of trouble. Thus, a person does not have to be mentally weak or underdeveloped in order to become overwhelmed by today’s stresses. Even the healer is not immune.
Because, however, traditional psychotherapy aims at healing an obscure emotional or behavioural dysfunction through indirect encouragement and advice from a highly trained person who must remain objective to the problem, it can be a restrictive process. Because it requires attachment (bonding), self-enlightenment, and eventually weaning, it can also be highly time consuming and self-limiting. The same result can be achieved with less time demands or personal restrictions, however, if the mechanics of mental distress is approached more from the position of empowering a person to manage their stresses more effectively. Psychotherapy should not be meant to keep a patient alive; it should be meant to show a patient how to LIVE!
Empowering the Patient
In order to offer effective therapy, the physician must be willing to view emotional pain as simply the temporary distortion of the emotional integrity of the person in a natural effort to confront a stress. In other words, the patient is already trying to manage. He/she is only stymied because internal resources are inadequate for the demands of external stresses as they are seen to exist. Sometimes, the patient has the resources but cannot access them appropriately. Sometimes their perception of the size of the external stresses is distorted by associated experiences and beliefs. Sometimes the stresses are unfairly enormous and the distress is realistic. Yet, in this latter case, we can also see that it relates to the first. Then, just as we are trained to analyze the cause of a medical condition before we attempt to treat it, so must we be required to analyze the cause of emotional distortion before we attempt to treat its symptoms. To effect a competent analysis, we must be able to make three observations regarding the nature of mental distress and use them to make rational conclusions about the state of wellbeing of the person.
The first observation refers to our understanding of biological distress as the malfunction of organ systems that are compromised by the invisible biochemical, biological or physical forces acting on it. Applying this to the psyche, we can observe psychological distress as the dysfunction of the emotional integrity of the person when significant external stress, usually of uncertainty or rejection, compromises the resources of the mind. Uncertainty imposes a stress by virtue of its infinite possibilities of presentation. An uncertain or undisclosed event is thus infinite in its stress value until it is revealed. Rejection imposes a stress by virtue of its effect of minimizing the strength of the person. The human psyche is enegrized by affirmation or esteem. Self-esteem is the most desirable affirmation, but it requires significant maturity for its realization. Rejection, the reversal of affirmation, can deplete mental energy and so render a person less capable, even in conditions they normally can manage. Thus, as an expressed act, rejection can allow any stress to be great in comparison to the reduced capability of the person. We do not always respect the enormity of these stresses. Yet, uncertainty and rejection are stresses that, though far less visible than the stresses that distort the body, can effect more damage on mental integrity than those more visible stresses have been observed to cause on the body. Moreover, in this world of immense and persistent change, the stresses of uncertainty and rejection can arise so readily that anyone’s mental capabilities can be often tested. Even the therapist is not immune to such offensives. Thus, the healer can, at times, be more wounded than the patient.
The second observation is that the resources of the mind are not simply the biochemical or physiological activity of the brain. They are the qualities of wisdom and courage, resources that allow the person to function with the integrity of self. Just as we have learned that the strength of the body relies on the ability of the individual cell to metabolize nutrients, so is the strength of the psyche is derived from the ability of the intellect to process information.
The third observation is that we cannot always remove or reduce the stresses of uncertainty or rejection in order to eliminate the stress on the psyche. Sometimes we can, but as we live in a world of open activity where seemingly unrelated events or opinions can appear to apply to anyone at any time, these stresses are often impossible to reduce or remove. Moreover, these stresses stimulate the development of the psyche. Removing them leaves the person just as vulnerable to their next appearance and more vulnerable to their further evolution. We can, however, achieve the desirable balance between the external stress and the resources of the person by strengthening the mental resources of courage and wisdom. Our training in healing the body allows us to aim at restoring biochemical and physiological integrity, not simply removing the pain or suppressing the stress response. Why, therefore, do we not apply the same logic to our attempts at healing the psyche? In the same argument, psychotherapy must be the restoration of emotional integrity through the strengthening of the internal strengths of wisdom and courage, not just pacifying the pain or redirecting the behaviour.
Let us learn, therefore, to treat the psychological distortion for what it is – a natural stress of the psychological integrity caused by external events that are larger than the internal strengths of the individual at that time. Of course, every measure is relative. The event may be unfairly large relative to a highly developed wisdom. Similarly, wisdom may be extraordinarily small relative to a naturally evolved event. We cannot provide wisdom to another. People must be directed and encouraged to procure it themselves. We cannot provide courage. The person must be taught how to develop it within the conditions in which they function. It is these challenges that make the process of psychotherapy, not only difficult for the well intentioned therapist, but fair game for those with delusions of being able to provide the better answer. In fact, no one can create the ideal solution for another. There are no seven easy answers to being a better manager of any of the pressures, whether from life, business, or relationships. The person must create his/her own answers. The only help we can give is to guide the person, assuming that they are not chronically disturbed, but simply made unwell by the pressures from an external event they do not have the internal strengths to manage. Of course, the chronically disturbed are those whose wisdom has been greatly stifled because of distortion, either in the information received or in its transmission through a diseased body over a prolonged period. Then, treatment must be directed at the appropriate source. To offer accurate information to those whose perceptive skills are compromised can be an exercise in frustration. To offer chemical treatment to those whose needs are for guidance and information can be cavalier and definitely a compromise to our diagnostic skills.
The Process of Instructional Psychotherapy
Now, let us see how we can both reverse a psychological distortion that is established and control the evolution of a new one before it begins. In a world of imposing immensity and persistent change, we cannot contain the external pressures. Pretending to do so is an insult to the intelligence of our patients, even if that is what they have requested. Believing we have either the tools or power at our disposal to do so is a delusion and a revelation of our own limitations of understanding.
We can only attempt to expand the internal strengths of the person facing those pressures. As human beings, we will always be bombarded by the immensity of work and the uncertainty of life to a greater degree than our developed strengths can resist. Rejection and criticism will always reach us. Therefore, we cannot presume to be able to reduce those stresses, not even for ourselves let alone our patients. Instead, we must help our patients develop the internal strengths to resist greater pressures than they have developed the ability to do easily and naturally. To expand their internal strengths we must first realize that no one is so experienced that their wisdom will embrace all events that can arise. Wisdom, a quality not present at birth, can be created progressively if only they can harness the courage to analyse events as changing paradigms, look for the patterns within those paradigms, and understand them as they appear. Courage, therefore, is the variable we must help them protect or immunize. This cannot be achieved if courage is derived from external sources of success, acceptance, or prescribed motivation since these external sources are secured within changing paradigms. Courage must be self-initiated, nurtured from a measure of self that cannot be eroded by the uncertainties of life. But how do we help them measure self?
As a measure of self, wisdom is always insufficient relative to the vastness of new events or the new twists that will consistently arise in old events. As a measure of self, the performance of the body, its stamina and its appearance are qualities that cannot endure. A tiny virus or a simple injury can negate their best-prepared presentation. As a measure, acceptability is unpredictable. Friends cannot always be there, and when they are, they cannot always be focused on that person’s needs, or they will measure him/her against standards that are inappropriate to his/her efforts.
Instead, we must teach patients to measure themselves by their efforts. We must teach them to see themselves as intelligent beings with sophisticated bodies, not as sophisticated bodies with intelligent minds. As sophisticated minds, their efforts are directed at examining obscure situations and creating insight, with or without direction. Thus, they must learn to measure themselves by how they are able to use their intelligence. If they have the wisdom to manage an event, they must be taught to recognize that their intelligence created it. If they do not have the wisdom to manage a particular event, they must be able to conclude that their intelligence can create it. It is this recognition that generates the strength of courage.
Courage then, is based on their use of intelligence, a facet no one else can measure. Once they can learn to accept this, they can free themselves from the fragile external measures that so easily reject them. We must help them recognize that their adherence to these fragile measures they once determined was greater than them is the condition that makes them fragile. We must also help them recognize that their self-directed measure of growth determines the security of their internal strengths. This is true self-esteem, not to be confused with esteem derived from external recognition of success, smugness with an achieved level of wisdom, or conceit with certain inherited qualities. True self-esteem can allow a person to create a solution and rise above oppression even when they are stressed by an external pressure or when other support systems are in short supply.
This is an education, not a treatment process!
Thus, psychotherapy aimed at teaching a person to strengthen their true self-esteem does not have as its prerequisite an unwounded therapist with a multitude of applicable solutions. In fact, it really does not require a therapist. It simply requires the exposure to logic and information that reinforces this theme and shows the person how to formulate his/her own self-assessment. The aim of this form of psychotherapy is to empower the other to find their own answers, not be their source of inspiration or enlightenment. This does not require long sessions or great brilliance. It requires, however, the acceptance that our real objective in life cannot be to survive. This is impossible as fragile bodies existing in a world of incessant change. It cannot be to form and shape the world by our efforts. This too is a pipe dream in a world where change defines existence. We must be willing to learn that we are sophisticated minds with the mandate to grow, formed and shaped by the world as new problems and new twists to old problems evolve.
Psychotherapy can then truly reach its objective of modifying behaviour through healing the stressed mind, the generator of all behaviour. Psychotherapy can thus also go the extra step of minimizing future stress by strengthening the internal forces of wisdom and courage through the practice of self-accountability and self-determination. It is only through a proper understanding of the inevitability and unpredictability of change that our patients can address themselves at using their greatest asset, reason, to explore new challenges and to keep doing so by truly UNDERSTANDING CHANGE.
UNDERSTANDING CHANGE is a technique that does not aim at relieving emotional pain or simplifying a complex society. Rather, it is directed by the UNDERSTANDING that the world will always change of its own accord; that change is the energy we use to stimulate and develop ourselves.
The UNDERSTANDING CHANGE argument can be used in three modalities of therapy. First, it can be used as the general technique for helping a person stressed by an existing situation to grow past the pressures and either manage the situation or accept it more comfortably. Secondly, it can be directed at people who need to be better equipped for a new or potentially volatile responsibility like parenting, marriage, etc. This is the preventive use. Thirdly, it can be used to rehabilitate a person to be better equipped to manage in the real world and emerge from a state of irresponsibility or aggressive immaturity.
However we look at it, psychotherapy has an advantage over other chemical therapies. These therapies address or stifle the symptoms leaving the problems to recur. Psychotherapy addresses the problems, leaving the symptoms to subside. Instructional psychotherapy goes the extra mile by providing the patient with the tools to address the next challenge with greater skill and insight.