This is not a talk show

Therapists, rather than helping their clients tackle the more critical, covert sources of their emotional distress, often treat them for the signs and symptoms they expressStress, for example, has a very loud voice and will not likely be easily concealed by contradictory behavior, i.e., unhappiness, depression, anger, rage and discontent are all common and quite obvious indicators of some form of personal hardship.  We have to be careful as therapists, however, not to treat these emotional and somatic gestures as if they were our client’s primary illness.  The emotional signals our clients send are more often symptomatic of something much larger.

  • Lethargy, lack of interest and inertia may be symptoms of thinking that one’s life is wholly irredeemable and that there is no hope left. 
  • Anger may be a symptom of fear
  • Attention deficit (ADHD) and behavior disorder (BDD) may be symptoms of weaknesses in a child’s physical and social environment – or a parent’s inability to undertake the responsibilities of raising a rambunctious and demanding child.   (The way I look at it, if Helen Keller’s parents were able to raise Helen through childhood into meaningful adulthood, and we elect to give children chemical lobotomies because they won’t sit in their chairs at school, we’ve lost an essential component  in our present-day system of parenting and education. We are also addressing, in this example, the symptoms of the real problem.)

Like most things in our fast food culture, people who seek help resolving an emotional hardship want immediate relief of their symptoms – step up, get your product, swipe your card and leave. (And there are many therapists who are happy to do it that way.) Rather than working to modify the source of the symptoms, people often want the kind of help that will, instead, make them sleep, stop crying, stop obsessing, stop caring, stop feeling – to be NUMB!  If we treat our client’s from this perspective, however, it is unlikely that we will ever help them achieve emotional stability over the course of their lives.  

Ah, I see you’re back.  How can I help you?”

“I’m really depressed, again!”

“Heavens, you’ve only been gone an hour.  I really thought the last year of therapy had helped. That can be expected. People get depressed when they lose their job. What happened?”

 “I got fired!”

Relieving the overt symptoms of distress is often a therapist’s first goal.  It isn’t nearly as tough, however, as resolving the covert problem.

“Oh, that’s horrible! What are your plans?”

“I don’t have any.  I can’t get out of bed in the morning.  My life has gone to hell in a hand wagon.”

“I am SO sorry to hear all this.  This is all normal, though. You can’t let this get you down.  This will all turn out good.  You watch!  You’ll get another job – you and those pearly whites!”

If we persist in addressing only the symptoms of emotional distress, and attribute their cause to some external source, we will be forever chasing after temporary, short-term relief. For example, if a child persistently gets second degree sunburns in the summer, and h/er physician treats the burn with a topical medicated cream – and does nothing else, we would not be recognizing and addressing the prevailing issue, which is that the child’s parents can learn to take steps to avoid the damage in the first place.  The child may need to learn about the suns potential to cause serious injury.  If we can take steps to impact the true problem, rather than the symptoms of the problem, we will likely be more successful at negotiating an intervention.

This example might be used to develop and improve our approach to mental health mediation.  If we teach our clients that depression is just an expected result of misfortune, the client will likely always express depression whenever s/he experiences misfortune.  The client will be forever, as well, left to seek outside help to resolve nearly all of h/er emotional problems.

Contrary to the conversation, above, we might, instead, practice differently:

“Ah, I see you’re back.  How can I help you?”

“I’m really depressed, again!”

“You’ve only been gone an hour. How do you know you’re depressed?”

 “I got fired!”

“What I mean is . . . how do you know you’re depressed?”

“I can’t eat.  I sleep all day.  I sit and stare at the wall. You know . . . that sort of thing.”

“How is that a problem for you?”

“Oh, here we go again!”

“Yes, this is not a talk show.  This is therapy.”

“Well, I shouldn’t have been fired in the first place.  My boss is an asshole.  He was out to get me.”

“So is your problem that you were fired or that you shouldn’t have been fired in the first place?  Or maybe your problem is that you think your boss is a rectum?”

“Both!  All three!”

“Which event do you think is contributing to you staying in bed and not eating?”

“Probably thinking that my boss shouldn’t have fired me in the first place.  It’s his fault I’m in this shit mess.”

“What do you suppose you’re telling yourself about your boss these days?  What are you saying to yourself about him and these events?”

“I tell myself that my boss shouldn’t have fired me.  I didn’t do anything and people shouldn’t have to suffer if they didn’t do anything. People who follow the rules shouldnt have to put up with shit! My boss should be fair with me.  I ought to be treated better.  I deserve it.  I think your boss should always show you respect!  I need things to go smoothly in my life in order to be happy. If things don’t go smoothly, then I just can’t stand it!”

“Is that it?”

“No! My wife things I am a fuck up!  My boss might as well have cut my balls off. Maybe he and my wife are right about me.  Maybe I am a fuck up! My kids are mad because we can’t do much anymore, because I don’t have any money. I’m sure people are laughing behind my back.  I can’t even go out and mow my grass.  If people see me out during the day, they are whispering that I am a failure.  Which I am. Oh, hell, it goes on and on.”

“Sounds to me like maybe losing your job and getting fired are not your problems at all.”

“How so?”

“All that stuff you’re saying to yourself about your boss and your neighbors, your kids and your wife, that might be a bigger problem than losing your job.  Maybe if we can change some of that self-talk, some of that insane, nutty shit you say to yourself, you might make yourself feel better.”

“How will we do that?”

“That’s the hard part. That’s why I’m a therapist and not Dr. Phil.”

It is NOT the therapist’s role to treat the obvious symptoms h/er client presents in therapy.  It is our role, however, to uncover and treat our clients’ problem thinking – something they don’t often know they have.  By doing so, we will improve the likelihood that our clients’ symptoms will experience some measure of relief through more logical and rational thought.

The very thing that separates a client from a therapist is in the therapist’s understanding of the human mind and the human body – not only its structure, but its plastic, ever-changing environment for emotional evolution.  Your client depends on your ability to show h/er around inside their own heads (a place where you would think everyone would be more intimately familiar) and help them uncover the true nature of their emotional distress.  If you can have an impact on your client in this way, you will have helped h/er build h/er skills at self-help and self-sufficiency.  If you continue to treat your client’s symptoms, you will be establishing a foundation for a lifelong commitment to dependency.


3 responses

  1. Albeit it looks like I am stalking your blog today rest assurred its only because I am behind in my reading.
    This post like so many of yours is not only is appicable in my own life and my families in how I approach others. Its also applicable to my CASA kids and their parents. I learn so much from your blog here Doctor, its almost like studying with you. Thank you!

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