In Search of a Friend
I believe, without discrediting the profession entirely, that some of the benefits derived from psychotherapy could just as well be provided by close friends and family members. Psychotherapy is a relatively young field, but even still, there is evidence that the most important factor in whether or not it actually works is the relationship between the therapist and the client. And if establishing a good relationship is the main way people benefit from psychotherapy, it stands to reason that they could potentially experience some of these same benefits if they established similar kinds of relationships outside of therapy. In fact they should be encouraged to do so by the therapist. What matters most in the final calculation, is the dynamics that are created between two people, not, in totality, who the two people are.
Freud told a story that helps to illustrate this point. He was working with a patient who was suffering from mental distress, loss of sleep, and a lack of appetite. He and the other physicians involved in her care had failed in their attempts to improve her condition which was only worsening. Until one day, a friend of the patient actually came and abducted her from the hospital and brought the patient home with her to care for her there. How she accomplished this is either unknown or unstated, but a year later Freud once again became involved in the care of this patient and was surprised to discover her in a much better condition than the one she was in when he last saw her.
What is more likely is that it was the care she received from her friend that made the crucial difference.
Freud credited himself for the change in her condition, attributing it to the lasting effects of his treatment, but this is unlikely because the little that was said about the treatment, spoke only to how ineffective it had been in helping this woman. What is more likely is that it was the care she received from her friend that made the crucial difference.
And it is safe to assume that this friend of the patient must have cared a great deal about her if she was willing to abduct her from a hospital. To this friend, it must have felt more like a rescue mission, and a serious responsibility to nurse her friend back to health. Her steady presence and consistent care is what allowed this woman to heal and start to become whole again.
Most of us have our stories like this. Stories of being in a low place in life and needing the love and support of someone else to carry us through. Sometimes that someone else is a therapist or a doctor, but as the story illustrates, it does not have to be. We can all provide this type of care for each other, and it is important that we do so because not everyone has access to professionals and even those who do might not have access to them in their time of need. And in those times, what we need, in reality, is a friend who will barge in and save us.
Therapists are skillful and curious learners, which eventually, we hope, will allow us to help someone in need.
The thing that therapists are trained to do well is listen. We listen to what is said and what is not said. We look at the actions of clients and understand that this is a form of communication that must be listened to as well. Through listening we form opinions and make interpretations, and as we get to know our clients better over time, we can make quicker, more accurate judgments about what is happening to them, or at least we should. The necessity of all this listening really implies that therapists are not experts on our clients’ lives, because we have not lived them. Therapists are skillful and curious learners, which eventually, we hope, will allow us to help someone in need.
And yet, it is possible for the friends and family that we keep closest to us to also learn and possess this intense curiosity about others. Friends and family may be even more capable of quickly becoming experts on our client’s lives because they have bore witness to them and have lived in close proximity to them for much longer than we have as therapists. It seems unwise for their testimony to be neglected.
Losing Control to Be Seen: What are the Unspoken Dynamics of Acting Out in Therapy
A client walked into my office for an appointment. They seemed fine at first, but it quickly became apparent that something was wrong as they sat down on the couch across from me and began to twiddle their thumbs and shuffle their legs uncomfortably. This went on long enough and eventually I asked if they were nervous.
“No” they replied. “Well, maybe a little…I did do cocaine.”
“…When?” I asked, somewhat surprised, mostly because it was only a few minutes past 10 o’clock in the morning.
“Right before I came here.”
I looked at the client, carefully considering what they had said to me, letting it settle in my mind. What did it mean for this person to sit before me, young, impulsive, painfully naïve, and share this information? To opt for truth when they easily could have lied. There was a look of disappointment and expectation on their face as they waited for me to say something.
“Do you want me to be upset with you?” I wasn’t sure if this was the right question, but I knew that any sort of declarative statement would be of no use. Not until I could understand this person more fully, and with my question I started in on that task.
Nothing is done for the sake of nothing, and human agency is goal directed even when the goal is unclear, as is the case in many instances. It is easy to judge someone who shows up to an appointment high on cocaine as being out of control. Maybe they are, but there are also certain benefits to “being out of control” which must be considered. Losing control, by which I mean acting in ways that are risky and potentially harmful to oneself or others is a proven way to elicit care from others.
Imagine a person whose experience teaches them that their wants and needs are not important, or even worse, receives the message that they are not entitled to have any wants or needs because of their status. This message crystallizes around their existence, and it is often the case that the only time an exception is made is when they are ill or in trouble. On these rare occasions, rather than being dismissed, the person is showered with attention, and this attention, no matter how positive or negative, caring or chastising, is still an improvement on being from being the recipient of emotional indifference.
At some point such a person makes a discovery, which is that when they are out of control, people are more likely to take care of them. The person sitting before me, who had been passed over many times in life, was such a person. Branded as a troublemaker already, they explicitly rejected this label, but implicitly accepted it and used it to get attention and care from others. They could have cancelled the appointment or just not shown up at all, but they didn’t, and their confession of drug use doubled as a confession of desire, that there was something they wanted from me. Chiefly, positive attention in the form of caring concern, but I suspect that if I had become angry at their confession this would have been an acceptable substitute. Anything but nothing.
The problems inherent in this strategy are obvious. As previously stated, it is risky, and there is the chance that a person goes too far in their bid for attention and commits a mistake they cannot easily recover from. This strategy of losing control to make people take care of you is also a form of manipulation, and once caught, the person is even less likely to receive the care they initially wanted. At that point either the jig is up, or the person becomes more desperate in their manipulation, resorting to more dangerous versions of losing control to get their needs met.
These regressions may involve harming oneself or others, risky drug use, indiscriminate sexual activity, and episodes of uncontrolled rage. The ways to lose control are numerous.
What other options are available? The person most likely to entertain this strategy struggles with recognizing and acknowledging their wants and needs so they must learn how to begin doing this. They must experience what it is like to be encouraged to share their experience with another and have it validated instead of dismissed. And they must learn that the stakes do not have to be so high for them to feel entitled to receiving care from others.
When they no longer must lose control, they are free to try other things. They can talk about how they feel and what they want and make requests of others. They can learn how to meet their own needs, through exercise, a warm bath, enjoying a favorite meal, and many other things. Or they can give up some of their wants and needs, which may be the greatest sign of an individual’s growth and maturity. When a person consistently gets at least some of their needs met, they are not desperate for limited opportunities to do so.
The client didn’t want me to be upset with them, as it turns out. Truthfully, they didn’t know what they wanted, or why they did what they did. Only that they were struggling and wanted help from somebody. An outcome they would have to learn could be achieved without clumsy concoctions that I would not choose for them, but am thankful that they chose to share with me.
Can Psychotherapists be Seen as Artists?
When approached and practiced in certain ways, psychotherapy can be elevated to the level of an art form. The fact that psychotherapy is still (and necessarily so) a private affair that is hidden from public consumption makes it more difficult to qualify or quantify its status as a form of art. But for the many who practice it and the few who get to observe it, there are differences between straightforward practitioners and artists in the trade.
Consider this—art is a realm of subjectivity, where often times consensus is king and the majority rules. The paintings of a Da Vinci and Picasso, or the designs of Frank Lloyd Wright still leave some cold. As do the writings of Baldwin, Morrison, or Rowling. But to a sizeable amount of people, their works represent titanic triumphs of human creativity. Whatever this sizeable number is, it represents mass approval, which is so often necessary for the triumph of art over obscurity, but of course a number is not all that art is. And this mass effect I speak of has lent its weight not only to the crafts of painting, architecture, or literature, but also to psychology, the study of the human mind.
To be clear, mass approval is not enough. The popularity of a thing does not mean that it is worthy of adulation. Art stirs something deep inside of us and brings it to the surface. Art disturbs, and is confrontational at times, but it also seeks pathways to deeper connection with oneself and with the world. The beauty of art lies in the way it makes us feel something that is deeply personal and at the same time relatable to all of humanity. How the artist achieves this effect differs based on their tools and the talents they possess, but the desired effect is always the same. To wake others up to themselves and get them to feel deeply.
It takes courage and a certain audacity to practice art
The psychotherapist does not use the brush of the painter, the instrument of the musician, or the charts, graphs, and measuring tools of the scientist. They use themselves—their presence, consisting of their body, heart, mind, and spirit, which allows them to forge an alliance with those they work with in hopes of bringing forth something new. The artist plays at God as they attempt to corral creation, and in a sense the psychotherapist does the same. The best are very intentional about their ambition.
At times the psychotherapists will fail: there will be clients who do not change or become better, and some who may become worse. To fail in the endeavor to create and bring forth something new in a person can be more devastating than errant brush strokes and misplaced musical notes. This is because a person expresses consciousness rather than simply being a product of consciousness. To work with another, knowing their potential and their limitations, and journey through the maze of their life with them takes courage and trust. Trust, in another and in oneself, is the bedrock on which creation takes place. Without it there is no sense of direction, no willingness to take risks, and no progress which can be made.
It takes courage and a certain audacity to practice art, because it requires a willingness to exist separate and apart from others. A distance that is necessary when one does not simply want to talk, but feels they truly have something to say. Whether or not the feeling is justified is a bargain which must be struck between the individual and society. Some psychotherapists have much to say about nothing. They regurgitate empty platitudes or vomit up their own insecurities, inappropriately praising themselves or judging others without having earned a right to do either. They move at a frenetic pace while accomplishing little of substance; they retreat into data and evidence whenever they are confused or unsure, signaling that they do not know how to practice the art of psychotherapy, but only how to follow the manual they were taught.
The client who comes before the psychotherapist may for the first time in their lives, as a result of their dissatisfaction, be open minded enough to have a real encounter with themselves. The approach of the typical psychotherapist is management and symptom reduction—to be able to give a pat on the back to the client as they walk out the door and assure them that they are okay without ever asking them to be better. The artist who practices psychotherapy seeks other things—connection, engagement, growth, and transformation in ways that are organic and unique to the individual they are working with at the time. Only art can do this. At its core the musician has there 12 notes to achieve this, the writer has there 26 letters, and the psychotherapist has their self. More than any theoretical background, use of the self is needed, a self that accepts life with its tensions and challenges, and helps others do the same.
What is the Purpose of Psychotherapy?
To tolerate life remains, after all, the first duty of all living beings. Illusion becomes valueless if it makes this harder for us.
— Sigmund Freud
The psychotherapist is always listening. They listen to the stories people tell them; stories that double as half-truths they simultaneously tell themselves. Stories that the therapist may tell themselves just as often. Listening comes with the territory, and part of what makes someone a good therapist is the ability to do so. To an outside observer it might not look like much is going on between a client and a therapist. Just two people having a conversation, but beyond initial appearances, a complicated exchange is playing out between the client and the therapist.
It is only through facing the things in life that are most difficult and confusing for us that we make sense of them.
In a therapeutic dialogue both client and therapist are constantly testing one another, and constantly testing themselves. The client wants to know if someone the therapist, purported to be a professional helper, is really up to the task, which is a fair question because therapist do not always know. More than that, the therapist is not always sure of the client’s commitment either, and there is enough uncertainty and trepidation to make one ask, what is the purpose of all this psychological probing and is there an end goal to be reached once it’s all done?
It’s certainly a fact that people test one another, in therapy and in life, to find out whether or not it is safe enough, physically and psychologically, for them to be honest about who they truly are. and few situations engender this more than the unfamiliarity of finding oneself for the first time sitting on in a therapist’s office with the expectation that you simply open your mouth and start to share your thoughts and feelings with someone you just met. In order for anyone to do this, the therapist has to quickly convince the client of their skill and capability. Without this initial convincing, there is no reason for the client to be there, and their presence will certainly be short-lived. With it, the client feels safe enough for the work to begin.
What the client gains is a place to retreat from life when they need to. A place where they can get enough distance from the world to start learning about it—if you live long enough you know that it is difficult to be curious when you are being assailed on all sides by challenges, at which point surviving life’s harsh realities becomes the main goal, the only goal, and the lens through which all other choices are filtered. Therapists are there, one hour at a time, to pull the client out of their world, and more importantly, to pull out the parts of the client’s world that they struggle with the most. To push the client to confront the parts of life they are most confounded by.
It is only through facing the things in life that are most difficult and confusing that people begin to make sense of them. It is a process that must be repeated numerous times throughout their lives because new challenges require new answers regarding how they will be met and eventually overcome. In the end, there simply is no cure for life.
The psychotherapist acts, for some length of time, as a secular guide on the client’s journey, helping them learn how to confront their deepest anxieties and overcome their most stressful life events. Helping clients to become more skilled in the art of living is the psychotherapist’s purpose, and in carrying it out, clients themselves begin to develop their own, one that is not based on unearned confidence, but is carefully arrived at, with the proper motivation to pursue it.
Why I Am an Existential Therapist
Life, it seems to me, lends itself to certain possibilities. Possibilities which themselves take on an air of inevitability - that perceptive persistent state in which choice and free will are at first subsumed and at last obliterated. I was born and just as quickly as I began to bloom I also began to be pruned and peppered for ends neither freely chosen nor wholly my own, if at all, barreling towards them until I would finally reach some unsatisfying conclusion.
Existentialism, a philosophy dealing with freedom, authenticity, meaning, and even the inevitability of death, the ultimate human concerns.
Having arrived, and realizing how little of my life was of my own choosing, I started to examine the whole affair in order to understand where I was, and if necessary to uproot myself. Some things have been said about what it feels like, this unshackling, this untethering, but very little about how frightening and arduous a task it is to really do it; to really choose for yourself. At times you wonder if you've gone crazy, a word I am less and less convinced describes anything substantial, least of all what one is actually going through. But if empty words are the cost of breaking with some old way of life that is ordered but agonizingly dull and predictable, then so be it.
I’m told I was born without a heartbeat or a pulse, by way of unforeseen complications during my mother’s pregnancy. That the first thing to wrap itself around me was not a warm blanket given by some nurse or orderly reeling from a night of dealing with birth and death and all of the excrements of life, and it was not the weary arms of my mother. Death covered me, prematurely yes, but it covered me all the same. I assume I lay quiet and breathless as seconds stretched into the ether, serving out a death sentence that at best would be reduced to a charge of brain damage and a lifetime of silent “if onlys.” I’d be incredulous if I had not seen faded pictures of the whole ordeal pressed into the yellowed pages of my family’s photo albums, themselves remnants of the past.
Somehow, I survived all of that, and the irreversible damage that was predicted never did set in. Eventually my lungs filled with the sweetness of air as I began to breathe, my heart started to beat, the cascading wires attached to my body were removed, and I was not plucked away too soon. This story has always stayed with me.
My interest in existentialism paired with my choice to become a clinical social worker led me to existential psychotherapy
As a child I wondered if I was special for surviving: I wanted to believe it, though I truly did nothing to accomplish the feat. My body wanted to live so it did; the rest is a mystery to me. Perhaps others knew it better and could explain it best back then, but all of those faces and most of those memories are lost now. More meaningful than the mystery or the facts involved was how the experience affected me, by which I mean it provided me with an early sense of my situation, which gradually grew into an awareness of the situation for us all. I was alive, but this did not have to be the case; it was not a guarantee, or a promise, or the fulfillment of some far off prophecy; it was the outcome of incalculable events, more innumerable than I could begin to understand.
Awareness being no guarantor of anything, least of all progress or change; I was not well equipped to deal with the conditions of my life that at times practically begged to be faced, and I was not well equipped precisely because no language that is given and not freely chosen can contain within it the power a man or woman needs to work out life’s problems in their own way. So I began, earnestly, to find my way through the use of philosophy and the deep introspection that accompanies it, and ultimately through existentialism, a philosophy dealing with freedom, authenticity, meaning, and even the inevitability of death, the ultimate human concerns. It did not ask me to shrink in the face of my responsibilities or to abdicate them to some force outside myself, but to accept them as my own, and more strangely than that, to accept myself as my own and value myself accordingly. It readied me for the challenge of trying to find answers to the questions about life that have perplexed humans for as long as our ancestors have walked under the warmth of African suns. It allowed me to meet, on neutral terms, the pervasive loneliness that ached inside of me and was reflected back in the eyes of the men and women in my community. It heightened my senses, and at the risk of romanticizing, brought to life, for the first time in a long time, a necessary intensity, an urgency to live while I can. It opened me up to the world and all the beauty and terror that lie therein.
My interest in existentialism paired with my choice to become a clinical social worker led me to existential psychotherapy - a dynamic method of therapy that was created out of the core principles of existential philosophy and fashioned to meet the needs of clients suffering with mental disorders. It provided a framework that aligned with me personally and professionally and connected me to a lived tradition that includes clinicians, writers, philosophers, activists, artists, and more.
I choose to work existentially because those same aches and pains that have plagued me have plagued us all. Because for the deeper problems of life there is no manualized method or simple solution that will banish from our sight for forever and ever, the pain and confusion and awe of living. We each must contend with our fair share of struggle and strife as we try to meet life on its own terms, and try we must, since the only way out is through (I’ve yet to find another). If somehow, in trying, I can sit with others compassionately, and bear witness to the fineness and the folly of the journey each human must undertake, then perhaps some growth and healing can be had for us all.