What Does an Ideal Therapy Approach Look Like? by Dr. Deb Hirschhorn

Dr. Deb What Does an Ideal Therapy Approach Look Like?

By Deb Hirschhorn, Ph.D.

Atiny scratch in an antique changes the price value from a lot of money to almost no money.

So it is with lots of things. Sometimes small differences turn out to make a big difference, after all.

Like the time you cried to your therapist about all the problems in the marriage, and he said you should get divorced…

That was not the answer you wanted.

So I’d like to give you a rundown of what I think an ideal therapy modality would look like. Ideally, therapy should be a form of work that fosters the individual’s self-love, self-compassion, and joy.

Here’s what I believe all therapists share: * We all care. * We for sure better be good listeners * We believe in you * We all have tons of patience

I think that’s where the similarities end between conventional therapy and one that fosters self-love.

Here are some differences that make a real difference in the outcome:

Therapy that fosters self-love absolutely knows, beyond a shadow of a doubt, that you and your spouse are NOT crazy, sick, mentally ill, narcissistic, borderline, or bipolar no matter how many “esteemed” doctors said so.

Well, that’s different!

In one work, this approach is called “non-pathologizing.”

Looking at clients this way has long roots. Milton Erickson, the father of modern hypnosis, simply went with whatever clients brought into the room as a starting point for healing. He called this “utilization.”

Thomas Szasz wrote a book, “The Myth of Mental Illness,” back in 1960, defying the psychiatric profession to define “mental” illness. His position was that it is whatever you call it. Proof was the vastly different approach to those definitions between Europe which, postwar, had an aversion to labeling people, and the United States, which had no such aversion.

Another of his proofs was in the changing definition of mental illness over time. No better example could be used than the changing – and expanding – definitions in the Diagnostic and Statistical Manual of Mental Disorders.

Somewhat later, in 1971, Seymour L. Halleck published “The Politics of Therapy” which had an approbation on the front cover by Karl Menninger. But the topics inside covered such things as, “Psychiatric Treatment in an Oppressive Environment,” “The Political Nature of Psychiatric Practice,” “The Social Meaning of Symptoms,” and “The Repressive Use of Drugs.” Why have people like Halleck, Szasz and others expended so much energy over so many years fighting against the stupidity of diagnosing “mental illness”?

Simple answer: Because you will never solve the problem by putting a label on it. Instead, the very act of diagnosing makes everything worse.

For the following reasons: 1. It takes away hope.

People start to feel that if they are saddled with a diagnosis, they’re stuck in it. 2. It takes away agency.

By “agency,” I mean a person’s ability to take action.

When you are told that, basically, you’re sub-par, you figure there’s nothing you can do. 3. It makes The Man (or woman) into a Superior Being – that is, the doc who diagnosed you suddenly gets inflated with all sorts of Power because he/she was so brilliant as to be able to “give” you that diagnosis.

Which, by implication, makes you into less than nothing.

Ugh.

But the most important aspect of this is that a diagnosis does not lead to a particular course of action; there are too many differences in how therapists see things to have the same approach to a diagnosis.

Which leads me to the next point: If the diagnosis doesn’t help, then what does?

An approach that says that our coping behaviors make sense. That is, they were necessary to help us handle painful, difficult, traumatic, or abusive circumstances. That was all we knew, so we did what we had to.

See, this is the exact opposite of a diagnosis. It is an Anti-Diagnosis!

It says that everything people ever did that looked crazy to other people was actually pretty smart.

It also says that the people who made the diagnoses were too terrified to peek inside their clients’ windows to discover their true Selves.

Think about it.

What options does a kid have when someone is yelling at him because he didn’t understand his homework?

Or when his parents are fighting?

Or when someone dies?

How does the kid handle any of it?

The answer is: the best he can. He’s only a kid.

So – you can argue – why does he keep doing the stuff he did as a kid if it’s not helping?

Because at some level, he is on auto-

matic. These behaviors worked to some degree when he was a kid so he or she keeps relying on them.

Now, you can argue some more: But we went to a Weekend which taught us new tools. Why did we stop using them?

Habits.

Habits die hard. The reason for that is that they are tied to emotions. Emotions rule.

Let me give you an example:

Let’s take Bill and Gloria (making this one up as I go along, the way I always do.).

Bill loses his temper and that is Gloria’s complaint. In particular, she reasons, she didn’t even do anything to provoke him. So they go to a weekend where they learn how to make “bids” towards each other . . . . . .and how to make attempts to “repair” broken communication.

They’re both enthusiastic at this. After all, Bill doesn’t want to be a jerk, right?

It lasts for two or three weeks if they’re lucky. And then it breaks down.

What did the weekend miss that the “symptoms make sense” approach will help Bill and Gloria with?

What the weekend missed is something Bill does not want to do: He has to recall why and how he learned to have a temper.

He doesn’t want to because it hurts. And yelling doesn’t.

But without doing that work, he’s only sweeping the dust under the rug.

Not only that, he has to then take leadership over the part of him that needed to learn to yell. And he screamed at her.

Wow, that felt so good.

Getting all that pent-up hurt, insult, rejection, and rage for the mistreatment out of his little heart.

And, oddly, no one yelled at him for it.

His father knew he couldn’t yell again; he knew in his heart that he’d overdone it and he hated himself at that moment.

You will never solve the problem by putting a label on it.

If Bill sits quietly and clears his mind after asking the question Where did the temper come from? he can see his younger self sitting in the kitchen being yelled at.

He can see how frightened that younger self felt.

He can also see that as he finally made his escape from the humiliation, disconnection, and aloneness he felt, he noticed his sister playing with his toy.

So Bill got away with it. And it felt so good. Like a thousand-pound weight off his back.

Over time, he learned that if he was being invalidated, dismissed, mistreated or misunderstood, all he had to do was take it out on someone else, and his power returned.

So when he went to that weekend, what, exactly, did he learn about soothing and healing that rage inside of him? Nothing.

Nothing at all.

And that’s the problem.

The tools told him what to do but not how to feel better. So a few weeks later, he forgot to call Gloria’s brother about something important. It was an oversight.

Gloria was upset, and her voice inched up. A bit. But that bit was too much for Bill. It triggered the past injuries.

That’s the part that the tools workshops don’t cover: When your past pains get triggered, how do you heal them on the spot?

The answer is, you need to work with the past pain when you’re not triggered so as to be well prepared for times when you are.

The ideal therapy goes beyond finding out what went wrong. It teaches you how to heal. And might even hold your hand along the way.

Dr. Deb Hirschhorn is a Marriage and Family Therapist. If you want help with your marriage, begin by signing up to watch her Masterclass at https://drdeb.com/myw-masterclass.