The Lost Potential of Psychotherapy Part 2

‘Give me a child until he is 7 and I will show you the man’.

Aristotle, The Philosophy of Aristotle

by Peter Boger, M.A.

In my last article I talked about the assumptions underlying psychotherapy and the most basic one being the unquestioned belief that the ‘map’ we are taught in our childhood is true and reliable so if we are having trouble finding our way in life the problem must lie with us, not the map we were given.   Thus psychotherapy is concerned with identifying the ‘problem’ or ‘dysfunction’ or ‘mental illness’ that needs to be ‘treated’ or ‘corrected’ and the presumption is that everything else is just fine, thank you. 

For most people this arrangement is accepted as perfectly appropriate and all the customary structures around it, the ‘authorities’ and ‘experts’ who research, teach, certify and regulate the practice of psychotherapy ensure that people have confidence that what is provided is going to be helpful and not harmful. 

Mental health treatment today is fundamentally defined as either ‘talk therapy’ or the use of medications that target what are considered brain disorders such as depression, anxiety among a long list of diagnoses, or both.   While these treatment approaches are both considered ‘mental health treatment’, they are profoundly different, and the health care providers come from completely different educational and training backgrounds.   Medical doctors who specialize in the brain and nervous system are called neurologists and a small subset of these go on to get further training in the specialization called psychiatry.   Psychotherapists are primarily educated in universities and while many major in psychology, their undergraduate studies can span a wide variety of different backgrounds.   In my experience over many decades of practice many male therapists started out pursuing a career in the clergy or ministry and ended up as psychotherapists.   All therapists have at least a Master’s degree in psychology, social work, or related fields.   Each state licenses therapists and sets rules governing mental health treatment.

Nowhere in the above described system for the training, certification, and regulation of mental health providers is the basic assumptions underlying our cultural and societal beliefs ever questioned or challenged.   In fact some have argued that mental health treatment is ultimately one of many ways societies maintain conformity and protect the ‘status quo’,  whether done in obvious ways such as political dissidents being ‘committed’ to psychiatric hospitals in dictatorships to more subtle ways it can be employed in more ‘democratic’ countries.   In any case no one wants the social stigma that comes from having one’s sanity called into question. 

To summarize,  we currently have an uneasy relationship with mental health and mental health treatment in this country.  While we have come light years from the days when we treated people suffering from emotional, cognitive or behavioral problems as possessed by demons, burned them as witches or isolated them in ‘madhouses’, we still keep mental health as a ‘stepchild’ in the larger healthcare system in this country.  

To further complicate an already complicated picture, we live in a current capitalist culture that has embraced the area of mental health as a lucrative marketplace where everything from the ubiquitous self help book to new drugs for everything from depression to addiction can be extremely lucrative and there is a virtual parade of mental health celebrities like Dr. Phil, that seem to come and go with great regularity. 

I write this here to give some context to this topic of the lost potential of psychotherapy, not to attack the field of mental health care.   When you start to get curious about yourself and others as conscious beings it’s important to appreciate both the complexity of the subject and the likelihood that your exploring will take you to places you hadn’t anticipated. 

Most people will live out their lives and die of old age without ever questioning anything –  they are too busy just trying to survive in a world dominated by war, natural disasters, poverty among a host of other challenges.   We in our country (and other so-called ‘First World’ nations) have the luxury to take basic survival for granted and put enormous resources of time and effort into thinking about things.  This has led to challenges to conventional wisdom in a number of areas, not just psychology.

I hope this series of essays contributes to this ongoing challenge in the  spirit of seeking understanding as a process that is never ending.   In my next article I will look further at the experience of psychotherapy and it’s still mostly unrealized potential. 

The Lost Potential of Psychotherapy

By Peter Boger, M.A.

When most people come to counseling, the usual scenario is that there is a problem, like anxiety or depression, or relationship issues that the person is wanting to address. In the usual case the therapist will work with the person to look for ways to ‘improve’ whatever the presenting problem might be.  In this article I will be talking about another way to think about what counseling is and what it can accomplish.  Even though both are about ‘counseling’, you’ll see that one is very limited in terms of the outcome and the other is radically unlimited. This essay will be presenting the non-traditional approach so that you can compare for yourself and choose which approach feels right for you.

We are all born with a basic awareness or consciousness, but from the beginning we encounter a world with a set of basic beliefs that are virtually universal, and as we grow and develop in early childhood, we are taught this belief system in order to make sense of our experience. This begins in the family and soon adds school to the process. As naïve and trusting children we ‘swallow whole’ this early programming, never questioning or using critical thinking to examine the validity or truth of these beliefs. This programming becomes our cognitive map that we will use to navigate through life. Since we never question this map, if we encounter difficulties in getting to where we’re going, the assumption is that the problem is with us and not the map. Also by the time we reach the end of childhood and begin to go out into the world we longer even know that this map exists, we just operate on the assumption that ‘this is the way things are’ and proceed accordingly. Since our early life is mostly confined to fairly predictable and contained environments of family and school, our experience reinforces the perception that the basic structure of our thoughts and behavior ‘work’ and our identification with and attachment to this hidden ‘map’ gets ‘cemented’ in place.

Since the shared beliefs of our larger human environment, called ‘culture’ or ‘society’, go unquestioned, we experience a subtle but powerful pressure to conform in order to ‘fit in’ or belong. We also see that those who fail to do so are labeled ‘deviants’ and suffer very real and in some cases dire consequences.  Again, this goes mostly unrecognized in the individual, who thinks they have ‘free will’ as opposed to the realization that they have become self-policing and operate within the acceptable boundaries of thinking and behavior.

Like a fish that is born in the ocean, the ocean where it lives becomes invisible until it gets caught in a net and pulled out of the water. Looking down it sees the ocean for the first time.

The ‘normal’ person, is also socialized to believe that the society or culture is healthy and functional and if they are experiencing distress or failure in some way the fault must lie with the individual. Conventional therapy also operates on this assumption, labeling the individual as a ‘patient’ who is being ‘treated’ for their ‘disorder’.

The alternative approach is to radically ‘flip the script’.  In this alternative approach the assumption is that the individual is fundamentally healthy and sound and it is the culture or society that is dysfunctional, toxic and essentially designed to generate an almost infinite range and variety of problems for those human beings living within it. The problem lies not with the person somehow misreading the map, the problem is with the map itself.

This approach asks the seemingly impossible of the person seeking therapy. To become willing to stop and open their mind to the possibility that things are not what they seem. 

In the next installment of this essay we will look at what determines whether a given individual coming to therapy will only tolerate the conventional approach to counseling or instead choose the alternative.