What is Therapy?

This might seem like the most basic question I try to answer on my website, yet it is also the most complex. If you look up a definition of psychotherapy online, you will find something to the effect of “treating mental health problems.” If you look up what running a marathon is online, you will find that it is running 26.2 miles. But if you find someone who has run a marathon and ask them what it meant to them to run a marathon, you will find a whole range of much more complex and personal answers to that very simple question.

So first: a simple answer.

Psychotherapy involves meeting with a therapist to work through issues of your mental health. Therapists usually refer to those who come in for therapy as clients. It is very common for clients to see their therapist once a week for 50 minutes, but the frequency and length of those meetings, or sessions, can vary widely. Mental health issues that I work with include anxiety, depression, relational problems, trauma, stress, struggles with meaning and purpose, difficulties that can come with Autism, ADHD, or other neurodevelopmental disorders, and difficulties with work or school. The goal is to increase your quality of life and relationships.

And second: a more complex, personal answer.

Our modern understanding of mental health and psychotherapy in the West was born out of the work of Sigmund Freud, an Austrian neurologist. From his work and the work of those who came after him a new field of study and practice was born. This was an area of health that stood apart from the medical field, but perhaps could be studied and explored in similar ways, and could be treated by what we now call talk therapy. There is still an area of medicine that treats mental health issues using the tools and treatments of medicine, which is what we call psychiatry. Talk therapy was something radically different, but it did not come out of thin air.

There is a much longer history of thinkers that set out to wrestle with the struggles and questions that Freud’s psychoanalysis developed techniques to address. In fact, the very notion that Freud was the beginning of psychotherapy actually sets up a central problem that is still present today in the mental health world. Freud was just another figure in a long list of philosophers that pondered over the human condition. These were not thinkers who used the tools and techniques of science. Instead they used the power of logic and questions to understand the world around them. So I ask: is psychology part of the world of science, or the world of philosophy? I admit, that seems like a high brow, abstract question to ask, but it has shaped the ebb and flow of our field since Freud; that question reveals two camps, often at war with each other.

Right now it looks like the science camp is controlling the majority of the field here in the United States. As health insurance companies control more and more of the health industry, the way of understanding human psychology known as Cognitive Behavioral Therapy, or CBT, becomes both the primary treatment that insurance companies will pay for and the type of treatment that gets the most funding for research and development. Insurance companies love treatments that seem to be proven by research to work and that promise measurable change with fewer and fewer sessions. That all seems great. In fact, I think CBT is one of the best ways to work with quite a few mental health issues. But does CBT give us everything we need?

The cat is probably already out of the bag if you’ve seen what I’ve written about my orientation as a therapist: CBT is not on my list, even though I’ve been trained in it and treated clients with it. It all boils down to this question: Why do people run the marathon? It’s miserable. It takes so much training, so much pain, so many lonely miles of road. It beats you down. And all sorts of people run marathons! I would guess that athletes are actually the minority of types of people who run marathons. Often it is normal, everyday people who want to push themselves and accomplish something. My wife ran the LA Marathon and spent a year training for it. But watching her train would not prepare me for being a spectator. I stood there, on the sidelines at mile 18 watching complete strangers running by, struggling, with more than 8 miles left to run… and I just started crying. I couldn’t stop. It was one of the most powerful emotional experiences I have ever had. Something in the shared pain, the passion, the comradery, the crowd of family and friends cheering the runners on, streets across LA shutting down for this communal experience, added up to an incredibly powerful, uniquely human experience. My existence, your existence, our existence is such a complex, powerful thing that cannot be summed up in the vacuum of observations in a carefully controlled study. The lives and words of philosophers and therapists who struggled to make sense of the human condition are testament to this.

At its core, psychotherapy is about connection. The tools that we use in our work are ourselves and our relationships with our clients. I walk alongside my clients during difficult times and help guide the way, but sometimes the thing that matters most is that they have someone on their team, cheering them on as they struggle to keep moving forward in this journey of life. My particular orientation and perspective comes from how I happen to see and understand life, but my work with clients incorporates so much more because they have their own way of seeing and understanding life.