To prospective clients

Many clients come to therapy to feel better, not to get better (from the Masterson Approach). That this is NOT a truism is one of the big problems in psychotherapy today. Many clients and therapists confuse the two goals – palliative versus enduring change – or more accurately, they do not know the difference. Of course we should listen to the client. If we over-talk or inappropriately disclose, we should be told. But if a client fears "facing painful experiences," while these experiences are intrinsic to the effective approach to their problem, then he or she should be told this. The customer is not always right in therapy.

This was my comment (https://nyti.ms/3HbUyUQ#permid=118767653) to an NYT article, "How To Give Your Therapist Feedback," subtitled: We often think of psychotherapists as "all-knowing," which can make patients feel that complaining about the therapy or the therapist is not allowed.

I would recommend to all prospective clients who are not in crisis – that is, those who have time to do some self-searching – that they try to answer this question for themselves: What is therapy? This may seem like a strange assignment. You already assume you know what therapy is. Or you assume it's whatever you're about to get. Or you assume the clinician will tell you what it is. But the new clients to whom I've asked this question almost always have no answer, or an incorrect answer, or a valid but too vague answer. Some say it's to gain "coping" skills. Some say it's to talk about their childhood: They assume that that is an end in itself. Some who've bought into the Cognitive Therapy idea believe it's to be helped to think in a healthier way. More in-touch clients say it's to deal with their childhood abuse or other trauma.

But what is "coping"? I can't say what it means. Can you? Does it mean to learn to be serene about suffering, or to straitjacket your anger? Could it possibly mean to get out of your marriage or to move a thousand miles away from your parents? Or let us say therapy is to mitigate childhood trauma. What does that mean? To steep in the memories and feelings until they are numb? To magically "get it out"?

Nursing students take a course in Critical Thinking. A college philosophy course teaches Logic and logical fallacies. These are not therapy. Can a therapist help you think better, more rationally? I believe the answer is "no," even if you are shown that you have exaggerated the badness of a situation, or have adopted an unrealistic "I must be" or "I must do" that will only exacerbate your insecurities. Once you are aware of the exaggeration or the false imperative, you are still left with the residue, or the full monty, of feeling that made you think so darkly. You will find that replacing one thought with another does not change your feeling. Not really. Then look: Thinking "right" while feeling wrong in your gut – is that actual improvement?

I have clients whose parents are so ignorant and wrong about their child and about themselves that some schizophrenics on psychiatric units are more in tune with the world, with clearer perception, than they are. Narcissistic, Borderline and solipsistic parents are blind to the truth. And they are in therapy, too. I guarantee you that the therapist often does not see their global dysfunction. Most of them won't know, acknowledge or reveal that they have mentally tortured their children for years, or that they feel in their bones that they own their child or that their child owes them self-sacrificial allegiance. Will any therapy help them? Even if they come in to deal with other issues?

There is legitimate relativity in the cosmos of therapy. On the one hand, I asked a kind of trick question. I believe that if prospective clients are about to think deeply and ruthlessly about the nature of therapy, they will discover at the bottom of their investigative labyrinth that it has one basic meaning: to be relieved of much of the pain that formed our defenses and our character in childhood, to then be a "chemically" different person who feels his or her life for the first time. On the other hand – this is the relativity part – if you just want to vent, get stuff off your chest, or have a nonjudgmental friend or mentor; or if you are incorrigibly blind to yourself, we are here for you, too, at least for awhile.

That's not therapy. But we aim to please.