Why Go
It all comes down to this: A person enters psychotherapy because he is lost or stuck. He may feel this way or it may be evident in behavior, but in any case that is the problem. "Lost or stuck?" I hear a voice asking. "What has that to do with anxiety, depression, panic, phobias, schizophrenia, obsessive-compulsive disorder, adolescent rebellion, drug abuse, school phobia, wife beating, compulsive promiscuity, etc.?" The answer is: Everything.
When a person enters psychotherapy, or is dragged into it by relatives, the common element among all these problems is that his behavior, feelings, thoughts, perceptions seem irrational. We, and he, cannot understand why he feels so angry, so depressed, so obsessed with triviality, so afraid of nothing. He says he is worthless, he believes he is hated, he believes the government has labeled him a terrorist and that he must hide, he is sure no woman could ever care for him, he is sure that all women love him. Turning to behavior, he may be ruining his life with drugs or alcohol despite his own desire to stop; or he washes his hands until they are raw, all the while knowing that this is pointless and self-destructive. He beats his wife or girlfriend, yet is sure that he loves her; perhaps he does. He alienates people with his arrogant and supercilious attitude, ruining his chances for social and professional success, yet he is the first one to see such self-destructive patterns in others. He gets into one masochistic relationship after another, each time suffering the abuse and insensitivity of his lover and swearing never to make that mistake again. He breaks out into a cold sweat, his heart races, and he is sick with fear when getting into an elevator, yet he knows all the statistics about how safe elevators are and that he is in fact in greater real danger sitting in his bathtub.
These people have lost track of something in themselves that is now driving their apparently irrational behavior, feelings, point of view. They may know they are unhappy, usually they are more than smart enough to understand that their behavior isn’t working for them anymore, but for some reason they can’t change. (As Felix Unger used to complain, "I know it, but I can’t help it"). There is some other motivation, agenda, feeling, that draws them into these repeated patterns. If they could see what it was, they might be able to resist the impulse or to choose another means of satisfying it. Instead, they have lost themselves and they are stuck in unproductive, unsatisfying, even self-destructive patterns of feelings and behavior. (George, Ed, Bully)
The same applies to squabbling couples, even to children and adolescents who seem to enjoy their misbehavior. Somehow, there are hidden agendas causing behavior and feelings which on the surface don't make much sense. The adolescent who steals and gets high all the time can usually understand that, although it feels good for the moment, his behavior will get him nowhere he wants to be in life (although you usually can't get him to admit that out loud); the class clown may want the kids to laugh, but he usually wants the teacher to like him as well (you won’t hear that out loud, either); the school phobic child does want to join the other kids in school. But these people have lost track of themselves in some way. Desires, needs, motives, even thoughts and perceptions, lie just out of awareness, and they are influencing behavior and feelings. Thus, the out of control child sent to treatment by the courts is lost and stuck in much the same way as were Ed and the Bully. And his psychotherapy will proceed by much the same steps, even if he doesn't talk for the first five sessions.
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