It all comes down to this: A person enters psychotherapy because he or she is lost or stuck. The person – who I’ll call “they” going forward – 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, domestic violence, 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 their behavior, feelings, thoughts, perceptions seem irrational. We, and they, cannot understand why they feel so angry, so depressed, so obsessed with triviality, so afraid of nothing. The person may claim to feel worthless, hated, may believe the government has labeled them a terrorist and that they must hide; they are sure no man or woman could ever care for them, they are sure that all women love them. Turning to behavior, they may be ruining their life with drugs or alcohol despite the desire to stop, may wash the hands until they are raw, all the while knowing that this is pointless and self-destructive. They beat their partner, yet are sure that they love that person; perhaps they do. They alienate people with an arrogant and supercilious attitude, ruining any chance for social and professional success, yet may be the first one to see such self-destructive patterns in others. They get into one masochistic relationship after another, each time suffering the abuse and insensitivity of his lover and swearing never to make that mistake again. They break out into a cold sweat, heart racing, sick with fear when getting into an elevator, yet knowing all the statistics about how safe elevators are and that one is in fact in greater real danger sitting in a 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. 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, such behavior will get one nowhere they want to be in life (although you usually can’t get a kid to admit that out loud); the class clown may want the kids to laugh, but usually also want the teacher’s affection (you won’t hear that out loud, either); the school phobic child does want to join the other kids in school. Again 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 psychotherapy will proceed by much the same steps, even if the youngster doesn’t talk for the first five sessions.
As to how psychotherapy will proceed – for anyone – here’s my outline. Assuming you’re not completely turned off in the first session, return for 3 or 4 more sessions. During that time your job is to show up, try to speak openly, and avoid obsessing in between sessions about your decision. It’s a little like the gym: You can’t go twice and then rush to the mirror to see if anything has changed; you have to go for a month, maybe even when you’re not in the mood, and then you can stop and see if anything’s happened. Meanwhile, allow the process to unfold. We are exploring, especially at first, and not every conversation or topic will lead to gold. By the end of those introductory sessions should have a sense that the conversations are becoming productive, interesting, and are not repetition of the same talking you may have done with other people in your life. Then if you then stay another 10 sessions, you should see some difference, something new in your thinking, some change in behavior, something to indicate that the sessions are having an impact. If you don’t see such movement, we will understand why and thus what you should try next.