ASK THE THERAPIST

Dear therapist, 

Q As a mother of four healthy children and a wonderful husband I still struggle with bouts of depression. I have been in therapy on and off over the years and sometimes it seems to help and other times not. One of the things I am confused about is that while some of my therapists would try to help me understand why I might be feeling sad by exploring my marriage, childhood and other possible contributing factors. Other therapists have told me to not focus on where it is coming from and just focus on the present and change my thoughts and behaviors. Some of the suggestions even included forcing myself to smile and other “happy” actions that are supposed to change how I feel. What approach do you think is better and why do therapists disagree on this?

A Thanks for the question. In the field of therapy there are many approaches therapists are trained in to help people achieve the changes that they want. As  you mentioned some of these approaches are more present focused on our current thoughts, feelings, and behaviors while others are focus on trying to help the person understand the source or root of the problem with the belief that the insight into the problem will provide the clearest path towards its resolution. So which one is better? What’s the more effective way in addressing an issue?

What we’ve come to understand is that rather than there being one answer for everyone it might be dependent on the particular nature and preferences of the person in addition to what they are struggling with. The approach or modality the therapist uses should “talk to you” and resonate.  Of course, whatever modality they practice should be something that they are well trained in but perhaps more important is the need for it to make sense to the client and feel like it’s a good fit. For example, if a behavioral approach seems unhelpful to you and doesn’t resonate it’s quite possible that you should not be using that approach. And if the therapist is only trained in that approach you might want to consider seeing a different therapist. 

As an aside, I would suggest looking for a therapist that’s trained in more than one modality so that if you get stuck or feel it is ineffective they can consider switching to something that might be a better fit. 

This also explains the potential danger in turning to friends or family for advice on an issue they too have struggled.  Many people can only reflect on their own experience and identify what worked for them assuming it is the “right” or best choice for everyone else too. Sometimes we have difficulty understanding that as human beings we function very different one from another and what works for one may not work for a friend. In fact, sometimes it can make the situation worse particularly when a person feels that despite being given “the  answer” they’re still stuck which can lead to self-judgment and criticism. If we see someone stuck despite suggesting to them a solution we need to consider that perhaps they remained stuck because what was suggested is not a good fit for them. 

It is crucial that we learn about ourselves and what talks to us and what seems to work rather than assuming that what worked for a friend should automatically have the same effect on us. This is important in relationships between a  couple, parents and children, and even friends. We can sometimes make the assumption but there is one right way to do things when often we see that it’s more about finding the right fit for the particular person and the particular struggle they are facing 

I am sure that some parents can relate to having  a parenting approach that worked so well for one child and then seemed to fail miserably with another. We need to have more “tools” so that we can apply the approach to the child rather than the opposite. Abraham Maslow famously stated “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail”.

As a therapist it is essential when working with a client to find out what they have found to be effective in helping themselves prior to making any new suggestions to them. 

Before the famous book Men Are from Mars, Women Are from Venus, John Gray wrote a book entitled Men, Women, and Relationships. He began that book with a story.

His father had offered a lift to a hitchhiker, who promptly robbed him before locking him in the trunk of the car. Police responded to two reports of an abandoned car, but bad directions stopped them from finding it. They made it to the car after the third call, but by then it was too late. Gray Snr had died of heat asphyxiation in the trunk of his own car.

When coming back home for the funeral, Gray asked that he be locked in the trunk to see what it must have felt like. In the darkness he ran his fingers over the dents where his father’s fists had hammered, and put his hand through the space where the tail-light had been knocked out for air. His brother suggested that he extend his arm further, to see if maybe he couldn’t touch the hood button. He reached – and pressed it open.

Gray took the manner of his father’s death as a sign for what his work was about: helping people by telling them about things “in their grasp” that they can do rather than insisting on a particular model or approach.

As a therapist I need to be aware of my client’s needs and preferences in working with them. For example, even though I tend to be more insight oriented by nature when addressing an issue, it will be of no help to a client that either struggles with insight into their behaviors or isn’t interested in it and just wants to focus on the here and now. In summary, I would suggest you think about what type of approach talks to you more and resonates with you and ensure that the therapist or approach you pick matches that.