[guest post] A Purpose-Driven Life – Is God Required?

My friend Gleb Tsipursky wrote this guest post about a secular approach to finding a sense of purpose in life.

We need God for a sense of purpose in life, at least according to the vast majority of mainstream perspectives in American society. Moreover, research confirms that people with a strong religious belief generally have a stronger sense of meaning and purpose than those who do not. But is it really necessary to believe in God to have a purpose-driven life? Based on my research on meaning and purpose, and my experience in helping people find life purpose in my role as President of Intentional Insights, I will illustrate some science-based strategies that we as reason-oriented people can use to find a deep sense of life meaning without a God.

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(Graphic created by Cerina Gillilan)

 

In a way, the American mainstream opinion is not surprising – after all, religious dogma generally gives clear answers to the question of life’s purpose. Moreover, it provides the main venue for exploring questions of meaning and purpose in life. According to faith-based perspectives, the meaning and purpose of life is to be found only in God. An example of a prominent recent religious thinker is Karl Barth, one of the most important Protestant thinkers of modern times. In his The Epistle to the Romans (1933), he calls modern people’s attention to God in Christ, where the true meaning and purpose of life must be found. Another example is The Purpose Driven Life (2002), a popular book written by Rick Warren, a Christian mega church leader.

But some thinkers disagree with the notion that religion is the only way to find meaning and purpose in life. Jean-Paul Sartre, in his Existentialism and Human Emotions, advances the notions of “existentialism,” the philosophical perspective that all meaning and purpose originates from the individual. The challenge for modern individuals, according to Sartre, is to face all the consequences of the discovery of the absence of God. He argues that people must learn to create for themselves meaning and purpose.

Another prominent thinker is Greg Epstein. In his Good Without God: What a Billion Nonreligious People Do Believe, he advocates striving for dignity as a means of finding “meaning to life beyond God.” According to Epstein, “we are not wicked, debased, helpless creatures waiting for a heavenly king or queen to bless us with strength, wisdom, and love. We have the potential for strength, wisdom, and love inside ourselves. But by ourselves we are not enough. We need to reach out beyond ourselves – to the world that surrounds us and sustains us, and most especially to other people. This is dignity” (93).

Likewise, Sam Harris, in his book, Waking Up: A Guide to Spirituality Without Religion (2014), states that “Separating spirituality from religion is a perfectly reasonable thing to do. It is to assert two important truths simultaneously: Our world is riven by dangerous religious doctrines that all educated people should condemn, and yet there is more to understanding the human condition than science and secular culture generally admit” (6).

Are they correct? Can we have meaning and purpose, which fall within the sphere that Harris refers to as spirituality and Epstein terms dignity, without belonging to a faith-based community?

In fact, research shows that we can gain a sense of meaning and purpose in life from a variety of sources. The classic research on meaning and purpose comes from Victor Frankl, an Austrian psychiatrist who lived through the concentration camps of the Holocaust. He described how those who had a sense of meaning and purpose in their lives were most likely to survive and thrive in the camps. He conducted research demonstrating this both during and after his concentration camp experience. His research suggests the crucial thing for individuals surviving and thriving is to develop a personal sense of individual purpose and confidence in a collective purpose for society itself, what he terms the “will-to-meaning and purpose.” Frankl himself worked to help people find meaning and purpose in their lives. He did so by helping prisoners in concentration camps, and later patients in his private practice as a psychiatrist, to remember their joys, sorrows, sacrifices, and blessings, thereby bringing to mind the meaning and purposefulness of their lives as already lived. According to Frankl, meaning and purpose can be found in any situation within which people find themselves. He emphasizes the existential meaning and purposefulness of suffering and tragedy in life as testimonies to human courage and dignity, as exemplified both in the concentration camps and beyond. Frankl argues that not only is life charged with meaning and purpose, but this meaning and purpose implies responsibility, namely the responsibility upon oneself to discover meaning and purpose, both as an individual and as a member of a larger social collective (Frankl).

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(Graphic created by Cerina Gillilan) 

Frankl’s approach to psychotherapy came to be called logotherapy, and forms part of a broader therapeutic practice known as existential psychotherapy. This philosophically-informed therapy stems from the notion that internal tensions and conflicts stem from one’s confrontation with the challenges of the nature of life itself, and relate back to the notions brought up by Sartre and other existentialist philosophers. These challenges, according to Irvin Yalom in his Existential Psychotherapy, include: facing the reality and the responsibility of our freedom; dealing with the inevitability of death; the stress of individual isolation; finally, the difficulty of finding meaning in life (Yalom). These four issues correlate to what existential therapy holds as the four key dimensions of human existence, the physical, social, personal and spiritual realms, based on extensive psychological research and therapy practice (Cooper; Mathers).

So where does this leave us? Religion is only one among many ways of developing a personal sense of life meaning. One intentional approach to gaining life meaning and purpose involves occasionally stopping and thinking about our lives and experiences: we can find an individual sense of life purpose and meaning through the lives we already lead. A great way to do so is through journaling, which has a variety of benefits beyond helping us gain a richer sense of life purpose – it can also help us deal with stress, process sorrows, experience personal growth, learn more effectively, and gain positive emotions through expressing gratitude.

Here are some specific prompts to use in journaling about meaning and purpose in life, as informed by Frankl’s research and logotherapy practice:

  1. What were important recent events in your life?
  2. Which of them involved stresses and adversity, and how can you reframe them to have a better perspective on these events?
  3. What did you learn from these events?
  4. What are you grateful for in your life recently?
  5. What was your experience of life meaning and purpose recently?

Try journaling about these topics for a week, and see what kind of benefit you get, what kind of challenges you run into, and what you learned about how this journaling can be adopted to your own particular preferences and needs.

There are a wide variety of additional strategies to gain meaning and purpose in life without belief in a deity. To help you learn and practice additional strategies, I developed and videotaped a workshop freely available online. I also created a free online course, which combines an engaging narrative style, academic research, and stories from people’s everyday lives with exercises to help you discover your own sense of life purpose and meaning from a science-based, humanist-informed perspective. I am also writing a workbook on this topic These are part of our broader offerings at Intentional Insights, which aims to help us as reason-oriented people use scientific evidence to live better lives and achieve our goals. I hope you can find our offerings helpful for your life, and am eager to hear any feedback you have to share about your experience!

Gleb Tsipursky, PhD, Co-Founder and President at Intentional Insights. Intentional Insights is a new nonprofit that provides research-based content for reason-oriented people to help us improve our thinking, feeling, and behavior patterns and reach our goals. Get in touch with him to learn more: gleb[at]intentionalinsights.org

[guest post] A Purpose-Driven Life – Is God Required?

The Importance of Self-Awareness for Men in Feminism

As I wrote recently, an inevitable consequence of certain communities or movements becoming more accepted and popular is that people will join them in order to feel accepted and popular. Having a sense of belonging is probably a primary motivation for joining all sorts of groups, and it makes sense that whenever someone is feeling lonely, we often advise them to join some sort of group that fits their interests.

Of course, most groups have goals other than “make people feel a sense of belonging.” Those goals may be “discuss books,” “put on a play,” “practice dance,” “critique each other’s writing,” “organize board game nights,” and so on. Even if someone is very invested in that explicit goal, their main motivation to join may still be that implicit goal of having a community.

Feminism–both as “a movement” and as individual organizations and friend groups–is no different. It has certain political goals (which vary from group to group) and it can also be a source of social/emotional support for its members. It can be a source of pride, too.

But feminism (and other progressive movements) differs from other types of groups in that its explicitly stated goals are sometimes in conflict with the goal of making its members feel welcome and accepted. Challenging injustice requires taking a long, critical look not just at society, but at yourself. Sometimes that means that others will be looking at us critically, too.

Self-criticism is never easy or pleasant, but what complicates matters is that people are not always aware of their motivations for doing things. I do believe that the vast majority of people involved somehow in [insert progressive movement here] are involved primarily because they believe in the cause and want to help make it happen. But for many of them, there’s a secondary motivation lurking in the background–they want to have friends. They want to feel liked and respected. They want a sense of purpose. They want community.

These are all normal and okay things to want; most of us want them. I wouldn’t even say that it’s wrong to seek those things from political groups and movements.

But you have to be aware that you’re doing that. If you’re not aware you’re doing it, you won’t be able to accurately interpret the negative emotions you might experience as an unavoidable part of this sort of work.

And that, I believe, is a big part of the difficulties we often have with male feminists and other types of “allies.”

I came across a piece by Mychal Denzel Smith about male feminists recently. In it, he wrote:

If you’re not going to challenge yourself to do better, why claim feminism? 

In part, it’s because there’s a seductive aspect to identifying as a male feminist. Kiese Laymon touched on this in an essay for Gawker last year. Remembering an encounter he had with a colleague, he wrote: “It feels so good to walk away from this woman, believing not only that she thinks I’m slightly dope, but that she also thinks I’m unlike all those other men when it comes to spitting game.” That you’re just out to get laid is one of the most common accusations lobbed at men who identify as feminists, and while I don’t think that’s true for all or even most, it’s definitely true for some. Enough so that my homegirl calls it predatory. That’s a scary thought. And even if you’re not out here attempting to use feminist politics to spit game and get laid, there’s this tendency to feel such pride about wearing that Scarlet F on your chest that you completely miss the ways you’re reinforcing the same oppressive dynamics you claim to stand against. You like the attention being considered “different” affords, but you’re not always up to the task of living those differences.

This resonates a lot with my experiences with men in feminism. While I doubt that most straight cis men join feminist communities primarily to find sex partners, I do think that most of them are hoping for some sort of approval and acceptance. Their opinions and values may make it difficult to fit in not only with other men, but with women who have more traditional views on gender. They may also be facing a lot of cultural pressure telling them that they’re not “real men” and nobody will ever want them. I don’t think it’s necessary or helpful to compare this with the isolation felt by women, queer people, and gender-nonconforming people. It exists.

When you feel like you don’t fit in anywhere because you’re too progressive, and you finally find a social group that shares your values, and suddenly they’re telling you that you’re still not Progressive Enough, it can be very painful. It can feel like rejection. And if you don’t have a conscious awareness of your motivations–of the fact that you feel rejected because you were really searching for belonging–you may interpret these negative feelings as resulting from other people’s behavior, not from your own (legitimate) unmet needs. You may be tempted, then, to lash out and accuse the person of being “mean” or “angry,” to warn them that they’re “just pushing loyal allies away,” to assert to them that you’re “a feminist” and couldn’t possibly have done what they said you’ve done or meant what they feel you meant, and so on.

Meanwhile, the person who called you out gets really confused. They thought you were here because you wanted to learn, to improve as a person, and to get shit done. And here you’re telling them that merely being asked to reconsider your opinions or behavior is enough for you to want to quit the whole thing. It would be like showing up at the hair salon and then getting furious when the stylist assumes you’d like to change your hairstyle.

No wonder many of us assume that many male feminists aren’t really that interested in feminism.

(While this dynamic seems much more pronounced for male feminists for a number of reasons I won’t derail with here, it definitely happens around issues like race, ability, etc as well.)

This isn’t even touching on blatantly abusive behavior, which men sometimes deny or excuse with claims of being feminists. Some male feminists do seem to hope that merely self-identifying that way, or make the cursory pro-equality gestures, will be enough to earn them the social acceptance they’re looking for. Sometimes it is.

But just like feminists are not obligated (and, in fact, are not qualified) to serve as therapists to men with serious issues pertaining to women, feminist spaces are not obligated to prioritize making everyone feel comfortable and included over doing the work that they were set up to do. Activist communities do have many overlapping (and, at times, conflicting) goals, but it’s not unreasonable for groups that were not set up to help men to prioritize people other than men.

(I would love for there to be more male-oriented feminist groups, but from what I have seen, they tend to dissolve into lots of mutual back-patting and not much personal change or action.)

I would like to see more male feminists move away from using the feminist label as a way to seek social acceptance and towards creating some separation between their politics and their search for belonging. It’s not that political affiliations can’t provide that–it’s that it’s dangerous to rely on them for it. It means you can never really question yourself and your beliefs, and you’ll have a lot of trouble accepting criticism (no matter how constructive) from others.

More broadly, I would like for male feminists to get more comfortable with becoming aware of their motivations, needs, and feelings. I would like for them to consciously notice that pleasant rush they feel when women “like” their Facebook posts about feminism, and to appreciate that feeling for what it is without prioritizing that feeling over everything else. I would like for them to recognize the unmet needs for community and acceptance that they have, and to be cognizant of the extent to which they ask (or simply expect) others to satisfy those needs for them. I would like for them to learn to notice these things without immediately rushing to judge them and shame themselves for them, because that’s not the way forward.

As for me personally, I no longer feel any increased trust or warmth towards men who declare themselves feminists. It does almost nothing for me. I need to see actual evidence that they are able to respect my boundaries, accept feedback from me, and generally act in accordance with their stated values. Many of the men I’m closest to have never explicitly identified themselves as feminists to me, but their every interaction with me exemplifies the traits that I look for in people.

By all means, call yourselves feminists to other men–it can open up useful conversations and upend established norms–or in order to filter people out of your life that you know you don’t want in it. But don’t expect a word to speak louder than your actions.

~~~

Caveats:

1. A lot of what I wrote here applies quite a lot to just about everyone, including feminist women. I know this. I focused on feminist men because this issue is particularly pronounced with them.

2. #NotAllFeministMen have such legitimate and good intentions as the ones I’m writing about. But I specifically wanted to write about the ones with the legitimate and good intentions.

For another example of how being aware of your own needs and motivations can make you a better, more effective person, see my previous post.

The Importance of Self-Awareness for Men in Feminism

"That totally happened to me, too!": The Urge to Relate

A lot of what happens in therapy should only happen in therapy. (I’m looking at you, folks who oppose trigger warnings because “exposure is very important for overcoming trauma.”) But a lot of other things that happen in therapy are very applicable to the rest of our relationships and interactions. One of those is the tension between normalizing someone’s experience and validating it.

Normalizing someone’s experience essentially means helping them feel that their experience is normal. Short of memorizing statistics, the easiest way to do that is to relate what they’re telling you to something that’s happened in your own life. This is a very common conversational move. Someone tells you about a bad breakup and you say, “Oh, I totally went through something similar recently. It can be really hard.” Someone tells you their NYC subway horror story and you respond with one of your own. (We all have an arsenal of those.)

Validating someone’s experience is a more complex conversational move. To validate means “to demonstrate or support the truth or value of.” In the context of therapy or supportive conversations between friends, validating someone’s experience means letting them know not only that you believe them when they say that it happened–which can be particularly important when someone discloses, say, sexual violence or mental illness–but also that you affirm this as an “okay” thing to talk about or think about. The opposite of validating is to say “That’s not that big of a deal.”

Obviously, you can both validate and normalize someone’s experience in the same conversation. Therapists frequently do both.

However, the way of normalizing that we most frequently use in casual settings–relating someone’s experience to our own lives and selves–can get in the way of that.

For instance, someone says, “I’m having such an awful time getting out of the house this winter.” If you immediately jump in to say, “Oh, me too, it’s so awful, I couldn’t even make myself go to my friend’s birthday party because it was so cold out,” you may succeed in helping them feel like it’s okay to be having this difficulty, but you may also miss an opportunity to affirm the fact that their own unique experience is legitimate and difficult for them.

I get this often with fatigue. I try not to talk about being tired very much because I don’t like “complaining,” but sometimes I do mention it, and people usually jump in immediately to talk about how tired they are and how they only slept four hours last night and so on. But the thing is…my tiredness is a little different. I sleep at least 8 hours almost every single night, and have been for years. If I let myself, I would sleep 10 or 11 or more hours. I don’t know what it means not to want to sleep. Every day I daydream about coming home and going to sleep.

Of course my friend’s experience is also legitimate, and it sucks to only get four hours of sleep and feel shitty. But for them, not feeling tired as often as simple as finding the time to sleep enough. For me, absolutely nothing I have been able to try without medical intervention has helped.

So when I mention being tired and people immediately jump in to relate, I feel like I can’t talk about how extensively awful it is for me, because everyone feels tired! Feeling tired is normal! That’s just how life is! (Deal with it!)

On the other hand, some things feel bad not just in and of themselves, but also because of the shame and isolation that surrounds them. Mental illnesses are often like this because few people know a lot of people who are open about it (though that may now be changing). When I was first diagnosed with depression, I didn’t know even one other person who was (openly) diagnosed with it. I thought everyone else had it together and I alone was a failure. I saw the statistics on how common depression is, but they did nothing for me. What helped was to start meeting other people who struggled with it. Depression still sucked, and still does, but I no longer had to carry the burden of Being The Only Person In The World Who Can’t Even Be Happy.

How can you tell what someone needs in a given moment? How do you know if it’ll be more helpful to normalize their experiences, or to validate them?

Often there isn’t really a way to tell. In sessions with clients, I rely a lot on intuition and previous experience. But there are some things that people say that can serve as hints as to what they might need from you.

For instance, when people say things like, “I can’t believe I’m having trouble with something so simple,” or “I’m such a failure; I can’t even find a job,” or “Nobody else has all these problems,” that can be a sign that normalizing might be helpful. It can reassure them to know that other people do have trouble with these supposedly simple things, or that other people do actually struggle a lot with finding a job, or that other people do have these same problems. Sometimes what the person is dealing with really is shitty, but it feels a lot shittier than it has to because they think they’re the only one who’s so pathetic and incompetent as to have that problem.

On the other hand, when people say things like, “I know it shouldn’t even be a big deal, but–” or “Everybody probably deals with this but–“, pay attention to those but‘s. The part after the but is the part they have trouble accepting as valid. Everybody deals with it! It’s not a big deal! Therefore, what right do I have to even complain about it?

When someone says things like this, sharing your own experience and relating to them might not be as helpful. What they really need to hear at that moment is that their unique version of that probably-common problem is worthy of paying attention to and talking about. They might know perfectly well that other people have similar problems, but it still feels bad and that’s the part they want to hear acknowledged. Yes, everybody hates winter, but here’s how it sucks for me. Yes, everyone is tired, but I almost passed out after climbing a few stairs. Yes, I know you probably miss your family too, but I just really really miss mine today.

“Common” problems are easy to relate to. Most of us have had bad breakups or manipulative family members or really exhausting days. But rushing to relate your own experience closes off the possibility of learning more about their life. When you feel an urge to share your own experience, instead, try asking more about theirs and seeing if your experience is still as relevant as you thought.

With certain types of issues, relating your own experiences can also easily come across as one-upping even when you don’t mean it to–although, to be real, sometimes that’s exactly how people mean it. Please don’t one-up people. There’s no need. There is not a limited quantity of sympathy in the world, so there is no need to compete for it.

You might also accidentally relate to only a very small part of what they actually said, leaving them feeling misunderstood or unheard. For instance, if I share a story about a classmate saying something very hurtful and ignorant about queer people, and you share a story about a classmate saying something very inaccurate about cell biology, you may have missed the fact that the relevant part of my story wasn’t “a classmate said something silly” but rather “a classmate made a homophobic comment in class that impacted me personally.”

The urge to relate to someone’s experiences comes from a lot of places, I think. It’s a common way of trying to show someone that you understand. Showing someone that you understand them is a common way of earning their trust, respect, and affection. It indicates that you have things in common.

In therapy, of course, things are different in that the focus should always be on the client and their needs. But therapists do sometimes share stories from their own lives, and the purpose is slightly similar to how it works in casual conversations between friends–it’s a way for therapists to signal understanding of their clients, and also to let them know that they are not alone in some of their experiences. Sharing a personal story can be more powerful than simply saying something like “You’re not alone in that,” because it gives something more than a reassurance: it gives evidence. (Anecdotal, but still.)

Yet both in therapy and in life, sharing one’s own experiences can get in the way of fostering a better, deeper understanding of another person. It can also make it difficult for them to tell you more about their experience, because you’ve now turned the conversation back to yourself. It can seem very disingenuous if it’s clear to the person that you don’t actually understand very well at all.

And while we often tell ourselves that we relate to others in order to make them feel better, there sometimes is some selfishness in it. We want to prove to others that we “get it” so that we feel better about ourselves and our ability to understand and connect with people. A natural impulse, but that doesn’t make it necessarily helpful or productive all of the time.

I see this often in conversations about injustice. A marginalized person shares an experience they have had with discrimination or prejudice, and a person who is categorically unable to have the same experience nevertheless tries to relate something from their own life. Sometimes they relate an experience of being treated badly in a way that has nothing to do with their societal position, and sometimes they relate an experience that has to do with another dimension of identity.

There are definitely some important similarities in the ways in which many different marginalized groups are treated, but that doesn’t necessarily always mean that we can relate. The presumption of understanding can easily get in the way of actual understanding when a white woman assumes that her gender helps her understand someone’s experience of racism, or when a gay man assumes that his sexual identity helps him understand a trans woman’s marginalization. I mean, maybe it does, in a few limited ways. But we should always strive to learn more before assuming we “get it.”

I think a lot of people experience the urge to relate. I’ve definitely felt it. For instance, once a friend of mine who is Black was sharing some experiences of racism they had had, and I suddenly noticed a little gear turning in my brain trying to generate similar experiences from my own life that I could share. I thought, wait a minute, I never told my brain to do that! That wouldn’t be helpful right now. How could I listen fully if part of my brain was so busy trying to connect my friend’s experience to my own? How could I even come close to understanding their experience if I was already biasing that understanding by thinking of my own interpretations of my own experiences, which had nothing to do with racism?

This, I think, is what drives a lot of the confusion and miscommunication that happens around issues like race and gender. For instance, suppose a Black woman is telling me about how her coworkers and supervisors always assume she is angry and hostile when she isn’t. I start thinking about times when I have been assumed to be angry and hostile, and how that hurt, and how I dealt with them. Maybe I dealt with them by adopting a more friendly and cheery approach, and that helped. Awesome! I’m going to tell my friend about My Experiences and What Worked For Me!

Except that What Worked For Me is very unlikely to work for someone who is not white. As a white woman, I am not automatically assumed to be angry and hostile no matter what I do, generally speaking. So adjusting my demeanor, even though I felt that I was behaving appropriately before, might help change others’ perceptions of me in a substantially helpful way. A Black woman can be as painfully polite and deferential as she possibly can and yet she’s still likely to face that sort of stereotyping. Maybe if I’d listened rather than spent all that brainpower thinking about my own life experiences, I would’ve understood that.

(See also: Lean In by Sheryl Sandberg.)

Likewise, when I talk about feeling threatened by a man in public and men jump in to tell me that I should’ve Just Punched Him or Just Told Him To Fuck Off, they are thinking of their own experiences and how they might’ve reacted in that situation (for better or worse). A man who decides to Just Punch a man who is being offensive to him may end up getting hurt in a fistfight, but the consequences would be much more severe for me if I tried the same thing.

(See also: “Just call the police!”)

So, what do you do when someone shares an unpleasant experience and you have no idea whether or not relating something from your own life might be useful?

Here are some scripts:

  • “Do you think it might help to hear about something similar I’ve dealt with?”
  • “I’ve gone through something that sounds a lot like that. Feel free to ask me more about it if you want, or to just talk about your own stuff.”
  • “I know this may not necessarily fix the problem, but something that helped me with that was _____.”
  • “That sounds really hard, but you’re not alone in dealing with that.”

Alternatively, it’s almost always a good idea to ask them more questions (with the caveat that they don’t have to talk about it more if they don’t want to) so that you can understand what they’re going through better.

In social work school, we learn a lot about the importance of being very aware of what’s going on in our own heads as we’re trying to help others. That’s useful for any sort of interpersonal situation. It’s a good idea to go into these types of serious conversations with an awareness of what you’re bringing to the table, including your own needs and desires and biases. Many of us want to feel competent when it comes to understanding and helping our friends. That’s commendable, but it too easily turns into a search for affirmation from people who are busy trying to share their own troubles.

Don’t let your need to demonstrate your understanding get in the way of actually understanding.

"That totally happened to me, too!": The Urge to Relate

A Case for Strengths-Based Diagnosis

[Obligatory disclaimer that I am not (yet) a licensed therapist and that the following is my personal opinion, informed by practice and academic study.]

Recently in a class on adult psychopathology, my professor was discussing the strengths and weaknesses of the DSM (Diagnostic and Statistical Manual of Mental Disorders), the text used to diagnose mental illnesses and categorize them for the purposes such as research, insurance billing, and sharing information among professionals.

One of the weaknesses he mentioned was one I’d actually never heard before: that the way the DSM diagnosis is written and shared does not include any space for also “diagnosing” the client’s strengths.

At first, this seemed irrelevant to me, not in the sense that thinking about your client’s strengths is not important, but in the sense that I didn’t see how it matters for a diagnosis. It almost seemed a little patronizing: “Yes, you have major depressive disorder and social phobia, but hey, at least you seem like you’re pretty resourceful and good at expressing yourself!”

But then I rethought that.

Here’s an example of a DSM-V diagnosis:

296.35 (F33.41) Major depressive disorder, early onset, recurrent episode, in partial remission, with atypical features

300.4 (F34.1) Persistent depressive disorder, early onset, with atypical features, with intermittent major depressive episodes, without current episode, moderate

V62.89 (Z60.0) Phase of life problem

It’s honestly difficult for me to imagine looking at this information with anything other than relief. For me, diagnosis has always meant one thing first and foremost: You’re not a terrible person; you just have an illness.

But to other people, seeing something like this can communicate a whole lot else. You’re sick. You’re fucked up. There is nothing redeeming about you. You can’t do something as simple as not being so sad. This is especially true when someone is already predisposed to interpret information about themselves in a negative light, because, well, that’s what mental illness always does.

In that moment, it can be really helpful to have confirmation–not just from a friend or loved one, but from a professional whose job it is to assess you–that you do have strengths and positive qualities.

So, here are some reasons incorporating strengths into diagnoses might be a really good thing.

  1. Giving hope and affirmation to the client.

Just like it can be nice to go get a dental checkup and hear, “You’ve been doing a great job at preventing cavities, but you need to floss more consistently in order to keep your gums from getting irritated,” it can be nice to hear, “Based on what you’ve told me, I believe that you’ve had a major depressive episode for the past few months. However, you’ve clearly been very good at reaching out to friends and family for support, and it sounds like you have a lot of people rooting for you to get better.”

Therapists and psychiatrists say “nice” things like this all the time, but writing it down as part of a diagnosis might be symbolically meaningful. To the client, that communicates the fact that their strengths are just as important as their diagnosis–important enough to be written on the form or in the chart. It shows that their mental healthcare provider, whom they might feel shy around or even judged by, does see them as a whole human being with strengths as well as a diagnosable illness.

  1. Providing possible avenues for treatment.

A psychiatrist may diagnose a client and then refer them to a therapist (therapy combined with medication tends to be more effective than either in isolation). Now what? The therapist can look at the diagnosis, or ask the client what it is, and proceed from there.

What if the diagnosis included something like, “Client reports that volunteer work helps them distract themselves from symptoms, and that writing in a journal has occasionally been helpful”? The therapist now has some potential ways to help the client. Or the diagnosis might include, “Despite severe symptoms, client shows a high level of insight about the possible origins of their depression.” The therapist now knows that lack of self-awareness isn’t the problem–symptom management might be.

I continue to be amazed that none of my therapists ever asked me if there’s any way I could incorporate writing into my depression recovery, or if there are any ways I’ve been incorporating it already. Writing is my life. Usually I’ve either said as much in therapy, or I haven’t because nobody ever asked me what I like to do or what makes me feel good. Why not?

  1. Reducing negative bias from providers.

I can’t make definitive statements without more research, but based on what I understand about bias, I can imagine that consistently viewing a client as “major depressive disorder with atypical features and moderate persistent depressive disorder” does things to one’s perception of that person. Not positive things.

It is difficult (if not impossible) to effectively help someone you view as deficient or weak. First of all, your likely pessimism about the person’s recovery will almost certainly be perceived (and possibly internalized) by them. Second, any roadblocks that come up in treatment will likely be interpreted as “resistance” or “not really wanting to get better” or “not being ready to do the work of therapy.” In fact, maybe it’s that your approach isn’t actually helpful to them. Third, without a conscious awareness of the person’s strengths and assets, what exactly are you using to help them recover? Therapy isn’t about “healing” people so much as helping them discover their own resources and help themselves. If you don’t even know what those might be, how could you possibly help the client see them?

Many therapists try to think of their clients’ positive traits in addition to their “negative” ones. However, formalizing and structuring this process as part of a diagnosis might make it sink in better, and become more embedded in one’s general impression of a person. The questions we generally have to ask while diagnosing someone are fairly negatively oriented–”Do you ever have trouble falling asleep? How often? To what extent does this impact your daily life?”. What if we also asked, “What helps you sleep better? How do you cope with being tired after a night of insomnia?” Maybe that can help shift a therapist’s perspective of this person from “insomniac” to “person with difficulty sleeping, who has reached out to friends for help with daily tasks.”

  1. Preventing provider burnout.

I dislike talking about my work because people are consistently amazed at it in a way that annoys me. “How could you deal with hearing these awful things?” they ask. “Isn’t it really depressing to work with all these people?” It isn’t, because thanks to my training, I’ve internalized a strengths-based perspective. When I think about the people I’ve worked with, I don’t see poor suffering depressives and trauma victims. I see resilient, determined individuals who are working to overcome their challenges in the best ways they can.

I think that some people in this field burn out because they can only see the suffering and the oppression and the unfairness of it. I also see those things, obviously, because they’re sort of a big deal. But if that’s all you see when you sit with a client, not only will that be reflected in your treatment of them, but it’ll also impact your own ability to persevere.

If every time a therapist made a diagnosis, they had to intentionally remind themselves of the client’s strengths, that might go a far way in helping them remember that there is hope and everything is not absolutely bad.

As I’ve mentioned, plenty of mental health professionals already incorporate a strengths-based perspective into their work. But this is more common in areas like social work, where diagnosis is rarely used and actually often criticized, anyway. I certainly don’t remember any of my psychiatrists or PhD-level therapists spending any time asking me about my strengths or coping strategies. They gave me my diagnosis, and that was mainly it as far as assessment goes.

One might argue that strengths assessment has no place in the DSM because it needs to be standardized and reliable. However, reliability may be a problem for the DSM regardless, meaning that different professionals assessing the same client may disagree in their DSM-based diagnosis.

One might also argue that the DSM is “about” mental disorders, not “about” a client’s overall set of traits or strengths. I’ll grant that. Regardless, I think that formally incorporating individual strengths into clinical assessments in therapy and psychiatry may be helpful. May be.

A Case for Strengths-Based Diagnosis

Facebook Needs a "Sympathy" Button

My latest piece for the Daily Dot is about the challenges of expressing sadness and loss on Facebook as it’s currently set up.

If you’ve ever posted some sad news on Facebook, you might’ve watched as the status received a few likes followed immediately by comments such as, “Liked for sympathy” or “I’m only liking this out of support.”

It’s not surprising that a gesture meant to stand on its own needs a little explanation when the post in question is negative rather than positive or neutral. “Like” is an odd verb to use when someone’s talking about their recently deceased pet or a crappy day at work, but a thread full of identical comments reading “Sorry to hear that” seems almost as awkward.

Many people still think of social networks like Facebook as places where people primarily share things like news about job offers and impending moves, BuzzFeed articles, and photos of food, babies, and animals. However, that view is out of date. Depending on your social circle, Facebook may also be a place to vent about health troubles, share articles about crappy things going on in the world, and seek condolences when loved ones pass away.

Commenting and “liking” may no longer seem sufficient as responses. Mashable writer Amy-Mae Elliot suggests a “sympathy” button as an addition to Facebook:

‘Sympathy’ is the perfect sentiment to cover what Facebook lacks. It can mean a feeling of pity or sorrow for someone else’s misfortune, and also an understanding between people—a common feeling. It would be appropriate for nearly every Facebook post that gears toward the negative, from sending ‘Sympathy’ if someone loses a loved one to saying ‘I sympathize’ if someone’s in bed with the flu.

Clicking the ‘Sympathy’ button would let your Facebook friend know you’ve seen his post and that he’s in your thoughts. And unlike the fabled ‘Dislike’ option, it would be difficult to hijack or abuse the notion of sympathy.

It’s not as snappy as a “like” button, and it doesn’t have an easily-recognizable symbol that can go along with it, but it would make it easier for Facebook users to engage with negative posts.

The “like” button isn’t the only way that Facebook’s design subtly encourages positive posts and discourages negative ones.

Read the rest here.

Facebook Needs a "Sympathy" Button

Why We Should Ban Conversion Therapy

[Content note: suicide, transphobia, abuse]

I wrote this article for the Daily Dot about conversion therapy. Please note that I did not write and do not endorse its headline as it appears at the Daily Dot.

At the close of a year that saw both incredible gains for transgender people and a number of tragic acts of transphobic violence, 17-year-old Leelah Alcorn, a trans teen from Ohio,committed suicide on Sunday. In a note that she had preemptively scheduled to post on her Tumblr, she described the bigotry she had faced from her parents, who tried to isolate her from her friends and the Internet as punishment. They also sent her to Christian therapists who shamed her for her gender identity.

In response, the Transgender Human Rights Institute created a Change.org petition on December 31. The petition asksPresident Obama, Senator Harry Reid, and Representative Nancy Pelosi to enact Leelah’s Law to ban transgender conversion therapy. Less than two days later, the petition has already gained 160,000 signatures and made the rounds online. It may be the most attention that conversion therapy has gotten outside of activist circles for some time.

Aside from LGBTQ activists, secular activists, and mental healthcare professionals seeking to promote evidence-based practice, not many people seem to speak up about conversion therapy, or understand much about it. Most discussions of it that I come across deal with therapies that attempt to “reverse” sexual orientation from gay to straight or to eradicate same-sex attraction. However, conversion therapy also includes practices aimed at transgender people with the goal of forcing them to identify as the gender they were assigned at birth.

In her suicide note, Alcorn wrote, “My mom started taking me to a therapist, but would only take me to Christian therapists (who were all very biased), so I never actually got the therapy I needed to cure me of my depression. I only got more Christians telling me that I was selfish and wrong and that I should look to God for help.” Although she did not elaborate further about her experience in therapy, it’s clear that the treatment goal was not to help Alcorn reduce her risk of suicide, accept herself, recover from depression, or develop healthy coping skills that would help her stay safe in such an oppressive environment. The treatment goal was to force Leelah Alcorn to identify as a boy and to fulfill her parents’ and therapists’ ideas about what being a Christian means.

This is not mental healthcare. This is abuse.

Read the rest here.

Why We Should Ban Conversion Therapy

Opening Up, Closing Down

[Content note: depression, suicide, self-harm]

The truth about mental illnesses that many of us have learned is that they change you for good. Even after the symptoms are gone, the medication gradually reduced to nothing or stabilized at a dose that works, something remains. (And for many of us the symptoms are never entirely gone.)

Depression left my scaffolds–indeed, my very foundation–cracked. I’m okay, even joyful, much of the time. But it feels a little flimsy.

One of the ways this plays out in my daily life is that I have problems with intimacy. I don’t mean the sexual euphemism, but rather the ability to be vulnerable, to let people in, to be seen as you are, to be comfortable with closeness.

I am intensely uncomfortable with all of this.

I hate talking about myself, whether it’s positive or negative. I hate feeling like I need someone’s help to deal with emotions. I hate wanting someone’s help to deal with emotions even when I know I don’t need it. I hate the first time I tell someone I love them and I hate many of the subsequent times too. I hate it when people know that I miss them. I hate being visibly upset around someone, which means that if it’s at all possible to leave, I leave. I hate expressing any emotion besides joy and anger (which I rarely feel) to anyone. I hate it when someone says things to me in an attempt to build intimacy but I don’t know what to do so I say nothing. I hate when people notice emotions I didn’t intend to share. I hate when they tell me this as though it’s going to somehow endear them to me. I hate that there’s nowhere I can cry without being seen or heard by someone.

So relationships, whether platonic or romantic or sexual or some combination, are difficult.

Some people have difficulties like these for their whole lives, but for me, it happened as a result of depression. And, ironically, depression is also the thing that’s hardest for me to share with people.

During my nine years of depression–in fact, probably my whole life up to and including that–I was very different. My experience of mental illness was that it triggered a sort of leaking of thoughts and emotions. I literally lacked the ability to hold them in. They spilled out of my hands, like when I try to move a big pile of laundry from the washing machine to the dryer and little bits and pieces–a sock here, a tank top there–keep falling on the floor. I remember crying apropos of nothing on the band bus in 10th grade and telling my boyfriend that there’s no way to be happy when you hate yourself. Fifteen is old enough to know that this is not an appropriate thing to say. It didn’t matter. It just came out.

It’s not like I didn’t try to plug the leaks. In 6th or 7th grade, I decided to keep a record in my journal of “things left unsaid.” Each day I intentionally tried to shut myself up at some crucial juncture, and rewarded myself for it by writing it down in the notebook later–the thing left unsaid, the person I didn’t say it to, and the reason I didn’t say it.

Years later, what I learned about psychology and behavior change suggested that this could be quite an effective strategy for some people. But it didn’t help me much, because my problem wasn’t purely behavioral. When I looked at those entries later, I noticed how many of them had to do with hurt feelings. “Thing left unsaid: that I was upset about what _____ said about my outfit. Reason: because it wouldn’t make a difference.”

I tried so very hard, but everything hurt. If they couldn’t read it explicitly in my words, they read it implicitly in my face, my body, my tone. I couldn’t hide it. I gave up writing the entries within weeks because it was already too late, everything was leaking out and I couldn’t patch the holes fast enough. In college the dam broke completely, and everything from those little hurts all the way up to wanting to kill myself became common knowledge for those who interacted with me a lot.

For a while it was okay. I thought that being so open was keeping me going–and, as I’ll get to in a moment, it was important in some ways–but what it ultimately did was it completely broke me. It destroyed any sense of self-respect, independence, and competence that I had. When I confided my depressive feelings to someone, usually a partner, I felt like garbage. I felt so much more shame about the act of confiding than I ever did about the feelings I confided themselves.

If you’ve ever had to call the last person you want to speak to right now because they’re the only one available to talk you out of slashing your own wrists, then maybe you know what I’m talking about.

You have to reveal. You have to open up, in order to live. You have to tell it to the therapist and the psychiatrist and your parents and your partner and anyone else who is in any way responsible for your well-being.

You tell people the darkest most horrible things not because you trust them and want to let them see this part of you, but because you have no fucking choice.

And so the concept of “opening up” has been totally ruined for me, because I didn’t get to save it for those special, bonding late-night conversations with someone I feel ready to show myself to.

I had to do it.

Now I don’t.

And not having to feels like freedom. It feels like victory. It feels like independence, finally. It feels like adulthood, although it shouldn’t. It feels like maturity, although it shouldn’t. It feels like wholeness. It feels like safety.

It feels like recovery.

So now I sit at the computer with words typed into the chat box–“I feel sad,” “I can’t stop crying,” “I miss you so much”–and I can’t send them. I want to send them and I don’t want to send them. Not wanting to send them almost always wins out.

In a way, intimacy was easy when I was depressed. I wore it on the outside and it created a sense of intimacy with many people almost instantly. New partners saw my neat little red scars so early on, too early on. “We’ll work on that,” said one, an aspiring psychologist. “I wish you wouldn’t do that,” said another.

Now nobody has to see, and it’s almost impossible to want it any other way. Intimacy has gotten much harder. Perhaps mirroring my own style, new partners disclose little and so I lose interest in them quickly, convinced we have nothing in common besides politics.

Instead I write. The stress of work, the rush of falling in love, the little depressions that come and go, the grief of losing my old lives, the fear of the future–they sink into paper and that’s where they stay.

It’s lonely and isolating as hell, but it beats feeling opened up and exposed.

And now, although I’m known as someone who talks about depression a lot, I don’t really talk about it. I speak obliquely of it, the way someone might mention the passing of a loved one without ever speaking openly of their grief.

I can say that there is fatigue. I can say that it feels sad and numb and dark and hopeless. I can say that I wanted to die. I can say that my head was–still is, much to my constant disappointment–fuzzy and slow, memory useless, words perpetually at the tip of my tongue but left unspoken. I can write this blog post about how depression has affected my ability to desire, build, and feel intimacy.

But I do not ever, not anymore, tell you how it really feels. I will not make you listen to me tell you I hate myself I hate myself like I’ve never hated anything before and I wish I could rip my body and my mind to shreds–

No, I stay on a meta level. I’m comfortable talking about it conceptually.

But the feeling of depression itself? That is a dark room into which I want to go alone. I don’t want anyone knocking on the door trying to get me to let them in. I don’t want to have to hold their hand and guide them around the sharp corners they can’t see, because when I’m in that room, I need to be caring for myself. Not for anyone else.

Of course, it always starts out with them hoping to care for me, but that’s never how it ends up. People end up needing my support to navigate the nightmares in my own head.

Well, I’m sorry, but I just don’t have the mental fortitude for that. Caring for one person–me–is enough.

Presumably, I don’t have to be stuck this way for my whole life just because I have/had depression. I’m hoping to start therapy again soon, for this and for other reasons. But for now, as I reflect on myself and my life at this very special (for me) time of year, it’s hard not to feel hopeless about all the little things I can no longer do, at least not without lots of anxiety and fear. Like tell someone how the stress actually feels. Or talk to someone about how powerless I feel in my work. Or ask someone if they can talk to me for a while to help me get my mind off of things.

In this way, and in many other ways, mental illnesses may never end, or may take much longer to end than we expect, and there is no hopeful cheery note for me to end this on.

Opening Up, Closing Down

Why Dudes Don't Greet Dudes

My newest Daily Dot piece is about #DudesGreetingDudes.

After that NYC catcalling video went viral online, some men (not all men!) were upset, not because they were trying to defend their right to shout “nice tits” at a random woman, but because even non-sexual comments were being defined as harassment. For instance, Michael Che, co-host of Saturday Night Live’s Weekend Update, wrote on Facebook, “I want to apologize to all the women I’ve harassed with statements like ‘hi’ or ‘have a nice day.’”

In response to comments like these, This Week in Blackness CEO Elon James White created a hashtag called #DudesGreetingDudes:

The #DudesGreetingDudes tweets are hilarious because they’re ridiculous. After all, everyone knows men would never actually talk to each other like that.

But why wouldn’t they?

The common explanation is that street harassment—yes, including the “nice,” non-explicitly sexual kind—is ultimately about asserting male dominance over women, forcing them to give men their time and attention. It wouldn’t make sense for a man to infringe on another man’s mental and physical space in that way.

But I think there’s also a little more going on here, and it has to do with the ways in which men are socialized to view women not only as sexual objects, but as their sole outlet for companionship, support, and affirmation. They’re socialized to view women as caretakers and entertainers, too.

Read the rest here.

Why Dudes Don't Greet Dudes

Therapists Can Be Wrong

Therapists, like many professionals who work directly with clients, need to present themselves confidently in order to be effective, even when they’re not feeling very confident. It can be difficult for therapists to admit that they have or could be wrong, or that they don’t know everything. Like doctors and teachers and others, therapists worry that acknowledging their own limitations will erode their credibility and trustworthiness. When your livelihood depends on people finding you credible and trustworthy, that adds to the aversion of being wrong and admitting mistakes that virtually all of us already experience.

Yet we have to learn how to admit and accept that we are sometimes wrong–not only because it’s a foundation of accountability and ethical practice, but also because clients can often see through that facade, and they won’t like what they see. It’s difficult to trust someone who will never–can never–admit that they’re wrong.

This was going through my mind as I read one of my required texts for school, Psychiatric Interviewing: The Art of Understanding“Psychiatric interviewing” is really just a term for the process of therapists asking their clients questions, so the book covers a lot of very important ground. While I’ve found it useful so far, a few things irk me about it.

For instance, the author has a strange preoccupation with labeling clients using the article “the” in a way that implies uniformity. The text is laden with references to what “the paranoid patient” may do or how “the guarded patient” may behave in an interview. This type of language is not only dangerously vague (who qualifies as “the paranoid patient” as opposed to “a person who has some paranoid thoughts”? Who gets to make that determination, and using which measure(s)?), but stigmatizing to therapy clients and a potential source of bias for therapists. If you’re a young therapist who reads this book and gets all these ideas about what “the paranoid patient” may do, you may project these assumptions onto every client you work with who struggles with paranoia or expresses thoughts that seem paranoid to you. Assumptions are not necessarily a bad thing–and may even be useful in some cases–but you need to be aware of them as you work. Thus far in my reading of this book, it has not provided any cautionary notes about making assumptions. Even in my classes, in which we are often told not to make assumptions, provide little if any guidance on learning to actually notice these assumptions in practice.

Shea also recommends a few other techniques that I find excessively presumptuous. Take this example dialogue from the book:

Pt.: After my wife left, it was like a star exploded inward, everything seemed so empty…she seemed like a memory and my life began to fall apart. Very shortly afterwards I began feeling very depressed and very tearful.

Clin.: It sounds terribly frightening to lose her so suddenly, so similar to the pain you felt when your mother died.

Pt.: No…no, that’s not right at all. My mother did not purposely abandon me. That’s simply not true.

Clin.: I did not mean that your mother purposely abandoned you, but rather that both people were unexpected loses.

Pt.: I suppose…but they were very different. I never was afraid of my mother…they’re really very different.

A lot of therapists, especially those in the psychodynamic tradition, are understandably attracted to the idea of making this sort of “insight.” As Shea points out, when you get it right, it can build a lot of trust because the client feels understood in a very special way. It feels good to feel “smart” and insightful, to be able to read people like that. It can remind us that there really is something special we can do as therapists that others cannot. It probably doesn’t hurt that this, the therapy-via-Sudden-Brilliant-Insight, is usually the only kind we see represented in the media.

But a lot of the time, there really isn’t enough information to reach this conclusion. Therapists may make these leaps based on hunches, but that doesn’t mean there’s data to back it up. Sometimes the client will tell you so, but I think that a lot of the time, they will say, “Hm, I suppose you might be right,” because you are an authority figure and they want to believe you have the answers.

From the information given, you can’t reasonably jump to the conclusion that the client felt similarly when their wife left them and when their mother died. Those are very different types of loss, and even similar types of loss–two breakups, two deaths in the family–can feel very different.

Certainly there can be conceptual similarities between losing a spouse to divorce and losing a parent to death. It might even be worthwhile to explore them, but the therapist need not assume they felt “so similar.” If I were the client, I would’ve liked the therapist to say something like:

Between this and your mother passing away, it sounds like you’ve been dealing with a lot of loss. I’m wondering if losing your wife is bringing up any memories of losing your mother.

This resonates with me; it might not with other clients. That’s why sometimes the more important thing as a therapist isn’t what you say, but how you respond once you realize you’ve said or done something that strains the connection between you and your client. In this case, a responsive therapist might say something like:

I’m sorry, I didn’t mean to make assumptions about how you’re feeling. Can you say a bit more about how this loss feels different for you?

The client is the expert on their experience.

But instance, in the dialogue, the therapist doubled down on the (mis)interpretation, attempting to justify their response to the client’s disclosure. This leads the client to double down as well, justifying to the therapist why the losses feel different. They shouldn’t have to justify themselves that way.

Here is the thought I had, as both a provider and a consumer of mental health services, when I read Shea’s example dialogue above:

The failure mode of Brilliantly Insightful Therapist is Arrogant, Presumptuous Therapist.

Now, I don’t know if Shea is arrogant or presumptuous; I don’t know him but I would hope he isn’t. I do know that refusing to acknowledge missteps and misunderstandings can lead one to across that way, though. And that’s exactly what Shea refuses to do both in the dialogue itself and when he analyzes the dialogue for the reader:

Needless to say, this attempt at empathic connection leaves something to be desired. The patient’s attention to detail and fear of misunderstanding have obliterated the intended empathic message, leaving the clinician with a frustrating need to mollify a patient who has successfully twisted an empathic statement into an insult of sorts.

This probably infuriated me more than anything else in this text. Here, the failure of the interaction has been blamed entirely on the client. Shea has assumed that the client has taken his statement as an “insult” when there is no evidence of this; the client is merely correcting the therapist’s misinterpretation. It reminds me of how, often when I tell people they’ve made inaccurate assumptions about me, they respond by shrieking about how “upset” I am and how I take everything as an “insult.” Correcting someone is not the same thing as being “insulted.”

If this situation is “frustrating” for the clinician, then, I can only imagine how much more so it must be for the client.

There is no room, in this approach, for any acknowledgment that the therapist’s interpretations might simply be wrong. No room for the possibility that it’s not the client’s personal characteristics (“paranoid,” “guarded,” “histrionic”) that made this interaction fall flat, but the therapist’s presumptions and subsequent refusal to step back from them.

I discussed this particular example because it’s what came up in my reading, but it’s hardly the most egregious thing of this type that happens. Therapists who cannot conceive of the possibility that they’re wrong not only fail to help their clients, but can actually hurt them.

Since there are probably a lot more therapy clients (or prospective therapy clients) reading this than there are therapists, I want to be clear about why I wrote this. It’s not to discourage people from seeking therapy, but to arm them with the knowledge and language to advocate for what they need from their therapists, and to find therapists that suit their needs.

That last part is important. Some people may want a therapist who makes bold interpretations and takes that authoritative, explanatory sort of role. Personally, I think conducting therapy in this sort of way opens practitioners up to all sorts of bias and errors, which is one reason I want to avoid it both as a client and as a therapist. But if that’s the approach that resonates with you, then it’s likely to work a little better for you, because the most important factor is the client-therapist relationship.

Aside from that, the reason I write about problems in mental healthcare is the same reason I write about problems in feminism or atheism–to hold my own communities accountable. Anecdotally, I know that this sort of thing makes it difficult for some people to benefit from therapy, or even to want to access it to begin with. I’m not the only person who dislikes having an authority figure tell me things about my life without bothering to find out if their assumptions are even accurate.

I trust people more when they admit their mistakes.

 

Therapists Can Be Wrong

Venting About Your Problems Is Therapy's Failure Mode

At least, it was for me.

The more I learn about how to conduct effective, evidence-based therapy, the more I understand why none of my attempts at getting therapy helped. (It is true that my depression is “in remission” or whatever you want to call it, but I don’t credit the few total months I spent in therapy with that development.)

Many people think that therapy is about paying a person to sit there and nonjudgmentally listen to you vent about your problems. Some of this might come from the prevalence of psychoanalytic thought in our culture, including in stereotypes about therapy and mental illness. Freud and his ideas are still very dominant in the many laypeople’s opinions about psychology. Specifically, I’m thinking of free association, a technique used in traditional psychoanalysis in which the client is asked to just say whatever happens to be on their mind, however silly or irrelevant it may seem. Free association is meant to inspire the client to reveal previously-repressed thoughts or feelings that both client and therapist are then able to learn from and understand.

I suppose that sometimes this can be useful, but other times or for other people, it may not be. The problem is that therapists operating from this perspective will be biased towards finding some sort of hidden meaning in the client’s free association whether it is there or not. If you asked me to free associate, I would probably just rant incoherently about how cool the buildings downtown are or cute things the children in my family say or how frustrated I am that whenever I enter a building I am always very cold because people use excessive air conditioning in this country.

And I’m sure an unscrupulous therapist could just assume that this means that I am obsessed with phallic-shaped objects or I am desperate to have children or I find that this world is too cold and unwelcoming and I long for the safe, warm environment of my mother’s womb. Sure. My own perspective is that the things that I happen to randomly think about when I am not directing myself (or being directed by someone else) to think about something in particular are rarely relevant to the major issues I have in my life. I will survive despite the prevalence of freezing-cold rooms in my day-to-day experience.

So it is with venting about my problems, which is somewhat similar to free-association in that one is asked to simply say whatever they want to talk about or are upset about at the moment. Yes, obviously, it can sometimes be very useful. I do not deny that whatsoever. A therapist may ask, “What’s been troubling you lately?” and a client might say, “My mother is sick.” Or they might say, “My children won’t listen to me and it’s making me mad,” and then the therapist probes a little more and the client reveals that the client and their partner are constantly fighting and contradicting each other and the children don’t know who they’re supposed to be listening to anymore.

The trouble starts when venting about their problems is all the client is ever asked or allowed or encouraged to do. Then you have a therapist who’s doing nothing more than what a trusted, patient, empathic friend could do. And while, to be fair, such friends aren’t as easy to find as we may wish they were, these are not skills that you need at least six years of higher education and at least one (possibly more) professional licenses in order to administer.

And that’s about all I recall doing when I went to therapy. Of course, because I was depressed, the things I vented about frequently had to do with depression in some oblique way. But the key thing on my mind as I headed off to my weekly appointments wasn’t necessarily, “I have depression.” It was, “I just had a fight with my partner and now I’m convinced they’ll dump me and I’ll be alone forever.” Or “I’m terrifying about this exam and if I don’t do well then I am a failure.” Or “I hate myself.” Or whatever.

And my therapists, for the most part, did succeed in creating a space where I felt slightly comfortable with sharing these things, and so I shared them. They would say, “What would you like to talk about?” and I wanted to talk about my conversation with my mother or how much I miss my siblings or my fears about my partner leaving me. The therapists would attempt to understand why I felt the way I did, but they did not seem to do much to change the way I felt, even though I continued seeing the same ones for a few months at least. By then, the real work of therapy should have begun.

Whereas what I’ve now been taught to do as part of my own training in mental healthcare goes more like this: A client comes to you. You ask for some basic information from the client about their life, family, history, cultural/ethnic/religious background, reasons for coming to therapy, and so on. You ask the client what they would like to accomplish in therapy. You tell them a little bit about your own therapy practice and what they can expect from it, and see if there’s anything that makes them uncomfortable or that they feel wouldn’t work for them.

Together, you set some concrete goals for therapy that are as measurable as possible. For instance, “I would like to stop having panic attacks when I leave the house.” Or “I want to find ways to deal with feeling very upset that do not involve self-harm.” Or “I want to learn how to approach people and make friends with them.” Or “My partner and I would like to find ways to manage jealousy.” If the client suggests goals that the therapist thinks are too vague, unrealistic, or dependent on factors beyond the client’s control (“I want to find a partner”), the therapist can discuss this with the client and help them adjust the goal so that it’s more manageable (“I want to get over my anxiety about asking people out on dates” along with “I want to learn ways to deal with feeling lonely”).

Then, the therapy progresses towards these goals. Every few weeks or so, the therapist and client assess how the therapy is going so far, and the client can weigh in on whether or not they think it’s helping, what concrete progress they feel they have made, and so on. The therapist may periodically administer scales or questionnaires that help gauge improvement in a slightly more objective way. The client and the therapist together can decide to adjust or change the goals if they want to, or introduce new ones as older ones are achieved. Being able to assess and adjust therapy as it’s going on, not just when it’s about to end, is very important.

Eventually, depending on the therapist’s style and the needs of the client, they may discuss termination, which is a word I hate that refers to the process of ending one’s work with a particular client. The client may feel that they’ve accomplished the goals they had, or that they’ve gotten as far as they think they can with a therapist and will be okay on their own now, or that they need to find a different therapist who may be able to help them better. Therapy should not continue indefinitely. The therapist and the client may agree to check in again in a certain number of months to see how the client is doing and whether or not they need to return to therapy.

Of course, this is just a template; everyone does it differently and not all clients may want or need all of these steps, but this is consistent with an evidence-based approach. This process holds therapists accountable by encouraging them and their clients to evaluate the therapy.

When I look back on my time in therapy, I wonder if I could’ve done a better job of making it work for me. Maybe I should’ve offered up specific changes that I wanted to see to the therapists, such as “I want to stop crying several times a week” or “I need to learn to be okay with being single.” (Both of these things happened without the help of a therapist, by the way.) But…I didn’t really know that I needed to do that. I saw my therapists as authority figures. I assumed they knew what they were doing, and that they would ask me for specific things if they needed to. I had only the vaguest ideas of how therapy is “supposed” to work, because my psychology classes mainly focused on theories and not on practice.

If you find yourself doing nothing but venting about your problems in therapy–without necessarily then developing any sort of plan to help resolve or cope with the problems–that’s a red flag. Venting can be therapeutic in its own right, but you shouldn’t have to pay for the opportunity to do it. Therapists have a responsibility to provide the best treatment they can; it’s literally in our code of ethics. You deserve that from your therapist.

Venting About Your Problems Is Therapy's Failure Mode