Jonathan Alpert’s article, We're Spending $300 Billion a Year on Mental Health Care. Why Is It Making Us Sicker? raises the question of whether we can do a proper job as psychotherapists if we’re afraid to cause clients psychological and emotional distress. The article prompted discussion among my colleagues about the point of therapy and how differing generational experiences impact therapeutic approaches.

In our 60s, 70s and 80s now, we were brought up by parents who’d endured World War II and the Great Depression and our therapeutic approach is old style—tell it like it is and play it as it lays. So, it makes sense that our method might differ from that of the current crop of therapists who were raised with gentle parenting, trigger warnings, and both the forgiveness and self-esteem-for-all movements at the end of the last century.

Our discussion brought to mind a former client I’d seen when I began my practice nearly 40 years ago. Suzanne was of such a high weight that it threatened her career and her health. She came to see me to deal, I assumed, with this problem, but as the session ended and I laid out what I thought our work ahead was, she seemed shocked that the process would be so complex, arduous and drawn out—and I never saw her again. 

The therapist’s initial job is to create a safe space for clients to be themselves and to forge a positive connection with them via active listening, exploring issues, mirroring, reflecting back and validation. When a relationship seems solid enough, we can then wade into deeper waters and gently probe emotional distress. When clients are ready, it’s time to pull on our hip boots and slog along with them through the depth of their emotional pain to relieve and release it and then help repair it.

What I’m describing is traditional psychotherapy. There are, of course, methodologies like Somatic Therapy, Rapid Resolution Therapy and others that work differently. But all involve the client identifying and tolerating some degree and duration of emotional discomfort for us to help alleviate it. The therapist, too, must be able to bear painful feelings, their own that arise from session content and those that come from feeling responsible for relieving another’s pain, sometimes with little success.

I know of clients and non-clients who’ve barely changed though they’ve been in therapy for years or even decades. There is, sadly, such a thing as being too comfortable, even in therapy. The goal is to tolerate enough discomfort now in the service of being more comfortable down the road. And to be very clear that therapists causing discomfort is not the same as causing damage. They don’t call them growing pains for nothing.

Best,

Karen