An Open Letter to My Students I: What Therapy Is All About

Hello!

So you’ve decided to become a therapist. I hope that it is as fulfilling as you hoped it would be when you enrolled. For me therapy, at times, has been filled with magic. I mean that in the most literal sense of the word. Therapy is magic and practicing therapy well makes you a magician, but as with all magic there is a cost. Therapy will break your heart. I once heard a wise man say that you give advice not to avoid struggle, struggle is inevitable, but to help someone find their way through struggle. I hope these letters are a light in dark places.

As a therapist, researcher, scholar, and student, I have found a few fundamental truths. The first thing I’ve learned is that we know a lot less than we say that we know. Twenty years from now most of the “latest” and “greatest” discoveries will not only turn out to be duds, but actually actively harmful, like how we used to irradiate appendices to reduce their size and ended up giving thousands cancer, or how we would blood let people to get ride of disease, or drill holes in to peoples heads, or would remove the eyes of blind people which disrupts their sleep cycle, and so on and so on. “Progress” has made lots of costly mistakes.

However, I’ve also learned a second thing. In every field there are fundamentals that nearly everyone agrees on. These fundamentals often have high upsides and small downsides. I’ve made it my life’s mission to not do the fancy therapy I read about in textbooks but to simply master the fundamentals. Ironically, the more I simply pay attention to the fundamentals, the more I find myself enacting magic.

In our field of psychotherapy there are a few fundamentals. One of these is that first and foremost psychotherapy is about helping people to manage their emotions. That’s it. That’s all we do. We do not give advice. We do not try to convince or change a client’s mind. When someone comes into therapy your only job is to help them managage emotions which they would rather not feel.

That’s it.

Others will say that therapy is about “cognitive restructuring” or “self actualization” or “finding solutions.” They are wrong because when people can manage their emotions they find themselves thinking differently (#cognitionsrestructured) and they come up with their own solutions. This is because emotions are the lens through which we navigate the world. If you assist people in changing their lens, then all sorts of options open up for them. This is a hard thing to swallow because we’ve been sold a false view of rationality. The funny thing is that the people who propose the false view of reason are the same ones who get the most frustrated when people don’t behave “rationally.” We all know that false view of rationality is false because we’ve all had the experience of saying “Man, I’m not going to eat that doughnut,”

or, “I’m going to go work out tomorrow,”

or, “I’m going to study for this test,”

or, “This is going to be my last drink,”

or, “Okay this is my last cigarette. I mean it this time.”

or, “I’ll read that book after I read watch this one show.”

We all know what happens. We know what would be good to do, but we just don’t feel like we can do it. Going against emotion is a Sisyphean effort.

The real problem is that most of us weren’t taught how to work with emotion or how emotion is the foundation of logic.

Your job as a psychotherapist is to help people with the emotions they negate, or don’t want to feel. The primary way we (humans) deal with difficult emotions is through relationships. Others will tell you that we need to be “independent.” Bollocks. We are either healthily dependent or unhealthily dependent. There is no independent.

So what your clients need most is you. They need you to show up and care and listen. If you do that you are 50% of the way there and MILES ahead of many therapists I meet. Too many therapists think therapy is accomplished through some sort of technique or intervention. The relationship IS the intervention. The research on common factors bears this out. The research on trust bears this out. The research on attachment and affect regulation bears this out.

Your job as a psychotherapist is to help people manage difficult emotions. You do this when you listen and care. If you do this you are 50% of the way there.

On a practical level this means learning and investing in therapy models which focus on the relationship as the main method of change. This is why I love Emotionally Focused Couples Therapy. This is why I think Trust Based Relational Intervention is a great model. This is why I think you cannot learn Solution Focused Brief Therapy without also learning Motivational Interviewing. And this is why you almost never go wrong studying on Carl Rodgers and Client Centered models.