Wednesday, June 27, 2012


Recently, I had a conversation with my father-in-law in which he asserted that it has never been proven that therapy helps anyone. He also said that many people go to counselors just to talk and don't want help. As one might imagine, I disagreed with this perspective, and I found it frustrating and somewhat insulting since both my husband and I are trying to work in a counseling profession in the future.

Nonetheless, one thing I realize is that these biases reflect his personal experience as well as his desires. He went to therapy while he was going to college as an undergraduate because of an obsession with death which started when he was 4 years old. His aim in going was to understand why he was so preoccupied with it from such a young age and the therapist did not help him. Therefore, he believes that, aside from cathartic talk, therapy is not very effective for most people.

This discussion taught me a lot of useful things, and one irony of it is that, at the end, I knew why he was obsessed with death at a young age and in his early adulthood (and he may yet be).* I didn't tell him why because he didn't ask, and he believes no one can help him with their psychological intervention anyway. I don't tell people things they don't want to hear, even if I believe I can offer them assistance. Suffice it to say, even if I gave him "the answer", I don't think he could benefit from it.

Before I get too much further, let me say that I believe that therapy is not the answer for every problem and that, for some problems, merely venting about your issues is all that therapy needs to accomplish. People do benefit from simply talking, but I think there are limits and that much more can be done if people really want to gain better tools for coping with life's difficulties.

There are many grades of psychological problems, and nearly everyone has some issues, particularly low-level neurotic behavior, that they can function quite well with. My father-in-law is what I would term "functionally neurotic". That's not a negative label. I would also call myself by that same term. That means that there is something about my thinking and emotions which degrades quality of life which I'd be better off trying to change. The difference between us is that I am working to decrease my neuroses and he doesn't seem to think his can be changed or that change is possible or necessary.

Most people with functional neuroses are what would be seen as "normal". They tend to go through life navigating as best they can around various obstacles that are put in their way due to their anxiety, fear, small obsessions and compulsions, or other troublesome behaviors. Sometimes, their issues cause their friends and family some level of grief, but never enough to destroy relationships in most cases. It simply is a case of quality of life. They could be happier, less annoying, more fulfilled, more productive, etc., but they do get by.

The thing about people with functional neuroses is that they rarely seek treatment because they have other outlets to help them cope. Often, they do what my father-in-law does and find a way to "burn off" the anxiety or mitigate the depression (in his case, through exercise), distract themselves from their ruminating (in his case, T.V. and reading), or purge their issues (in his case, through talking to others about how he feels).

One thing I realized, and I'm not going into the details of a protracted talk I had with my father-in-law here, is that one of the reasons that people do not benefit from therapy is that they have other resources which are easier to access and tap into. If he truly  had no other recourse, he'd probably work harder to solve his issues rather than simply burn off, distract, or purge. When we were talking about therapy and whether or not it could help people, both my husband and I talked about doing the work involved and that few people are willing to do it. I realized that they don't do it because they don't have to.

In weight loss terms, and I use this as an analogy, not because I'm applying this to weight loss, it is like exercising like a maniac to burn off calories from eating large meals rather than reducing the meal size. You cope with one issue (overeating) by finding another outlet, but the core problem remains. If you lose access to that resource (exercise) by becoming injured, you will then suffer the consequences of your core problem. It's much better to solve the actual problem than to find ways to work around it.

When I mentioned that fact that people like my father-in-law don't have to push themselves to benefit from therapy, he paused and said that, if he could no longer exercise (a big outlet for his depression since his wife passed away late last year), he'd have some serious problems. Then he went back to essentially asserting his core belief that therapy wasn't proven to work anyway. Attempts to have a more meaningful discussion with him were essentially derailed by his sliding around about how things like "happiness" are defined and arguing that psychology was a "soft science". Every time we closed in on a point, he moved the goal post or topic.

At the end of the day, I realized that people with functional neuroses go to therapists for help, but as long as they have access to other resources, they are unlikely to push themselves to do the hard work it takes to actually get better. It's immensely difficult to change yourself and it's just easier to do what is comfortable rather than face the work of mentally reprogramming yourself. It's not that it is so elusive as people seem to think, but rather than people who are anywhere but at the end of their rope with exhausted or non-existent resources aren't likely to try very hard.

In terms of weight loss, I think this is a huge part of the core issue people have. They don't deal with their real problems, but rather find a path to becoming more functional. It's far easier to exercise, eat diet foods, and reshape your environment than to deal with the core issue, the inability to develop a relationship with food which leads ones particular body to a state of health and well-being. Unfortunately, when those resources no longer become available because one is injured, schedules change, finances are altered, or the control over ones environment is lost, people regain because their problematic relationship with their eating and all that drives it is still there. So, just as my father-in-law may have to finally deal with his depression if he cannot exercise, the person who loses weight by devoting significant energy and time to weight control practices will regain when that ability is lost.

*For the curious, one thing which I understood after all of his discussion about science and "soft science" as well as having an overview of his lifestyle and choices is that he has an uncommonly high intolerance for uncertainty. This is so deeply rooted that he won't try even minor variations in food and has a very low desire for novelty in daily life. I can't go into all of the evidence here, but it is clear that his fear of death at a young age that came from a strong core character trait which makes him desire very precise and certain answers. 

Death is the ultimate uncertainty. He can't process the outcome in any meaningful way, but he can't avoid the ultimate nature of it. The obsession is like a program loop for him. He needs certainty, but will never get it. Had I had access to him at a younger age, I believe I could have helped him by systematically making him more comfortable with uncertainty by encouraging him to slowly take steps into various situations that were uncertain and becoming acclimated to existing in that state or seeing that the outcome may not always be negative. 

Though I don't believe he would ever be comfortable with the idea of dying (who is?), I believe the obsession could have been ameliorated. However, now that he is 75 and has no belief in the effectiveness of therapy anyway, it's essentially an academic exercise for me to ponder treatment.


Arwenn said...

I was struck by the fact that when your FIL tried therapy he felt it failed because it didn't give him the answers he wanted. I think that's often a misconception, that there is an "answer" and once we find it all will be well. I have an acquaintance who is very frustrated with therapy right now because she wants to talk about her difficult childhood, complicated relationship with ther mother, etc., and the therapist is trying to focus on her rather severe OCD which is impacting her job. I guess I believe that therapy works best when we have a reasonable, concrete goal - to learn to live with whatever problem we have and that's why so many people cope using these other methods that you describe.

I don't think it is all that different from the psychology you've described for weight loss....we want there to be a "why" when in fact that doesn't matter nearly as much as what we do every day to change to get to where we want to be.

screaming fatgirl said...

I think what we do is informed by the "why". If we know why, we can better plot a course of action away from destructive thoughts and behaviors. If my FIL knew he had this issue, he could approach it from that angle rather than just engage in deflection (which he may or may not be capable of doing forever and is not always effective).

Instead of coping by exercising, watching T.V. and dumping on willing listeners, if he had addressed the true problem (excessive discomfort with uncertainty), he wouldn't experience emotional difficulty at the same level as he does now. Knowing why really would have lead him to a less painful future. Though certainly the coping mechanisms might still be useful, they wouldn't be things he'd be bereft without. He can't even change his exercise type when he is injured because his mind has to be engaged while he exercises. He tried to swim when he had a tennis-related injury but being in his own head in the water rendered that avenue ineffective. He needed/needs to fix the core problem, not simply engage in band-aid coping strategies. Eventually, the box of band-aids will be empty.

I'm a fan of both knowing the why and taking action. I just think that taking action without knowing why is too scattershot to be effective unless one is lucky and a coping mechanism happens to hit the bulls eye. I say this because knowing why I ate compulsively and relied upon food to cope helped me find more effective strategies to stop. Sure, I might have managed not being so introspective, but I think it both helped me make better choices when I engaged in systematic behavior modification and mental pattern alteration.