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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.

Therapy and Weight Loss

For quite some time, I've been following blogs and forums about weight loss, and occasionally the topic of therapy and the role of psychology come up. Most of the time, people who have lost or are losing weight say that counseling does not assist them in weight loss. Their general attitude is that their issues are biological in nature (e.g., sugar addiction, insulin resistance) or simply the result of poor self-control or discipline. The former can be treated with drugs and lifestyle changes. The latter has to be pushed through by "sheer force of will" until you have magically found the discipline (a notion I reject as I think "willpower" is a useless term which does nothing to assist people in making behavioral changes).

Setting aside the fact that bad habits are psychological issues, I've often wondered why people reject the idea that therapy will aid them in their efforts. I've reached various conclusions, but the primary one is that most weight loss therapy is likely too abstract in its reasoning. There need to be multiple stages to the process, and I think some counselors might be level jumping on the type of feedback they provide. For most people, the fact that their alcoholic father drowned his pain in booze and therefore role-modeled addictive behavior that the person undergoing treatment may be emulating but substituting food instead of alcohol is of limited value in dealing with the problem at hand.

If the information can't be directly applied to a change in lifestyle or at the moment when the impetus to behave destructively is motivated by that underlying psychology, it comes across as merely academic. If you stuff yourself with food to a point of physical discomfort because you create a new discomfort to blunt, mask, or distract yourself from painful emotional feelings, it means nothing as you sit in the therapist's office the day after a binge. The information has to be timely as well as accurate and relevant to be of value in the weight loss process.

In the sterile environment of the therapist's office, when the circumstances that may cause you to eat are far removed from that time and place, it is hard for the counselor to know what is driving you, and it's nearly as hard for you to know. What tends to happen is that it all boils down to "I eat because life is hard and food comforts me." This generic conclusion is of very limited value, particularly when no solution to the pain of your life is forthcoming via therapy.

In essence, knowing the cause doesn't really help with the solution for many people, particularly if the deeper knowledge doesn't come hand in hand with behavior modification therapy that teaches them new and concrete techniques for addressing stress in a fashion which does not involve food, but is adequate for alleviating your difficulties. Of course, for many food addicts, nothing soothes like food and they find all other options falling short in offering a palliative for their pain.

That being said, as someone who feels profoundly that analyzing the psychology of my problems and applying behavior modification techniques to myself have brought me to where I am today, I think that therapy can make the difference between being someone who loses weight and keeps it off and someone who starts to regain with the first forced lifestyle change or bad patch, or, perhaps worse, someone who is obsessed with food in a way which is conducive to physical health.

The process of weight loss is one thing, but living in a manner in which your relationship with food is psychologically as well as physiologically healthy is another. I believe that insights and understanding are something which should be made concurrent with changes in habits or routines, but they should not be expected to have an immediate effect or direct application. It is rather the case that they create a mass of self-knowledge that will reach a critical mass when your understanding of self comes together at later periods of time. This is something I figured out when I talked about my mental conditioning work. I didn't know how I one day stopped obsessing about food or using it destructively. It just seemed to happen, but it actually was the culmination of a great deal of therapeutic effort coming together after months and months of hard psychological work.

Many people believe that thin = cured. They think that as long as they lose weight, they have solved the problem and are effectively dealing with it. To me, this is a very narrow definition of "health" and focuses exclusively on appearances over a balanced existence in which your relationship with food is one in which your thoughts are not consumed by this issue. If you remain preoccupied with food, exercise, and weight throughout your day in a manner which consumes an inordinate amount of time or disrupts your ability to have relationships with others that do not revolve around body image, diet, or exercise, then you probably need some counseling to help you adjust your relationship with food regardless of what your weight is.

A lot of people have no idea what a mentally healthy relationship with food is, and they will fight and argue with you about what is and is not "healthy" based on the composition of their diet, their weight, and health status. Physical health as a result of lifestyle choices does not indicate mental health in regards to food. There are people who are at a healthy weight, eat nothing but healthy food, and still spend their days ruminating about eating. I'm not even talking about pining for a piece of cake or a slice of pizza, but rather people who think about their apple and yogurt snack for hours before they can eat it. They are honed in on food to the point of distraction in a manner which a person with a normal relationship with food does not think or feel.

The aforementioned types of people have all of the behavioral changes necessary in place for weight maintenance and physical health. However, they need counseling to adjust their thinking such that they spend less of their energy on diet and body image and can focus more productively, creatively, and, frankly, in a more fulfilling manner, on other aspects of their lives.

One of the many things I have learned through losing weight is that I was much more dysfunctional overall at the start of my changes in habits and choices than I was before them, and than I am now. The dysfunction was food obsession and there were times when I thought that I could simply not live the rest of my life like that. The preoccupation I had was oppressive, and I'm sure would have continued had I not labored to deal with the underlying psychological issues (particularly in regards to identity, but also all of the stuff I grew up with that caused me to become a food addict). Frankly, I'd rather remain fat than continue to live the sort of torment I experienced during the first 10 months of my weight loss process.

There are people out there who have successfully lost weight who do live in a constant state of preoccupation with food and their bodies, and they are okay with it because they are so deeply immersed in their neurotic obsession with food that they cannot see how dysfunctional they are. To the people around them, they seem to be almost manic and are clearly obsessed, but they cannot gauge themselves by anything other than their bodies. As long as they are thin, they think all is well, and they are some of the people who most frequently say that they feel counseling is not necessary if you want to lose weight. In a way, they are right. If you want to merely be thin, you don't need to have any sort of therapeutic process (be it self-reflection or with a professional), but if you want to live a life in which you are not mentally enslaved to food and preoccupied with your body, you probably need a little psychological work as well.