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I do think that one of the biggest reasons for problems 1 & 2 at least is that therapy is typically provided as a fairly expensive personal service to fairly materially comfortable people. There's a tacit assumption that "if it was that simple the client would have done that already". There's a tacit assumption that the lives of people who can afford and are willing to undergo therapy as at least roughly ok. And sometimes it's true. But sometimes the client is also in a similar mindset, of "it can't be that simple". And yet it can: for example acquiring practical means of doing certain things, or making things easier or less painful, can go a huge way towards promoting behavioural change, which in turn can do wonders for mental wellbeing.

Yes, there's something to be said for learning to tolerate distress, and therapy can help with this for sure, but the "change what you can change" is as much part of the strategy as "accept/reframe the pain you cannot avoid".

Oh and I LOVE the unattractiveness example!! I don't know if it's complicating a simple problem. It might be more than we're not "allowed" nowadays to consider ourselves physically unattractive, it's seen a problem with self esteem and never a realistic assessment.

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Yes totally agree with all of this, esp the part about clients believing "it can't be that simple." A friend pointed out that this inability to see a problem as simple can lead to stuff that is eventually very complicated. Thanks for reading and commenting!

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Is meaning truly part of the therapeutic purview? Are we talking about care of the psyche or care of the soul? When is it appropriate for a therapist to suggest a patient see a priest, minister, rabbi, etc? Does this ever happen? Certainly, chaplains turn care over to therapists.

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I think so, but I'm not dead-set on it or anything, so if you have thoughts, I'd love to hear them. In my opinion, meaning has become part of the therapeutic purview to the extent that people are moving away from religion and other traditional sources of meaning. Like, most of my clients wouldn't go to a priest, minister, rabbi, etc., because they don't belong to or believe in those religions. So where do they turn? Seems like therapy has become a secular religion for many. But what do you think?

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I think so, too, but for a patient who *does* have a traditional religious belief, I think maybe meaning is better addressed by a religious figure. OTOH, should the parameters of a field change based on the clinet's beliefs?

I address questions of meaning in primary care internal medicine all the time. I agree w Frankl that lack of meaning is a huge cause of suffering for people. Is meaning truly part of the primary care purview? No, because show me a shred of the pathophysiological basis for meaning. Yes, because it's what is causing the patient in front of me to suffer, as surely as their failing lungs are and if they don't get their meaning sorted out, their shortness of breath will be more difficult to deal with, especially as they die which will happen at some point and, likely in my care.

Care of the body, psyche, soul all impinge on each other. I think it's worth considering where, if at all, there are boundaries.

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