Mental Health Therapy Addresses Connection Not Pathology
Relationship as the ground of our humanity
"I want to help people” is an easy answer when asked about pursuing a career in counseling. However, it masks an underlying uncertainty as to what is in store for that journey. It’s often accompanied by some fairy-tale vision of deep conversations with clients and plumbing the depths of the human psyche. From this psychical embarkation, powered by active listening and the provision of a safe space, revelations will occur leading to immediately powerful behavioral changes.
Please trust me when I say that this image is not meant as sarcastic. Rather, it is an acknowledgment of the very real and very raw emotional need accompanying the calling to therapy. Fantasy is not always about avoidance, sometimes it is a representation of a primal desire. For the counselor/therapist, that need/desire is to search out and explore the myriad examples of a shared humanity.
When I consider such a point I am brought to Michael J. Mahoney’s words from “Constructive Psychotherapy: Theory and Practice (2005):
“Can we help one another change? Most definitely. In fact, most change takes place in contexts of human relatedness. We are fundamentally relational beings. Our relationships with one another are crucial to our survival and adaptation. We live in and from the bonds of belonging.”
The call to counseling is based on this felt, though not always well articulated, belief. Humanity calls to itself, which means pain calls to pain and love calls to love, leading inexorably to some version of the above fantasy. Such framing is not just found in the mental realm of the prospective or actual therapist, but also in that of the client/patient. “Everyone should get therapy” is as much a declaration of the universal need to connect with others as it is an attempt at reducing the stigma of that need.
Pursuing Connection
There are, of course, things missing from the utopian vision of therapy. There are the obvious missing parts: the paperwork, the bureaucracy, a lack of funding for programs, the diminished pay for services, and the perpetual need for self-care that the work demands of therapists to stay healthy and present. Those are all programmatic examples that exist at the intersection of business and the delivery of services.
No, the missing part I want to focus on is one that is overlooked for being so obvious: the connection itself. We as human beings are not mere talking heads, as if billiard balls on the table of life, waiting to careen off one another to find out in which direction we’ll be traveling. No, instead we exist in a maelstrom of connection, where our thoughts and emotions are as much the stuff of our relational existence as they are solely “ours” to claim. Daniel Siegel has coined the phrase “the Me that is We” and it is in that framework that the vision of a fantasized therapy gives way to the deeper and more emotionally grounded reality of our relational identities.
In every conversation we engage not merely with the client in front of us, or the client with us, but their and our families and friends, their and our societal constraints, and the behaviors they and we have learned to walk through life’s challenges. All of these variables have gone into each one of us and in that open and vulnerable space of the therapeutic dyad, connections are inevitably growing in ways that even the greatest therapist can never hope to see all of at any given moment. A word, a phrase, or a gesture, can mean the difference between thought-provoking and triggering, whether in this time or when reflected on down the road of a life.
As Paul Wachtel states in his book “Psychoanalysis and Behavior Therapy:”
The therapist can never really be a ‘blank screen,’ nor can one ever see ‘the patient’ in any abstract or isolated sense. One always sees the person in a context, and in psychotherapy the therapist is part of that context.
We speak of transference and counter-transference but this is an academic version of the initially-offered fantasy, sterilized from the humanity none of us can run away from.
The reality is more fluid, more visceral, more of everything that makes the psychology of humanity the birthplace of cathedrals and air flight, ghettos, and suburbia. Can we help one another? Most definitely. Our shared humanity calls to us to mend the tapestries of our lives and provides us the means of doing so through the power and intricacy of relationship.
Therapy is a Formalized Connection
I use relationship in the singular because I’m referencing it as if it’s a fundamental law of humanity, which I believe it is. Relationships, plural, are variable manifestations of relationhip as a structural underpinning of how our brains function, we create our sense of self, and select the direction of our lives.
“Our self is a construction of relationships and interactions, constrained and yet in search of the feeling of freedom.”
Mental health therapy, rather than being some mysterious space for exploration, is a formalized relationship that builds off relationship as a base biological need. There is a requirement for rapport building talked about in therapy that takes time to establish, in large part, I believe, because the parties involved are still holding onto the mystery framing. The therapist is not a guru, and however much therapy has taken the place once associated with priests and rabbis, the therapeutic relationship is fundamentally that of a shared humanity, warts and all.
The therapist hasn’t “figured things out,” they’ve instead, hopefully, determined a principled smoother path for self-discovery and navigating the inevitable difficulties being human entails. This is why advice-giving in the form of specific actions a person should take is generally, or should be, frowned upon in the service. The therapist does not and cannot know the ripple effects of a particular action in the other person’s life.
Intervention strategies like meditation, mindfulness, journaling, changing thought framing, challenging beliefs that don’t lead to desired outcomes, values identification, the empty chair, and so on, are all about opening up the person to new ways of considering their own life and by extension gaining greater flexibility in behavioral response. Direct advice giving is substituting the frame of reference of the therapist for that of the client.
The power of the therapeutic relationship is that these intervention strategies are bound within a formalized structure with the purpose of self-discovery and flexibility as resilience. Both of these things can and in healthy relationships of various kinds should also result, but only in the therapeutic relationship (and some forms of coaching, but that’s a whole other topic) are those outcomes the formal overarching goal.
Specific outcomes that are desired and the content that each person brings to therapy will be different, but the formal goals of the relationship remain the same: that with greater self-awareness and flexibility the person will move on more easily to engage in the power of relationship with others. There is an end to therapy, and it’s bound up in where it started, an appreciation that our humanness is what brought us in and will carry us out.