Research explaining how therapy might help is filled with very technical terminology, e.g., invoking “transference”, “extinction”, heightening access to “cognitive–emotional structures and processes”, “reconfiguring intersubjective relationship networks” (see over here for more).
Could simpler explanations be provided? Here are some quick thoughts, inspired by literature, discussing with people, and engaging myself as a client in therapy:
- You know the therapist is there to listen to you — they’re paid to do so — so there’s less need to worry about their thoughts and feelings. One can and is encouraged to talk at length about oneself. This can feel liberating whereas in other settings it might feel selfish or self-indulgent.
- The therapist keeps track of topics within and across sessions. This can be important for recognising patterns and maintaining focus, whilst allowing time to tell stories, meandering around past experiences, to see where they lead.
- The therapist has knowledge (e.g., through literature, supervisory meetings, and conversations with other clients) of a range of people who may have had similar feelings and experiences. So although we’re all unique, it can also be helpful to know that others have faced and survived similar struggles — especially if we learn what they tried and what helped.
- Drawing on this knowledge, the therapist can conjecture what might be going on. This, perhaps, works best if the conjectures are courageous (so a step or two away from what the clients says) — and tentative, so it’s possible to disagree.
- There can be an opportunity for practice, for instance of activities or conversations which are distressing. Practicing is a good way to learn.
- Related, there’s a regular structure and progress monitoring (verbally, with a diary, or using questionnaires). Self-reflection becomes routine and constrained in time, like (this might be a bit crude but bear with me) a psychological analogue of flossing one’s teeth.
- (Idea from Clare) “… daring to talk about things never spoken of before with someone who demonstrates compassion and acceptance; helpful because allows us to face things in ourselves that scare us and develop less harsh ways of responding to ourselves”
- (added 27/10/2014) The therapist has more distance from situations having an impact on someone than friends might have so, e.g., alternative explanations for interpersonal disputes can more easily be provided.
- (added 27/10/2014) It’s easier for a therapist to be courageous in interactions and suggestions than for a friend as — if all goes wrong — it’s easier for the client to drop out of the therapeutic relationship without long-term consequences (e.g., there’s no loss of friendship).
- (added 15/01/2015) Telling your story to a therapist gives you an audience who is missing all of the context of your life. Most of the context can feel obvious, until you start to tell your story. Story telling requires explaining the context, making it explicit. For instance who are the people in your life? Why did you and others say and do the things they did? Perhaps this act of storytelling and making the context explicit also makes it easier to become aware of and find solutions.
Interesting multidisciplinary background — some excerpts from Valenstein (1995):
“When I was sixteen years old I built my own short-wave receiver and transmitter and became a ham radio operator. This bent towards electronics motivated me to enter the engineering school at Cornell University in 1931 with the intention of becoming an electrical engineer…”
“But those were depression years, and it seemed unlikely that I could make a sufficient livelihood as an electrical engineer.”
“… from early years I had been curious about people, how and why they were as they were. I was puzzled about myself as well, feeling myself to be something of an ‘outsider’ in school. As I learned later, this is one of the elements contributing to psychological-mindedness, a predisposition that is conducive to psychoanalytic inquiry.”
“I have always had one foot in hard science and one foot in literature and the humanities, and fortunately I don’t seem to have fallen between the two.”
“George Henry was carrying out a heavily funded research project on homosexuality. This opened a whole world to me that I had never known, especially the gay world, and I learned something about it, even getting to know some of its colloquial terms. Later Henry and his research assistant, who in retrospect I realize was homosexual, published several books on homosexuality from a descriptive point of view.”
“… I came to be in Boston, which I never left except for one year in neurology with Foster Kennedy (a colourful man, a Northern Ireland Orangeman of great sartorial splendour and the gift of marvellously eloquent, elegant speech) at Bellevue Hospital in New York, and my years in the military.”
“My initial exposure to the activities and ambience of the Hampstead Child Therapy Clinic [now the Anna Freud Centre] forty years ago, and my continued contact with it and with Anna Freud over many years, greatly influenced my identity as a psychoanalyst, both theoretically and clinically. Before my sabbatical in London in 1955, I had become interested not only in what nowadays seems to be called ‘cognitive developmental psychology’ and ‘attachment theory’, but also what might be termed ‘affect developmental psychology’.”
Valenstein, A. (1995). How I became an analyst. Bulletin of the Anna Freud Centre, 18, 283–291.
- It’s okay if participants see the logic underlying a self-report questionnaire, e.g., can guess what the subscales are. It’s a self-report questionnaire — how else are they going to complete the thing? (Related: lie scales — too good to be true?)
- Brain geography is not sufficient to make psychology a science.
- Going beyond proportion of variance “explained” probably is necessary for psychology to become a science.
- People learn stuff. It’s worth explicitly thinking about this, especially for complex activities like reasoning and remembering. How much of psychology is the study of culture? (Not necessarily a criticism.)
- Fancy data analysis is nice but don’t forget to look at descriptives.
- We can’t completely know another’s mind, not even with qualitative methods.
- Observation presupposes theory (and unarticulated prejudice is the worst kind of theory).
- Most metrics in psychology are arbitrary, e.g., what are the units of PHQ-9?
- Latent variables don’t necessarily represent unitary psychological constructs. (Related: “general intelligence” isn’t itself an explanation for anything; it’s a statistical re-representation of correlations.)
- Averages are useful but the rest of the distribution is important too.
“Winwood Reade is good upon the subject,” said Holmes. “He remarks that, while the individual man is an insoluble puzzle, in the aggregate he becomes a mathematical certainty. You can, for example, never foretell what any one man will do, but you can say with precision what an average number will be up to. Individuals vary, but percentages remain constant. So says the statistician.”
—The Sign of Four by Sir Arthur Conan Doyle (hat-tip MP)
“When the ego has taken its defensive measures against an affect for the purpose of avoiding unpleasure, something more besides analysis is required to undo them, if the result is to be permanent. This child must learn to tolerate larger and larger quantities of unpleasure without immediately having recourse to his defense mechanisms. It must, however, be admitted that theoretically it is the business of education rather than of analysis to teach him this lesson.”
—Anna Freud (1966, pp. 64-65)
Freud, A. (1966). The ego and the mechanisms of defense (revised ed.). New York: International Universities Press.
Alternative to evidence-based practice: FIGJAM-based practice.
(F**k I’m Good, Just Ask Me.)
Evidence is for the bureaucrats.
Trust us, we’re experts.
Join the school of the FIGJAM.
Throw your positivist randomised trials on the fire.
“I used the FIGJAM approach and I felt better.”
Coming to a social enterprise near you soon.