Psychotherapy and Side-Effects

Aeon, Psychotherapy is not harmless: on the side-effects of CBT  

The research cited in this article doesn’t sound all that robust, but it’s an interesting question to think about. Personally, I think therapists of all stripes are well aware that the process has side-effects, but they see it as part of the therapy and I’m not sure they always fully appreciate the potentially negative and unwanted impacts. One of the reasons why I ended my last course of therapy was because I didn’t feel that my therapist was taking my concerns about unwanted effects seriously enough.

When is it time to end therapy?

I’ve decided to bring three years of therapy to a close by the end of August. This is difficult because my therapist doesn’t really agree with the decision. She thinks we should continue and explore some of the more painful issues that I’ve largely avoided bringing into the room. She says she’s concerned that I may be “abandoning myself” by stopping therapy right now.

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Grieving and Re-grieving

I’m trying to deal with a lot of unprocessed grief at the moment and wanted to share a couple of things that I’ve found helpful.

This little video, Why grief is not something you have to get over offers a perspective that really makes sense to me. The counsellor in the video talks about how the therapeutic model for working with grief is shifting, from seeing grief as something that gets less over time, to something that’s always there, but that other aspects of your life can grow around. So, while the grief doesn’t go away, it isn’t so all-consuming. But you can dip back into it at certain times, which brings me to the next point.

@hallygrace posted a long thread on twitter about the concept of re-grieving. Hallygrace makes the point that grief can be a life-long emotional process and you are likely to experience it again and again, especially at significant moments (anniversaries, life milestones etc). Here’s the tough bit, you have to re-process it every time. It’ not a good idea to repress the feelings or shame yourself for having them.

Thoughts on Depression and Self-Support

Depression snuck up on me and took over my life these last few weeks.  I had so many things I wanted to do, blog posts to write, books to read, people to catch up with.  Instead, I just about managed to do the essentials at work and stagger home in the evenings to sit on the sofa and watch Star Trek.

This particular bout of depression got me thinking about how to identify that I am depressed and then how to support myself through an attack.  Over the years, I’ve come to the conclusion that my own depression is probably transposed anger. Rage always seems close to the surface when I’m depressed, which suggests to me that it’s the underlying emotion in my case.  Growing up, I had a lot to be angry about in my life, but middle-class girls are not allowed to express anger in healthy or assertive ways, so like a lot of them, I turned my anger against myself and, inevitably, depression, self-harm, and eating disorders followed.  I hate the depression, but maybe it’s easier to cope with than facing up to my anger and the causes of that anger.  Right now I’m dealing with the emotional fall-out from a very difficult holiday period which brought up a lot of issues around my family.  In fact, I think I’m just starting to really get to grips with what really happened in my family, something that has only started to become possible since I’ve lost the buffer-zone represented by my father.

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Irvin D. Yalom, Love’s Executioner and Other Tales of Psychotherapy (1989)

Though these tales of psychotherapy abound with the words patient and therapist, do not be misled by such terms: these are everyman, everywoman stories.  Patienthood is ubiquitous; the assumption of the label is largely arbitrary and often dependent more on cultural, educational and economic factors than on the severity of pathology. Since therapists, no less than patients, must confront these givens of existence, the professional posture of disinterested objectivity, so necessary to scientific method, is inappropriate.  We psychotherapists simply cannot cluck with sympathy and exhort patients to struggle resolutely with their problems.  We cannot say to them you and your problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together (14).

By the end of the ‘Prologue’ I already knew that I was in the company of a writer who was going to stay with me long after I finished reading the book.  Irvin D. Yalom is a renowned psychiatrist and existentialist psychotherapist who works at Stanford University.  Existentialist psychotherapy is one of the less well known strands in comparison to psychodynamic, person-centred and cognitive  behavourial approaches.  It is concerned with the “existence pain” that comes from our awareness of the inevitability of death, the terrors of freedom, our ultimate aloneness and the absence of any obvious meaning to life.  It is interested in finding meaning in what we do.

I’m not an existentialist and have no intention of training as a therapist in this particular tradition. Yalom also does quite a few things in therapy that I disagree with and hope I would never do if I was a therapist.  But I found his book profoundly moving as well as interesting.  In this world of “self-help” books and “positive thinking” in which we’re constantly bombarded with techniques we can use to make our lives better, happier, more profitable etc, it was so refreshing to read a book by a therapist that doesn’t propose any easy answers or quick fixes and acknowledges the fact that life is difficult and often painful, and that therapy does not necessarily cure everything.  Yalom depicts therapy as a deeply uncertain process in which two people work towards change. He assumes that change is the goal of therapy, but that the change which results may not be the one hoped for or anticipated by either party.

As a therapist Yalom is totally open to and engaged with his clients. Existentialist therapy does not accept the power relationship assumed in traditional psychoanalyses which sets up the therapist as the expert who interprets the words of the patient.  He is at times disturbingly honest about his own emotional reactions to his patients, but this honesty enacts his argument that the therapist is not superior to the patient.  He is also very revealing about the workings of transference, counter-transference and projection and how these dynamics can be put to constructive use in the therapeutic relationship.  Yalom often has to overcome his own prejudices in order to help his clients.

The client’s stories are fascinating.  Among them there’s Thelma, a 70 year-old woman with an all-consuming love obsession (Yalom totally botches her therapy too).  Carlos is dying of terminal cancer and believes that every woman he meets is irresistibly attracted to him.  Betty forces Yalom to confront all his prejudices about fat people.  Penny neglects her living sons because her favoured daughter died.  Marge suddenly manifests a completely different personality during therapy.  Marvin is an apparently boring and uptight accountant who has the most amazing dreams.  It is also interesting that the clients who present with the worst problems tend to do the best in their therapy.

Ultimately the stories affirm the incredible complexity and courage of people while demystifying psychotherapy and representing it as a deeply human encounter.