A paradox in counseling and therapy?
Many people talk about mental health symptoms or life problems as things to be cut out, like surgery. “X medication works for Y. This manualized counseling / behavioral mod treatment works, too. Just follow procedures.” Brings to mind the phrase about unwanted behavior, “Just cut it out.” In my opinion that does not work for mental health (see also, About). One way I think of symptoms is unconscious control routines that are not to be simply extracted. Instead, unconscious control routines are to be understood, appreciated, and negotiated with, so change smoothly follows.
A question of meaning
Of course, there should be procedures in psychotherapy and counseling. Not having some would be quite a problem. However, I have learned that procedures, taken alone, ‘do not a therapy make’. So, I’m going to turn 180 degrees and ask: have you ever been asked what symptoms mean? In today’s mechanistic climate, probably not.
One way to see symptoms is extreme ways to cope with our basic survival concerns. Whatever their origins, biological, learned, or both, symptoms provide an illusion of getting or having greater control or certainty than we really have in life. However, the real result of symptoms is not total control. Instead, symptoms produce an unpleasing, but less anxious, compromise. We only go for help when the compromise no longer works (see these sources and more: Ecker & Hulley; Carey, Mansell, & Tai; Beier & Young).
A workplace example with depressed mood
If someone becomes depressed due to workplace pressures and goes on a work leave, the depression (symptom) helped them get away temporarily. They might have left, for example, to avoid uncomfortable anger or anxiety emotions, or a painful feeling of loneliness and futility. Those emotional / feeling threats arose because there is (mostly unconscious) knowledge of four basic choices:
- Become more skillful at coping with the job and one’s self in it
- Try to ‘force’ the coworkers or situation to change (often doesn’t work)
- Do nothing, leading to continued depression (hard to tolerate) or
- Find a different job (not always optimal or practical)
Often, these choices seem intolerable and unfair. The only one with no real drawbacks is #1. That is, for #1 the sacrifice is not ‘real’ but it is not easy. To use #1, one must give up the mental / emotional idea and feeling of being in control of things other than one’s self.
How is the symptom an unconscious control routine?
Depression or another symptom arises to give us a break from the emotions, feelings, and tough choices. Depressed mood about this type of work situation is understandable and might indirectly express desires to imaginally control:
- one’s self-perceived and other-perceived value and deservingness
- the perception of fairness and the outcome of relational exchanges
- the certainty of what will happen / what one will receive
- the social image of self or others
Unlike a tumor, systemic compromise issues cannot be forcibly removed. That would be too disrupting. Some other method must be found to replace them over time. Sometimes the replacement process is relatively quick, other times a bit longer.
What about other types of symptoms?
Many symptoms can be described as unconscious control routines. To use psychoanalytic terminology, we each have areas in which we assume our own omnipotence (magically limitless ability). I typically add omniscience just to be clearer (magically limitless knowledge). The trick to symptoms is to realize that, in addition to being impossible, assumptions of omnipotence and omniscience do not lead to good feelings or good situations. They are, remember, an anxiety-relieving trade-off.
For example, if someone needs to avoid a deep anxiety about the unpredictability of life, they might blame others–or, more subtly, they might self-blame (“ ‘my fault’ means I could have controlled things”).
We all do this
There is a similar flavor to children thinking all conversations and decisions are somehow about them. Yes, their social brains are still developing, but this is also (mostly) adaptive for lowering anxiety. Imagine the fear in being as vulnerable as a child while consciously realizing you are sometimes not the center of attention and foresight.
We adults still have hidden omnipotence / omniscience stories. To be clear, however, people do not produce symptoms like a plan. The best way to approximate the process is a development of automatic, habit-like ways to put deeper anxieties on the back burner. That way, we temporarily avoid much negative emotion and pain…until the compromise pain is too much.
The main point for counseling and therapy
Good psychotherapists should use general methods that get at meaning. One way is to cultivate and use empathy while also thinking of symptoms as unconscious control routines. Therapists and counselors should pay attention to emotional, relational, and existential factors and situations in context, rather than only the verbal content. There should be procedures in therapy, but it is not a car repair process. It is an organic process, like growing.