Do You Need Therapy?

By Carl Sherman
Excerpted from How to Go to Therapy by Carl Sherman, copyright 2001

Things aren't going well. You leave for work with a sense of dread and come home half-dead with fatigue. You fight incessantly with those you love - or can't find anyone to love. The toll of smoking or excessive drinking is obvious, even to you, but you keep on doing it.

Maybe something happened to knock you off balance. You lost your job, and now it's hard to get up and get dressed. A friend is terminally ill, and you can't put thoughts of him out of your mind. Since that emergency landing at O'Hare, every business trip gives you nightmares.

Or, there's nothing really wrong, nothing you can put a finger on. But one day you realize that you've been struggling through the motions in a miasma of low-level discomfort and dissatisfaction. Whatever you do doesn't seem like the right thing, and none of it gives you much pleasure.

What are you going to do? There's no shortage of books to tell you how to heal whatever ails you, no lack of talk-show gurus with wise advice on everything from beating the blues to finding lasting love or the job of your dreams. Maybe you've assembled your own little arsenal of strategies that help when the burdens get heavy and the skies refuse to brighten: taking a long, strenuous walk, a hot bath, a vacation, volunteering at a soup kitchen, cultivating your garden.

Friends and family are an age-old source of solace in times of trouble. Human beings are essentially social creatures; we need each other, and a sympathetic ear, an encouraging word can work wonders. It's been shown that simply having a confidant - someone you can trust to listen and care - reduces stress, eases anxiety and lifts mood.

But sometimes the usual fixes just don't work; you know you've got a problem, and it's not about to go away. And the question comes up, moves up rapidly from the back of your mind: Should you try therapy? (Or perhaps it's suggested - diplomatically or otherwise - by a friend or loved one.)

We all know what therapy is - until we try to pin it down and realize how many very different things have come to carry that label. "Therapy" can last six years. It may involve two people - you and the therapist - or your whole family, or even a group of strangers. You may talk about today's crisis or last night's dreams, or events you scarcely remember. You may be encouraged to keep a diary of your thoughts, or to free-associate. To pound pillows or take pills.

What do they all have in common? No matter what particular form therapy takes, the essence is an ongoing relationship. Researchers who seek to find what makes therapy successful return again and again to that central fact: whatever else happens, the closeness and trust between patient and therapist - what is called the "therapeutic alliance" - is a key factor. It even appears to be important when medication is the main treatment.

Therapy is a unique type of relationship, and what makes it valuable is what sets it apart from friendships, working partnerships, family connections and love affairs. Its purpose is well defined: understanding and change. It comes into being, that is, to help you identify and understand dysfunctional ways of thinking, feeling and acting, and to generate more productive and satisfying ways of thinking, feeling and acting.

Friends and family members want to help us when we're in distress, and the advice they offer (with or without solicitation) can be useful. But the kind of counsel you'll get from a therapist is different. Rather than being simply instructive ("Here's what you ought to do"), it's likely intended to be a catalyst, to quicken your own ability to work things out.

Perhaps the most essential difference between therapy and other significant relationships is a matter of balance. You and the therapist are collaborating on a single project: helping you deal with your problems and achieve the changes you want. There is no other agenda.

This makes it very different from even close, supportive friendships in which you get a sympathetic ear and even useful feedback. Eventually, your friend will get bored, or tired, or simply need to talk herself. The essence of friendship is mutuality: you meet each other's needs. In therapy, your needs are what matters. The word itself, therapy, comes from a Greek word meaning "to serve." You receive the service - of being listened to, understood, helped - not out of friendship, love or altruism, but for a fee. Crass as it sounds, this is a strength of therapy - there are no strings attached.

Another essential quality of therapy is safety. If it works well, you can be yourself, say what you feel, reveal your fantasies, fears, and aspirations, without repercussions. The therapist's professional role includes receiving your disclosures without moral judgment or rancor. You won't be ridiculed, censured, or resented - not when you speak, not a week or a year later. Can your best friend, spouse, or partner offer this guarantee?

You can say whatever you need to and know it will go no further.

Confidentiality is a key component of the therapeutic relationship, as it is in certain religious settings. With the exception of well-defined circumstances (to be discussed fully later), the therapist is bound by ethics, and by law, to reveal nothing that transpires during your sessions. The communication, in fact, is privileged, which means that the therapist cannot be required (again, with exceptions) to reveal what you've said, except under court order.

Part of the safety zone in which therapy takes place is its reliability. It generally happens at the same place and at the same time, and follows a predictable format. It isn't contingent on your performance - the therapist won't get up and leave if you fail to keep her entertained or to live up to her expectations. Even intimate relationships can be jeopardized when one of the partners goes through personal changes. ("You don't seem like yourself"), but in therapy, change is whole point.

In addition to everything else, therapy is an educational experience. Some therapists actually describe what happens as a kind of learning, and compare their role to that of a teacher or coach. But even when this isn't explicit, any kind of effective therapy leads you to step back and reconsider what you may have always taken for granted, to try out new ways of looking at yourself, your emotions, and your world.

Carl Sherman is a New York-based freelance journalist who has written for Family Circle, Self, Us, GQ and Clinical Psychiatry News.