An article in the April 22, 2012 New York Times entitled: “In Therapy Forever? Enough Already” did its job and caused me to reflect on my career, my personal journey, and the complexity of the therapeutic process. I ended up evoking an audible “hmmmmm.”
Some of my therapist colleagues and I meditated on the clinical and ethical reasons for working with clients and wondered how we know when our clients can ‘graduate’ from therapy. The article, written by New York psychotherapist Jonathan Alpert, is not anti-therapy. It’s mostly a conversation-starter about why clients seek therapy and the reasons that they stay in it. I strongly encourage you to read the article and come up with your own thoughts and opinions about it — as it is a very personal subject.
Therapy, in general, is very personal. This is why I don’t think there is a black-and-white answer to the question of “when is enough, enough?”. When are we ever finished evolving and changing as human beings?
I was motivated to reflect on my own personal philosophy about therapy as I read the article, both as a client of therapy myself and as a clinician. As I work often with eating disorders (bulimia nervosa, anorexia nervosa, binge eating), I contemplated an additional factor of readiness for change in the therapeutic process. I am blessed with encountering clients who are at every stage of the change process….for some, this means coming once or twice and then taking their own journey, perhaps, to decide how and when they are ready to commit to recovery.
Recovery in and of itself is fluid and ambiguous. Some clients come for a while, take some time off, and then return when they feel they need some accountability, some support, some insight. When I was struggling with my own eating disorder, I was in and out of therapy many times — “tasting” it a bit, smelling it, figuring out if it was what felt right at the time. I had to do a lot of soul searching before I committed to therapy, and I credit my experience in therapy as my saving grace and the avenue I chose to get to my own recovery. Since that time, I have gone back to therapy several times, as a way of checking in and tuning up any loose ends. I believe that therapy will be an essential tool for my mental health for decades to come. I also believe it helps me grow as a mental health professional, as I am able to know and understand the benefits of working with a therapist whom I wish to emulate myself.
What struck me about the article was the way the author looked at different therapeutic orientations and how (he felt) some are more effective than others. For example, Mr. Alpert states: “there’s a difference between feeling good and changing your life; feeling accepted and validated by your therapist doesn’t push you to reach your goals. It might even encourage you to stay mired in dysfunction.” Herein lies the debate between supporting and enabling a client: how do we know when to encourage a client to try to spread their wings and fly, and how do we know if it would be harmful (ethically, therapeutically) to do so? This caused me to consider three of the foundations of therapy: unconditional positive regard, empathy, and non-judgment.
Are these enough and sufficient to help clients create the change they wish to see in their lives? Or do clients need something more?
I believe that the answers depend on each unique client and the therapist with whom they commit to working with. Not every client and therapist are going to be a perfect fit at the perfect time. This is why it is important for clients to get to know a therapist, see if they connect, decide if the therapeutic relationship will be strong enough to create a framework for healing and change. I feel that when the relationship is based on trust, safety and honesty, change can happen. What is said or not said can be secondary.
I am still reflecting on the complexity of therapy and the players that it involves. Client needs and goals are the focus of the process, but these can be met in so many different ways. Just as every human is different, there is no one “perfect” or “right” way to engage in therapy…and that’s the beauty of it!
