Last week I started to introduce the topic of individual psychotherapy, describing some of the basic logistics involved. This week, I want to talk about some reasons people reach out for help from a therapist.
I think there are two general reasons someone calls me for a first appointment: external crises, or internal struggles. Of course there can be overlap between the two, but the majority of people will call me because something in the outside world of their lives is not working: a marriage is failing, they were just fired from another job, a loved one has died.
The second category, internal struggles, is less common: someone says "I feel like I'm not maximizing my potential" or "I just don't think I'm firing on all cylinders." Often with these people the outside world regards them as highly functional and would be surprised to learn they're seeking help.
These two general categories correspond to two stages in the therapy process which most people follow: "fixing what's broken" and "facilitating growth."
Fixing what's broken is what I call it when a person comes in with a problem and wants help fixing it. It can be a long term problem (I think, by the way, that most of us work on one or two issues our entire lives, but this is a topic for another posting) or a short term problem, and in the process of fixing it a lot of psychological and emotional issues get explored.
At a certain point, if the person comes in long enough, these crises recede into the background and the person's life is functioning much more smoothly. Here is the juncture where many people choose to stop coming to therapy. They have fixed what was broken, have gotten what they came for, and feel ready to go it alone.
At this point I consider it my professional and ethical responsibility to at least name the following: it is wonderful that your life is working well, and you may want to ask yourself if the best you can hope for from your life is an absence of problems. We are infinite beings, and the removal of the largest problems frees us up to focus on who we are at our deepest stratum. I say this to counteract the prevailing cultural norm, where we are taught to equate mental health with how well we function. That is indeed important, but we are much more important than what we do. We are most important because of what we are. This is one of the many reasons I love my job: it is impossible for me to get bored in it because every single individual with whom I work is totally unique and infinite.
Having said all this, I want to acknowledge that it is something of a false dichotomy to divvy up a person's process into "fixing what's broken" and "facilitating growth." When you're doing one, to some degree you're doing the other. But there does come a time in a person's process where they feel like they don't have what to talk about, and it's important not to rush out the door when that happens, but to wait and see if there isn't something deeper waiting to emerge.
Next week: why can't you go to a friend with your problems?
Do you have a question about struggles with your partner or within yourself? Is there a particular topic on relationships or individual psychological issues you would like addressed in this blog? Ask Josh in the comments below or email him at email@example.com.
Josh Gressel, Ph.D., is a couples and individual therapist based in Pleasant Hill, CA. Visit his website at joshgressel.com. He is accepting new referrals.