I haven’t heard it in a number of years, but every once in a while, a client will ask why we talk only about “what’s wrong” in therapy. It’s a valid question. Australian blogger Evan Hadkins, who frequently comments here on After Psychotherapy, has chided me for over-emphasizing the painful aspects of the work I do; the occasional site visitor will accuse me of “pathologizing” everything, rather than trying to view certain behaviors in a more positive or “normal” light. I’ve been thinking about the various reasons why I (and other therapists) don’t accentuate the positive in our work more than we do. What follows are a number of explanations, each of which contains an element of truth.
1. Unhappiness Feels More Meaningful
You might recall that Tolstoy’s Anna Karenina begins with a famous quotation: “Happy families are all alike; every unhappy family is unhappy in its own way.” In other words, novelists don’t write books about happy families because after you’ve described their experience one time, everything that comes after will be repetitive. The intricacies of misery are so much more interesting than satifaction, both in books and in therapy; happiness and contentment, after a time, become boring.
At the end of the first half of Stephen Sondheim’s Into the Woods, all of the characters have arrived at a state of happily-ever-after. Act Two opens with a melodically repetitive and uninteresting song about how happy they all supposedly are when, in fact, they are bored. Sondheim’s message is that going “into the woods” — focusing on what’s missing in our lives and searching for what might make us happy — is what actually makes life meaningful. In other words, it’s the journey, not the destination.
I always say that successful therapy comes to an end, not when clients are healthy and happy, but when they’re able to continue the work of self-exploration alone. In part, this means continually discovering something new about the ways we deceive ourselves in order to avoid pain or unpleasant truths. A journey that focuses exclusively on defense mechanisms and self-deception would be far too “negative,” of course, but probably a lot more interesting than one that continually emphasizes the good things. Candide while living in his “best of all possible worlds” was a bore.
2. Theoretical Emphasis on Pathology
While all developmental theories have a model of what normal is supposed to look like, they spend far more time on the way things can go wrong; in our training, we focus primarily on pathology — those deviations from the norm. Beginning with Freud, psychodynamic theorists have devoted countless volumes to the defense mechanisms we use and the pathological symptoms they produce and very little to describing a picture of mental health. As trainees, we’re taught to identify the features that characterize particulars disorders; the Diagnostic and Statistical Manual of the APA is nothing but a compendium of all the ways things can go wrong. How to Identify the Healthy Personality is a book that has yet to be written.
3. Resistance to Growth and Development
Human beings, by and large, are creatures of habit who resist change. In my experience, clients are rarely unambivilanet when confronted with evidence of growth and greater capacity. Sometimes awareness of change brings up the idea of treatment ending and separation from the therapist. Growth and maturation often connect to ideas about the passage of time: we may prefer to focus instead on everything that’s wrong and hasn’t changed in order to sustain the belief that time isn’t actually passing, leading us inevitably toward death. For clients who long for a corrective emotional experience — that is, to regress to an infantile state and be cared for by a loving therapist — growth and greater capacity can feel like deprivation if it means they’re better able to look after themselves alone.
Lately, I’ve heard myself saying to clients something like — “Wait, back up. What you were just describing was an improvement. You need to stop and celebrate that.” My efforts to accentuate the positive, to focus on evidence of growth or change, is usually met with a kind of skepticism, mostly because the client is focused on what’s still wrong. Therapists and clients alike can fall prey to this tendency — to miss the small steps that signal incremental growth because we’re looking at all the work yet to be done. Given how much I talk to my clients about the way change actually occurs — bit by bit over time — I’m trying to acknowledge and “celebrate” those steps as clients take them.
5. Your Growth Means I’m Out of a Job
I mostly mean this tongue-in-cheek, but especially for therapists in highly competitive markets, referrals may be infrequent; when a client feels ready to go it alone, that can mean a loss of income that might not be easily replaced. For this reason, a professional with a full practice and a waiting list usually makes a better, more impartial therapist. (As a struggling young professional, I tended to interpret as “resistance” mentions of termination or dissatisfaction with treatment much more than I do now.) Emphasizing positive signs of growth might feel unconsciously threatening because it could mean the client no longer needs us.
For all these reasons, therapists and clients tend to focus more on the negative than to accentuate the positive. Lately, I’ve been trying to combat that tendency (are you listening, Evan?) and to identify the small steps, the signs of growth, the positive emotional experiences as they come up. I’m no Pollyanna, but much more often than I before, I find myself saying things like, “Good for you! That’s definitely different from what you used to do.” I especially like pointing out to clients the ways in which they are brave, facing the difficult emotions and experiences they used to defend against.
But more often than not, I still find myself at a loss for what to say next.