Another Crack at the Unique Challenge of Psychotherapy

 An Englishman, an Irishman and a Frenchman walk into an emergency ward.

I only need one of them to make my analogy though. So one of them gets in front of a doctor and states their primary complaint: 'My back hurts.'

The doctor observes, immediately that the likely culprit for the back pain is the dagger sticking in that person's back. 

Now enters the unique challenge Psychotherapists face -

The doctor says 'Okay, well looks like this dagger missed all the organs, arteries and nerves, we should be able to pull it out, stitch you up and in a few weeks you'll be all fixed.'

and the patient says 'Nope. No. No way. The dagger stays.'

Then the doctor is like 'So, just to be clear. You want us to treat your back pain...without removing the dagger?'

...

So, adulthood has brought with it some disillusionment regarding the esteem and compliance afforded physicians. But on the whole, I feel maybe as much as 50% of the general population of the cultures I've been to, go see doctors when they feel sick, or are in pain, or have an injury and pretty much do as the doctor tells them, give or take forgetting to set an alarm to take their pill every 6 hours or trying to play tennis again a few weeks earlier than recommended.

The unique problem faced by those delivering psychotherapy is that any and all medicine has to taste good to the patient.*

As John Cleese repeated: 'How many psychologists/psychiatrists(?) does it take to change a light bulb? One, but the lightbulb has to want to change.' 

I have friends that have said to me things to the effect of 'I tried talking to a shrink, but it didn't really work for me, I just handle my anxiety/depression with alcohol.'

What didn't work?

Well I think it's that: 'no, the dagger stays' part of the analogy. 

There's a wide scope of reasons people seek psychotherapy, and a wider scope of reasons people should seek psychotherapy. But I feel a large chunk of change involve 'I want to feel better, I want to like myself, I want to be satisfied with my life...but my father/mother/partner stays.'

And yeah, relationships are less invasive than a few inches of steel in your back, but they can be just as obvious. Not just to a licensed, qualified practitioner of psychotherapy, but pretty much everyone.

And I've been there. I needed counselling because I was struggling to get into an intimate relationship. I had problems with mate selection.

So it was never particularly difficult for my psychologist to diagnose what was going wrong. It was more that it would take 10 hours over a year and a half to surgically remove what ailed me from my mind. 

And then, frustratingly for us both, I would go out and get another dagger in my back requiring maybe 6 hours over 6 months to remove.

The thing was, I was committed to the process of getting better. No matter how much I struggled or resisted getting better.

My feeling is that most people hold this ultimatum to their counsellors head - 'find me a way to lose my suffering while keeping my meaning, or I'll just go with my addiction, I'll just keep my toxic relationship - I'll accommodate, I'll indulge my suffering.'

Thus I feel most people ask the impossible of psychotherapy - I want all my groceries in one bag, I don't want that bag to be heavy though. It's understandable, because psychotherapy is a service and in many/most cases and places in the world, it's quite costly. People aren't going to see it, necessarily, as a give and take process.

Because they probably can make you feel better, if you give up calling your mother every night. They can make you feel better, if you give up your relationship, move into a single apartment and change all your daily routines. etc. A psychologist can help support you undertake difficult changes. 

I've compared it, in the past to dislocating a shoulder. Reducing a dislocated shoulder (the strange, to me, term for popping the shoulder back into it's socket) can be a painful process. But once it's in, healing begins. There's this neutral position my dislocated shoulder and arm can be in where it isn't painful, but to get the shoulder in, it generally has to travel across a threshold of pain.

Having said that, I recently dislocated my shoulder again, for the first time in like 3 years, and while explaining to my partner how I'd dislocated it, it reduced itself, painlessly too. So you know, things can and do get easier with practice (or loose ligaments maybe).

But I do feel it's different. I feel almost nobody chooses to leave their dislocated joints out. People do choose to live with their anxiety and depression, with toxic partners, keep shitty jobs. They'll dismiss the counsellor to keep the suffering. 

Admittedly, maybe more people would keep their dislocated shoulder, if they could treat the pain and discomfort symptoms successfully with cigarettes and alcohol, online gaming, tinder swiping etc.

And maybe it's because physical ailments are by definition, unfamiliar. They are a shock to our system, our experience rather than the norm.

But I think psychotherapy is possibly, more difficult than surgery. Maybe not as risky, where one wrong move can kill the patient or paralyse them and send you to a medical malpractice suit, but the patient isn't anaesthetised and one wrong move can have them get up and leave and never come back as you try to extract their attachment to the persons or behaviors that are distressing them.

Anyway, that's my latest crack. I hope it inspires somebody to maybe give psychotherapy another crack. It's not all on you, incompetent counsellors exist, shopping for the right one is often financially unfeasible and COVID and everything.