Saturday, January 29, 2011


Talk therapy gets a bad rap. Yackety-yak therapy. Woody Allen poking fun at therapy, therapists, and people like Woody Allen who go to therapy. Penis envy, castration anxiety, Freud and his red couch—they’re just too good not to make fun of.
In the early days, if you underwent psychoanalysis, the granddaddy of talking psychodynamic therapies, you could spend days each week of your adult life on your analyst’s couch talking about a few days from your childhood. How fun!
Now we have cognitive behavior therapy, rational emotive therapy and their cousins, streamlined therapies that get you to look at how and what you think, and change them for the better. There are piles of studies. Insurance companies love these therapies. No need to dwell on the past, no need to go into the stories, no need to look at the hidden motives for why you do certain things, like get divorced all the time, or feel depressed. No reason to dig up dirt. No reason to shed any tears or beat any pillows. No muss, no fuss, no mess.
We love it!
Cognitive therapy, ‘think’ therapy, is the way to go.
Except it’s not so simple.
We’ve learned a lot since Freud.
Some of the things we’ve learned are the techniques of cognitive behavior therapy, which are amazing.
But when it comes to human beings, to who we are, how we behave, what we feel, how we react, and what we believe—and how to change all that for the better—no single way of looking at things, or working with things, will cover all things human.
Turns out that yackety-yak therapy, when done well, is actually really good stuff, even, it seems, better than cognitive behavior therapy, the gold standard for many insurance companies and other data-driven types.
While cognitive behavior therapy has been getting all the favorable press, the data has been quietly piling up in favor of the new and improved versions of talk therapy. 
We human beings are a complicated and tricky lot, which is a great thing and makes for great literature and movies, and the luscious stories of the foolish escapades of the rich and famous, but it also makes us genuinely tragic. We can suffer so profoundly, often because of our own actions, because we do not know ourselves, our deeper motives, the nature of our inner conflicts, our forgotten, but still powerful wounds.
We do at times seem like fallen angels, not angels gone to hell, but angels fallen from heaven trying hard to get back there, but we’re not sure how. It’s a tricky business, this mind/body of ours, how it works, how it sees the world, what it knows but can’t speak, and how it is divided against itself by design.
Talk therapy, more properly called psychodynamic therapy, is an attempt to open up the doors to deeper material that a person may be unable to access by himself.
The trained and attuned person listens for the material in the gaps, hears what is not being said, intimates hints of unexpressed emotion, and resonates with the client and begins to ‘feel’ some of what the client is feeling, though possibly not able to say.
It’s not easy work, especially not for the client. That’s why it often takes help to go where she has never gone before, in a way that is not traumatizing.
Let’s make up an example.
A man finds himself at a very difficult place in his life. This is the culmination of many miss-steps he has made over the years. He really seems to have almost intentionally dug himself into a hole, and now he has almost buried himself alive. His life is a shambles.
Why? Why would he do this to himself?
With help, he begins to share the details of his painful childhood. Not only does he share the details, he feels the pain of it, the sadness, the disappointment and the shame. He begins to see, feel and know that much of his self-destructive behavior took place as he was trying not to feel the pain he had been carrying with him all his life.
“Oh yeah, sure”, you might be saying. “I’ve heard this liberal crap before. But show me the meat. That’s why we’ve made fun of you talking types for years, because it doesn’t do any good. Oh, woe-is-me therapy. Enough, already, just get off your butt and do the right thing.”
If only it were that easy. In some sense, that’s what cognitive behavior therapy tries to do in a thoughtful, organized and sustained way: address the issues head-on by challenging the thoughts that lead to the destructive behaviors. Change the thinking and you change the feelings and the behaviors. That’s the theory anyway. Often it’s quite effective, but not always.
Research is now showing that psychodynamic therapy does have the ‘meat’ to show for its efforts. Like the big bad hunter, psychotherapy brings home the meat, the bacon, or the tofu—whichever you prefer.
In a recent research review by Dr. Jonathan Shedler, published in American Psychologist, the well-respected journal of the American Psychological Association, psychodynamic therapy was shown to be very effective in rigorous controlled studies, and its benefits continued to accrue even after the therapy was over.
Research has shown that there’s a lot that goes into making good therapy good. Psychodynamic therapy explores emotions and helps the client feel things she may have been avoiding. She is helped to ‘see’ and ‘feel’ and understand her avoidances. Patterns are looked at and felt. The past is carefully explored, where necessary, to a great degree, the stories, the images, the sounds, the feelings, and the judgments.
It’s in relationship that problems often arise, so exploring the client’s experiences in relationship is important.
The challenge is that we are complex, multi-storied, multifaceted beings, who are often ignorant of much of what is going on in us. Good talk therapists use talk to go beyond talk, to drop into the places where unspoken material lies. The job of the therapist, or good friend, or minister is to help the person ‘hear’ the inner story, to be able to go beyond the barriers of shame, fear, and discomfort, and see, hear, and feel what is going on at a deeper level. 
Good talk therapy is not really ‘talk’ as we normally understand it. Just talking about things can be helpful, but only goes so far, because it usually stays close to where the person is comfortable. Good therapy involves going to the uncomfortable, but doing so in ways that are not traumatic.
This process is much more expanded than talking. It involves experiencing sensations, seeing images, feeling into the body, sharing the stories and words without editing or discounting them, and observing the meaning, judgments and commentary that arise from all this. Talking is used to share a report of the process. It’s part of the process, but often not the most important part.
            “Know thyself”, turns out to be good advice, as good as it has ever been. Though we’ve learned a good bit more, and gotten better at helping others to know themselves, knowing yourself is still hard work. But it’s good work, work worth doing, work that can change the course of a life, maybe your life, for the better.

            I can be reached at or 805/680-5572.

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